Background Auditing of surgical outcome is controversial due to lack of standard auditing system. POSSUM (Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality)system provides a risk adjusted auditing in surgical practice, which is a reliable scoring system. However it has not been generalized in China, especially in gastric surgery. Present study evaluates the application of POSSUM system to compare surgical outcome of malignant gastric disease between specialized unit and general unit. Methods Retrospective study was performed on 394 patients who underwent surgical intervention for gastric cancer and malignant gastric lymphoma. POSSUM data were collected according to standard criteria described by its original authors. Exponential analysis method was used for data analysis. Observed to Expected morbidity (O:E) ratio was calculated for each unit to give risk adjusted comparison. All the complications were categorized into minor to severe to give an objective view of complications. Results There was significant difference in surgical outcome between specialized unit and general unit. POSSUM predicted morbidity well and O: E ratio of specialized unit was better than general unit. Further more postop stay wassignificantly shorter(P ＜0.001 ) in specialized unit and number of moderate and severe morbidity was significantly lower (P＜0.001) than general unit. Conclusions Surgical outcome of specialized unit was better than general unit. POSSUM can be used for risk adjusted auditing of postop complications in malignant gastric disease, which provides a reliable audit. However morbidity definition in POSSUM should be amended and modification in POSSUM formula may be necessary to fit major surgical interventions like gastric cancer surgery.

Triceps rupture is the least common among all tendon injuries. The usual mechanism of injury is a fall on an outstretched hand, although direct contact injuries have also been reported to cause this injury. The diagnosis of acute triceps tendon rupture may be missed, which can result in prolonged disability and delayed operative management. We presented three cases of acute triceps tendon rupture each at different site showing the spectrum of injury to the muscle and mechanism of injury and management were also discussed.
Adult ; Arm Injuries ; surgery ; Humans ; Male ; Middle Aged ; Rupture ; Tendon Injuries ; surgery

High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons. Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics. Anatomic reconstruction of the proximal tibial articular surfaces, restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment. In cases of complex bicondylar tibial plateau fractures, isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions. However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane. In such fractures it is imperative to fix the medial plateau with buttressing in both planes. One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury, surgical approach and management.
Adult ; Bone Plates ; Humans ; Male ; Tibia ; surgery ; Tibial Fractures ; surgery

Perilunate dislocations are rare injuries of the wrist and complete dislocation of the lunate is also rare. There is controversy in literature regarding the optimal management of such injuries. Complete lunate enucleation is associated with high rate of osteonecrosis of lunate thus wrist arthrodesis or proximal row carpectomy has been advocated as primary treatment for such injuries. We report a case of transradial styloid complete palmar lunate enucleation in a 25-year-old male patient who sustained injury to the left wrist due to fall on outstretched hand. Carpal row salvage surgery initially by closed reduction and wrist distractor application followed by open reduction and internal fixation with K-wires along with ligamentous repair resulted in restoration of normal wrist anatomy and good functional outcome. As many of these injuries are missed on initial presentation and outcome is poor for missed injuries, prompt diagnosis and early surgical management to restore vascularity of lunate is recommended.
Adult ; Arthrodesis ; Humans ; Joint Dislocations ; surgery ; Lunate Bone ; injuries ; surgery ; Male ; Wrist Injuries ; surgery

Japanese encephalitis (JE) is an important vector-borne viral disease of humans and horses in Asia. JE outbreaks occur regularly amongst humans in certain parts of India and sporadic cases occur among horses. In this study, JE seroprevalence and evidence of JE virus (JEV) infection among horses in Haryana (India) is described. Antibodies against JEV were detected in 67 out of 637 (10.5%) horses screened between 2006 and 2010. Two foals exhibiting neurological signs were positive for JEV RNA by RT-PCR; JEV was isolated from the serum of one of the foals collected on the second day of illness. This is the first report of JEV isolation from a horse in India. Furthermore, a pool of mosquitoes collected from the premises housing these foals was positive for JEV RNA by RT-PCR. Three structural genes, capsid (C), premembrane (prM), and envelope (E) of the isolated virus (JE/eq/India/H225/2009) spanning 2,500 nucleotides (from 134 to 2,633) were cloned and sequenced. BLAST results showed that these genes had a greater than 97% nucleotide sequence identity with different human JEV isolates from India. Phylogenetic analysis based on E- and C/prM genes indicated that the equine JEV isolate belonged to genotype III and was closely related to the Vellore group of JEV isolates from India.
Animals ; Antibodies, Monoclonal ; Cloning, Molecular ; Culex/virology ; Encephalitis Virus, Japanese/*genetics/*isolation & purification ; Encephalitis, Japanese/epidemiology/*veterinary/virology ; Enzyme-Linked Immunosorbent Assay/methods/veterinary ; Female ; Genes, Viral ; Genotype ; Horse Diseases/epidemiology/*virology ; Horses ; India/epidemiology ; RNA, Viral/genetics/isolation & purification ; Reverse Transcriptase Polymerase Chain Reaction/veterinary ; Seroepidemiologic Studies

BACKGROUND: Kojic acid was used for decades in the cosmetic industry as an antimelanogenic agent. However, there are two major drawbacks of Kojic acid, one is cytotoxicity and second are instability on storage. These limitations led the scientist to synthesize the active Kojic acid peptides. OBJECTIVE: In the present study, we synthesize and investigate the effect of five Kojic acid peptides to overcome the limitation of Kojic acid. METHODS: The peptide was analyzed and purified by high-performance liquid chromatography and matrix-assisted laser desorption ionization time of flight mass spectroscopy. Further, the tyrosinase activities of the Kojic acid and Kojic acid peptides were compared. The toxicity was measured and the melanin content is recorded in B16F10 mouse melanoma cells. RESULTS: Maximum tyrosinase activity was measured by Kojic acid peptides. Therefore, Kojic acid peptides were subjected to melanin assay and cytotoxicity assay and finally the stability of the Kojic acid peptide was measured. CONCLUSION: It was observed that this newly synthesized Kojic acid peptide is stable and potent to inhibit the tyrosinase activity and melanin content of B16F10 mouse melanoma cells without exhibiting cell toxicity. Together, these preliminary results suggest that a further exploration is being needed to establish Kojic acid peptide as antimelanogenic agent.
Animals ; Chromatography, Liquid ; Mass Spectrometry ; Melanins ; Melanoma ; Mice ; Monophenol Monooxygenase ; Peptides

Human-elephant conflict (HEC) in India is becoming a growing health problem causing many fatalities every year. Elephants produce injuries by trampling, stomping, squeezing, tossing in the air, or crushing/targeting the head and chest commonly. The adult elephants are most aggressive in their mating season, leading to maximum incidences of HECs in this period. These attacks are mostly unprovoked, though most HECs are provoked. In this case series, the authors described the injuries sustained by three survivors in a short span of one month due to the sudden and unprovoked elephant attack. All the injuries were mild to moderate in severity and involved the chest in common. Timely rescue and prompt initiation of treatment were pivotal in their survival. The authors also want to create awareness about the mating season of elephants to minimize these unfortunate events in the future.
Animals ; Elephants ; Humans ; India ; Seasons ; Survivors

Objective This study aimed to identify clinicopathological factors predictive of lymph node metastasis in patients with the poorly differentiated early gastric cancer (EGC) to assess the feasibility of using endoscopic submucosal dissection (ESD). Methods The records of patients with poorly differentiated early gastric cancer undergoing gastric radical resection between January 2012 and December 2016 were reviewed in Ruijin hospital. Those with distant metastasis, two or more malignant tumors, remnant gastric cancer, neo adjuvant therapy, previous history of gastric surgery or clear history of perigastric lymphadenectomy, and mixed tumors were excluded. Age, sex, presence of ulcerous lesion, tumor size, tumor location, depth of invasion, type of differentiation, lymphatic vessel invasion, vascular invasion, nerve invasion and HER2 expression were collected. Univariate and multivariate stepwise logistic regression analyses were used to identify the independent risk factors of perigastric lymph node metastasis.According to the Guidelines for the Treatment of Gastric Cancer (2018 edition) of the Chinese Society of Clinical Oncology (CSCO), the expanded indications of ESD for EGC are as follows: (1)no ulcerative lesions, the maximum diameter of lesions >2 cm of differentiated intramucosal cancer; (2) ulcerative lesions, the maximum diameter of lesions ≤3 cm of differentiated intramucosal cancer; (3)no ulcerative lesions, undifferentiated intramucosal carcinoma with diameter≤2 cm. The relationship between clinicopathological factors and lymph node metastasis was analyzed. Results A total of 517 patients, aged 21?83 (57.1±11.7), including 307 males and 210 females, were enrolled in the study. Among them, 114 (22.0%) patients had lymph node metastasis. Univariate analysis showed that ulcerative lesion (P=0.042), tumor diameter (P=0.048), depth of invasion (P<0.001), location of tumors (P<0.001), lymphatic vessel invasion (P=0.009), vascular invasion (P<0.001) and nerve invasion (P=0.028) were related to lymph node metastasis after radical resection of poorly differentiated early adenocarcinoma. Age, sex, type of differentiation and HER2 expression were not significantly correlated to lymph node metastasis (P>0.05). Multivariate analysis showed that tumor size (OR=1.61, 95% CI: 1.03?2.52, P=0.037), depth of invasion (OR=2.77, 95% CI:1.66?4.63, P<0.001), lymphatic duct invasion (OR=14.74, 95% CI: 1.58?137.36, P=0.018) were independent risk factors for lymph node metastasis in poorly differentiated EGC, and ulcerative lesion was not a risk factor for lymph node metastasis (OR=0.82, 95% CI:0.56?1.18,P=0.285). A total of 119 patients with poorly differentiated EGC fully complied with the relative indications of ESD recommended by the Japanese Statute and the criteria for radical resection after ESD. Among them, 14 (11.8%) still had perigastric lymph node metastasis, while the gender, tumor diameter, location, differentiation and HER2 expression were not associated with lymph node metastasis (P>0.05). Conclusion For patients with poorly differentiated EGC, the application of ESD should be carefully weighed with precise assessment of tumor diameter, depth of invasion, and lymphatic duct invasion.

Objective This study aimed to identify clinicopathological factors predictive of lymph node metastasis in patients with the poorly differentiated early gastric cancer (EGC) to assess the feasibility of using endoscopic submucosal dissection (ESD). Methods The records of patients with poorly differentiated early gastric cancer undergoing gastric radical resection between January 2012 and December 2016 were reviewed in Ruijin hospital. Those with distant metastasis, two or more malignant tumors, remnant gastric cancer, neo adjuvant therapy, previous history of gastric surgery or clear history of perigastric lymphadenectomy, and mixed tumors were excluded. Age, sex, presence of ulcerous lesion, tumor size, tumor location, depth of invasion, type of differentiation, lymphatic vessel invasion, vascular invasion, nerve invasion and HER2 expression were collected. Univariate and multivariate stepwise logistic regression analyses were used to identify the independent risk factors of perigastric lymph node metastasis.According to the Guidelines for the Treatment of Gastric Cancer (2018 edition) of the Chinese Society of Clinical Oncology (CSCO), the expanded indications of ESD for EGC are as follows: (1)no ulcerative lesions, the maximum diameter of lesions >2 cm of differentiated intramucosal cancer; (2) ulcerative lesions, the maximum diameter of lesions ≤3 cm of differentiated intramucosal cancer; (3)no ulcerative lesions, undifferentiated intramucosal carcinoma with diameter≤2 cm. The relationship between clinicopathological factors and lymph node metastasis was analyzed. Results A total of 517 patients, aged 21?83 (57.1±11.7), including 307 males and 210 females, were enrolled in the study. Among them, 114 (22.0%) patients had lymph node metastasis. Univariate analysis showed that ulcerative lesion (P=0.042), tumor diameter (P=0.048), depth of invasion (P<0.001), location of tumors (P<0.001), lymphatic vessel invasion (P=0.009), vascular invasion (P<0.001) and nerve invasion (P=0.028) were related to lymph node metastasis after radical resection of poorly differentiated early adenocarcinoma. Age, sex, type of differentiation and HER2 expression were not significantly correlated to lymph node metastasis (P>0.05). Multivariate analysis showed that tumor size (OR=1.61, 95% CI: 1.03?2.52, P=0.037), depth of invasion (OR=2.77, 95% CI:1.66?4.63, P<0.001), lymphatic duct invasion (OR=14.74, 95% CI: 1.58?137.36, P=0.018) were independent risk factors for lymph node metastasis in poorly differentiated EGC, and ulcerative lesion was not a risk factor for lymph node metastasis (OR=0.82, 95% CI:0.56?1.18,P=0.285). A total of 119 patients with poorly differentiated EGC fully complied with the relative indications of ESD recommended by the Japanese Statute and the criteria for radical resection after ESD. Among them, 14 (11.8%) still had perigastric lymph node metastasis, while the gender, tumor diameter, location, differentiation and HER2 expression were not associated with lymph node metastasis (P>0.05). Conclusion For patients with poorly differentiated EGC, the application of ESD should be carefully weighed with precise assessment of tumor diameter, depth of invasion, and lymphatic duct invasion.