bluuebunny/crossref_metadata_2025 huggingface dataset:
Gas Induced Superheated Slurry: Industrial Applicability, Energy Savings and Sustainability in High Pressure Die Casting
Authors: Botter Tommaso , He You Feng , Wannasin Jessada , Schiavon Davide , Paramento Simone , Mambretti Alessandro
Published: August 2023

Objective of the paper is to present the latest applications of GISS technology, a little more than six years since the launch in the die casting industry. Industrial applicability and robustness of the solution have been the main targets of GISSCO development which is focussed on providing a technology appliable to mass production with short lead time and cost effectiveness. Based on the concepts of viscosity control and feeding compensation the GISS technology can lead to reduction of production costs (energy, lubrication, waste disposal, die life extension) as well as increase of the casting quality. Life Cycle Inventory and Carbon Footprint calculation of a case study are presented.
Flow Length Influence of Cores Made of High-Temperature Composite in Semi-Solid AZ91 Produced in Thixomolding
Authors: Schilling Andreas , Schütz Christian , Stockmann Marcel , Fros Adam Peter , Fehlbier Martin
Published: August 2023

Die casting of metallic materials is a highly economical manufacturing process for producing complex functionally integrated components close to the final shape. Thixomolding of magnesium alloys is a special process of die casting. In this process, the magnesium alloy granulate is brought to a semi solid state in a screw conveyor and then injected into the mould. The production of the casting material in the Thixomolding screw allows the temperature conditions to be set for thermally controlled solid content. These are produced by heating the Mg granulate above solidus temperature and have significantly lower casting temperature compared to conventional die casting.In this study, a flow length tool for semi solid AZ91 is designed and flow length tests are performed. Also the general use of a composite material cores in semi-solid magnesium Thixomolding and their influence on flow length are investigated. Cast-in cores allow the reproduction of complex internal hollow geometries of castings or the integration of special materials.
On the Liquid Portion Composition Deviation in the RheoMetal Process
Authors: Jarfors Anders E.W.
Published: August 2023

Semisolid processing can provide an avenue to reduced rejection rates during casting and increased capability of thin-walled castings leading to improved resource efficiency and reduced climate impact. In the RheoMetalTM process, the slurry is formed far from equilibrium. A consequence to the deviation from equilibrium is that conventional guidelines for process stability may not give the correct appreciation of the process window, nor on the correct solid fractions generated. The solid fraction provides the slurry properties and its dependence on temperature should in theory provide the stable process window. This is discussed using data from literature and an alternative approach to identify the process stability window is given.
New Addressable Applications for Rheocasting to Escape from an Oversupplied Market
Authors: Niklas Fabian
Published: August 2023

The current market change of aluminium HPDC castings started with the “Dieselgate”. First, there was a shift from diesel to petrol engines. In the second step, hybrid and battery-powered cars gained significant market shares in sales statistics. Therefore, lucrative powertrain components are falling away. As powertrain foundries still want to utilize their machines to capacity, they are pushing into the structural castings market. As a result, there is an oversupply of casting machines here, which massively depresses prices and, thus, margins for tenders. With rising energy costs, these declining margins were eaten up, bringing foundries into crisis. Implementing Rheocasting at the existing die-casting cells is the solution to move into new market shares that are now not accessible in conventional HPDC.One of the new applications is electronic housings, high wall thickness parts, and fatigue bearing parts. These parts are commonly manufactured in sand or gravity castings because of their high wall thickness and low tolerance of porosity. Rheocasting is the perfect process for high-wall thickness components. Because of the semisolid melt preparation and the lamellar filling behavior, these components can be manufactured from the same alloy without pores or voids.This flow behavior of the semisolid slurry also results in a longer flow length. Slower casting speeds and lower pressure settings result in lower clamping forces. This gives an advantage in production costs and targets battery constructions made of castings and sheet metal. Structural battery housings must be leak-tight, even in a crash event. Having it in one casting instead of an assembly reduces the leakage area and improves crash performance.Another industry that relies on Rheocasting is the telecommunications industry. The power electronics in these 5G modules are significantly larger and generate much more waste heat. Until now, many antennas have been actively cooled or milled from a block of aluminum. The milled housings are significantly too expensive to enable series production. Therefore, the goal is to reproduce the passively cooled modules in die casting. Due to the process, the thermal conductivity in conventional HPDC is around 120 to 130 W/m*K. Similarly, no slim cooling fins can be formed. Only the Rheocasting process makes it possible to cast other alloys with low proportions of alloying elements, such as AlSi2Mn. This allows fins with a wall thickness of down to 0.4 mm and thermal conductivity of up to 190 W/m*K.Rheocasting enables access to market segments out of reach. These bring an unbeatable cost advantage against the current suppliers: gravity and sand casters. The low cycle time in Rheocasting brings back the high margins needed to sustain the business. Also, these products can be delivered with even better properties on smaller casting machines.
An Application of Injection Molding to Semisolid Processing of Metallic Alloys: A Role of SIMA in Feedstock Transformation
Authors: Czerwinski Frank
Published: August 2023

Injection molding has proven for over 150 years to be the efficient mass manufacturing technology of net-shape components from plastics, however, its application to metallic alloys, despite four decades of commercialization, still creates challenges. Although early designs assumed a direct replacement of plastic with magnesium, subsequent research revealed essential differences in machinery and processing requirements, imposed by metallic alloys. The key discovery revealed that the dendrite-to-globule transformation during coarse particulate melting is caused by strain induced melt activation (SIMA) due to feedstock deformation imposed at their manufacturing stage, not due to the injection screw shearing during processing. As a result, the process control parameters and the screw and barrel design can be optimized with a focus on other screw functions. That discovery also led to the simplified machinery designs, eliminating the complex injection screw, and replacing it with a simple plunger.
High Speed Roll Casting of Al-5%Mg Strip at Semisolid Condition
Authors: Haga Toshio , Yamazaki Kazuki , Nishida Shinichi
Published: August 2023

Semisolid Al–Mg alloy strips were cast using high-speed twin-roll casting under very low roll loads to investigate the effect of low roll loads on surface cracking and center segregation of Mg. In the conventional twin-roll caster for aluminum alloys, the roll speed is usually less than 2 m/min, and the roll load is typically greater than 1 kN/mm to solidify the aluminum alloy and reduce casting defects. In the vertical type high-speed twin-roll caster, the roll speed can range from 10 to 90 m/min, and strips can be cast at roll loads below 500 N/mm, down to loads as low as 2 N/mm. Strips cast at 2 N/mm in this study did not completely solidify when released from the rolls; this means that the strips were semisolid. Al–Mg strips can be continuously cast without breaking when they are semisolid. The surface cracking and center segregation of these strips were compared with those of strips cast at a higher load of 88 N/mm. The effect of the small load on the presence of Mg at cross sections of the strip was investigated using etching with Weck’s reagent.
Cross-cultural adaptation and psychometric evaluation of a Sinhalese version of the Multidimensional Scale of Perceived Social Support (MSPSS) in patients with cancer
Authors: Weeratunga Eranthi , Senadheera Chandanie , Hettiarachchi Manjula , Perera Bilesha
Published: August 2023

Introduction: The Multidimensional Scale of Perceived Social Support (MSPSS) is a tool widely used in health surveys to assess social support (SS) perceived by individuals. The lack of an appropriate tool to measure SS perceived by patients with cancer has hindered our understanding of how SS is associated with the management and recovery process of Sri Lankan patients with cancer. The study aimed to examine the reliability and validity of the Sinhalese version of the MSPSS.Methods: Cross-cultural adaptation of the MSPSS was done following the standard guidelines of the process of translation and adaptation set by the World Health Organization. The study sample consisted of 40 patients with cancer at the Teaching Hospital Karapitiya, Galle, Sri Lanka. Data analysis was done using SPSS 25.0. Internal consistency of the overall MSPSS was calculated using Cronbach’s alpha. Test-retest reliability of the tool was also assessed using the intra-class correlation coefficient (ICC). The convergent and divergent validity of the tool was assessed using the Centre for Epidemiological Studies-Depression (CES-D) and the World Health Organization-Quality of Life-Brief Scale (WHOQoL-BREF). Construct validity was assessed using Exploratory Factor Analysis (EFA).Results: The Sinhalese version of MSPSS showed high reliability (Cronbach’s alpha-0.911). The tool showed favourable test-retest reliability (ICC=0.91). The overall MSPSS score was correlated negatively with depressive symptoms (r= -0.459, p<0.001) and positively with dimensions of quality-of-life scores; overall (r=0.674, p<0.001), physical (r=0.426, p<0.001), psychological (r=0.540, p<0.001), social (r=0.674, p<0.001) and environmental quality of life (r=0.767, p<0.001) ensuring strong discriminant/divergent and convergent validity of the Sinhalese version of the MSPSS. Factor analysis extracted three factors (e.g., family, friends, and significant others) explaining 96.65% of the variance.Conclusion: The Sinhalese version of MSPSS is a reliable and valid tool to assess the perceived SS from family, friends, or significant others among patients with cancer.
Sec22b and Stx4 Depletion Has No Major Effect on Cross-Presentation of PLGA Microsphere–Encapsulated Antigen and a Synthetic Long Peptide In Vitro
Authors: Tondeur Emma G M , Voerman Jane S A , Geleijnse Mitchell A A , van Hofwegen Laure S , van Krimpen Anneloes , Koerner Julia , Mishra Gunja , Song Ziye , Schliehe Christopher
Published: August 2023

The induction of CTL responses by vaccines is important to combat infectious diseases and cancer. Biodegradable poly(lactic-co-glycolic acid) (PLGA) microspheres and synthetic long peptides are efficiently internalized by professional APCs and prime CTL responses after cross-presentation of Ags on MHC class I molecules. Specifically, they mainly use the cytosolic pathway of cross-presentation that requires endosomal escape, proteasomal processing, and subsequent MHC class I loading of Ags in the endoplasmic reticulum (ER) and/or the endosome. The vesicle SNARE protein Sec22b has been described as important for this pathway by mediating vesical trafficking for the delivery of ER-derived proteins to the endosome. As this function has also been challenged, we investigated the role of Sec22b in cross-presentation of the PLGA microsphere–encapsulated model Ag OVA and a related synthetic long peptide. Using CRISPR/Cas9-mediated genome editing, we generated Sec22b knockouts in two murine C57BL/6-derived APC lines and found no evidence for an essential role of Sec22b. Although pending experimental evidence, the target SNARE protein syntaxin 4 (Stx4) has been suggested to promote cross-presentation by interacting with Sec22b for the fusion of ER-derived vesicles with the endosome. In the current study, we show that, similar to Sec22b, Stx4 knockout in murine APCs had very limited effects on cross-presentation under the conditions tested. This study contributes to characterizing cross-presentation of two promising Ag delivery systems and adds to the discussion about the role of Sec22b/Stx4 in related pathways. Our data point toward SNARE protein redundancy in the cytosolic pathway of cross-presentation.
Comparison of marginal and internal adaptation of provisional polymethyl methacrylate restorations fabricated by two three-dimensional printers: An in vitro study
Authors: Hasanzade Mahya , Zabandan Dariush , Mosaddad Seyed Ali , Habibzadeh Sareh
Published: August 2023

Background:

Chairside fabrication of provisional restorations using three-dimensional (3D) printers is rising in digital dentistry. The purpose of this research was to compare the marginal and internal adaptation of provisional polymethyl methacrylate (PMMA) restorations fabricated by two different 3D printers.

Materials and Methods:

In this in vitro investigation, an intact maxillary 1st molar acrylic model was first digitalized by a laboratory scanner. It was then prepared for an all-ceramic restoration and scanned again by the same scanner. The final restoration was designed in Exocad according to the scan files with a 50 μm cement gap. PMMA restorations were printed by two 3D printers; Group 1: Asiga (n = 10) and Group 2: Digident (n = 10). The replica technique was used to assess the marginal and internal fit of the restorations, and one-way ANOVA was used to analyze the data. P <0.05 was regarded as statistically significant.

Results:

The mean marginal gap of crowns in Group 1 was significantly lower than that of Group 2 (75 vs. 195 μ, P = 0.001). Regarding internal adaptation, no significant difference was found between the axial gap values in both groups (P > 0.05). The mean occluso-axial gap (90 vs. 140 μ, P = 0.026) and the mean occlusal gap (116 vs. 300 μ, P = 0.001) of crowns in Group 1 were significantly smaller compared to the equivalent values in Group 2.

Conclusion:

Provisional PMMA crowns fabricated by the Asiga printer showed significantly higher marginal and internal adaptation than those manufactured by Digident at all points except for the axial surface.
Comparison of the apical seal obtained by Adseal, Proseal, and AH26 sealers in root canal obturation with lateral compaction technique
Authors: Saeidi Akam , Hajipour Romina , Mahmoudi Elham , Feizi Farideh , Khafri Soraya
Published: August 2023

Background:

Root canal obturation is an important step in endodontic treatment, which is performed aiming to three-dimensionally seal the canal and prevent microleakage, reentry, and proliferation of microorganisms in the root canal system. On the other hand, microleakage eventually leads to root canal treatment failure. Sealing ability is an important property of endodontic sealers. This in vitro study aimed to compare the quality of apical seals obtained by three endodontic sealers.

Materials and Methods:

This in vitro experimental study evaluated 48 extracted single-canal maxillary incisors. Hard- and soft-tissue residues were removed and the teeth were immersed in 5.25% of sodium hypochlorite for disinfection. The teeth were decoronated at the cementoenamel junction with a diamond disc such that 10 mm of root length remained. Canal patency was ensured using a #10 K-file. The canals were then instrumented with ProTaper rotary system. The canals were randomly divided into three experimental groups for the application of Adseal, Proseal, and AH26 sealers, and positive and negative control groups. Sealers were applied in the canals using lateral compaction technique. The external root surfaces were then coated with two layers of nail varnish except for the apical 3 mm. The amount of microleakage was quantified using the dye-penetration technique. The Tukey's test was used to compare the microleakage between the experimental and control groups. The Kruskal–Wallis test was applied to compare the microleakage of experimental groups (P < 0.05).

Results:

The amount of microleakage in canals filled with Adseal, Proseal, and AH26 sealers with lateral compaction technique was 2.33 ± 0.64, 2.2 ± 0.81, and 2.22 ± 0.71 μm, respectively. No significant difference was noted among the three sealers regarding microleakage (P = 0.84). However, the amount of microleakage in the sealer groups was significantly lower than that in the control group (P < 0.001).

Conclusion:

The application of Adseal, Proseal, and AH26 had equal efficacy for the provision of optimal apical seal in filling of root canals with lateral compaction technique. The application of sealers yielded a significantly superior apical seal compared with the control group.
Assessment of the Salivary Level of Malondialdehyde in Localized Periodontitis Versus Generalized Periodontitis: An Analytical Cross-Sectional Study
Authors: Miran Alla Ali Jan , Akram Hadeel Mazin
Published: August 2023

Introduction: We aimed to compare the salivary level of malondialdehyde (MDA) in localized periodontitis versus generalized periodontitis. Methods: Nineteen healthy participants, 35 cases of generalized periodontitis, and 36 cases of localized periodontitis included in the study. The enzyme-linked immunosorbent (ELISA) assay was used to blindly quantify the amounts of MDA in saliva. Data analyzed using one-way ANOVA and Tukey’s post hoc test via R software. Results: Ninety subjects completed the study. There was a statistically significant difference among study groups (P < 0.001). The Tukey’s post hoc test showed a statistically significant difference for all pairwise compressions (P < 0.001) Conclusion: The salivary levels of MDA increase in periodontitis patients. Within limitations of this cross-sectional study, it could be concluded that salivary MDA levels may possibly be a potential biomarker to examine oxidative stress in periodontal disease.
Prevalence and Predictors of Prediabetes in Adolescents and Young Adults with Turner Syndrome: A Cross-Sectional Study from Eastern India
Authors: Mondal Sunetra , Gargari Piyas , Bose Chiranjit , Chowdhury Subhankar , Mukhopadhyay Satinath
Published: August 2023

Background:

Individuals with Turner syndrome (TS) have a high risk for prediabetes/type 2 Diabetes Mellitus (T2DM). There is scarce data regarding risk factors for prediabetes in TS, specially from South Asia.

Methods:

We conducted a cross-sectional study on girls with TS aged 12–30 years who had achieved pubertal stage B3 and above—spontaneously or with oestrogen. Anthropometric measurements and biochemical tests were conducted, and medical records were reviewed for details about pubertal onset and progression, growth hormone (GH) and oestrogen therapy.

Results:

Out of 129 patients with TS in our database, 99 met the criteria for inclusion, mean age 18.33+/-3.78 years and mean BMI 20.57+/- 3.71 kg/m2. Prevalence of prediabetes was 23.23%. Plasma-glucose measured after 75 g-oral-anhydrous-glucose-load (OGTT-PPG) identified five additional prediabetes cases, who had normal fasting plasma glucose (FPG) or HbA1c%. Compared to those without prediabetes, TS with prediabetes (n = 23) had higher mean body weight, BMI, waist circumference (WC) [42.02+/- 5.83 vs 36.22+/-8.07, 22.77+/-2.78 vs 19.91+/- 3.72, 85.26+/- 3.52 vs 81.08+/- 4.59, pall < 0.03 ], higher median WC-to-height ratio (WHtR) and WC-to-hip ratio (WHR)((0.64 [0.6–0.69] vs 0.59[0.56- 0.66], 0.9[0.84–1.12] vs 0.85[0.75–1.01], pboth < 0.02), and higher LDL-cholesterol, triglycerides, and greater prevalence of hepatosteatosis (47.1% vs 21.1%, P < 0.01). Among GH recipients (n = 36), those with prediabetes had delayed initiation and shorter duration of GH therapy. There were no differences in cardiometabolic parameters or the prevalence of diabetes between different karyotypic variants of TS. BMI, WC and WHR had significant positive correlation with FBG, OGTT-PPG and HbA1c% (pall < 0.004). Delay in oestrogen initiation had a significant correlation with OGTT-PPG (Spearman’s-rho = 0.69, P < 0.004). BMI, WHR and pubertal status were independent predictors for prediabetes (OR: 1.27 [1.03–1.57]), 1.18 [1.04–1.34]) and 0.09[0.02–0.38], respectively, pall < 0.02), but karyotype was not. BMI had the highest sensitivity [cut-off: 21.04 kg/m2 (sensitivity: 82.6%, specificity: 62.2%) and WHR had the highest specificity [cut-off: 0.89 (sensitivity: 73.9%, specificity 78.4%)] for predicting prediabetes.

Conclusion:

Indian girls with TS have a high risk for prediabetes, irrespective of underlying karyotype and should be screened with oral glucose challenge to identify prediabetes. Timely intervention against central obesity and early initiation of GH and oestrogen should be ensured in TS. Late presenting girls should be closely monitored for dysglycaemia before and during treatment with GH and/or oestrogen.
Kundalini Shakti
Authors: Deshmukh Vinod D.
Published: August 2023

Kundalini Shakti is an ancient Sanskrit word for the psychobiological energy or arousal. Kundalini means coiled up, spiral, circular, or cyclic. Shakti means energy or arousal. Both Indian and European authors have written extensively on this dormant energy and the seven energy circuits or chakras with their symbolic meanings. After reviewing the literature on Kundalini, and briefly summarizing the modern neuroscience of conscious arousal and awareness, it is hypothesized that the lower two Kundalini Chakras, Muladhara and Swadhisthana, are functionally related to the Medullary Reticular Formation; the middle two Chakras, Manipura and Anahata, are functionally related to the Pontine Reticular Formation, and the upper three Kundalini Chakras, Vishudhi, Ajna, and Sahasrara, are functionally related to the Midbrain Reticular Formation and its ascending-activating and descending-deactivating circuits including the Reticular-Limbic, and the Reticular-Thalamic-Cortical-Striatal circuits. In the final section, a brief review of the current literature on the relatively new scientific field of Neuro-Psychobiology and its recent development is provided. There are five major neural networks in the cerebral cortex. They are the Default Mode Network, the fronto-parietal Executive network, the cingulo-opercular salience network, and the Dorsal and Ventral Attention networks. The Salience network senses and appraises the present situation that an organism is facing, and makes an instantaneous decision whether to engage or disengage from the situation actively. Engagement occurs through the Fronto-Parietal network, and disengagement occurs through the Default Mode Network. The Ventral Attention network processes the object that is present, and the Dorsal Attention network maps the experiential space-time, where the object is in relation to the conscious observer, the witness, or the agent of action. Thus, the main function of the Brain-Mind-Self is to adapt to the ongoing self-situation. It is crucial for survival, growth, and flourishing.
TSPYL5 inhibits the tumorigenesis of colorectal cancer cells in vivo by triggering DNA damage
Authors: Huang Chao , Ruan Peng , He Chunping , Zhou Rui
Published: August 2023

Context:

Testis-specific protein Y-encoded-like 5 (TSPYL5) suppresses several cancers in vivo, including colorectal cancer (CRC); however, its mechanism and role in CRC cell tumorigenesis in vivo remain unknown.

Aims:

To elucidate the molecular mechanisms of colorectal cancer and find new therapeutic targets to improve CRC patient outcomes.

Settings and Design:

Male mice (4 weeks old, 16–22 g) were housed in sterile cages in a temperature-controlled room (20–25°C) with a 12 h light/dark cycle and ad libitum food and water.

Methods and Materials:

TSPYL5 overexpressing or non-overexpressing HCT116 cells were used to create a nude mouse tumor model. Tumor tissue was evaluated histologically after hematoxylin and eosin (H and E) staining. TUNEL staining assessed tumor cell apoptosis. Ki67 expression in excised tumor tissue was measured by immunohistochemistry. Western blotting examined double-stranded break (DBS)-associated protein expression in vivo.

Statistical Analysis Used:

IBM SPSS Statistics for Windows, Version 21.0 was used for all analyses (IBM Corp., Armonk, NY, USA). At least three independent experiments yield a mean value ± standard deviation. Unpaired Student’s t-tests compared groups. One-way analysis of variance and Dunnett’s test were used to compare groups with a P value < 0.5.

Results:

TSPYL5 overexpression inhibited CRC cell tumorigenicity and damaged tumor cells in vivo. TSPYL5 overexpression also significantly increased Bax and p-H2AX (early double-stranded break indicators) and decreased Ki67, Bcl-2, and peroxisome proliferator-activated receptor expression.

Conclusions:

Collectively, TSPYL5 overexpression inhibited the tumorigenicity of CRC cells in vivo by inducing DNA damage.
Prognostic and pathological implications of contrast-enhanced ultrasound features in hepatocellular carcinoma
Authors: Wang Yuling , Chai Suwan , Cai Wenjia , Yu Jie , Liang Ping
Published: August 2023

Background:

Contrast-enhanced ultrasound (CEUS) plays a vital role in diagnosing hepatocellular carcinoma (HCC) and, to some extent, reflects tumor prognosis. This suggests that some pathological features of HCC may be associated with CEUS features.

Aim:

This study aimed to verify the prognostic significance of four CEUS features and further explore their pathological significance.

Materials and Methods:

This study included 243 HCC patients who underwent a preoperative CEUS examination. All pathological diagnoses and immunohistochemical information were obtained from the pathological report. The prognostic significance of four CEUS features, including nodule-in-nodule architecture, mosaic architecture, intratumoral feeding arteries, and peritumoral arterial phase (AP) hyperenhancement, was analyzed. The correlation between prognostic-related features and immunohistochemical information was further analyzed.

Results:

The disease-free survival (DFS) of HCC was significantly affected by mosaic architecture or intratumoral feeding arteries (HR = 1.79; 95% confidence interval (95% CI), 1.09–2.95; P = 0.004; HR = 1.70; 95% CI, 1.07–2.71; P = 0.025, respectively). Intratumoral feeding arteries were positively correlated with the expression of serum alpha-fetoprotein (AFP), microvascular invasion (MVI), differentiation, size, and Ki-67, among which the correlation with size was the strongest, followed by Ki-67 and MVI. The mosaic architecture was positively correlated with serum AFP, MVI, differentiation, and size, among which the correlation with size was strongest, followed by MVI.

Conclusion:

The mosaic architecture and intratumoral feeding arteries of CEUS were closely related to the postoperative progression of HCC. Mosaic architecture had a good correlation with tumor size and MVI, whereas intratumoral feeding arteries were closely associated with tumor size and Ki-67 expression.
Microwave ablation for the treatment of peripheral ground–glass nodule-like lung cancer: Long-term results from a multi-center study
Authors: Yang Xia , Jin Yong , Lin Zhengyu , Li Xiaoguang , Huang Guanghui , Ni Yang , Li Wenhong , Han Xiaoying , Meng Min , Chen Jin , Lin Qingfeng , Bie Zhixin , Wang Chuntang , Li Yuliang , Ye Xin
Published: August 2023

Introduction:

Microwave ablation (MWA) is an effective and safe approach for the treatment of ground–glass nodule (GGN)-like lung cancer, but long-term follow-up is warranted. Therefore, this multi-center retrospective study aimed to evaluate the results of MWA for the treatment of peripheral GGN-like lung cancer with a long-term follow-up.

Materials and Methods:

From June 2013 to January 2018, a total of 87 patients (47 males and 40 females, mean age 64.6 ± 10.2 years) with 87 peripheral lung cancer lesions showing GGN (mean long axis diameter, 17 ± 5 mm) underwent computed tomography (CT)-guided percutaneous MWA. All GGN-like lung cancers were histologically verified. The primary endpoints were local progression-free survival (LPFS) and overall survival (OS). The secondary endpoints were cancer-specific survival (CSS) and complications.

Results:

During a median follow-up of 65 months, both the 3-year and 5-year LPFS rates were 96.6% and 96.6%. The OS rate was 94.3% at 3 years and 84.9% at 5 years, whereas the 3-year and 5-year CSS rates were 100% and 100%, respectively. No periprocedural deaths were observed. Complications were observed in 49 patients (51.6%). Grade 3 or higher complications included pneumothorax, pleural effusion, hemorrhage, and pulmonary infection, which were identified in ten (10.5%), two (2.1%), two (2.1%), and one (1.1%) patient, respectively.

Conclusions:

CT-guided percutaneous MWA is an effective, safe, and potentially curative treatment regimen for GGN-like lung cancer.
Prospective analysis of the diagnostic accuracy of digital rectal examination and magnetic resonance imaging for T staging of prostate cancer
Authors: Zhu Junming , Wu Xiaohui , Xue Yuting , Li Xiaodong , Zheng Qingshui , Xue Xueyi , Huang Zhiyang , Chen Shaohao
Published: August 2023

Background:

Accurate staging of prostate cancer (PCa) is the basis for the risk stratification to select targeted treatment. Therefore, this study aimed to compare the diagnostic accuracy rates of magnetic resonance imaging (MRI) and digital rectal examination (DRE) for preoperative T staging of potentially resectable PCa.

Methods:

From March 2021 to March 2022, patients with PCa with T staging by prostate biopsy were included. All examinations used postoperative histopathologic T staging as the reference standard. All patients underwent DRE and MRI before the puncture. Two blinded urologists and radiologists independently evaluated DRE and MRI, respectively. Before the examination, patients were then divided into early- (T1, T2) and late-(T3, T4) stage cancer. Analysis of a paired sample sign test was performed to determine differences between DRE and MRI.

Results:

A total of 136 study participants with PCa were evaluated histopathologically, of whom 71% (97/136) and 29% (39/136) were at the early- and late-stage cancer, respectively. MRI had a significantly higher accuracy (91.9% vs. 76.5%, P < 0.001) compared with DRE. Further, MRI showed a higher sensitivity than DRE to diagnose early PCa (92.8% vs. 74.2%; P < 0.001). However, the specificity was not significantly different between them (89.7% vs. 82.1%; P = 0.375). Area under the curve (receiver operating curve) values were calculated as 0.78 ± 0.038 (95% confidence interval [CI], 0.71–0.86), 0.91 ± 0.028 (95% CI, 0.86–0.97), and 0.872 ± 0.028 (95% CI, 0.80–0.92) for DRE-, MRI-, MRI + DRE-based PCa predictions, respectively. The prediction performance of MRI was better than that of DRE (DeLong test, z = 3.632, P = 0.0003) and MRI + DRE (DeLong test, z = 3.715, P = 0.0002).

Conclusion:

For resectable PCa, the diagnostic potential of MRI in assessing the T stage was higher than that of DRE. However, DRE is still valuable, especially for patients with locally advanced PCa.
Pediatric granular cell tumor of the larynx: A case report and literature review
Authors: Ke Jing , Xiong Junwei , Zhang Juhong , Ma Haiyu , Yuan Wei
Published: August 2023

An 8-year-old child was admitted to our ENT department for a year because of a hoarse voice. An endoscopic examination displayed that a cystic, solid lesion can be seen in the right subglottis. The lesion was removed using a CO2 laser under general anesthesia. Postoperative histopathology confirmed granular cell tumor (GCT), S-100(+), vimentin (+), and SOX-10(+). GCT, also known as the Abrikossoff tumor, is a rare benign tumor that rarely occurs in the larynx, particularly in children. This case report emphasizes that considerable attention should be given to the differential diagnosis of the laryngeal granulosa cell tumor. Given the recurrence risk of GCT, long-term postoperative follow-up is necessary.
Clinical application of radiofrequency ablation-assisted coaxial trocar biopsies for pulmonary nodules at a high risk of bleeding
Authors: Zhu Shidi , Li Jing , Guan Weiwei , Li Hailiang , Fan Weijun , Wu Di , Zheng Lin
Published: August 2023

Context:

The purpose of this study was to assess computed tomography (CT)-guided puncture biopsy of pulmonary nodules at a high risk of bleeding. First, a coaxial trocar technique was used to radiofrequency ablate small blood vessels in the puncture area, followed by a biopsy of the pulmonary nodule.

Aim:

This study aimed to evaluate the effectiveness and safety of this procedure.

Methods:

In this retrospective research, we assessed the relevant data of 45 patients who had undergone needle biopsy of pulmonary nodules at a high risk of bleeding. Twenty-five of these patients had CT-guided coaxial radiofrequency ablation (RFA)-assisted biopsy (group A). The remaining 20 had undergone conventional CT-guided needle biopsy (group B). We equated the technical success rate and the incidence of complications such as bleeding, pneumothorax, and pain in the two groups of needle biopsies.

Results:

Both groups had a 100% success rate with puncture biopsy. The incidences of pneumothorax in groups A and B were 10% (2/20) and 24% (6/25), respectively; this difference is not significant (P > 0.050). The rates of bleeding in groups A and B were 10% (2/20) and 44% (11/25), respectively, and the rates of pain were 30% (6/20) and 60% (15/25), both of which were statistically significant (P = 0.030; P = 0.045, respectively).

Conclusions:

CT-guided coaxial trocar technique for RFA-assisted biopsy of pulmonary nodules at a high risk of bleeding is effective and safe and can significantly reduce the risk of biopsy-induced pulmonary hemorrhage.
High-power green-light laser endoscopic submucosal dissection for non-muscle-invasive bladder cancer: A technical improvement and its initial application
Authors: Zheng Jilu , Liu Feifan , Zhang Keqin , Xiang Yuzhu , Li Lianjun , Zhang Haiyang , Zhang Yinan , Suo Ning , Wang Zilong , Han Chenglin , Jin Xunbo , Wang Muwen , Wei Chunxiao , Chen Ji
Published: August 2023

Background:

The technique of laser en bloc resection of bladder tumor (ERBT) has been a valuable alternative technique to transurethral resection of bladder tumor (TURBT). However, the combination of laser ERBT and endoscopic submucosal dissection (ESD) technique has not been well studied. Here, a novel technique integrating a high-power green-light laser with ESD was presented. This study aimed to evaluate the safety and efficacy of high-power green-light laser endoscopic submucosal dissection (HPL-ESD) for the treatment of primary non-muscle-invasive bladder cancer (NMIBC).

Materials and Methods:

From January 2015 to December 2018, a total of 56 patients with NMIBC underwent HPL-ESD. All tumors were transurethral en bloc resected in the ESD technique. Perioperative clinical data were retrospectively collected and analyzed.

Results:

All operations were safely performed by the technique of HPL-ESD without blood transfusion. The mean tumor diameter was 2.04 ± 0.65 cm, ranging from 0.5 to 3.5 cm. The mean operative time was 28.39 ± 16.04 min. The average serum hemoglobin decrease was 0.88 ± 0.54 g/dL. The mean postoperative catheterization time was 2.88 ± 0.94 days. The pathologic stages included pTa (32 cases), and pT1 (24 cases). Double-J stent indwelling was not performed for four patients whose tumors were adjacent to the ureteral orifice and no postoperative hydronephrosis was observed. Only one case of ectopic bladder tumor recurred due to irregular bladder irrigation during the 36-month follow-up.

Conclusion:

HPL-ESD is a safe and effective alternative for the treatment of primary NMIBCs, especially for tumors adjacent to the ureteral orifice.
Immunotherapy for early-stage non-small cell lung cancer: A system review
Authors: Gao Jingyi , Zhang Chao , Wei Zhigang , Ye Xin
Published: August 2023

With the addition of immunotherapy, lung cancer, one of the most common cancers with high mortality rates, has broadened the treatment landscape. Immune checkpoint inhibitors have demonstrated significant efficacy in the treatment of non-small cell lung cancer (NSCLC) and are now used as the first-line therapy for metastatic disease, consolidation therapy after radiotherapy for unresectable locally advanced disease, and adjuvant therapy after surgical resection and chemotherapy for resectable disease. The use of adjuvant and neoadjuvant immunotherapy in patients with early-stage NSCLC, however, is still debatable. We will address several aspects, namely the initial efficacy of monotherapy, the efficacy of combination chemotherapy, immunotherapy-related biomarkers, adverse effects, ongoing randomized controlled trials, and current issues and future directions for immunotherapy in early-stage NSCLC will be discussed here.
The curious case of extinction of family physicians from the Indian Health System – An open letter to the members of the National Medical Commission: Draft competency-based medical education curriculum regulations 2023 – Complete exclusion of family physicians/family medicine education from the MBBS course curriculum!
Authors: Kumar Raman
Published: August 2023

In 2012, India Today, a news agency, reported that ‘Family Physicians are dying silent death’ in India. The number of practicing family physicians is declining rapidly in the most populous country in the world with pressing public health needs. The previous generation of general practitioners/family physicians/family doctors has entered the age group of the seventies and eighties in both urban and rural areas. Unfortunately, no new family physician is opening the practice in these areas. The recent COVID pandemic has clearly demonstrated the ongoing need, demand, and popularity of family physicians among the general public as first-contact dependable and trustworthy doctors. While it may be an enigma why MBBS doctors are no longer opting to become family physicians, to the experts of this domain, it is not a surprise. To outside observers, this phenomenon may appear to be an outcome of changing times, the expansion of medical sciences, new emerging career choices for medical students, or competition within the healthcare market. However, a closer study reveals that the decline of family physician services in India is not a default situation but an outcome of decades of institutional neglect and perhaps a deliberate exclusion. According to the recently released National Medical Commission (NMC) draft curriculum 2023, the undergraduate medical education program is designed with the national goal of creating an “Indian Medical Graduate” possessing the requisite knowledge, skills, attitudes, values, and responsiveness so that she or he may function appropriately and effectively as a PHYSICIAN OF FIRST CONTACT of the community while being globally relevant. However, we are disappointed to note that the Family Medicine subject (discipline of family physicians) component has been entirely excluded from the draft of the MBBS curriculum. The words such as ‘Family medicine’, ‘Family Physician’, ‘General practitioners’, and ‘Family Practice’ have not even been mentioned in the entire 83 pages of the draft MBBS curriculum document. This is not an inadvertent occurrence or a default situation. The erstwhile MCI, the Medical Council of India, played a significant role in diminishing the role of family physicians in the Indian health system. It is to be seen if the NMC is able to reverse this trend by easing the regulatory restrictions on family physicians/family medicine training by including it in the MBBS course.
A rare case of genital myiasis in a patient with genital prolapse
Authors: Manna Souvik , Gupta Varsha , Kumari Asha
Published: August 2023

Genital myiasis is an infestation of genital organs by fly larvae, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. We report a rare case of genital myiasis in an elderly postmenopausal woman aged 82 years from Udaipur, Rajasthan. She presented with complaints of intense pain in the genital region and was diagnosed as a case of genital myiasis of a prolapsed uterus. Pelvic examination revealed ‘Stage-IV’ genitourinary prolapse according to Pelvic Organ Prolapse-Quantification (POP-Q classification), with a big excavatory ulcer indwelled with maggots of Musca domestica. About 100 such maggots were subsequently manually removed with forceps. With proper surgical and nonsurgical interventions, the patient healed completely and the prolapse was reduced completely.
Immediate cause and the role of multimorbidity in deaths associated with COVID 19 among hospitalized patients in a low resource district in Kerala India: A record-based case-control analysis
Authors: Vaman Raman Swathy , Valamparampil Mathew J. , Dalmita Niya James , Reghukumar Aravind , Anish T. S.
Published: August 2023

Introduction:

Multimorbidity is the coexistence of two or more chronic medical conditions in a person. The study aims to investigate the immediate cause of death and risk factors of mortality including multimorbidity among patients hospitalized with SARS CoV2 infection in Kasaragod district in Kerala, India.

Methods:

A record-based case-control study was done using the hospital records and follow-up surveillance system of SARS-COV 2 patients admitted in the Kasaragod district. SARS-COV 2 patients who had expired during the study period from June to December 2020 and reported as COVID-19 deaths (N = 226) were the cases, and an equal number of hospital controls were the study participants.

Results:

The mean (SD) age of the cases and controls were found to be 64.6 (14.2) years and 61.5 (13.4) years, respectively. Covid pneumonia alone was reported as the cause of death in more than half (52%) of the study participants. This was followed by cardiovascular events (8.5%) and acute kidney injury (6.5%). Among individual comorbidities among people who expired, diabetes mellitus (53%) was the most common, followed by hypertension (46%) and cardiovascular diseases (23%). More than 50% were found to have multimorbidity. Logistic regression showed chronic kidney disease (CKD) (Adjusted odds ratio (AOR) = 2.18 (1.24–3.83)) and malignancy (AOR = 3.05 (1.27–7.32)) to be significantly associated with mortality as individual determinants. Hypertension–diabetes mellitus [AOR = 1.68 (1.02–2.76), P = 0.043] and hypertension–CKD [AOR = 3.49 (1.01–12.01), P = 0.48] dyads were multimorbidities significantly associated with mortality.

Conclusion:

Combinations of hypertension with diabetes mellitus and CKD were found to be significant determinants for mortality in hospitalized COVID-19 patients. Uniformity in death certification is required to understand the causes and contributors to death in COVID-19.
Critical analysis of American heart association and European society of cardiology guidelines for hypertension
Authors: Sorte Akshayata G. , Turankar Tileshkumar B. , Sawale Shantanu , Acharya Sourya , Shukla Samarth
Published: August 2023

This study places more of an emphasis on the hypertensive guidelines that are recommended for the management of hypertension by the American College of Cardiology (ACC) and the American Heart Association (AHA), as well as the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). This study examines the development of several different guidelines and focuses primarily on contrasting the similarities and differences that are given by American and European guidelines. Both sets of recommendations encourage the use of an optimal method for measuring blood pressure, such as the use of home blood pressure (BP) monitoring, or ambulatory monitoring, which a key recommendation is given by both sets of recommendations for the primary prevention of hypertension, and non-pharmacological treatment, such as modifying one’s lifestyle, as the primary intervention. There are some differences between American and European BP treatment guidelines when it comes to determining what constitutes high BP and determining what BP level should serve as the treatment goal. To start pharmacological therapy, the AHA and ACC suggest maintaining a BP of at least 130/80 mmHg with an ASCVD positive or a cardiovascular risk of more than 10%, but the ESH and ESC propose maintaining a BP of at least 140–159/90–99 mmHg. Following American rules, high BP is divided into two stages; however, according to European recommendations, it is divided into three stages. Both sets of recommendations strongly encourage the use of combination therapies that only require one pill, such as single-pill treatment for multiple conditions, and both sets of recommendations restrict the use of certain drugs, such as beta-blockers, to patients who also have additional medical conditions.
Immunological survey of COVID-19 among medicos of tribal preponderant state of India
Authors: Kumari Sushma , Jeseena K , Kiran Asha K. , Kujur Manisha , Saroj Usha , Hembrom Shailesh S. , Kujur Anit
Published: August 2023

Background:

Immunological Survey or serosurveys have yielded useful information regarding the spread of the COVID-19 pandemic in the general population, but the impact of the continuing pandemic on the medical students in India is yet to be fully recognised. In this study we assessed the students who had received at least two doses of the COVID-19 vaccine for their antibody response.

Methodology:

A Hospital based, age-stratified, cross-sectional Analytical study design was adopted for the survey, carried out in tribal state of India among medical students. Consecutive sampling method was used where serum samples were tested for antibodies against the SARS-CoV-2 nucleocapsid (N) protein.

Result:

The vaccinee group comprised of 187 students mostly aged between 18-23 years 68.4% were females, 56.6 % were vaccinated with covishield. The mean IgG (Immunoglobin G) titre was 7343.74 AU/Ml, less than 1000 AU/Ml was found in 8% of participants, while more than 8000 AU/Ml was found in 32.1%. Participants who got the covaxin vaccine had a higher median IgG titre (median 6491.8 AU/mL, interquartile range 8898 AU/mL).The antibody titre of male was 0.328 times lower than that of female.

Conclusion:

Despite the fact that covishield’s mean antibody titre was higher, covaxin’s protection lasted longer.
Azithromycin-Induced Generalized Nonbullous Fixed-Drug Eruption
Authors: Adhimoolam Mangaiarkkarasi , Akili Karuna
Published: August 2023

ABSTRACT

Azithromycin-induced severe cutaneous reactions occur rare. We report a case of azithromycin-induced generalized nonbullous form of fixed-drug eruption (FDE). A 19-year-old male consulted the dermatology department for multiple painful oval-shaped, sharply defined, and hyperpigmented patches on his chest, abdomen, and upper limbs after consuming oral azithromycin tablets for his sore throat. The generalized nonbullous form of FDE was diagnosed, and the offending drug was stopped immediately. He was treated with antihistamines and steroids, and recovered on follow-up. This FDE is reported due to the spareseness of documentation from South India and to improve the awareness among the prescribing physicians about this severe cutaneous reaction (FDE) for a commonly used drug. This case report gives insight to the clinicians and health-care workers on rare side effects caused by the commonly used antimicrobial agent, azithromycin.