Effectiveness of Pentoxifylline Therapy for Management of Oral Submucous Fibrosis

Introduction: Oral submucous fibrosis is a chronic oral disease characterized by progressive buildup of constricting collagen bands in the cheeks and adjacent structures of the mouth due to chewing of areca nut. This can severely restrict mouth opening and tongue movement causing pain and burning sensation in the mouth. Aims: This study evaluates the efficacy of pentoxifylline in the management of oral submucous fibrosis. Methods: A hospital-based study, conducted in the dental outpatient department of Nepalgunj Medical College from October 2019 to September 2020. Forty-nine patients who were diagnosed histopathologically with oral submucous fibrosis were included. The patients were divided into two groups. In group A, patients were given, 200 mg thrice daily for first 30 days, then dose hiked to 400 mg thrice daily for two more months. Group B patients received treatment with multi-vitamin capsules (B-complex one capsule before sleep daily) for three months. All patients were followed up for six months and were assessed for maximum inter-incisor opening, pain on opening of mouth and burning sensation. Results: There was no statistical difference in mouth opening at baseline and first follow up. The mouth opening was significantly more in group A compared to group B from second follow up which persisted till third follow up (p <0.05). Pain and burning sensation significantly reduced in group A compared to group B from 2nd follow up which persisted till 3rd follow up (p <0.05). Few patients had nausea, dyspepsia and vomiting during treatment in group A which resolved within a few days without the need for cessation of the drug. Conclusion: Pentoxifylline can bring about significant clinical improvements in the symptoms of oral submucous fibrosis like mouth opening, pain and burning sensation, thereby improving the quality of life of the affected individuals.

Fragility Analysis of Structural Pounding Between Adjacent Structures Arranged in Series With Various Alignment Configurations Under Near-field Earthquakes

A major cause of local to total damages is related to structural pounding in a large number of past earthquakes. In general, these collisions take place as a result of differences in the dynamic characteristics of the colliding structures. To acquire a better perception of the behavior of structures, in this paper, three structures featuring different heights are modeled in series and with various configurations next to each other in OpenSees. To determine the collision effects of the structures, three different configurations of 4-, 8- and 12-story adjacent reinforced concrete special moment resisting frames were considered. Then, by conducting an incremental dynamic analysis, their structural seismic limit state capacities were assessed via 20 near-field record subsets recommended by FEMA-P695. At last, for the above adjacent buildings with various separation distances and configurations, the fragility curves were determined, and the probability of exceedance from the primary Hazus-MH failure criteria was estimated. In addition, the results were compared with those obtained when this phenomenon did not take place for buildings to have a better perception of the pounding phenomenon. The results of the analyses show that arranging adjacent structures in series greatly affects the collapse capacities of the colliding structures. In addition, in the case when the shorter structure is placed in the middle of two taller structures, it results in the most critical situation among all configurations, and in this case, a higher reduction is observed in the structural performance levels.

Widespread choroid plexus contamination in sampling and profiling of brain tissue

The choroid plexus, a tissue responsible for producing cerebrospinal fluid, is found predominantly in the lateral and fourth ventricles of the brain. This highly vascularized and ciliated tissue is made up of specialized epithelial cells and capillary networks surrounded by connective tissue. Given the complex structure of the choroid plexus, this can potentially result in contamination during routine tissue dissection. Bulk and single-cell RNA sequencing studies, as well as genome-wide in situ hybridization experiments (Allen Brain Atlas), have identified several canonical markers of choroid plexus such as Ttr, Folr1, and Prlr. We used the Ttr gene as a marker to query the Gene Expression Omnibus database for transcriptome studies of brain tissue and identified at least some level of likely choroid contamination in numerous studies that could have potentially confounded data analysis and interpretation. We also analyzed transcriptomic datasets from human samples from Allen Brain Atlas and the Genotype-Tissue Expression (GTEx) database and found abundant choroid contamination, with regions in closer proximity to choroid more likely to be impacted such as hippocampus, cervical spinal cord, substantia nigra, hypothalamus, and amygdala. In addition, analysis of both the Allen Brain Atlas and GTEx datasets for differentially expressed genes between likely “high contamination” and “low contamination” groups revealed a clear enrichment of choroid plexus marker genes and gene ontology pathways characteristic of these ciliated choroid cells. Inclusion of these contaminated samples could result in biological misinterpretation or simply add to the statistical noise and mask true effects. We cannot assert that Ttr or other genes/proteins queried in targeted assays are artifacts from choroid contamination as some of these differentials may be due to true biological effects. However, for studies that have an unequal distribution of choroid contamination among groups, investigators may wish to remove contaminated samples from analyses or incorporate choroid marker gene expression into their statistical modeling. In addition, we suggest that a simple RT-qPCR or western blot for choroid markers would mitigate unintended choroid contamination for any experiment, but particularly for samples intended for more costly omic profiling. This study highlights an unexpected problem for neuroscientists, but it is also quite possible that unintended contamination of adjacent structures occurs during dissections for other tissues but has not been widely recognized.

An atypical presentation of Ormond’s disease

Retroperitoneal fibrosis is a rare condition defined by an overproduction of fibro-inflammatory tissue in the retroperitoneum, usually involving the abdominal aorta, but also managing to invade adjacent structures. We report a case of a 47-year-old female patient with an atypical radiological presentation of retroperitoneal fibrosis, involving predominantly the right kidney. Ultimately, the diagnosis was performed by an immunohistochemical study that identified IgG4+ plasmocytes after kidney nephrectomy, also known as Ormond’s disease. There are no universal guidelines for the treatment of retroperitoneal fibrosis, due to its rarity and lack of randomized controlled trials comparing different therapeutic strategies.

MRI findings of epithelial–myoepithelial carcinoma of the parotid gland with radiologic–pathologic correlation

Purpose This study aimed to describe the MRI findings of epithelial-myoepithelial carcinoma (EMC) of the parotid gland. Materials and methods Seven patients (four males and three females) aged 40–86 years (mean age, 64 years) with histologically proven EMC of the parotid gland who underwent surgical resection after preoperative MRI were enrolled. MRI images were retrospectively reviewed and contrasted with pathological findings. Results Five patients (71%) had predominantly solid lesions, and two (29%) had predominantly cystic lesions. All seven lesions had well-demarcated margins and capsules without the invasion of adjacent structures. The capsules were incomplete in five lesions (71%) and complete in two (29%). Four lesions (57%) exhibited a multinodular structure with internal septa. Cystic components were observed in three lesions (43%). On T1-weighted images, the solid components were frequently homogeneous (5/7, 71%), and demonstrated isointensity in five lesions (71%) and hypointensity in two (29%) relative to the spinal cord. On T2-weighted images, the solid components were usually heterogeneous (6/7, 86%), and demonstrated hyperintensity in five lesions (71%) and isointensity in two (29%) relative to the spinal cord. The mean apparent diffusion coefficient value of the solid components was 0.967 × 10−3 mm2/s. Conclusion Parotid gland EMCs usually appeared as predominantly solid lesions with well-demarcated margins and capsules. A multinodular structure with internal septa was characteristics of EMCs.

Congenital Disorders

This chapter is devoted to specific diseases presenting usually in early infancy or childhood as a result of disruption in the normal development of the cornea and its associated structures. These disorders may develop due to one or a combination of various genetic, infectious, inflammatory, toxic, metabolic, traumatic, or mechanical processes and may occur at any time during tissue induction, differentiation, and maturation. Adjacent structures (anterior chamber angle, iris, and lens) can be impacted too. Congenital limbal stem cell deficiency is usually associated with aniridia and ectodermal dysplasia. Aniridia can occur in a sporadic or familial form. The familial inheritance pattern of aniridia is predominantly autosomal dominant. The aniridia phenotype varies depending on the mutation present. Interesting ocular congenital disorders associated with Neurofibromatosis, Axenfeld-Rieger syndrome, Icthyosis are shown in this chapter. It presents a rare case of porphyria-associated sclerocorneal melting with before and after treatment photos.

Stability Assessment of Rock Mass System under Multiple Adjacent Structures

Numerical modeling is important for exploring the fundamental processes occurring in rock and for evaluating the real performance of structures built on and in rock mass system, and thus for supporting the design of rock engineering problems. Estimating the stability of rock mass foundation systems entirely based on a theoretical approach is a complicated task if there exists overlapping of their potential collapse modes. This paper applies finite element limit analysis to evaluate the bearing capacity of equally spaced multiple strip footings resting on rock mass obeying the modified non-linear Hoek–Brown failure criterion. Numerical solutions are expressed in terms of the efficiency factor that is dependent on the spacing between footings, as well as the rock mass properties. In addition, the effects of surface surcharge and footing roughness are quantified. The maximum spacing at which the interfering effect of adjacent footings becomes disappeared is evaluated and an algebraic expression for approximating the maximum spacing is proposed. Failure mechanisms for a few cases of rock mass under multiple strip footings are examined.

Chemoradiotherapy is an Alternative Choice for Patients with Primary Mediastinal Seminoma

Background: The low incidence of primary mediastinal seminomas has precluded the development of clinical trials on mediastinal seminomas. We investigated the clinicopathologic characteristics, prognosis of patients with primary mediastinal seminomas as well as the efficiency of nonsurgical treatments compared with treatments containing surgery.Methods: We retrospectively collected data on the clinicopathologic characteristics, treatments, toxicities, and survival of 27 patients from a single center between 2000 and 2018. Patients were divided into two groups according to whether they received operation. Survivals were assessed using the Kaplan-Meier method. Univariate analysis was performed using the log-rank test.Results: The median age was 28 (13-63) years. The most common symptoms were chest pain (29.6%), cough (25.9%), and dyspnea (22.2%). There were 13 and 14 patients in surgery and non-surgery group. Patients in the non-surgical group were more likely to be with poor performance scores (100% vs.76.9%) and disease invaded to adjacent structures(100% vs.76.9%) especially great vessels(100% vs.46.2%).The median follow-up period was 32.23 (2.7-198.2) months. There was no significant difference of overall survival (5-year 100% vs 100%), cancer-specific survival (5-year 100% vs.100%), local regional survival (5-year 91.7% vs.90.0%, p=0.948) , distant metastasis survival (5-year 100.0% vs. 90.9%, p=0.340) and progression-free survival (82.5% vs.90.0%, p=0.245) between patients with and without surgery. Conclusions: Primary mediastinal seminoma was with favorable prognosis, even though frequently invasion into adjacent structures brings difficulties to surgery administration. Chemoradiotherapy is an alternative treatment with both efficacy and safety.

Case studies on seismic assessment of historical buildings using advanced analysis

Seismic risk mitigation in existing buildings requires an engineering assessment of the current condition and expected seismic performance and an identification of possible deficiencies that should be addressed. For heritage and historical buildings in particular, there is significant benefit in using the most detailed analysis methods available to avoid the conservatism inherent in simpler methods and thereby minimise unnecessary interventions and more precisely pinpoint where strengthening is required. On recent heritage projects, Arup has used the analysis software LS-DYNA and a new material model, calibrated against experimental tests on unreinforced masonry components and buildings to carry out (or supplement) seismic assessments. The analysis method (non-linear response history analysis) is not new, but its application on detailed finite-element models of complex historic structures has previously been computationally prohibitive and requires significant analyst experience to deliver reliable results. This paper summarises three of these recent Arup projects: Woltersum Church (Netherlands), Procuratie Vecchie (Venice) and a building cluster in the historical centre of Appingedam (Netherlands). The case studies show that these analyses allow complex features of seismic performance to be considered, such as damage or modifications to the building over time, pounding (separate buildings colliding into one another due to seismic movements) and load sharing between adjacent structures.