Prior Surface Integrity Assessment of Coated and Uncoated Carbide Inserts Using Atomic Force Microscopy

Coated carbide inserts are considered vital components in machining processes and advanced functional surface integrity of inserts and their coating are decisive factors for tool life. Atomic Force Microscopy (AFM) implementation has gained acceptance over a wide spectrum of research and science applications. When used in a proper systematic manner, the AFM features can be a valuable tool for assessment of tool surface integrity. The aim of this paper is to assess the integrity of coated and uncoated carbide inserts using AFM analytical parameters. Surface morphology of as-received coated and uncoated carbide inserts is examined, analyzed, and characterized through the determination of the appropriate scanning setting, the suitable data type imaging techniques and the most representative data analysis parameters using the MultiMode AFM microscope in contact mode. The results indicate that it is preferable to start with a wider scan size in order to get more accurate interpretation of surface topography. Results are found credible to support the idea that AFM can be used efficiently in detecting flaws and defects of coated and uncoated carbide inserts using specific features such as “Roughness” and “Section” parameters. A recommended strategy is provided for surface examination procedures of cutting inserts using various AFM controlling parameters.     

Reversed rotation of the midgut in adults – a case report

Intestinal obstruction is a common surgical emergency. It is often due to adhesions; however, when the patient is young and has a virgin abdomen, we have to consider uncommon causes. We present a rare case of reversed rotation of the midgut as a cause for intestinal obstruction.     

Social Support and Stress Among University Students in Jordan

The purpose of this study was to examine the relationship between perception of social support and perceived stress among university students in Jordan. A sample of 241 university students from private and government universities in Jordan answered self-report questionnaires including the perceived social support scale and perceived stress scale. The results showed that university students have moderate perception of social support and stress. Female university students had higher perception of stress and social support than male university students. Perceived stress had a negative correlation with perceived social support from family (−0.29, p < 0.05). The perceived social support from family was a better predictor of perceived life event as stressful situations than perceived social support from friends. The study implications for research and intervention were discussed.     

Orbital alveolar soft part sarcoma: Histopathologic report of two cases

Alveolar soft part sarcoma is considered as a distinct histopathological entity with rare cases reported from the orbit area. Two cases of alveolar soft part sarcomas occurring in the orbit of two patients along with their histopathologic findings are reported herewith. In both cases, the patients presented with eyelid swelling and proptosis. The diagnosis was made by incisional biopsies and histopathology. The literature is reviewed regarding occurrence of this tumor, its diagnosis and management.     

Chloroacetonitrile induces oxidative stress and apoptosis in mouse fetal liver

Chloroacetonitrile (CAN) is a disinfection by-product of chlorination of drinking water. The present study was designed to investigate the potential adverse effects of maternal exposure to CAN on fetal liver in mice. Based on an initial dose–response experiment, CAN (25 mg/(kg day)) was given orally to pregnant mice at gestation day (GD) 6, till GD 18. Fetuses were collected and fetal livers were used for assessing oxidative status, apoptosis and histopathological changes. Maternal exposure to CAN resulted in observed oxidative stress and redox imbalance in fetal liver tissues as marked by significant decrease in reduced glutathione (GSH) and elevation of oxidized glutathione (GSSG), malondialdehyde (MDA) and 8-hydroxy-2′-deoxyguanosine (8-OHdG) in genomic DNA. Further, CAN induced apoptosis as indicated by a significant increase in binding of Hoechst reagent to damaged DNA fragments of fetal liver and enhancement of the activity of caspase-3 in cytosolic fractions of fetal livers. Histopathological examination of fetal livers of CAN-treated mice showed hepatocytes with vacuolated cytoplasm, karyolysis and karyorrhexis as well as depletion of their glycogen content. In conclusion, maternal exposure to CAN adversely affects mouse fetal livers as evidenced by the induction of oxidative stress, apoptosis and histopathological changes.     

Neoadjuvant Chemotherapy Plus Conventional Radiotherapy or Accelerated Hyperfractionation in Stage III and IV Nasopharyngeal Carcinoma - A Phase II Study

A prospective phase II trial was initiated in previously untreated patients with locally advanced nasopharyngeal carcinoma (NPC). The goal was to achieve improvement in locoregional control, disease-free interval and overall survival using induction chemotherapy and to compare conventional fractionation (CF) with an accelerated hyperfractionation (AHF) regimen. Fifty patients were treated (5 AJCC Stage III, 45 Stage IV) with induction chemotherapy consisting of two cycles of cisplatin and 5-fluorouracil. Patients were then randomized between CF and AHF therapy. A clinical response to induction chemotherapy was reported in 86% of patients prior to radiotherapy (44% complete response, 42% partial response). Patients with complete or major partial responses to induction chemotherapy had a significantly better 5-year overall survival (60%) and disease-free interval (59%) than those with no response or minor partial response (15% and 18%, p = 0.009 and 0.0009). Acute radiation reactions were more pronounced in the AHF group (p = 0.0002), and the incidence of late normal tissue injury was more frequent (p = 0.08). At 5 years, the locoregional control rate was higher in the AHF arm (76%) than in the CF group (54%), but the difference was not significant (HR, 0.52; 95% CI, 0.15?2.83; p = 0.186). With a median follow-up period of 55 months (range 4?120), the 5-year disease-free interval and overall survival rates were more favorable in the AHF group than in the CF group, but the differences were not significant (59% and 54% vs. 34% and 36%, respectively, HR for disease-free interval=0.71; 95% CI, 0.27?1.88; p = 0.198 and HR for overall survival = 0.81; 95% CI, 0.37?1.78; p = 0.433). The overall treatment failure rate was 48%. Locoregional failures occurred in 12 patients (24%) and the incidence of distant metastases reached 30%. Response to induction chemotherapy is strongly predictive for locoregional control, disease-free interval and overall survival. Accelerated hyperfractionation was associated with high incidence of acute and late toxicity without significant improvement in locoregional control rate. The optimal chemotherapy dose and sequencing with radiotherapy needs to be investigated in future studies. Distant metastases remain the main cause of treatment failure in NPC.     

Longitudinal assessment of hepatic fibrosis in responders to direct‐acting antivirals for recurrent hepatitis C after liver transplantation using noninvasive methods

Successful eradication of recurrent hepatitis C virus (HCV) infection following liver transplantation (HCV) improves graft survival. This study aimed at evaluation of hepatic fibrosis changes among long‐term responders to DAA therapy for recurrent HCV after liver transplantation using noninvasive methods. Patients with significant hepatic fibrosis (≥F2) who achieved SVR12 after treatment with DAAs for recurrent HCV were included (n = 52). Hepatic fibrosis status was assessed, noninvasively, by calculation of fibrosis‐4 score (FIB‐4) and Aspartate Aminotransferase Platelet Ratio Index (APRI) and by measurement of graft stiffness using FibroScan at baseline and 12 and 18 months post‐treatment. Acoustic radiation force imaging (ARFI) was done for all patients 12 and 18 months post‐treatment. Patients were classified into two groups based on baseline liver stiffness measurement (LSM) by FibroScan; significant fibrosis (F2; n = 28) and advanced fibrosis groups (≥F3). Over 18‐month follow‐up period, there was serial improvement of FIB‐4, APRI, and LSM by FibroScan in both groups. Higher baseline LSM and delayed initiation of antiviral therapy were significant predictors of lack of fibrosis regression (P‐value 0.01 and 0.04, respectively). Fibroindices and LSM improved over time in liver transplant recipients who responded to DAAs. Baseline LSM can predict post‐treatment fibrosis regression.     

Retropubic versus transobturator tension‐free vaginal tape (TVT vs TVT‐O): Five‐year results of the Austrian randomized trial

Aims

To compare outcomes of the retropubic versus the transobturator tension‐free vaginal tape (TVT vs TVT‐O) at 5 years.

Methods

A total of 569 women undergoing surgery for primary stress incontinence were randomized to receive a retropubic or a transobturator tensionfree vaginal tape (TVT or TVT‐O). Follow‐up at 5 years included clinical examination, urodynamic studies and quality of life. The primary outcome measure was continence defined as a negative cough stress test at a volume of 300 mL. Secondary outcomes included urodynamic parameters, complications and quality of life. ClinicalTrials.gov (NCT 0041454).

Results

Three hundred and thirty‐one patients (59%) were evaluated at 5 years (277 were seen, examined and completed questionnaires; 54 only completed questionnaires). No significant differences were seen in rates of a negative cough stress test (83% vs 76%, respectively), urodynamic parameters and complications. Quality‐of‐life improved significantly in both groups, without significant differences between the groups. Erosion rates were 5.2% and 4.5%, and reoperation rates were 4.1% and 3.2% respectively.

Conclusions

At 5 years, subjective and objective results after TVT and TVT‐O are stable and similar, without statistical significant differences between the procedures. Major long‐term problems appear rare.