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Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes.

BACKGROUND AND AIM: Diffusion-weighted imaging (DWI) has now become an integral component of the musculoskeletal tumor protocol magnetic resonance imaging (MRI). Although a conventional radiograph is still considered the primary modality, MRI is invariably performed for further characterization of the tumor. Being a fast noncontrast sequence and considering its role in detecting highly cellular lesions, DWI can prove as a helpful tool for those who have inconclusive radiographic or conventional MRI diagnosis. The aim of this study was to determine the role of DWI and apparent diffusion coefficient (ADC) value in the evaluation and differentiation of malignant and benign bones and soft-tissue neoplasms. We also derived a cutoff ADC value to differentiate the above two. MATERIALS AND METHODS: This is an IRB-approved retrospective study of 85 patients with histopathologically proven bone (n = 61, 47 malignant and 14 benign) or soft-tissue (n = 24, 21 malignant and 3 benign) neoplasms. Conventional MR features such as size, margins, T1/T2 signal intensity, cortical breach/bone expansion/medullary involvement, and neurovascular bundle involvement were assessed. DWI analysis was done by a blinded radiologist having MRI reporting experience of 3 years by placing three regions of interest on solid (nonnecrotic) components, and mean ADC values were derived for each neoplasm. These were confirmed by another senior radiologist with an experience of more than 15 years with MRI. Histopathological diagnosis was considered a gold standard. Mean ADC values of the benign and malignant groups were compared statistically. Sensitivity, specificity, and diagnostic accuracy were obtained. Receiver operating characteristic (ROC) curves were generated, and a cutoff ADC value was derived to differentiate benign and malignant tumors. RESULTS: True visual diffusion restriction was confirmed among 34/47 malignant bone tumors on b-800 DW images, whereas 10/14 benign bone tumors showed facilitated diffusion. Similarly, visual restriction was seen among 20/21 malignant soft tumors, whereas 2 out of 3 benign soft-tissue tumors showed visually facilitated diffusion. Statistically, a significant difference was noted between the mean ADC value of malignant (1.20 ± 0.68 × 10−3 mm2/s) and benign bone tumors (1.57 ± 0.69 × 10−3 mm2/s) (P = 0.04). Relatively high ADC values were noted in the chondrosarcoma group (n = 19), with 11/19 chondrosarcomas showing facilitated diffusion with a mean ADC value of 1.73 × 10−3 mm2/s. Similarly, among benign bone tumors, contrary to expectation, relatively lower ADC values were noted in giant cell tumors (n = 4) with a mean ADC value of 1.18 × 10−3 mm2/s. For soft-tissue tumors, a lower mean ADC value was noted for the malignant (0.85 ± 0.26 × 10−3 mm2/s) versus the benign group (1.33 ± 0.20 × 10−3 mm2/s) (P = 0.006). For bone neoplasms, a cutoff mean ADC value of 1.1 × 10−3 mm2/s was derived from the ROC curve with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 72.3%, 71.4%, 89.5%, and 43.5%, respectively. For the soft-tissue group, a cutoff mean ADC value of 1.0 × 10−3 mm2/s was achieved with sensitivity, specificity, PPV, and NPV of 100%, 85.7%, 50%, and 100%, respectively. CONCLUSIONS: In addition to conventional MR, DWI with ADC analysis is a powerful tool in musculoskeletal tumor evaluation and an ADC cutoff value may help differentiate benign from malignant neoplasms. In chondroid malignancies, relatively high ADC values may be seen and DWI analysis may not be as useful.

Carbon nanotubes have been explored in various fields of science and technology due to their unique properties. However, their toxic nature put limitations to its consideration for the bio-medical applications. In our work, we report the synthesis of paramagnetic CNT/Gd2O3 hybrid nanostructures through easily scalable electrochemical deposition technique. The nanostructure has shown significant longitudinal relaxivity of 18.93 mM−1s−1 for water protons indicating its possibility to be used as an MRI contrast agent. The in-vitro cytotoxicity test on the normal (HaCaT) and cancerous (HeLa) cells reveal that CNT/Gd2O3 hybrid nanostructure is bio-compatible in comparison to the pure CNTs, which is further supported by our theoretical studies using MD simulations.

Background This study was conducted to compare the immunogenicity and safety profile of two quadrivalent influenza vaccines (QIVs) in healthy adults (18–60 years) and elderly (>61 years) participants. Method This phase III study was conducted from March 2018 to April 2018 across 12 sites in India. In this randomized, observer-blind, active-controlled study, 480 participants were randomized to receive a single dose of test vaccine (subunit, inactivated influenza vaccine; Influvac® Tetra, Abbott) (n = 240) or reference vaccine (split virion, inactivated influenza vaccine; VaxiFlu-4, Zydus Cadilla Healthcare) (n = 240). The primary objective was to describe and compare the immunogenicity of each vaccination group based on hemagglutination inhibition (HI) assay seroprotection and seroconversion rates, and geometric mean fold increase (GMFI) against four vaccine strains in two age groups. Safety and reactogenicity were also compared for the vaccines in both the age groups. Results The pre- and post-vaccination HI titers for both the vaccines were comparable. The GMFI varied from 4.3 – 22.7 in the test and 3.7–21.6 in the reference vaccine group. The seroprotection rates were >90% for the A-strains and ranged between >43% and

The paper presents the analysis of closed-die forging of eccentrically-located SiCp AMC cylindrical preforms at cold conditions using ‘U pperBound0 approach. The deformation has been considered in two subsequent stages, i.e. free barreling and constrained deformation stages. The second stage was again divided into two modes, i.e. unilateral and bilateral constrained deformations. For basic experimental analysis, the preforms were fabricated via liquid metal stir casting manufacturing route using LM6 Aluminium alloy and Silicon Carbide particles as reinforcements. These preforms were located eccentrically in the closed-die with respect to the die axis and subsequently forged into double-hub flange components. The generalized expressions for the velocity field, strain rates, various energy dissipations and average forging load were formulated for all the above deformation stages and results were compared with the experimental findings. It is expected that the present work will be useful for the analysis of the precision net-shape flashless closed-die forging operations at cold conditions.

Schwannoma occurring in the psoas muscle is rare. We report a 49-year-old male who presented to the orthopaedic oncosurgery team with persistent lower back pain radiating to the right lower limb following a fall on the back a few months ago. Magnetic resonance imaging revealed a well-defined lesion in the right psoas muscle at the level of third lumbar vertebra (L3). He underwent a laparoscopic excision of this mass using one 10 mm and two 5 mm ports. Intraoperative frozen section after a complete excision showed this to be a benign schwannoma. He was discharged the day after surgery. His symptoms gradually reduced over a period of time and he remains well 3 years after surgery. This case highlights the feasibility and safety of minimally invasive treatment of this rare tumour.

Background: Withaferin-A (WA), an active principle obtained from a traditional Indian herb known as Ashwagandha or the Indian ginseng, has been shown to prevent and cure urethane-induced lung tumors in mice, and also inhibit the growth of transplanted sarcoma in mice. Objectives: In this study, we evaluated the safety and pharmacokinetics of WA in patients with advanced stage high-grade osteosarcoma. Methods: A phase I dose escalation study was planned using the classical 3 + 3 design (C33D). Dose escalation cohorts comprised of 72, 108, 144 and 216 mg of WA administered in two to four divided doses per day. Three patients were enrolled in each cohort and the last patient was observed for at least 30 days for any dose-limiting toxicity before progressing to a higher cohort. Pharmacokinetic studies were performed using high performance liquid chromatography (HPLC) technique with sensitivity up to 50 ng/ml. Safety evaluation including clinical examination, detailed history of adverse events, Liver Function Tests , Renal Function Tests and complete blood counts were performed at each visit. WA was administered daily till progression. Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 was used for grading adverse events. Results: The formulation used was generally well tolerated. Eleven adverse events of grade 1 or grade 2 severity were observed. No grade 3 or grade 4 adverse events were observed. Elevation of liver enzymes (5/11) and skin rash (2/11) was the most common adverse events. Other adverse effects include fatigue, fever, edema, and diarrhea (one each). None of the patients had detectable levels of WA in circulation. Conclusion: The formulation was well tolerated. However, WA appears to have low oral bioavailability. Further studies with improved formulations are warranted. Keywords: Withaferin-A, Ashwagandha, Osteosarcoma, Safety, Pharmacokinetics

Summary: Most of the knowledge in materials science literature is in the form of unstructured data such as text and images. Here, we present a framework employing natural language processing, which automates text and image comprehension and precision knowledge extraction from inorganic glasses’ literature. The abstracts are automatically categorized using latent Dirichlet allocation (LDA) to classify and search semantically linked publications. Similarly, a comprehensive summary of images and plots is presented using the caption cluster plot (CCP), providing direct access to images buried in the papers. Finally, we combine the LDA and CCP with chemical elements to present an elemental map, a topical and image-wise distribution of elements occurring in the literature. Overall, the framework presented here can be a generic and powerful tool to extract and disseminate material-specific information on composition–structure–processing–property dataspaces, allowing insights into fundamental problems relevant to the materials science community and accelerated materials discovery. The bigger picture: Most knowledge generated through scientific enquiry in materials domain is presented in the form of unstructured data. Among the available sources such as online websites, digital data, and publications, peer-reviewed journals serve as the undisputed source of reliable information regarding materials synthesis, characterization, and properties. Despite the availability of large data, only a limited fraction is compiled in the form of machine-readable databases, most of which are manually curated. Here, applying natural language processing on a large corpus of journal publications on inorganic glasses, we present a framework of information extraction from text and images, which answers queries related to synthesis and characterization techniques, and even chemical elements used. The scalable approach presented here can be applied to other domains for efficient information retrieval from scientific literature.

Background: Because nearly 23,000 more neurosurgeons are needed globally to address 5 million essential neurosurgical cases that go untreated each year, there is an increasing interest in task-shifting and task-sharing (TS/S), delegating neurosurgical tasks to nonspecialists, particularly in low- and middle-income countries (LMICs). This global survey aimed to provide a cross-sectional understanding of the prevalence and structure of current neurosurgical TS/S practices in LMICs. Methods: The survey was distributed to a convenience sample of individuals providing neurosurgical care in LMICs with a Web-based survey link via electronic mailing lists of continental societies and various neurosurgical groups, conference announcements, e-mailing lists, and social media platforms. Country-level data were analyzed by descriptive statistics. Results: The survey yielded 127 responses from 47 LMICs; 20 countries (42.6%) reported ongoing TS/S. Most TS/S procedures involved emergency interventions, the top 3 being burr holes, craniotomy for hematoma evacuation, and external ventricular drain. Most (65.0%) believed that their Ministry of Health does not endorse TS/S (24.0% unsure), and only 11% believed that TS/S training was structured. There were few opportunities for TS/S providers to continue medical education (11.6%) or maintenance of certification (9.4%, or receive remuneration (4.2%). Conclusions: TS/S is ongoing in many LMICs without substantial structure or oversight, which is concerning for patient safety. These data invite future clinical outcomes studies to assess effectiveness and discussions on policy recommendations such as standardized curricula, certification protocols, specialist oversight, and referral networks to increase the level of TS/S care and to continue to increase the specialist workforce. Key words: Capacity, Global health, Global neurosurgery, LMIC, Task-sharing, Task-shifting, Workforce

Traditionally, conventional periapical radiology formed the backbone of endodontics for diagnosis, treatment planning, and management. One of the major associated gripes being the technique created two-dimensional images of three-dimensional (3D) structures, suffered magnification, superimposition, and distortion, leading to compromised diagnostic information. The need to analyze the area of interest in all the possible planes led to the introduction of cone-beam computed tomography (CBCT), a novel modality specifically designed to produce precise, undistorted 3D reconstructed images of the maxillofacial skeleton. CBCT is increasingly being embraced by various fields in dentistry, remarkably in endodontic practice. A systematic literature-based and book-based review was conducted using the keywords “CBCT in endodontics” and “endodontic applications of CBCT.” This article hereby discusses the prospects of CBCT in endodontics with an emphasis on its application in diagnosis and management along with treatment outcome assessment.

Bone sarcomas are rare tumors, approximating 0.2% of all cancers, with osteosarcoma (OGS), chondrosarcoma, and Ewing sarcoma being the most common cancers in this subset. The formation of disease management groups/clinics focused on sarcomas has resulted in better understanding and management of these uncommon tumors. Multiple large-scale retrospective data from Tata Memorial Hospital (TMH) and All India Institute of Medical Sciences have reported outcomes comparable to Western data in the field of OGS and Ewing sarcoma, with interesting prognostic factors identified for further evaluation. Soft tissue sarcomas are a rare heterogeneous group of tumors, more than 50 different tumor entities. The common subtypes identified in India include Ewing sarcoma and synovial sarcoma. Valuable work regarding brachytherapy has been done by radiation oncologists from the TMH, especially in pediatric patients.

Aims: The aim of this study was to evaluate the number of intracanal bacteria extruded apically during root canal preparation using rotary ProTaper, K3XF, twisted, and hand K-file system. Subjects and Methods: Seventy extracted single-rooted human mandibular premolar teeth were used. Access cavities were prepared and the teeth were mounted in glass vials. Root canals were then contaminated with a pure culture of Enterococcus faecalis (ATCC 29212) and incubated at 37°C for 24 h. The contaminated roots were divided into four experimental groups of 15 teeth each and one control group of 10 teeth. Group 1: ProTaper; Group 2: K3XF; Group 3: Twisted file; Group 4: Hand K-file; Group 5: Control group. Bacteria extruded from the apical foramen during instrumentation were collected into vials. The microbiological samples were incubated in culture media for 24 h. Colonies of bacteria were counted and the results were given as number of colony-forming units (CFU)/ml. Statistical Analysis Used: The obtained data were analyzed using the Kruskal–Wallis one-way analysis of variance and Mann–Whitney U-tests. Results: There was a significant difference between the rotary and hand instrumentation system related to the apically extruded intracanal bacteria. Conclusions: Both the rotary and hand instrumentation systems extruded intracanal bacteria through the apical foramen. K3XF file system showed least bacterial extrusion amongst all instrumentation groups.

The oral-facial-digital syndromes (OFDS) are rare genetic heterogenous group of disorders characterized by oral (mouth and teeth), facial and digital (fingers and toes) anomalies. OFDS are classified into 13 potential forms. OFDS Type II (Mohr syndrome) is an autosomal recessive disease characterized by oral (median cleft/pseudocleft lip, lobed tongue, high arched or cleft palate), facial (low nasal bridge with lateral displacement of inner canthi, broad nasal tip, retromicrognathia) and digital anomalies (clinodactyly, syndactly and polydactyly of hands and feet and duplication of thumb and hallux). This is the case report of an indian new born with OFDS type 2 manifestations.