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Abstract

The University of Wisconsin, Madison (UW) is the State University of the State of Wisconsin. It is one of the largest and best known public universities in the USA with 30,000 undergraduates and 14,000 graduate students. These include many students and visiting scholars from foreign countries.  Its research spending is among the top ten universities in the USA.

As a former undergraduate, medical student, and faculty member of the UW, I gained a deep appreciation for its many contributions to biologic science and medicine. The individuals that were responsible for these advances are detailed below. Many were my teachers and colleagues.

I have divided the individuals responsible for these advances into four categories, The Vitamin Chemists, The Cellular Biologists, The Physician Scientists and The Organization Leaders.

The Vitamin Chemists

Harry Steenbock PhD (1886-1967) Professor and Chair of Agricultural Chemistry

Harry grew up on a farm near New Holstein, Wisconsin. When he was 17 his father had an offer to sell the farm so he asked Harry if he wanted to eventually take over the farm. The answer was.an emphatic NO! So the family sold the farm and moved to Madison so Harry could enter the University. He graduated from the School of Agriculture in 1908 and then worked for Professor Edwin Hart of the Agriculture School on the optimal feeds for farm animals, receiving a PhD in 1916.

He continued his studies on animal nutrition by studying animal models of vitamin deficiencies. He read that experimental dietary rickets, a deforming bone disease, could be reversed by ultraviolet radiation of the animals, the sun’s rays allowed their skin to make Vitamin D. Dr. Steenbock then made his break-through observation that the same effect could be achieved by irradiating their feed; this converted fat lipids in the food to vitamin D. He then showed that irradiated cow milk could make Vitamin D and this would provide a ready source in the diets of both children and adults. .

Using his own funds Dr. Steenbock patented this procedure in 1927.  The Quaker Oats Company offered him the equivalent of three million dollars for the patent; instead he turned it over to the University of Wisconsin. Several prominent UW alumni, headed by Thomas Brittingham, started a foundation to manage the royalties from that patent for the next 27 years.

The foundation was named the Wisconsin Alumni Research Foundation (WARF) and its revenue became a major funding source for UW research, particularly during the depression years, (1933-1939), but continuing to the present. WARF now holds multiple patents and provides the university 100 million dollars of research funds every year.

The Agriculture/Life Science library is named after Dr. Steenbock. His former student and successor Hector DeLuca PhD holds the Steenbock Endowed Chair and now is the foremost authority on Vitamin D and its derivatives as used in the therapy of multiple disorders.

Karl Paul Link PhD (1901-1978) Professor of Agricultural Chemistry

Karl was born in La Pointe, Indiana, one of eight children. His father was a Lutheran minister who died when Karl was twelve. With family support and his mother’s admiration for Senator Robert LaFollette, Karl entered the University of Wisconsin, receiving a BS in 1932, a MS in 1924 and a PhD in 1925 in carbohydrate chemistry.

After postdoctoral work in Europe, interrupted by a hospitalization in Switzerland. for tuberculosis,  he joined the UW faculty in 1927  He soon distinguished himself by his non-traditional clothing (large bow ties, flannel shirts, work shoes and a cape)  a booming voice, long hair and radical views, all of which  kept his students amused and attentive.

His international fame began with the legendary story on a cold Saturday in February 1933.  Farmer Ed Carson had driven his truck 200 miles in a snowstorm to the UW Agriculture building to confront Professor Albert Carson (no relation)---the only one in the building that Saturday.  He also brought along a dead heifer (cow), a bucket of its uncoagulated blood and 100 pounds of fermented sweet clover hay. He told the professor “This hay is making my cows bleed to death.” The cows had the previously described Sweet clover disease.

Professor Carson turned this problem to Dr. Link. Over the next 6 years, Dr. Link and his colleagues isolated the factor in the clover that caused the bleeding a natural substance called dicoumarol, an inhibitor of Vitamin K, which is necessary for blood coagulation. Their laboratory synthesized enough dicoumarol to be tested, first in animals, and then in humans. Its first use was as a rat poison, causing the critters to bleed to death.

The Link laboratory synthesized and tested many related compounds and settled on one, Coumadin, which was a potent anticoagulant which  was orally absorbed, fast acting and quickly reversible by vitamin K. It was licensed for human use in 1954 and patented by the Wisconsin Alumni Research Foundation as WARFARIN. It soon became the most widely used blood thinner in the world. The drug received widespread acceptance after it was used on President Dwight Eisenhower after his heart attack. Its proceeds allowed the Foundation to grow just as the patents on irradiation of milk were expiring.

The best tribute to Karl Paul Link is the WARF building on the UW campus, in part financed by the patent for WARFARIN, the most widely used blood thinner in the world.

Conrad Elvehjem PhD (1901-1962) Professor and Chair of Agricultural Biochemistry, Dean of the Graduate School, UW President

Conrad was born in McFarland, Wisconsin to Norwegian emigrants. He received a BS in 1924 and a PhD in 1927   He then joined the Agricultural Biochemistry faculty and served as its chair, as Dean of the Graduate School and then served as the 13th UW President from 1958 to 1962.

Dr. Elvehjem worked on the cause of pellagra, a nutritional disease causing dementia, dermatitis and diarrhea with early death i.e. the four D’s. It was common among people living on a corn diet deficient in fruits and vegetables; this included many persons in prisons and asylums.

Earlier work by Dr. Joseph Goldberger had cured a similar disorder in dogs called black tongue disease by a liver extract. Elvehjem then showed that a liver extract could cure dietary pellagra in chicks and thus cold be used to identify the exact component of the liver extract that prevented pellagra in chickens. Elvehjem isolated and characterized this as niacin, Vitamin B3. Niacin was then used worldwide to treat and prevent pellagra, including curing some demented and institutionalized patients.

Dr. Elvehjem became a major advocate for the need for vitamins in the diet. He authored 780 papers and trained multiple graduate students. His first student was Frederick Stare PhD. who founded and chaired the Department of Nutrition of the Harvard School of Public Health.

The Cellular Biologists

Har Gobind Khorana PhD (1922-2011) Professor of Biochemistry, Director of the Enzyme Institute

Har was born In Raipur, a little village in India’s Punjab, and now part of Pakistan. The family was the only literate one in a village of 100. He received early schooling under a tree from a village teacher. Har received a BS and MS from Punjab University and then moved to the UK in 1945, receiving a PhD in 1948 from the University of Liverpool.  After positions in Zurich, Cambridge, and British Columbia he came to UW in 1952 to head the WARF-supported Enzyme Institute.

Dr. Khorana’s work focused on the DNA genetic code, determining the sequence of the four DNA nucleotides which direct the synthesis of the 21 amino acids, the building blocks of all proteins. He then synthesized the first artificial DNA gene. For this work he was awarded the 1968 Nobel Prize with Robert Holley of Cornell and Marshall Nirenberg of the US National Institutes of Health.

In 1970 Dr. Khorana moved to the Massachusetts Institute of Technology, focusing on rhodopsin, a visual protein when mutated causes retinitis pigmentosa and night blindness. He retired in 2007 and died in 2012.

Howard M Temin PhD (1934-1994) Professor of Oncology

Howard was born and raised in Philadelphia.  He received a BS from Swarthmore College in 1955 and a PhD from the California Institute of Technology in 1959. He then joined the UW McCardle Cancer Research Laboratory where he remained until his death from lung cancer in 1994.

Dr. Temin’s main contribution was the co-discovery of the reverse transcriptase enzyme of the Rous Sarcoma Virus (RSV) of chickens.  In 1911 Dr. Pierre Rous showed that a cell-free extract of this tumor would cause the same sarcoma in another chicken. The cell-free agent was an RNA virus, which, unlike DNA viruses, mutates readily when it makes a DNA copy for its replication.  Dr. Temin identified the enzyme reverse transcriptase that catalyzes this reaction. An inhibitor of this enzyme, azovudine (AZT) was the first effective drug against the Human Immunodeficiency Virus (HIV) that causes the Acquired Immune Deficiency Syndrome (AIDS). AZT given to HIV positive-pregnant women and their newborns greatly reduces the rate of HIV transmission from mothers to their infants.

Dr. Temin received the Nobel Prize in Medicine 1n 1975 with David Baltimore of the Massachusetts Institute of Technology and Renato Dulbecco of the London Cancer Research Laboratory.  Dr. Temin became a spokesman against smoking as a cause of cancer including it in his Nobel acceptance speech in front of the Queen of Sweden who was a smoker.   He died of lung cancer in 1994 at age 59.

Joshua Lederberg PhD (1925-2008) Professor and Chair Department of Genetics    

Joshua was born in Montclair New Jersey and grew up in New York City. He entered Columbia as an undergraduate and then its medical school. Before completing his medical degree, he transferred to Yale for a PhD in genetics with Edward Tatum PhD. Instead of returning to medical school he joined the Department of Genetics at Wisconsin, eventually becoming its Chair.

Dr. Lederberg’s Nobel Prize studies showed that a bacterial virus (a phage) that made an E. coli bacterium resistant to a specific antibiotic could transfer its resistance to another strain of E coli if grown together in the same culture. These studies were labelled “bacterial sex” and “jumping genes.” This transduction, as it is called, can also occur from one strain of bacteria to a completely different type of bacteria, thus explaining the emergence of multi drug resistant bacteria in severely ill patients.

Dr. Lederberg received the 1958 Nobel Prize along with his Yale mentor Edward Tatum and George Beadle of the California Institute of Technology. Shortly thereafter he moved to Stanford as Chair of Genetics. After the moon landing he became interested in the possibility of extra-terrestrial microorganisms brought to earth by the astronauts and the development of technology to harvest them.  He was named President of Rockefeller University in 1978 and died in 2008.

James Thomson DVM, PhD (1938- ) Professor of Anatomy, Director Cellular and Regenerative Medicine Institute  

James was born in Oak Park Illinois. He received a BS from the University of Illinois and a DVM   and a PhD from the University of Pennsylvania. After two years at the Oregon Primate Research Center he came to UW in 1991 to complete a residency in Veterinary Pathology.  He joined the UW Anatomy Department faculty in 1994, and was named the director of the Regenerative Medicine Laboratory of the Morgridge Research Institute in 2006.

In 2008 Dr. Thomson was the first to culture pluripotent stem cells from human embryonic cells. These cells are immortal, and can differentiate into different types of cells such as blood cells, nerve cells and organ cells.  Shortly thereafter President Bush vetoed research funding on human embryonic stem cells. In 2013 the Thomson laboratory developed human stem cells from the skin using a cocktail of growth factors,

Dr. Thomson, in conjunction with WARF, established a non-profit WiCel Research Institute that distributes stem cells to researchers at Wisconisinnand other laboratories around the world.

The Physician Scientists

Frederic Mohs MD.  (1910-2002) Professor of Surgery

Fred was born in Darlington in southwestern Wisconsin. His widowed mother moved to Madison in 1915 so Fred could attend the UW where he received a BS in1930 and an MD in 1932.

As an undergraduate he assisted Dr. Michael Guyer of the Zoology Department on skin cancers in rats provoked by chemical exposures. After surgical training at the University of Oregon he returned to UW to continue his work on skin cancer. His breakthrough observation was that rat skin cancers caused by chemical exposures, could be treated by local application of a caustic paste of zinc chloride. This not only killed the cancer cells but fixed the tumor for its easy removal allowing microscopic analysis of the tumor edge to see if all the tumor had been removed. If not, the cancerous areas were retreated, layer by layer, until all the cancer was removed. Further, the cavity left by the tumor was resistant to infection and healed quickly.

One disadvantage was that every reapplication took a day since the slides had to be stained and examined that evening, prolonging the treatment for several days. Dr. Mohs later modified the technique by using frozen sections of the tumor that can be prepared shortly after each application thus allowing the procedure to be completed in a single day.

Dr. Mohs treated his first patient in 1936, calling it Chemosurgery. Despite its name, the UW surgical department did not support his work. However Dean Middleton recognized its importance and gave him a suite in the dermatology division.

As word spread of its success of tumor removal with minimal scarring, patients came from all over the country for their treatment.  Dr. Mohs showed his technique to other doctors and soon training programs in chemosurgery were established. Chemosurgery was renamed Mohs micrographic surgery and centers were added all over the country. Over 1500 doctors have been trained in the technique and nowadays it is a recognized subspecialty with clinics at all major medical centers.

Harry Waisman MD, PhD (1912-1971) Professor of Pediatrics, Director Joseph P Kennedy Memorial Laboratory for Developmental Disabilities.

Harry, born in Milwaukee received four UW degrees, a BS in 1935, an MS in1937 a PhD in 1939 and an MD in 1941.  He then was a pediatric resident before joining the Pediatric Faculty in 1943.   He started his research on childhood cancers but switched to hereditary inborn errors of metabolism that cause mental retardation, particularly phenylketonuria (PKU). This disease is caused by an enzyme deficiency needed for the metabolism of the amino acid phenylalanine, causing it to build up in the blood and brain resulting in mental retardation.  Carriers of the disease are unaffected but if both mother and father pass on their abnormal gene their infant will develop phenylketonuria. The disease can be diagnosed at birth by a heel-stick blood test and treated successfully with a phenylalanine-free diet.

Dr. Waisman was an early researcher on the disease using animal models, methods to detect asymptomatic carriers, newborn diagnosis, and its dietary treatment. PKU was the first disease detected by routine newborn heel stick testing; now every US newborn is tested for PKU and 26 other hereditary diseases.

In 1963 the Kennedy Foundation provided funds to UW for the Joseph P Kennedy Memorial Laboratories for Developmental Disabilities directed by Dr. Waisman.  Two years later the National Institutes of Child Health and Human Development awarded funds for a multi-disciplinary building for research on intellectual and developmental disabilities, The Waisman Center on the medical campus was completed two years after Dr. Waisman’s death in 1973.

Folkert Belzer MD (1930-1996) Professor and Chair of the Department of Surgery

Folkert was born in Indonesia and moved to the USA as a teenager. He graduated from Maine’s Colby College in 1953 of Waterville, Maine and then received an MD from Boston University in 1958. Following a surgical residency and fellowship at the University of Oregon. He joined the transplant team at the University of California, San Francisco, He was named Professor and Chair of UW Surgery, 1974 to 1995.  He and his colleagues developed the third largest transplant center in the USA before his death in 1996. In the 1960s Dr. Belzer developed a perfusion machine that kept donated kidneys viable for several hours permitting the recipient to get to the hospital for the transplant. Using this machine a kidney donated in San Francisco was flown to Holland and successfully transplanted 37 hours later.

At Wisconsin, he and colleague Dr. James Southard developed a solution that kept a refrigerated donor organ (a kidney, heart, pancreas, or liver) viable for up to 30 hours. It contained 15 ingredients to nourish the organ, prevent edema, maintain sterility, and prevent enzyme release. Called the Wisconsin Solution it was patented by WARF and distributed as Viaspan by a WARF-supported company named Bridge to Life.  Later work included a similar solution for organ preservation at room temperature.

These solutions had an enormous role in organ transplantation since the donor organ could be flown to the patient in another city thus facilitating survival rates of 70 to 90 percent.

The Organization Leaders

Harold P Rusch MD (1908-1988) Professor of Oncology, Director, McCardle Laboratory for Cancer Research

Harold was born in Merrill Wisconsin.  He became interested in medicine as a result of his own appendectomy as a youngster. He attended the UW, receiving a BA in 1931 and an MD in 1935. He then joined the Medical School faculty teaching physiology and beginning his cancer research on the effect of obesity and ultraviolet light as precursors to cancer.  In 1938 the McCardle family donated funds to establish a Cancer Research Program and Dr. Rusch at the age of 30 was named its director.

In 1949 the McCardle Laboratory for Cancer Research was opened in a building attached to the Wisconsin General Hospital, the first such institute dedicated to cancer research. In 1964 the McCardle laboratory moved to its own building on the medical campus, and moved again in 2013 to the newly constructed Wisconsin Institutes for Medical Research on University Avenue.

Dr. Rusch gathered an impressive group of scientists for his laboratory including Van Potter (triple chemotherapy, bioethics), Elizabeth and James Miller (chemical carcinogenesis), Rosewell Boutwell (nutrition and cancer), Gerald Mueller (hormonal control of cancer), Charles Heidelberger (development of the drug 5-fluoruracil), (V. Craig Jordan (development of the drug tamoxifen), and Howard Temin, (Nobel Prize for discovery of the reverse transcriptase enzyme in RNA cancers).

In 1972 Dr. Rusch became the Director of the UW Comprehensive Cancer. Before his retirement in 1970 he recruited Dr. Paul Carbone to continue his work. Dr. Rusch died of cancer in 1988, the disease that he spent a lifetime searching for its causes and cures.

William S. Middleton MD (1890-1975) Professor of Medicine, Dean of the University of Wisconsin Medical School

William was born in Norristown Pennsylvania to working class parents. Based on his outstanding high school record he was directly admitted to the medical school of the University of Pennsylvania in 1907, graduating with an MD in 1911. After a one year internship at Philadelphia General Hospital he joined the Student Health Service of the University of Wisconsin and an instructor in Medicine in its two year medical school.

In 1924 Wisconsin General Hospital opened and the medical school became a 4 year school with Charles Bardeen MD. Professor of Anatomy as the first Dean.  In 1935 Dr. Middleton was named the dean, a position he held until 1955, interrupted by two leaves of absence to serve in the military.

Dr. Middleton was a master teacher and clinician beloved by his students, both delighted and feared at his bedside rounds. He spent mornings in the hospital and afternoons in the Dean’s office.

From 1917 to 1919 Dr. Middleton’s served as a Lieutenant in the US Army Medical Corps in France during World War I.  In 1942 again Dr. Middleton, now Colonel Middleton, volunteered for war duty. He was named Chief Consultant in Medicine of the European Theater of Operations stationed in Britain. From there he planned the medical care of casualties of the D-day landing of June 6, 1944.

Shortly after the invasion Colonel Middleton went to Normandy for several months to supervise the care of 2600 medical and 2000 neuropsychiatric casualties. Upon his return to Britain, he coordinated the hospital care of battle casualties up through 1945. One of his patients was General George Patton who he diagnosed with malaria.

For his military service he was awarded an Honorary Office of the British Empire (military), the Croix de Guerre from France, the Lion of Merit with Oak Leaf Cluster from the USA and an honorary degree from the University of Cambridge.

He returned to Wisconsin in 1945 and remained Dean until 1953. He then was appointed Chief Medical Director of the Veterans Administration in Washington DC, overseeing the 273 VA hospitals that served 106,000 patients per day. The VA research program grew from $6.4 million to $30.5 million during his tenure.

Upon Dr. Middleton’s retirement, President John F. Kennedy thanked him for his lifetime service to the soldiers and the veterans that served our country. The Middleton Medical Library next to the Wisconsin General Hospital was opened in 1967. The Madison Veteran’s hospital was renamed the William Middleton VA Medical Center.

Judith Faulkner MS (1943- ) Founder EPIC Systems, Lecturer Department of Computer Science

Judith was born and raised in Cherry Hills, NJ. She graduated from high school at age 15 and then received a BS in mathematics from Dickenson College in 1969. She received an MS in computer science from the UW in 1978. Upon graduation she borrowed $70,000 from friends and family and with Dr. John Greis started a company, Human Service Computing which became EPIC Systems.

EPIC is a healthcare software provider, now located in Verona, a suburb of Madison. It is now the largest system of computerized medical records, used by many major healthcare systems including Kaiser of California, Mayo Clinic, UCLA, and UW Madison. The system records medical visits, laboratory reports   treatments, pharmacy orders, future appointments and billing and insurance, all available to the patient and to the health care team, locally and at other medical facilities. EPIC is also used in an increasing numbers in other countries including the UK, The Netherlands, Australia and Singapore.

The Verona campus has 8 buildings and employs 10,000 people. The company’s large work force is gender, ethnic, religion and attire neutral.  EPIC has improved the economy of the Madison, Wisconsin area; for example flights in and out of the Dane County airport have increased dramatically as EPIC employees visit multiple medical centers for training and updates.

Ms. Faulkner recently stepped down as the CEO of the company She has participated in The Giving Pledge, promising to donate a majority of her wealth to a worthwhile philanthropic organization.

For more information about Article : https://ijclinmedcasereports.com/

Abstract

Patients of Herpes Zoster Ophthalmicus (HZO) develop several ocular complications that need surgical interventions such as cataract, glaucoma and corneal scar.  Managing these complications is challenging in which the patient might go into several intera and post-surgical complications. We are reporting a case of Herpes Zoster Ophthalmicus (HZO) having diffuse iris atrophy and the intumescent cataract of the left eye.  Both pupiloplasty and cataract surgery were done.  Iris atrophy reconstructed by single-pass four-throw technique and phacoemulsification for cataract at the same time. The results were promising, the patient's visual outcome improved, the pupil has a good shape and contour and patient satisfied from the outcome both visually and cosmetically.

Keywords: Cataract; Pupilloplasty; Herpes Zoster Ophthalmicus

Introduction

The risk of developing herpes zoster infection in general during the lifetime is 20%, and the involvement of the ophthalmic division of the trigeminal nerve is up to 20% of these patients leading to a condition called Herpes Zoster Ophthalmicus (HZO), in which all structures of the eyes can be involved leading to various ocular diseases like Scleritis, Keratitis, Cataract, Uveitis, and glaucoma, However chronic inflammation and prolonge steroids use can lead to cataract formation [1].

We are reporting a case of HZO, who underwent surgical intervention for diffuse iris atrophy and intumescent cataract developed in less than 1 year of diagnosis and the post-cataract surgery result in visual improvement.

Case Report

A 35 years old male, presented to our clinic complaining of decreased vision, glare and abnormal-looking left eye due to diffuse iris atrophy over the left eye. He was diagnosed as a case of Herpes Zoster Ophthalmicus (HZO) having the first attack of anterior uveitis and high intraocular pressure along with forehead vesicular rash for which he was treated with an oral antiviral (valacilovir) and tapering topical corticosteroids at our uveitis service.

He was on regular follow up for the past 8 months' time with uveitis well controlled. Eight months later he presented to the uveitis service with further reductions of the vision over the left eye which was counting finger (CF) and glare due to his pre-existing diffuse iris atrophy.

His examination showed an intumescent cataract of the left eye (Figure1, A/B). Full ophthalmic examination of left eye BCVA  Counting finger near the face, clear cornea with intact sensation, deep and quiet anterior chamber, diffuse iris atrophy pupil size around 11.5 , open-angle by gonioscopy, intraocular pressure 16 mmHg and no view of fundus  B-scan done show flat retina and no abnormality detected. The right eye examination was within normal limits.

At the corneal service, he was scheduled for phacoemulsification with posterior chamber intraocular lens implant with pupiloplasty of the left eye under local anesthesia. The patient was seen first-day post-op and his examination revealed improvement of his vision from counting finger to 20/60 without correction, IOP 18 mmHg, clear cornea, anterior chamber deep with +3 cells, pupil 9.5 mm size with a round contour, Fundus within normal limit, He was happy about his visual outcome and his glare was almost resolved completely (Figure 2). The patient was continued on antibiotics and steroid drops.

Second-week post-op, the vision was improved, VA (SC) 20/30, the Cornea cleared, Intraocular Pressure (IOP) 14mmHg, Anterior chamber deep and quiet and normal fundus.

Discussion

Our reported case had an intumescent cataract with diffuse iris atrophy of the left eye in which the cataract removed and the residual iris reconstructed. The exact pathogenesis of HZO complications is not well understood, it could be due to viral replication in the early disease stages and the inflammation associated with that [2]. In HZO, the complications requiring surgical intervention are the Neuroparalytic ulcer, Glaucoma, Corneal scar and Cataract [3] in which the cataract is the most common one [1].

The common presentation is the posterior subcapsular cataract in which the steroid and chronic inflammation (uveitis) from virus play a role [2] in our case the patient was having an intumescent type of cataract which is not common in HZO and also its surgical management (phacoemulsification) is a bit difficult as compared to posterior sub-capsular cataract.

A retrospective study of 24 operated eyes of HZO patient having a cataract, the corrected distant visual acuity (CDVA) before surgery 20/112 after phacoemulsification + posterior capsular intraocular (PCIOL) the patient had CDVA 20/44 in the first year [1].  The choice of either ECCE or phacoemulsification and quince 6 months patient have better results on favorable long-term follow up (> 20y) the best-corrected visual acuity ( BCVA ) was 20/20 [2]. Another study done 11 eyes operated, the BCVA was 20/40 [1]. Most surgeons delay surgical intervention up to 3 months of quiescence and avoiding the active phase of the disease since the surgical intervention can trigger the disease [4]. Our patient had 6 months quiescence period since the last episode of uveitis.

Patients of HZO have the risk of complications after cataract surgery such as developing a corneal scar, fractional retinal detachment or recurrence of uveitis requiring further intervention [1]. Thus the adequate control of inflammation, intraocular pressure, and ocular surface disease improved the visual prognosis of cataract surgery of HZO patient [4], despite the advance of therapy HZO complication may be reduced but not eliminated [2]. Visual recovery compromised by the preexisting chronic ocular condition [1] thus it has an unpredictable result for cataract surgery.

Another situation we had in our patient which is rudimentary iris contour this may be due to chronic iritis and diffuse iris atrophy [3]. We were concern about cataract surgery results that may be compromised by the absence of iris coverage. Patient’s glare might worsen further causing more severe glare and photophobia due to reactivation of herpetic uveitis thus leading to unacceptable cosmetic appearance.

There are many techniques for pupilloplasty such Siper slipknot and the modified version, these options were on the table but using single-pass four-throw pupilloplasty technique provide a better option for our patient having advantages of minimal iris manipulation single pass, thus fewer iris pigment dispersion saving what we have of iris structure and also minimizing the reactivation of post-surgical induced uveitis [5]. This technique has an only single pass through the anterior chamber wherein 4 throws in helical configuration taken externally through the suture loop withdrawn from the anterior chamber, few steps were captured (Figure 2). Minimal iris manipulation single pass, thus fewer iris pigment dispersion saving what we have of iris structure [5] and also minimizing the reactivation of post-surgical induced uveitis. Although it has no true looking knot system, this technique provides a self-looking and self-retaining mechanism preventing the loop from reopening [6]. Single-pass four throw pupilloplasty provide adequate pupil dilatation after pupilloplasty facilitating retina examination if needed for patients of HZO. This technique achieves good pupil size, and contour [5].

In Conclusion

HZO patient has many ocular complications, with adequate control, the proper selection of cases to intervene and the proper selection of surgical technique can carry good prognosis of the patients.

For more information about Article : https://ijclinmedcasereports.com/

Abstract

A new physical model is proposed for the appearance of an astronomical object - the Black Hole. It is shown that the Black Hole is the center of the cosmic, etheric, gravitational torsion. An equation for determining the radius of this object based on the theory of vortex gravity is presented. A substantiation is proposed that the force of gravity on the surface of the Black Hole does not depend on the mass of this Black Hole. The mass of the Black Hole can not be determined. A contradiction is shown in the Schwarzschild solution by the definition of the radius of the Black Hole.

Keywords: theory of vortex gravitation, celestial mechanics.

Introduction

According to many astrophysicists, astronomical object the Black Hole (BH) is an area in the space which gravitational attraction is so great that light quanta can't leave it even. Researchers believe that Black holes could result from catastrophic gravitational collapse of a massive star at that historical moment when it dies. At collapse - catastrophic compression of a star - intensity of gravity over its surface becomes so terribly big that the space surrounding a star - time is displaced. This star disappears from the Universe and there is only strongly bent area of space - to time. The border of this area is called as gravitational radius. Spherically a symmetric black hole it is equal in the elementary case to Shvartsshild's radius. Theoretically possibility of existence of such areas of space - time follows from some exact solutions of the equations of Einstein, first of which was received by Karl Shvartsshild in 1915 [1].

Where, rs – the radius of the Black Hole, M – the mass of a black hole, with - the velocity of light, G=6.672 ∙10 -11 N∙m2/kg2 – a gravitational constant. We will consider objectivity of a hypothesis of an origin of the Black hole on the example of similar object which is in the center of our galaxy. In work [2] the radius of this BH which is called the Sagittarius A * is determined –

At such radius and the corresponding volume, the mass of this BH has to be on the basis of a formula (1) about 1039 kg. Then density of the Black Hole in the center of our galaxy has to be about 5 kg/m3! ? On the basis of the classical equation about a mutual attraction gravitation force on a surface of the Sagittarius A * is equal

F =  6.8 x 104 M

Agree, it is impossible to call this Black hole "catastrophically squeezed", and gravitation forces on its surface  "terribly big". It is obvious that the theoretical explanation of an astronomical phenomenon of the Black hole doesn't correspond to physical parameters. In addition, equation (1) is mathematically absurd. In it, the quantities (G) and (c) are constants. Therefore, the mass of the Black Hole (M) is directly proportional to its radius (r). In fact, the mass of any body is always proportional to its volume. The volume is proportional to the radius of this body in the cube (r3). Then the mass must also be proportional to the radius in the cube. From this discrepancy with the laws of mathematics of equation (1) it follows that the density of the Black Hole (P) is inversely proportional to the root of its cubic radius. P ~ r-1/3

Example, On the basis of formula (1), we shall determine the mass of the Black Hole with a radius equal to 1 m.

Then the density of this black hole is

This density is several orders of magnitude greater than the density of the nucleon. Consequently, equation (1) is absurd. It is offered to study the theory of vortex gravitation and cosmology below. On the basis of this theory it is possible to explain genesis of the Black hole without contradictions.

About the Theory of Vortex Gravitation

The theory of vortex gravitation [3] is based on the well-known astronomical fact – all heavenly objects rotate. The most logical explanation of the reason of this movement can be only one – rotation of heavenly objects generated vortex rotation of space substance – ether. Ether forms system of the interconnected whirlwinds in world space. Orbital speeds of ether in each tuft (torsion) decrease in the direction from the center to the periphery under the law of the return square of this removal.  If orbital speeds of a stream of ether decrease then, under aerodynamics laws, pressure in this stream increases. The gradient of pressure generates pushing out force in the direction to zones with the smallest pressure, that is to the center of this torsion. We will consider the equation of vortex gravitation received in the theory [3]. In this section, a model of appearance of the gravitation attraction force is considered from the viewpoint of aerodynamics. Namely, the two-dimensional model is considered on the basis of the following initial postulates. These postulates will be expanded and defined more exactly below.

Forces operating on a body 2 are specified. The Fc-centrifugal force, Fp-force of an attraction of a body 2 from a body 1, v2 – the linear speed of a body 2 on an orbit, R – the radius of an orbit, r1 – the radius of a body 1, r2 – the radius of a body 2, w1 – the angular speed of rotation of air on a surface of a body 1, m2 – body weight 2.

As it was already spoken, movement of a whirlwind is resulted by pressure gradient. Radial distribution of pressure and ether speed in work [3] are defined on the basis of Navier-Stokes's equation for movement of viscous liquid (gas).

In cylindrical coordinates taking into account radial symmetry of vr=vz=0, vj=v (r), P=P (r) the equation will register in the form of system

Where r = 8.85 х 10-12  kg \m3 - density of ether [4], – a vector of speed of ether, P – pressure of ether, h- viscosity.

In cylindrical coordinates for the module of force of gravitation

Then comparing (3) and (4) for incompressible ether (r=const) we find that

After necessary transformations (full calculation is stated in the theory [3]) it is received:

1 . the equations for determination of force of gravitation depending on the speed of rotation of ether

rn,  mn  – radius and mass of a nucleon.

We will transform a formula (6). We will equate r1 = r. We will substitute w1 r1 = v1 and numerical values rn,  mn, r, we receive:

2. The equations for determination of dependence of pressure of P0, from the speed of rotation of ether of V1

Where – pressure of ether on we consider P0 to an orbit, using a boundary condition

In fig. 2 pressure distribution according to a formula (8) is graphically shown.

Vortex Black Hole

Асcording to laws ether-loudspeakers [4] pressure in motionless air is accepted size

Ether density

By means of the equation (8) we will find the orbital speed of ether of V0 = V1 at which pressure of P0 will be equal to zero.

from where  

Orbital speed of ether to belong to the radius of the orbit under the law of the return square

where

R0  – radius of an orbit of a whirlwind on which ether reaches speed

Rkn – radius of an orbit of a whirlwind in which the speed of ether is known (Vkn).

From the equation (9) we find the orbital radius of the radio torsion with zero pressure.

Orbital speed of ether of Vkn is determined by the known force of gravitation in the same orbit, by means of the equation (7).

Radius of the Vortex Black Hole of the Sagittarius*

We will consider the Sun address in a galaxy orbit.

Orbital speed of solar system -V = 2.2 * 105

Radius of an orbit of solar system - Vkn = 2.46*1020 [5].

We determine the centrifugal force operating on the Sun.

Provided that centrifugal forces, in any point of an orbit, are always equal to attraction forces, we find force of the galactic gravitation operating on the Sun.

We substitute value Fп and r in the equation (7) and we find ether speed in a solar orbit.

Radius of an orbit of astronomical object the Sagittarius* with the zero pressure upon surfaces, on the basis of the equation (10)

The strength of the vortex gravitation on the surface of a black hole

Fg = 620 x M

Similarly, we find radiuses of Black holes at other objects:

Sun - R0 = 155500 m

Eartht - R0 = 0.478 m

Conclusion

Obviously, the modern theory of the origin of black holes contradictory. On the example of a celestial object Sagittarius A* can be argued that Black holes are not superdense and supermassive objects. They may not have a huge force of gravity at its surface.  Based on the theory of vortex gravitation and cosmology, black holes is the central region of space, ether, gravitation torsion. Orbital velocity of the ether on the surface of this area reaches the maximum possible value

At this speed, the pressure on the rotationorbitof theesterdecreases to zero. No substanceorradiation is notable tobreak out ofthis zone.Therefore, the centerspace, gravitation torsioninvisible.Insidethe black holerotationetherorstopsorslows down. In this case,there can existinside a black holeof antigravity.

Note. A similar phenomenon is noted in the center of tropical meteorology and sea storms. Where there is complete peace of mind (calm). This phenomenon is called the "eye of the storm." Radius of the black hole Sagittarius A * at the center of our galaxy observations to determine the magnitude

The estimated value of the radius of the black hole Sagittarius A *, obtained in Chapter 4 (1,382×〖10〗^14 m) higher than the observed value of two orders of magnitude. This is not a calculation error, and the inequality of the radii of the Black Hole in the longitudinal (orbital) and transverse (axial) dimension. The fact that black holes have their form likeness forms of galaxies - and the disk are located in outer space, in the same direction as the galaxies themselves. Terrestrial observer is on the periphery of our galaxy and it can measure their visual observations center of the galaxy (Sagittarius A *) only in the transverse axial dimension. At the same time, disk Sagittarius A * its plane directed to us, so we can determine the calculations only the distance in the longitudinal direction radially. Therefore, calculations determined the orbital radius, and observations - transverse axial thickness of the black hole Sagittarius A *. Radius of gyration of any cosmic torsion far exceeds its axial thickness. For the black hole Sagittarius A * this fact recorded in this paper calculations and astronomical observations.

Gravitational torsions can be of different sizes. Each torsion creates its material object. Micro torsion create atoms. Planetary - planet. Star - star. Galactic - galaxies. Universe - the universe. All torsions in their centers hase black holes. In celestial bodies (atoms, planets, stars, etc.) they are under a layer of the material of which they are created. Therefore, they are hidden from us. In large space objects such as galaxies, they are open and subject to study. Modern classic exercise in cosmology and astrophysics have a lot of controversy for one reason. All of them are based on a global error of the classical theory of gravitation, which states that all bodies create gravity. In fact the opposite is true - gravity creates the body.

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A Bit Scary Statistics

For a start, as a preamble, here are some excerpts from various sources on the problem of tuberculosis (TB), which are quite strange to read at the beginning of the third millennium, since many people confidently believed that there has been enough time to solve this problem during the past two millennia:

- Tuberculosis symptoms and signs: cough, loss of weight, chest pain, fever, night sweats. If untreated, 50 percent of patients die within five years;

- More than any other infectious disease, TB kills approximately 1 million women per year. Each year, TB kills 100 000 children. Tuberculosis is the most common cause of orphanage;

- Untreatable bacteria can destroy the progress of TB control achieved in the last 50 years. There are no drugs to combat some resistant TB bacteria (in developed countries 50 million people may be infected);

- The majority of people infected with TB never become sick because their immune system prevents the development of TB mycobacteria. Only 5 to 10 percent of those infected develop TB. Scientists today do not know exactly why some infected people develop TB and die, while others do not;

- At least one person is infected with TB every second, 1 percent of the world's population are infected each year. Untreated persons infect on average 10–15 neighbors during a year. For major cities, this figure is considerably higher. The most susceptible to infection are prisons, the Army and the Navy, where the concentration of people living together for a long time is the greatest. According to the WHO over the past two centuries, TB killed about a billion people. The WHO warns that unless we take urgent action, in the next 10 years, TB will kill an estimated 30 million people and infect 90 million people. Further, by the end of 2020 a billion people will have been already infected: 200 million people will be sick and 70 million people will die. So much for the White Plague (because of the extreme pallor seen among those infected)!

Laser Treatments for Tuberculosis

Currently, we know two approaches to fabricating laser systems for the TB treatment. They are based on excimer lasers and installations making use of important benefits of miniature solid-state diode-pumped lasers. The peak of the bacteriostatic activity of the generated laser radiation in various forms of TB lies at a wavelength of 265 to 266nm, and in this case, the effectiveness of its action is equal to unity. The wavelength of 248nm, which is emitted by an excimer laser, is closest to this range. At this wavelength, the interaction efficiency amounts to 0.8, which requires a proportional increase in the irradiation time. For a solid-state Nd:YAG laser (fourth harmonic) the radiation wavelength is equal to 266nm. The interaction efficiency of this wavelength is 1.0. The pulse energy with an average output power of 10mW (equal to the product of the energy in a single pulse by the pulse repetition rate). The power is determined experimentally in cultures of bacteria for the exposure time of 10 to 15min.

For an excimer laser the pulse repetition rate is no more than 100Hz; therefore, the energy of a single pulse is less than 0.1mJ, which can lead to tissue burn at a pulse duration of 5–10ns. To ensure a ‘soft’ effect on tissues, it is needed to reduce the pulse energy by one or two orders of magnitude, which is possible, but requires a proportional increase in the exposure time. At these energies (0.1mJ) an optical fiber is usually damaged. An optical fiber requires a high optical purity of working surfaces which is problematic when administering it in various cavities. The destruction of the output end of the fiber may cause penetration of small glass fragments into the patient. In a solid-state laser the pulse repetition rate is maintained at a level of 10000Hz; therefore, the energy of a single pulse is only 0.001mJ. That is why the soft tissue burn and destruction of optical fibers in the case of solid-state lasers is fundamentally impossible.

Now let us say a few words about the service life of some elements of lasers. In the case of an excimer laser, the main element is a gas tube, whose service life is about 1000–2000 hours at a cost of about 1000 USD. High-energy pulses can also lead to an early failure of optical elements. In the case of a solid-state laser, the essential element is a laser diode, whose service life amount to least 5000 hours at a cost of 700–800 USD.

The presence of hazards when working with lasers discussed is as follows. An excimer laser has in its design a significant amount of harmful gas. Besides, this laser requires a high voltage for its operation (about 10kV). The design of solid-state lasers is free of hazards, whereas the cost of the components of these lasers is approximately comparable with that of excimer lasers.

As for the additional conditions of production of the laser sources discussed, excimer lasers, apart from standard a optical-mechanical and an installation sites, also require the presence of a vacuum site, equipped to work with poisonous gases. The production of solid-state lasers requires only a standard optical-mechanical and an installation sites.

Amulet Semiconductor Laser Apparatus

An Amulet semiconductor laser apparatus with a fiber for introducing radiation in the affected area through an injection needle is intended for the treatment of destructive forms of pulmonary and bone TB that are resistant to conventional medical treatment, as well as to shorten the treatment of common forms of TB by topical exposure of the infected surface to ultraviolet (UV) radiation with a wavelength of 266 nm, which has very strong bactericidal and bacteriostatic effects. UV radiation in this case has low intensity and only affects the microflora without any damage of the living tissues of the human body. The typical time of UV irradiation of the affected area is 5 to 15min. In this case, the traumatic effect is absent.

The Amulet apparatus (Figure 1.) is designed to treat patients with tuberculosis affecting lungs, bronchi, bones and joints, to cure diseases associated with suppurative infections and other inflammatory processes, with the abnormal healing process, with the immune system variations and instability of the capillary circulation. In addition, the apparatus can be used in endosurgery, phthisiology, otolaryngology, traumatology, stomatology, treatment of burns, gynecology, therapy, surgery, urology, proctology, and dermatology.

Clinical Trials of the Amulet Apparatus

Fryns syndrome (FS) is a rare autosomal recessive congenital anomaly syndrome with an incidence of 0.7 per 10000 births [1]. The 6 diagnostic criteria for FS are as follows: 1) congenital diaphragmatic defect, 2) characteristic facial appearance, 3) distal digital hypoplasia, 4) pulmonary hypoplasia, 5) characteristic associated anomalies like polyhydramnios, brain malformations, ren

Conclusions

Thus, the clinical trials performed allow us to make a conclusion that a therapy UV solid-state diode-pumped Amulet laser is effective in the treatment of TB-affected tissues and bones due to the bactericidal and bacteriostatic effect and stimulation of reparative processes. It could be used for many other applications in the practical medicine.

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Abstract

The chondromyxoid tumor is a primitive benign tumor of cartilaginous differentiation. We report the case of a 10-year-old child presenting with an aggressive form of the tumor that mimics a malignant process, atypical localization at the iliac axis.

Keywords: Fibromy Chondromyxoid; Child; IRM

Introduction

The chondromyxoid tumor is a benign benign tumor, presenting 0.5% of primitive tumors. She is generally interested in the metaphysics of the lungs. The objective of our article is to illustrate an aggressive form of this tumor, atypical localization in a child, highlighting the role of the IRM in its taking charge.

Case Report

Child of 10 years, consulted at the emergency room of the Rabat Children's Hospital for a prolonged and painful tumult of the right iliac fossa, rapidly increasing in volume. The biological balance was normal. The radiography objective showed a mixed lithic and condensing lesion, heterogeneous, of the right iliac artery, inciting the realization of an IRM. The IRM has objectiveed a legal process centered on the right iliac axis (Figure 1), multi-locale, in hyposignal T1, hyerignal heterogeneous T2, reproducing multiple septa stages in hyposignal T2 enhanced by Gadolinium, without restriction in diffusion. It is associated with a compact reaction with respect, without overriding adjacent structures. Absence of infiltration of fat or associated adenopathies. The process was in favor of a more benign origin than a chondrosarcome. The chondromyxoid fibroma was among the evacuated diagnostics, and was histologically confirmed. The surgical excision was indicated. A tumor recurrence was objective by a follow-up IRM after 5 months. It should be noted that tumor recurrence is more voluminous than primitive tumor (Figure 1 d).

(a) After (b) Gadolinium injection, and in sequential T2 in sagittal cup before (c) 5 months after a surgical resection (d) The images show a tumor process centered on the right, multi-locus iliac axis, in hyposignal T1 (a), enhanced by Gadolinium (b). The tumor shows a heterogeneous T2 hyersignal, confirming multiple septa steps in hyposignal T2 (c). It is a compact periodic response with regard to, without overheating of adjunct organs.

Discussion

Chondromyxoid fibrosis generally affects young subjects and manifests itself clinically through pain and tumors. Pathological fractures are common [1]. On standard radiography, at the level of the lungs, one finds an eccentric geographical gap, soufflant the cortical. On the sites where the iliacs are, the tumor is often polycyclic and mixed, associated with a condensation and a bright osseuse. Intra-tumor microcalcifications may be encountered [2]. The IRM is the key exam that can evoke the diagnosis of chondromyxoid fibroma. The myxoid component appears in hyposignal T1, hypersignal T2, and is enhanced by Gadolinium. The IRM also allows the detection of other associated intratumoral components: fibrous, cystic and calcareous [3,4]. Chondromyxoid fibroma is characterized by the absence of intra-medial extension, which allows to differentiate its aggressive form of a chondrosarcoma, the latter being the differential diagnostic principal. In the interest of a meticulous analysis of tumor reports in IRM. Histological confirmation after a biopsy is always indicated [3,4]. The treatment consists of a complete tumor excision with curettage and joint osseux. Note that total resection is not always possible given the frequency of relapses that occur in 25% of cases. The malignant tumor transformation is exceptional [1,2].

Conclusion

The imagery and in particular the IRM play multiple and fundamental roles in taking charge of the chondromyxoid fibroma. The IRM offers a diagnostic orientation, in particular in the case of atypical localization, a precise study of tumor reports guiding surgical treatment, as well as the search for a recurrent postoperative operation.

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Letter to Editor

As we are all combating the COVID-19 pandemic , a war being imposed by an invisible enemy, each day we need to “spy” the new moves by our enemy in order to design our own strategy. This metamorphic menace has ways to amaze us and to bluff us by presenting in unexpected ways. Since we have never suffered from this novel viral infection before, there is no data to correlate and guide us regarding the possible ways of presentation of this virus. It has pushed us back in teaching ourself the basic science based on observation, building new words from the alphabets we find, and playing Columbus to discover the new faces through which SARS-CoV-2 may manifest itself while looking for the hallmark set of signs and symptoms. The tendency of masquerading itself of the SARS-CoV-2 , a virus that ruined the famous Venetian Carnival as it unveiled itself , has put all the researchers into a mayhem.

Sir, I really want to bring into your kind notice that we have found some signs and symptoms that are related with the central nervous system particularly the hypothalamus. It came into our observation that many patients with COVID-19 infection have presented to us with polyuria and polydipsia with and without polydipsia.

In a short study, we detected at least 27 patients who suffered from “unquenchable thirst” and “ravenous appetite”. 7 of them were diabetic including 2 who were insulin dependent .Most of them did not develop severe COVID-19 . Polydipsia and polyphagia raise suspicion of hypothalamic infliction, since hypothalamus has centers of thirst, hunger and satiety [1]. The interplay between stimulation and inhibition leads to the normal hunger and thirst sensations. We further noted that 21 of them had other signs and symptoms related with peripheral nerves. They all suffered from dysosmia and dysgeusia as well. If we put all of these symptoms together and correlate it with the viral entry through the nose, it is quite simple to explain that SAS-CoV-2 affects the olfactory nerve and from there finds its way to the hypothalamus [2].

Addressing polyphagia and polydipsia separately, if we discuss polyphagia first in relation with hypothalamus , there can be various causes directly or indirectly related with the hunger and satiety centres in the hypothalamus. The most straight-forward mechanism of hunger and satiety is defined by the balance of signals coming from two hypothalamic centers: the lateral hypothalamus that responds to internal and external signals and cause one to feel hungry and the ventromedial hypothalamus that signals satiety. Secondly, polyphagia is It is also the part of the 3Ps of diabetes [3]. With an increasing experimental and clinical evidences showing hypothalamic dysregulation as one of the underlying mechanisms of abnormal glucose metabolism, it can be postulated that hypothalamic infliction is likely in SARS-CoV-2 that leads to polyphagia in both diabetic and non-diabetic patients as well as poor diabetic control in the diabetic patients. Koshiyama et al postulated several points to suggest the role of hypothalamus in causing diabetes mellitus noticeably an increased hypothalamic-pituitary-adrenal axis activity caused by extreme stress [4]. So a deranged hypothalamic function causing diabetic tendency and polyphagia can be one cause. Due to financial constraints, proper blood sugar level testing could not be performed in the non-diabetic patients, however, in the diabetic patients with COVID-19 it was evident that glucose control was poorer .The other important point regarding the causation of polyphagia is the direct effect on the hypothalamic centers for satiety. It is evident that mutations in several genes related with hypothalamic satiety signaling lead to polyphagia and the so called hypothalamic obesity [5]. This points towards a possibility of SARS-CoV-2 affecting hypothalamus not only directly but also via genetic mutations. In a study by Gu et al., neuronal histopathological changes were found in the hypothalamus who in the autopsies of 8 victims of SARS [6].

Nampootheri et al suggested SARS-CoV-2 invasion in the hypothalamus . Hypothalamus plays a key role in hypertension, diabetes, obesity and other risk factors for developing severe COVID-19 infection. They also suggested a non-respiratory system origin for respiratory failure. Hypothalamus being connected to brainstem cardio respiratory centers can cause respiratory arrest. They further showed that the human brain gene-expression analyses revealed that the hypothalamus with its associated regions express angiotensin-converting enzyme 2 and transmembrane proteinase, serine 2 which allows SARS-CoV-2 entry in the cell. They also showed that immunolabeling in human as well as in animal brains proves that the central role of the hypothalamus that by allowing SARS-CoV-2 brain invasion through multiple routes, influences brain susceptibility and various severe manifestation of the COVID-19 infections [7].

If we now discuss polydipsia then again we have various explanations via different causation pathways involving hypothalamus. The most straight forwards pathway is via Angiotens in II . Since SARS-CoV-2 also acts via the ACE2 receptors, somehow at any level whether central or peripheral , it is able to cause polydipsia[8]. Hypothalamus does have osmoreceptors that regulate thirst mechanisms.[9] So, basically, hypothathalamus plays a central role in thirst mechanism. Due to limited resources and an overwhelmed system, we were not able to follow any specific lab investigatory protocol. However, correlating with serum electrolytes and urine output records, none of them had either diabetes insipidus or dehydration. The only notable point was a poorer diabetic control during illness, but this can be from various different reasons, again hypothalamus does play a role in several of such mechanisms including blood sugar control.

Again, if we join all these pieces of information together, with patients presenting with polydipsia and polyphagia as well as signs involving olfactory nerve and other peripheral nerve signs and symptoms and provided the fact that SARS-CoV-2 does interact with the nervous pathways and it also interacts with ACE-II receptors, it is likely thatSARS-CoV-2 finds a way to the hypothalamus leading to the manifestations related with hypothalamic structures.

I believe there is a need to perform further research on this topic. This can be an important point to understand the level of severity of COVID-19 infection and may help in determining a proper management plan with monitoring as well as determining prognosis.

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Abstract

A new physical model of the appearance of light, properties, and its trajectory. Explains the paradox of invariance and isotropy of light based on the laws of classical physics.

Keywords: Theory Ofvortex Gravitation; Cosmolog;Cosmogony; Aerodynamics

Introduction

For many years, scientists- physicists have tried to measure the speed of light. Galileo-in the seventeenth century. Early experiment to measure the speed of light was held Ole Roemer, a Danish physicist, in 1676. Another, more accurate way to measure the speed of light is made in Europe Hippolyte Fiziin 1849. Francois Arago determines the speed of light in 1838bya rotating mirror. In 1862, on the production of the speed of light worked Leon Foucault  [1]. In 1926,a result of years of efforts Albert Michelsonhas had some very high accuracy of the speed of light:

с = 299 796 000±4 000 m/s

The main and paradoxical conclusion in the study was his invariance speed of light. In other words, the speed of light is the same in all inertial frames of reference is independent of the velocity of the observer and emitter. This surprising fact for the classical physics of his time for the first time proved the Michelson experiment: the independence of the speed of light on the direction (isotropic) and the orbital motion of the Earth around the sun. In the future, this paradox was confirmed by astronomers. In particular, Willem de Sitter in monitoring the spectral binaries found that the speed of light flux from removing the stars and approaches are constant speed of light (c) and equal to each other. That is, they do not depend on the rate of the star (light sources) [2]. From the point of view of classical physics this paradox so far can’t be explained. Therefore, on the basis of the unknown properties of light in 1905, Einstein proposed the special theory of relativity (STR) in the paper "On the Electrodynamics of Moving Bodies" [3]. SRT conclusions were as paradoxical as the invariance of light. On the basis of the SRT can assert that the events simultaneous in one inertial reference frame will not be simultaneous in another, if these frames of reference are moving relative to each other. In this article we propose to explain the origin, properties and the invariance of light, in full compliance with the classical laws of physics using the theory of vortex gravitation, cosmology and cosmogony [4].

Luminiferous Ether

In the theory of vortex gravitation, cosmology and cosmogony all celestial bodies (matter) are essential vortices. The values of the bodies (system of bodies)) and the corresponding vortices may vary to an infinite value. The biggest ethereal vortex that people can watch this universal whirl wind, the smallest atomic. The orbital speed of ether in each vortex increases towards the center of an inverse square law. Change of orbital velocity is inversely proportional to the pressure change in the air. Pressure gradient force creates vortex gravitation. This pattern works equally essential in a whirlwind of various volumes.

In theory, the vortex gravitation obtained an equation to determine the gravitational force in the etheric vortex [4]:

Depending on the next

Where

V - Volume of the nucleons in the body, which is in torsion

r = 8.85×10-12kg /m3 -the density of ether [5]

v(r) - Velocity of ether in the orbit

r - The radius of the orbit are risen the vortex

The same relationship between the force of gravity and orbital velocity exists in atomic torsion (vortex).

Each atomic vortex ether rotation occurs continuously around the core with a radius r, which creates the effect of an atomic attraction. For this scheme, gravity can explain the origin of the interatomic forces of attraction. In theory, the vortex gravitation made the condition that the ether penetrates all matter and the body other than atomic nuclei (nucleons). Maximum speed ether several orders of magnitude greater than the speed of light. The rotational speed and the pressure gradient of ether, and the attractive force Fn on the surface atoms reaches a maximum value.

Make a guess:

The assumption № 1. Under the action of attractive forces on the surface of the atom or on surface of nucleus of the atom or ether stream is converted into an electromagnetic flux including a light. The light has mass. Gravity act on the light. When converting the ether is the emergence into the light particles (photons) with a mass greater than the mass of the particles of the ether -Amer. Increasing the mass of the particles, according to the law of conservation of angular momentum of rotation, must be accompanied by a decrease inversely proportional to the orbital speed of light. Thus, the light gets its velocity- c.

When orbital revolution of the magnetic flux (light) around the atom to it are two forces: the force of the vortex atomic attraction and centrifugal force. For uniform orbital motion of light is needed to create its orbital speed centrifugal force equal to the force of an atomic attraction. This rate is equal to the atomic orbit well-known speed of light-(c). In aerodynamics this force is called the first space. The atomic attraction is generated bythe pressure gradient in the atomic vortex (uravn.4). The pressure gradient is the difference of pressure values in free ester stationary and the center of the vortex. In a free state, the pressure is always constant and maximum. In the center of the vortex ether pressure depends on the rotational speed and air temperature. Upon heating of a substance (atom), the pressure (P)atom in the center increases in proportion to the temperature (T),in accordance with the law of Charles (6):            (2)

Then the pressure gradient must be reduced and, in accordance with equation(1) reduces the force of attraction of the vortex. In this case, there comes a predominance of centrifugal force Fc over the forces of atomic, vortex attraction Fn. The speed of light is converted into the second cosmic speed. Lightis removed from the atom at the most economical spiral trajectory according to calculations by Walter Hohmann [7]. At the same time near the surface of the atom (at the lowest atomic orbits), the place flown away luminous flux takes a new ether flow. This stream is the same principle is converted into light. If the external effects (heating) are stored, the conversion and emission light from the atom will continue permanently. This is the nature of light. Light is generated and emitted not by the energy or mass of matter (atoms), but only by making the ether in the light under the influence of the atomic vortex gravitation and external influences (temperature). Light emissions top only when the external action (heating) or destruction of the atom, and with it the atomic vortex.

Fig. 1 shows an aerodynamic scheme of movement of the light flux from a single atom. In the emission of light from the set of atoms aerodynamic design principle does not change, only multiplied many times. Light will always be supplied to each of the observer to any atom on the same helical path (at a large angle to the radius of the light field) with its constant velocity - v. Spiral light fluxes from these atoms can twist in different directions. The orbit planes of light fluxes arranged in space with any inclinations from each other. Thus, the light is almost infinite set of ultra-thin, light, spiral threads. These streams are combined into a single spherical light field. Radius and circumference of the light field in their values are directly proportional. Consequently, the light field radially increases with the same speed of light. If the viewer moves around the light source light over a circular orbital path, and in this case a considerable part of the light will make its spiral rotation along a plane perpendicular to the plane of movement of the observer. Consequently, this light will also enter the observer at a right angle with its constant velocity- v. Isotropy of light is also a consequence of the propagation of light streams through an infinite number of spiral trajectories.

Output: To put the speed of light (c) at the speed of any body (v) in space is possible only according to the laws of vector algebra. Relative movement of any other body in space, light always moves at a right angle. Therefore, the relative velocity of the entering light to any body will always be equal to the absolute speed of light, regardless of the speed of motion of the considered point (O) relative to the light source (S).

Mathematically this can be written:  +   =  -   =

Conclusions

The concept of the luminiferous ether was launched in the XVII century Rene Descartes. In the future, the wave theory, the luminiferous ether developed in the writings of Huygens. A detailed justification for this theory was in the XIX century in the framework of wave optics and electromagnetic theory of Maxwell. The proposed spiral model of light is very close to the concept of the wave motion of light and differs only in the trajectory of the light flux.

According to modern concepts light has a dual nature (wave-particle duality): - light has wave properties and is an electromagnetic wave, but is also the stream of particles-photons. It should be noted that until now scientists have not explored yet another important property of light: what is the mechanism and how can instantly disperse photons up to the maximum speed-c?!

Spiral model of the origin and movement of light, this problem is not difficult, because the momentum of the movement all the magnetic flux received from the ether, which at the outbreak of the world itself was moving at a speed exceeding the speed of light. Under Chapter 2 of this article can be argued that this is a consequence of the invariance of the light path of movement of the light flux. Researchers relative velocity of light in their calculations are not stacked vector velocities and their modules. The movement of the luminous flux is not contrary to the laws of classical physics. Invariance was introduced into scientific consideration only because of a misunderstanding of the movement of light as straight and radial.

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Abstract

In his operating work, the surgeon often uses the patient's tissue to solve practical problems. For our work, the data of Liebermann-Meffert D. and White H. (1989) on the greater omentum are of interest [1]. Research shows that the "policeman of the abdominal cavity" - the great omentum in pathological conditions, acquires very special properties: plasticity; the ability to adhere to an injured and inflamed surface; the ability to hemostasis; the ability for ingrowth and revascularization; the ability to absorb liquids and microparticles from the abdominal cavity; the ability to phagocytosis and immunological response. Adhesions with the omentum are formed much faster than with other organs of the abdominal cavity. Even the freely transplanted omentum tissue without blood supply retains these properties. After 21 days, the omentum tissue is completely fused with the recipient [2].

Introduction

Experimental studies of ingrowth of the omentum graft and its vessels are very indicative. Sections of the omentum of different thickness and size were separated from its bulk and fixed without revascularization to various organs and tissues of the same or another animal: stomach, small and large intestine, liver, spleen, kidney, urinary bladder, lung, pleura, peritoneum, mesentery, aorta, inferior vena cava. Within a week, the graft is firmly attached to the tissues of the recipient organs, its separation is difficult, due to a decrease in the amount of fat, its thickness is reduced, necrobiotic processes, necrosis zones are reduced. After three weeks, the graft cannot be separated, when an attempt is made, bleeding occurs, the amount of fat decreases and is replaced by dense fibro- and angioplastic tissues so that its surface resembles the surface of the recipient tissue. After 12 weeks, it is difficult to distinguish the omentum tissue from the recipient tissue; the suture line serves as a reference point. The engraftment of free grafts did not depend on their size, but necrosis zones are more often formed in thick grafts. The graft remains viable when frozen for two weeks or even longer. Stages of omentum transplant engraftment: attachment - up to 4 hours, beginning of vascular ingrowth - 24 hours, tight fit - 48 hours, revascularization - 3 days, fat resorption - 3 weeks, fibrous degeneration - 24 weeks [1].

These studies allowed us to use a strand of the free area of ​​the greater omentum in the small intestine in 107 patients. Here is an example of the clinical use and preservation of the viability of the free strand of the greater omentum.

Case Report

A 25 years old, was admitted to the GBUZ NO "GKB No. 12" in Nizhny Novgorod on 11.11.2013 with a diagnosis of "Closed abdominal trauma". After dynamic observation, an emergency laparotomy was performed, during which a rupture of the pancreatic head was detected. Outflow of bile, pancreatic juice was not detected. A tampon was brought to the site of damage to the gland through a separate incision in the right lumbar region. The drains were placed in the right lateral canal, in the omental bursa, in the small pelvis. On 20.11.2013, the intake of contents up to 3 liters with an admixture of bile was noted. On an urgent basis, relaparotomy was performed, during which two perforations were revealed on the posterior wall of the vertical part of the 12-PC, each with a diameter of up to 7 mm, from which, after the introduction of methylene blue, a blue discharge began to flow into the stomach. After excision of the edges of the perforations, the latter are sutured with interrupted single-row sutures. The seam line is reinforced with a large gland strand. A drainage-foam rubber system for active aspiration is connected to this zone through the opening of the right lumbar region (the place of the gauze pad). A loop of the jejunum was isolated 30 cm from the Treitz ligament, on which an areflux nutritional jejunostoma was formed with an interintestinal anastomosis according to Brown and a "plug" on the leading loop 1 cm below the anastomosis. The stoma was placed in the left mesogastric region. A feeding tube was inserted 25 cm behind the anastomosis line.

On January 20, 2014, the patient was admitted to the Nizhny Novgorod City Clinical Hospital No. 12 for the second stage of treatment - closing the nutritional jejunostomy. The skin around the stoma is intact. Performed fistuloenterography through a probe introduced into the leading section of the stoma to the "plug". The contrast does not pass through the "plug" zone, which confirms its areflux function.

01/23/2014 under general anesthesia in the left mesogastric region with two bordering incisions around the stoma, the latter was isolated from the tissues of the anterior abdominal wall. The segment of the intestine with the stoma is brought out to the anterior abdominal wall. The area of ​​the free omentum with the ligature, which acts as a "plug", is viable, loosely welded to the jejunum. The interintestinal anastomosis is passable. Near the anastomosis, the sections of the intestine were stitched with the UO apparatus. The section of the intestine bearing the stoma was resected. The intestinal stumps were additionally sutured with two semi-lace sutures each. Layered suture of the wound of the anterior abdominal wall. Preparation: a section of the jejunum up to 10 cm long with a stoma and a free section of the greater omentum - “plugs”. The area of ​​the free omentum with a ligature, which acts as a "plug", was loosely welded to the jejunum (Fig. 3). The mucous membrane of the jejunum of the "plug" formation zone is not visually changed (Fig. 4). The interintestinal anastomosis is passable.

Morphological examination of the "plug" zone at 3, 6, 9, 12 hours of the intestinal wall circumference showed only edema, moderate lymphohistiocytic infiltration, moderate circulatory disorders [3].

The wound healed by primary intention. In satisfactory condition 02/03/2013 was discharged for outpatient observation by a surgeon.

Conclusion

Thus, our observation confirms the possibility of using a strand of "free", devascularized omentum as a plastic material in small bowel surgery.

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