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Compacted bentonite or sand-bentonite mixtures are considered buffer/backfill materials in the engineering barriers of deep geological repositories for high-level nuclear waste (HLW) disposal in many countries. The design and long-term functionality of nuclear repositories have critical importance for environmental safety and public health. The initially unsaturated buffer material could become re-saturated long after following the sealing of the repository. Although the saturation degree of the buffer might decrease due to high temperatures and evaporation, it tends to increase with groundwater intrusion. Therefore, the soil water characteristic curves (SWCCs) for these unsaturated soils are a key factor in geotechnical engineering. Yet, the determination of SWCCs can be time-consuming and prone to inaccuracies. The HYPROP (Hydraulic Property Analyzer) evaporation technique is a preferred method for accurately determining water retention curves of soils. This reliable method was applied to estimate the water retention curves for sand-bentonite mixtures in the presence of boron minerals. Known for their minimal thermal expansion and commonly used in various industries, boron minerals may improve the thermal stability of sand-bentonite mixtures. The findings revealed that the boron addition increased the water retention capacity of the 10% bentonite mixtures but had a negligible impact on the 20% bentonite mixtures.

43-year-old lady presented with incidentally discovered liver lesions while she was being managed for her complaints of menorrhagia. CT and MRI showed hepatomegaly with multiple lesions in both lobes of the liver with vascular element in the background of diffuse fatty infiltration. Patient underwent laparoscopic core biopsy. Histopathology showed extensive steatosis, intracytoplasmic giant mitochondria and absence of portal tracts, features highly suggestive of hepatic adenomatosis. IHC staining showed membranous and cytoplasmic positivity in hepatocytes for B-catenin consistent with multiple hepatic adenomatosis. Hepatic adenomatosis is a new clinical entity in the hepatological practice characterized by the presence of 10 or more nodules in the liver known for its major complication of bleeding. Hepatic adenomatosis is managed by regular imaging and resection of large (> 5cm) superficial and painful adenomas along with liver function tests and tumor markers to rule out malignant transformation. However, the potential cure being the liver transplantation.

Introduction In actual pharmacological therapy we can see that some drugs can be added to other medical instruments to improve their activity: in example we can see medicated stent for some coronary disease, or hormonal medical devices used in pregnancy prevention, but other example are known today. In example Carmustine wafer is delivered by delivery systems in some brain cancer and radioactive seed implants in prostatic cancer. Ocular intra vitreal implants for some macular degenerations (MABS or cortisones) other implants delivery systems drugs, naltrexone implant for opiate dependence. Other strategies imply carrier use to deliver the drugs in the site of action: In example MABS linked to radioactive isotopes in some relapse of severe Hodgkin disease but many other example we can see in therapy used today. So we can think that other chronic conditions can be treated using a combination of drugs with other instrument to improve the clinical outcomes. This to make possible that the ERLICH MUGIC BULLETS can act in the right site reducing the side effect. In example today we can see various medical interventional radiological strategy to treat in coronary and hearth disease with medicate stents positioning or to local use of contrast agents or other valvle surgery procedures with global good clinical results.

From the first case of primitive cardiac surgery (CS), treatment of stab wound of the heart (Dr. Daniel Hale Williams, 1893), to recent surgical procedures and device implantations for end-stage heart failure (HF), the CS has grown and emerged in the public health more and more [1]. The heart valve disease had interested immediately since the non-cardiopulmonary era because of the multitude of rheumatic patients and congenital valve disease. In the 1952, Hufnagel implanted the first valve in descending aorta and it was the sign of the first step of the CS evolution. New prosthesis and heart valve techniques were tested between 1970 and 2000 with optimal results in patients’ quality of life and survival, at the same time of CPB evolution. Whilst, the evolution of heart valve surgery had stimulated new devices, prosthesis and the development of minimally invasive surgery, this was partially diminished by the spreading of trans catheter valve implantation. In the 2002, Dr. Alain Crabbier described a non-surgical prosthetic valve implantation firstly: it was the revolution of CS evolution [2]. The transcatheter valve implantation has evolved and spread rapidly with multiple approaches femoral to apical, aortic, axillary and carotid, and many suitable and technological devices. The higher and higher risk patients, the needs to avoid surgical complications, the evolution of available devices and the fabrication of new technologies have increased the efforts to improve trans catheter valve implantation [3]. The recent article of Loyalka et al, described a special case of tricuspid valve in valve replacement with Sapien 3, an innovative and alternative therapeutic choice to a tricuspid valve degeneration [4]. Instead, Sawara et al [5], documented as trans catheter aortic valve implantation for a failing surgical bio prosthesis or native aortic valve regurgitation has become an alternative for patients at high risk for redo surgical aortic valve replacement or aortic regurgitation since now off-label: that was a reliable and significant results in the era of trans catheter valve implantations. What would we attend from the future? In the most surgical centres, the trend were a significant decrease in patients undergoing to open-heart valve surgery compared to trans catheter valve implantation. Maybe the new ongoing studies of lower and mild-risk patients undergone to transcatheter procedure would open either a deeper collaboration of the heart team and a new therapeutic perspectives in the public health with a shift to more minimally invasive procedures, less day of hospitalization and I don’t see why not less costs for public health.

Introduction: Laparoscopic approach is emerging as a standard of care approach for management of masses amenable to partial nephrectomy. Laparoscopic partial nephrectomy is a challenging surgery and its successful performance depends on various factors. We aim to evaluate the influence of tumor characterestics on the operative performance for laparoscopic partial nephrectomy. Methods: Patients undergoing laparoscopic partial nephrectomy in our institution were recruited for this study. The tumor profile was evaluated by a senior radiologist from cross sectional imaging (computed tomography or magnetic resonance imaging). Tumor characerestics was defined by assessing tumor size, tumor location and RENAL score. The operative performance was evaluated in terms of warm ischemia time, blood loss, operation duration and any significant operative complications. Statistical inference was drawn. Results: 37 patients who underwent laparoscopic partial nephrectomy between January 2010 and June 2012 were included in this study. The mean tumor dimension was 3.81 cms. 21 tumors involved left kidney and 16 involved right kidney. 12 were located in upper pole, 8 were located in midpole and 17 were located in lower pole. The average RENAL score was 6.56. The mean warm ischemia time, blood loss and operation duration was 26.29 minutes (min), 256.76 millilitres (ml) and 208.11 min respectively. Statistically significant correlation was appreciated between tumor location (polar location, side, anterior/ posterior location) and RENAL score and operative parameters (warm ischemia time and operation duration). Tumor size did not have any correlation with the operative parameters. Conclusion: The operative performance of laparoscopic partial nephrectomy is significantly influenced by the tumor location and RENAL score.

Solar lentigo is defined as an alteration in cutaneous pigment deposition on account of exposure to ultraviolet radiation. Solar lentigo is a benign, pigmented lesion with a characteristic increment in the quantification of pigmented keratinocytes. It can manifest as a dark brown spot on the skin. The benign, pigmented spot or solar lentigo or multiple solar lentigines are preponderantly delineated in the sun exposed skin in a majority (> 90%) of Caucasians above 60 years of age although younger individuals and Asians can be implicated. Solar lentigines are induced by repetitive exposure to ultraviolet light with constituent mutagenic potential. Ultraviolet radiation can induce a localized proliferation of melanocytes with a subsequent accumulation of melanin within the keratinocytes. Individuals who are genetic carriers of one or two melanocortin-1- receptor (MC1R) gene or cogent variants demonstrate a 1.5 to twice the probability of developing solar lentigines [1,2].

Introduction: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) was first reported in 2003. In 2014, it was revealed that not only bisphosphonates but also other antiresorptive and antiangiogenic drugs can cause osteonecrosis (Medication-related osteonecrosis of the jaw: MRONJ). The aim of this study is to compare awareness and knowledge about BRONJ and MRONJ among specialists/trainers (ST), general dental practitioners (GDP); and dentists who graduated before and after the year 2014. Materials and methods: A survey regarding demographic information and knowledge about BRONJ and MRONJ was prepared and delivered to dentists via social media.Results: A total of 422 dentists participated in our study. It was observed that the awareness and knowledge about BRONJ and MRONJ were statistically higher in ST and in dentists who graduated in 2014 or later. In addition, when their specialties were compared to each other, it was seen that the awareness and knowledge of Oral and Maxillofacial Radiologists (OMR) and Oral and Maxillofacial Surgeons (OMS) were higher than others.Discussion: According to the results of this study, it was seen that the awareness and knowledge of the ST group were higher than GDP, maybe because they may encounter these cases more. In addition, dentists who graduated in 2014 or later had higher awareness, maybe because MRONJ was coined and entered the dentistry education curriculum in 2014. Awareness and knowledge of OMR and OMS were found higher may be because they encounter these patients more frequently. Planning educational strategies for all dentists, especially GDP and dentists who graduated before 2014 is very important for post-graduate dentistry education.

Background: After the closure of patent processus vaginalis (PPV) in boys with indirect inguinal hernia (IIH) or hydrocele, large scrotal hydroceles can occur on rare occasions despite the complete occlusion of internal inguinal ring (IIR). We present some cases that may help to explain the cause of this rare occurrence. Materials: During last 14 years, six boys exhibited non-communicating large scrotal hydroceles (2 right, 1 left, 3 bilateral) among 352 children who underwent laparoscopic repair for hydroceles. Ages ranged from 7 months to 15 years with a median of 12 years. Five of them had a history of repair for hydrocele or IIH prior to the definitive surgery and one boy underwent an initial operation. Results: In all the patients, laparoscopic inspection at the definitive surgery revealed completely closed IIRs. One infant with primary hydroceles was found to have large hydroceles bulging into the peritoneal cavity. All the patients were treated with subtotal removal of the sac without any recurrence. Marked thickness of the sack walls with abundant lymph vessels was characteristic histopathological findings. Conclusions: The complete occlusion of the PPV does not always prevent the recurrence of hydrocele through alternative pathogenesis. The pathological findings of resected specimens suggested a disturbance in lymph flow in the testicular system. The subtotal removal of the sac is the treatment of choice. Diagnostic laparoscopy prior to a direct cut-down approach to the neck of the seminal cord is advisable to identify non-communicating hydroceles to avoid further impairment of lymph drainage around the IIR.

Granulomatous diseases can cause hypercalcemia due to elevated 1,25-dihydroxyvitamin D through the production of 1-α hydroxylase by macrophages in the granulomas. Tophaceous gout is not considered to cause this picture. However, there are a few case reports of this occurrence in tophaceous gout, as well as the description of intense 1-α hydroxylase activity in granulomas of tophi in gout patients. We review this literature, and we report a well-documented case of hypercalcemia with elevated serum 1,25 dihydroxyvitamin D in a patient with extensive tophaceous gout and tophi loaded with granulomas. An extensive work-up ruled out other causes of hypercalcemia and granulomatous diseases. Prednisone corrected the chemical abnormalities. Diffuse tophaceous gout should be considered a rare cause of hypercalcemia due to excessive 1,25 dihydroxy vitamin D.

Background: Clinical education is an important component of physiotherapy education programs. It provides insights to the students in the fields of physiotherapy practice, develops leadership, and enhances their clinical skills in patient assessment, examination, diagnosis, treatment, planning, and intervention selection. The dimension of physiotherapy education is in the developing phase in Nepal. For further growth, the experience and the perception of the students are very important. Through this, the facilitators and barriers in physiotherapy clinical education need to be recognized. Therefore, this study aimed to explore the facilitators and barriers in physiotherapy clinical education in Nepal from a student’s perspective.Objectives: The main objective of this study was to identify the perception of physiotherapy undergraduate students about their clinical education and to find out the facilitators and barriers in clinical education.Methods: A qualitative research using focused group discussion was conducted. Ethical considerations were taken from respective departments and IRC approval was taken. BPT 3rd year, 4th year, and intern students of KUSMS were called to participate in the study. After the consent from the participants, focus groups of 6 participants (2 participants from each 3rd year, 4th year, and intern) were formed. In five FGDs, data saturation was observed and no further FGDs were conducted. FGDs were collected with audio tape recordings. The data were transcribed verbatim and translated into the English language. Then data coding was done and themes and sub-themes were generated from the codes.Results: Through the transcribed and translated data, seven themes were generated which were clinical education, student expectation, student attitude and behavior, roles and responsibilities of clinical educators, exposure, resources, and miscellaneous. These headings explained the perception of facilitators and barriers.Conclusion: The facilitators and barriers to physiotherapy clinical education were identified through student’s perspectives. These findings should be considered while preparing the guiding document for clinical education to enhance the quality of education.