bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endothelial nitric oxide synthase gene polymorphisms in patients with slow coronary flow
Authors: Sezgin Nurzen , Tekin Abdullah , Atac Fatma Belgin , Verdi Hasibe , Sezgin Alpay Turan 
Published: September 2017

Background and aims
The aim of this study was to explore potential associations of the intron 4 variable number of tandem repeats (VNTR) and E298A polymorphisms of the endothelial nitric oxide synthase (eNOS) gene with slow coronary flow (SCF). The association between plasma nitrate and nitrite (NOx) concentrations and eNOS gene polymorphisms was also assessed.

Materials and methods
The intron 4 VNTR and E298A polymorphisms of the eNOS gene were evaluated in the isolated DNA blood samples obtained from the SCF patient group (n = 30) and healthy group consisted of age- and sex-matched controls (n = 61).

Results
Plasma NOx level was significantly lower in patients with SCF than in controls. In addition, patients with SCF have significantly lower nitric oxide levels than control subjects within each genotype variants. The allele and genotyped frequencies of the eNOS intron 4 VNTR and E298A polymorphisms were similar between patients with SCF and the controls. Plasma NOx concentrations with respect to the relevant genotypes were found insignificant.

Discussion and conclusion
Plasma NOx is lower in patients with SCF than in healthy subjects. Our findings may suggest the lack of association between intron 4 VNTR and E298A polymorphisms of the eNOS gene and SCF.
Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy
Authors: Thyagarajan Mohanapriya , Singh Balaji , Thangasamy Arulappan , Rajasekar Shobana 
Published: September 2017

Background: Gall stone disease is a common disease affecting human beings. Over the past two decades, laparoscopic cholecystectomy has become gold standard for the surgical treatment of gallbladder disease. The advantages of laparoscopic cholecystectomy over open surgery are a shorter hospital stay, less postoperative pain, faster recovery, better cosmoses. This study was planned to identify the circumstances and the risk factors influencing the conversion of laparoscopic cholecystectomy to open procedure.Methods: This is a Prospective study conducted over a period of 24 months. A total of 50/500 patients who were electively posted for laparoscopic cholecystectomy and got converted into open cholecyctectomy were included in the study. The Factors recorded and analysed were Age and Sex of the patient, presence of diabetes mellitus, previous episode of Acute Cholecystitis, Body Mass Index, presence of abdominal scar, total count, Ultrasonagram Abdomen findings of Gallbladder wall thickness and presence of pericholecystic fluid.Results: In our study, it has been observed that Patient Related Factors - Age >50yrs, Male gender, Presence of Diabetes Mellitus, Obesity, previous Abdominal surgeries and Disease Related Factors - previous episode of Acute Cholecystitis, presence of Acute Cholecystitis, Gallbladder wall thickness >4mm, presence of Pericholecystic fluid were found to be significant risk factors in conversion of laparoscopic to open cholecystectomy.Conclusions: These risk factors help to predict the difficulty of the procedure and this would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy.
Study of laparoscopic repair of hiatus hernia
Authors: D. Sagrule Dhiraj , M. Lanjewar Sunil , N. Gajbhiye Raj , Nadagawali Vishal 
Published: September 2017

Background: Traditionally, repair of giant PEH has been performed through an open laparotomy or thoracotomy. This population of patients is often elderly, with comorbidities, which has led to concern over surgical referral. With the advent of laparoscopy, giant PEHs are now being approached with minimally invasive techniques. Less invasive procedures may decrease the amount of postoperative pain and the perioperative complication rate and shorten recovery time. Recently, a few series have reported that laparoscopic repair of PEH is technically feasible, effective, and safe. Thus, once paraoesophageal hernia is identified current thinking is that it should be surgically treated regardless of symptoms. Methods: Prospective study of patients diagnosed with hiatus hernia on endoscopy and barium swallow was conducted from October 2010 to November 2013. All patients with consent were operated with standard laparoscopic Nissens fundoplication and some require crural repair and studied during the course.Results: 22 cases with haitus hernia type I 8 (36.41%), type II 7 (31.8%) and type III 7 (31.8%), 68.18% having heart burn, 54.55% regurgitation, dysphagia 36.36% and chest pain 31.82% were treated and observed preoperative, intraoperative and postoperative. Most cases 15 (68.18%) were between 61-70 years age group with 13 (59.09%) males and 9 (40.91%) females. 9.9% had asthma, 13.64% DM and 36.36% systemic HT out of 22 cases. Mean blood loss was 29.09 ml, mean operative time was 181.27±8.80 minutes, mean hospital stay was 3.68 days with 4.55% intraoperative complication, 4.55% postop complication rate having mean VAS on post op day 1 was 6.31 and on day 7 it was 0.52.
Comparative study of steristrips and subcuticular suture for wound closure after thyroid surgery
Authors: G. Vinay , K. S. Balasubrahmanya 
Published: September 2017

Background: Any skin closure technique aims at opposing the skin edges precisely without tension for sufficient time to allow healing to take place. The ease and speed with which the skin closure is completed, the level of patient discomfort, the complication rate, and the final cosmetic result are the factors which has to be considered in making a comparison of different types of wound closure. This study aims at comparing steristrips and subcuticular sutures for wound closure after thyroid surgery based on assessment of post-operative pain, neck mobility and cosmetic appearance.Methods: A comparative study was carried out among 90 subjects attending Department of Surgery, K. R. Hospital, Mysuru over a period of 10 months. Subjects of either sex undergoing thyroidectomy will be randomized to had their wounds closed by steristrips or subcuticular sutures using a simple randomization table. Patients who underwent previous neck irradiations, secondary neck surgeries, and patients with poor compliance were excluded from the study. Descriptive statistics, unpaired t-test and chi-square test were used to analyse the results.Results: The mean age group of the study subjects was 48.6 (range 24-76) years. The gender distribution showed a higher number of females (82) as compared to males (8). 70 patients were diagnosed with multinodular goitre, 16 patients were of thyroid neoplasms and 4 were of inflammatory thyroid conditions. 12 patients underwent subtotal thyroidectomy and 78 patients underwent total thyroidectomy. Wound closure by steristrips had less post-operative pain, acceptable neck mobility and excellent scar appearance as compared to subcuticular sutures.Conclusions: The choice of materials for wound closure will depend on the surgeon's preference. However, this study does show that steristrips sutures can be removed more quickly and is more acceptable method of wound closure as compared to subcuticular sutures after thyroid surgery.
A prospective randomized comparison of primary outcome between laparoscopic appendectomy and open appendectomy
Authors: T Shivakumar , Ranjan Ved Prakash , V. S. Yamuna , P. Karthik 
Published: September 2017

Background: Open appendectomy is one of the most common surgeries done in an emergency operation theatre even after three decades of introduction of laparoscopic surgeries. The previous studies done on laparoscopic appendectomy produced conflicting recommendations, and the adequacy of sample sizes is generally unknown. We compared primary outcomes after laparoscopic and open appendectomy in a sample of predetermined statistical power.Methods: A pre-study power analysis suggested that 200 randomized patients would yield 80% power to show a mean decrease of 1.3 days hospitalization. One hundred ninety-eight patients with a preoperative diagnosis of acute appendicitis were randomized prospectively to laparoscopic or open appendectomy. The primary outcomes measured were duration of operative time, postoperative pain and analgesia, length of hospital stay and cosmetic advantages.Results: It was found that mean operation time was 33±5.8 minute and 37± 7.5 minute in OA and LA respectively. Duration of post-operative hospital stay was 1.2 days shorter in Laparoscopic group. LA required 1.1 shots of less analgesic than OA. Oral feeding was resumed 21 hours earlier following LA compared to OA. Laparoscpic appendectomy was safely performed in paediatric patient without any adverse effect. We also found that, in female patient, concurrent ovarian cysts, tubal pregnancy and endometriosis can be diagnosed and managed laparoscopically in the same sitting.Conclusions: Present study found that laparoscopic appendectomy is an effective and safe procedure irrespective of age and sex of the patient. LA has added advantage of early return of bowel movement, less post-op hospital stays and less requirement of narcotic analgesic.
A clinico-pathological study of posterior triangle neck swelling: a case series
Authors: Tonape Trupti , P. Lad Aditya , Shetty Iresh , Raval Bhoomi , Kumar Balasubramanian Sree 
Published: September 2017

Background: The neck swelling is often surrounded by mystique in arriving at a diagnosis as well as in its management. There are many good approaches to a patient with a swelling in the neck.Methods: This study was done in Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune. In this study, we have taken 30 cases in study group. Only posterior triangle neck swellings were considered during the study. Clinico-pathological co-relation was done during the study.Results: In the present study group of 30 patients we found 10 patients to be having Lymphadenitis which includes both tuberculous and non-tuberculous, 8 patients to be having lipoma, 4 patients to be having neck secondaries, 2 patients of cystic hygroma and 6 nonspecific causes like cavernous haemangioma, madelung disease, Kikuchi Fujimoto disease. Further histological co-relation was done.Conclusions: Incidence of different types of neck swellings were found and rare diseases like Madelung’s disease and Kikuchi fujimoto’s disease.
Addition of Braun enteroenterostomy to standard reconstruction in pancreaticoduodenectomy: impact on early outcomes
Authors: Vutukuru Venkatarami Reddy , Gavini Sivaramakrishna , Chandrakasan Chandramaliteeswaran , Musunuru Brahmeshwara Rao , Settipalli Sarala 
Published: September 2017

Background: Morbidity following Pancreaticoduodenectomy still remains high. Few studies have shown decrease in morbidity with the addition of Braun Enteroenterostomy (BEE). Aim of the present study was to determine any possible benefit with addition of BE to the standard reconstruction after pancreaticoduodenectomy.Methods: In this prospective randomized controlled study, all patients who underwent Pancreaticoduodenectomy from June 2012 to July 2016 were included. They were randomized to undergo either standard reconstruction (Group A) or with addition of Braun Enteroenterostomy to standard reconstruction (Group B). Outcomes were compared between 2 groups and the results were analyzed. P value of <0.05 was considered significant.Results: 104 patients were included in the study. Group A included 56 patients who underwent standard reconstruction and Group B had 48 patients who had addition of BEE to standard reconstruction. The demographic profile, tumour characteristics, and biochemical profile were similar in 2 groups. Mean operating time and Intra operative blood loss were similar. The incidence of pancreatic fistula (POPF) did not differ significantly in 2 groups (14/56, 25% in group A versus 8/48, 16.6% in group B; p = 0.42). The incidence of Delayed Gastric Emptying (DGE) was not statistically different in 2 groups (20/56, 35.7% in group A versus 12/48, 25% in group B; p=0.77). Infection rates were similar in two groups. Mean hospital stay was similar in both groups (11.2 days versus 10.7 days; p=0.68).Conclusions: The outcomes of patients after pancreaticoduodenectomy were not altered by addition of Braun Enteroenterostomy to standard reconstruction.
Abdominal tuberculosis: a clinical study in a tertiary care hospital
Authors: Krishnaswamy Jawahar , Rahaman Khalilur , S. Reshma , N. Bharath 
Published: September 2017

Background: Abdominal tuberculosis is the sixth most common form of extrapulmonary site of infection after lymphatic, genitourinary, bone and joint, miliary and meningeal TB with a rising incidence in recent years. Tuberculosis can affect any part of the gastro-intestinal (GI) tract including anus, peritoneum and hepato-biliary system. The clinical manifestations of abdominal tuberculosis are non-specific and mimic various GI disorders and cause delay in diagnosis and management. The aim of this study is to study the incidence of abdominal tuberculosis, percentage of acute presentation, to study and analyse clinical presentation, various diagnostic modalities, role of surgery and to evaluate the spectrum of surgeries done for abdominal tuberculosisMethods: Study was done by analyzing 108 cases in our tertiary care hospital, Chennai, India, during the period of June 2015 to January 2016. All suspected and diagnosed cases of abdominal tuberculosis were included in the study. The relevant clinical information, laboratory results, microbiological and radiological investigations were recorded. Histopathological examination of all the resected or excised specimens was done to detect tuberculosis in all the cases.Results: Out of 108 cases with abdominal tuberculosis, the average age of presentation was between 21 and 40 years with a slight male predominance (male:female = 1.1:1). Abdominal pain (92%) was the most common presenting symptom followed by anorexia (70%), loss of weight (70%), and intestinal obstruction (13%). 29 cases underwent surgical management. All patients were put on anti-tubercular treatment and majority showed good response to therapy.Conclusions: Abdominal tuberculosis should be considered as a differential diagnosis in patients with vague GI symptoms. To diagnose abdominal tuberculosis, high degree of suspicion is needed, and its incidence being common in people with lower socioeconomic status. This study gives a basic outline of presentation, diagnosis and management of abdominal tuberculosis in developing country.
Comparison of mannheim peritonitis index and revised multiple organ failure score in predicting mortality and morbidity of patients with secondary peritonitis
Authors: Pattanaik S. K. , John A. , Kumar V. A. 
Published: September 2017

Background: Secondary peritonitis carries high mortality and morbidity. Many scoring systems have been designed to assess its severity. This study was undertaken to compare the Mannheim peritonitis index (MPI) and revised multiple organ failure score (Revised MOFS) in predicting the mortality and morbidity.Methods: A prospective observational study was undertaken in adults operated for gastrointestinal perforation. Clinical and biochemical parameters as required for MPI and Revised MOFS were recorded. Each of the scores were divided under four categories; MPI <14, 14-21, 22-29 and >29; Revised MOFS 0, 1, 2 and >2. Data was compared for predicting mortality and morbidity. P-value, ROC curve and 95% CI were used as statistical tools.Results: Two thirds of 120 patients studied presented after 48 hours. MPI score of <14, 14-21, 21-29 and >29 had mortality of 0%, 2.2%, 27.2% and 50% respectively. ROC curve showed highest sensitivity and specificity of 79% and 70% respectively at MPI of 25. Significant value for mortality was obtained with MPI >25 (p= 0.000012) and with Revised MOFS >1 (p< 0.001); for morbidity with MPI >21 (p= 0.010) and with Revised MOFS >1 (p< 0.001). 20% patients with Revised MOFS zero were also morbid.Conclusions: Both MPI and Revised MOFS systems are good in predicting the mortality, but MPI is easy scoring system and a better option for predicting morbidity. MPI score >25 for mortality and >21 for morbidity are significant.
Contribuições do Aprendizado Ativo ao Estudo das Relações Internacionais nas universidades brasileiras
Authors: Inoue Cristina Yumie Aoki , Valença Marcelo M. 
Published: September 2017

The article has two main goals. The first is to introduce the active learning conceptual framework tools and apply it to International Relations scholarship as a tool to enhance learning in undergraduate courses. The second is to propose that, despite representing a break with traditional pedagogical models, active learning offers ideal conditions for use in Brazilian higher education, as it would help to overcome limitations commonly found in our universities.
The X-ray diffraction beamline MCX at Elettra: a case study of non-destructive analysis on stained glass
Authors: Plaisier Jasper Rikkert , Nodari Luca , Gigli Lara , Rebollo San Miguel Elena Paz , Bertoncello Renzo , Lausi Andrea 
Published: September 2017

<p class="Abstract"><span lang="EN-US">The MCX beamline at the synchrotron Elettra is the general purpose diffraction beamline that is well suited for non-destructive and innovative X-ray diffraction (XRD) experiments in the field of cultural heritage. The experimental station houses a large number of instruments facilitating a range of different types of analysis. Recently, a comprehensive study of the alteration products in grisaille paints was performed at the beamline. This type of analysis is very important to understand the complex processes involved in the deterioration of this type of glass decoration. An exhaustive characterization of these products and so a full understanding of the mechanism of their formation may lead to the development of new protective materials for conservation and restoration. XRD experiments at the MCX beamline allowed us to recognize the alteration products on the grisailles surface and to propose a mechanism for the formation of alteration patina. Here we present the beamline, its instrumentation and its capabilities by showing an example of the study on grisaille paints. </span></p>
Streptococcus pneumoniae Osteomyelitis in a 25-Year-Old Man as the Initial Presentation of Multiple Myeloma
Authors: Webber Tracy , Lawlor Michael , Balach Tessa 
Published: September 2017

Case:We report the case of a 25-year-old man with femoralStreptococcus pneumoniaepyomyositis as well as hypercalcemia, mild anemia, and elevated inflammatory markers; he subsequently was diagnosed with immunoglobulin G (IgG) kappa multiple myeloma.Conclusion:Multiple myeloma most commonly affects patients who are >60 years of age, and causes clinical symptoms from anemia, lytic bone lesions, hypercalcemia, and renal failure. These findings and a monoclonal protein spike serve as initial diagnostic and treatment criteria. Multiple myeloma is associated with susceptibility to bacterial infections, especially encapsulated organisms; however, this is rarely the initial presentation. Additionally, it is unusual for myeloma to be diagnosed in a young person (<40 years of age).
Nonunion of a Nondisplaced Radial Neck Fracture
Authors: Coury John G. , Lum Zachary C. , Trzeciak Marc A. 
Published: September 2017

Case:
We describe the case of a 66-year-old man who sustained a nondisplaced radial neck fracture and subsequently developed a symptomatic nonunion. After a period of unsuccessful conservative treatment, a radial head resection was performed.

Conclusion:
Radial neck fractures, unlike their radial head counterparts, have a low rate of nonunion. Our patient’s only positive risk factor was age, but he developed a nonunion. At the 2-year follow-up after excision of the radial head, there was a lack of proximal migration of the radius during axial loading, demonstrating a positive outcome without the need for replacement of the radial head.
Arthroscopic Repair of Recurrent Posterior Shoulder Subluxation After Total Shoulder Arthroplasty
Authors: Grieshaber-Bouyer Ricardo , Gerber Christian 
Published: September 2017

Case:
A 53-year-old man presented with osteoarthritis (Walch biconcave [B2] glenoid retroversion, 22°; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. Following anatomic total joint replacement, he developed disabling recurrent posterior subluxation despite a stable prosthesis and a correctly centered glenoid head, as observed with postoperative radiography and computed tomography. In order to avoid bone loss and the complications associated with revision arthroplasty, we performed arthroscopic reefing of the posterior capsule as an experimental minimally invasive treatment. The reduction in capsular volume successfully stabilized the shoulder for approximately 9 years; thereafter, the recurrence of instability ultimately required the conversion to a reverse prosthesis.

Conclusion:
Arthroscopic capsular reefing proved to be an effective treatment for posterior shoulder subluxations after total shoulder arthroplasty, and can be considered to avoid revision arthroplasty in young patients with a stable and correctly centered prosthesis.