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This article describes an innovative methodology to calibrate EM simulators, oriented to monolithic microwave integrated circuit design, in order to achieve the highest level of accuracy achievable in electromagnetic simulation. In particular, a two-stage measurement technique based on two types of network analyzer calibrations is adopted as a practical and accurate process for on-wafer S-parameter measurements of suitable test structures on semiconductor epitaxial wafers. Thus, a substrate parameter set for the electromagnetic simulator is appropriately identified by an optimization process that combines measurements of dedicated simple test structures and the corresponding models in the circuit simulator. The proposed approach allows one to accurately estimate the substrate characteristics without realizing expensive on-wafer structures that require a large substrate area. We will demonstrate, through several comparisons between measurements and electromagnetic simulations of different passive structures, how higher accuracy can be achieved, describing and quantifying the limitations that arise from commonly adopted calibration procedures for electromagnetic simulators.

Radiotherapy (RT) and electrochemotherapy (ECT) are established local treatments for cancer. While effective, both therapies have limitations, especially in treating bulky and poorly oxygenated tumors. ECT has emerged as a promising palliative treatment, raising interest in exploring its combination with RT to enhance tumor response. However, the potential benefits and challenges of combining these treatments remain unclear. A systematic review was conducted following PRISMA guidelines. PubMed, Scopus, and Cochrane libraries were searched. Studies were screened and selected based on predefined inclusion and exclusion criteria. Ten studies were included, comprising in vitro and in vivo experiments. Different tumor types were treated with ECT alone or in combination with RT. ECT plus RT demonstrated superior tumor response compared to that under single therapies or other combinations, regardless of the cytotoxic agent and RT dose. However, no study demonstrated a clear superadditive effect in cell survival curves, suggesting inconclusive evidence of specific ECT-induced radiosensitization. Toxicity data were limited. In conclusion, the combination of ECT and RT consistently improved tumor response compared to that with individual therapies, supporting the potential benefit of their combination. However, evidence for a specific ECT-induced radiosensitization effect is currently lacking. Additional investigations are necessary to elucidate the potential benefits of this combination therapy.

Lung cancer is one of the common cancers globally with high mortality and poor prognosis. Most cases of lung cancer are diagnosed at an advanced stage due to limited diagnostic resources. Screening modalities, such as sputum cytology and annual chest radiographs, have not proved sensitive enough to impact mortality. In recent years, annual low-dose computed tomography has emerged as a potential screening tool for early lung cancer detection, but it may not be a feasible option for developing countries. In this context, exhaled breath condensate (EBC) analysis has been evaluated recently as a noninvasive tool for lung cancer diagnosis. The breath biomarkers also have the advantage of differentiating various types and stages of lung cancer. Recent studies have focused more on microRNAs (miRNAs) as they play a key role in tumourigenesis by regulating the cell cycle, metastasis and angiogenesis. In this review, we have consolidated the current published literature suggesting the utility of miRNAs in EBC for the detection of lung cancer.

BackgroundHistopathological analysis of intervertebral disc (IVD) tissues is a critical domain of back pain research. Identification, description, and classification of attributes that distinguish abnormal tissues form a basis for probing disease mechanisms and conceiving novel therapies. Unfortunately, lack of standardized methods and nomenclature can limit comparisons of results across studies and prevent organizing information into a clear representation of the hierarchical, spatial, and temporal patterns of IVD degeneration. Thus, the following Orthopaedic Research Society (ORS) Spine Section Initiative aimed to develop a standardized histopathology scoring scheme for human IVD degeneration.MethodsGuided by a working group of experts, this prospective process entailed a series of stages that consisted of reviewing and assessing past grading schemes, surveying IVD researchers globally on current practice and recommendations for a new grading system, utilizing expert opinion a taxonomy of histological grading was developed, and validation performed.ResultsA standardized taxonomy was developed, which showed excellent intra-rater reliability for scoring nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous end plate (CEP) regions (interclass correlation [ICC] > .89). The ability to reliably detect subtle changes varied by IVD region, being poorest in the NP (ICC: .89-.95) where changes at the cellular level were important, vs the AF (ICC: .93-.98), CEP (ICC: .97-.98), and boney end plate (ICC: .96-.99) where matrix and structural changes varied more dramatically with degeneration.ConclusionsThe proposed grading system incorporates more comprehensive descriptions of degenerative features for all the IVD sub-tissues than prior criteria. While there was excellent reliability, our results reinforce the need for improved training, particularly for novice raters. Future evaluation of the proposed system in real-world settings (eg, at the microscope) will be needed to further refine criteria and more fully evaluate utility. This improved taxonomy could aid in the understanding of IVD degeneration phenotypes and their association with back pain.

Over the past decade, endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become an indispensable tool in the diagnostic armamentarium of the pulmonologist. As the expertise with EBUS-TBNA has evolved and several innovations have occurred, the indications for its use have expanded. However, several aspects of EBUS-TBNA are still not standardized. Hence, evidence-based guidelines are needed to optimize the diagnostic yield and safety of EBUS-TBNA. For this purpose, a working group of experts from India was constituted. A detailed and systematic search was performed to extract relevant literature pertaining to various aspects of EBUS-TBNA. The modified GRADE system was used for evaluating the level of evidence and assigning the strength of recommendations. The final recommendations were framed with the consensus of the working group after several rounds of online discussions and a two-day in-person meeting. These guidelines provide evidence-based recommendations encompassing indications of EBUS-TBNA, pre-procedure evaluation, sedation and anesthesia, technical and procedural aspects, sample processing, EBUS-TBNA in special situations, and training for EBUS-TBNA.

Introduction: Quantitation of microRNAs secreted by lung cells can provide valuable information regarding lung health. Exhaled breath condensate (EBC) offers a non-invasive way to sample the secreted microRNAs, and could be used as diagnostic tools for lung cancer. Materials & Methods: EBC samples from twenty treatment-naïve patients with pathologically confirmed lung cancer and twenty healthy subjects were profiled for miRNAs expression. Selected microRNAs were further validated, using quantitative-PCR, in an independent set of 10 subjects from both groups. Results: A total of 78 miRNAs were found to be significantly upregulated in the EBC of lung cancer patients compared to the control group. Six of these 78 miRNAs were shortlisted for validation. Of these, miR-31–3p, let7i, and miR-449c were significantly upregulated, exhibited good discriminatory power. Discussion: Differential expression of miRNAs secreted by lung cells could be quantitated in EBC samples, and could be used as a potential non-invasive tool for early diagnosis of lung cancer.

Abstract Background Cellulases are well known for their various industrial applications. They are naturally produced by different species of bacteria and fungi. Fermentation process of cellulase producers has limitation due to the high substrate cost required for cellulase induction and challenges to maintain the suitable condition for the respective cellulase production. Recombinant cellulase production could be the potential solution to these problems. In the current study, we investigated recombinant cellulase expression in Escherichia coli using cellulase gene from Bacillus subtilis. Results Extracellular cellulase production from B. subtilis strain was first confirmed on CMC agar and then the cellulase gene (1500 bp) was amplified from this strain and was further cloned in pET21a expression vector. In initial experimental studies, recombinant cellulase expression was achieved in inclusion bodies through shake flask level fermentation of transformed E. coli expression host BL21DE3. Attempts were made to express this 55 KDa His tagged recombinant cellulase into soluble form by modifications in fermentation conditions. Partially purified recombinant cellulase was obtained using Ni-NTA affinity chromatography. The activity of the purified enzyme was confirmed by 3,5-dinitrosalicylic acid (DNS) qualitative assay. Conclusion Soluble expression of active recombinant cellulase can be achieved by subtle alteration in the upstream process.

Effective immunization programs have always resulted in successful eradication of targeted infectious diseases. Apart from childhood immunization, adult immunization is required for two major reasons: 1. failure of primary immunization, 2. to boost waning effect of childhood vaccines. Adult immunization gained its importance in the recent years with detailed recommendations laid down by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC). In most countries, adult vaccination guidelines fall back on the WHO and CDC adult immunization schedules. With evolving number of chronic lung disease patients, it is mandatory to educate and encourage patients on available options for vaccination. A successful immunoprophylaxis given to high-risk group individuals will definitely improve their quality of life.

In this paper, a new modeling technique is proposed for extracting small-signal lumped-element equivalent-circuit models for microwave transistors. The proposed procedure is based on using an optimization approach that is improved by targeting a quasi-static behavior as additional objective function rather than only minimizing the error between the simulated and measured scattering parameters. The validity of the developed modeling methodology is successfully demonstrated by considering a 0.25x1000 $\mu \text{m}^{2}$ gallium nitride (GaN) high-electron-mobility transistor (HEMT) as a case study.

A 23-year-old female presented with 3 months of central chest pain and fever. Clinico-radiological investigations were consistent with an anterior mediastinal mass. This clinicopathologic conference discusses the differential diagnoses of such a presentation and their management options.

During the twenty years of Fascist rule, the diffusion and pervasiveness all throughout Italy of the popularized image of the ancient roman symbol of fasces lictoriae well reflects the sense of a political crusade that had made from the very beginning a decisive appeal on the symbolic lure of a spatially based rhetoric.the emergent regime would be well prepared in emotionally involving the Italians through a complete arsenal of symbols and rites that, much more than autonomous  elements, will come to form - in the course of twenty decisive years - a well displayed set of spatially based dramatizations, where the figurative aspect would have paved the way to a rising and robust popular consensus.It was then in the name of a mythical idea of Romanity, that the Fascist leaders will lay the basis of a complex cultural project aimed at discarding the young and still imprecise construction of the Italian national ethos, through genuinely aesthetically based actions, perfectly functional to the systematic fascistization of the liberal institutions of Italy.Among the most successful aspects of this ‘branding strategy’, should be considered the re-invention of the fasces lictoriae operated by Fascism and its diffusion throughout Italy, starting from 1923.

The innate immune system, through pattern recognition receptors, intercepts any kind of pathogen and reacts through chemotactic, phagocyting, cytokines-secreting and cell-killing mechanisms in a very quick and effective way. Meanwhile, the adaptive immunity arm, through dendritic and T and B cells memory activation, is alerted and starts, more slowly, to produce antibodies, seen thanks to the progress of immunological investigations in comparative vertebrates, invertebrates, and vegetal models. However, it has been stated that the innate immune system also displays adaptive potential in terms of reinfection resistance through immune memory, in addition to the modulation of responses against repeated low doses of lipopolysaccharides (Lps) or cross-immunization, starting from one pathogenic species and extending to others.

Schistosomiasis is an uncommon waterborne helminthic infection that infects humans. Although it is not prevalent in India, many cases are reported due to contact with infested water bodies. Schistosomiasis primarily involves the lower urinary tract and colorectal region. Pulmonary schistosomiasis, although very unusual, has been described with the systemic manifestation of the disease; however, pleural involvement with schistosomiasis has never been described before in the literature. We report this first case of pleural schistosomiasis masquerading as tuberculosis, which posed a diagnostic challenge and later a new learning point in the presentation of the disease.

Abstract Background Histopathological analysis of intervertebral disc (IVD) tissues is a critical domain of back pain research. Identification, description, and classification of attributes that distinguish abnormal tissues form a basis for probing disease mechanisms and conceiving novel therapies. Unfortunately, lack of standardized methods and nomenclature can limit comparisons of results across studies and prevent organizing information into a clear representation of the hierarchical, spatial, and temporal patterns of IVD degeneration. Thus, the following Orthopaedic Research Society (ORS) Spine Section Initiative aimed to develop a standardized histopathology scoring scheme for human IVD degeneration. Methods Guided by a working group of experts, this prospective process entailed a series of stages that consisted of reviewing and assessing past grading schemes, surveying IVD researchers globally on current practice and recommendations for a new grading system, utilizing expert opinion a taxonomy of histological grading was developed, and validation performed. Results A standardized taxonomy was developed, which showed excellent intra‐rater reliability for scoring nucleus pulposus (NP), annulus fibrosus (AF), and cartilaginous end plate (CEP) regions (interclass correlation [ICC] > .89). The ability to reliably detect subtle changes varied by IVD region, being poorest in the NP (ICC: .89‐.95) where changes at the cellular level were important, vs the AF (ICC: .93‐.98), CEP (ICC: .97‐.98), and boney end plate (ICC: .96‐.99) where matrix and structural changes varied more dramatically with degeneration. Conclusions The proposed grading system incorporates more comprehensive descriptions of degenerative features for all the IVD sub‐tissues than prior criteria. While there was excellent reliability, our results reinforce the need for improved training, particularly for novice raters. Future evaluation of the proposed system in real‐world settings (eg, at the microscope) will be needed to further refine criteria and more fully evaluate utility. This improved taxonomy could aid in the understanding of IVD degeneration phenotypes and their association with back pain.

Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the spine, including lower back pain, with or without numbness and/or dysfunction in the lower extremities, disc herniation, spinal stenosis, and spondylolisthesis. Promising and established treatment modalities include repair of the annulus fibrosis, injection of expanded or nonexpanded autologous or allogenic cells that are chondrogenic or from a stem cell lineage used to promote matrix tissue regeneration of the intervertebral disc, including nucleus pulpous cells and mesenchymal stem cells isolated from bone marrow, umbilical cord blood, or adipose tissue; and injection of platelet-rich plasma, platelet-rich fibrin, or fibrin sealant. Early clinical studies show promise for pain reduction and functional recovery. Level V, expert opinion. [ABSTRACT FROM AUTHOR]

(1) Background: It is well-established that coronavirus disease-2019 (COVID-19) is highly pro-inflammatory, leading to activation of the coagulation cascade. COVID-19-induced hypercoagulability is associated with adverse outcomes and mortality. Current guidelines recommend that hospitalized COVID-19 patients should receive pharmacological prophylaxis against venous thromboembolism (VTE). (2) INTERACT is a retrospective, phase IV, observational cohort study aiming to evaluate the overall clinical effectiveness and safety of a higher than conventionally used prophylactic dose of anticoagulation with tinzaparin administered for VTE prevention in non-critically ill COVID-19 patients with moderate disease severity. (3) Results: A total of 705 patients from 13 hospitals in Greece participated in the study (55% men, median age 62 years). Anticoagulation with tinzaparin was initiated immediately after admission. A full therapeutic dose was received by 36.3% of the participants (mean ± SD 166 ± 33 IU/Kgr/day) and the remaining patients (63.9%) received an intermediate dose (mean ± SD 114 ± 22 IU/Kgr/day). The median treatment duration was 13 days (Q1–Q3: 8–20 days). During the study (April 2020 to November 2021), 14 thrombotic events (2.0%) were diagnosed (i.e., three cases of pulmonary embolism (PE) and 11 cases of deep venous thrombosis, DVT). Four bleeding events were recorded (0.6%). In-hospital death occurred in 12 patients (1.7%). Thrombosis was associated with increasing age (median: 74.5 years, Q1–Q3: 62–79, for patients with thrombosis vs. 61.9 years, Q1–Q3: 49–72, p = 0.0149), increased D-dimer levels for all three evaluation time points (at admission: 2490, Q1–Q3: 1580–6480 vs. 700, Q1–Q3: 400–1475, p < 0.0001), one week ± two days after admission (3510, Q1–Q3: 1458–9500 vs. 619, Q1–Q3: 352–1054.5, p < 0.0001), as well as upon discharge (1618.5, Q1–Q3: 1010–2255 vs. 500, Q1–Q3: 294–918, p < 0.0001). Clinical and laboratory improvement was affirmed by decreasing D-dimer and CRP levels, increasing platelet numbers and oxygen saturation measurements, and a drop in the World Health Organization (WHO) progression scale. (4) Conclusions: The findings of our study are in favor of prophylactic anticoagulation with an intermediate to full therapeutic dose of tinzaparin among non-critically ill patients hospitalized with COVID-19.

Abstract Amyloidosis is an uncommon heterogeneous and multi‐systemic disease characterized by extracellular amyloid deposition. The size of proteins varies and forms a part of local disease or systemic process. Light chain amyloidosis (AL) is the most prevalent form of systemic amyloidosis which may also be seen in localized disease. Isolated tracheobronchial amyloidosis (TBA) is rather unusual with local amyloid deposition which may pose a diagnostic dilemma with subsequent therapeutic challenge. Awareness of such a presentation is crucial in the diagnosis of this rare disease. We describe three cases who presented with haemoptysis, which on further evaluation were diagnosed as isolated TBA, and a review of literature.

Abstract Chylothorax is an uncommon pleural effusion characterized by the presence of chyle in the pleural space. Malignancy, trauma, and infections such as tuberculosis and filariasis can result in chylothorax. The chyle is an odourless and white liquid; however, around 50% of chylothorax is not milky (serosanguineous) and 10% of chylothorax is idiopathic which can pose a diagnostic dilemma. We propose a systematic approach which includes pleural fluid triglycerides and cholesterol for all undiagnosed pleural effusion. The case highlights the diagnostic dilemma as well as therapeutic challenges.

Patients of chronic obstructive pulmonary disease (COPD) during COVID-19 pandemic have higher morbidity. Treatment of these patients require aerosolization procedures like nebulization and noninvasive modalities for ventilation like non-invasive ventilation (NIV) and high flow nasal cannula (HFNC). Role of these procedures in corona virus transmission when treating a case of acute exacerbation of chronic obstructive pulmonary disease should be further studied.

Luca Imperatori,1 Damiano Giardini,2 Gino Latini,2 Giuseppe Migliori,2 Claudio Blasi,3 Feisal Bunkheila,3 Cesare Breschi,4 Rodolfo Mattioli,1 Silvia Pelliccioni,1 Carmen Laurino,5 Maria Vadalà,5 Beniamino Palmieri,5 Tommaso Iannitti6 1UOC Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy; 2UOC Otorinolaringoiatria Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy; 3UOC Radioterapia Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy; 4UOC Anestesia e Rianimazione Az. Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy; 5Department of General Surgery and Surgical Specialties, Surgical Clinic, University of Modena and Reggio Emilia Medical School, Modena, Italy; 6KWS BioTest, Marine View Office Park, Portishead, Somerset, UK Background: Neoplasms of the head and neck represent approximately 5% of cancers and they require complex multidisciplinary clinical management. Desmodium adscendens (Desmodium) is a plant that possesses anti-allergic, antioxidant and hepato-protective properties. Lithothamnium calcareum (Lithothamnium) is a calcified seaweed that possesses remineralization properties and the ability to maintain homeostasis.Aim: In this single-arm study, we investigated the efficacy of a combination therapy based on Desmovit® which contains Desmodium and Lithothamnium, and chemotherapy in patients with head and neck cancer.Methods: Twelve patients with histological or cytological diagnosis of stage IV head and neck cancer were enrolled in this study that was approved by the ethics committee of the Unità Operativa Complessa (UOC) di Oncologia Medica Azienda Ospedaliera Ospedali Riuniti Marche Nord and followed the Declaration of Helsinki guidelines. The patients were monitored by investigation of the performance status according to the Glasgow Prognostic Score (GPS), which evaluates the plasma level of C-reactive protein and albumin levels, and the Eastern Cooperative Oncology Group (ECOG) examination. Pain and fatigue were also monitored using the visual analog scale and visual analog fatigue scale, respectively. All the above parameters were assessed biweekly to week 10.Results: GPS, ECOG, and albumin remained stable throughout the study with a trend towards a decrease in GPS and albumin at week 10 post-treatment. Pain significantly improved at week 8 (P

The need for mastering microscopic diagnosis arises in all laboratory specialties, especially when working in resource-poor community laboratories which lack newer diagnostic instruments. Certain clues from microscopic appearance should be carefully analyzed to clinch diagnosis and to not miss out these findings. In addition, if turnaround time is reduced, there is better patient outcome and satisfaction from the clinical colleagues.

Thomas I Mulcahey,1 James E Coad,2 Wei Li Fan,1 Daniel J Grasso,1 Brian M Hanley,1 Heather V Hawkes,1 Sean A McDermott,1 John P O’Connor,1 Ellen E Sheets,1 Charles J Vadala1 1CSA Medical Inc., Lexington, MA, 2Pathology Laboratory for Translational Medicine, West Virginia University, Morgantown, WV, USA Abstract: In this article, a novel cryotherapy approach using a uniform, controlled, and consistent in vivo application of liquid nitrogen (LN2) spray as a Metered Cryospray™ (MCS) process is described. Although MCS may be used for many potential clinical applications, this paper focuses on the development that led to the controlled and consistent delivery of radial LN2 cryogen spray in order to generate a uniform circumferential effect and how the amount of MCS can be adapted to specifically ablate targeted diseases within a patient’s lumen such as an airway or esophagus. Keywords: Metered Cryospray™, cryoablation, rejuvenative healing, LN2 spray cryotherapy

Background: Oxidative stress is involved in the pathophysiology of several diseases such as cardiovascular disorders, cancer, neurodegeneration. Aims and Objectives: Our study evaluated the oxidant/antioxidant status on a cohort of healthy patients matched with some independent variables as a basic individual redox balance monitor on a disease-prevention perspective. Materials and Methods: The anecdotic, retrospective and observational study included 200 apparently healthy volunteers after formal informed consent release whose personal history and physical examination had been recorded specifically on the following items: age, previous diseases, sport activities, smoking habit, balanced/unbalanced nutrition, current absence/presence of inflammatory processes, oral health hygiene, administration of oral contraceptives or hormone replacement therapy in postmenopausal women. No drug treatment was admitted in the recruited patients, up to 6 months before the evaluation. The laboratory instruments used were Point of care FRAS 4 Evolvo (H&D, Parma, Italy) measuring the oxidative stress in plasma samples and antioxidant capacity in plasma and saliva samples. Results: Two-hundred patients were recruited. Statistically relevant differences were observed in oxidative stress-related variables, namely a significant relationship between plasma oxidative stress level and female gender (p

Low back pain (LBP) can significantly reduce the quality of life of patients, and has a considerable economic and social impact worldwide. It is commonly associated with disc degeneration, even though many people with degenerate discs are asymptomatic. Degenerate disc disease (DDD), is thus a common term for intervertebral disc (IVD) degeneration associated with LBP. Degeneration is thought to lead to LBP because of nerve ingrowth into the degenerate disc, inflammation, or because degradation of extracellular matrix (ECM) alters spinal biomechanics inappropriately. Thus, while the objectives of some interventions for LBP are to control pain intensity, other interventions aim to deal with the consequences of disc degeneration through stabilizing the disc surgically, by inserting artificial discs or by repairing the disc biologically and preventing progressive IVD degeneration. Despite tremendous research efforts, treatment of LBP through the use of regenerative interventions aiming to repair the IVD is still controversial. The use of mesenchymal stem cells for IVD regeneration in a patient‐based case will be discussed by an ensemble of clinicians and researchers.

The infectious disease which created a huge impact on mankind over the past few decades is the Acquired Immunodeficiency Syndrome (AIDS). Although the devastating nature of this syndrome is not directly due to the virus, the immune suppression that ensues triggers a cascade of opportunistic infections that can kill an individual. The process of a person acquiring Human Immunodeficiency Virus (HIV) can therefore be referred to as “Opening the Pandora`s box”. The commonest system in the body prone to opportunistic infections is the respiratory system. The types of pulmonary infections in AIDS, organisms associated, clinical manifestations, diagnosis and management have been compiled for collective understanding.

Extraintestinal manifestations are common in inflammatory bowel disease; however, muscular involvement in Crohn disease is rarely reported. We present a case of a 26-year-old male with ileocolonic Crohn disease who developed sudden tenderness in both calves. Doppler ultrasound was negative for deep vein thrombosis. Magnetic resonance imaging of the gastrocnemius muscle showed high intensity signal in the muscle fibers, and muscle biopsy demonstrated nonspecific lymphocytic myositis. Other relevant laboratory results included normal antineutrophil cytoplasmic antibodies and creatine kinase as well as elevated C-reactive protein, erythrocyte sedimentation rate, and anti-Saccharomyces cerevisiae IgG titer. The patient was in clinical remission, being treated with azathioprine 2.5 mg/kg. Prednisone 60 mg/day was initiated with rapid resolution of calf tenderness; however, tenderness soon returned when the dose was tapered to 10 mg/day. Subsequently, prednisone and azathioprine were discontinued, and adalimumab was started at standard induction and maintenance doses. The patient’s symptoms resolved shortly after the first induction dose. A repeat magnetic resonance imaging of the calves – 3 months after starting adalimumab – showed complete resolution of muscle inflammation. To our knowledge, this is the first case of gastrocnemius myositis – a rare extraintestinal manifestation of Crohn disease – successfully treated with anti-tumor necrosis factor agents.

Both wildland recreationists and conservationists report that wildland childhood play is an important socialization experience. However, researchers know little about the details of play experiences during the formative childhood years. In this article, the authors describe the content and physical and social components of childhood play as recalled by 51 young adults involved in serious leisure and environmental professions related to natural history and a contrast group of 10 adults not participating in natural history activities. On the basis of their interviews, the authors identified stationary and exploratory play, social facilitation of play, play away from the home restricted only by distance, fantasy play, creative play, gaming play, searching and trapping play, and play interspersed with outdoor chores. The authors distinguish between playing with nature and playing with friends within nature and discuss the implications for further research and environmental education programming. (Contains 5 figures.)

Introduction: The Six Minute Walk Test (6MWT) is used to assess disease progression and survival in chronic cardiopulmonary disorders. However, variability is noted in the six minute walk test distance (6MWD) in different populations. Aim: We aimed to develop a reference equation for 6MWD in healthy Western India population and compare the results with previously published Indian and Caucasian reference equations. Materials and Methods: Total 174 healthy subjects between 25 to 75 years performed the 6MWT. Variables assessed were age, height, weight, body mass index and sex. Predicted equations were derived using multiple linear regression and compared with the equations for North Indian male, South Indian and Caucasian population using Bland – Altman method. Results: The 6MWD mean (SD) was 512.38 (67.84) m for men and 457.27 (56.75) m for women with p=0.001. The 6MWD correlated with age (r=-0.44), height (r=0.43), weight (r=0.21) in univariate analysis. Stepwise multiple regression analysis showed age and sex to be independent predictors of 6MWD, R2 =0.307. The reference equation for healthy Western India population is 553.289 + (-2.11 x age) + (45.323 x sex; men=1 and women =0). Bland Altman analysis showed that the mean bias was 50.87m (95% limits of agreement 134.77 to – 33.0) for North Indian male equation, 50.75m (95% limits of agreement 105.72 to - 4.22) for South Indian equation and 122.72m (95%limits of agreement 254.11 to – 8.67) for Enright and Sherrill’s equation. Conclusions: The North Indian male, South Indian and Caucasian equations significantly over-estimated the predicted walk distance for our healthy population. Hence, there is a need to develop subgroup population specific reference equations.

Introduction: Bronchoscopy is a safe & effective means of diagnosing bronchogenic carcinoma with a varying diagnostic yield of different bronchoscopic procedures. Cell-Block (CB) preparation of cytology specimen has been shown to increase the diagnostic yield further. To the authors’ knowledge, the diagnostic value of CB as an adjunct to conventional smear cytology (CS) of bronchial washing specimens in the detection of bronchogenic carcinoma has not been well evaluated. Aim: The present study was aimed to evaluate the diagnostic utility of CB of bronchial washings when compared with CS. Materials and Methods: A total of 104 patients of suspected bronchogenic carcinoma were subjected to bronchoscopy as per British Thoracic Society (BTS) protocol. Bronchial biopsy, brushings and washings were collected. Smears were prepared immediately of bronchial washings and another aliquot was subjected to CB preparation and further processing by paraffin embedding and H&E staining. Results: Out of 104 patients, 92 were diagnosed by bronchoscopy with a cumulative diagnostic yield of all sampling techniques being 88.46%. Yield of CB of bronchial washings (44.23%) was higher than Bronchial washings – conventional smears (36.53%). CB detected additional 8 cases of malignancy where corresponding bronchial washings-conventional smears were negative. Exclusive diagnosis by CB was obtained in 2 cases. Brushings and biopsy confirmed malignancy in 49.03% and 57.69% cases. Conclusion: CB of bronchial washings had a higher yield as compared to corresponding conventional smears. Increase in yield was also noted when CB of bronchial washings was combined with biopsy and compared to bronchial washingsconventional smears combined with biopsy. In limited resource settings, CB preparation is a simple method that increases diagnostic yield of flexible bronchoscopy, is cost effective & hence can be routinely used. The immunohistochemical and molecular studies are possible with CB only, which is a distinct advantage over conventional smears of bronchial washings.