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Objective: In this study on patients with Cushing disease, post-transsphenoidal surgery (TSS), we attempt to predict the probability of remaining in remission, at least for a year and relapse after that, using Bayes’ theorem and the equation of conditional probability. The number of parameters, as well as the weightage of each, is incorporated in this equation. Design and methods: The study design was a single-centre ambispective study. Ten clinical, biochemical, radiological and histopathological parameters capable of predicting Cushing disease remission were identified. The presence or absence of each parameter was entered as binary numbers. Bayes’ theorem was applied, and each patient’s probability of remission and relapse was calculated. Results: A total of 145 patients were included in the study. ROC plot showed a cut-off value of the probability of 0.68, with a sensitivity of 82% (range 73–89%) and a specificity of 94% (range 83–99%) to predict the probability of remission. Eighty-one patients who were in remission at 1 year were followed up for relapse and 23 patients developed relapse of the disease. The Bayes’ equation was able to predict relapse in only 3 out of 23 patients. Conclusions: Using various parameters, remission of Cushing disease can be predicted by applying Bayes’ theorem of conditional probability with a sensitivity and a specificity of 82% and 94%, respectively. This study provided an objective way of predicting remission after TSS and relapse in patients with Cushing disease giving a weightage advantage to every parameter.

ABSTRACTThe tribological simulation can be seen as a new study problem developed through modern information technology and computer simulation technology in combination with a variety of mathematical approaches in the field of tribology. There is a need to seek new conducts and means of in-depth study of the wear quantitative law, or else, it will become difficult for a fundamental breakthrough in the prevention and control of wear to be achieved. The tribological simulation research of the typical Pin-on-Disc sliding wear test system has been carried out by the adoption of computer technology and mathematical analysis methods to provide a new wear-analysis method for the simulation of the basic tribological contact problems. In the present research conduct, an attempt has been made to establish the wear simulation model considering multiple parameters based on experimental and theoretical facts. The parameters of the computational model have been determined through the experimental test data. The simulation model has been observed to reflect the basic relationship between input and output of the pin on the dry disc sliding wear test. Experiments performed have confirmed that, under the conditions analysed, the load effect on the wear rate is more critical than the other conditions. The wear rate varies linearly with the considered load conditions. The simulations have been conducted at the different angular velocities of 50, 60 and 70 rpm. These simulations have also revealed the effect of pin diameter on the depth of wear, and the deep insight into the increase of same with an increase in surface area.

Background: Etiological diagnosis of delayed puberty is difficult. Despite availability of various basal and stimulation tests differentiation between constitutional delay in puberty and hypogonadotropic hypogonadism is still challenging. Objective: To elucidate the role of GnRH agonist-stimulated inhibin B (GnRH-iB) for the differential diagnosis of delayed puberty. Study design: Participants were recruited into “exploratory cohort” (n= 39) and “validation cohort” (n= 16). “Exploratory cohort” included children with spontaneous puberty and patients with hypogonadotropic hypogonadism. “Validation cohort” constituted children who presented with delayed puberty. Intervention and outcome: GnRHa (Triptorelin) stimulation test along with measurement of inhibin B level at 24 h after GnRHa injection was performed in all the study participants. Cut-offs for GnRH-iB were derived from the “exploratory cohort”. These cut-offs were applied to the “validation cohort”. Basal LH, basal inhibin B(INH-B), GnRHa-stimulated LH at 4 h (GnRH-LH) and GnRH-iB were evaluated for the prediction of onset of puberty on prospective follow-up. Results: GnRH-iB at a cut-off value of 113.5 pg/ml in boys and 72.6 pg/ml in girls had 100% sensitivity and specificity for the documentation of puberty. In the “validation cohort” basal LH, basal INH-B, GnRH-LH, and GnRH-iB had a diagnostic accuracy of 68.75%, 81.25%, 68.75% and 93.75% respectively, for the prediction of onset of puberty. Basal LH, basal INH-B and GnRH-LH used alone or in combination were inferior to GnRH-iB used alone. Conclusion: GnRHa-stimulated inhibin B (GnRH-iB) is a convenient and easily employable test for the differentiation of constitutional delay in puberty from hypogonadotropic hypogonadism. CTRI registration no: CTRI/2019/10/021570.

Aluminum alloy-based metal matrix composites (AMMCs) are the most common material used in the field of automotive sectors because of their lightweight, economical, high strength-to-weight ratio, anti-corrosive properties, and large-scale availability. In the present study, Al7075-T6 as a base matrix with silicon carbide (1.5, 2.5, and 3.5 wt.%), graphite (2, 3, and 4 wt.%), and S-glass fiber (3, 4, and 5wt.%) as three distinct reinforcements was used for the fabrication of aluminum-based hybrid metal matrix composites through vacuum sealed stir casting technique. Taguchi design of experiments L9 orthogonal array and analysis of variance (ANOVA) have been adopted to investigate the influence of selected input process parameters such as silicon carbide (SiC), graphite (Gr), and S-glass fiber content on the output response parameters such as micro-hardness and impact strength. The experimental study revealed that micro-hardness and impact strength of synthesized composite have been enhanced by an amount of 31.40% and 33.33%, respectively, as compared with monolithic Al7075-T6 base alloy. In addition, the microstructure of fabricated hybrid AMMCs based on optical micrographs, SEM-EDS measurement along with XRD examination (for phase identification) showed a uniform dispersion of reinforcement particles over a base matrix. Furthermore, a fit regression model was prepared to develop the relationship between the variable process parameters corresponding to the response outcomes in terms of micro-hardness and impact strength.

Aim: To ascertain the predictors of remission and relapse in patients of Cushing’s disease (CD) undergoing pituitary transsphenoidal surgery (TSS). Methods: Patients with CD subjected to TSS over 35 years at a tertiary care center were included. Patients were grouped into remission and persistent disease at 1 year after surgery, and were further followed up for relapse. Demographic, clinical, biochemical, histological, radiological and post-operative follow-up parameters were analyzed. Results: Of the 152 patients of CD, 145 underwent TSS. Remission was achieved in 95 (65.5%) patients at 1 year. Patients in remission had shorter duration of symptoms prior to presentation (p= 0.009), more frequent presence of proximal myopathy (p= 0.038) and a tumor size of < 2.05 cm (p= 0.016) in comparison to those with persistent disease. Post-TSS, immediate post-operative 0800-h cortisol (< 159.85 nmol/L; p= 0.001), histological confirmation of tumor (p= 0.045), duration of glucocorticoid replacement (median 90 days; p= 0.001), non-visualization of tumor on MRI (p= 0.003), new-onset hypogonadism (p= 0.001), 3-month 0800-h cortisol (< 384.9 nmol/L; p= 0.001), resolution of diabetes (p= 0.001) and hypertension (p= 0.001), and recovery of hypothalamic–pituitary–adrenal axis (p= 0.018) favored remission. In logistic regression model, requirement of glucocorticoid replacement (p= 0.033), and resolution of hypertension post-TSS (p= 0.003) predicted remission. None of the parameters could predict relapse. Conclusion: The study could ascertain the predictors of remission in CD. Apart from the tumor characteristics, surgical aspects and low post-operative 0800-h cortisol, the results suggest that baseline clinical parameters, longer glucocorticoid replacement, and resolution of metabolic complications post-TSS predict remission in CD. Long-term follow-up is essential to look for relapse.

Purpose: To present the data on primary hyperparathyroidism (PHPT) in pregnancy from India obtained from a large database maintained over 15 years. Methods: We retrieved data of all women with gestational PHPT from the Indian PHPT registry between July 2005 and January 2020, and compared their clinical, biochemical, and other characteristics with age-matched non-pregnant women with PHPT. Results: Out of 386 women, eight had gestational PHPT (2.1%). The common presenting manifestations were acute pancreatitis (50%) and renal stone disease (50%); two were asymptomatic. Five women (62.5%) had a history of prior miscarriages. Seven patients (88%) had preeclampsia during the present gestation. Serum calcium and intact parathyroid hormone (iPTH) were not statistically different from the age-matched non-pregnant PHPT group. Six patients with mild-to-moderate hypercalcemia were medically managed with hydration with/without cinacalcet while one patient underwent percutaneous ethanol ablation of the parathyroid adenoma; none underwent surgery during pregnancy. Mean serum calcium maintained from treatment initiation till delivery was 10.5 ± 0.4 mg/dl. One patient had spontaneous preterm delivery at 36 weeks; the remaining patients had normal vaginal delivery at term. None had severe preeclampsia/eclampsia. Fetal outcomes included low birth weight in three newborns (37.5%); two of them had hypocalcemic seizures. Conclusion: The prevalence of gestational PHPT was 2.1% in this largest Indian PHPT cohort, which is higher than that reported from the West (< 1%). Gestational PHPT can lead to preeclampsia and miscarriage. Pregnant PHPT patients with mild-to-moderate hypercalcemia can be managed with hydration/cinacalcet; however, long-term safety data and large-scale randomized controlled trials are required.

Plant-parasitic nematodes cause severe damage to the various agricultural crops, leading to economic losses for farmers. Therefore, identification and development of novel and environmentally benign nematicides is critically important. In this study, a silver nanoparticle (AgNP) formulation was synthesized, characterized, and investigated as a potential nematicide against rice root-knot nematode, Meloidogyne gramnicola, on rice (Oryza sativa). A series of lab assays (water and sand screening) and glasshouse experiments (using soilless system, autoclaved soil, and naturally infested soil) were conducted to examine the nematicidal effects of AgNP. The results from lab assays revealed 0.1 µg/ml as the minimum concentration for 100% irreversible nematode mortality after 12 hr in the water screening test. However, results from the sand screening test indicated 100% nematicidal effect of AgNP at 2 µg/ml after 24 hr of incubation. In glasshouse assays in soilless system of rice cultivation, 1 µg/ml concentration of AgNP applied directly to the trays achieved significant suppression of root gall formation. The effective dosage to kill nematodes in field soil assays was determined to be 3 µg/ml, which is lower than the value of 150 µg/ml reported in the literature. No visible adverse effect of AgNP was observed on seed germination or plant growth in all the experiments. The results indicate that AgNP has effective nematicidal activity against M. graminicolain rice.

To study the clinical profile and the management of patients with disorders of sex development (DSD).Retrospective study from a tertiary care hospital of North India.One hundred ninety-four patients of DSD registered in the Endocrine clinic of Postgraduate Institute of Medical Education and Research, Chandigarh between 1995 and 2014 were included.One hundred and two patients (52.5%) had 46,XY DSD and seventy-four patients (38.1%) had 46,XX DSD. Sex chromosome DSD was identified in seven (3.6%) patients. Of 102 patients with 46,XY DSD, 32 (31.4%) had androgen insensitivity syndrome and 26 (25.5%) had androgen biosynthetic defect. Of the 74 patients with 46,XX DSD, 52 (70.27%) had congenital adrenal hyperplasia (CAH) and eight (10.8%) had ovotesticular DSD. Five patients with sex chromosome DSD had mixed gonadal dysgenesis. Excluding CAH, majority of the patients (90%) presented in the post-pubertal period. One-fourth of the patients with simple virilising CAH were reared as males because of strong male gender identity and behaviour and firm insistence by the parents. Corrective surgeries were performed in twenty patients (20%) of 46,XY DSD without hormonal evaluation prior to the presentation.Congenital adrenal hyperplasia is the most common DSD in the present series. Most common XY DSD is androgen insensitivity syndrome, while CAH is the most common XX DSD. Delayed diagnosis is a common feature, and corrective surgeries are performed without seeking a definite diagnosis.

AbstractEfficiency and performance are two critical characteristics of the internal combustion engine. The power generating component is required to be efficient so as to increase the overall performance of the vehicle and to make maximum use of the energy. In this study, we investigate the effect of load and speed on the wear of plasma sprayed coating with 60% Mo and Fe, 20% Mo, 10% NiCr, 10% Mo on cast iron substrate were investigated. Cylinder liner material was used as the counter body. We analyzed wear behavior, wear mechanism, the coefficient of friction, and temperature variation with different load and speed on a pin on disc tribometer in a dry run condition for a constant run of 2500 m. The specific wear rate was found to be increasing with the increase of the load from 50 to 70 N. Simultaneously with the increase in sliding velocity, the coefficient of friction decreased from 0.4 to 0.3. Further, the microstructure of the coating was studied with the help of SEM, EDX, and X-ray diffraction.

The immunological role of exosomes in allograft rejection remains unknown. We sought to determine whether exosomes are induced during lung allograft rejection and to define the antigenic compositions of HLA, lung‐associated self‐antigens (SAgs) and microRNAs (miRNAs). Exosomes were isolated from sera and bronchoalveolar lavage fluid from 30 lung transplant recipients (LTxRs) who were stable or who had acute rejection (AR) or bronchiolitis obliterans syndrome (BOS). Exosomes were defined by flow cytometry for CD63 and western blotting for annexin V SAgs, collagen V (Col‐V) and Kα1 tubulin were examined by electron microscopy; miRNAs were profiled by a miRNAarray. Donor HLAand SAgs were detected on exosomes from LTxRs with ARand BOSbut not from stable LTxRs. Exosomes expressing Col‐V were isolated from sera from LTxRs 3 mo before ARand 6 mo before BOSdiagnosis, suggesting that exosomes with SAgs may be a noninvasive rejection biomarker. Exosomes isolated from LTxRs with ARor BOSalso contained immunoregulatory miRNAs. We concluded that exosomes expressing donor HLA,SAgs and immunoregulatory miRNAs are present in the circulation and local site after human lung transplantation and play an important role in the immune pathogenesis of acute allograft rejection and BOS. Alloimmune responses induce exosomes with lung‐associated self‐antigens and regulatory microRNA, enabling the spread of immune responses that lead to lung allograft rejection.

Fourteen populations of Meloidogyne graminicolawere collected from different agroecological regions of India. Morphological and morphometrical comparisons were made for various nematode life stages. Three populations (Hisar, New Delhi, and Samastipur) were different from typical M. graminicolaon the basis of the length of eggs; J2 length, a-value, hyaline tail portion; male length, distance up to excretory pore, spicule and gubernaculum lengths; female length and width, stylet length, distance up to excretory pore, EPST (distance of excretory pore from anterior end / stylet length [females]) ratio, and vulval length. Morphological and morphometrical comparison with closely related species M. graminis, M. oryzae, M. salasi, M. triticoryzae, and M. liniclustered these populations into two groups: Anand, Bhubaneswar, Hyderabad, Jammu, Jorhat, Kalyani, Kanpur, Ludhiana, Mandya, Palampur, Vellayani grouped with M. graminicola, M. triticoryzaeand M. salasi; whereas, Hisar, New Delhi, Samastipur grouped with M. oryzaeand M. graminis. Molecular phylogenetic analysis using internal transcribed spacer (ITS) suggested that in spite of morphological differences, these populations belonged to M. graminicola.

This study reveals the successful low pressure cold spray deposition of near-uniform, defect free and dense copper coatings approximately 700-1900 µm thick, on Al alloy for electro-technical applications. The micro structural characteristics of the deposits have been studied using the combined techniques of X-ray diffraction (XRD), scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDS) and electron-probe micro analysis (EPMA). The coatings exhibited characteristic splat-like, layered morphologies due to the deposition of solid powder particles which appeared to have been plastically deformed on impact to the substrate. The developed coatings have a dense (in the range of 3090-5015 kg/m3)and nearly uniform microstructure, with almost uniform hardness values in the range of 120 -140 Hv, and electrical conductivity in the range of 23-30 MS/m. EDAX, XRD and EPMA results revealed that the main constituent in the coating is Cu.

Abrasive flow machining (AFM) is a fine finishing process in which an abrasives laden semi-solid paste is used for finishing of internal inaccessible recesses or surfaces. Recently, several modifications in the tooling with/without additional machining action have been tried for increasing the material removal in the AFM. The present study is about a novel development in the AFM process, towards the enhancement of material removal rate while polishing the internal cylindrical surfaces. The modified process is termed as helical abrasive flow machining process (HLX-AFM). Taguchi’s quality engineering approach has been applied to the developed HLX-AFM process, leading to the optimization of various process parameters and thus the development of a robust machining process with significantly enhanced material removal.

ABSTRACTBackground: Adolescent acromegaly is a rare disorder and these patients present with tall stature/gigantism, tumor mass effects and menstrual irregularities.Patients and Methods: 34 consecutive (26 males) patients having onset of disease prior to 21 years of age were included in this retrospective analysis. Their clinical features and treatment outcome were studied.Results: Mean age and lag time at presentation were 21.6 ± 3.9 years and 5.1 ± 3.5 years respectively. Common presenting manifestations included acral enlargement, tumor mass effects and menstrual irregularities. Mean height at presentation was 174.6 ± 13.7 cms (range: 150 – 210 cm) and one third had gigantism (height ≥ 97thpercentile, WHO growth charts). Hypertension and glucose intolerance were seen in 15% and 23.5% respectively. Mean nadir GH after glucose load was 58.2± 13.7 ng/ml and IGF -1 was 534.8± 132.8 ng/ml. Half of the patients had concomitant hyperprolactinemia. Almost all (97%) had macroadenoma and anterior pituitary hormone deficiencies were frequent (75%). Patients with gigantism were younger (19.6±4.9 vs 22.6± 2.9 years; p=0.001), had higher GH values (66.68±27.22 vs 53.98± 15.99 ng/ml; p=0.04) and hypogonadism was more common (90.9% vs 56.5%, p=0.03) than those with normal stature. 32 patients (94.1%) were treated primarily with surgery, 7(21.9%) received post operative radiotherapy. Mean duration of follow up was 33.1±10.1 months. Only 30% had nadir GH values of < 1ng/ml.Conclusion: One third of adolescent patients had acrogigantism. These patients were younger, had higher GH levels and concurrent hypogonadism was more common. Cure could be achieved only in about one third of the patients.

Centrifugal-force-assisted abrasive flow machining (CFAAFM) process has recently been tried as a hybrid machining process with the aim towards performance improvement of the abrasive flow machining process by applying centrifugal force on the abrasive-laden media with a rotating centrifugal-force-generating rod introduced in the workpiece passage. In the CFAAFM process, the surfaces are generated by erosion from random attack of abrasive particles. This article deals with the theoretical investigations into the mechanism of material removal in the CFAAFM process. Analytical model is developed to estimate the material removal during the process. A good correlation is found to exist between the theoretical results and the experimental data.

The Cascadia accretionary margin off Vancouver Island is one of the best studied margins world-wide for the determination of in situproperties of marine gas hydrates. Most quantitative information has come from cores and downhole logs of the Ocean Drilling Program (ODP) Leg 146 and from extensive seismic and other geophysical surveys. As part of the ODP site surveys, large-offset multichannel seismic lines outlined the regional distribution of hydrate, and seismic velocity analyses coupled with full waveform inversion provided estimates of the vertical distribution of hydrate and gas. High resolution single-channel seismic surveys indicate correlations between hydrategas concentrations and topographic highs, and between geothermal flux and topography; these correlations provide insight into fluid and methane flow through the sediments. A deep-towed multichannel seismic survey (DTAGS), together with other data from 20-600 Hz, provide constraints on gradients at the base of the hydrate and gas layer. Extensive heat flow measurements, from probes and from depths of the bottom simulating reflector (BSR), have been modelled numerically, including the regional effects of sediment thickening and advective fluid flow in the accretionary prism. Other geophysical surveys include several seafloor electrical sounding experiments and seafloor compliance measurements of hydrate. ODP drilling has provided valuable downhole log data, core physical property data, and detailed pore fluid chemistry and isotopes. Several semi-independent estimates of hydrate and gas concentrations have been obtained; all are dependent on reference sediment properties for which no hydrate and no gas is present. From a vertical seismic profile and other seismic data, the velocity increase in a hydrated region is consistent with hydrate concentrations of 20-30 of the pore space in a 100-m interval above the BSR. Similar values are determined from log resistivity data and from core pore fluid chlorinity.

Immunotherapy with a vaccine consisting of autoclaved Mycobacterium wwas given in addition to chemotherapy in 54 multibacillary, lepromin negative patients belonging to BB, BL and LL types of leprosy. Thirty-seven patients with similar types of diseases received chemotherapy and placebo injections. The ‘vaccine’ was repeated every 3 months. Bacterial clearance was more rapid in the vaccinated patients. Two lepromatous leprosy patients with initial bacterial index (BI) of 1.8 and 2.8 became bacteriologically negative in 1 year. One LL patient with BI of 6.0 had a BI fall to 0.16 after four doses of the vaccine. None of the LL patients belonging to placebo group during the same time period became bacteriologically negative. Rapid bacterial clearance was accompanied by distinct signs of clinical improvement. One hundred percent of BB, 85.7% of BL patients and 61.5% of LL patients converted to lepromin positivity after four doses of the vaccine. A significant number of vaccinated patients demonstrated an upgrading in skin lesions histopathologically.

Cryphodera kalesari n. sp., recorded on Colebrookea oppositifolia Sm. from the Kalesar forests (Haryana), India, is described. Females: swollen, saccate, with two to three lip annules, with vulval lips protruding. Second stage juveniles: length 384±19 µm, spear=26.5±1 µm, tail 46.5±6 µm, hyaline portion 21.5±2.5 µm, en face dorsal and ventral arcs of head skeleton bifurcate. Males: not found.

The normal state resistivity of highTcY-Ba-Cu-O compounds has been investigated and it is shown that the room temperature resistivity depends exponentially on the volume fraction of the non-superconducting phase. It is further shown that the dependence of normal state resistivity on temperature upto 300 K can be explained on the basis of a short-range co-operative electron-phonon coupling. This model also explains the observed positive Seebeck coefficient for the pure phase superconducting sample.

Studies of stable phases containing copper have been made when mixtures of Y2O3, BaCO3and CuO are reacted. It is found that out of four phases there is only one phase which is superconducting and the volume ratio of superconducting to non-superconducting phase decreases rapidly as we move away from the stoichiometry of the superconducting phase having composition YBa2Cu3O8−y.

This study was designed to characterize the direct effects of hyperglycemia on plasminogen activator inhibitor-1 (PAI-1) expression in cultured vascular smooth muscle cells. Glucose induced dose- and time-dependent increases of PAI-1 mRNA expression in rat aortic smooth muscle (RASM) cells in vitro. Using a series of luciferase reporter gene constructs containing PAI-1 5'-flanking sequence (from -6.4 kilobase to -42 base pairs (bp)) transfected into RASM, we found that glucose (25 mM) consistently induced a 4-fold increase in luciferase activity, with the response localized to sequence between -85 and -42 bp. Mutagenesis of two putative Sp1-binding sites located in the region of interest essentially obliterated the glucose-response. Electrophoretic mobility shift assays with radiolabeled oligonucleotides containing the two putative Sp1-binding sites from PAI-1 promoter and nuclear extracts from RASM cells revealed that glucose treatment markedly changed the mobility pattern of the major protein-DNA complexes. Supershift assay showed that transcription factor Sp1 was present in the complexes under control and hyperglycemic conditions. These results suggest that glucose regulates PAI-1 gene expression in RASM cells through an effect on two adjacent Sp1 sites located between -85 and -42 bp of the PAI-1 5'-flanking region and that the release of a transcriptional repressor from the Sp1 complexes may explain the activation of the PAI-1 gene under high glucose conditions in RASM cells.

Leprosy patients undergoing phase II trials in two hospitals of New Delhi, India, were HLA typed to see the association of HLA with differential responsiveness toMycobacterium w vaccine. The vaccine comprises an atypical, nonpathogenic mycobacterium,Mycobacterium w, which has cross-reactive antigens withM. leprae. Multibacillary patients who are lepromin negative are vaccinated at an interval of 3 months. Considerable improvement is evident in the patients in terms of a decline in bacterial indices and histopathological and immunological upgrading. But all the patients do not respond to the vaccine in the same manner; some are slow responders, while others are good responders. HLA-A28 and DQw3 (DQw8+9) were found to be associated with slow responsiveness, while DQw1 and DQw7 were found to be associated with a more rapid responsiveness to theM. w vaccine. However, these associations were not significant afterP correction for the number of antigens tested for each locus except for HLA-DQw3 (DQw8 and DQw9) and DQw7. DQw7, a new defined split of HLA-DQw3, seems to be associated with the responsiveness toM. w vaccine.