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Introduction : Most colonoscopies are completed in the left lateral (LL) position but in cases of suboptimal caecal preparation, changing the patient’s position to supine (S) and, if needed, to right lateral (RL) improves caecal intubation rate, mucosal visibility, and adenoma detection. Aim : To determine if position change during colonoscopy facilitates optimal visualisation of the caecum. Material and methods : A total of 359 patients were grouped into three categories based on the initial caecal intubation position. After caecal intubation, caecal visibility was scored on a four-point scale depending on the number of imaginary quadrants of the caecum completely visualized – Arya Caecal Prep Score. A score of 1 or 2 was unsatisfactory, while 3 or 4 was considered satisfactory. In patients with unsatisfactory score, position was changed from LL to S and then RL and visibility was scored again. Results : The initial caecal intubation in the LL position was achieved in 66.8% of patients, S in 28.5%, and RL in 4.8% of patients. 84.5% (300/355) of patients had an acceptable visualisation score at the initial caecal intubation position. Of the 55 patients with unsatisfactory caecum visualisation scores in the initial intubation position, 30 (8.5%) had satisfactory scores after the first position change (95% CI: 5.77–11.84). Twenty-five (7.04%) subjects required two position changes (95% CI: 4.61–10.22%). An additional 9.3% (11/118) of adenomas were detected in caecum and ascending colon following position change. Conclusions : Changing patient position improves caecal intubation rate, mucosal visibility, and adenoma detection.

Background Parkinson’s disease (PD) is predominantly recognized for its motor symptoms, but patients struggle from a morbid and heterogeneous collection of non-motor symptoms (NMS-PD) that can affect their quality of life even more. NMS-PD is a rather generalized term and the heterogeneity and non-specific nature of many symptoms poses a clinical challenge when a PD patient presents with non-motor complaints that may not be NMS-PD. Case presentation We report two patients with idiopathic PD who presented with acute episodes of cognitive changes. Structural brain images, cardiovascular and laboratory assessment were unremarkable. Both patients experienced a considerable delay before receiving an epilepsy-evaluation, at which point electroencephalogram abnormalities supported the diagnosis of focal non-motor seizures with alteration of awareness. Antiepileptic therapy was implemented and was effective in both cases. Conclusions Diagnosing non-motor seizures can be challenging. However, PD patients pose an even greater challenge given their eclectic non-motor clinical manifestations and other disease-related complications that could confound and mislead adequate clinical interpretation. Our two cases provide examples of non-motor seizures that may mimic non-motor symptoms of PD. Treating physicians should always consider other possible causes of non-motor symptoms that may coexist in PD patients. Epilepsy work-up should be contemplated in the differential of acute changes in cognition, behavior, or alertness.

Saliva is known to be protective for esophageal mucosa. Increased chewing strokes result in a quantitative and qualitative enhancement of saliva. Reduction in the amount of saliva produced results in an increased incidence of gastroesophageal reflux disease (GERD), which can be objectively measured by the DeMeester score. The impact of increased chewing strokes on the DeMeester score remains largely unknown, thus this study aimed to find out their impact on the value of the DeMeester score and its individual components.The effect of increased chewing strokes on the DeMeester score was investigated in 12 subjects (5 male and 7 female) who were diagnosed with GERD. All subjects underwent a 48-hour pH monitoring using the Bravo® pH capsule. All the patients chewed their food 20 times more on Day 2 as compared to Day 1. The data were analyzed for change in the DeMeester score and its individual components in 2 days.In patients with GERD (DeMeester score > 14.72 on Day 1), the number of long refluxes (>5 minutes) on Day 2 (mean = 3.2, SD = 2.3) was significantly lower than on Day 1 (mean = 6.4, SD = 2.7); Z = -2.032, p = 0.04. Though, the DeMeester score and its other individual parameters decreased on Day 2, they were not statistically significant.In patients with GERD, increased chewing strokes lead to a decrease in the number of long reflux episodes. Though there is a decrease in the DeMeester score and its other individual components, larger randomized controlled studies are required to reach statistical significance.

Background and Purpose: The first of the 2 NINDS Stroke Study trials did not show a significant increase in early neurological improvement (ENI), defined as NIHSS improvement by ≥ 4, with alteplase treatment. We hypothesized that ENI defined as a percentage change in NIHSS (percent change NIHSS) at 24 hours is superior to other definitions in predicting 3-month functional outcomes and using this definition there would be treatment benefit of alteplase over placebo at 24 hours. Methods: We analyzed the NINDS rt-PA Stroke Study (Parts 1 and 2) trial data. Percent change NIHSS was defined as [(admission NIHSS score–24-hour NIHSS score)x100/admission NIHSS score] and delta NIHSS as (admission NIHSS score–24-hour NIHSS score). We compared ENI using these definitions between alteplase vs. placebo patients. We also used receiver operating characteristic (ROC) curve to determine the predictive association of ENI with excellent 3-month functional outcomes [Barthel Index (BI) score 95 – 100 and modified Rankin scale (mRS) 0-1], good 3-month functional outcome (mRS 0-2) and 3-month infarct volume. Results: There was a significantly greater improvement in the 24-hour median percent change NIHSS among patients treated with alteplase compared to the placebo group (28% vs. 15%, p = 0.045) but not median delta NIHSS (3 vs. 2, p = 0.471). ROC curve comparison showed that percent change NIHSS (ROC percent ) was better than delta NIHSS (ROC delta ) and admission NIHSS (ROC admission ) with regards to excellent 3-month BI (ROC percent 0.83, ROC delta 0.76, ROS admission 0.75), excellent 3-month mRS (ROC percent 0.83, ROC delta 0.74, ROS admission 0.78), and good 3-month mRS (ROC percent 0.83, ROC delta 0.76, ROS admission 0.78). Percentage change had a stronger association with 90-day infarct volume than delta NIHSS score and both delta NIHSS and percent change in NIHSS were more pronounced with faster treatment times. Conclusion: In the NINDS rt-PA trial, alteplase was associated with a significant percent change improvement in NIHSS at 24 hours. Percent change in NIHSS may be a better surrogate marker of thrombolytic activity and 3-month outcomes.

Granular intrusions, such as dynamic impact or wheel locomotion, are complex multiphase phenomena where the grains exhibit solid-like and fluid-like characteristics together with an ejected gas-like phase. Despite decades of modeling efforts, a unified description of the physics in such intrusions is as yet unknown. Here we show that a continuum model based on the simple notions of frictional flow and tension-free separation describes complex granular intrusions near free surfaces. This model captures dynamics in a variety of experiments including wheel locomotion, plate intrusions, and running legged robots. The model reveals that three effects (a static contribution and two dynamic ones) primarily give rise to intrusion forces in such scenarios. Identification of these effects enables the development of a further reduced-order technique (Dynamic Resistive Force Theory) for rapid modeling of granular locomotion of arbitrarily shaped intruders. The continuum-motivated strategy we propose for identifying physical mechanisms and corresponding reduced-order relations has potential use for a variety of other materials., Comment: 41 pages including supplementary document, 10 figures, and 8 video

Background and Purpose: Early neurologic improvement (ENI) in patients treated with alteplase has been shown to correlate with functional outcome. However, the definition of ENI remains controversial and has varied across studies. We hypothesized that ENI defined as a percentage change in the National Institute of Health Stroke Scale (NIHSS) score (percent change NIHSS score) at 24-hours would better correlate with favorable outcomes at 3 months than ENI defined as the change in NIHSS score (delta NIHSS score) at 24 hours. Methods: Retrospective analysis of prospectively collected single-center quality improvement data was performed of all acute ischemic stroke (AIS) patients treated with alteplase. We examined delta NIHSS score and percent change NIHSS score in unadjusted and adjusted logistic regression models as predictors of a favorable outcome at 3 months (defined as mRS 0-1). Results: Among 586 patients who met the inclusion criteria, 194 (33.1%) had a favorable outcome at 3 months. In fully adjusted models, both delta NIHSS score (OR per point decrease 1.27; 95% confidence interval [CI] 1.19-1.36) and percent change NIHSS score (OR per 10 percent decrease 1.17; 95% CI 1.12-1.22) were associated with favorable functional outcome at 3 months. Receiver operating characteristic (ROC) curve comparison showed that the area under the ROC curve for percent change NIHSS score (.755) was greater than delta NIHSS score (.613) or admission NIHSS (.694). Conclusions: Percentage change in NIHSS score may be a better surrogate marker of ENI and functional outcome in AIS patients after receiving acute thrombolytic therapy. More studies are needed to confirm our findings.

Undulatory swimming in flowing media like water is well-studied, but little is known about loco-motion in environments that are permanently deformed by body–substrate interactions like snakes in sand, eels in mud, and nematode worms in rotting fruit. We study the desert-specialist snakeChion-actis occipitalistraversing granular matter and find body inertia is negligible despite rapid transit and speed dependent granular reaction forces. New surface resistive force theory (RFT) calculation reveals how this snakes wave shape minimizes memory effects and optimizes escape performance given physiological limitations (power). RFT explains the morphology and waveform dependent performance of a diversity of non-sand-specialist, but overpredicts the capability of snakes with high slip. Robophysical experiments recapitulate aspects of these failure-prone snakes and elucidate how reencountering previously remodeled material hinders performance. This study reveals how memory effects stymied the locomotion of a diversity of snakes in our previous studies [Marvi et al, Science, 2014] and suggests the existence of a predictive model for history-dependent granular physics.

Introduction: In Parkinson’s disease (PD), postural imbalance and gait disorders (PIGD) are predictors of decreased quality of life and survival. PIGD often become unresponsive to pharmacological treatments and are commonly associated with cognitive dysfunction. Physical therapy (PT) training and falls prevention education are considered effective treatments; however, improvements are generally short-lived and only partially maintained. In this population, cognitive dysfunction hampering the consolidation of new motor skills (motor learning) is one principal reason. Transcranial magnetic stimulation (TMS) is an emerging tool for neuro-rehabilitation and growing evidence supports its potential to improve motor learning. Prompted by a shared location between our TMS lab and the PT rehabilitation center, we aimed to test whether adjuvant repetitive TMS combined with PT for PIGD is a feasible neuro-rehabilitation paradigm in patients with PD. Methods: Double blind, randomized, sham-controlled, pilot trial to evaluate the feasibility of recruitment, randomization, retention, assessment procedures and implementation of adjuvant TMS paired back-toback with PT in PD patients with PIGD. Result: 41 paired sessions were completed with 100% adherence. All sessions were tolerated. There were no severe adverse events. One subject withdrew consent. Blinding of study was deemed adequate. The average time between PT and TMS administration was 13.9 (SD 7.3) minutes. After completion of the 5th enrolled subject, the study was early terminated due to relocation of the PD center away from the PT facility. Clinical outcome mean values improved at follow up; however, the small sample size prevented further analysis of efficacy. Conclusions: When the TMS device is located in the proximity of a rehabilitation setting, adjuvant TMS appears to be feasible, safe, and well tolerated in PD. The efficacy of this modality of neuro-rehabilitation and its generalizability remain to be determined.

Background Dystonia is a debilitating disease that causes abnormal, often repetitive, movements, postures or both. The pathophysiology is unknown but related to loss of neuronal inhibition, aberrant sensorimotor integration, and/or derangements of synaptic plasticity. Current treatments include pharmacotherapy, botulinum toxin injections and deep brain stimulation (DBS). The response to these treatments are often limited and carry the risk of side effects requiring alternative therapies such as non-invasive brain stimulation. Case presentation We present a case report of a 65-year -old man with refractory focal ‘task-specific’ dystonia. The treatment plan included 10-daily sessions of 1 Hz, 2600 pulses of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex. Conclusion There were no clinical benefits noticed. Currently, there are no rTMS protocol treatments for dystonia. Publication of negative results will help in refining the optimal stimulation parameters, thus maximizing the effectiveness and reproducibility of future therapeutic protocols. Electronic supplementary material The online version of this article (10.1186/s40734-019-0076-z) contains supplementary material, which is available to authorized users.

To assess whether multifocal, high-frequency repetitive transcranial magnetic stimulation (rTMS) of motor and prefrontal cortex benefits motor and mood symptoms in patients with Parkinson disease (PD).Patients with PD and depression were enrolled in this multicenter, double-blind, sham-controlled, parallel-group study of real or realistic (electric) sham rTMS. Patients were randomized to 1 of 4 groups: bilateral M1 ( + sham dorsolateral prefrontal cortex [DLPFC]), DLPFC ( + sham M1), M1 + DLPFC, or double sham. The TMS course consisted of 10 daily sessions of 2,000 stimuli for the left DLPFC and 1,000 stimuli for each M1 (50 × 4-second trains of 40 stimuli at 10 Hz). Patients were evaluated at baseline, at 1 week, and at 1, 3, and 6 months after treatment. Primary endpoints were changes in motor function assessed with the Unified Parkinson's Disease Rating Scale-III and in mood with the Hamilton Depression Rating Scale at 1 month.Of the 160 patients planned for recruitment, 85 were screened, 61 were randomized, and 50 completed all study visits. Real M1 rTMS resulted in greater improvement in motor function than sham at the primary endpoint (p0.05). There was no improvement in mood in the DLPFC group compared to the double-sham group, as well as no benefit to combining M1 and DLPFC stimulation for either motor or mood symptoms.In patients with PD with depression, M1 rTMS is an effective treatment of motor symptoms, while mood benefit after 2 weeks of DLPFC rTMS is not better than sham. Targeting both M1 and DLPFC in each rTMS session showed no evidence of synergistic effects.NCT01080794.This study provides Class I evidence that in patients with PD with depression, M1 rTMS leads to improvement in motor function while DLPFC rTMS does not lead to improvement in depression compared to sham rTMS.

Tubercular dactylitis is a rare entity and usually involves bones of hands and feet, involvement of feet is less common. Here we report case of 18 years old female with neglected tubercular involvement of her left thumb and left great toe of foot with hallux varus deformity. Her diagnosis was delayed as she did not seek any healthcare advice for a long time and also lack of suspicion of entity. This entity which should be kept in mind when making differential diagnosis that can be treated conservatively when diagnosed early.

We analyze the capabilities of various recently developed techniques, namely granular Resistive Force Theory (RFT) and continuum plasticity implemented with the Material Point Method (MPM), in capturing dynamics of wheel-dry granular media interactions. We compare results to more conventionally accepted methods of modeling wheel locomotion. While RFT is an empirical force model for arbitrarily-shaped bodies moving through granular media, MPM-based continuum modeling allows the simulation of full granular flow and stress fields. RFT allows for rapid evaluation of interaction forces on arbitrary shaped intruders based on a local surface stress formulation depending on depth, orientation, and movement of surface elements. We perform forced-slip experiments for three different wheel types and three different granular materials, and results are compared with RFT, continuum modeling, and a traditional terramechanics semi-empirical method. Results show that for the range of inputs considered, RFT can be reliably used to predict rigid wheel granular media interactions with accuracy exceeding that of traditional terramechanics methodology in several circumstances. Results also indicate that plasticity-based continuum modeling provides an accurate tool for wheel-soil interaction while providing more information to study the physical processes giving rise to resistive stresses in granular media.

Background Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that has been shown to improve common symptoms of neurological disorders like depressed mood, fatigue, motor deficits and cognitive dysfunction. tDCS requires daily treatment sessions in order to be effective. We developed a remotely supervised tDCS (RS-tDCS) protocol for participants with multiple sclerosis (MS) to increase accessibility of tDCS, reducing clinician, patient, and caregiver burden. The goal of this protocol is to facilitate home use for larger trials with extended treatment periods. In this study we determine the generalizability of RS-tDCS paired with cognitive training (CT) by testing its feasibility in participants with Parkinson’s disease (PD). Methods Following the methods in our MS protocol development, we enrolled sixteen participants (n = 12 male, n = 4 female; mean age 66 years) with PD to complete ten open-label sessions of RS-tDCS paired with CT (2.0 mA × 20 min) at home under the remote supervision of a trained study technician. Tolerability data were collected before, during, and after each individual session. Baseline and follow-up measures included symptom inventories (fatigue and sleep) and cognitive assessments. Results RS-tDCS was feasible and tolerable for patients with PD, with at-home access leading to high protocol compliance. Side effects were mostly limited to mild sensations of transient itching and burning under the electrode sites. Similar to prior finding sin MS, we found preliminary efficacy for improvement of fatigue and cognitive processing speed in PD. Conclusions RS-tDCS paired with CT is feasible for participants with PD to receive at home treatment. Signals of benefit for reduced fatigue and improved cognitive processing speed are consistent across the PD and MS samples. RS-tDCS can be generalized to provide tDCS to a range of patients with neurologic disorders for at-home rehabilitation. Trial registration ClinicalTrials.gov Identifier: NCT02746705. Registered April 21st 2016.

Renal involvement is an uncommon extra-glandular manifestation in Sjogren’s syndrome (SS). We present the case of a young male who presented with nephrotic range proteinuria and advanced irreversible renal disease, with positive anti-Ro antibody (Ab) and antineutrophil cytoplasmic antibody (ANCA) with myeloperoxidase (MPO) specificity. He was initially treated with steroids for suspected ANCA vasculitis but treatment was discontinued as there was no response and renal biopsy revealed interstitial lymphocytic infiltrates, advanced glomerular disease with immune complex mediated glomerulonephritis more suspicious for SS. SS usually affects exocrine glands and patients rarely have renal involvement in which cases it is commonly tubulo-interstitial nephritis. This report describes a rare case of anti-Ro Ab and MPO–ANCA positive patient with advanced irreversible renal disease due to immune-complex mediated glomerulonephritis felt to be due to SS and without any classic sicca symptoms.

Experiments, upper bound models, and finite element simulations are used to determine forming loads needed to microcoin surface ripples in thin metal foils. Coining is traditionally performed in a closed die, however enclosing all non-patterned surfaces is difficult to directly scale down to sub-millimeter foils. We find different forming regimes can exist at this small scale in an open pressing configuration. We explore the effects of the metal foil thickness and its work hardening behavior, two primary factors controlling the microcoining ripple forming load. For very thin foils, the load needed to coin a ripple pattern is lower than the load needed to compress the foil so that the open pressing configuration behavior is effectively closed with pattern formation without thickness change. For moderate thickness foils, the load needed to coin significantly drops as the entire foil compresses. For thick foils approaching bulk materials, the pattern will not completely form as the die macroscopically indents into the metal. Work hardening is found to raise the forming load for the thin, effectively closed die scenario, however it is a secondary effect at moderate thickness. This insight is used to microcoin patterns in extremely hard, thin metal foils.

Consider stenting of the proximal subclavian artery to correct symptomatic subclavian steal syndrome due to dialysis arteriovenous fistula.

Medical datasets including X-rays, histopathological images and blood test reports include high dimensional features. It is cumbrous task in diagnosing such high dimensional datasets. These datasets need to be reduced to lower dimensional dataset to perform computations easily on lower configuration computer systems. This paper focuses on developing a hybrid algorithm helps in medical diagnosis of the diseases with less number of computations and lower convergence time. Medical datasets analyzed includes breast cancer (WBDC), Parkinson’s disease (PD), arrhythmia, and spectf heart disease. The data has been preprocessed using hybrid model (Fuz-SOM-DE) of fuzzy c-means, self-organizing maps (SOM), and differential evolution (DE). It also includes analysis of the optimized feature selection algorithms on clustered dataset including SVM with backward search, filter wrapper method and correlation-based feature selection (CFS Subset) with best first search, greedy search, and other feature selection techniques. Usage of optimized metaheuristic techniques resulted in lower and better feature dataset. This hybrid algorithm has been analyzed on the datasets including categorical, integral, and binary outputs.

The novel concept of multiple spacecraft formation flying as a substitute for a single large vehicle will enhance future space mission performance. The benefits of a spacecraft formation include more cost effective synthetic aperture radar for observations, flexibility of the satellites altering their roles, reduction of cost owing to the reduction of mass launched into orbit etc. A significant challenge in the domain of control design is to contrive a formation maintenance controller that will enable the member spacecrafts to maintain a desired relative orbit with optimal propellant expenditure while maintaining the desired formation. This paper examines a low earth orbit formation control methodology, with the aim of evaluating formation from a propellant budget, thrust level and error dynamics standpoint. A State feedback controller has been applied on J 2 perturbed Clohessy-Wiltshire dynamics, and the system is checked for its stability and performance.

The role of general anaesthesia is to produce a reversible and safe loss of consciousness, to maintain the patient’s physiological parameters within a normal range while blunting the sympathetic response to noxious stimuli and to facilitate optimum surgical conditions for the operation.

Background Anal stricture is a disabling condition which is often unresponsive to conservative medical management. The complications of surgical procedures such as dilatations and anoplasty make it a formidable treatment challenge. Through this case, we report and explore a new medical treatment for ano-rectal strictures with an analogy to Plummer Vinson syndrome. A 69-year-old male presented with chronic constipation, rectal pain, and easy fatigability. The physical exam was negative for anal fissure and a digital rectal examination could not be completed because an index finger could not be advanced through the narrowed anus. Laboratory reports revealed microcytic hypochromic anemia with iron deficiency. A colonoscopy performed with a GIF XQ180 OLYMPUS scope, confirmed anal stricture with non-specific colitis. Conservative management with laxatives, high fiber diet, local anesthetics with a trial of mesalamine was initiated but the patient continued to have symptoms. He was referred to a hematologist for an evaluation of anemia and was started on intravenous (IV) iron infusion. Findings The patient’s symptoms of constipation, anal stricture and iron deficiency anemia resolved with iron infusion over 3 months. A repeat rectal exam was painless and confirmed resolution of anal stricture. Conclusion IV iron supplementation combined with conventional anal dilatation presents as a promising approach toward the treatment of anal strictures.

Freezing of gait (FOG) is ‘an episodic inability to generate effective stepping in the absence of any known cause other than parkinsonism or high level gait disorders’. FOG is one of the most disabling symptoms in Parkinson's disease, especially in its more advanced stages. Early recognition is important as FOG is related to higher fall risk and poorer prognosis. Although specific treatments are still elusive, there have been recent advances in the development of new therapeutic approaches. The aim of this review is to present the latest knowledge regarding the phenomenology, pathogenesis, diagnostic assessment and conventional treatment of FOG in Parkinson's disease. A review of the evidence supporting noninvasive brain stimulation will follow to highlight the potential of these strategies.

There are various methods of indexing the hidden web database like novel indexing, distributed indexing or indexing using map reduce framework. Our goal is to find an optimized indexing technique keeping in mind the various factors like searching, distribute database, updating of web, etc. Here, we propose an optimized method for indexing the hidden web database. This research uses Hierarchical Distributed Dynamic Indexing (HDDI) Framework for indexing the Data downloaded by the Siphone++ crawler. As HDDI technology develops, we are discovering novel approaches that address several issues of managing distributed digital information within the context of the HDDI paradigm.

The team at the University of Wisconsin-Milwaukee developed an information retrieval and machine learning framework. Our framework requires only the standardized training data and depends upon minimal external knowledge resources and minimal parsing. Within the framework, we built our text mining systems and participated for the first time in all three BioCreative II.5 Challenge tasks. The results show that our systems performed among the top five teams for raw F1 scores in all three tasks and came in third place for the homonym ortholog F1 scores for the INT task. The results demonstrated that our IR-based framework is efficient, robust, and potentially scalable.

Introduction Viscoelastic methods of estimating fibrinogen measure clot formation under platelet inhibition; these methods are gaining in popularity because of their convenience and speed. The aim of this study was to compare the results of the TEG(®) functional fibrinogen (FF) assay with the Clauss fibrinogen method in a group of patients presenting for cardiac surgery and to assess whether they gave equivalent results. Methods As part of a larger study evaluation a transfusion algorithm for use in cardiac surgery, 320 paired samples of TEG(®) FF and Clauss fibrinogen were compared. These were taken from 160 patients undergoing cardiac surgery at two time points - prior to heparinisation and 10 min after the administration of protamine. The results of the two fibrinogen measurements were also analysed in relation to the platelet count at the time. Results There was no significant correlation between the TEG(®) FLEV and Clauss fibrinogen at baseline (R(2) = 0.106) or 10 min postprotamine (R(2) = 0.025) The TEG(®) FF maximal amplitude and the Clauss were also found to have no significant correlation (at baseline R(2) = 0.061), at 10 min postprotamine (R(2) = 0.260). Bland-Altman analysis showed no significant agreement between the two methods. Conclusion The TEG(®) FF does not produce results equivalent to those of the Clauss fibrinogen regardless of platelet count.

Physicians are increasingly using the Internet for finding medical information related to patient care. Wikipedia is a valuable online medical resource to be integrated into existing clinical question answering (QA) systems. On the other hand, Wikipedia contains a full spectrum of world's knowledge and therefore comprises a large partition of non-health-related content, which makes disambiguation more challenging and consequently leads to large overhead for existing systems to effectively filter irrelevant information. To overcome this, we have developed both unsupervised and supervised approaches to identify health-related articles as well as clinically relevant articles. Furthermore, we explored novel features by extracting health related hierarchy from the Wikipedia category network, from which a variety of features were derived and evaluated. Our experiments show promising results and also demonstrate that employing the category hierarchy can effectively improve the system performance.

Introduction: Management of benign osteolytic lesions of bone involve intralesional excision and filling of the bone defect. Allograft used as a filler in these lesions confer advantages of being available in sufficient quantity without the risk of donor site morbidity. However use of allografts may carry a potential risk of infection and has debatable osteogenic potential. This study used Allogenic Bone Graft using antibiotic impregnated allografts and adjuvants like bone marrowso as to address these shortcomings. Materials and Methods: Eight cases of benign osteolytic lesions were treated by intralesional curettage and bone grafting using allogenic bone graft. Appropiate surgical procedure for fixation was done wherever necessary. Five cases had Allogenic Bone Graft impregnated with vancomycin solution. Three cases had autogenic bone graft while 1 case used bone marrow as adjuvant. Outcome was assessed in terms of fracture healing, infection and osteointegration. Results: In all the cases adequate osteointegration and complete healing of the lesion was observed in all the cases with time period of healing closely matching that of complete osteointegration. There was no statistically significant difference in the duration of osteointegration and bone healing between vancomycin impregnated group vis a vis allograft used alone. Only one case developed infection who responded to Intravenous antibiotics. No failure was observed in this study was probably due to use of adjuvants in half of the cases. Discussion and Conclusion: Use of allogenic bone graft alongwith adjuvants (bone marrow and autologous bone graft) appears to be effective in treatment of benign lytic lesions. Healing rates may be attributed to use of osteogenic potentiators. Vancomycin impregnation of allograft appears to be a beneficial step in controlling the graft related infection and does not affect graft osteointegration and bone healing.