Search

 More than 3 million tons of e-waste were generated in 2007 in the United States, with 13.6 percent collected for recycling and 86.4 percent going to landfills and incinerators.  The environmental impacts of LCDs disposal are significant and increasing Millions of tonnes of e- waste in the United States are being discarded into landfills, about 1.36 – 1.72 million metric tonnes, of which 0.34 million went to recycling .  Few studies on recycling of cell phone LCD have been accomplished. Since everyday around 300,000 mobile phones are sent to trash in United States alone, the recycling of LCD of cell phones is still a challenge for recyclers. Introduction Environmental Impact Assessment Methodology Need of Recycling of LCD of Cell Phone Sensitivity Analysis  By using the sustainable minds software, we ran tests that involved changing the steel in the phone which was the highest used material in phones at 33.5%.  In the Environmental Feasibility section of the results it was found that manufacturing, not the End-Of-Life of the product was the largest contributor of toxins, when preforming an entire life cycle analysis.  In the Environmental Feasibility section of the results it was found that manufacturing, not the End-Of-Life of the product was the largest contributor of toxins, when preforming an entire life cycle analysis.  The manufacturing side represented no less than 40% of the pollution in each category.  When focusing on LCD’s in cellphones it was found that the recovery value of the phones at $74 is drastically outweighed by the dismantling costs of around $128/hour. Conclusion  Future researchers and companies can make tremendous improvements to improve this area through implementation of a more sustainable systems and more efficient products. In doing so, we hope to create more sustainable LCD products and reduce the impact it has on the environment. Future Work Economic Feasibility  The LCD screens were composed of different materials, including connectors, adhesives, diffusive sheets, reflective sheets, polarizing film, plastic frame, and LCD panel.  For the impact assessment, sustainable mind software was used. The categories are climate change, ecosystem quality, human health and resources.  The manufacturing phase dominates in all the categories for all LCD cellphones. The LCD of cellphones consume less power, so the effect of use phase is very low in most of the categories except acidification potential, climate change and abiotic depletion categories. It contributes negligibly to all eco-toxicity categories. Environmental Feasibility  The cell phone market is increasing in the past 15 years, as figure shows. Worldwide, cell phone subscribers are growth at average 13.5% per year from 2,205 million to 7,085 million in 2005 to 2015.  The statistic in figure shows a forecast of number of mobile users worldwide from 2015 to 2020.  Of the collected phones, 65% can be reuse with only minor refurbishment, while 35% are damaged beyond repair and are thus recycled for raw materials.  There are many health concerns that come from not properly disposing of LCD’s rather than looking to recycle.  These toxins have posed a potential problem for implementing a fully sustainable process.  There is not much data about the average compositions of cell phone LCD screens, it is assumed that technology and material composition is in similar ratio to those of larger screens.  We will match with average material content in LCD and find the approximate values of all compounds in LCD of cellphone.  The average composition of the most important parts of LCD screens by weight will be used to model cell phone LCD screens in LCA software sustainable minds.  The two main processes for LCD recycling: 1. The removal of the liquid crystals 2. Recovery of glass and polarizer  Global cell phone subscriptions per 100 inhabitants went from 33.9 in 2005 to 96.8 in 2015. Monitor TV Cell Phones Material Revenues ($/t) 194 117 74 Dismantling Cost ($/t) -948 -477 -128 Total ($/t) -755 -359 -54 Total ($/unit) -4.30 -5.43 -1.92  For monitors, TV-sets and cellphones, costs of dismantling were considerably higher than material revenues. Labor costs were a main cost factor in the dismantling process. Average Weight (lb) Market Value ($/lb) Recovery Value ($) Steel 1.15 0.79 0.91 Mixed Plastics 1.48 0.19 0.28 Wire and Cable 0.02 0.93 0.02 Screen Driver Circuit 0.08 6.56 0.53 Other Circuit Boards 0.3 4.28 1.28 Backlight Lamps 2-4 pieces -$0.40/piece -1.20 Recovery Value Total $1.82  For precise yields, a market research was assumed and costs and revenues of dismantling and recycling were calculated. Data of cellphone LCD is extracted from the data of LCD of Monitor. Energy Source Europe Electricity Mix US Electricity Mix Coal + Ignite 43.24 % 67.9 % Oil 1.42 % 1.0 % Natural Gas 14.94 % 11.6 % Nuclear Power 23.76 % 2.3 % Wind Power 10.37 % 2.3 % Biomass Power 1.74 % 0.9 % Hydroelectricity 1.57 % 1.0 %  In this case, US electricity mix was replaced with the Europe electricity mix to measure robustness of model.  The Europe and US electricity mixes are giving similar values for manufacturing and EoL phases where the electricity consumption is low.

To analyse the clinic-radiological factors associated with neurological deficit following lumbar disc herniation. A prospective, cross-sectional study was performed in 140 cases of micro-discectomy following lumbar disc herniation. Group 1 included 70 consecutive patients with motor deficit and group 2 (controls) included 70 patients with intact neurology. Motor deficit was defined as the occurrence of motor power ≤3/5 in L2–S1 myotomes. Multiple clinical and radiological parameters were studied between the two groups. Patients with diabetes (p 0.004), acute onset of symptoms (p 0.036), L3–4 discs (p 0.001), sequestrated discs (p 0.004), superiorly migrated discs (p 0.012) and central discs (p 0.004), greater antero-posterior disc dimension (p 0.023), primary canal stenosis (p 0.0001); and greater canal compromise (p 0.002) had a significant correlation with the development of neurological deficit. The presence of four or more of these risk factors showed a higher chance of the presence of motor deficit (sensitivity of 74%, specificity of 77%). Age, sex, previous precipitating events, severity of pain, smoking, and number of herniations levels did not affect the occurrence of deficit (p > 0.05 for all). Patients with or without bladder symptoms were similar with respect to all clinico-radiological parameters. However, the time delay since the occurrence of deficit was significantly shorter in patients with bladder involvement (p 0.001). Patients with diabetes, acute presentation, central, sequestrated and superiorly migrated discs, high lumbar disc prolapse, and greater spinal canal compromise are predisposed to the presence of motor deficit.

Proteomic and 16S rDNA analysis of disc tissues obtained in vivo. To address the controversy of infection as an aetiology for disc disorders through protein profiling. There is raging controversy over the presence of bacteria in human lumbar discs in vivo, and if they represent contamination or infection. Proteomics can provide valuable insight by identifying proteins signifying bacterial presence and, also host defence response proteins (HDRPs), which will confirm infection. 22 discs (15-disc herniations (DH), 5-degenerate (DD), 2-normal in MRI (NM) were harvested intraoperatively and immediately snap frozen. Samples were pooled into three groups and proteins extracted were analysed with liquid chromatography-tandem mass spectrometry (LC–MS/MS). Post identification, data analysis was performed using Uniprotdb, Pantherdb, Proteome discoverer and STRING network. Authentication for bacterial presence was performed by PCR amplification of 16S rDNA. LC–MS/MS analysis using Orbitrap showed 1103 proteins in DH group, compared to 394 in NM and 564 in DD. 73 bacterial specific proteins were identified (56 specific for Propionibacterium acnes; 17 for Staphylococcus epidermidis). In addition, 67 infection-specific HDRPs, unique or upregulated, such as Defensin, Lysozyme, Dermcidin, Cathepsin-G, Prolactin-Induced Protein, and Phospholipase-A2, were identified confirming presence of infection. Species-specific primers for P. acnes exhibited amplicons at 946 bp (16S rDNA) and 515 bp (Lipase) confirming presence of P. acnes in both NM discs, 11 of 15 DH discs, and all five DD discs. Bioinformatic search for protein–protein interactions (STRING) documented 169 proteins with close interactions (protein clustering co-efficient 0.7) between host response and degenerative proteins implying that infection may initiate degradation through Ubiquitin C. Our study demonstrates bacterial specific proteins and host defence proteins to infection which strengthen the hypothesis of infection as a possible initiator of disc disease. These results can lead to a paradigm shift in our understanding and management of disc disorders.

STUDY DESIGN Prospective observational cohort study. OBJECTIVE The aim of this study was to analyze the efficacy of diffusion tensor imaging (DTI) anisotropy indices in predicting the postoperative recovery in cervical spondylotic myelopathy (CSM) patients and to describe postoperative changes in the DTI indices based on neurological recovery after surgery. SUMMARY OF BACKGROUND DATA Surgical results of CSM are unpredictable and cannot be estimated based on preoperative MRI. DTI indices were found to have good sensitivity to detect changes in CSM, but their efficacy in predicting postoperative recovery and postoperative changes in DTI indices has not been studied before. METHODS Thirty-five patients who underwent surgical decompression for cervical spondylotic myelopathy underwent DTI evaluation preoperatively and postoperatively at 12 months. DTI indices-fractional anisotropy, apparent diffusion coefficient (ADC), relative anisotropy, volume ratio, and eigen vectors (E1, E2, and E3)-were obtained and clinical evaluations were made preoperatively and 12 months postoperatively. RESULTS Twenty-six patients were available for final follow-up at 12 months. Twenty patients showed improvement by at least 1 Nurick grade, five maintained the preoperative Nurick grade status and one patient was noted to have deterioration by 1 grade. The preoperative DTI values could not predict neurological recovery patterns postoperatively. Although conventional MRI showed adequate decompression in all patients irrespective of the clinical outcome, DTI indices showed variable results. There were significant improvements in postoperative DTI indices for ADC (P = 0.002), E1 (P

Fasting and feasting are integral part of many religions and cultures. As the amount of food and fluid intake are markedly altered during these phases, patients with diabetes are prone to higher risk of complications. Even though several guidelines for fasting and feasting are available; Indian specific recommendations are the need of the hour, because of the distinct dietary habits and the diet content (high carbohydrate) of Indians. To fill this void, the current guidelines have been developed by experts from India who extensively reviewed the literature, shared their practical knowledge and ultimately arrived at a consensus.

Current European hypertension guidelines recommend to initiate the treatment of patients with moderate to severe hypertension with a Single Pill Combination (SPC) containing two drugs, as SPC use leads to more effective and faster blood pressure control. The guidelines also recommend tighter blood pressure control in hypertensive patients with cardiovascular risk factors such as diabetes mellitus.To evaluate efficacy on blood pressure reduction and acceptability of the single pill combination of Perindopril/Indapamide in patients with moderate to severe hypertension.In this multicentre, prospective, observational study, patients with moderate to severe hypertension were prescribed Perindopril 4mg/ Indapamide 1.25 mg for 90 days. The primary outcomes were blood pressure decrease and achievement of BP control. Patients were up-titrated to Perindopril 8 mg/Indapamide 2.5 mg SPC, if target BP control (≤140/90 mm Hg) could not be achieved by day 30.In this study, 173 hypertensive patients, with a mean age of 51 years were enrolled at 3 centres from different geographic areas within India. Mean SBP/DBP decreased significantly from baseline (155.70 (±10.39) / 95.72 (±6.99) mmHg) over 90 days (30.31 (±14.15) / 17.14 (±9.33) mmHg; p0.0000). Few side effects were reported during the 90-day period.: Perindopril/Indapamide given as a SPC was found to be an effective and well-tolerated antihypertensive combination resulting in rapid blood pressure control in patients with moderate to severe hypertension.

Variational autoencoders (VAEs) learn representations of data by jointly training a probabilistic encoder and decoder network. Typically these models encode all features of the data into a single variable. Here we are interested in learning disentangled representations that encode distinct aspects of the data into separate variables. We propose to learn such representations using model architectures that generalise from standard VAEs, employing a general graphical model structure in the encoder and decoder. This allows us to train partially-specified models that make relatively strong assumptions about a subset of interpretable variables and rely on the flexibility of neural networks to learn representations for the remaining variables. We further define a general objective for semi-supervised learning in this model class, which can be approximated using an importance sampling procedure. We evaluate our framework's ability to learn disentangled representations, both by qualitative exploration of its generative capacity, and quantitative evaluation of its discriminative ability on a variety of models and datasets., Accepted for publication at NIPS 2017

Widely used in the management of diabetes, insulin therapy is influenced by several patient preferences and physician choices. This article reports the findings of the IMPACT survey, designed to assess insights on various factors which influence the choice of insulin therapy in India.We administered a questionnaire which focused on the practice and patient profiles and the preferred regimens in specific clinical situations using a case scenario. Respondents were asked about preferred insulin regimens for various phases of life, comorbid conditions, dietary choices and psychological factors.Overall, 314 doctors participated in the survey. Majority were general physicians (51%) and diabetologists (37%). In clinical practice, the most preferred regimens included premix insulin BD in adults (59%) and elderly (53%), and basal bolus therapy in pregnant women (47%) and in acute illness (62%). Both regimens were equally preferred for symptomatic patients (41% basal bolus and 38% premix insulin) and those with renal or hepatic failure (36% each). Premix insulin was preferred for patients with high carbohydrate intake (73%) while basal bolus was preferred for patients with variable meal timings (39%) and in pronounced postprandial glucose excursions (45%). Insulin co-formulation and high-mix insulins were not a part of the survey questionnaire.Indian physicians exercise logic in the choice of insulin regimens. Preference is based on patient characteristics including glucophenotype, dietary patterns, psychosocial needs, clinical situations, and comorbid conditions.

Inference amortization methods share information across multiple posterior-inference problems, allowing each to be carried out more efficiently. Generally, they require the inversion of the dependency structure in the generative model, as the modeller must learn a mapping from observations to distributions approximating the posterior. Previous approaches have involved inverting the dependency structure in a heuristic way that fails to capture these dependencies correctly, thereby limiting the achievable accuracy of the resulting approximations. We introduce an algorithm for faithfully, and minimally, inverting the graphical model structure of any generative model. Such inverses have two crucial properties: (a) they do not encode any independence assertions that are absent from the model and; (b) they are local maxima for the number of true independencies encoded. We prove the correctness of our approach and empirically show that the resulting minimally faithful inverses lead to better inference amortization than existing heuristic approaches., Comment: To appear at the 32nd Conference on Neural Information Processing Systems (NeurIPS 2018), Montreal, Canada

Learning generative models that span multiple data modalities, such as vision and language, is often motivated by the desire to learn more useful, generalisable representations that faithfully capture common underlying factors between the modalities. In this work, we characterise successful learning of such models as the fulfillment of four criteria: i) implicit latent decomposition into shared and private subspaces, ii) coherent joint generation over all modalities, iii) coherent cross-generation across individual modalities, and iv) improved model learning for individual modalities through multi-modal integration. Here, we propose a mixture-of-experts multimodal variational autoencoder (MMVAE) to learn generative models on different sets of modalities, including a challenging image-language dataset, and demonstrate its ability to satisfy all four criteria, both qualitatively and quantitatively.

We develop a generalisation of disentanglement in VAEs---decomposition of the latent representation---characterising it as the fulfilment of two factors: a) the latent encodings of the data having an appropriate level of overlap, and b) the aggregate encoding of the data conforming to a desired structure, represented through the prior. Decomposition permits disentanglement, i.e. explicit independence between latents, as a special case, but also allows for a much richer class of properties to be imposed on the learnt representation, such as sparsity, clustering, independent subspaces, or even intricate hierarchical dependency relationships. We show that the $\beta$-VAE varies from the standard VAE predominantly in its control of latent overlap and that for the standard choice of an isotropic Gaussian prior, its objective is invariant to rotations of the latent representation. Viewed from the decomposition perspective, breaking this invariance with simple manipulations of the prior can yield better disentanglement with little or no detriment to reconstructions. We further demonstrate how other choices of prior can assist in producing different decompositions and introduce an alternative training objective that allows the control of both decomposition factors in a principled manner., Comment: Accepted for publication at ICML 2019

We aimed to identify the incidence and preventability rate of adverse events (AEs) occurring in a specialty orthopaedic unit. Four thousand nine hundred and six consecutive in-patient admissions over six months in an orthopaedic unit were prospectively analysed. The total indoor patient capacity was segregated into 25-bed units each, and AEs were recorded on a daily basis by two observers. Each event was assessed by allotting a causation score (1–6), with a score of ≥ 4 implying a systemic/individual failure of healthcare provision. A preventability score (1–6) was allotted and scores ≥ 4 were considered to be preventable. Four hundred and sixty-seven patients (9.5 %) suffered a total of 529 AEs, including 127 readmissions; 49 patients suffering multiple events. Three hundred and thirty-three (62.9 %) events had a causation score of ≥ 4, indicating a failure of healthcare delivery systems. Three hundred and one (56.8 %) events could have been prevented with better regulation and adherence to management protocols. Hospital-acquired infections were the most common event, with surgical-site infection in 102 cases (19.2 and 2 % overall) and catheter-associated urinary tract infections noted in 45 (8.5 %) patients. Medical events included seven deep vein thrombosis, two pulmonary embolisms, five myocardial infarctions and one stroke. AEs occurred 56.3 % in the ward, 4.3 % in the intensive care unit (ICU), 6.2 % in the emergency room, and 9.0 % in the operating theatre. This prospective study documented an adverse event rate of 9.5 %, of which 56 % were preventable. AEs occurred in all stages of treatment care, emphasising the need for vigilance during the entire treatment process.

Aneurysmal bone cysts (ABC) form 1 % of primary bone tumors. Reported incidence rates are no more than 1.4 to 1,00,000. ABC of spine frequently involves posterior elements and commonly affects the lumbar spine (45 %). We present a case of C2 ABC for the challenges it poses due to the rarity of the lesion, tedious to access location, dilemmas relating to the suitable approach for tumor resection and technically demanding stabilization and reconstruction strategy post resection. Clinical data analysis was performed to discuss a method of novel anterior column reconstruction following resection of a C2 aneurysmal bone cyst in a 8 year old child with anterior and posterior elements being involved. An 8-year-old girl with an aneurysmal bone cyst of the C2 vertebra underwent staged surgery following pre-operative embolisation. First a posterior approach tumor excision with posterior instrumented fusion was performed. Following which, using a modified anterior retropharyngeal approach anterior tumor excision and fibular graft reconstruction between the C1 lateral mass and C2 body was performed. Complete tumor clearance and stable reconstruction was successfully achieved in our patient. Patient showed excellent clinical outcome with radiological fusion. Preoperative embolisation in the treatment of ABC has supplemental advantage by reducing blood loss. Modified anterior retropharyngeal approach allows satisfactory clearance for C1–2 lesion and fibular strut graft between the C1 lateral mass and C2 body can provide a stable graft placement with good chance of fusion. Instability and spinal deformity, whether preexisting or post-excision, should be corrected with reconstruction and stabilization to offer best chance of cure in such cases.

Spinal cord herniation following surgery is an extremely uncommon clinical condition with very few reports in published literature. This condition usually occurs as a spontaneous idiopathic phenomenon often in the thoracic spine or following a scenario of post traumatic spinal cord/nerve root injury. Rarely has it been reported following spinal cord tumor surgery.To document a case of cervical spinal cord herniation as a late onset complication following spinal cord tumor surgery with an atypical presentation of monoparesis.Case report.We describe the clinical presentation, operative procedure, post operative outcome and review of literature of this rare clinical condition.A 57-year-old man presented with right upper limb monoparesis due to a spinal cord herniation 6 years after a cervical intradural meningioma excision. The patients underwent surgery to reduce the herniation and duroplasty with subsequent complete resolution of symptoms.Spinal cord herniation must be considered as differential diagnosis in scenarios of spinal cord tumor excision presenting with late onset neurological deficit. These cases may present as paraparesis, Brown-sequard syndrome and rarely as in our case as monoparesis.

Stochastic control-flow models (SCFMs) are a class of generative models that involve branching on choices from discrete random variables. Amortized gradient-based learning of SCFMs is challenging as most approaches targeting discrete variables rely on their continuous relaxations---which can be intractable in SCFMs, as branching on relaxations requires evaluating all (exponentially many) branching paths. Tractable alternatives mainly combine REINFORCE with complex control-variate schemes to improve the variance of naive estimators. Here, we revisit the reweighted wake-sleep (RWS) (Bornschein and Bengio, 2015) algorithm, and through extensive evaluations, show that it outperforms current state-of-the-art methods in learning SCFMs. Further, in contrast to the importance weighted autoencoder, we observe that RWS learns better models and inference networks with increasing numbers of particles. Our results suggest that RWS is a competitive, often preferable, alternative for learning SCFMs., Tuan Anh Le and Adam R. Kosiorek contributed equally; accepted to Uncertainty in Artificial Intelligence 2019

STUDY DESIGN: Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database. OBJECTIVES: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies. SETTING: Nine centers from Asia. METHODS: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers. RESULTS: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%). CONCLUSIONS: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Lenke 5 C curves are frequently associated with clinically and radiological coronal imbalance. Appropriate selection of proximal and distal levels of fusion is essential to ensure good coronal balance (CB). We aimed to evaluate radiological factors associated with (I) global CB in the early post-operative period; (II) late decompensation of CB; and (III) favourable spontaneous correction of CB on long term follow up.Twenty-three Lenke type 5C scoliosis cases treated with selective posterior lumbar instrumentation were retrospectively evaluated. Pre-operative, early post-operative and late post-operative (2 years) whole length radiographs were analysed. Cobb's angle, lumbar lordosis, coronal imbalance, lower instrumented vertebra (LIV) tilt and translation and upper instrumented vertebra (UIV) tilt and translation were measured. The proximal and distal fusion levels were noted and correlated with post-operative CB.There were 21 females and 2 males with a mean follow up of 36 months. The mean pre-operative cobb angle was 55°±13.26°, which corrected to 14.7°±8.84° and was maintained on follow up. Eight patients had early post-operative coronal imbalance with spontaneous resolution seen in six cases on long term follow-up. At final follow-up, four cases had coronal imbalance (persistent imbalance since early post-operative period =2; late decompensation =2). In cases with early imbalance 5/8 cases had a pre-operative LIV tilt of ≥25°. All four patients with coronal imbalance at final follow-up had pre-operative LIV tilt ≥25°. Radiographic parameters which correlated with post-operative coronal imbalance were pre-operative LIV tilt (r=0.64, P=0.001), pre-operative LIV translation (r=0.696, P0.001), pre-operative UIV translation (r=0.44, P=0.030), post-operative LIV tilt (r=0.804, P0.001), and post-operative UIV tilt (r=0.62, P=0.001).In Lenke 5C scoliosis, a pre-operative LIV tilt ≥25° significantly correlates with post-operative global coronal imbalance. Increasing UIV tilt may be a factor that accounts for improvement of CB in late follow-up period.

We characterise some of the quirks and shortcomings in the exploration of Visual Dialogue - a sequential question-answering task where the questions and corresponding answers are related through given visual stimuli. To do so, we develop an embarrassingly simple method based on Canonical Correlation Analysis (CCA) that, on the standard dataset, achieves near state-of-the-art performance on mean rank (MR). In direct contrast to current complex and over-parametrised architectures that are both compute and time intensive, our method ignores the visual stimuli, ignores the sequencing of dialogue, does not need gradients, uses off-the-shelf feature extractors, has at least an order of magnitude fewer parameters, and learns in practically no time. We argue that these results are indicative of issues in current approaches to Visual Dialogue and conduct analyses to highlight implicit dataset biases and effects of over-constrained evaluation metrics. Our code is publicly available., Comment: 2018 NeurIPS Workshop on Critiquing and Correcting Trends in Machine Learning

Osteolipoma is a rare variant of the ubiquitous lipoma. Published literature appears in the form of isolated case reports affecting soft tissue structures in the head, neck and rarely affecting the spine. We present a unique instance of an intraspinal osteolipoma in the cervical spine, without evidence of accompanying spinal dysraphism and an atypical clinical presentation of isolated dorsal column dysfunction. We describe the clinical presentation, operative procedure and post-operative outcomes with histopathological findings of this rare entity. A 61-year-old male presented with impaired dorsal column sensation due to an intraspinal extradural ossifying lesion in the cervical spinal canal. The patient underwent excision of the lesion with complete resolution of symptoms. Ossifying lesion in the spinal canal may be frequent finding on radiological imaging but presence of possible adipose tissue in the lesion should raise suspicion of rare clinical scenario of an osteolipoma.

Study Design Case report Objective To present three cases of coronal vertebral dislocation due to congenital multiple thoracic and lumbar pedicle agenesis. Summary of Background Data Congenital pedicle agenesis is an uncommon condition and is frequently identified as an incidental finding on diagnostic imaging in asymptomatic individuals. This agenesis is frequently limited to a single level and is commonly seen in the cervical and lumbar spine. Methods We report three patients who presented with multiple thoracic and lumbar pedicle agenesis resulting in coronal vertebral dislocation. The patients presented with progressive kyphoscoliosis deformity. Identification of this malformation on conventional radiographs is difficult, and computed tomographic (CT) scan with 3D reconstruction provides a better delineation of the deformity. Results Computed tomography showed complete absence of pedicles and dissociation of anterior column from the posterior column, resulting in coronal vertebral dislocation. Magnetic resonance imaging confirmed the absence of pedicles and decreased anteroposterior diameter, causing canal stenosis. Two patients were treated by spanning internal fixation, partial deformity correction, and posterior fusion, with satisfactory results. Conclusion Coronal vertebral dislocation can be easily missed on plain radiograph because many patients with severe scoliotic deformity have thin or sclerotic pedicles. Computed tomography is essential to demonstrate these anomalies. It is important to recognize pedicle aplasia early to prevent rapid progression of deformity and neurologic deficit.

The process of drug discovery and development today encompass a myriad of paths for bringing a new therapeutic molecule that has minimal adverse effects and of optimal use to the patient. Chirality was proposed in the direction of providing a purer and safer form of drug [Ex- cetrizine and levocetrizine]. Decades have passed since the introduction of this concept and numerous chiral molecules are in existence in therapeutics, yet somehow this concept has been ignored. This review aims to rediscover the ignored facts about chirality, its benefits and clear some common myths considering the example of S-Metoprolol in the management of Hypertension and other cardiovascular diseases.Relevant articles from Pubmed, Embase, Medline and Google Scholar were searched using the terms "Chiral", "Chirality", "Enantiomers", "Isomers", "Isomerism", "Stereo-chemistry", and "S-Metoprolol". Out of 103 articles found 17 articles mentioning in general about the concept of chirality and articles on study of S-metoprolol in various cardiovascular diseases were then reviewed.Many articles mention about the importance of chirality yet the concept has not been highlighted much. Clear benefits with chiral molecules have been documented for various drug molecules few amongst them being anaesthetics, antihypertensives, antidepressants. Benefits of S-metoprolol over racemate are also clear in terms of responder rates, dose of administration and adverse effects profile in various cardiovascular diseases.Chirality is a good way forward in providing a new drug molecule which is safe with lesser pharmacokinetic and pharmacodynamics variability, lesser side effects and more potent action. S-metoprolol is chirally pure form of racemate metoprolol and has lesser side effects, is safer in patients of COPD and Diabetes who also have hypertension and comparable responder rates at half the doses when compared to racemate.

Introduction Unplanned readmissions are an undesirable and expensive outcome of clinical practice. Previous reported literature is limited by retrospective study designs and 30 day study intervals. We analyzed causes for 90-day unplanned readmission, temporal occurrence of major causes, possible predisposing factors, bed days lost and economic impact. Materials & methods A prospective analysis of 12729 admissions was performed over 1 year in an Orthopaedic unit. Consecutive readmissions for unplanned circumstances within 90-days of discharge following the index procedure were included. Open injuries, polytrauma, primary osseous infections and planned readmissions were excluded. Results We noted an overall readmission rate of 2.07% and subspecialty rate of 1.43%, 3.32%, 2.9% in trauma, spine and total joint arthroplasty (TJA) respectively. The leading cause was wound complications accounting for 49.62%, followed by medical causes (trauma −18.37%; TJA −27.5%) and aseptic pain (spine-31.6%). Though 87.1% of superficial surgical site infections (SSIs) occurred within 30 days, 21.1%, 41.2% and 60% of the deep SSIs in spine, trauma and TJA respectively occurred beyond 30 days. The financial burden amounted to INR 1,01,55,770 and mean bed days lost was 7.6 per readmission. Age ≥70 years, indoor-stay ≥10 days, health insurance and co-morbid illnesses were associated with readmissions (p Conclusions Our study showed that limiting analysis to 30 day unplanned readmissions would lead to failure in identification of 34.85% of readmissions especially deep surgical site infections in TJA and trauma.

For analysis of power consumption of resistance spot welding systems field-circuit modelling is required. It includes both 2D eddy-current FEA analysis for estimation of the leakage impedance of transformer and P-Spice program for the circuit simulation. It is shown that the design of the transformer influences on the output current and power consumption. We used the equivalent circuit of three-winding transformer which differs from well-known equivalent circuit of such a transformer. This circuit is based on replacing the three-winding transformer with two two-winding transformers. The mutual impact of these transformers is modelled as a change of EMF on the terminals of their secondary windings by magnetic leakage fields. We investigated several transformer designs for the 7.5 kHz resistance spot welding system. Designs differ interleaving of primary and secondary windings and the number of primary winding coils. They have different leakage inductances and different coupling factors for the leakage flux. Calculations have shown that it is necessary to reduce the leakage inductances of transformers for increasing the operating current if output voltage is constant for all investigated transformers. On the bases of the investigations we developed transformer with the operating current 11 kA and frequency 7.5 kHz. It has almost twice less power consumption than the basic one. This result is confirmed experimentally.

Agriculture and, consequently, food production depend, among other factors, on the proper management of water. Land drainage, an integral component of water management, is well known to have ameliorated salinity and waterlogging problems in rain fed and irrigated agriculture. In so doing, it has contributed substantially to sustainable agricultural development through enabling increased crop production, decreased farming costs, and the maintaining of soil quality. In areas where rainfall is excessive, it is necessary to manage land drainage, both surface and subsurface, in order to prevent waterlogging. In areas where rainfall is deficient, drainage management is still important in order to minimize soil salinization. In the arid and semi-arid regions, soil salinity still limits crop production significantly. Hence, it has a negative effect on food security. In the wetter regions, flooding and waterlogging still limit crop production in many parts of the world. As the global population and the demand for food increase, additional new drainage systems will be installed in a broader range of climate, soil and hydrological conditions, and existing systems will be renovated. This study on surface drainage is intended to serve as a reference for an integrated drainage system. The main text of this study provides critical general information about the agricultural surface drainage.

Delayed presentations have been reported following gunshot wounds (GSW) with retained intraspinal bullets due to migration of projectile or lead intoxication. We report on the rare occurrence of delayed pyogenic spondylodiscitis and neurological dysfunction following injury from low velocity GSW to the spine with a retained projectile. A 55-year-old male presented 4 months following GSW to the abdomen which resulted in colonic injury and L5 fracture. The patient was treated initially with ileo-transverse anastomosis, antibiotics, without retrieval of the bullet. He developed low back pain, claudication 4 months following GSW and investigations suggested a pyogenic spondylodiscitis at L5–S1. The patient was treated with surgical debridement of infective focus and stabilisation with definitive fusion being performed after an interval of 14 days. The biopsy of the lesion confirmed findings of spondylodiscitis and the culture isolated Enterococcus faecalis species. The patient was treated with antibiotics as per sensitivity and made an uneventful recovery over 4 weeks. The follow-up radiographs showed satisfactory healing at final follow up of 24 months. GSW with colonic perforation have higher incidence of infective complications however majority to these occur in the early postoperative period. This case report demonstrates the possibility of late onset presentation due to spinal infection occurring following colonic perforation with retained intraspinal bullet.

Object Halo orthosis placement is a common neurosurgical procedure for the treatment of cervical spine injuries. Frontal sinus puncture by the anterior pins may occur using standard techniques, and up to 30% are dissatisfied with forehead scarring, especially women and African Americans. Methods The authors describe a frontolateral (FL) anterior pin site placement supported by high-resolution CT scan skull thickness measurements. The standard supraorbital (SO) pin site is several centimeters above the lateral orbit, whereas the FL pin site is 2–3 cm posterolateral to the SO site. Frontolateral placement is just anterior to the temporalis muscle close to a triangular anterior projection of the temporal hairline. For quantitative information on skull thickness at the SO and FT pin sites, thin 0.625-mm CT scan measurements of the outer table, diploic space, and inner table were obtained in 40 adults (80 sites). Results The mean values for total skull thickness at the SO and FT sites were not significantly different. The inner table was significantly thicker at the FL site in both males and females, buttressed by the nearby greater sphenoid wing. The mean total skull thickness was significantly less in females than in males, but the values were not significantly different at the SO and FL sites. Conclusions The FL and SO anterior pin sites are comparable with respect to skull thickness CT measurements, with a significantly thicker inner table at the FL site. In the senior author's experience, the FL anterior pin site yielded secure fixation without skull perforation, neurovascular injury, or propensity to infection. The cosmetic result of the FL site is more acceptable, and the authors recommend its general usage be adopted.

The "condylus tertius" or the "third occipital condyle" is an embryological remnant of the proatlas sclerotome. Anatomically, it is attached to the basion and often articulates with the anterior arch of the atlas and the odontoid apex; hence, it is also called the "median occipital condyle". It is a rare anomaly of the cranio-vertebral junction (CVJ) that can lead to instability and compression of important surrounding neurovascular structures. We report a case of a 16-year-old boy who presented with suboccipital neck pain, torticollis and right sided hemiparesis. Plain radiographs revealed an increased atlanto-dental interspace (ADI) with a retroflexed odontoid. Open mouth view showed asymmetry of the articular processes of the atlas with respect to the dens. Computed tomography (CT) of the CVJ delineated the third occipital condyle. Furthermore, on dynamic CT study, a type 3 atlanto-axial rotatory fixation (AARF) was clearly demonstrated. Magnetic resonance imaging (MRI) of the CVJ revealed severe right-sided spinal cord compression by the retroflexed and rightward deviated dens. It also revealed disruption of the left alar and transverse ligaments. The patient was treated with 8 weeks of cranial traction and reasonable alignment was obtained. This was followed by C1-C2 lateral mass screw fixation and C1-C2 interlaminar wiring to maintain the alignment. A review of the literature did not reveal any cases of condylus tertius associated with non-traumatic AARF. An accurate knowledge of the embryology and imaging features of this rare CVJ anomaly is useful in the prompt diagnosis and management of such patients.

Chronic seizures as a presenting feature of low grade temporal lobe gliomas and hippocampal sclerosis (HS) are reported to have similar outcomes although the prognostic indicators may not be the same. This study seeks to identify the variables that are associated with poor surgical outcome in both conditions. A retrospective analysis from our epilepsy data base was performed. All low-grade temporal lobe gliomas were selected and relevant variables were compared to the same variables in HS patients. There were 34 tumors (out of 233 cases of chronic temporal lobe epilepsy = 14.6 %) with a mean age of onset of 19 years, and the preoperative duration was 12.3 years. When compared to 120 HS patients both of these factors were significantly different (p < 0.001). Age at the time of surgery for tumors was 31.08 (p = 0.5). Tumors were left sided in 20 patients. In tumor cases amygdala resection was complete in 75 %, for hippocampus 24 % were complete and 39 % partial. Astrocytoma, ganglioglioma and oligodendroglioma constituted 80 % of tumor cases. Good outcome (Engel’s Class I) was achieved in 88.2 % of tumor cases and 71 % of HS cases while poor outcome (Class III + IV) was seen in 5.9 and 16.7 % respectively. The follow up period for the two groups was not significantly different. In multivariate logistic regression analysis, the groups differed significantly in preoperative delay (between diagnosis and surgery) and in epilepsy outcome. Chronic temporal lobe epilepsy due to low-grade tumors had significantly better surgical outcome with considerably less preoperative delay. The age of onset of seizures was younger in HS patients but a delay in surgical treatment was significantly longer. Given that the diagnosis of treatment-resistant TLE secondary to HS can be established after two failed AED trials at optimal doses, shortening the interval between diagnosis and surgery may improve epilepsy outcome.

Bleeding lesions of the small bowel are often difficult to identify due to the obscure symptomatology. Localizing these lesions requires specific techniques. The Double-balloon enteroscopy (DBE) could be used to precisely localize and mark lesions, so that a minimally invasive surgical treatment could be performed.Twenty robot-assisted small bowel procedures are presented using a combination of DBE for localization and robotic resection.There were 10 jejunal resections and 10 ileal resections. Mean age was 58.7 years. Mean operative time was 153.4 minutes, mean blood loss of 46 mL. No conversion-to-open and there were 4 post-operative complications. The 90-day mortality was nil and the median length of stay was 4.1 days. Final pathology was consistent with malignancy in 10 cases.The combination of double-balloon enteroscopy and robotic technology allows accurate identification and selective treatment of lesions that could be otherwise difficult to treat in a minimally invasive fashion.

We aimed to formulate a radiological index based on plain radiographs and computer tomography (CT) to reliably detect posterior ligamentous complex (PLC) injury without need for MRI. Sixty out of 148 consecutive thoracolumbar fractures with doubtful PLC were assessed with MRI, CT and radiographs. PLC injury was assessed with the following radiological parameters: superior-inferior end plate angle (SIEA), vertebral body height (BH), local kyphosis (LK), inter-spinous distance (ISD) and inter-pedicular distance (IPD) and correlated with MRI findings of PLC injury. Statistical analysis was performed to identify the predictive values for the parameters to identify PLC damage. MRI identified PLC injury in 25/60 cases. The ISD and LK were found to be significant predictors of PLC injury. On radiographs the mean LK with PLC damage was 25.86° compared to 21.02° with an intact PLC (p = 0.006). The ISD difference was 6.70 mm in cases with PLC damage compared to 2.86 mm with an intact PLC (p = 0.011). In CT images, the mean LK with PLC damage was 22.96° compared to 18.44° with an intact PLC ( p = 0.019). The ISD difference was 3.10 mm with PLC damage compared to 1.62 mm without PLC damage (p = 0.005). On plain radiographs the presence of LK greater than 20 °(CI 64–95) and ISD difference greater than 2 mm (CI 70–97) can predict PLC injury. These guidelines may be utilised in the emergency room especially when the associated cost, availability and time delay in performing MRI are a concern.

Insulin therapy remains the cornerstone of effective diabetes management. Timely intensification of insulin therapy reduces the progression of diabetes and the development of diabetes-related complications. Given that overall hyperglycaemia is a relative contribution of both fasting and postprandial hyperglycaemia, use of basal insulin alone may not achieve optimal glucose control due to its inability to cover postprandial glucose excursions. Intensifying therapy with addition of bolus insulin or switching to premixed insulin is a viable option in patients failing on basal alone therapy. Although the benefits of early insulin treatment are well established, a considerable delay in intensifying insulin therapy in patients with sub-optimal glycaemic control is still observed. Most of the patients and physicians are reluctant to intensify therapy due to the fear of hypoglycaemia, regimen complexity, and increased burden of multiple daily injections. In this context, there is a need for a flexible, alternative intensification option taking into account individual patient considerations to achieve or maintain individual glycaemic targets. An ideal insulin regimen should mimic physiological insulin release while providing optimal glycaemic control with low risk of hypoglycaemia, weight gain and fewer daily injections. The current paper reviews the challenges of insulin intensification in patients with type 2 diabetes mellitus poorly controlled on current treatment regimens.

To evaluate the effectiveness of Riluzole as a pharmacotherapeutic treatment option for early cervical myelopathy using clinical parameters and DTI analysis. Early cervical myelopathy cases with MJOA scores ≥13, were recruited for the double-blinded, placebo-controlled randomised control trial. Thirty cases with fifteen cases each in the test and placebo group were studied. Analysis was done using diffusion tensor imaging (DTI) and clinical evaluation, pre- and post-institution of sodium channel blocker Riluzole for a period of 1 month (50 mg twice daily). Placebo group was treated with Vitamin B complex tablets. Diffusion co-efficient fractional anisotrophy (FA), apparent diffusion co-efficient (ADC), volume ratio (VR), relative anisotrophy (RA) and Eigen vectors were calculated. Outcomes analysis was based on clinical scores of MJOA, Nurick grading, SF-12, NDI, and statistical analysis of DTI datametrics. The mean MJOA score was 15.6 (13–17) with no significant change in the test and control groups. The mean ADC, FA values were 1533.36 (1238–1779) and 494.36 (364–628) and changed to 1531.57 (1312–2091) and 484.86 (294–597), respectively, in the Riluzole group. However, the changes in the values of ADC, FA, and other co-efficients including VR, RA and eigenvectors in the two groups were not statistically significant. The functional scores in the SF-12 and NDI questionnaires did not change significantly. Our study did not show a significant change in the clinical outcome and DTI Indices with the use of Riluzole as a standalone pharmacotherapeutic agent for early cervical myelopathy. More studies may be needed to confirm the usefulness of Riluzole as a treatment option for cervical myelopathy.