bluuebunny/crossref_metadata_2025 huggingface dataset:
Religious War and Brutal Killing of Christians in Nigeria; Its Effects and Consequences in Related to John 18:5-11
Authors: Adetunji Emmanuel
Published: August 2023

Brutal killings of Christians in the northern and middle parts of Nigeria at the hands of Muslim militants and terrorists have been a daily occurrence in recent years. Nigeria daily news are always full of records of shielding of innocent bloods both adult and young, burning of Churches, the worst of them all is killings of Christian members during Church services. The major concerns now are days are kidnapping people after which the ransom will be paid and victim will eventually be killed. Increasingly, the attackers have included another group, militant nomadic Fulani herdsmen who raid villages and kill Christian men, women, children, and babies with, local weapon AK-47s, machetes and many others. This work considers the attitude of both the past and present administrations towards the brutal killings of Christian in the Northern part of the country it was equally linked with the story of Jesus Crucifixion and those that were supposed to speak and defended him master minded the killing of the Saviour of the entire universe. However, the work came out with the effect of the brutal killings, causes and concludes by suggesting the way out
Pedagogical Practices of Elementary Teachers in Promoting Numeracy Skills Amidst Pandemic
Authors: Bernardino Kenneth Jhon
Published: August 2023

This study aimed to describe the pedagogical practices of elementary educators as well as divulge their lived encounters as they promote numeracy skills of students in the midst of the pandemic. This study employs a descriptive approach. Results indicated that Elementary teachers have a variety of experiences upon promoting numeracy skills of students in light of the new educational landscape brought by the COVID-19 pandemic; these pedagogical practices need to be suitable in the new context in education
Від семінару Ґраве до похідних категорій
Authors: Дрозд Юрій
Published: August 2023

Ця стаття виникла з моєї лекції на Перших Ґравевських читаннях, у якій я намагався прослідкувати шлях, що розпочався з лекцій і семінару Д. Ґраве в Київському університеті й привів до досліджень у найсучасніших галузях математики. Звичайно, я вибрав ту галузь з численних напрямків, розвинених учнями Ґраве та їх науковими спадкоємцями, яка близька до Київської школи теорії зображень і до моїх власних досліджень. Вибір матеріалу у статті також цілком суб'єктивний і вона не претендує на те, щоб бути історичним оглядом. Скоріше, це - спогади учасника подій.
Розширені можливості аналітичної механіки суцільного середовища
Authors: Лімарченко Олег
Published: August 2023

Обговорюються розширені можливості аналітичної механіки суцільного середовища і джерела, які сприяли виникненню, розвитку і високим досягненням такого напрямку досліджень саме в Україні. Відстежуються зв'язки цього напрямку досліджень з Д. О. Ґраве і його учнем М. О. Кільчевським. Скорочено викладено і проілюстровано на ряді прикладів нові елементи такого підходу і його переваги. Показано, що подібні дослідження і дотепер розвиваються саме в Україні.
Diffeomorphism groups of Morse-Bott foliation on the solid Klein bottle by Klein bottles parallel to the boundary
Authors: Maksymenko Sergiy
Published: August 2023

Let $\mathcal{G}$ be a Morse-Bott foliation on the solid Klein bottle $\mathbf{K}$ into $2$-dimensional Klein bottles parallel to the boundary and one singular circle $S^1$. Let also $S^1\widetilde{\times}S^2$ be the twisted bundle over $S^1$ which is a union of two solid Klein bottles $\mathbf{K}_0$ and $\mathbf{K}_1$ with common boundary $K$. Then the above foliation $\mathcal{G}$ on both $\mathbf{K}_0$ and $\mathbf{K}_1$ gives a foliation $\mathcal{G}'$ on $S^1\widetilde{\times}S^2$ into parallel Klein bottles and two singluar circles. The paper computes the homotopy types of groups of foliated (sending leaves to leaves) and leaf preserving diffeomorphisms for foliations $\mathcal{G}$ and $\mathcal{G}'$.
Evidence of Stellar Oscillations in the Post-common-envelope Binary Candidate ASASSN-V J205543.90+240033.5
Authors: Takata J. , Kong A. K. H. , Wang X. F. , Song F. F. , Mao J. , Hou X. , Hu C.-P. , Lin L. C.-C. , Li K. L. , Hui C. Y.
Published: August 2023

ASASSN-V J205543.90+240033.5 (ASJ2055) is a possible post-common-envelope binary system. Its optical photometric data show an orbital variation of about 0.52 days and a fast period modulation of P
0 ∼ 9.77 minutes, whose origin is unknown. In this Letter, we report evidence of the stellar oscillation of the companion star as the origin of the fast period modulation. We analyze the photometric data taken by the Transiting Exoplanet Survey Satellite, the Liverpool Telescope, and the Lulin One-meter Telescope. It is found that the period of the 9.77 minutes signal measured in 2022 August is significantly shorter than that in 2021 July/August, and the magnitude of the change is of the order of ∣△P
0∣/P
0 ∼ 0.0008(4). Such a large variation will be incompatible with the scenario of the white dwarf (WD) spin as the origin of the 9.77 minutes periodic modulation. We suggest that the fast periodic signal is related to the emission from the irradiated companion star rather than that of the WD. Using existing photometric data covering a wide wavelength range, we estimate that the hot WD in ASJ2055 has a temperature of T
eff ∼ 80,000 K and is heating the oscillating M-type main-sequence star with T
eff ∼ 3500 K on its unirradiated surface. The stellar oscillation of the M-type main-sequence star has been predicted in theoretical studies, but no observational confirmation has been done. ASJ2055, therefore, has the potential to be a unique laboratory for investigating the stellar oscillation of an M-type main-sequence star and the heating effect on stellar oscillation.
Deep belief improved bidirectional LSTM for multivariate time series forecasting
Authors: Jiang Keruo , Huang Zhen , Zhou Xinyan , Tong Chudong , Zhu Minjie , Wang Heshan
Published: August 2023

Multivariate time series (MTS) play essential roles in daily life because most real-world time series datasets are multivariate and rich in time-dependent information. Traditional forecasting methods for MTS are time-consuming and filled with complicated limitations. One efficient method being explored within the dynamical systems is the extended short-term memory networks (LSTMs). However, existing MTS models only partially use the hidden spatial relationship as effectively as LSTMs. Shallow LSTMs are inadequate in extracting features from high-dimensional MTS; however, the multilayer bidirectional LSTM (BiLSTM) can learn more MTS features in both directions. This study tries to generate a novel and improved BiLSTM network (DBI-BiLSTM) based on a deep belief network (DBN), bidirectional propagation technique, and a chained structure. The deep structures are constructed by a DBN layer and multiple stacked BiLSTM layers, which increase the feature representation of DBI-BiLSTM and allow for the model to further learn the extended features in two directions. First, the input is processed by DBN to obtain comprehensive features. Then, the known features, divided into clusters based on a global sensitivity analysis method, are used as the inputs of every BiLSTM layer. Meanwhile, the previous outputs of the shallow layer are combined with the clustered features to reconstitute new input signals for the next deep layer. Four experimental real-world time series datasets illustrate our one-step-ahead prediction performance. The simulating results confirm that the DBI-BiLSTM not only outperforms the traditional shallow artificial neural networks (ANNs), deep LSTMs, and some recently improved LSTMs, but also learns more features of the MTS data. As compared with conventional LSTM, the percentage improvement of DBI-BiLSTM on the four MTS datasets is 85.41, 75.47, 61.66 and 30.72%, respectively.
Reconsidérer l’industrie « déjà là » : l’exemple des systèmes productifs territorialisés de la vallée du Gier
Authors: Périnaud Clémentine , Morel Journel Christelle
Published: August 2023

Au-delà des imaginaires historiques liés à l’industrie, la vallée du Gier, entre Lyon et Saint-Étienne, constitue un secteur géographique complexe, constitué d’un chapelet de petites et moyennes villes articulant autant de polarités domestiques et industrielles. L’ancrage territorial des entrepreneurs, et la perpétuation des processus de production de la métallurgie-mécanique notamment, garantit le maintien relativement discret d’un système de TPE-PME dynamique. L’article discute la façon dont s’y envisage le redéveloppement industriel, en lien avec les processus de renouvellement urbain en cours ou à venir dans une vallée très urbanisée et insérée dans une double dynamique métropolitaine (stéphanoise et lyonnaise).
Réindustrialiser les territoires, la revanche des villes petites et moyennes ?
Authors: Gros-Balthazard Marjolaine , Talandier Magali
Published: August 2023

Après des décennies de déclin, l’emploi industriel progresse à nouveau à l’échelle européenne, comme en France, depuis 2016. Dans un contexte où les crises ont accéléré le besoin de repenser les modes de production et la souveraineté économique des nations, cet article pose la question des opportunités territoriales que la réindustrialisation induit et notamment, du rôle que pourraient jouer les villes petites et moyennes dans ces processus. Particulièrement marquées par la désindustrialisation, ces villes seraient-elles en train de prendre leur revanche sur les métropoles ou bien restent-elles en marge de ce rebond industriel ? Si les résultats montrent que la réindustrialisation se produit principalement dans les grandes aires urbaines, l’analyse révèle le rôle structurant que jouent les villes petites et moyennes, mais également les communes rurales au sein de ces espaces métropolisés. Par ailleurs, ils soulignent également les complémentarités stratégiques qui relient les villes petites et moyennes, leur hinterland rural et les métropoles.
Navigation through blood vessels - My journey in vascular surgery
Authors: Samarasinghe B.
Published: August 2023

No abstract available
Diagnostic yield of ambulatory cardiac monitoring in pediatric patients with palpitations
Authors: Goto Lisa , Witkowska Olga , Slusarczyk Magdalena E. , Grotek Agnieszka M. , Dziubinski Marek J. , Clark Bradley C.
Published: August 2023

Background:

Palpitations are a frequent reason for referral to pediatric cardiology providers and diagnostic workup includes ambulatory cardiac monitoring. While common practice, the diagnostic yield is unknown in the pediatric population. The objective is to evaluate the diagnostic yield of 24-h Holter and extended ambulatory cardiac monitoring in pediatric patients with palpitations.

Methods and Results:

All pediatric patients aged 10–18 years who had ambulatory cardiac monitoring (1–30 days) through the Pocket Electrocardiogram (PocketECG™) system (Medi-Lynx) between January 2016 and July 2020 were included. Patients with an International Classification of Diseases-10 diagnosis code of palpitations (R00.2) during enrollment were evaluated separately. Tachyarrhythmia diagnoses included atrial fibrillation (AF), nonsustained supraventricular tachycardia (nSVT), supraventricular tachycardia (SVT), nonsustained ventricular tachycardia (nVT), and ventricular tachycardia (VT). Age, heart rates, arrhythmia type, and symptomatic transmission data were collected and analyzed. A total of 2388 patients (mean age 11.6 years, 58% F) with the R00.2 code had ambulatory cardiac monitoring (28% 24-h Holter, 72% extended) performed during the study period and there were 6287 total patients (mean age 13.9 years, 54% F) that underwent ambulatory cardiac monitoring (42% 24-h Holter, 58% extended) during that time. Of 2388 patients, 321 (13%) were diagnosed with tachyarrhythmia: AF (9), nSVT (192), SVT (59), and nVT (61). In the overall cohort, 764 (12%) patients were diagnosed with tachyarrhythmia: AF (22), nSVT (478), SVT (85), nVT (177), and VT (2). Symptomatic transmissions with normal cardiac rhythm were common in the R00.2 (n = 1697, 71%) and overall (n = 3848, 61%) groups. No episodes of nSVT, SVT, nVT, or VT were associated with symptomatic transmissions.

Conclusion:

Ambulatory cardiac monitors are an integral part of the diagnostic workup for pediatric palpitations patients and have demonstrated a high yield of combined positive arrhythmia diagnoses and symptomatic normal transmissions. Further prospective study of this population with the integration of clinical information is warranted.
Pheochromocytoma presenting with QT prolongation and catecholamine-induced myocarditis in a child
Authors: Saengsin Kwannapas , Sethasathien Saviga , Dejkhamron Prapai , Sittiwangkul Rekwan , Makonkawkeyoon Krit , Silvilairat Suchaya , Wejaphikul Karn , Pongprot Yupada
Published: August 2023

Pheochromocytomas are catecholamine-producing tumors derived from the adrenomedullary chromaffin cells. The presentation is a classic triad of episodic headaches, sweating, and tachycardia. Hypertensive crisis can occur due to profuse catecholamine excess. Unusual manifestations mimicking cardiogenic shock, arrhythmia, and myocarditis have been rarely reported in children. We present a case with uncommon manifestations of pheochromocytoma in a child, including the episodes of exercised-induced presyncope with QT prolongation, and subsequently cardiogenic shock due to fulminant myocarditis. He later developed hypertensive crisis. The adrenal mass on abdominal computed tomography with an increased chromogranin A level and elevated plasma normetanephrine, and the histological study confirmed the diagnosis of pheochromocytoma. Cardiac functions completely recovered after adrenalectomy. Genetic testing was positive for von Hippel-Lindau syndrome. We describe pheochromocytoma crisis presenting with prolonged QT and catecholamine-induced myocarditis. We discuss the clues to assist in the diagnosis of this condition and its appropriate treatment.
Implications of Inflammatory markers for disease management in patients with chronic kidney disease and COVID-19 infection: A cross-sectional study from North India
Authors: Khurana Vatsala , Goswami Binita , Aggarwal Sunita , Kaushik Smita
Published: August 2023

Background:

The world witnessed the emergence of a global pandemic. Individuals with chronic illnesses like chronic kidney disease (CKD), already known to be immunologically compromised, have the potential to develop a scenario of an acute-on-chronic condition on coronavirus disease 2019 (COVID-19) contraction. Measurement of serum inflammatory biomarkers like interleukin (IL-6), high-sensitivity C-reactive protein (hsCRP) and ferritin may foresee the prognosis despite the pre-existing low-grade inflammation in these patients.

Aims:

To determine the utility of serum IL-6, hsCRP and Ferritin levels to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.

Materials and Methods:

A cross-sectional study was performed on 100 adult known cases of stage 5 of CKD, recently diagnosed as COVID-19 positive by real-time reverse transcription-polymerase chain reaction. The study population was divided into two groups according to COVID-19 severity: A non-severe and a severe group based on guidelines given in the Clinical Management Protocol: COVID-19. Their clinical and laboratory data obtained on the day of admission were analysed.

Results:

The severe group (n = 17) had 65% of males and 35% of females. A significant difference was found with respect to the age, body mass index and serum IL-6, hsCRP and ferritin levels between the two groups (P < 0.05). Among the three inflammatory biomarkers, hsCRP was found to have the maximum potential to categorise COVID-19 as severe or non-severe disease.

Conclusion:

Similar to patients with uncomplicated COVID-19 disease, higher serum levels of inflammatory biomarkers – IL-6, hsCRP and ferritin are seen in patients of CKD with severe COVID-19 illness in comparison to those with non-severe COVID-19, despite having a pre-existing background of low-grade chronic inflammation. The serum levels of IL-6, hsCRP and ferritin can be utilised to determine COVID-19 severity and probable prognosis in CKD patients with COVID-19.
Skeletal Metastases of Unknown Primary
Authors: Saini Vivek Kumar , Markam Kanishk , Nazar Aftab Hassan , Ora Manish , Gambhir Sanjay
Published: August 2023

Skeletal metastases of unknown primary represent skeletal metastases where primary tumors remain obscure. They usually arise from lung and prostate cancer. We present a case of a young male who presented with severe bone pains, weight loss, and generalized weakness. Fludeoxyglucose positron emission tomography–computed tomography reveals extensive skeletal metastases, a mass in the pancreas tail, and other metastatic lesions. He had no liver or lung metastases. This case presents a rare presentation of carcinoma pancreas.
Benign Metastasizing Leiomyoma and Findings on Fluorodeoxyglucose Positron Emission Tomography/Contrast-Enhanced Computed Tomography
Authors: Gosavi Atul , Shah Sneha , Purandare Nilendu C. , Puranik Ameya , Agrawal Archi , Rangarajan Venkatesh
Published: August 2023

Benign metastasizing leiomyoma is a rare condition where benign smooth muscle tumors having a histological appearance similar to uterine leiomyoma are present at distant sites. This entity is commonly associated with a past history of hysterectomy done for uterine fibroids. The knowledge of the presence of significant fluorodeoxyglucose uptake in leiomyoma helped in the diagnosis of this condition in a 47-year-old patient who being evaluated for multiple unusual sites of metastases; this was further confirmed on histopathology.
Utero-Ovarian Involvement in Non-Hodgkin's Lymphoma on 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography
Authors: Saini Vivek Kumar , Mammoottil Alen Elias , Nazar Aftab Hassan , Pavecha Punita , Ora Manish , Gambhir Sanjay
Published: August 2023

Lymphomas are common solid malignancies. They are associated with substantial morbidity and mortality. Hodgkin's lymphoma (HL) and Non-HL (NHL) are subtypes of lymphoma. Lymph nodes are the most common site of involvement, though practically any organ may be involved. NHL has preponderance for extranodal involvement. Primary uterine and ovarian NHL is scarce. However, in advanced systemic disease, secondary utero-ovarian involvement may be seen. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a pivotal imaging modality in lymphomas. It abets in pretreatment staging, posttherapy restaging, and surveillance. We present three stage-IV NHL cases with secondary utero-ovarian involvement. FDG PET/CT as a baseline imaging modality established the disease burden and organ involvement.
Advantages of Sentinel Lymph Node Mapping by Single Photon Emission Computed Tomography/Computed Tomography in Early-Stage Malignant Head-and-Neck Skin Tumors
Authors: Cadena-Pineros Enrique , Goìmez-Herrera Juliaìn , Mayo-Patiño Melissa , Carreño Alexander
Published: August 2023

Background:

The aim of this study was to determine the advantages of preoperative sentinel lymph node mapping (SLNM) by single photon emission computed tomography/computed tomography (SPECT / CT) in patients with early-stage cutaneous head-and-neck malignancies.

Materials and Methods:

We conduct a 7-year and 6 months retrospective, cross-sectional study. Patients with early-stage malignant head-and-neck skin tumors and cutaneous adnexa who underwent SLNM by SPECT/CT from March 2012 and December 2019, were included in the study.

Results:

We retrospectively analyzed 28 patients: Melanoma was the most frequent tumor (64.2%), followed by squamous cell carcinoma (25%). The anterior cheek was the most common functional subsite (25%). Twenty-seven patients (96.4%) had a successful SLN detection with SPECT/CT. Neck lymph node dissection was performed in 23 patients (82.1%). According to the pathological specimen, lymph nodes were found in all of them; hence, the efficacy of the SPECT/CT for SLNM was 100%. At 7-year follow-up, systemic recurrence was found in one patient (3.6%), another had locoregional recurrence (3.6%), and the mortality rate was 3.6%.

Conclusions:

In early-stage malignant head-and-neck skin tumors, there is a high concordance between SLN found by SPECT/CT and the histopathological results. Preoperative SPECT/CT accurately detects the SLN, assesses unexpected lymph nodes and their drainage pathways, and facilitates their location by reliably showing the relationships between sentinel nodes and important anatomic structures. This allows to perform a clear preoperative evaluation, an accurate staging for all patients and to avoid excessive dissections that could result in cosmetic and functional deformities.
Optimizing biopsy strategy for prostate cancer
Authors: Rahman Ilham Akbar , Nusaly Ilham Fauzan , Syahrir Syakri , Nusaly Harry , Kasim Firdaus
Published: August 2023

Overdiagnosis and overtreatment are well known problems in prostate cancer (PCa). The transrectal ultrasound (TRUS) Guided biopsy (GB) as a current gold standard investigation has a low positive detection rate resulting in unnecessary biopsies. The choice of optimal biopsy strategy needs to be defined. Therefore, we undertook a Bayesian network meta analysis (NMA) and Bayesian prediction in the hierarchical summary receiver operating characteristic (HSROC) model to present a method for optimizing biopsy strategy in PCa. Twenty eight relevant studies were retrieved through online databases of EMBASE, MEDLINE, and CENTRAL up to February 2020. Markov chain Monte Carlo simulation and Surface Under the Cumulative RAnking curve were used to calculate the rank probability using odds ratio with 95% credible interval. HSROC model was used to formulate the predicted true sensitivity and specificity of each biopsy strategy. Six different PCa biopsy strategies including transrectal ultrasound GB (TRUS GB), fusion GB (FUS GB), fusion + transrectal ultrasound GB (FUS + TRUS GB), magnetic resonance imaging GB (MRI GB), transperineal ultrasound GB (TPUS GB), and contrast enhanced ultrasound GB were analyzed in this study with a total of 7584 patients. These strategies were analyzed on five outcomes including detection rate of overall PCa, clinically significant PCa, insignificant PCa, complication rate, and HSROC. The rank probability showed that the overall PCa detection rate was higher in FUS + TRUS GB, MRI GB, and FUS GB. In terms of clinically significant PCa detection, FUS + TRUS GB and FUS GB had a relatively higher clinically significant PCa detection rate, whereas TRUS GB had a relatively lower rate for clinically significant PCa detection rate. MRI GB (91% and 81%) and FUS GB (82% and 83%) had the highest predicted true sensitivity and specificity, respectively, whereas TRUS GB (62% and 83%) had a lower predicted true sensitivity and specificity. MRI GB, FUS GB, and FUS + TRUS GB were associated with lower complication rate, whereas TPUS GB and TRUS GB were more associated with higher complication rate. This NMA and HSROC model highlight the important finding that FUS + TRUS GB, FUS GB, and MRI GB were superior compared with other strategies to avoid the overdiagnosis and overtreatment of PCa. FUS GB, MRI GB, and FUS + TRUS GB had lower complication rates. These results may assist in shared decision making between patients, carers, and their surgeons.
Abdominal wall closure in adult patients with untreated exstrophy of bladder
Authors: Gupta Ashish Kumar , Gohil Amish Jayantilal , Lamba Shashank
Published: August 2023

Introduction:

Bladder exstrophy is an anomaly, which if not treated early in the age, poses a surgical challenge in providing an adequate abdominal wall closure. We report our experience in patients with untreated exstrophy of the bladder, who underwent cystectomy, ileal conduit, and abdominal reconstruction using the anterior rectus sheath turndown flap and paired inguinal skin flaps.

Materials and Methods:

Ten previously unoperated adult patients with exstrophy with epispadias, who underwent surgery at our institute from January 2010 till January 2021, were included in this study to evaluate the adequacy of abdominal wall closure with our technique of retrograde turndown anterior rectus sheath flap with paired inguinal flap, and to document immediate and delayed complications, especially incisional hernia.

Results:

The mean follow-up period of the study was 16.5 months. We found that our technique provided adequate local tissue for a sturdy two-layered closure of the lower abdominal wall defect. Out of the ten patients, only one required an additional flap for abdominal wound closure. There were no stoma-related complications or incisional hernia.

Conclusion:

Abdominal wall reconstruction, for skin and fascial defects, in such complex cases can be performed by local skin and fascia using a relatively simple, safe, easy, and affordable technique as we have described. Our technique avoids the use of synthetic mesh, thereby reducing the chances of infection in such chronic open wounds.
Timing of intraoperative crystalloid infusion may decrease total volume of infusate without affecting early graft function in live related renal transplant surgery
Authors: Singh Abhishek , Ramachandran Rashmi , Chandralekha C. , Trikha Anjan , Ray Bikash Ranjan , Bansal Virinder Kumar , Mahajan Sandeep , Asuri Krishna , Rewari Vimi
Published: August 2023

Introduction:

Early graft function is crucial for successful kidney transplantation. Intravascular volume maintenance is paramount in ensuring reperfusion of transplanted kidney. This study was planned to compare whether the timing of fluid infusion can help to decrease amount of fluid given without altering early graft function during renal transplantation.

Materials and Methods:

The present study included forty recipients, randomized into standard (Group-S) or targeted fluid therapy (Group-T). Group S received fluid according to conventional fasting deficit while Group T received at 1 ml/kg/h from the start of surgery till start of vascular anastomosis after which fluid infusion rate in both group was increased to maintain a central venous pressure of 13–15 mm of Hg till reperfusion. Primary outcome measured was serum creatinine level on first postoperative day while secondary outcomes were IV fluid given, perioperative hemodynamics, onset of diuresis, graft turgidity, urine output, and renal function during first 6 postoperative days.

Results:

The study showed Group T postoperatively had early fall in serum creatinine (day 3) than S (day 6) although this difference was not statistically significant. Group T had received significantly less fluid per kg of dry weight (T-42.7 ± 9.7 ml/kg, S-61.1 ± 11.1 ml/kg, P < 0.001), had early diuresis, better graft turgidity and urine output than Group S.

Conclusion:

Targeted hydration significantly decreases the total amount of fluid infused during the intraoperative period without altering early graft function. Targeted hydration during vascular anastomosis produced stable hemodynamics and early diuresis without any side-effects pertaining to hypo or hyper-volemia.

Clinical trial identifier number-CTRI/2016/07/007111.
Tubeless mini-percutaneous nephrolithotomy for renal stones larger than 20 mm
Authors: Khadgi Sanjay , Darrad Maitrey , EL-Nahas Ahmed R. , AL-Terki Abdullatif
Published: August 2023

Introduction:

The aim of this study is to evaluate the outcomes of tubeless mini- percutaneous nephrolithotomy (PCNL) for the treatment of large (>20 mm) renal stones.

Patients and Methods:

This study included consecutive patients who underwent single-session tubeless mini-PCNL (tract size 16–20 F) for large (>20 mm) renal stones. Stone-free status meant complete clearance or residual fragments <4 mm. Complications were recorded and classified according to modified Clavien-Dindo classifications. Risk variables for significant residuals were determined with univariate (Chi-square and t-test) and multivariate logistic regression analyses.

Results:

Between July 2015 and November 2018, 225 patients were included. The mean age was 42.9 years; the mean stone size was 30.2 ± 9.6 mm and 75% of patients were males. A single renal stone was present in 54 patients (24%), multiple stones in 108 (48%), and staghorn stones in 63 (28%). The stone-free rate was 87.6%. The complication rate was 8.4% (Grade I–II in 7.5%, III in 0.9%). Three patients (1.3%) required blood transfusion. Independent risk factor for significant residual fragments was the presence of stones in multiple sites inside the pelvicalyceal system (relative risk: 13.44, 95% confidence interval: 1.78–101.43, P = 0.012).

Conclusions:

Mini-PCNL is an effective and safe treatment option for patients with large renal stones (>20 mm). Stones located in multiple sites is the only predictor of significant residual stones.
Thulium fiber laser versus holmium
Authors: Mahajan Abhay Dinkar , Mahajan Sumeeta Abhay
Published: August 2023

Introduction:

We aimed to evaluate the effectiveness and safety of the newly launched thulium fiber laser (TFL) with holmium laser lithotripsy in the miniaturized percutaneous nephrolithotomy (Miniperc) procedure for renal stones.

Methods:

The prospective study included patients with renal stones of size >1 cm to ≤3 cm. The patients who opted for extracorporeal shock wave lithotripsy, retrograde intrarenal surgeries, and stones >3 cm were excluded from the study. Demographics such as patient's age, sex, stone volume, and hardness were evaluated. The patients were randomized into holmium and TFL group for stone lithotripsy. Both the procedures were evaluated for stone disintegration time, operative time, hospital stay, intra- and postoperative complications, and stone-free rate.

Results:

A total of 125 patients with renal stones who underwent Miniperc were included in this study. The average size of the stone was comparable in both the groups (P = 0.053). The median stone disintegration time with holmium laser was 20 min 45 s and with TFL, it was 11 min 19 s (P < 0.001). The most common complications were Clavien grade I and II complications (P = 0.128). Prolonged postoperative hematuria was observed in the Thulium fiber laser group, which was conservatively managed. The stone-free rate with TFL (94.9%) was better than Holmium lithotripsy (90.9%).

Conclusions:

The TFL has significant less stone disintegration time which effectively reduced the operative time of Miniperc procedure. The stone-free rate is better, but the incidence of self-limiting hematuria is higher with TFL as compared to Holmium laser.
Urethral caruncle in penile urethra in a young male
Authors: Kore Rishikesh Arun , Kore Rajiv Nilkanth
Published: August 2023

Urethral caruncles are seen almost exclusively in women. When these lesions are diagnosed in a male patient, he is likely to undergo unnecessary radical treatment mistaking a urethral caruncle for a malignant urethral neoplasm. Hence, a proper histopathological diagnosis is mandatory before deciding the final treatment. We report a case of fleshy masses in the penile urethra of a young male patient. Simple excision was performed and the histopathology revealed a urethral caruncle of the angiomatous variety.
Urethral duplication with congenital megacystis and obstructive megaureter – A rare association
Authors: Singh Praveen , Krishnamoorthy H. , Biju S. Pillai
Published: August 2023

Urethral duplication (UD) in a female is a rare congenital anomaly. Although UD is commonly associated with other congenital anomalies of the urinary tract, its association with congenital megacystis with obstructive megaureter has not yet been reported. We present the case of a 9 year old girl child with complete sagittal duplication of the urethra associated with congenital megacystis and left obstructive megaureter.
Superselective angioembolization in posttraumatic pseudoaneurysm of corpora cavernosa presenting as acute urinary retention
Authors: Surwase Pavan , Lele Suhas , Sabnis Ravindra , Ganpule Arvind
Published: August 2023

Pseudoaneurysm of corpora cavernosa is rare and its presentation as acute urinary retention has not been reported in the literature so far. We report a 47-year-old gentleman who presented with acute urinary retention. Doppler ultrasound revealed pseudoaneurysm of corpora cavernosa at bulbar urethra region with 2 feeder vessels with turbulent flow inside. Selective internal pudendal artery angiogram was done and two feeder arteries from bilateral pudendal arteries were confirmed. Trans perineal thrombin & fibrinogen instillation and selective coil embolization of left internal pudendal artery were done, leading to complete obliteration of pseudoaneurysm and alleviation of patient's symptoms.
Ventricular Septal Defect and Right-Sided Infective Endocarditis
Authors: Sforna Stefano , Padoan Laura , Del Papa Marco , Grikstaite Egle , Sardone Mariagrazia , Savino Ketty
Published: August 2023

Right-sided infective endocarditis (IE), which represents a small but not negligible percentage of IE cases, can be observed in patients with congenital heart diseases. We discuss the case of a young woman with unrepaired perimembranous ventricular septal defect and repeated episodes of right ventricle and tricuspid valve IE with septic embolism.
Real-Time Three-Dimensional Transthoracic Echocardiography as a Decision-Making Tool for the Management of Postmyocardial Infarction Ventricular Septal Rupture: Guiding the Percutaneous Transcatheter Closure
Authors: Ardini Tengku Winda , Zebua Juang Idaman , Ilyas Kamal Kharrazi , Nasution Ali Nafiah
Published: August 2023

Postmyocardial infarction ventricular septal rupture (PI-VSR) is a rare but lethal complication of acute myocardial infarction (AMI). The diagnosis and management of AMI remain challenging. When VSR is suspected, transthoracic and/or transesophageal echocardiography at patient’s bedside is a test of choice for early diagnosis and therapeutical guidance. We aim to discuss the management of patients with VSR due to AMI with the focus on transcatheter closure management guided by real-time three-dimensional (RT3D) transthoracic echocardiography (TTE). A 64-year-old male patient was diagnosed with recent anterolateral ST elevation myocardial infarction and complication intra VSR as its complication. After remeasurement of the defect by TTE, we found an 8–11 mm defect in VSR. We performed transcatheter closure for VSR guided by RT3D TTE using Septal Occluder device No. 14. Evaluation after the procedure by TTE revealed that the device was well-seated. Percutaneous closure of PI-VSR may be considered in hemodynamically unstable patients if the risk of surgery is deemed to be too high or the anatomy is amenable to device insertion. RT3D echocardiography allows better delineation of the size and shape of the rupture, while serves as a guide during percutaneous transcatheter PI-VSR closure.
Medical students' perception on ethics and communication module
Authors: Palimar Vikram , Gupta Chandni
Published: August 2023

Background:

For the overall development of medical professionals, the affective domain compromising attitude, communication, and ethics needs to be taught. Hence, the aim was to analyze the perception of the students regarding the ethics and communication module “How to deal with Death?”

Materials and Methods:

A study was conducted on 81 undergraduate students of the 9th semester who attended the module. They were told to fill the questionnaire based on Likert scale regarding the module after the module was over. Later, the results were analyzed.

Results:

More than half of the respondents felt that role-play was the best method of teaching this module. This module had a positive impact on more than 90% of the students. More than 90% felt that empathy and compassion are required while dealing with death. Half of the students felt that empathy and compassion while dealing with death can be taught to medical students. More than 80% felt that this module helps them in developing patient-centered care. More than 75% felt that such modules help them to become good doctors. More than 95% of the students felt that medical students should know about euthanasia and end-of-life issues.

Conclusion:

Students feel that such a module on ethics and communication should be taught in their regular MBBS curriculum.
Introducing telesimulation as an innovative tool in the delivery of medical education
Authors: Shrivastava Saurabh RamBihariLal , Shrivastava Prateek Saurabh
Published: August 2023

A medical student is expected to acquire multiple learning competencies during the course of his/her training period. The present review was carried out to explore the scope, merits, and challenges attributed to telesimulation in medical education, and devise a plan to successfully implement the same in medical college settings. An extensive search of all materials related to the topic was carried out on the PubMed search engine and a total of 33 articles were selected based on their suitability with the current review objectives. Keywords used in the search include telesimulation and medical education in the title alone only. Telesimulation has emerged as an innovative approach in the last couple of decades to strengthen and facilitate education, training, and assessment processes in the field of medicine. Similar to any method, even telesimulation has its own limitations that need to be addressed for enhancing the overall effectiveness and benefit to the medical students. Telesimulation plays an important role in facilitating the acquisition of knowledge, kinesthetic, and procedural skills through real-time training and via the inputs given during feedback or debriefing sessions. To conclude, telesimulation is a new domain in medical education, which has the potential to offer an ample number of opportunities in application and research. The need of the hour is to explore the effectiveness of telesimulation in training different topics and the learning objectives that can be covered and accordingly integrate the same for the benefit of medical students or other health professionals.
Usefulness of exercise stress test in early diagnosis of coronary artery disease in diabetic patients
Authors: Gupta Garima , Raina Sunil Kumar , Bhatnagar Mukul , Kapoor Dheeraj
Published: August 2023

Introduction:

Treadmill test (TMT) is a safer, cheaper, reliable, and easily available noninvasive screening tool for the early detection of coronary artery disease (CAD) in diabetic patients.

Materials and Methods:

150 patients suffering from type 2 diabetes mellitus without established clinical diagnosis of CAD attending cardiology outpatient department at a tertiary care center of Northwest India who fulfilled the inclusion and exclusion criteria during the study period were enrolled in the study. Subjects were classified into three groups based on their symptoms and electrocardiogram (ECG) findings. Group 1 (n = 50): Cases who had no symptoms suggestive of CAD and had a normal ECG, Group 2 (n = 50): Cases who were asymptomatic but resting ECG showed some abnormality (ST-T changes), and Group 3 (n = 50): Cases who were symptomatic for CAD (typical or atypical) with either normal or abnormal resting ECG. The TMT was done using a computerized TMT machine model and continuous ECG recording was taken.

Results:

In Group 1, 18% were TMT positive and 82% were TMT negative, in Group 2, 34% were TMT positive and 66% were TMT negative, and in Group 3, 50% were TMT positive and 50% were TMT negative. Hence, out of the three groups, Group 3 has a proportionally, significantly higher number of TMT-positive cases and this difference in TMT positivity was statistically significant.

Conclusion:

Exercise stress test can be widely used test as a test for early diagnosis of ischemic heart disease in diabetic patients.
The Dosimetric Comparison Between Tandem-Ovoid and Tandemring Applicator in Cervical Cancer Brachytherapy
Authors: Prakash Aaditya , Mandal Kaustav , Pokala Neelima , Amanapu Govinda Rao
Published: August 2023

Aim:

The study aims to evaluate the differences in dosimetry between tandem-ovoid (TO) and tandem-ring (TR) gynecologic brachytherapy applicators using different optimizing techniques in image-based brachytherapy.

Background:

Conventionally, TO applicators are in use to deliver doses to tumor in intracavitary brachytherapy. Nowadays, different types of applicators are available for cervical cancer brachytherapy treatment such as TR, tandem-cylinder, hybrid intracavitary, and interstitial applicators.

Materials and Methods:

In the present study, we used a TR and Fletcher-style TO applicator in the same patient, in two different sessions of brachytherapy. Four plans were generated for each patient, utilizing two different optimization techniques for each applicator used. A dose of 9 Gy (Gray) was prescribed and plans were normalized to left point A, and in other techniques, the optimization is done to achieve the recommended organ at risk (OAR) dose–volume constraints. Dose–volume and dose point parameters were compared.

Results:

The results indicate that the (OAR doses assessed by dose–volume histogram criteria were lower than the International Commission on Radiation Units and Measurements (ICRU) point doses for bladder and rectum with both TO and TR applicators for point A normalized plans. Both bladder and sigmoid received higher doses in TO than in TR but were statistically not significant (NS), but the rectum doses are higher in TR than in TO and it was statistically significant. The isodose volumes are higher in point A normalized plans than in OAR-based optimized plans in both applicators. The ICRU point doses are lower in OAR optimized plans than in point A normalized plans in both applicators.

Conclusions:

TO and TR applicators are commonly used gynecological intracavitary applicators. In this present study we did not find any significant difference between doses delivered to ICRU Point and Isodose volumes, after using both applicators .Critical OAR doses were also comparable. The only advantage of the ring applicator is, it provides an additional degree of freedom to load the vaginal sources over the ovoids and easy application in cases of narrow fornices with greater reproducibility.
"Far-field interaction" of concentrated masses in two-dimensional Neumann and Dirichlet problems
Authors: Nazarov Sergei Aleksandrovich
Published: August 2023

We study the eigenvalues of the Neumann and Dirichlet boundary-value problems in a two-dimensional domain containing several small, of diameter $O(\varepsilon)$, inclusions of large "density" $O(\varepsilon^{-\gamma})$, $\gamma\geqslant2$, that is, the "mass" $O(\varepsilon^{2-\gamma})$ of each of them is comparable ($\gamma=2$) or much bigger ($\gamma>2$) than that of the embracing material. We construct a model of such spectral problems on concentrated masses which (the model) provides an asymptotic expansions of the eigenvalues with remainders of power-law smallness order $O(\varepsilon^{\vartheta})$ as $\varepsilon\to+0$ and $\vartheta\in(0,1)$. Besides, the correction terms are real analytic functions of the parameter $|{\ln \varepsilon}|^{-1}$. A "far-field interaction" of the inclusions is observed at the levels $|{\ln \varepsilon}|^{-1}$ or $|{\ln \varepsilon}|^{-2}$. The results are obtained with the help of the machinery of weighted spaces with detached asymptotics and also by using weighted estimates of solutions to limit problems in a bounded punctured domain and in the intact plane.
On the transference principle and Nesterenko's linear independence criterion
Authors: German Oleg Nikolaevich , Moshchevitin Nikolai Germanovich
Published: August 2023

We consider the problem of simultaneous approximation of real numbers $\theta_1,
…,\theta_n$ by
rationals and the dual problem of approximating zero by
the values of the linear form $x_0+\theta_1x_1+…+\theta_nx_n$ at
integer points. In this setting we analyse two transference inequalities
obtained by Schmidt and Summerer. We present a rather simple geometric
observation
which proves their result. We also derive several
previously unknown corollaries. In particular,
we show that, together with German's
inequalities for uniform exponents, Schmidt and Summerer's inequalities imply
the inequalities by Bugeaud and Laurent and "one half" of the inequalities
by Marnat and Moshchevitin. Moreover,
we show that our main construction
provides a rather simple proof of Nesterenko's linear independence
criterion.
A solution to the multidimensional additive homological equation
Authors: Ber Aleksei Feliksovich , Borst Matthijs , Borst Sander , Sukochev Fedor Anatol'evich
Published: August 2023

We prove that, for a finite-dimensional real normed space $V$,
every bounded mean zero function $f\in L_\infty([0,1];V)$
can be written in the form $f=g\circ T-g$ for some $g\in L_\infty([0,1];V)$
and some ergodic invertible measure preserving transformation $T$
of $[0,1]$.
Our method moreover allows us to choose $g$, for any given $\varepsilon>0$,
to be such that $\|g\|_\infty\leq (S_V+\varepsilon)\|f\|_\infty$,
where $S_V$ is the Steinitz constant corresponding to $V$.
Residents’ Report of COVID-19 Associated Training Disruptions, Stressors, and Opportunities During the Pandemic—The Singapore Experience
Authors: Koh Samuel Ji Quan , Woon Ting Hui , Fong Warren , Kwan Yu Heng , Lim Swee Han , Lee Jodie Ling Horng , Tan Hak Koon
Published: August 2023

Background The COVID-19 pandemic has disrupted residency training. Several studies have been performed to investigate the impact of the pandemic on residency training in Accreditation Council for Graduate Medical Education–International (ACGME-I)-accredited institutions. However, these were either limited to certain specialties or failed to consider possible opportunities from the pandemic.

Objective To determine the stressors on residents as well as the opportunities that arose from the COVID-19 pandemic across multiple specialities in Singapore.

Methods A cross-sectional survey among SingHealth residents was conducted between July and September 2020. The survey assessed the balance between service and training during hospital postings, the pandemic’s influence on examination and teaching, the psychological impact of the pandemic, the level of burnout, and the effect on morale of residents during the pandemic.

Results The response rate was 27.1% (253 of 934). Out of the 253 residents, 136 (53.8%) felt stressed during the pandemic. Concerns about family’s health and safety pertaining to potential COVID-19 infection, progression in training, and completion of examinations were the top 3 stressors. One-hundred and three residents (40.7%) had their training disrupted either by being placed in an interim posting not part of their residency requirements or being deployed to care for patients with COVID-19. Although administrative support and information for virtual teaching were sufficient, only 108 (42.7%) agreed it had the same value as face-to-face sessions. Despite the challenges, 179 (70.8%) thought that experiencing this crisis provided more meaning in their career.

Conclusions The COVID-19 pandemic has brought about challenges and learning opportunities for residents.
Mleko, stvar udomačitve
Authors: Mlekuž Vrhovnik Dimitrij
Published: August 2023

Mleko je izhodišče raziskovanja intenzivnih sonastajanj različnih teles, vrst in stvari; tega, kar običajno imenujejo udomačitev. Mleko je del skupka, ki povezuje živali, hormone, encime, bakterije, hrano, gene, tehnologije in materialno kulturo. Ta kompleksna sonastajanja producirajo nove, nepričakovane rezultate in učinke ter spreminjajo vse komponente v skupku udomačitve.