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Background and importance: Fahr’s syndrome is also known as idiopathic calcification of the basal ganglia. It is described as a rare, degenerative, neuropsychiatric disorder characterized by seizures, extrapyramidal, and neuropsychiatric symptoms as a result of symmetric and bilateral calcifications within the basal ganglia. Involvement of the nucleus pallidus, the putamen, the dentate nucleus of the cerebellum, and the hemispheric white matter at the base of the skull, are common radiological hallmarks of this syndrome. The calcification probably occurs due to lipid deposition and demyelinization. Clinical presentation: We present the case of a post thyroidectomy patient with hypoparathyroidism (HPT) with incidentally detected basal ganglia calcification (BGC). Retrospectively the patient was found to have hypocalcemia, secondary to a total thyroidectomy performed on her, 2 years ago. The second case was that of a 35 year old patient who presented with sudden onset of “worst headache of his life” since the previous night associated with multiple episodes of vomiting. Here we discuss our clinical dilemma and treatment strategy. Conclusion: In presence of BGC, HPT should be investigated, especially in patients who have undergone thyroidectomy, since in the early stage, the recovery could be expedited with a precise diagnosis and prompt treatment. This case report illustrated the benefits of calcium supplementation and calcitriol, even with the patient being in advanced stage of disease.

Background: Lhermitte-Duclos is a rare hamartomatous lesion of the cerebellar cortex with both neoplastic and hamartomatous features. Also known as dysplastic cerebellar gangliocytoma, they usually occur in the setting of Cowden’s syndrome, an autosomal dominant condition characterized by multiple hamartomas and neoplastic lesions in skin and internal organs. Although enlargement of the internal granular layer of the cerebellum is a consistent finding in our case, the background setting of Cowden’s syndrome was not present in our case. Case description: We present a unique case of LDD in the absence of Cowdens syndrome in a 58-year old gentleman who presented with cerebellar signs, a first to be reported in literature. Here we describe our clinical vignette. C onclusion: Most of the cases of LDD, reported in literature, were associated with Cowdens disease, however our case is the first to present without Cowdens disease. To date no other similar cases have been reported in literature.

Salvage Robot Assisted Radical Prostatectomy (sRARP) for recurrent prostate cancer is considered a higher risk procedure due to its inherent risk of increased intra- and post operative complications. Of note, vesicourethral anastomosis (VUA) leak can occur in up to one third of cases (1). Contributing factors are often attributed to prior therapy and include increased tissue friability and postoperative necrosis, and despite efforts to ensure a high quality of surgical anastomosis, poor surrounding tissue quality can result in anastomosis disruption (2). The deleterious effects of a VUA leak are numerous; urethral stricture formation, bladder neck contracture, urinary peritonitis and paralytic ileus. In addition, prolonged urethral catheterization or drain placement can result in secondary infection, protracted inpatient hospital stay or necessitate a second reconstructive procedure.

Unaccounted transient or permanent changes in sensor performances can compromise the overall quality of datasets obtained with a glider. From the specific perspective of the principal physical variables (temperature and conductivity), the main short-term risk is the deterioration of the quality of salinity data that is primarily due to the fouling of the glider’s conductivity sensor, especially when the glider approaches the sea surface and is deployed in coastal waters. Another potential short-term risk is a sudden shift in the glider’s temperature response caused by the blanketing of the temperature sensor by extraneous material. The long-term risks are the intrinsic drifts of the two sensors as specified by the sensor manufacturer. Given the way a glider operates, it is practically impossible to obtain sufficiently representative temperature and salinity samples in the field for effective comparisons with sensor data. Hence, laboratory testing of the temperature and conductivity sensors is one approach used to estimate the qualitative changes in pre- and postdeployment sensor performance in order to mitigate measurable drift effects on the collected data. This paper presents a systematic procedure that can be used to conduct reproducible laboratory evaluations of the temperature and conductivity sensors on a Teledyne Webb Research (TWR) Slocum glider. It is shown that the data from such tests can give useful information regarding the data quality as a result of fouling of the sensors during missions. Obviously, this kind of information is valuable when the reliability of mission-generated temperature and conductivity data, which are used to determine salinity, have to be assessed.

Background: Recent era of agricultural boon is partially the result of extensive use of insecticides and pesticides. But these compounds also have potential to significantly alter the ecosystem and can cause acute poisonings as well as long term detrimental health effects in humans. These compounds can cause toxicity through all routes of exposure. They exert their effect mainly by the inhibition of Acetylcholinesterase (AC hE), which functions by removing acetylcholine (AC h) from its postsynaptic receptors. Aims and Objectives: Human exposure to Organophosphorous (OP) pesticides can develop lowered cholinesterase levels. The aim of the present study was to estimate the plasma levels of AC hE in personnel involved in handling of these compounds, during the period of active spraying operations. Methodology: The present study was conducted on 38 subjects working as Multipurpose Health Workers (MPHW GROUP-1) and Field Workers (FW GROUP-2) involved in the actual spraying of the insecticides, in District Rohtak, Haryana, India to see the effect of exposure to OP insecticides. Plasma cholinesterase activity was measured by a kinetic method based on hydrolysis of butrylthiocholine. The data was statistically analyzed using SPSS statistical package (SPSS version 5.0). Results and interpretation: The mean cholinesterase activity in group-2 was lower by 27.76% than that in group-1 and this difference was statistically significant (p < 0.05). The workers involved in actual spraying of the insecticides had a more marked reduction in the levels of Plasma AC hE, compared to the workers involved only in the handling of the insecticides indicating that this group is at a bigger risk.

Arteriovenous fistula (AVF) is an anomalous communication between an artery and a vein, caused by an iatrogenic or traumatic etiology. Surgically created upper limb AVF remains the preferred vascular access for patients on maintenance hemodialysis. Nonetheless central vein cannulation for hemodialysis is a common procedure done in patients who need hemodialysis. We incidentally detected a thyrocervical artery - jugular fistula in a patient on maintenance hemodialysis. He underwent a successful intra arterial coil embolization of the feeding vessel. Review of literature has shown that, a thyrocervical artery - internal jugular vein arteriovenous fistula following a central venous catheterization has not been reported so far.

Oxygenic photosynthesis is initiated by photosystem II (PSII) in the thylakoid membranes of plants, algae and cyanobacteria. PSII is a multi-subunit pigment-protein complex responsible for splitting water into oxygen gas, hydrogen ions and electrons transferred to electron acceptors during photosynthesis.1 Two homologous membrane-spanning proteins D1 (PsbA) and D2 (PsbD) form the PSII complex core.1 Peripherally, two chlorophyll (Chl)-binding inner antenna proteins CP47 (PsbB) and CP43 (PsbC) are bound to the D1-D2 PSII complex core.1 These four large proteins are surrounded by a large number of smaller membrane proteins.2 Most of these small proteins have been observed in the crystal structures of the PSII complex from cyanobacteria.3,4 However, one small protein, Psb28, previously detected as a nonstoichiometric component of PSII,5 was not observed in the crystal structures indicating that Psb28 might not be a true PSII subunit. Recent studies revealed that Psb28 was preferentially bound to PSII core complex lacking CP43 (RC47) and involved in the biogenesis of CP47.6 Understanding the association of Psb28 with the PSII core complex should provide additional insight into its role in PSII-mediated function. However, the structure of Psb28 has remained unknown up until now. In this note, we report the solution NMR structure of Psb28 protein encoded by gene sll1398 [gi|952386] of Synechocystis sp. strain PCC 6803 (SWISS-PROT ID: PSB28_SYNY3, NESG target ID: SgR171).7 This protein, also named Psb13 or ycf79, belongs to the Psb28 protein family (Pfam ID: PF03912), which is currently made up of ~48 protein sequences (E score less than 0.001 using PSI-BLAST, Table S1). Both PSI-BLAST sequence similarity and Dali8 structure similarity searches indicate that this is the first atomic resolution structure available for the Psb28 family. ConSurf9 was used to identify conserved surface residues potentially involved in binding to the PSII core complex.10

Background: Venous and arterial thromboembolism are frequently seen in nephrotic syndrome. They generally occur during periods of sustained proteinuria in patients who are not responding to treatment and more commonly seen in minimal change disease and membranous nephropathy. Case Presentation: A 28-year-old male presented to cardiology department of our hospital with worsening breathlessness for 1 week. We found pulmonary embolism and an infarct in the lower pole of the right kidney by CT pulmonary angiogram. He had no previous history or features of nephrotic syndrome. Urine analysis showed numerous red blood cells, 3+ proteinuria and granular casts. Urine protein creatinine ratio was 5.2 g/g of creatinine. Serum creatinine was 2.61 mg/dL. Renal biopsy was suggestive of IgA nephropathy and patient was started on steroids and warfarin and responded to treatment. Conclusions: Patients with nephrotic syndrome can rarely present initially with venous and arterial thromboembolism. Rarely even IgA nephropathy can present with such thromboembolic episodes.

Background: Hypothyroidism is a causal agent sub serving a multitude of complications in pregnancy. There is a lot of controversy regarding universal screening for thyroid abnormalities during pregnancy. An attempt was made to ascertain the incidence of hypothyroidism during pregnancy in a peripheral hospital.Methods: All patients reporting to ANC OPD were subjected to thyroid profile and results tabulated as per ATA guidelines 2017. Patients with clinical hypothyroidism were followed up with treatment to look for condition related complications if any. Complications despite treatment were noted and included only after ruling out masquerading mimickers or co existent conditions.Results: An incidence of 14.46% per two years was detected with hypothyroidism.Conclusions: The need for universal screening for hypothyroidism is inescapable particularly in hilly terrain.

A 61-year-old man was wheeled in to our emergency triage bleeding profusely from his mouth and nose in an unconscious state. His Glasgow Coma Scale was 7 and was intubated for airway safety. A failed anterior nasal packing was followed by insertion of a Foley urinary catheter through the right nostril to secure posterior nasal packing and haemostasis. CT of the brain following nasal packing showed diffuse traumatic subarachnoid haemorrhage and basifrontal contusions with multiple fractures of the anterior cranial fossa, cribriform plate including the frontal sinus. Multiple specs of air in the frontal lobe was initially …

Suspicion and subsequent detection of renal disease is by an assessment of the urinalysis and renal function in the clinical context. Our attempt in this study is to correlate initial presenting features of urinalysis and renal function to the final histopathological diagnosis. A retrospective analysis of 1059 native kidney biopsies performed from January 2002 to June 2015 at Amrita Institute of Medical Sciences was conducted. Correlative patterns between urinalysis, renal function, and final histopathological diagnosis were studied. Five hundred and eleven (48%) patients had nephrotic syndrome. Out of these, 193 (38%) had pure: nephrotic syndrome, 181 (35.8%) had associated microhematuria, 110 (21.7%) had microhematuria and renal failure, and 27 (5.3%) had only associated renal failure. Minimal change disease (MCD) (30%), membranous nephropathy (30%), and IgA nephropathy (29%) were the major diseases in the respective groups. Five hundred and five (47.6%) patients had subnephrotic proteinuria. Out of these, 29 (5.6%) had only subnephrotic proteinuria, 134 (27%) had additional microhematuria, 300 (59%) had subnephrotic proteinuria, microhematuria, and renal failure, and 42 (8%) had subnephrotic proteinuria with renal failure. Lupus Nephritis (45% and 40%) and IgA Nephropathy (32% and 21%) were the major disorders in the subgroups respectively. Forty-two patients (3.7%) were biopsied for isolated renal failure with bland urinary sediment. Cast nephropathy and acute interstitial nephritis were the major diseases. Out of 89 patients with diabetes who were biopsied, 15 (16.8%) had diabetic nephropathy, 45 (50.5%) had no diabetic nephropathy, and 29 (32.5%) had diabetic nephropathy along with a non-diabetic renal disease. Postinfectious glomerulonephritis was the major glomerular disease. IgA nephropathy (22.2%) and membranous nephropathy (15.5%) were the major diseases in patients with diabetes with no diabetic nephropathy. In our population, MCD and membranous nephropathy formed the majority of diseases in biopsied nephrotic syndrome. Added microhematuria did not seem to decrease the incidence of either disease on the whole. We found a significant number of patients with membranous nephropathy with nephrotic syndrome, microhematuria, and additional renal failure. IgA nephropathy formed a majority of cases with nephrotic syndrome, microhematuria, and renal failure. The presence of renal failure regardless of other abnormalities in urinalysis showed a trend toward IgA nephropathy. Membranous nephropathy may have a more varied presentation than was originally thought and IgA nephropathy presenting as nephrotic syndrome may not be uncommon. MCD is the major subgroup of diseases in the pediatric population and presents both as nephrotic syndrome as well as nephrotic syndrome with microhematuria. Thus, urinalysis and renal failure may be a valuable tool in assessing renal disease.

Summary One major objective of structural genomics efforts, including the NIH-funded Protein Structure Initiative (PSI), has been to increase the structural coverage of protein sequence space. Here, we present the target selection strategy used during the second phase of PSI (PSI-2). This strategy, jointly devised by the bioinformatics groups associated with the PSI-2 large-scale production centers, targets representatives from large, structurally uncharacterized protein domain families, and from structurally uncharacterized subfamilies in very large and diverse families with incomplete structural coverage. These very large families are extremely diverse both structurally and functionally, and are highly overrepresented in known proteomes. On the basis of several metrics, we then discuss to what extent PSI-2, during its first 3 years, has increased the structural coverage of genomes, and contributed structural and functional novelty. Together, the results presented here suggest that PSI-2 is successfully meeting its objectives and provides useful insights into structural and functional space.

The more proteins diverged in sequence, the more difficult it becomes for bioinformatics to infer similarities of protein function and structure from sequence. The precise thresholds used in automated genome annotations depend on the particular aspect of protein function transferred by homology. Here, we presented the first large-scale analysis of the relation between sequence similarity and identity in subcellular localization. Three results stood out: (1) The subcellular compartment is generally more conserved than what might have been expected given that short sequence motifs like nuclear localization signals can alter the native compartment; (2) the sequence conservation of localization is similar between different compartments; and (3) it is similar to the conservation of structure and enzymatic activity. In particular, we found the transition between the regions of conserved and nonconserved localization to be very sharp, although the thresholds for conservation were less well defined than for structure and enzymatic activity. We found that a simple measure for sequence similarity accounting for pairwise sequence identity and alignment length, the HSSP distance, distinguished accurately between protein pairs of identical and different localizations. In fact, BLAST expectation values outperformed the HSSP distance only for alignments in the subtwilight zone. We succeeded in slightly improving the accuracy of inferring localization through homology by fine tuning the thresholds. Finally, we applied our results to the entire SWISS-PROT database and five entirely sequenced eukaryotes.

Cysteine peptidases (CP) are ubiquitous enzymes that play fundamental roles in many cellular metabolic pathways.1 In mammalian cells they are highly regulated in apoptotic pathways related to cancer and other severe disorders.2,3 In bacterial cell division, cell-growth and lysis peptidases are employed in the cleavage of peptidoglycans (autolysin).4,5 As secreted antigens and toxins, CPs are key to virulence in Gram-positive pathogens,6 and used to attack competing species in bacterial warfare.7 Viral genomes encode forms of the enzyme for the purpose of capsid trimming during maturation.8 CPs have been classified in clans based on their evolutionary relationships,9 in particular, the CHAP (cysteine, histidine-dependent amidohydrolases/peptidases) domain (pfam: PF05257, MEROPS ID: C51) is classified as an endopeptidase and part of the CA clan of peptidases (CL0125). This 27-member superfamily includes synthetase/amidases, peptidases, viral proteinases, the NPLC/P60 families and other papain-related families.10 Pfam 22.0 lists 602 members for the CHAP domain family, including 475 from the bacterial kingdom (396 in the firmicutes phylum without any known 3D structure), 39 from eukaryota, and 81 from viruses and phage (predominantly involving Gram-positive phage). CHAP domains are often associated with other peptidases, bifunctional glutathionyl spermidine (GSP) amidases (type 2 and 3), choline binding, and with SH3 and/or Von Willebrand (VWA) domains to form multidomain systems that act cooperatively as versatile machineries for murein septum processing while anchored to the cell surface. Deletion of the CHAP-containing cse gene in Streptococcus thermophilus results in impaired separation of cells during mitosis, demonstrating its involvement in cell division.11 The staphylococcal phage ϕ11 hydrolase, a CHAP domain-containing enzyme, exhibits D-alanyl-glycyl endopeptidase and N-acetylmuramyl-L-alanyl amidase activity.12 In this note we present the solution NMR structure of CHAP domain encoded by gene SSP0609 of Staphylococcus saprophyticus [SWISS-PROT ID: Q49ZM2_STAS1; NESG target ID: SyR11]. S. saprophyticus, one of the three major human Gram-positive pathogens, possesses anchoring fimbriae that help colonize the urinary tract resulting in infection.13 Bacterial antigens are known virulence agents7, and SSP0609 is a secreted antigen with potential roles in the onset of S. saprophyticus infection. The protein comprises a type-I signal peptide in the N-terminal region (res. 1 - 47) and a globular CHAP domain in the C-terminal region (res. 48 - 155). The SSP0609 CHAP domain was found to have a highly-conserved Cys – His – Glu – Asn proteolytic relay active site.

Background: Posterior fossa extradural haematomas (PFEDHs) are an uncommon entity, accounting for only 4 to 12.9% of all extradural haematomas encountered in clinical practice (EDHs). They have a characteristic clinical presentation, which if detected early, can be life saving. Most PFEDHs are operated owing to the imminent propensity of brainstem compression and death. However, a growing number of neurosurgeons, now consider conservative therapy for smaller bleeds. Clear and reliable criteria do not exist, to assist this critical decision-making process. Hence, here with our clinical experience, we attempt to formulate a clinico-radiologic criteria for the management of PFEDHs. When to operate and when to conserve –the jury is still out on this matter. Methods: The clinical and radiological data of patients with PFEDHs admitted to Kasturba Medical College hospital, Manipal between the period of January 2012 and September 2014 were considered to test the efficacy of the criteria proposed. We carried out a retrospective analysis of 12 patients with PFEDH who were admitted during the above said period. A transverse diameter of 4 cms (of the extradural haematoma) was taken as a cut-off for the decision-making process. Results: Of the 12 cases reviewed only 4 were operated with a single mortality. All the operated cases had bleeds of a transverse diameter of >4 cms or had a GCS of less than 13. 46% of bleeds occurred due to occipital bone fracture resulting in a diploic venous ooze or a sinus bleed. Conclusion: PFEDHs are relatively less often encountered in clinical practice. The PF is an unfavorable location for a hematoma. Good GCS scores, at the time of presentation, have a favorable prognosis. Our proposed criteria, for the management of PFEDHs, concluded that all bleeds greater than 4 cms in transverse diameter are to be treated surgically while those with less than 4 cms in diameter are to be managed on the basis of GCS.

Cerebral infarction developing concomitantly or soon after a parenchymal intracerebral hemorrhage is a rare occurrence and is usually limited to small cortical or subcortical infarcts. We report two cases of malignant cerebral infarction secondary to large vessel occlusion occurring subsequent to the decompression of large intracerebral hematomas.

Background: Catastrophic Antiphospholipid syndrome (CAPS) is a scarcely understood entity with a high mortality approaching 50%The rapid deterioration is triggered by a deadly cytokine storm, which is difficult to recognize and almost impossible to treat in time. Various regimens have been advocated, which include administration of monoclonal anti-phospholipid antibodies and pulses of high dose methyl prednisolone. However, these treatment modalities are only effective if the disease is diagnosed early and instituted. Clinical presentation: We present an unusual case of multiple spontaneous intracranial haematomas in a young individual, with evidence of severe refractory coagulopathy in a background of multisystem dysfunction. A retrospective analysis of the subsequent rapid deterioration and resultant fatality provided us with important learning points for early diagnosis and management of triggers which can initiate and lead to a cascade of events that eventually end in death. Conclusion: CAPS is a fatal disease which should be considered when dealing with spontaneous intracerebral bleeds with multisystem dysfunction in the background of coagulation derangements. Rapid treatment with steroids and monoclonal antibodies may be helpful in halting the progression of the disease and eventually help in repressing a fatal outcome. Identifying the trigger factors, that usually initiate the downhill cascade, are a priority, and avoiding such provocative factors is an important aspect of management. This will help in the prevention of morbidity and eventual mortality in such patients.

Background and Importance: Lumbar drain placement and diversion of cerebrospinal fluid is a therapeutic procedure, often done bedside to accentuate wound healing in case of dural transgression following cranial or spinal procedures. Indications include cases of open head injuries with Cerebrospinal fluid (CSF) leak and for re-establishment of CSF flow in primary intraventricular bleed with prolonged periods of External ventricular drain (EVD) placement. Complications include central herniation as a result of over drainage of spinal fluid, low-pressure headache and, in some cases profound dyselectrolytemia and nausea and vomiting. Clinical Presentation: We illustrate a complication, which presented to us, in a 42-year old gentleman with primary intraventricular bleed with EVD in situ. Lumbar drain placement was planned to re-establish CSF flow and for EVD removal, however, once spinal fluid was drained patient deteriorated neurologically. He developed a tight posterior fossa secondary to tonsillar herniation with vermian foliar haemorrhage and had to undergo emergency surgical decompression as a salvage procedure. Conclusions: Herniation following CSF diversion is a known complication, however, they are less often seen after a lumbar drain placement. Early clinical suspicion and posterior fossa decompression can prevent, the otherwise, lethal outcome in such patients. Here we discuss the complications that ensued and the management thereafter in this clinical vignette.

BACKGROUND: There is a robust empirical evidence base supporting the acute efficacy of electroconvulsive therapy (ECT) for severe and treatment resistant depression. However, a major limitation, probably contributing to its declining use, is that ECT is associated with impairment in cognition, notably in anterograde and retrograde memory and executive function. Preclinical and preliminary human data suggests that ketamine, used either as the sole anaesthetic agent or in addition to other anaesthetics, may reduce or prevent cognitive impairment following ECT. A putative hypothesis is that ketamine, through antagonising glutamate receptors, protects from excess excitatory neurotransmitter stimulation during ECT. The primary aim of the ketamine-ECT study is to investigate whether adjunctive ketamine can attenuate the cognitive impairment caused by ECT. Its secondary aim is to examine if ketamine increases the speed of clinical improvement with ECT. METHODS/DESIGN: The ketamine ECT study is a multi-site randomised, placebo-controlled, double blind trial. It was originally planned to recruit 160 moderately to severely depressed patients who had been clinically prescribed ECT. This recruitment target was subsequently revised to 100 patients due to recruitment difficulties. Patients will be randomly allocated on a 1:1 basis to receive either adjunctive ketamine or saline in addition to standard anaesthesia for ECT. The primary neuropsychological outcome measure is anterograde verbal memory (Hopkins Verbal Learning Test-Revised delayed recall task) after 4 ECT treatments. Secondary cognitive outcomes include verbal fluency, autobiographical memory, visuospatial memory and digit span. Efficacy is assessed using observer and self-report efficacy measures of depressive symptomatology. The effects of ECT and ketamine on cortical activity during cognitive tasks will be studied in a sub-sample using functional near-infrared spectroscopy (fNIRS). DISCUSSION: The ketamine-ECT study aims to establish whether or not adjunctive ketamine used together with standard anaesthesia for ECT will significantly reduce the adverse cognitive effects observed after ECT. Potential efficacy benefits of increased speed of symptom improvement and a reduction in the number of ECT treatments required will also be assessed, as will safety and tolerability of adjunctive ketamine. This study will provide important evidence as to whether adjunctive ketamine is routinely indicated for ECT given for depression in routine NHS clinical practice. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN14689382 (assigned 30/07/2012); EudraCT Number: 2011-005476-41.

Partial obstruction of sphincter of Oddi, secondary to Ascaris, is a clinically descried entity. Herewith we describe our institutional experience in a 46-year old gentleman who presented with obstructive jaundice and recurrent cholangitis. On surgical exploration of the common bile duct (CBD), a round worm was found obstructing the proximal lumen and on extraction of the worm, the patient was rendered symptom free postoperatively. He remained asymptomatic after three weeks and on further follow up. Here we describe our case.

INTRODUCTION AND OBJECTIVES: The treatment of renal lesions in the aging population continues to present challenges both from an individualised signatured approach and from a health burden point of view. Recent advances in minimally invasive approaches challenged previous age related bias in deciphering optimal treatment strategies in this population. However, the risk to benefit ratio of surgical treatment of renal lesions in patients aged 80 and over has not been objectively and comprehensively quantified. Herein, we share our experience with the management of this challenging stratum of patients. METHODS: Between Sept. 1989 to Oct. 2014 we performed. 1,100 procedures targeted at renal lesions in a United Kingdom tertiary referral renal cancer center. Data were tallied and interrogated for demographic and outcome parameters. Full comprehensive data was available for 1,084 cases (98.5%). Of this, we selected those aged 80 and over for the present analysis (n1⁄485;8%). RESULTS: The median age of the study population (n1⁄41,084) was 63yrs [range 16-92yrs; IQR: 53-73; Male(M)1⁄466%, Female(F)1⁄4 34%]. Group A(GpA) consisted of patients under 80 years of age [92%] and Group B(GpB) consisted of 80 and over age group (n1⁄485; 8%);[M1⁄460%:F1⁄440%(IQR:81-85)]. From GpB, 84% had procedures for malignant disease and 16% had benign disease. Median American Society of Anaesthesiologists (ASA) score of 2.0. Procedures carried out in GpB included Laparoscopic(Lap) Radical Nephrectomy1⁄414/ 151(9%); Hand Assisted Lap (HAL) Radical Nephrectomy1⁄48/94 (9%); Lap Nephroureterectomy1⁄417/70(24%); Open Nephroureterectomy1⁄47/ 30(23%);HAL Nephroureterectomy1⁄42/8 (25%);Open Simple Nephrectomy1⁄41/16(6%);Open Radical Nephrectomy1⁄415/287(5%);Open Partial Nephrectomy1⁄43/185(2%);Robot Assisted Partial Nephrectomy1⁄43/98(3%) and Cryotherapy(Percutaneous and Lap1⁄413/ 84(15%)]. Overall postoperative length of hospital stay was [GpA 1⁄46 days (1-91) vs. GpB 1⁄46 days (2-31). Clavien Dindo (CD) score in GpA versus GpB was CD1(A1⁄434%vs. B1⁄432%); CD2(A1⁄425%vs.B1⁄424%); CD3(A1⁄47.0%vs.B1⁄45.0%); CD5(A1⁄41%vs.B1⁄41%). In GpA, at a median follow-up of 27 months(1-287), 79% were alive and disease free. In GpB, at a median follow-up of 13 months (1-165), 78% were alive and disease free revealing no significant outcome differences between GpA and GpB. CONCLUSIONS: In patients 80 and over with renal lesions, favourable outcomes can be achieved in dedicated tertiary referral renal cancer centers. In our study when evaluating comparable goups, favourable outcomes were achieved in the 80 and and over age group on par with the under 80 age group. Therefore, the risk to benefit ratio should be weighed carefully and age should not be considered a barrier to intervention.

18 English-language studies published between January 2003 and April 2013 were retrieved from the MEDLINE database using the key word ‘total wrist arthroplasty’. In most studies, total wrist arthroplasty achieved improvement in pain and function over time. In a meta-analysis, the revision rate was 17% for third-generation implants. The survival rate was 92% for fourth-generation implants at 4 years. Complication rates ranged from 0% to 100% for third-generation implants and from 6% to 47% for fourth-generation implants. Results of total wrist arthroplasty vary greatly; longer-term studies are needed to determine its cost-effectiveness.

Metastasis forms the most common brain malignancy. Solitary or multiple ring enhancing intra-axial lesions bordered on the gray-white matter junction with disproportionate edema is the usual pattern on imaging. No reports of high protein content parenchymal metastatic lesion can be found in literature till now. Authors here describe a case of 42 year old female presenting with features of intracranial hypertension and imaging suggestive of a high protein containing lesion. Gross total resection was performed and histopathological features were suggestive of metastatic papillary adenocarcinoma.

The global climate change stabilization regime will have a bearing on future emission pathways of each nation. Corresponding to a combination of stabilization targets and a future global socioeconomic and technology scenario, there are national emissions pathways that when aggregated would make the global regime most cost effective. The underlying hypothesis of this article is that the disaggregated national (regional) scenarios, with explicit inclusion of developing country dynamics in scenario constructions and modeling frameworks, would enhance the qualitative and quantitative understanding of emissions pathways and mitigation strategies compared with the present exercises. The scenario construction for India pays specific attention to developing country dynamics, including multiple socioeconomic and demographic transitions. The article also delineates the lessons for modeling of these transitions in developing countries. The emissions pathways discussion, to begin with, considers 100-year nonintervention scenarios. For the business-as-usual scenario, the optimal portfolio of mitigation interventions in India corresponding to 550ppm (by volume) global concentration stabilization is presented. In conclusion, the article asserts the need for realistic inclusion of developing country transitions in global scenarios and modeling exercises so as to improve the emissions assessments and delineation of mitigation strategies for stabilization.

A finite element model has been developed to simulate two-phase, (i.e., oil and gas) flow and solid deformation in a dual-porosity medium. The model accounts for coupling between solid deformations and fluid flow in both the primary medium (representing the matrix pores and solid) and the secondary medium (used to represent fractures in the present study). The model is verified against relevant analytical solutions and then applied to the problem of an inclined wellbore under generalized plane strain conditions, subjected to a three-dimensional in situ state of stress in a fractured formation saturated with oil and gas. A parametric study has been carried out to demonstrate the effect of dual-porosity parameters, phase saturations, and interaction between the two media. The implementation of double effective stress laws in the present study is a significant deviation from some classical dual-porosity models and helps to incorporate the effect of deformation of the secondary medium (representing the fractures).

The selective serotonin reuptake inhibitor escitalopram is the active enantiomer of citalopram and has proven efficacy in the treatment of major depression, panic disorder and social phobia. Accumulating data indicate that it is also efficacious in the treatment of patients with generalized anxiety disorder. This drug profile summarizes the current evidence-base for the treatment of generalized anxiety disorder, describes the findings of a series of randomized placebo-controlled and comparator-controlled trials of escitalopram, examines the strengths and weaknesses of current treatment approaches and considers potential new therapies for the treatment of this common, chronic and impairing anxiety disorder. In summary, escitalopram is effective and well tolerated in both the short- and long-term treatment of generalized anxiety disorder, and has advantages over benzodiazepines and the selective serotonin reuptake inhibitor paroxetine.

Predicting the native subcellular compartment of a protein is an important step toward elucidating its function. Here we introduce LOCtree, a hierarchical system combining support vector machines (SVMs) and other prediction methods. LOCtree predicts the subcellular compartment of a protein by mimicking the mechanism of cellular sorting and exploiting a variety of sequence and predicted structural features in its input. Currently LOCtree does not predict localization for membrane proteins, since the compositional properties of membrane proteins significantly differ from those of non-membrane proteins. While any information about function can be used by the system, we present estimates of performance that are valid when only the amino acid sequence of a protein is known. When evaluated on a non-redundant test set, LOCtree achieved sustained levels of 74% accuracy for non-plant eukaryotes, 70% for plants, and 84% for prokaryotes. We rigorously benchmarked LOCtree in comparison to the best alternative methods for localization prediction. LOCtree outperformed all other methods in nearly all benchmarks. Localization assignments using LOCtree agreed quite well with data from recent large-scale experiments. Our preliminary analysis of a few entirely sequenced organisms, namely human (Homo sapiens), yeast (Saccharomyces cerevisiae), and weed (Arabidopsis thaliana) suggested that over 35% of all non-membrane proteins are nuclear, about 20% are retained in the cytosol, and that every fifth protein in the weed resides in the chloroplast.

INTRODUCTIONAbdominal cocoon syndrome is characterized by small bowel encapsulation by a fibro-collagenous membrane or “cocoon”. It is a rare cause of intestinal obstruction.PRESENTATION OF CASEA 42-year old man presented with sub-acute intestinal obstruction. Intra-operatively, the entire small bowel was found to be encapsulated in a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesions. Postoperative recovery was unremarkable.DISCUSSIONMost patients with abdominal cocoon syndrome present with features of recurrent acute or chronic small bowel obstruction secondary to kinking and/or compression of the intestines within the constricting cocoon. An abdominal mass may also be present due to an encapsulated cluster of dilated small bowel loops.CONCLUSIONAbdominal cocoon is a rare condition causing intestinal obstruction and diagnosis requires a high index of suspicion because of the nonspecific clinical picture. CECT of the abdomen is a useful radiological tool to aid in preoperative diagnosis. Peritoneal sac excision and adhesiolysis is the treatment and the outcome is usually satisfactory.

Nail-patella syndrome (NPS) is an autosomal-dominant pleiotropic disorder characterized by dyplasia of finger nails, skeletal anomalies and frequently renal disease. In the reported case, genetic analysis revealed a new missense mutation in the homeodomain of LMX1B, presumed to abolish DNA binding (c.725T>C, p.Val242Ala). A missense mutation at codon 725 was identified, where thymine was replaced by cytosine which led to the replacement of valine by alanine at position 242. It was not detected in both parents. A 2005 study by Bongers et al. described a significant association between the presence of clinically relevant renal involvement in an NPS patient and a positive family history of nephropathy, which was lacking in our case.

The need for compact models for ICs is a well-recognized problem in electronics cooling simulations of systems containing multiple PCBs and many devices per board. The disparate length scales inherent in the problem and the necessity of resolving these size scales renders the computational problem intractable. Many resistance-capacitance (RC) network compact models have been proposed in the literature. We present a methodology to automatically construct both the topology and characteristics of the reduced-order or compact models of devices (primarily Integrated Circuit (IC) packages) for use in system-level simulations using the multigrid operator. The multigrid technique has been extensively used over the past 20 years to accelerate the solution of liner systems. In addition to automatically generating both the RC network topology and its values, the procedure is general enough to be applicable for complex IC device types like Multi-Chip Modules (MCMs), stack up dies, distributed sources on the die, DC-DC converters and devices such as hard disk drives.Copyright © 2003 by ASME

LOCtarget is a web server and database that predicts and annotates sub-cellular localization for structural genomics targets; LOCnet is one of the methods used in LOCtarget that can predict sub-cellular localization for all eukaryotic and prokaryotic proteins. Targets are taken from the central registration database for structural genomics, namely, TargetDB. LOCtarget predicts localization through a combination of four different methods: known nuclear localization signals (PredictNLS), homology-based transfer of experimental annotations (LOChom), inference through automatic text analysis of SWISS-PROT keywords (LOCkey) and de novo prediction through a system of neural networks (LOCnet). Additionally, we report predictions from SignalP. The final prediction is based on the method with the highest confidence. The web server can be used to predict sub-cellular localization of proteins from their amino acid sequence. The LOCtarget database currently contains localization predictions for all eukaryotic proteins from TargetDB and is updated every week. The server is available at http://www.rostlab.org/services/LOCtarget/.

Cavernomas arising from nerve roots in the cauda quina are extremely rare with less than 30 reported cases in world literature. We report a case of a 21-year old lady with a L3-4 cavernoma successfully managed by surgery thereby adding to the general fund of knowledge on this rare entity.

Entrepreneurship is the driver of growth. It helps creating innovative enterprises which provide foundation for building a nation's competitiveness. Enterprise creation needs risk capital. Venture capitalists provide risk capital and facilitate the development of entrepreneurship. There are several issues relating to entrepreneurship development and venture capital that deserve serious discussion. To put these issues into perspective, the Centre for Innovation, Incubation, and Entrepreneurship and Entre Club at IIMA organized a panel discussion which was coordinated by I M Pandey, Professor at Indian Institute of Management, Ahmedabad. Some of the key questions that the panel has addressed to are: What is the contribution of entrepreneurship in the economic development of India? What factors have facilitated or hindered the development of entrepreneurship in India? What role has venture capital played in fostering the growth of entrepreneurship in India? What do entrepreneurs look for from venture capitalists other than the capital in the growth of their enterprises? What are the experiences of venture capitalists and entrepreneurs vis-a-vis the interface between venture capital and entrepreneurship? The following are some important points that emerged from the panel discussion: There is a direct link between entrepreneurship and the economic growth. There is some evidence that entrepreneurship has made contribution to India's growth. Factors responsible for the slow growth of entrepreneurship and lack of innovative spirit included the faulty education system, absence of proper incentives and environment to innovate, lack of proactive and favourable government policies, non-availability of risk capital, and the Indian mindset favouring comfortable and secured career choices. Entrepreneurship is a prerequisite for building our nation's global competitiveness. There is no short-cut. The liberalization of the Indian economy and the increased access to the global capital have paved way for entrepreneurship development and for facing international competition. The role of venture capital in fuelling the growth of entrepreneurship is inevitable. Venture capitalists need to play a proactive role. The Indian experience shows that venture capital is capable of creating a facilitating environment to build entrepreneurship culture and help entrepreneurship develop as a preferred career option. Venture capitalists should play the dual role of financiers and mentors. They should facilitate the networking of entrepreneurs with customers, distributors, financial institutions, consultants, etc. Efforts should be made by public and private sectors to create critical mass of venture capital funds, especially to finance start-ups and ventures of the first-time entrepreneurs. The education system in India should focus on developing entrepreneurship skills and risk-taking abilities of students.

This paper presents entrepreneurship as an emotional pursuit. It is the gut feeling that is most important in making a start-up decision. Drawing on his own experiences and of those closely associated with start-ups, the author offers a framework that reflects on how a company can be started-the various stages, the key problems in each stage, and suggestions for sailing smoothly through them. The different stages are as follows: Confusion: It includes three phases of Fright, Flight, and Fantasy. The initial apprehensions of a failure could hold an aspirant from starting up. It is possible that he gets frightened about the possibility of failure or gets frustrated about his lack of focus and keeps jumping from one idea to another or be overconfident about the success of his idea. Crossing threshold: The limited few who cross the stage of confusion face the three P's: Peer Pressure, Procrastination, and Poverty. A green signal from family, friends, and industry leaders and the confidence of a sound financial backing are important for a take-off. Although starting up should be a bold step, yet one needs to have at least six months financial expenses, an activity plan for the first month, and lots of ‘hope’ in the baggage. Start-up: The key issues at this stage include how to set up a team, share equity or raise funds. It is important to realize that responsibilities cannot be shared equally. There has to be a leader with highest equity who would be ready to own the consequences of a decision. First thousand days: This is believed to be the decisive phase. There could be difficulties in capturing clients, managing too many jobs at a time or getting payments in time. At this stage, it is very important to have a clear set of priorities, be flexible, and responsible. Success or failure would also depend a lot on how the ‘hard’ issues such as finance, marketing, technology, and partnership and alliances are tackled. Growth: Once the company crosses the hurdles of the first thousand days and is in the winning track, there emerges the fear of losing focus. This is the most difficult period in the company's life with the possibility of the business ending up in a disaster. To sustain the focus on organizational growth, it is important for the entrepreneurs to: decide whether he really wants to grow and if yes, be prepared to face the emerging issues separate the two roles of investor and entrepreneur-manager break the vicious cycle of money-recruitment-retention align the important individuals to a common organizational vision through equity. No entrepreneur should forget the supremacy of cash, mind, and intuition. He who has these would be able to fight, take rational decisions, and remove mistakes at the earliest. Above all, what is important is to enjoy the journey towards the destination.

Colloid cysts are benign cystic lesions located in the third ventricle close to the foramina of Monro and carry a good prognosis following surgery. Hemorrhage within a colloid cyst is an extremely rare cause for sudden deterioration, with potentially fatal complications. We report the case of a 60‑year‑old lady who presented with a hemorrhagic colloid cyst. The patient was managed successfully by microsurgery.