Rajan Gupta

Coverage of denuded roots has become one of the most challenging procedures in periodontal plastic surgery. The search for the appropriate root coverage technique has taken many different approaches. Various surgical options with predictable outcomes are available. In this clinical study, patients were treated using polyglactin 910 (Vicryl mesh) and a coronally positioned flap. Clinical parameters for 15 patients were recorded immediately prior to surgery and after a minimum of 6 months. Postoperatively, significant root coverage, reductions in probing depths, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. The final esthetics, both color match and tissue contours, were acceptable to both the patients and the clinicians.

Venous thromboembolic disease remains a difficult problem in the trauma patient population. The purpose of this study was to delineate the incidence and natural history of below-knee deep venous thrombosis (BKDVT) in high-risk trauma patients. Patients were stratified into risk categories (low, high, or very high) for deep venous thrombosis on the basis of an institutional practice management guideline and known risk factors. All at-risk patients received either sequential compression devices (SCDs) or subcutaneous heparin (SQH) compounds, and high-risk patients also underwent weekly surveillance by duplex scanning. Very-high-risk patients had prophylactic inferior vena cava (IVC) filter placement. This prospective, observational study examines the duplex results on all high-risk patients. Data regarding method of prophylaxis, the incidence of proximal propagation on serial duplex examinations, and changes in management (anticoagulation or IVC filter placement) were collected on the high-risk patients who developed a BKDVT. Between March 1997 and June 2001, 601 patients were stratified into the high-risk category and underwent a total of 1,109 duplex examinations. Eighty-five patients (14.1%) had 113 BKDVTs. These patients underwent a total of 212 duplex examinations; all patients developed their BKDVTs within 34 days. Weekly incidence was 40 (47.1%), 25 (29.4%), 15 (17.6%), 1 (1.2%), and 4 (4.7%) for weeks 1 through 5, respectively. SCDs, SQH compounds, and SCDs with SQH compounds were used on 73, 3, and 9 patients, respectively. In 4 of 85 (4.7%) patients, the BKDVT propagated proximally to an above-knee location in 4 to 8 days. Two of these patients were anticoagulated, and two underwent placement of an IVC filter. One patient (1.2%) with a BKDVT that had not propagated on duplex study developed a pulmonary embolus. Patients identified as high-risk by our practice management guideline had a 14.1% incidence of a BKDVT; 94.1% were diagnosed within the first 3 weeks of hospitalization. Proximal propagation occurred in 4.7% and led to changes in management. Serial duplex examination of the BKDVT alone, rather than systemic anticoagulation or IVC filter placement, appears to be a reasonable treatment alternative.

A study was conducted on twenty indigenous goat kids allocated into two different groups. All animals were offered ad libitum rice straw and berseem hay (40:60). Group I (T1) was fed concentrate mixture (100 g/d). Group II (T2) was supplemented with urea molasses mineral block (200 g/d). The experiment lasted for 90 days. There was significant decrease in serum sodium (60.68 mEq/L), increase in serum potassium (34.50 mEq/L) and increased activity of AST (340.42 U/L) and ALT (164.96 U/L) was observed in kids of group T2 in comparison to the controls (T1). On histopathological examination mild degenerative changes in kidney of group T2 with congestion in intertubular vessel, granular cytoplasm of the epithelial cells in PCT and DCT, necrosis and swelling of the epithelial cells, congestion of vessels and cloudy swelling was observed in PCT and DCT. Albuminious mass was also present in tubule. On histopathological observation of liver of kid of group T2 oedema in liver parenchyma and proliferation of fibrious tissue in periportal area was observed.

The assessment and management of neurotrauma have progressed significantly over the past several years. Improved understanding of the physiology of injured neural tissue and advances in technology have refined the approach to the care of patients suffering neurologic injury. Evidence-based clinical management guidelines, such as those developed by the Brain Trauma Foundation and the American Association of Neurological Surgeons, for the management of traumatic brain injury have been introduced to standardize certain aspects of care. The ongoing evolution of critical care also has had a significant impact on the care of patients suffering from neurotrauma. This article reviews some current issues related to the diagnosis and management of traumatic brain injury and spinal cord injury as we head into the next millennium.

The purpose of this study is to investigate the usefulness of flexion and extension radiographs of the cervical spine for the acute evaluation of ligamentous injury in cases of awake blunt trauma. A review of 106 consecutive cases of blunt trauma evaluated with flexion and extension radiographs of the cervical spine obtained in the acute setting at a Level I trauma center was performed. The data compiled included the age, sex, mechanism of injury, type of radiographic evaluations, interpretation of all radiographic studies, and clinical outcome on follow-up. Sixty-six of the patients (62%) were involved in motor vehicle crashes. Other injuries included 15 falls (14%), 9 blunt assaults (8.5%), and 16 other types of blunt trauma (15%). Thirteen cervical spine injuries were diagnosed in 9 of 106 patients (8.5%). Injuries included two fractures, eight acute disc herniations, two ligamentous injuries, and one cord contusion diagnosed on the basis of all radiologic evaluation and clinical follow-up. Seventy-four patients (70%) had a range of flexion and extension motion interpreted as adequate for diagnostic purposes. Five of the 74 patients (6.75%) with an adequate range of motion had cervical spine injuries. No ligamentous injuries were misdiagnosed in this group. Thirty-two of the flexion and extension examinations (30%) were interpreted as inadequate because of limited motion. Four of the 32 patients (12.5%) with inadequate flexion and extension examinations had injuries subsequently detected on cross-sectional imaging (computed tomographic scanning or magnetic resonance imaging) including severe ligamentous injury. When adequate motion was present on flexion and extension radiographs, the false-negative rate was zero in this study. However, in the acute setting, 30% of the examinations were limited by inadequate motion. A higher percentage of injury (12.5%) was detected by subsequent cross-sectional imaging in these patients. Limited flexion and extension motion on physical examination should preclude the use of flexion and extension radiographs, as they are of limited diagnostic utility. Cross-sectional imaging may be warranted in this high-risk group of patients.

There has been considerable discussion on the national level on the future of trauma surgery as a specialty. One of the leading directions for the field is the integration of emergency general surgery as a wider and more attractive scope of practice. However, there is currently no information on how the addition of an emergency general surgery practice will affect the care of injured patients. We hypothesized that the care of trauma patients would be negatively affected by adding emergency general surgery responsibilities to a trauma service. Our institution underwent a system change in August 2001, where an emergency general surgery (ES) practice was added to an established trauma service. The ES practice included emergency department and in-house consultations for all urgent surgical problems except thoracic and vascular diseases. There were no trauma staff changes during the study period. Trauma registry data (demographics, injuries, injury severity, and procedures) and performance improvement data (peer-review judgments for all identified errors, denied days, audit filters, and deaths) were abstracted for two 15-month periods surrounding this system change. Chi-square, Fisher's exact, and t tests provided between-group comparisons. The trauma staff evaluated a total of 5,874 patients during the 30-month study. There were 1,400 (51%) trauma admissions in the pre-ES group and 1,504 (48%) in the post-ES group, of which 1,278 and 1,434, respectively, met severity criteria for report to our statewide database (Pennsylvania Trauma Outcome Study [PTOS]). There were 163 (12.7% of PTOS) deaths in the pre-ES group compared with 171 (11.9% PTOS) deaths in the post-ES group (p = not significant [NS]). There was one death determined to be preventable by the peer review process for the pre-ES group, and none in the post-ES group. Both groups had 10 potentially preventable deaths, with the remaining mortalities being categorized as nonpreventable (p = NS). Unexpected deaths by TRISS methodology were 36 (2.8%) and 41 (2.9%) for the two groups, respectively (p = NS). There was no difference in the number of provider-specific complications between the groups (23, [1.8%] vs. 19 [1.3%], p = NS). The addition of emergency surgery has resulted in an additional average daily workload of 1.3 cases and 1.2 admissions. Despite an increase in trauma volume over the study period, the addition of emergency surgery to a trauma service did not affect the care of injured patients. The concept of adding emergency surgery responsibilities to trauma surgeons appears to be a valid way to increase operative experience without compromising care of the injured patient.

Abstract: We describe recent progress in numerical computations of the properties of strongly interacting elementary particles. On the 1024 node Connection Machine-5 (CM-5) at Los Alamos National Laboratory [ACL], we are calculating the spectrum of light hadrons, scattering amplitudes and a variety of electroweak matrix elements. On the Cray C-90 at NERSC we are studying topology and calculating the kaon B-parameter, BK. By working on a large lattice (32^ 4x64), and collecting a large sample of gauge configurations, we are ...

The thermodynamics of quantum chromodynamics (QCD) and, especially, its numerical analysis using the lattice regularized definition of QCD (lattice QCD) is of great importance to the phenomenology of heavy ion collisions and the physics of the early universe. Lattice calculations for the equation of state (EoS) 1–4 are of direct relevance for model calculations describing the expansion of dense matter formed in relativistic heavy ion collisions as well as in the early universe. In large heavy ion collision experiments at LHC, RHIC, SPS, and ...

Abstract We present a detailed analysis of the nonperturbativeβ function along the Wilson axis for theSU (3) pure gauge theory using the Monte Carlo renormalization group method. The scaling behavior of the string tension, the deconfinement transition temperature, and the O++ glueball mass obtained from published data is compared. The results show that there is no asymptotic scaling forK F=(6/g 2)< 6.1. We also estimate the renormalized action generated by the√ 3 block transformation for use in future calculations.

Description/Abstract We have undertaken a large-scale computer simulation of the 3d Ising model using the Monte Carlo Renormalization Group (MCRG) method. Our calculation improves on past calculations in three ways. Firstly, larger lattices are used--we have run on 128 {sup 3} as well as 64 {sup 3}. Secondly, many more spin operators--53 even and 46 odd--are measured. Lastly, we have incorporated more efficient ways of spin update--Wolff's single-cluster variant of the Swendsen and Wang algorithm. In addition to calculating the ...

Description/Abstract Recent work showing the validity of hyperscaling involved results for finite size systems very near the critical point. The authors study this problem in more detail, and give estimators related to the Binder cumulant ratio which seem to approach the critical temperature from above and below. Based on these results, they estimate that the renormalized coupling constant, computed for the temperature fixed at the critical temperature and then taking the large system-size limit, is about 4.9 {+-} 0.1, and give a ...

We explore existing sum rule analyses of the and quark masses. We argue that certain assumptions about the behavior of unmeasured continuum scalar and pseudoscalar spectral functions can lead to significant overestimates of these masses, and illustrate the source of the problem in the analogous isovector vector channel.© 1997 American Institute of Physics.

Description/Abstract This is the final report of a three-year, Laboratory-Directed Research and Development (LDRD) project at the Los Alamos National Laboratory (LANL). The project objectives were (1) to develop highly optimized codes for the simulation of lattice Quantum Chromodynamics (QCD) on the Connection Machine CM-5,(2) to use these codes to carry out a comprehensive analysis of Standard Model phenomenology using a large statistical sample, and (3) to combine the results of numerical simulations with ...

Description/Abstract This is the final report of a one-year, Laboratory Directed Research and Development (LDRD) project at Los Alamos National Laboratory (LANL). The objectives of this project were (1) to develop the computer code necessary for the simulation of heavy quarks using the nonrelativistic quantum chromodynamics (NRQCD) approach using the massively parallel Connection Machine CM-5; and (2) to combine these heavy quarks with O (a) improved light quarks to obtain experimentally interesting predictions of QCD. We ...

Abstract An extensive study of heavy-light spectroscopy using NRQCD b-quarks is described. Results include radially and orbitally excited heavy meson states and masses of baryons with one or two b-quarks. New determinations of the b-quark pole and MS-bar masses are presented.

Description/Abstract This is the final report of a three-year, Laboratory Directed Research and Development (LDRD) project at Los Alamos National Laboratory (LANL). The goal of this project was to extend and develop the predictions of the Standard Model of particle physics in several different directions. This includes various aspects of the strong nuclear interactions in quantum chromodynamics (QCD), electroweak interactions and the origin of baryon asymmetry in the universe, as well as gravitational physics.

Subgap structures in the IV curves of layered superconductors are explained by the excitation of phonons by Josephson oscillations. In the presence of a magnetic field applied parallel to the layers additional structures due to fluxon motion appear. Their coupling with phonons is investigated theoretically and a shift of the phonon resonances in strong magnetic fields is predicted.

Description/Abstract This talk is based on my experiences with issues in development and education in India. I will describe three unfinished journeys:(i) How HIV/AIDS education and awareness lead to a program of" students as agents of change" through the creation of multimedia presentations on societal issues;(ii) how teaching health to village outreach workers lead to an understanding of adolescent migration from villages to towns in search for jobs and the spectre of alcoholism; and (iii) how teaching health to sex workers in ...

Description/Abstract The following pages show results from the first series of runs on BG/L using the unoptimized code from the MILC collaboration. The calculations were run with the AsqTad improved staggered fermion action and the RHMC algorithm on a 32 {sup 3} x 8 lattice. The jobs were run mostly during October, 2006 on approximately 5% of the machine. The run consisted of approximately 1000 trajectories per beta value, spanning beta= 6.458 to 6.85, covering a temperature range of 140-210 MeV.