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Laryngotracheal stenosis management remains largely discretionary in surgical practice. Duration of stenting remains variable following open reconstruction procedures in absence of clearly established differences. The current study evaluates successful decannulation after short-term periods compared with longer periods.
Method
A comparative study over 18 months evaluated differences in successful decannulation between short- and long-term stent groups. Patients with grade II, III or IV laryngotracheal stenosis were placed on Montgomery T-tube for a short-term period (n = 15), and decannulation rates were compared with age-, sex- and diagnosis-matched patients (n = 15) from historical cases with long-term stent placement.
Results
Thirty patients were included. There was no difference between the two groups at baseline. Nine patients (30 per cent) were successfully decannulated, and there was no difference in rates of decannulation between the two groups (p = 0.8). Granulations at the proximal end of tube (38.7 per cent), superior migration of tube (16.1 per cent) and dysphonia (12.9 per cent) were common complications.
Conclusion
Decannulation was not more successful after placing Montgomery T-tubes for longer periods of time when compared with removal within the first three months. Early removal after proper case selection and planning may be considered for a successful outcome in laryngotracheal stenosis.
The coronavirus disease 2019 pandemic has posed a new challenge for medical educators worldwide. While teaching and learning shifted online, assessment posed a roadblock. A pilot study was performed to check the feasibility and acceptability of online open-book examination.
Methods
A pilot study was carried out on sixth semester (fourth year) students. An online open-book examination was conducted on an ENT topic, and feedback was obtained using a pre-validated questionnaire. Two teachers scored and collated the answers, and the marks were averaged for each candidate.
Results
Ninety-eight students appeared for the examination: 21.4 per cent failed and 78.6 per cent passed. Eight students scored above 75 per cent correct. Only 55 students volunteered to give feedback; most agreed that the best advantage of this assessment was that it was stress-free. The disadvantage most complained of was network connectivity issues.
Conclusion
Online open-book examination has the potential to be the new normal in the present circumstances and beyond.
The study aimed to evaluate the shear bond strength (SBS) of metal brackets and adhesive properties of bonded irradiated and non-irradiated teeth.
Methods:
Sixty-six extracted premolar samples were randomly divided into three groups—(a) Control group consisting of 22 non-irradiated, non-aged teeth (Group 1), (b) 22 non-irradiated, aged samples (Group 2) and (c) 22 irradiated, aged samples (Group 3). Irradiation was done using gamma irradiation with a fractionated dose of 60 Gy for 5 consecutive days per week over 6 weeks. Metal brackets were bonded on all samples with light cure adhesive and subjected to SBS test using universal testing machine. The samples were assessed under the scanning electron microscope to check for the adhesive remnant index (ARI) and tag depth.
Results:
There was a statistically significant decrease in the mean SBS of the irradiated samples compared to the non-irradiated teeth. The non-irradiated, aged samples showed a majority of ARI scoring 1 and 2. Whereas, the irradiated samples showed ARI scoring 2 and 3. Approximately, 77·3% of the non-irradiated samples showed no adhesive present on the tooth surface, and 27·2% of the irradiated samples had more than 50% adhesive present on the enamel surface.
Conclusion:
There is a statistically significant decrease in SBS of irradiated enamel compared to that of non-irradiated teeth. However, the SBS observed in the three groups was well above the ideal SBS for orthodontic bonding, that is, 5·6–6·8 MPa. The adhesive remnant was found on all samples of the irradiated group. Deeper adhesive resin tags were found in the irradiated group in the resin–enamel interface.
To assess the relapse-free survival (RFS) and the factors influencing local recurrence in patients with desmoid fibromatosis (DF) treated at our centre and to determine the role of post-operative radiotherapy (RT) in improving local control.
Methods:
A retrospective analysis of 51 patients treated for DF from January 2004 to December 2013 was undertaken. The RFS was calculated using the Kaplan–Meier curve. Univariate analysis was done to assess correlation with tumour size, site, the extent of surgery, margin status and adjuvant RT with RFS.
Results:
The median age was 28 years with a male:female ratio of 1:3. The most common location of the tumour was anterior abdominal wall (47%). The median tumour size was 10 cm. Wide local excision was done in most patients. Complete resection with negative margin was achieved in eight patients. Post-operative RT was indicated for 43 patients of whom 19 received RT. At a median follow-up of 37 months, RFS in the complete resection with margin negative group was 100%. RFS for the patients with positive or close margins who received RT was 79% and for those who did not receive RT, it was 87%.
Conclusions:
Complete excision with negative margins gives the best local control in DF. The benefit of post-operative RT could not be ascertained.
For the first time, we report the identification of NUV bright red clump (RC) stars and the extension of RC stars over two magnitudes both in color and magnitude axis in NUV vs (NUV – optical) color magnitude diagram. We find that the extension of RC is not due to photometric uncertainties. We suggest that the extension could be an effect of field star contamination. We also suggest that if it is an intrinsic property of the cluster then age and/or metallicity spread within the cluster could be the possible reasons for extended RC.
High-intensity electron linacs have severe space-charge effects that lead to the production of beam halo which degrade the beam quality. For a given charge per bunch, hollow beams have a weaker nonlinear space-charge force. In this paper, we have investigated the possibility of using hollow beam to control halo growth in linacs. We simulate the dynamics of such a beam in a 17 MeV radio frequency linac using ASTRA beam dynamics code and show that it experiences a smaller emittance growth as well as reduced beam halo. The results suggest that using a hollow beam, high charge per bunch could be propagated and accelerated in a radio frequency linac.
ICAR-Directorate of Cashew Research is the nodal agency for conducting cashew research and manages the largest field gene bank in India. Cashew is a perennial tree and needs more land and other resources to maintain accessions. Conservation through seeds is not feasible because of cross-pollination. Tissue culture efforts to regenerate plants from mature explants are not successful. Therefore, efficient management of the filed gene bank particularly utilization requires designation of the core collection representing the spectrum of diversity present in the entire collection. In this study, a relatively new technique, the advanced M strategy with heuristic approach was deployed to develop the core collection. Sixty-eight morphometric characters of 478 accessions were subjected to analysis resulting in the core collection of 49 accessions. Further, another core collection of same number was constituted by K-Means clustering to compare the efficiency of two approaches. The validation parameters like mean difference, variance difference, coincidence rate, variable rate and class coverage among others were employed for comparative analysis. The results of these parameters revealed that the core collection designated by heuristic approach was better able to efficiently represent and retain the diversity of the entire collection compared with the core identified by clustering approach. Future conservation and breeding efforts will be focused on establishing a separate block in the field gene bank having 49 accessions of cashew core collection.
The solar active region (AR) 12192 was one of the most flare productive region of solar cycle 24, which produced many X-class flares; the most energetic being an X3.1 flare on October 24, 2014 at 21:10 UT. Customarily, such events are believed to be triggered by magnetic reconnection in coronal magnetic fields. Here we use the vector magnetograms from solar photosphere, obtained from Heliospheric Magnetic Imager (HMI) to investigate the magnetic field topology prior to the X3.1 event, and ascertain the conditions that might have caused the flare. To infer the coronal magnetic field, a novel non-force-free field (NFFF) extrapolation technique of the photospheric field is used, which suitably mimics the Lorentz forces present in the photospheric plasma. We also highlight the presence of magnetic null points and quasi-separatrix layers (QSLs) in the magnetic field topology, which are preferred sites for magnetic reconnections and discuss the probable reconnection scenarios.
Magnetic reconnections (MRs) for various magnetic field line (MFL) topologies are believed to be the initiators of solar eruptive events like flares and coronal mass ejections (CMEs). Consequently, important is a thorough understanding and quantification of the MFL topology and their evolution which leads to MRs. Contemporary standard is to extrapolate the coronal MFLs using equilibrium models where the Lorentz force on the coronal plasma is zero everywhere. In tandem, a non-force-free-field (NFFF) extrapolation scheme has evolved and allows for a Lorentz force which is non-zero only at the photosphere but asymptotically vanishes with height. The paper reports magnetohydrodynamic (MHD)- simulations initiated by NFFF extrapolation of the coronal MFLs for a flare producing active region NOAA 11158. Interestingly, quasi-separatrix layers (QSLs) which facilitate MRs are detected in the extrapolated MFLs and, here the paper makes an attempt to asses the role of QSLs in the flare onsets.
Low-temperature stress is an important factor affecting the growth and development of rice in temperate and high-elevation areas. In this study, 220 germplasm lines were used for screening of tolerant genotypes, validation of molecular markers and identification of robust markers for seedling-stage chilling stress tolerance to be used in marker-assisted breeding (MAS) programme. The temperature regimes imposed in the growth chamber simulated cold-stress injuries at the seedling stages of the germplasm lines. The genotypes were classified into six classes: those having susceptible genotypes were classified into moderately and highly susceptible types, while tolerant types into moderately tolerant, tolerant, highly tolerant and very highly tolerant classes. Genotypes namely Langma, Umleng-1 and Geetanjali showed survival up to 25 d, which were better than the positive check Kalinga-III surviving up to 20 d under chilling stress. Ten simple sequence repeat (SSR) markers were tested for differentiation of genotypes. Individual use of SSR markers like RM284, RM286, RM85, RM341 and RM5746 can be applied in MAS breeding including combination use of non-pair markers like RM284, RM239 and RM85, which was even better than the combined use of RM284 and RM85. However, combined use of all ten markers can most effectively be employed for cold tolerance through MAS breeding.
Antarctic and Southern Ocean science is vital to understanding natural variability, the processes that govern global change and the role of humans in the Earth and climate system. The potential for new knowledge to be gained from future Antarctic science is substantial. Therefore, the international Antarctic community came together to ‘scan the horizon’ to identify the highest priority scientific questions that researchers should aspire to answer in the next two decades and beyond. Wide consultation was a fundamental principle for the development of a collective, international view of the most important future directions in Antarctic science. From the many possibilities, the horizon scan identified 80 key scientific questions through structured debate, discussion, revision and voting. Questions were clustered into seven topics: i) Antarctic atmosphere and global connections, ii) Southern Ocean and sea ice in a warming world, iii) ice sheet and sea level, iv) the dynamic Earth, v) life on the precipice, vi) near-Earth space and beyond, and vii) human presence in Antarctica. Answering the questions identified by the horizon scan will require innovative experimental designs, novel applications of technology, invention of next-generation field and laboratory approaches, and expanded observing systems and networks. Unbiased, non-contaminating procedures will be required to retrieve the requisite air, biota, sediment, rock, ice and water samples. Sustained year-round access to Antarctica and the Southern Ocean will be essential to increase winter-time measurements. Improved models are needed that represent Antarctica and the Southern Ocean in the Earth System, and provide predictions at spatial and temporal resolutions useful for decision making. A co-ordinated portfolio of cross-disciplinary science, based on new models of international collaboration, will be essential as no scientist, programme or nation can realize these aspirations alone.
The affiliation listed for author Sergio Iannazzo for the article “Economic Evaluation of Intravenous Iodinated Contrast Media in Italy” was incorrect. The study and writeup were completed while Sergio Iannazzo was an IMS Health employee, and the author's correct affiliation for this paper is “IMS Health Italy.” The publisher regrets the error.
Resistance spot welding (RSW) of dual-phase (DP) steel subjected to various conditions of cooling rate (holding time) is studied in this work. Lap-shear tensile testing is used in order to evaluate the mechanical performance of the weldments. The microstructure is analyzed through optical and electron microscopy and the hardness is obtained through Vickers method. Results indicate an effective tempered region along the sub-critical heat affected zone in all the samples. A broken morphology accompanied with presence of small carbides within tempered martensite phase is consistently observed. Variations in the cooling rate (holding time) indicate minimal effect on the degree of softening and on the mechanical performance of the welds.
Faecal specimens of diarrhoea cases (n=2495, collected between November 2007 and October 2009) from Infectious Diseases and Beliaghata General (ID&BG) Hospital, Kolkata, India, were screened by RT–PCR using specific primers targeting region C of the capsid gene of noroviruses (NoVs) to determine the seasonal distribution and clinical characteristics of NoVs associated with diarrhoea. NoV infection was detected in 78 cases, mostly in children aged <2 years. In 22/78 positive cases, the virus was detected as the sole agent; others were as mixed infections with other enteric pathogens. Sequencing of NVGII strains showed clustering with GII.4 NoVs followed by GII.13 and GII.6 NoVs. Clinical characteristics of the diarrhoeic children and adults in Kolkata indicated that NoV infections were detected throughout the year and were associated with a mild degree of dehydration.
Nonlinear Rayleigh-Taylor instability of a heavy, infinitely conducting fluid, supported against gravity by a uniform magnetic field in the vacuum, is studied for three-dimensional disturbances using the method of multiple time-scales. The three-dimensional problem can be reduced to two dimensions as it is found that an instability present for a three-dimensional disturbance of a given wavelength, for a given equilibrium magnetic field, is also present for a two-dimensional disturbance of the same wavelength propagating along an equilibrium magnetic field of lower strength. The instability is studied for both standing and progressive waves. Although in the linear stability problem the instability growth rate for a progressive wave of a given wavelength is equal to that for a stationary wave of the same wavelength, in the nonlinear instability problem studied here these waves are found to have different growth rates. Our results are compared and contrasted with those for the two-dimensional instability problem studied earlier.
Oral submucous fibrosis is a chronic disease characterised by progressive inability to open the mouth. Various treatment modalities are available for its management, but these have largely been ineffective.
Materials and methods:
Nine cases of oral submucous fibrosis underwent a release procedure using a KTP-532 laser, from March 2005 to January 2006, within the ENT – head and neck surgery department of a tertiary centre.
Results:
Pre- and post-operative mouth-opening was compared using the Wilcoxon signed rank test, and a significant difference observed (Z = −2.690, p = 0.007). Follow up over an average period of 12 months showed encouraging results.
Conclusion:
This preliminary study indicated that adequate release of oral submucous fibrosis can be achieved by using a KTP-532 laser release procedure, with minimal morbidity and satisfactory results. These promising results should encourage more widespread use of this technique in the management of this condition.
Screening of patients for common mental disorders (CMDs) is needed in primary-care management programmes. This study aimed to compare the screening properties of five widely used questionnaires.
Method
Adult attenders in five primary-care settings in India were recruited through systematic sampling. Four questionnaires were administered, in pairs, in random order to participants: the General Health Questionnaire (GHQ, 12 items); the Primary Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale (K10, 10 items), and from which we could extract the score of the shorter 6-item K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were interviewed with a structured lay diagnostic interview, the Revised Clinical Interview Schedule (CIS-R).
Results
Complete data were available for 598 participants (participation rate 99.3%). All five questionnaires showed moderate to high discriminating ability; the GHQ and SRQ showed the best results. All five showed moderate to high degrees of correlation with one another, the poorest being between the two shortest questionnaires, K6 and PHQ. All five had relatively good internal consistency. However, the positive predictive value (PPV) of the questionnaires compared with the diagnostic interview ranged from 51% to 77% at the optimal cut-off scores.
Conclusions
There is little difference in the ability of these questionnaires to identify cases accurately, but none showed high PPVs without a considerable compromise on sensitivity. Hence, the choice of an optimum cut-off score that yields the best balance between sensitivity and PPV may need to be tailored to individual settings, with a higher cut-off being recommended in resource-limited primary-care settings.
Elongated styloid process is a relatively common cause of facial and neck pain, but it is often misdiagnosed due to its varied clinical presentation. Since an elongated styloid process is often confirmed by radiological means, it would be helpful to find a more accurate mode of depicting the styloid process.
In this prospective study, 39 cases were evaluated. A three-dimensional computed tomography (3D CT) reconstruction of the styloid process was performed in 18 cases. In these patients, we compared the length and medial angulation of the symptomatic styloid process as viewed on an orthopantomogram and a 3D CT reconstruction.
It was noted that a 3D CT reconstruction was more accurate in depicting the styloid process. This investigation can be considered as the ‘gold standard’ in the radiological diagnosis of an elongated styloid process.