Search for Tissue Equivalent Materials Based on Exposure and Energy Absorption Buildup Factor Computations

Tissue equivalent materials (TEM) are frequently used in research as a means to determine the delivered dose to patients undergoing various therapeutic procedures. They are used in routine quality assurance and quality control procedures in diagnostic and therapeutic physics. However, very few materials that are tissue equivalent have been developed for use in research at the low photon energies involved in diagnosis radiology. The objective of this study is to describe a series of TEMs designed to radiographically imitate human tissue at diagnostic photon energies. TEMs for adipose, cortical bone, fat, lung, and muscle tissues were investigated in terms of energy absorption and exposure buildup factors for photon energy range 15–150 keV and for penetration depths up to 40 mean free path. BUF was computed based on GP-fitting method. Moreover, we also compared some radiological properties, including the total attenuation and the energy-absorption attenuation, the effective atomic number, and the CT number at 30, 100, and 120 kVp. We found that SB3, Glycerol trioleate, and MS15 perfectly mimic cortical bone, fat, and muscle tissues, respectively. Additionally, AP6 and Stracey latex are good TEM for adipose and lung tissues, respectively. The results of this work should be useful in radiation diagnosis and dosimetry applications for the large physician researcher community.

MULTIPLE VACUUM SYRINGE BLOOD ASPIRATION PROCEDURE (MVSBAP): A NEW HORIZON OF RAKTAMOKSHANA PROCEDURE IN PANCHAKARMA THERAPY OF AYURVEDA

Panchakarma is a specialized branch of Ayurveda that primarily deals with the body's purification (Shodhana) of doshas. As we know, the word Panchakarma refers to five special therapeutic procedures like Vamana, Virechana, Vasti, Nasya and Raktamokshana. Raktamokshana is an effective bloodletting therapy. Classically it is described as of six types, i.e. (1) Shringa, (2) Jalauka, (3) Alabu, (4) Shiravedha, (5) Prachchhana and (6) Ghatiyantra. In the present study, a clinical trial has been done, especially in the disease of Gridhrasi, with particular reference to Sciatica by combining Parchchhana and Ghatiyantra, a modified form of Raktamokshana therapy, called Multiple Vacuum Syringe Blood Aspiration Procedure (MVSBAP). Sciatica is painful neuralgia of the Sciatic Nerve in which pain starts from the gluteal region and buttock and comes down through the back of thigh, knee, calf and outer border of the foot. Sixty patients were selected for the clinical trial using a simple random sampling method from the OPD and IPD of Government Ayurveda College and Hospital, Varanasi, Uttar Pradesh, India. Two groups are made like Group-A and Group-B, each consisting of 30 patients. Patients of Group-A are treated with only traditional Ayurvedic medicines, and patients of Group-B are treated with MVSBAP and traditional Ayurvedic medication. After one month of final treatment, assessment is done on statistical parameters, which show pretty better results in Group-B patients. The application of MVSBAP in the disease of Gridhrasi draws a new horizon to the ailing humanities.

ROLE OF MANUAL THERAPY AND MASSAGE IN THE TREATMENT OF FIBROMYALGIA: TESTING THE HYPOTHESIS

Fibromyalgia syndrome (FMS) is a chronic rheumatic disease in which pain is predominant and accompanied by fatigue, anxiety, depression, sleep disturbance and cognitive dysfunction. Although there are numerous pharmacological and non-pharmacological therapeutic alternatives, symptom control is frequently problematic. Manual therapy covers manipulating soft tissue and various joints using the hands. It is organized by mapping of soft tissue structures with rhythmically applied pressure to improve physical function, facilitate daily activities, promote rehabilitation procedures and decrease pain. Massage is generally accepted as an essential component of manual therapy. Stretching and mobilizations are also part of manual therapy. Although numerous beneficial effects of manual therapy and massage on the musculoskeletal system and pain have been proven, the data in FMS patients studies are inconclusive. We hypothesize that manual therapy and massage are beneficial therapeutic options for the control of symptoms of FMS patients. Furthermore, these strategies can be employed in conjunction with well-established and high-evidence therapeutic procedures. Future research should focus on establishing standardized protocols for manual therapy and massage, which is one of the major limitations. To ensure a high level of evidence, research studies with large sample sizes, long follow-up periods and methodologically complete are needed.

REVIEW ON PHYSIOLOGICAL EVALUATION OF ABHYANGA

Lifestyle interventions are the major Ayurvedic preventive and therapeutic approach that helps in building a healthy metabolic system, attaining good digestion and proper excretion. To achieve the aim of Ayurveda, i.e., to preserve and promote the health of healthy, it prescribes many measures in the form of daily routine [Dinacharya], seasonal regime [Rtu charya] etc. Abhyanga has been included as a part of Dinacharya and as a treatment for certain diseases. It is also a part of the pre-therapeutic procedures of Panchakarma (five purificatory measures). It prevents Jara [ageing process], help to overcome Srama [fatigue], cures disease caused by Vata, promotes eyesight, improves texture and quality of skin, longevity etc. Since Vata dominates in the Sparsanendriya (skin) and Taila (oil) possess those qualities opposite to that of Vata, Abhyanga pacify Vata to a great extent. Since Sparsha is also the seat of Pitta dosha, and the eye itself is the seat of Pitta, Drshtiprasada effect of Abhyanga described in classics can be explained. By massaging, through oil application and generating heat by friction, Abhyanga stimulate blood circu- lation and lymphatic circulation. It also serves as the transporting medium of nutritional substances, metabolic end- products etc. So, it is an attempt to explore the physiological effects of Abhyanga as Dinacharya in the body. Keywords: Abhyanga, Pancha karma, Physiology

MUKHA KRIYAKALPA - PROCEDURES FOR PREVENTION AND MANAGEMENT OF ORAL CAVITY DISORDERS

Mukha (oral cavity) is considered as a gateway for the alimentary canal, health of the oral cavity reflects the body health as healthy oral cavity aids in proper digestion of the food consumed. The oral cavity also takes part in bodi- ly functions like respiration and speech. It also contributes to the beauty and confidence of an individual. Mukha is comprised of Osta (lips), Dantamula (Gums), Danta (Tooth), Jinhva (Tongue), Taalu (Palate), Gala (Throat). Since the Oral cavity is constantly exposed to the external environment, there are more chances of trauma and infections. Hence to avoid the chances of oral cavity diseases it is very important to maintain good oral hygiene. Kriyakalpa is the therapeutic procedure applied locally and are considered under bahirparimarjana chikitsa. Ka- vala, Gandusha and Pratisarana are kriyakalpas explained for good oral hygiene. These can be used as a daily regimen to maintain good oral hygiene and in mukharoga as therapeutic procedures. These mukha kriyakalpa- due to their cleaning action and by increasing defence mechanism, promotes oral health and prevents many oral disorders. Various formulations for mukha kriyakalpa are available for a healthy person based on prakriti and for treatment based on vitiated dosha avastha. Keywords: Mukha kriyaklpa, Oral hygiene, kavala, Gandusha, Pratisarana.

A cadaveric study of relationship of external carotid artery with reference to adjacent anatomical landmarks

Evaluation of carotid bifurcation level and relationship of External Carotid Artery (ECA) with reference to adjacent anatomical landmarks is important in planning various surgical and radiological procedures related to the carotid arteries. The aim was to study the relationship of External Carotid Artery with reference to Adjacent Anatomical landmarks in cadavers. 60 cadavers - 52 male and 8 female embalmed with 10% formalin were dissected over the period of two years for this study. The distance between the origin and the termination of ECA was found to be in the range of 25–70 mm on the right side and in the range of 25–68 mm on the left side. The distance between the origin of ECA and the carotid tubercle was found to be in the range of 23–50 mm on the right side and in the range of 22–48 mm on the left side. The distance between the origin of ECA and the angle of the mandible was found to be in the range of 18–30 mm on the right side and in the range of 20–32 mm on the left side. The anatomical knowledge of relationship of External Carotid Artery with reference to adjacent anatomical landmarks is helpful for vascular surgeons to plan surgeries and prevent complications during various diagnostic and therapeutic procedures.

The Impact of Fast-Rise-Time Electromagnetic Field and Pressure on the Aggregation of Peroxidase upon Its Adsorption onto Mica

Our present study concerns the influence of the picosecond rise-time-pulsed electromagnetic field, and the impact of nanosecond pulsed pressure on the aggregation state of horseradish peroxidase (HRP) as a model enzyme. The influence of a 640 kV/m pulsed electromagnetic field with a pulse rise-time of ~200 ps on the activity and aggregation state of an enzyme is studied by the single-molecule atomic force microscopy (AFM) method. The influence of such a field is shown to lead to aggregation of the protein and to a decrease in its enzymatic activity. Moreover, the effect of a shock wave with a pressure front rise-time of 80 ns on the increase in the HRP aggregation is demonstrated. The results obtained herein can be of use in modeling the impact of electromagnetic and pressure pulses on enzymes and on whole living organisms. Our results are also important for taking into account the effect of pulsed fields on the body in the development of drugs, therapeutic procedures, and novel highly sensitive medical diagnosticums.

Melanoma Management during the COVID-19 Pandemic Emergency: A Literature Review and Single-Center Experience

Background: The current COVID-19 pandemic has influenced the modus operandi of all fields of medicine, significantly impacting patients with oncological diseases and multiple comorbidities. Thus, in recent months, the establishment of melanoma management during the emergency has become a major area of interest. In addition to original articles, case reports and specific guidelines for the period have been developed. Purpose: This article aims to evaluate whether melanoma management has been changed by the outbreak of COVID-19, and if so, what the consequences are. We summarized the main issues concerning the screening of suspicious lesions, the diagnosis of primary melanoma, and the management of early-stage and advanced melanomas during the pandemic. Additionally, we report on the experience of our dermatological clinic in northern Italy. Methods: We performed a literature review evaluating articles on melanomas and COVID-19 published in the last two years on PubMed, as well as considering publications by major healthcare organizations. Concerning oncological practice in our center, we collected data on surgical and therapeutic procedures in patients with a melanoma performed during the first months of the pandemic. Conclusions: During the emergency period, the evaluation of suspicious skin lesions was ensured as much as possible. However, the reduced level of access to medical care led to a documented delay in the diagnosis of new melanomas. When detected, the management of early-stage and advanced melanomas was fully guaranteed, whereas the follow-up visits of disease-free patients have been postponed or replaced with a teleconsultation when possible.

Das Team in der Neurorehabilitation

Neurological rehabilitation is rehabilitative therapy that is concerned with neurological patients in a multi-professional team under the leadership of a physician. The members of this interdisciplinary team work together closely with an intense exchange of knowledge and competence. This primary treatment team includes specialists in neuropsychology, speech therapy, occupational therapy and physiotherapy (including physical therapy), along with social workers and co-therapeutic nursing. Other forms of therapy may also be included. A secondary team is defined by the cooperation of the neurologist with other medical fields, e.g., neurosurgery, geriatrics, psychiatry, orthopedics and neuropediatrics. A tertiary team exists in the form of organizational cooperation between the medical und economic clinic management with insurance companies and political decision makers. Every kind of rehabilitation is basically multi-professional from an organizational viewpoint, and it is performed interdisciplinarily applying the methods of all therapeutic disciplines to create synergies. This particularly applies to neurorehabilitation, as in this field – generally following a disease or an injury to the brain as the central regulation organ – several different disorders occur in combination: sensorimotor symptoms and signs like paralysis, spasticity, dysphagia and loss of coordination; cognitive or speech disorders; or finally psychological alterations like depression or anxiety. Therefore it is particularly important that the professional team members match and coordinate their therapeutic procedures to reach common rehabilitative goals. »Multi-professional« in this context means that the representatives of the different therapeutic fields work with the patient on an advanced competency level, and »interdisciplinary« means that the members of the team work together closely with thorough cross-consultation between their disciplines. Transdisciplinary cooperation represents the highest level of team competency and includes regularly adopting the tasks and therapeutic procedures from other disciplines. All kinds of cooperation are performed under the supervision of a physician who assumes full responsibility for the rehabilitative therapy, including the prescription of medication and introduction of acute interventions, e.g., surgical procedures. This paper is only concerned with the primary – therapeutic – team. The secondary and tertiary forms of team cooperation are planned to be published separately.

Clinical Approach to Neuroendocrine Neoplasm Associated With Ovarian Teratoma

BackgroundNeuroendocrine neoplasms are a heterogeneous group of cancers that develop from enterochromaffin cells of the diffuse endocrine system, with an increase in incidents over the last years. Ovarian neuroendocrine tumors (NET) are rare neoplasms, comprising 0.1% of all ovarian neoplasms and less than 5% of all neuroendocrine tumors. They may arise alone (as monodermal, specialized teratoma – ovarian carcinoid) or as a part of other ovarian lesion: cystic mature or immature teratomas. Due to the rarity and limited amount of such cases reported in the literature, there is no consensus on diagnostic and therapeutic procedures in this group of patients.Materials and MethodsThe group of 10 patients at the age of 19 to 77 years (mean 42.8 ± 17.9), diagnosed with unilateral NET within ovarian teratoma were analyzed. The histopathological type of tumor, progression free survival after surgical treatment and presence of hormonally active syndrome were assessed.Results70% (n=7) of patients was diagnosed with mature cystic teratomas containing NET component and 30% (n=3) with monodermal teratoma (strumal carcinoid). All cases of monodermal teratomas were found in women at premenopausal age. Determined Ki67 ranged from 2% to 9%. Ninety percent of lesions (n=9) stained positive for synaptophysin and chromogranin, while markers: CK20, CK7, TTF-1 and CDX2 were negative in all cases, which ruled out their metastatic nature. None of the patients presented with carcinoid syndrome. All followed-up patients remain progression-free, which confirms surgical intervention being a crucial and sufficient method of treatment.ConclusionsThe prognosis and clinical behavior of NETs associated with ovarian teratomas are good with long progression-free survival.