Background Endophytic fungi represent a compelling assemblage of microorganisms that inhabit plant tissues without inflicting any discernible detriment to the host organism. They foster a symbiotic association with their host plants, frequently conferring advantages such as augmented growth, enhanced resilience to stressors, and safeguarding against pathogens. Study design Dillenia indica is a medicinal tree of Dilleniaceae. This study aims to isolate and identify the fungi growing as a contaminant in leaf callus. For the identification, both morphological observation and molecular methods were used. The presence of secondary metabolites in different fungal extracts were observed by FTIR and High-resolution accurate mass spectroscopy (HRAMS) methods. Different biological activities (antioxidant, antibacterial and antitumor) of fungal extracts were assessed. Methods For callus initiation, leaf tissues of Dillenia indica were inoculated on Murashige and Skoog's medium supplemented with BAP (1mgl-1) and NAA (1mgl-1) plant growth regulators. To raise pure cultures of endophyte, fungal hyphae were isolated from the contaminated cultures and were grown on Potato Dextrose Agar medium. For molecular identification, genomic DNA (gDNA) was isolated from fungal mycelia. Internal transcribed spacers (ITS1 and ITS4) were used to amplify the conserved ITS region of the fungal gDNA. Previously deposited sequences in the Gene bank were used for the identification and making of phylogenetic tree. Antioxidant, antibacterial and anticancer potential of fungal extracts were studied. Results The endophyte was identified as Aspergillus flavus. FTIR study showed the presence of diverse types of secondary metabolites in fungal extract. A significant presence of phenolics, flavonoids, terpenes, steroids, etc. was observed by High-resolution accurate mass spectroscopy analysis (HRAMS) of fungal extract. Endophyte extract prepared in chloroform showed both antioxidant (IC50 430.23) and antibacterial (maximum inhibition of E. coli:15 ± 0.62 mm) potential compared to other solvents. Cell viability decreased at high concentrations of endophyte extract prepared in chloroform and ethyl acetate solvents. Fungal extract prepared in ethyl acetate showed considerable cytotoxicity and growth inhibition of DL tumor cells. Conclusion In the present study, isolated endophyte of Dillenia indica showed high occurrence of secondary metabolites. Fungal extracts showed antioxidant, antibacterial and antitumor activities. As, endophytes are remarkable source of active constituents, there is a great need to explore such endophytes. Their extensive studies are required to develop an alternative of plant less production of valuable compounds.

Anterolateral thigh (ALT) flap is currently the workhorse flap in many centers as it provides variable reconstructive options. ALT flap can be raised subfascially or suprafascially based on the requirement. The localization of a reliable perforator is a key step during the flap elevation.[1] ALT perforator at the deep fascia level can be divided into three groups: thin (<0.5 mm), medium (0.5–1 mm), and thick (>1 mm). Earlier, 1-mm perforator was considered to be a reliable perforator.[2] But recent literature shows that a perforator of equal to or more than 0.5 mm can be considered reliable, and a flap can be safely raised on it,[3] whereas in the case if it's <0.5 mm, at least two perforators should be included in the flap.[4]

The public cloud is the backend of a massive and exponential growing percentage of online software services [1]. These services consume exabytes of storage, petabytes of network bandwidth, and millions of processor cores. The requirement for networking speeds has gone up by almost 10 times in the last few years. Software Defined Network policies of customers change rapidly in weeks or months so they required a solution that could provide software-like programmability while providing hardware like performance [3]. Field programmable gate array based smart network interface card or SmartNIC is the best-suited solution for this requirement. SmartNICs are pushing computation and therefore, acceleration to the edge of the network, freeing up server CPUs to work on more solutions focused on complex business-critical processing. Network on Chip is an integral part of this architecture which enables concurrent communication among multiple clients. We highlight limitations of traditional IP vendor Arteris Network On Chip architecture [5] and discuss novel Network On Chip architecture that was introduced to support high bandwidth requirement, crossbar connectivity across 30 unique sets of initiators and targets, handling traffic type of various protocols, end-end non-blocking architecture with 54 isolated logical paths, as part of architecture definition of 400 G Infrastructure Processing Unit or IPU solution for Cloud Service Providers under tight constraints of power and area targets.

The free fi bula fl ap is one of the most versatile fl aps with a skin paddle of variable blood supply. Here, we describe a rare anatomic variant of septocutaneous perforator and propose an addendum to the existing classi fi cation system to accom-modate the variations of our case. A

of cutaneous neurocristic hamartoma and

We report a post-traumatic case of tendoachilles injury with an overlying skin defect. Following debridement, tendon reconstruction was done by using vascularised peroneus brevis musculotendinous unit and proximal part of the same muscle provided the skin cover. Postoperative recovery was uneventful. At 2 years follow-up, he had a near-normal gait. The main advantage of this flap is not being only a local flap but also providing a vascularised tendon.

Annals of Plastic Surgery: September 2021 - Volume 87 - Issue 3 - p 359 doi: 10.1097/SAP.0000000000002558

Fluid replacement is an integral part of adult burn care, especially in patients with more than 20% total body surface area involvement. The fluid loss in burns has to be adequately replaced to maintain satisfactory tissue perfusion and prevent shock. Over these years, many different formulas and a variety of fluids have been used to resuscitate these patients. This article reviews the current trends and different approaches in fluid management.

This paper illustrates the signal integrity (SI) performance enhancement in an LPDDR5 system running at 6400 Mbps through the Data Bit Inversion (DBI) feature available in the controller. To demonstrate the above-mentioned phenomenon, an SIPI co-simulation is performed, to estimate the link performance. For SI, the eye margins for one byte and its corresponding DBI pin in an LPDDR5 channel are simulated. The eye margins are evaluated with and without DBI-compliant versions of the Peak Distortion Analysis (PDA) patterns and are statistically extrapolated to reflect a bit error rate (BER) of 10(-16). Upon comparing BER-16 eye margins for the DBI-compliant bit patterns to the original patterns, a significant improvement is observed. The eye height shows 14.8% improvement and the eye width increases by 8.3%.

KEY POINTS Acute aortic syndrome (AAS) is a life-threatening emergency, accounting for 1/2000 presentations of acute chest or back pain to the emergency department.[1][1] It is a clinical spectrum of diagnoses including aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer at

Background To study mean core to peripheral temperature difference (CPTD) and the mean lactate levels over the first 6 h of admission to hospital, as indicators of prognosis in critically ill children. Methods A prospective observational study in a tertiary level Pediatrics ICU in Delhi, India. Seventy eight paediatric patients from 1 month to 12 years were studied. Children with physical trauma, post-surgical patients and patients with peripheral vascular disease were excluded. Core temperature (skin over temporal artery) to peripheral temperature (big toe) difference was measured repeatedly every minute over 6 h and mean of temperature difference was calculated. Pediatric Risk of Mortality (PRISM) II, lactate clearance and mean lactate levels during that time were also studied. In-hospital mortality was used as the outcome measure. Results Mean temperature difference During the first 6 h after admission the mean temperature difference was 9.37 ± 2 °C in those who died and 3.71 ± 2.27 °C in those who survived ( p < 0.0001). The area under the receiver operating curve (AUROC) was 0.953 ( p < 0.0001). The comparable AUROC of PRISM II was 0.999 ( p < 0.0001). Mean Lactate Mean lactate level in the first 6 h was 7.1 ± 2.02 mg/dl in those who died compared to 2.86 ± 0.87 mg/dl in those who survived ( p < 0.0001). The AUROC curve for mean lactate was 0.989 (95% CI = 0.933 to 0.999; p < 0.0001). AUROC for the lactate clearance was 0.682 ( p = 0.0214). Conclusions The mean core to peripheral temperature difference over the first 6 h is an easy-to-use and non-invasive method that is useful to predict mortality in children admitted to the Pediatric ICU. The mean lactate during the first 6 h of Pediatric ICU admission is a better index of prognosis than the lactate clearance over the same time period. They may be used as components of a scoring system to predict mortality.

Introduction Anal incontinence brings lot of social embarrassment, mental distress, dignity loss, anxiety, low confidence, and eventually a low self-esteem with a restricted social life to the affected person. Surgical repair is the mainstay of treatment for anal incontinence. However, some patients need additional procedures such as gluteoplasty, graciloplasty (adynamic and dynamic), artificial bowel sphincter, and sacral nerve stimulation, which help to reinforce or augment the anal sphincter. Methods A retrospective analysis of 17 patients who underwent adynamic graciloplasty for reconstruction of anal sphincter from January 2008 to December 2017 was done. Demographic profile, fecal incontinence scores (Wexner score and KAMM score), and anal manometric findings were recorded pregraciloplasty and postgraciloplasty. Results Of the total 17 patients, 9 were males and 8 were females. Satisfactory continence was achieved in 13 patients out of 17 (76.47%). Continence was defined as satisfactory for patients having a postoperative Wexner score of 2 or less and KAMM score of 4 or less. It was considered to be poor if the Wexner score was greater than 6 and KAMM score was greater than 8 in the follow-up period or if the stoma was not reversed. Conclusions Unstimulated or adynamic graciloplasty is a relatively safe procedure, has a short learning curve, is affordable, and avoids the additional implant-related complications. We feel that the unstimulated graciloplasty still has a significant role in the management of anal incontinence.

INTRODUCTION Marjolin ulcer is a rare skin malignancy. Marjolin ulcer arises in zones of long-standing scars, inflammation, or chronic wounds. MATERIAL AND METHODS The present study was conducted to assess the demographic profile and identify the predictors of recurrence in 55 patients with Marjolin ulcer admitted over 10 years. Patients underwent either wide local excision with 2-cm peripheral margin or amputation if clinically indicated due to joint involvement. Lymph nodes were dissected if found positive. Patients received adjuvant radiotherapy if tumor clearance was less than 4 mm or the draining lymph nodes were positive. RESULTS Of the total 55 cases (mean age, 48.75 years; range, 24-74 years), 34 were men and 21 were women (male/female, 1.6:1). The most common cause of injury was flame burn (n = 32, 58%) followed by trauma (n = 10, 18%). The lower limb was frequently affected (n = 38, 69.1%). Twenty-six patients with resection margins less than 4 mm had received adjuvant radiotherapy. Among the 55 patients, 6 (11%) had undergone lymph node dissection. Local recurrence was noted within 18 months in 9 (16.35%) patients, of which 5 patients had a tumor-free margin of less than 4 mm. We found 2 predictors for local recurrence. First, moderately differentiated squamous cell carcinoma (P = 0.04) and, second, patients with lymph node involvement (P = 0.001). CONCLUSION Marjolin ulcer is a high-risk skin tumor. Patients with positive lymph node or with moderately differentiated squamous cell carcinoma have high chances of recurrence. Frequent and intense follow-up is required for at least 2 years.

Purpose: Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects. Methods: This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery. Results: There were 21 males and 4 females with the mean age of 39 (5-76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4-50) cm(2). The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting. Conclusion: The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting. (C) 2019 Chinese Medical Association. Production and hosting by Elsevier B.V.

With the ever-increasing demand for portable electronic devices to provide longer battery life, extremely low power consumption becomes an SoC design imperative. Aggressive SoC and system-level power management methods (PMM) are key to this drive towards low power consumption and extended battery life. These methods pose many challenges to the validation of the low-power states, SoC and system-level debug, and overall product time to market (TTM). This paper discusses techniques developed to address these SoC validation and debug challenges efficiently.

Introduction: Trauma is the major cause of death and disability in developing country, is responsible for more years of life lost than most human diseases. This study aims to establish the value of a trauma registry by measuring, monitoring, and analyzing etiological factors of common musculoskeletal injuries caused due to several forms of trauma. Materials and Methods: This study has been conducted retrospectively. The patients attending the emergency department in tertiary care hospital were included in this study. Personal data and pattern of injuries sustained were extracted from the casualty admission register of emergency department and trauma unit, case records, and operation records. Results: A total of 6574 injured patients were seen in the emergency department. The most common injury was bony injury (65.38%, n = 4298) and soft-tissue injury 34.62% (n = 2276) and the most common sites were lower limbs in 41.39% of cases, amputation/crush injury in 7.82%, and 32.03% of cases (n = 1377) were of compound fractures. The most common soft-tissue injury was lacerated wound 45.21%. Most commonly associated injury was the head injury in 5.53% of cases. Maximum cases were in the age group of 30-59. Conclusion: Fractures were the most common pattern of injuries frequently associated with other injuries, especially head injuries, particular age group, and time period need special attention, and we need more such institutes near highways.

The aim of this study is to document the incidence of early lymphedema and study the risk factors influencing post mastectomy lymphedema. It is a prospective cohort study involving 98 adult women who underwent surgery including axillary lymph node dissection for biopsy-proven breast carcinoma. Serial measurements of the arm were taken preoperatively and postoperatively at 3, 6 and 12 months. Lymphedema was diagnosed if there was an increase in girth by more than 2cm in the concerned limb. All patients received standard lymphedema prevention advice. Risk factors assessed were age, body mass index, comorbid conditions, hypertension, medications, socioeconomic status, upper limb symptoms, laterality of disease, type of surgery, stage of the disease, histopathology, node status, wound complication, receptor status, seroma volume, duration of seroma drainage, radiotherapy, chemotherapy, post radiation skin reaction and post therapy weight gain. The statistical analysis was done using chi-square test with SPSS version 16. The incidence of lymphedema was 23.47%. The univariate analysis showed that prolonged or high volume seroma, taxane-based chemotherapy, radiotherapy to axilla and skin necrosis following radiation were significantly associated with lymphedema. In the multivariate analysis, only post radiation skin necrosis was significant.

Intravenous Immunoglobulin (IVIg) can cause Autoimmune Haemolytic Anaemia (AIHA) in some patients. There are many reports of AIHA developing in children with Kawasaki Disease (KD) after they were treated with IVIg. However, AIHA is seldom reported at the onset of KD, prior to the treatment with IVIg. Here, we report a case of a 10-month-old infant, who developed AIHA alongside the manifestations of KD. Treatment with IVIg resulted in the resolution of symptoms of both KD and AIHA. We also present a review of the literature on similar findings. This suggests that AIHA may be an uncommon manifestation of KD; or that KD and AIHA may both be stimulated, in susceptible persons, by some common agent.

Context: In a filariasis endemic country like India, the need for an effective and consistent treatment for filarial lymphedema has long been recognized. In this study, we set out to evaluate decongestive lymphatic therapy (DLT) for postfilarial lymphedema. Aims: The aims of this study are to determine the efficacy of DLT in the management of postfilarial lymphedema of extremities. Settings and Design: This is one prospective study from April 1, 2010, to March 30, 2011 included twenty patients with the diagnosis of lymphedema of the extremities. After the Institutional Review Board approval, consent was taken. Subjects and Methods: Patients with unilateral postfilarial lymphedema were included in the study. Exclusion Criteria: (1) Other forms of lymphedema, (2) Clinical evidence of local infection, (3) Severe cardiac disease, (4) Uncontrolled hypertension, (5) Malignancy. The clinical profile of the patient was recorded and was noted. Limb circumferences were measured at axial intervals of 10 cm for the entire limb length. Each segment's volume was calculated with the truncated cone formula H × (C2 + Cc + c2)/12 Π, H = height, C = circumference at the top of the cone, c = circumference at the base of the cone. Total limb volume was acquired by adding the segments. Patients were subjected to daily DLT which included manual lymphatic drainage, low-stretch compression bandaging, and skin care and exercises and volume reduction measured. The patients were followed up for 1 year. Statistical Analysis Used: Spearman's rank correlation coefficient, one sample t-test, Mann–Whitney U-test. Results: The mean reduction in the volume of the affected limb was 63.12% with standard deviation of 11.38 and P < 0.001. Long-term therapeutic benefits were maintained through self-massage, self-bandaging, exercise, and consistent use of compressive garments. The average volume of the affected limb at presentation was 10067.45 ml ± 3768.42. After DLT, the average volume was 7860.4 ml ± 2617.36. The average volume after 1-year follow-up was 8109.3 ml ± 2438.4. There was no correlation between the severity of pretreatment limb volume and the extent of reduction after DLT. No complications were seen during the course of the study. Conclusions: DLT is an effective and safe modality for the treatment of lymphedema of the extremities. It has wide applicability, especially in postfilarial lymphedema.