Double Derangement Permutations

Let n be a positive integer. A permutation a of the symmetric group of permutations of is called a derangement if for each . Suppose that x and y are two arbitrary permutations of . We say that a permutation a is a double derangement with respect to x and y if and for each . In this paper, we give an explicit formula for , the number of double derangements with respect to x and y. Let and let and be two subsets of with and . Suppose that denotes the number of derangements x such that . As the main result, we show that if and z is a permutation such that for and for , then where .

MRI Evaluation of Acute Internal Derangement of Knee

Introduction: Internal derangement of the knee is a blanket term used to cover a group of disorders involving destruction of the normal functioning of the ligaments or cartilages. MRI provides excellent soft tissue contrast and is capable of evaluating the soft tissue and bony structures in multiple imaging planes which provide significant advantage in IDK. Methods and Materials: A prospective study of hundred twenty patients who underwent MRI for the diagnosis of internal derangement of knee between the period January 2013 and January 2015 was conducted. All the patients gave a history of knee joint pain following trauma and clinically suspected to have meniscal and ligament tears. Patients were evaluated using Philips intera R 11 1.5 T with pulsar gradient system using a sensor extremity coil. Results: Commonest lesion detected in our study was ACL tear followed by meniscal tear and medial collateral ligament injury. The most common sign of cruciate ligament injury was hyper intensity in the ligament. Grade 3 was the most common grade of meniscal tear. Conclusion: MRI is unique in its ability to evaluate the internal structure as well as the surface of the meniscus. Many anatomical variants can mimic a tear on MRI. MRI is an excellent non invasive modality for imaging the knee.

The Development of Metabolic Derangement in Male Offspring after Perinatal Exposure to Di-(2-Ethylhexyl) Phthalate

The prevalence of obesity and type 2 diabetes mellitus（T2DM）has been increasing throughout the world over the past 20 years.Environmental chemicals known to regulate the endocrine system have been considered as a risk factor for the development of metabolic diseases.Several people are exposed to environmental chemicals during their lives.

The Great Derangement and Storyteller’s Prerogative: Knowledge From the Hearth

Mythology plays an important role in the sustenance of a particular community.It embeds the ancient knowledge that percolates through folktales into the knowledge system of that community.However,such mythologies have often been dismissed by votaries of scientific knowledge on the ground that these mythologies are preposterous and do not have scientific basis.Consequently,the traditional form of knowledge which has helped in the sustenance of particular community is disrupted.It eventually led to invasion of alien ideas and culture which is not conducive for the growth and protection of that community life.As a result,the relation between man and nature is also disrupted.The present world has been ripped apart by the onslaught of industrialisation in the name of progress and development and people have turned immensely materialistic and as such have not only lost their reverence for nature,but also have facilitated into the decadence of their traditional system of knowledge that otherwise would have shielded the affinity between man and nature.Amitav Ghosh talks about this problem in his non-fiction The Great Derangement;and similarly many Indian writers have also addressed this issue through stories,poetry,and fiction.Eastern Kire Iralu is one such writer from the Northeast India who has blended myth and folktale in her novella titled The Son of the Thundercloud.Her purpose is to allegorie the pathetic plight of the people in present-day world because of their irreverence to nature.She does it by invoking myth and folktale.She has shown in her novella that how ancient system of knowledge,through folk tales,tries to provide valuable knowledge that is required for sustenance of mankind.This paper analyses the novella of Eastrine Kire Iralu which offers a way-out from the present day crisis mentioned by Amitabh Ghosh.Easterine Kire Iralu’s novella has established the importance of folktales in primitive societies and its relevance in the present day world.Kire has bended mythology and realism to show the symbiotic relationship between man and nature and thereby she establishes the indispensability of storytellers’role in bailing out mankind of the present crisis.

Graph Derangements

We introduce the notion of a graph derangement, which naturally interpolates between perfect matchings and Hamiltonian cycles. We give a necessary and sufficient condition for the existence of graph derangements on a locally finite graph. This result was first proved by W. T. Tutte in 1953 by applying some deeper results on digraphs. We give a new, simple proof which amounts to a reduction to the (Menger-Egerváry-K?nig-)Hall(-Hall) Theorem on transversals of set systems. We also consider the problem of classifying all cycle types of graph derangements on m × n checkerboard graphs. Our presentation does not assume any prior knowledge in graph theory or combinatorics: all definitions and proofs of needed theorems are given.

Hypokalemia Havoc: Unraveling the Mystery of Unexplained Potassium Depletion

Hypokalemia, defined as serum potassium below 3.5 mEq/L, can lead to severe complications such as arrhythmias and muscle paralysis, potentially resulting in rhabdomyolysis. The etiology of hypokalemia is often multifactorial, involving but not limited to gastrointestinal losses, renal losses, medication effects, and inadequate dietary intake. Chronic heavy alcohol use, obstructive sleep apnea (OSA), and the use of diuretics such as hydrochlorothiazide (HCTZ) are also significant contributing factors. Effective management requires thorough evaluation and investigation to effectively treat a patient. This case report aims to illustrate the diagnostic challenges and comprehensive treatment approach required in a patient with multiple comorbidities and severe hypokalemia, emphasizing the need for a multidisciplinary and comprehensive approach to address all underlying causes.

Internal derangement of temporomandibular joint: role of arthocentesis with steriod

Aim:The aim of this study was to compare the efficacy of arthrocentesis with arthrocentesis plus steroid in the treatment of temporomandibular joint(TMJ)internal derangements.Methods:Nine males and 11 females aged 17–39 years were enrolled in the study.The patients were complaining of limited mouth opening and TMJ pain.Arthrocentesis was performed under aseptic conditions.All patients were clinically evaluated before the procedure,and 1 week and 6 months after the procedure.Intensity of TMJ pain and maximal mouth opening was recorded at each follow-up visit.Results:Both groups showed significant improvement in mouth opening and a reduction in pain scores in the postoperative period;however,the addition of steroid did not improve the overall outcome of the procedure.Conclusion:Arthrocentesis is a simple and safe procedure for patients with internal derangement of the TMJ with closed lock.However,the outcome was not improved by the addition of steroid.

Impact of hepatitis B virus infection on hepatic metabolic signaling pathway

A growing body of epidemiologic research has demonstrated that metabolic derangement exists in patients with hepatitis B virus(HBV) infection, indicating that there are clinical associations between HBV infection and host metabolism. In order to understand the complex interplay between HBV and hepatic metabolism in greater depth, we systematically reviewed these alterations in different metabolic signaling pathways due to HBV infection. HBV infection interfered with most aspects of hepatic metabolic responses, including glucose, lipid, nucleic acid, bile acid and vitamin metabolism. Glucose and lipid metabolism is a particular focus due to the significant promotion of gluconeogenesis, glucose aerobic oxidation, the pentose phosphate pathway, fatty acid synthesis or oxidation, phospholipid and cholesterol biosynthesis affected by HBV. These altered metabolic pathways are involved in the pathological process of not only hepatitis B, but also metabolic disorders, increasing the occurrence of complications, such as hepatocellular carcinoma and liver steatosis. Thus, a clearer understanding of the hepatic metabolic pathways affected by HBV and its pathogenesis is necessary to develop more novel therapeutic strategies targeting viral eradication.

Subclinical hypothyroidism in atopic South Italian children

AIM:To verify if subclinical hypothyroidism(SCH) could be associated to atopy in children.METHODS:Seven hundred and thirty-two Caucasian children from South Italy presenting symptoms of allergic disease were enrolled and submitted to atopy,obesity,chronic low grade inflammation,and SCH work up.RESULTS:Four hundred and forty-five out of 705(63.12%) children affected by allergic disease were diagnosed as atopic and 260(36.88%) as not atopic.The SCH prevalence was 6.3%.Significant higher prevalence of SCH among atopic children with average(group 2) and high(group 3) low grade chronic inflammation compared to atopic children with mild(group 1)low grade chronic inflammation was present.Moreover,group 1 and group 2 presented an OR to show SCH of2.57(95%CI:1.55-6.26) and 2.96(95%CI:1.01-8.65),respectively.Both in atopic and not atopic children we found C3 serum levels significantly higher in group 3respect to group 2 and group 1.Noteworthy,among atopic patients,also total immunoglobulin E(IgE) serum levels,were significantly higher in group 3 compared to group 2 and group 1 children.In atopic children,C3 and total IgE serum values increased in parallel with the increase of C-reactive protein values,while in not atopic children this phenomenon was not evident.CONCLUSION:The possibility exists that an increasing atopic inflammation contributes to SCH occurrence.So far this is the first report in literature showing an association between SCH and atopy but further studies are needed to confirm our data.

Strenuous Exercise—An Unusual Cause of Deranged Liver Enzymes

Liver enzymes and function tests are routinely taken in clinical practice. Deranged liver enzymes however, do not always necessarily imply an underlying liver pathology. The standard liver enzymes measured include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl-transpeptidase (GGT) and alanine phosphatase (ALP). These enzymes, especially ALT and AST, can be released by other organs in the body. We report an unusual case of a 48-year-old patient with deranged enzymes related exclusively to intensive exercise that resolved on discontinuing such exercise.

Increased Prevalence of Severe Rheumatic Heart Disease Requiring Early Valve Replacement Surgery and Fragmented Germ Cells

Background: Patients requiring valve replacement at a younger age, for rheumatic heart disease was apparently increasing after the new age practice of contraception. Methods: In 2012, data of patients referred to tertiary care hospital from two cardiology screening camps conducted in the community, were analyzed for the severity of presentation of rheumatic heart disease and associated contraception status by dividing into the three age groups—20 - 35 years, 36 - 50 years, >51 years;~400 patients attended the camps;31 female and 2 male patients were referred to the tertiary care hospital for further evaluation and categorized treatment, including valve replacement surgeries;among the 33 referred patients, belonging to the three age groups, the data were analyzed for [if any] correlation of contraception status with severe rheumatic heart disease. 8 randomly chosen males, of the 3 age groups, from a different community, whose life partners had undergone sterilization, were assessed for their serum testosterone levels. Results: Among 20 - 35 years, 7 female patients with contraception required valve replacement surgeries [p 51 years, 3 female and 2 male patients without contraception received medical treatment only

<i>“Withered Tree” Concept Host</i>, Achieved by Global Contraception and Abortion, Secondary to Fragmented Germ Cells, Agonizingly Reduced Endogenous Estrogen/Androgen, Defaulted Genomic Repertoire, Deranged Cell Metabolism, Metabolic Syndrome, <i>Result in Failure of Pharmacological Therapeutics with Advanced Technologies</i>

Background: In spite of advanced technologies and drug discoveries, morbidity and mortality were undoubtedly increasing in the era of contraception and abortion. Aims: Altruistic correlation of increasing morbidity, mortality, with contraception, abortion was planned for. Methods: In 2012, a retrospective analysis of prevalence of mortality in 350 patients of 20 - 35 years, 35 - 50 years and >50 years from data collected between 2003 and 2012 by convenient, stratified random sampling, from community, hospital, and its association with contraception and abortion status was undertaken;simultaneously, serum estrogen levels obtained from 105 patients were analyzed. In 2014, randomly chosen 8 males, of the 3 age groups, from a different community, whose life partners had undergone sterilization, were assessed for their serum testosterone levels. Results: Contraception users exhibited 3 - 4 fold increased mortality [p 50 years [p < 0.0005]. Endogenous estrogen was reduced in 75% [p < 0.0005] of contraceptive users. Plasma testosterone was reduced in males observing contraception, to less than 50% of normal, e.g. 1.3 ng/ml;66.6% contraception users aged 20 - 35 years had reduced [p < 0.0005] testosterone;100% of male contraception users aged 36 - 70 years showed reduced testosterone [p < 0.0005]. Conclusion: The “withered tree akin host” concept is contraception, abortion, with smashed fragmentation of germ cells. Reduced endogenous estrogen, androgen [dried up, destroyed life factors] result in deranged cell metabolism, cell cycle, and defaulted genomic repertoire, leading to failure of all established pharmacological therapeutics, including advanced technologies which yield gratifying results in non contracepted people today and in every one, before the era of contraception;subsets of people, host with contraception, with destroyed life factors, behave helplessly, concerning therapeutic applications, compared with subsets of people, host without contraception, with intact genomic repertoire, God ordained Life factors, make a remarkable recovery. Contraception reversal replants the germ cells [germ cells destruction stops], hormones rejuvenate to 79.9% of age normal, and diseases abate with recovery.

Novel immunotherapeutic approaches in head and neck cancer

Unresectable recurrent or metastatic head and neck cancer is an incurable disease with survival of approximately 12 months. Head and neck tumors exhibit numerous derangements in the tumor microenvironment that aid in immune evasion and may serve as targets for future therapies. Pembrolizumab is now approved as a first line therapy. Despite the promise of currently approved immunotherapies there continues to be low response rates and additional strategies are needed. Here, alterations in the immune microenvironment and current therapeutic strategies are reviewed with a focus on novel immunologic approaches.