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Background: Introduction of laparoscopic surgical methods requires exact knowledge of the topography of the spleen and its surrounding. Further advances in splenic conservative surgery are dependent on better knowledge of vascular anatomy of the spleen. Hence segmental arteries of spleen are of great surgical importance and their early identification in splenic trauma will lead to enhanced splenic conservation. Materials and methods: Present study carried out on 50 human spleen by dissection, silicon injection and radiological methods. We found different types of variations in hilar and segmental branching pattern of splenic artery. Observations and Results: in present study splenic artery divided in two primary branches in 86% and in three primary branches in14% of the spleens. superior polar branches were found in 44% while inferior polar branches were in 52% of the spleens. Two segmental branches found in 24%, three segmental found in 50%, four segmental in 18% and five segmental in 8% of the specimens. Intersegmental anastomosis found in 2% of spleens. Discussion: These segmental resection of spleen and further advances in splenic conservation are dependant on better understanding of vascular anatomy of the spleen.

Higher-risk myelodysplastic syndrome (HR-MDS) has a poor prognosis in the absence of efficient therapy. The evaluation of new therapies in animal models of HR-MDS is hampered by the absence of accurate in vivo biomarkers of the disease. In this study we compared [18F]Fluoro-desoxyglucose Positron Emission Tomography (FDG-PET) and [18F]Fluoro-thymidine (FLT)-PET imaging for disease follow-up in a triple transgenic MMTVtTA/TetoBCL-2/MRP8NRASD12 mouse model of HR-MDS. Normal control FVB/N mice (G1,n=9) and HR-MDS mice (G2,n=12) underwent both FDG- and FLT-PET procedures at 2-day intervals, on a dedicated small animal device. Blood cell counting, BCL-2 and Mac-1hi/Gr-1lo expression measurements in blood were performed before each PET procedure. Visually, PET images of G2 mice demonstrated homogeneous FDG uptake in the whole skeleton similar to that observed in G1 mice, and abnormal FLT hot spots in bone marrow not observed in G1 mice. The intensity of FLT hot spots in bone marrow was higher in 3-months old G2 mice than in 2-months old G2 mice, concordant with a higher percentage of cells expressing Mac-1hi/Gr-1lo and lower platelets counts. We conclude that FLT-PET/CT imaging is a more valuable surrogate non-invasive quantitative marker of HR-MDS bone marrow involvement than FDG-PET/CT in our mouse model of HR-MDS.

Introduction Cardiac involvement is the major prognostic factor in patients with light chain amyloidosis (AL). Cardiac dysautonomia can occur early in amyloidosis and can be assess by Iodine-123-metaiodobenzylguanidine (123I-MIBG) scintigraphy. Its prognostic value has been shown in TTR amyloidosis but is unknown in AL amyloidosis. We aimed to evaluate the prognosis impact of cardiac dysautonomia in patients with AL amyloidosis. Methods We carried out a prospective study in consecutive patients with biopsy-proven AL amyloidosis. All patients underwent clinical examination, EKG, echocardiography, cardiac MRI and biological tests. The 2012 Mayo clinic prognostic classification was calculated by using blood levels of NT-proBNP, cardiac T troponin and the differential of free light chains as recommended. The sympathetic cardiac innervation was assessed by using 123I-MIBGscintigraphy and measurement of the heart-to-mediastinum uptake ratio (late H/M) in the anterior view of the chest. A cardiac denervation was defined by late H/M Results Fifty consecutive patients with AL amyloidosis were included. The median age was 68 years old [58–73]. By using both echocardiography and MRI, cardiac involvement was diagnosed in 33 patients (66%) and thirteen of these patients were NYHA class III or IV. By using Mayo clinic classification, patients were I, II, III and IV classes in 9 (18%), 14 (28%), 16 (32%) and 11 (22%) cases respectively. According to echocardiographic data, the median wall thickness of left ventricle was 13 mm [12–15]. The late H/M was 1.51 [1.33–1.67]. Cardiac denervation was found in 44 patients (88%). The 6 patients (12%) with a normal late H/M had no cardiac amyloidosis involvement. During a median follow-up of 24 months, 9 patients (18%) died. The area under the ROC curve of late H/M for predicting death was 0.74 (CI 95% 0.58–0.86). According to this curve, the best threshold was 1.44 and 7 of the 9 patients who died had late H/M ≤1.44. The figure shows the 2 year-survival according to late H/M. Late H/M ≤1.44 predicted all-cause death irrespective of the Mayo clinic classification: HR 8.0 (CI 95% 2.1–63) after adjustment on the Mayo clinic score (p=0.005). In addition, unplanned hospitalization for heart failure occurred in 8 patients with late H/M ≤1.44 versus 3 patients with late H/M >1.44 (p=0.03). Survival according to late H/M Conclusion Late H/M ≤1.44 is predictive of adverse outcomes in patients with AL amyloidosis, independently of the Mayo Clinic prognostic classification.

Background Sentinel lymph-node (LN) biopsy (SLNB) is a valuable tool to assess the regional LN status in Merkel cell carcinoma (MCC). However, its prognostic value is still debated. This study was undertaken to assess SLNB usefulness for MCC management and to determine the impact of SLNB status on disease-free survival (DFS) and overall survival (OS) by comparing SLNB-positive versus -negative patients according to demographic, clinical and treatment characteristics. Patients and methods In this retrospective, multicenter observational study, SLNB was proposed to all patients referred for clinically N0 MCC. Treatment schedule consisted of wide-margin surgical resection of primary MCC followed by adjuvant radiation therapy (aRT) to the primary site and, for SLNB-positive patients, radical LN dissection followed by regional aRT. Univariate and multivariate analyses determined factors associated with DFS and OS. Results Among 87 patients with successful SLNB, 21 (24.1%) were SLNB-positive. Median follow-up for the entire series was 39 months; respective 3-year DFS and OS rates were 73% and 81.4%, respectively. Univariate analysis (all patients) identified SLNB-negativity as being associated with prolonged OS (P = 0.013) and aRT (all sites considered) was associated with longer DFS (P = 0.004) and OS (P = 0.018). Multivariate analysis (all patients) retained SLNB status and aRT (all sites considered) as being associated with improved DFS (P = 0.014 and 0.0008) and OS (P = 0.0020 and 0.0019). Moreover, for SLNB-negative patients, tumor-bed irradiation was also significantly associated with prolonged DFS (P = 0.006) and OS (P = 0.014). Conclusion(s) The present study demonstrates that SLNB-negativity is a strong predictor of longer DFS and OS in stage I and II MCC patients. The similar benefit for aRT on tumor bed observed in this study has to be confirmed by a prospective study. The results advocate for SLNB being considered to all MCC patients.

Resume Contexte La selection des patients atteints de carcinose peritoneale (CP) est essentielle afin d’identifier les candidats a une chirurgie de cytoreduction associee a une chimiotherapie hyperthermique intraperitoneale peroperatoire (CHIP) a visee curative. L’interpretation de la TEP/TDM au 18F-FDG peut parfois conduire a recuser a tort un patient eligible a une chirurgie de cytoreduction avec CHIP en raison d’une hyperfixation non tumorale. Objectifs Determiner le taux de faux positifs de la TEP/TDM au 18F-FDG et en eclaircir les causes possibles chez les patients suspects de CP d’origine colorectale. Methodes Une etude retrospective portant sur 37 patients suspects de CP d’origine colorectale ayant eu une TEP/TDM au 18F-FDG avant chirurgie de cytoreduction avec CHIP a ete realisee pour determiner le taux et les causes des faux positifs. La TEP/TDM au 18F-FDG etait consideree faussement positive quand aucune tumeur n’etait identifiee en peroperatoire, par l’analyse histologique et durant du suivi. Resultats Des lesions etaient faussement classees comme tumorales par la TEP/TDM au 18F-FDG chez quatre patients soit un taux de faux positifs de 11 % (IC 95 % : 3–25 %). Les causes de ces faux positifs ont ete elucidees chez deux patients (filet prothetique de cure d’eventration abdominale et granulome a corps etranger). Conclusion Des faux positifs de la TEP/CT au 18F-FDG sont observes chez 11 % des patients suspects de CP d’origine colorectale. Une connaissance plus precise des causes de faux positifs permettrait une meilleure selection des patients candidats a la chirurgie de cytoreduction avec CHIP.

Summary Background Optimal selection is critical in patients with peritoneal carcinomatosis (PC) in whom curative cytoreductive surgery can be anticipated. 18F-FDG-PET/CT may result in false-positive findings that may eliminate patients for whom cytoreductive surgery would be beneficial. Objectives To determine the rate of false-positive findings on 18F-FDG-PET/CT and clarify their causes in patients with suspected PC from colorectal cancer. Methods A retrospective analysis of 37 patients with suspected PC from colorectal cancer who had 18F-FDG-PET/CT before cytoreductive surgery was performed to determine the rate and the causes of false-positive findings. 18F-FDG-PET/CT was considered falsely positive when no tumor was found at surgery, histopathological analysis and follow-up. Results False-positive findings were observed in four patients, yielding a 11% (95%CI: 3–25%) false-positive rate on a per-patient basis. The causes of false-positives were elucidated in two patients (surgical mesh after umbilical hernia repair and one foreign body granuloma). Conclusion False-positive findings on 18F-FDG-PET/CT are observed in 11% of patients with suspected PC from colorectal cancer. Familiarity with false-positive findings would result in more accurate selection of patients candidates to cytoreductive surgery.

Resume Les champs d’application de l’imagerie post-mortem sont en croissance exponentielle depuis 10 ans. Son potentiel pour identifier la cause du deces dans des situations traumatiques et balistiques est maintenant correctement documente. Dans la pratique pediatrique et perinatale, des grandes series sont moins nombreuses, sauf pour l’IRM et en particulier l’analyse du systeme nerveux central ou les preuves scientifiques sont maintenant robustes. Apres un bref rappel historique et l’analyse de l’etat de l’art, nous allons essayer de decrire les defis actuels et la facon dont nous voyons l’avenir de cette sur-specialite de l’imagerie en coupe post-mortem, en particulier dans les situations specifiques a la perinatalite.

In the world of connected enterprises and Internet of Things (IOT), millions of users and devices are connecting and transacting online simultaneously. Further, introduction of multi-core hardware platforms resulted in multi-fold increase in processing speed and volumes. To support the increasing volumes generated, building end-end-end scalable business applications has become the key focus of these service organizations. The reliability expectation of these systems is 100% and hence persisting of transaction information and key activities information is crucial to the success of the business applications. However, the performance of such software applications is inherently limited by disk input/output (I/O). Often, CPU activity gets suspended till I/O activity completes. Redesigning and tuning I/O can enhance application performance significantly. This paper presents our approach of ‘Log Flush Daemon Service’ (LFDS) in which application takes control of the I/O by taking it off the main transaction path along with hybrid of approaches from the techniques for optimization of the ancillary tasks of logging. This helps to enhance the performance, reduce the jitter and outliers.

Large mission critical real-time legacy OLTP systems supporting the service sectors like banking, telecom, and financial services are monolithic in nature and thereby not flexible to enable business transformation which is the need of the hour due to emerging dynamic changes to business ecosystem. Broadly speaking, these large mission critical applications can be classified into three stages of activities: pre-processing, core business processing and post processing activities. This paper focuses on making the Business processing activities tier lean and efficient. By leveraging recent advances in technologies, a methodology is described by which the OLTP applications can be successfully transformed into agile systems. The methodology enables a view of the Business Tier in five dimensions. The first dimension is identifying the business‟s core critical path and how to make it lean. The second dimension is how to enhance concurrency of the activities in the critical path. The third dimension is to improve the parallelism in execution of concurrency. The fourth is to separate I/O operations off the critical path. The fifth being how to minimize contentions for shared resources to ensure higher efficiencies. The paper also presents, the results of the experiments carried out by applying the above recommendation and the performance improvements to decide the optimal setup for an environment for given workload. Addressing the five dimensions of Business Tier, this paper demonstrates the transformation that can be achieved which will enable the business to be agile and respond to market ecosystem demands in a very efficient and effective manner.

Queries are expressed by farmers related to their crop in natural language, which are usually answered by human experts. Knowledge required to answer such queries can be modeled as ontologies that include agricultural practices, data related to the farm being queried about, recent weather conditions, and other contextual information. Farmers depend on trends followed by other farmers, vendor recommendations, and government advisories, which form a part of the spatiotemporal context. OntoAQ is an ontology-based knowledge system that is designed for answering questions based on a fact database. We have implemented OntoAQ using a cotton crop database and provide a keyword-based query interface to enable farmers to ask specific questions about the problem they face. Questions are filtered using context parameters such as the crop and activities that the farmer is engaged in. Context parameters are inferred from the ontological information. Based on the users’ input, answers are provided using a graph-matching algorithm that locates the set of best matches. Answers are ranked based on relevance of the keywords. We discuss the relevance ontologies of farming practices based on spatial and temporal contexts of each activity and provide recommendations to further improve the system.

Making efficient evacuation plans for large buildings is an important task in operating a large building infrastructure. The plans require a capacitated building network, well-defined exit points, and expected occupancy of a building to analyze evacuation time in different scenarios. Such type of analyses helps us in both the re-design to improve evacuation times as well as for creating more optimal allocations of the building spaces. In this chapter, we model the problems in the following two different types of situations and present heuristic algorithms which are extensions of the existing capacity-constrained route planner (CCRP) algorithm: (i) Additional exits with ladders need to be placed for faster evacuation, and (ii) all evacuees cannot be evacuated by themselves and require help from rescuers. For large and complex buildings, it is difficult to model indoor network and understand an evacuation plan for different scenarios without any user interactive interface. We have designed an evacuation planner which is publicly available and can be used for making indoor network from floor images, creating multiple scenarios, computing evacuation plans of these scenarios, and performing sensitivity analyses of an evacuation plan to evacuees’ behavior.

Over the past years, efforts have been made by the NSDI to re-engineer the geospatial feature data sets and compile and serve their metadata as per ISO/OGC specifications. These are required for provision of interoperable geospatial data services in a service-oriented architecture and automated development of GIS applications. Identification, registration and maintenance of metadata of the feature data sets and related services from the national- and state-level partnering agencies in a central metadata registry, called the National Data Registry (NDR), are essential for improving data utilization. Registering spatial data sets and services may typically involve capturing their semantics (definition), making each data item persistently and uniquely identifiable by assigning unique identifiers and organizing/maintaining their schema and associated classification systems (code lists) in a set of standard registers. In line with these requirements, a proof-of-concept (PoC) of a National Data Registry (NDR) for the Indian NSDI has been implemented and demonstrated using data services from Survey of India, National Remote Sensing Centre and the Ministry of Railways’ train running information. The PoC successfully demonstrated the utility of a sample registry and technical architecture and led to the development of a strategy for selection of a suitable system integrator for a real-life NDR development for the NSDI.