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Background: Glioblastoma (GB) is the most malignant primary brain tumor. Isolated restricted diffusion (IRD) is restricted diffusion outside the confines of enhancing tumor with no corresponding enhancement on post contrast study. The aim of our study was to prospectively assess the incidence of IRD in GB patients, determine how often these foci proceed to contrast enhancement on follow up, and analyze the survival pattern. Methods: In a prospective pilot cohort study, consecutive adult patients with GB on initial MRI of brain, were included and screened for IRD. All images were independently analyzed by two experienced radiologists. The survival pattern of patients with IRD was assessed with Cox-regression and Kaplan-Meier curve analysis. Results: Of the 52 patients (median age- 63 years; male-63.5%), 21% (11 of 52) exhibited IRD. Inter-rater agreement on the diagnosis of IRD foci was fair (kappa=0.29). Seven (64%) showed enhancement in the IRD focus. The Kaplan Meier analysis revealed a significant decrease (p=0.035) in the survival was observed among patients with IRD focus. Conclusions: IRD focus was seen in 21% of patients with GB, with 64% of these demonstrating enhancement at the IRD focus on follow up imaging. A shorter survival was associated with IRD foci.
In this study, morphological and molecular features were used to identify a new Steinernema sp. from Kerala, India. Morphological and molecular features provide evidence for placing the new species into the longicaudum clade. The new species is characterized by the following morphological features: infective juveniles with a body length of 1067 μm (914–1268 μm); a distance from the anterior end to excretory pore of 82 μm (73–92 μm); a distance from anterior end to nerve ring of 105 μm (91–118 μm). The distinguishing feature of the infective juveniles of S. keralense n. sp. is the presence of seven ridges in the mid-body region, while all other species classified within the logicaudum clade to date are characterized by eight ridges. The first-generation males are characterised by 25 genital papillae, very short spicules, with a length of 68 μm (60–72 μm), and the SW% ratio is 136 (114–169). The new species is further characterized by sequences of the internal transcribed spacer and partial 28S regions of the ribosomal DNA. Phylogenetic analyses show that S. keralense n. sp. is closely related to species within the longicaudum clade.
Indigofera oblongifolia Forssk. locally known as ‘Goilia or Jhil’, is an important underutilized leguminous browse shrub for small ruminants in hot arid region of India and traditionally utilized for its medicinal value. Its irregular patchy distribution was observed in depression of rocky areas, bunds of farmer fields and along the depression on the road sides in Jaisalmer and Pali district during collection. Soil samples collected from Pali district have high level of pH and electrical conductivity as compared to Jaisalmer which indicates its suitability to saline areas. It exhibited good plant growth under Jodhpur conditions with respect to plant height (171.5 cm), number of branches (47.9) and canopy diameter (100–210 and 115–180 cm in north-south and east-west direction, respectively) after 12 months of planting in fields under protected condition. Morphological characterization showed the presence of high coefficient of variation (%) in the number of raceme per branch (27.3) followed by raceme length (22.9), pod length (21.0) and least in pod width (8.1). Phytochemical results revealed that leaves of I. oblongifolia contained considerable amounts of total phenols (31.44 mg g−1), flavonoids (29.73 mg g−1) and antioxidant capacity (6.26 FRU g−1) which make its suitability as a browse species to ruminants in rangelands. Along with these finding, its traditional knowledge and utilization are detailed in this paper as to hasten further research on its various aspects for its sustainable utilization in rangelands or in alternate land use systems in the Indian hot arid region.
Mung bean is highly susceptible to insect attack during storage. Hermetic storage is an effective technique to control insect damage. This study investigated the potential of the hermetic SuperGrain bag (SGB) for controlling bruchids during storage. The dry samples were packed in SGB infested with adult bruchids (SGB-I), SGB natural field infested (SGB-N), woven polypropylene bags (WPP-I and WPP-N) and kept at room temperature for 180 days. Oxygen (O2) and carbon dioxide (CO2) concentrations were measured at 15 days intervals. Moisture content, infestation level, seed damage and weight loss were determined at 60 days intervals. Seed colour, hardness, crude protein and fat contents were analysed before and after storage. The O2 level decreased to 10.09%, whereas the CO2 level increased to 8.87% in both SGB-I and SGB-N treatments. The moisture content of mung bean was maintained as onset storage in both SGB-N and SGB-I treatments, whereas reduced in WPP-N (9.26% db) and WPP-I (9.21% db). In SGB treatments, no significant bruchids were detected, but they increased drastically in WPP-N (52 ± 9) and WPP-I (377 ± 14). Seed damage (2–3%) and weight loss (0.8–1.0%) were recorded in both SGB-N and SGB-I. Conversely, seed damage reached 26.67 and 54.17%, corresponding to weight losses of 12.33 and 20.82% in WPP-N and WPP-I, respectively. Seed colour, hardness, crude protein and fat contents in SGBs showed no significant changes than in the WPP bags. The study illustrated that the SGB is an efficient hermetic device in protecting mung beans against bruchids attacks compared to the WPP bags.
Background: Chordomas are rare malignant skull-base/spine cancers with devastating neurological morbidities and mortality. Unfortunately, no reliable prognostic factors exist to guide treatment decisions. This work identifies DNA methylation-based prognostic chordoma subtypes that are detectable non-invasively in plasma. Methods: Sixty-eight tissue samples underwent DNA methylation profiling and plasma methylomes were obtained for available paired samples. Immunohistochemical staining and publicly available methylation and gene expression data were utilized for validation. Results: Unsupervised clustering identified two prognostic tissue clusters (log-rank p=0.0062) predicting disease-specific survival independent of clinical factors (Multivariable Cox: HR=16.5, 95%CI: 2.8-96, p=0.0018). The poorer-performing cluster showed immune-related pathway promoter hypermethylation and higher immune cell abundance within tumours, which was validated with external RNA-seq data and immunohistochemical staining. The better-performing cluster showed higher tumour cellularity. Similar clusters were seen in external DNA methylation data. Plasma methylome-based models distinguished chordomas from differential diagnoses in independent testing sets (AUROC=0.84, 95%CI: 0.52-1.00). Plasma methylomes were highly correlated with tissue-based signals for both clusters (r=0.69 & 0.67) and leave-one-out models identified the correct cluster in all plasma cases. Conclusions: Prognostic molecular chordoma subgroups are for the first time identified, characterized, and validated. Plasma methylomes can detect and subtype chordomas which may transform chordoma treatment with personalized approaches tailored to prognosis.
There is increasing concern regarding efficacy of organ preservation protocol in laryngeal and hypopharyngeal cancers.
Method
This study retrospectively assessed disease-related and functional outcomes of 191 patients with non-metastatic laryngeal or hypopharyngeal squamous cell carcinoma treated with curative intent (radiotherapy with or without chemotherapy).
Results
Seventy-six patients (39.8 per cent) had a primary cancer in the larynx, and 115 patients (60.2 per cent) had a primary cancer in the hypopharynx. The median follow up was 39 months. The 3-year time to progression, overall survival, local control and laryngectomy free survival was 56.2 per cent, 76.3 per cent, 73.2 per cent and 67.2 per cent, respectively. At the time of analysis, 83 patients (43.5 per cent) were alive and disease free at their last follow up and did not require tube feeding or tracheostomy. The laryngo-oesophageal dysfunction-free survival was 61 per cent at 3 years.
Conclusion
Organ conservation protocols remain the standard of treatment in appropriately selected patients with laryngeal and hypopharyngeal cancers.
With type 2 diabetes presenting at younger ages, there is a growing need to identify biomarkers of future glucose intolerance. A high (20%) prevalence of glucose intolerance at 18 years was seen in women from the Pune Maternal Nutrition Study (PMNS) birth cohort. We investigated the potential of circulating microRNAs in risk stratification for future pre-diabetes in these women. Here, we provide preliminary longitudinal analyses of circulating microRNAs in normal glucose tolerant (NGT@18y, N = 10) and glucose intolerant (N = 8) women (ADA criteria) at 6, 12 and 17 years of their age using discovery analysis (OpenArray™ platform). Machine-learning workflows involving Lasso with bootstrapping/leave-one-out cross-validation identified microRNAs associated with glucose intolerance at 18 years of age. Several microRNAs, including miR-212-3p, miR-30e-3p and miR-638, stratified glucose-intolerant women from NGT at childhood. Our results suggest that circulating microRNAs, longitudinally assessed over 17 years of life, are dynamic biomarkers associated with and predictive of pre-diabetes at 18 years of age. Validation of these findings in males and remaining participants from the PMNS birth cohort will provide a unique opportunity to study novel epigenetic mechanisms in the life-course progression of glucose intolerance and enhance current clinical risk prediction of pre-diabetes and progression to type 2 diabetes.
This study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes.
Method
An online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures.
Results
Of the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis.
Conclusion
The majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.
Knowledge of anatomical variations of the frontal recess and frontal sinus and recognition of endoscopic landmarks are vital for safe and effective endoscopic sinus surgery. This study revisited an anatomical landmark in the frontal recess that could serve as a guide to the frontal sinus.
Method
Prevalence of the anterior ethmoid genu, its morphology and its relationship with the frontal sinus drainage pathway was assessed. Computed tomography scans with multiplanar reconstruction were used to study non-diseased sinonasal complexes.
Results
The anterior ethmoidal genu was present in all 102 anatomical sides studied, independent of age, gender and race. Its position was within the frontal sinus drainage pathway, and the drainage pathway was medial to it in 98 of 102 cases. The anterior ethmoidal genu sometimes extended laterally and formed a recess bounded by the lamina papyracea laterally, by the uncinate process anteriorly and by the bulla ethmoidalis posteriorly. Distance of the anterior ethmoidal genu to frontal ostia can be determined by the height of the posterior wall of the agger nasi cell rather than its volume or other dimensions.
Conclusion
This study confirmed that the anterior ethmoidal genu is a constant anatomical structure positioned within frontal sinus drainage pathway. The description of anterior ethmoidal genu found in this study explained the anatomical connection between the agger nasi cell, uncinate process and bulla ethmoidalis and its structural organisation.
To characterize and compare severe acute respiratory coronavirus virus 2 (SARS-CoV-2)–specific immune responses in plasma and gingival crevicular fluid (GCF) from nursing home residents during and after natural infection.
Design:
Prospective cohort.
Setting:
Nursing home.
Participants:
SARS-CoV-2–infected nursing home residents.
Methods:
A convenience sample of 14 SARS-CoV-2–infected nursing home residents, enrolled 4–13 days after real-time reverse transcription polymerase chain reaction diagnosis, were followed for 42 days. After diagnosis, plasma SARS-CoV-2–specific pan-Immunoglobulin (Ig), IgG, IgA, IgM, and neutralizing antibodies were measured at 5 time points, and GCF SARS-CoV-2–specific IgG and IgA were measured at 4 time points.
Results:
All participants demonstrated immune responses to SARS-CoV-2 infection. Among 12 phlebotomized participants, plasma was positive for pan-Ig and IgG in all 12 participants. Neutralizing antibodies were positive in 11 participants; IgM was positive in 10 participants, and IgA was positive in 9 participants. Among 14 participants with GCF specimens, GCF was positive for IgG in 13 participants and for IgA in 12 participants. Immunoglobulin responses in plasma and GCF had similar kinetics; median times to peak antibody response were similar across specimen types (4 weeks for IgG; 3 weeks for IgA). Participants with pan-Ig, IgG, and IgA detected in plasma and GCF IgG remained positive throughout this evaluation, 46–55 days after diagnosis. All participants were viral-culture negative by the first detection of antibodies.
Conclusions:
Nursing home residents had detectable SARS-CoV-2 antibodies in plasma and GCF after infection. Kinetics of antibodies detected in GCF mirrored those from plasma. Noninvasive GCF may be useful for detecting and monitoring immunologic responses in populations unable or unwilling to be phlebotomized.
This literature review examines the issues facing foreign mentally disordered offenders (FNMDOs) in accessing psychiatric care in the UK.
Methods:
Studies/reports relevant to FNMDOs in Healthcare, Probation services, Inspectorate of prisons, Crime reduction charities, Department of Health were examined. Keywords searched on MEDLINE and Psychinfo: ‘foreign, mental,*offender,*criminal.*’
Results:
According to 2009 statistics, 14% of UK prisons consisted of foreigners of which 80% suffered mental health problems. FNMDOs face a number of issues like negative stereotyping, racism, poor family contact, language/cultural barriers, which hinder accessing psychiatric help. Indefinite detention of foreign prisoners, post-amendment of the UK Borders Act 2007, has been found to result in increased depression and suicidal ideation. Self-inflicted deaths increased since 2006. Research on migration-morbidity hypothesis and refugees/asylum-seekers demonstrates higher psychiatric morbidity. A 2005 meta-analysis reported worse outcomes for institutionalized refugees. Detention centres often have poor healthcare provision, though prevalence of PTSD, depression, anxiety, somatoform disorders is high. FNMDOs face limitations in availability of legal aid and immigration advice across the prison system. Lack of a clear care pathway compounded by poor inter-agency communication and understanding of immigration procedures adversely affects treatment and continuity of psychiatric care.
Conclusions:
FNMDOs are a vulnerable group with complex needs which may go unidentified. Improving care and outcomes for FNMDOs requires adequate prison staff training, ready interpreter access, facilitation of family visits/cultural contact. Effective multi-agency collaboration in early identification, intervention, clarity in care pathway and immigration advice would result in reduced psychiatric morbidity in this vulnerable group of offenders.
Polypharmacy continues to be a major concern in psychiatry. Besides the risk of unintended and untoward pharmacological interactions, it carries the potential to cause prescriber liability and increased healthcare costs. Although polypharmacy has been commonly reported in forensic units, there have been no studies examining potentially serious pharmacological interactions in secure settings.
Aims and objectives:
To identify the prevalence of potential pharmacological interactions through a cross-sectional study of prescribing patterns in a medium secure unit in the UK.
Methods:
Medications prescribed for all 43 patients on 3 male medium secure wards in London in September 2012 were analyzed for potential pharmacological interactions using the Medscape Drug Database/Interaction checker.
Results:
A total of 233 regular and 113 ‘as required (p.r.n)’ medications were prescribed. 98 medications were psychotropic and 248 were physical health related. 284 potential pharmacological interactions were present with an average of 6.6 interactions per patient (1-28), involving 31 of the 43 patients(72.09%). These interactions were categorized into four groups: 1.Contraindicated (4.65% of patients;2 interactions) 2.Serious-Use Alternative(30.23% patients;20 interactions) 3.Significant- Monitor Closely(69.6% patients; 232 interactions) and 4.Minor(39.53% patients;30 interactions). Interestingly, 65% of contraindicated/serious interactions involved non-psychotropic medication.
Conclusions:
The findings highlight the high prevalence of potential pharmacological interactions in the forensic population. The challenging presentations in forensic psychiatry often necessitate ‘p.r.n. prescribing’ and medication augmentation to treat partial response. However, this can lead to unpredictable and dangerous interactions. Clinicians should be mindful of the pharmacodynamic and pharmacokinetic implications prior to prescribing psychotropic and non-psychotropic drugs.
Diminished Responsibility has formed an important aspect of the law of homicide in England and Wales since 1957. It acts as a partial defence to murder and if successful, reduces the charge to manslaughter. Despite operating for over fifty years in England and Wales, it was subjected to regular criticism leading to the enactment of a revised plea.
Aims and objectives:
This paper examines diminished responsibility, the elements of the revised plea and its legal/ clinical impact.
Summary:
The core components of the old plea involved abnormality of mind substantially impairing mental responsibility. However, the obscure wording, the lack of psychiatrically recognized concepts and expert-jury role confusion led to a number of proposed reforms to the plea. The revised plea which came into force in 2010 consists of four limbs- abnormality of mental functioning, recognized medical condition, substantial impairment of mental ability and an explanation/causation requirement.
Conclusions:
Although the new plea has intended to accommodate medical advances and modernize and clarify the law, its scope has been largely narrowed. Academics have criticized the explanation/causation requirement for being too complex to prove and so restrictive that satisfying an insanity plea might be easier. Concern has been expressed that more contested cases and murder convictions would result from this restriction in the plea's scope. Cases such as mercy-killing and battered spouses which previously could be dealt with ‘sympathetically’, might now be excluded. Interestingly, role confusion continues to be present with medical experts treading onto the jury's territory, opining on legal issues.
Early detection of karyotype abnormalities, including aneuploidy, could aid producers in identifying animals which, for example, would not be suitable candidate parents. Genome-wide genetic marker data in the form of single nucleotide polymorphisms (SNPs) are now being routinely generated on animals. The objective of the present study was to describe the statistics that could be generated from the allele intensity values from such SNP data to diagnose karyotype abnormalities; of particular interest was whether detection of aneuploidy was possible with both commonly used genotyping platforms in agricultural species, namely the Applied BiosystemsTM AxiomTM and the Illumina platform. The hypothesis was tested using a case study of a set of dizygotic X-chromosome monosomy 53,X sheep twins. Genome-wide SNP data were available from the Illumina platform (11 082 autosomal and 191 X-chromosome SNPs) on 1848 male and 8954 female sheep and available from the AxiomTM platform (11 128 autosomal and 68 X-chromosome SNPs) on 383 female sheep. Genotype allele intensity values, either as their original raw values or transformed to logarithm intensity ratio (LRR), were used to accurately diagnose two dizygotic (i.e. fraternal) twin 53,X sheep, both of which received their single X chromosome from their sire. This is the first reported case of 53,X dizygotic twins in any species. Relative to the X-chromosome SNP genotype mean allele intensity values of normal females, the mean allele intensity value of SNP genotypes on the X chromosome of the two females monosomic for the X chromosome was 7.45 to 12.4 standard deviations less, and were easily detectable using either the AxiomTM or Illumina genotype platform; the next lowest mean allele intensity value of a female was 4.71 or 3.3 standard deviations less than the population mean depending on the platform used. Both 53,X females could also be detected based on the genotype LRR although this was more easily detectable when comparing the mean LRR of the X chromosome of each female to the mean LRR of their respective autosomes. On autopsy, the ovaries of the two sheep were small for their age and evidence of prior ovulation was not appreciated. In both sheep, the density of primordial follicles in the ovarian cortex was lower than normally found in ovine ovaries and primary follicle development was not observed. Mammary gland development was very limited. Results substantiate previous studies in other species that aneuploidy can be readily detected using SNP genotype allele intensity values generally already available, and the approach proposed in the present study was agnostic to genotype platform.
Human parechoviruses (HPeVs) are known to cause various clinical manifestations including acute gastroenteritis. Although HPeV infections and their genotypes have been detected in human patients worldwide, no such reports are available from India to ascertain the association of HPeVs in acute gastroenteritis. The present study was conducted to determine the clinical features and genetic diversity of HPeVs detected in children hospitalised for acute gastroenteritis. Stool specimens (n = 979) collected from children aged ⩽5 years hospitalised for acute gastroenteritis in Pune, western India during January 2006–December 2010 were included. HPeV RNA was detected by reverse transcription-polymerase chain reaction (RT-PCR) (5′UTR) followed by genotyping using VP1 gene-based PCR and phylogenetic analysis. HPeV was detected in 13·9% (136/979) of the cases, co-infections with other enteric viruses were found in 43·4%. HPeV was more frequent in children ⩽1 year age with infections reported throughout the year. A total of 102/136 (75%) HPeV strains were genotyped, which comprised 13 different HPeV genotypes. Of these, HPeV1 was the most predominant genotype detected and phylogenetically clustered with the Harris strain which is rarely reported. The study documents circulation of heterogeneous HPeV genotypes. Two variant strains of HPeV4 and ‘RGD absent’ HPeV5 and 6 strains were also detected. This is the first report of HPeV with diversified genotypes identified in acute gastroenteritis patients from India.
This paper presents the numerical simulations of flowfield over a typical Crew Module at Mach 4 for different angles-of-attack ranging from 0 to –25°. Detailed flow features such as contour of density gradient over the model, numerical oil flow and near wake vortex structures are captured very well in the present simulations. The location of the sonic line and its behaviour due to angles-of-attack is also captured in the simulations. The CP distribution on the windward and leeward side shows excellent match with the experimental results. Also, the prediction of aerodynamic coefficients shows very good agreement with the experimental results. The numerical simulation predicts CMcg, CN and CA within 8%, 4% and 3·5% respectively with respect to experimental values.
A spontaneous cerebrospinal fluid leak can sometimes only become apparent following grommet insertion and usually represents dehiscence of the tegmen tympani, which is an uncommon condition.
Objectives:
This report aimed to reaffirm the importance of recognising this unusual presentation and outline management options.
Case report:
A 63-year-old man with conductive hearing loss and type B (flat) tympanometry underwent grommet insertion into his left ear, which resulted in cerebrospinal fluid otorrhoea. A defect of the tegmen tympani was found. This was successfully repaired via a transmastoid approach using a multi-layered grafting technique.
Conclusion:
Dehiscence of the tegmen tympani is uncommon and may only come to light following grommet insertion, which may be problematic for the uninformed otolaryngologist. Education is important to ensure early recognition and appropriate management.