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Device embolization is an uncommon complication in the course of percutaneous coronary intervention (PCI). Newer balloon-mounted stents and advanced techniques have significantly reduced the incidence of stent dislodgement and embolization. However, it has not completely eliminated the risk. Here, we are reporting a case series of stent dislodgements while performing coronary angioplasty through radial artery access, which were managed by various approaches.

Familial hypercholesterolemia is a rare, monogenic, co-dominant, life-threatening disorder resulting from loss of function mutations in the genes responsible for synthesis of low-density lipoprotein receptors or apo-B genes or gain of function mutations in PCSK9 genes in the liver which affects 0.2% of the population. It is characterized by severe lifelong elevation of LDL cholesterol and by development of xanthelasma, xanthomas, premature coronary artery disease and peripheral artery occlusive disease. Most patients develop PCAD and aortic stenosis before the age of 20 years and die before 30 years of age. The diagnosis of FH is usually based on clinical presentation and commonly used criteria are the Dutch lipid clinic network criteria, Simon Broome criteria or the WHO criteria. We encountered four cases of familial hypercholesterolemia over last 10 years. All the four patients presented with effort angina and all were found to have obstructive coronary artery disease oncoronary angiogram and two of them had severe supravalvular aortic stenosis. All four patients were on dietary modifications, high intensity statin and cholesterol absorption inhibitor. Two patients underwent coronary artery bypass grafting with aortoplasty, one patient underwent coronary artery bypass grafting and one patient underwent percutaneous transluminal coronary angioplasty. Familial hypercholesterolemia leads to development of life-threatening manifestations early in the second and third decades of life. Early diagnosis, aggressive treatment and control of risk factors and cascade screening are important in management and will help to reduce the morbidity and mortality associated with this disease.

Pharmacokinetics of meropenem differ widely in the critically ill population. It is imperative to maintain meropenem concentrations above the inhibitory concentrations for most of the interdose interval. A population pharmacokinetic/pharmacodynamic model was developed to determine the probability of target attainment for 3-hour and 30-minute infusion regimens in this population.This study was performed in an intensive care setting among adult patients who were initiated on meropenem at a dose of 1000 mg. Multiple blood specimens were collected at predetermined time points during the interdose period, and meropenem concentrations were measured using high performance liquid chromatography. Using Pmetrics, a pharmacokinetic/pharmacodynamic model was developed and validated. Monte Carlo simulation was performed, and probability of target attainment (100% Tminimum inhibitory concentration (MIC), with a probability0.9) for doubling MICs was determined for different regimens of meropenem.A 2-compartment multiplicative gamma error model best described the population parameters from 34 patients. The pharmacokinetic parameters used in the final model were Ke (elimination rate constant from the central compartment), Vc (volume of distribution of central compartment), KCP and KPC (intercompartmental rate constants), and IC2 (the fitted amount of meropenem in the peripheral compartment). Inclusion of creatinine clearance (CLcreat) and body weight as covariates improved the model prediction (Ke = Ke0 × (Equation is included in full-text article.), Vc = Vc0 × Weight). The Ke and Vc [geometric mean (range)] of the individuals were 0.54 (0.01-2.61)/h and 9.36 (4.35-21.62) L, respectively. The probability of attaining the target, TMIC of 100%, was higher for 3-hour infusion regimens compared with 30-minute infusion regimens for all ranges of CLcreat.This study emphasizes that extended regimens of meropenem are preferable for treating infections caused by bacteria with higher MICs. The nonparametric analysis using body weight and CLcreat as covariate adequately predicted the pharmacokinetics of meropenem in critically ill patients with a wide range of renal function.

The systematic chemical analysis of leaves of Wrightia tinctoria were found to contain two flavonoid glycosides Kaempferol 3-O-rhamnoside and Quercetin 3-O-sophoroside and two flavonoid aglycone Kaempferol and Quercetin. The detailed UV 1H 13C NMR and Mass spectral data confirm the characterization of the above compounds. All these compounds are reported first time from the leaves of Wrightia tinctoria.

In this paper, we analyze 2CNF formulas from the perspectives of Read-Once resolution (ROR) refutation schemes. We focus on two types of ROR refutations, viz., variable-once refutation and clause-once refutation. In the former, each variable may be used at most once in the derivation of a refutation, while in the latter, each clause may be used at most once. We show that the problem of checking whether a given 2CNF formula has an ROR refutation under both schemes is NP-complete. This is surprising in light of the fact that there exist polynomial refutation schemes (tree-resolution and DAG-resolution) for 2CNF formulas. On the positive side, we show that 2CNF formulas have copy-complexity 2, which means that any unsatisfiable 2CNF formula has a refutation in which any clause needs to be used at most twice., Comment: 14 pages, 3 figures

The modern integrated circuit is one of the most complex products that has been engineered to-date. It continues to grow in complexity as the years progress. As a result, very large-scale integrated (VLSI) circuit design now involves massive design teams employing state-of-the art computer-aided design (CAD) tools. One of the oldest, yet most important CAD problems for VLSI circuits is physical design automation, where one needs to compute the best physical layout of millions to billions of circuit components on a tiny silicon surface \cite{Lim08}. The process of mapping an electronic design to a chip involves a number of physical design stages, one of which is clustering. In this paper, we focus on problems in clustering which are critical for more sustainable chips. The clustering problem in combinatorial circuits alone is a source of multiple models. In particular, we consider the problem of clustering combinatorial circuits for delay minimization, when logic replication is not allowed ({\sc CN}). The problem of delay minimization when logic replication is allowed ({\sc CA}) has been well studied, and is known to be solvable in polynomial-time \cite{Wong1}. However, unbounded logic replication can be quite expensive. Thus, {\sc CN} is an important problem. We show that selected variants of {\sc CN} are {\bf NP-hard}. We also obtain approximability and inapproximability results for these problems. A preliminary version of this paper appeared in \cite{Don15}., Comment: 20 pages, 10 figures

Objectives: The aim of the present study was to compare a newly developed biodegradable polylactide/polyglycolide/N-methyl-2-pyrrolidone (PLGA/NMP) membrane with a standard resorbable collagen membrane (RCM) in combination with and without the use of a bone substitute material (deproteinized bovine bone mineral [DBBM]) looking at the proposed tenting effect and bone regeneration. Materials and methods: In five adult German sheepdogs, the mandibular premolars P2, P3, P4, and the molar M1 were bilaterally extracted creating two bony defects on each site. A total of 20 dental implants were inserted and allocated to four different treatment modalities within each dog: PLGA/NMP membrane only (Test 1), PLGA/NMP membrane with DBBM (Test 2), RCM only (negative control), and RCM with DBBM (positive control). A histomorphometric analysis was performed 12 weeks after implantation. For statistical analysis, a Friedman test and subsequently a Wilcoxon signed ranks test were applied. Results: In four out of five PLGA/NMP membrane-treated defects, the membranes had broken into pieces without the support of DBBM. This led to a worse outcome than in the RCM group. In combination with DBBM, both membranes revealed similar amounts of area of bone regeneration and bone-to-implant contact without significant differences. On the level of the third implant thread, the PLGA/NMP membrane induced more horizontal bone formation beyond the graft than the RCM. Conclusion: The newly developed PLGA/NMP membrane performs equally well as the RCM when applied in combination with DBBM. Without bone substitute material, the PLGA/NMP membrane performed worse than the RCM in challenging defects, and therefore, a combination with a bone substitute material is recommended.

To compare the time course of clinical recurrences and reoperations following primary resections for fistulization versus fibrostenotic obstruction in ileal Crohn's disease, we performed a retrospective cohort study of 71 patients undergoing their first resection at The Mount Sinai Hospital between 1961 and 1984. Among these 71 patients, 35 were classified as fistulizing and 36 as fibrostenotic. Follow-up was 93% complete through 1990, with a median follow-up of 73 months to reoperation and 105 months to last contact. The fistulizing and fibrostenotic patients experienced virtually identical numbers of clinical recurrences : 25 from the former group and 24 from the latter. The recurrences appeared very slightly earlier among the fistulizing than among the fibrostenotic group, but the difference did not approach statistical significance. Only 18 patients came to reoperation during follow-up: 12 from the fistulizing and 6 from the fibrostenotic group. The earliest reoperation in the fistulizing group occurred at 14 months and in the fibrostenotic group at 44 months. There was a trend for earlier reoperation in the fistulizing group, but the difference was not statistically significant. Different clinical patterns of Crohn's disease have yet to be correlated with distinctive subclinical biologic markers.