Valorisation of jackfruit seed flour in extrusion and bakery products: a review.

Jackfruit seeds are a highly nutritious, underutilized byproduct that can combat malnutrition and promote a healthy diet. This review evaluates the effects of jackfruit seed flour (JSF) on extrusion and bakery processing, examining its nutritional, functional, and physical properties. Comprehensive analysis showed that JSF in extruded and bakery products improves their nutritional properties and increases functional properties such as bulk density and water holding capacity, whereas it decreases oil holding capacity and expansion ratio. Furthermore, the textural and colour properties became poorer with the higher concentration of JSF due to the absence of gluten. Consumer studies revealed that the overall acceptability of extruded products containing JSF was higher than that of bakery products with similar substitutions. However, optimal formulations are needed to balance nutritional enhancement with desirable textural properties, and the sustainable utilization of this byproduct can lead to the development of a variety of nutritious food products. Supplementary Information: The online version contains supplementary material available at 10.1007/s10068-024-01665-2.

Analysis of the gamma index using an indigenously developed anthropomorphic heterogeneous female pelvis (AHFP) phantom.

BACKGROUND: It is essential in modern radiotherapy treatment practices to evaluate the quality assurance (QA) of the treatment plan prior to the exclusion of patient from treatment. The typical suitable tools used for patient pretreatment QA are phantoms representing the human anatomy. An anthropomorphic heterogeneous female pelvic (AHFP) phantom has been developed to represent the real female pelvic structure. PURPOSE: The objective of the current study is to assess the findings of relative dosimetry carried out utilizing an electronic portal imaging device (EPID) on the AHFP phantom fabricated. METHODS: The planning target volume (PTV) was created on CT slices of an AHFP phantom to confirm the tool's ability to represent female pelvic anatomy and serve as a QA tool. In order to assess the dose received by healthy organs during radiotherapy, organs at risk such as the bladder and rectum were additionally drawn alongside the PTV. Rapid Arc and Intensity modulated radiation therapy (IMRT) were both used to create the treatment plan on treatment planning system, and the Anisotropic Analytical Algorithm Version 11.0.31 was used to calculate the dose. RESULTS: The results obtained for the average gamma value in RapidArc plans are 0.26, 0.27, and 0.28 (g ≤1) and IMRT plans are 0.39, 0.40, and 0.46 (g ≤1) for target 1, target 2, and target 3, respectively. CONCLUSION: According to the findings of the current study, the AHFP phantom was used to explore the potential of relative dosimetry using EPID as a QA tool, which was found to be suitable.

UV blocking edible films based on corn starch/moringa gum incorporated with pine cone extract for sustainable food packaging.

Corn starch (CS) is a good alternative to synthetic polymers due to its sustainability; nevertheless, because of its weak tensile strength, the matrix requires another polymer. Therefore, 0.5 % (w/v) moringa gum (MG) was added. The purpose of this study was to assess how pine cone extract (PCE) affected the physiochemical and mechanical properties of corn starch and moringa gum (CS/MG) films and their use as UV-blocking composites. The findings suggest that the PCE improved the elongation at break from 3.27 % to 35.2 % while greatly reducing the tensile strength. The hydrogen bonding between CS/MG and PCE was visible in the FTIR spectra. The XRD graph indicated that the films were amorphous. In comparison to CS/MG films, PCE-incorporated edible films demonstrated significant UV-blocking ability indicating their potential as sustainable packaging material for light-sensitive food products.

Structure-led manifestation of photocatalytic activity in magnetically recoverable spinel CuFe2O4nanoparticles and its application in degradation of industrial effluent dyes under solar light.

An efficient removal of the photocatalysts used in the decontamination of water is crucial after its application beside its expected visible light sensitive activities. This study presents the synthesis of magnetically separable CuFe2O4nanoparticles (CFNPs) with enhanced photoactivity under AM 1.5 G sunlight. A simple two-step process involving co-precipitation and hydrothermal treatment is employed, with subsequent annealing at temperatures from 200 °C to 1000 °C to synthesize the CFNPs. The characteristic features of the highest photoactive tetragonal phase of CFNP are confirmed by powder XRD studies with Rietveld refinement. This scheme strategically controls the growth of a highly photoactive tetragonal phase with predominant (224) facets over other less active facets in cubic CuFe2O4. Mott-Schottky analysis confirms thep-type semiconducting nature of CFNPs. A favourable direct optical band gap of 1.73 eV, as well as photoluminescence emission quenching for visible photons, show that the (224) oriented CFNPs are good photocatalysts in the visible spectrum with demonstrated organic dye degradations, including methylene blue and others. A density functional theory-based approach validates that the adsorption of such dye is thermodynamically more favourable on (224) facets of CuFe2O4to facilitate the redox action by the excitons.

Efficacy of the collapsed cone algorithm calculated radiotherapy plans in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT): A comparative dosimetric study in tumors of thorax.

AIM: In this study, efficacy of collapsed cone algorithm-generated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) were evaluated for treatment of thoracic esophageal cancer. MATERIALS AND METHODS: Ten previously treated patients with VMAT were considered for evaluation. The planning parameters were evaluated in terms of max dose, mean dose, Homogeneity Index, Conformity Index for planning target volume, and organ at risk doses. Total monitor unit, treatment time, and gamma passing index were also reported. RESULTS: The target dose coverage of the VMAT and IMRT plans achieved the clinical dosimetric criteria for all ten patients in the evaluation. Under the condition of equivalent target dose distribution, the VMAT plan's Conformity Index, monitor unit, treatment time, and gamma passing index rate were superior than in the IMRT plan, and the result was statistically significant. CONCLUSION: Collapsed cone algorithm-based VMAT can have a more effective and better approach for esophageal cancer than IMRT.

Efficacy and outcome of indocyanine green-based intraoperative cholangiography using near-infrared fluorescence imaging: A prospective study.

INTRODUCTION: The most dreaded complication during laparoscopic cholecystectomy still remains to be injury to the common bile duct. The primary cause for bile duct injury during LC is misinterpretation of the biliary anatomy. Intra-operative cholangiography was introduced as a means of reducing the chances of biliary injury, done using Fluoroscopic imaging or Near-infrared fluorescence imaging method. NIRF is one of the most popular imaging methods in biomedical sciences. Indocyanine Green is sterile and water soluble which completely binds to albumin and is excreted in bile. PATIENTS AND METHODS: This prospective study was conducted among 70 patients between July 2020 and December 2021. Subjects were administered 5mg of ICG dye pre-operatively and procedure performed using Karl Storz HD image S1 system with a D-light P light source for NIRF imaging. RESULTS: The average duration of surgery was 58.10 minutes. After calot's dissection, the CBD was visualized in 88.71 % patients, with a mean time to visualization at 26.33 minutes. The cystic duct was visualized in 87.3% cases with a mean time of visualization of 32.10 minutes. The hepatic duct was visualized in 28.57% and the hepatic duct-CBD confluence was visualized in 34.28% patients. CONCLUSION: Near infrared imaging based intra-operative cholangiography, using Indocyanine Green dye, during Lap. Cholecystectomy is an easy, useful and inexpensive method of visualizing the biliary ductal anatomy.

Clinicodemographic profile, management, and treatment outcomes in advanced retinoblastoma at a tertiary care center in North India.

PURPOSE: The study was undertaken to look into the clinicodemographic profile, management, and clinical outcomes of advanced retinoblastoma at a tertiary care center. METHODS: A prospective cohort study was conducted from Jan 2019 to Dec 2022. Forty-two patients of intraocular advanced retinoblastoma were assessed. The treatment protocol was formulated based on size, extension of tumor, and laterality. Primary outcome measure was response to the treatment in terms of regression of tumor and seeds and no evidence of recurrence after 12 month in enucleated eyes. Secondary outcome measures were complications like implant exposure, metastasis, and death associated with each treatment modality. RESULTS: The mean age of the study group was 13 months. The most common presentation was leukocoria with diminished vision. Most of the patients had group E retinoblastoma ( n = 40, 95%) as per the International Classification of Retinoblastoma. In 12 patients with group E retinoblastoma, primary enucleation was performed and in six patients, secondary enucleation was done, in which initially, globe salvage treatment was tried. In 30 patients, globe salvage treatment was attempted and we could manage to save 23 eyes. The most common treatment modality was intra-arterial chemotherapy using a triple-drug regimen. One patient developed intracranial spread and died due to systemic metastasis during the follow-up period. CONCLUSION: The current study showed that globe salvage is possible in advanced retinoblastoma if appropriate therapy is instituted depending upon the extent of the tumor and availability of latest treatment modalities. Intra-arterial chemotherapy using triple drugs can be offered as a first-line therapy in advanced unilateral retinoblastoma as it has been found to be very effective in the present study.

Evaluation of Radiation Treatment Planning Algorithms in IMRT and VMAT: A Comparative Dosimetric Study in Lung Equivalent Heterogeneous Medium.

Background: In Radiotherapy, computation of dose is important since in a small field with heterogeneity, dose is usually computed with discrepancies. Objective: The present study was aimed to evaluate the dosimetry of treatment planning algorithms in lung equivalent heterogeneous medium for Volumetric Modulated Arc Therapy (VMAT) with step and shoot Intensity-Modulated Radiation Therapy (ss-IMRT), and dynamic Intensity-Modulated Radiation Therapy (d-IMRT). Material and Methods: In this experimental study, Computerized Imaging Reference System (CIRS) phantom was used with an inhomogeneous Racemosa wood cylinder for two types of tumors, namely, Left Lung Central Tumor (LCT) and Left Lung Peripheral Tumor (LPT) in the CIRS left lung cavity. The computed tomography (CT) datasets were employed with the generation of VMAT, d-IMRT and ss-IMRT plans for the LCT and LPT irradiated with 6 MV photon beams. In this study, the accuracy and efficacy of two algorithms: Monte Carlo (MC) and the Pencil Beam (PB), from the Monaco treatment planning system (TPS), were tested by using Gafchromic EBT3 films and CIRS thorax phantom. Results: Regardless of treatment techniques, both algorithms exhibited higher divergence in LPT than LCT. In both LCT and LPT, the highest deviation was near the tumor-lung junction. However, the deviation was higher in the PB algorithm than MC algorithm, with a minimally acceptable variation of -0.8%. Conclusion: The MC algorithm shows more consistency for EBT3 measured dose in lung equivalent heterogeneous medium. However, accurate dose predictions are complicated due to electronic disequilibrium within and at the interface of inhomogeneity. These constraints may cause variations from the anticipated outcomes of the treatments.

Analysis of 'enhanced-view totally extra-peritoneal' (eTEP) approach for ventral hernia: Early results.

Introduction: Laparoscopic ventral hernia repair is undergoing a paradigm shift with the introduction of numerous new techniques to improve the outcomes. Enhanced-view totally extra-peritoneal (eTEP) is a novel approach for the repair of ventral herniae introduced by Belyansky et al. The key innovation lies in placing the mesh in a large retrorectus-pre-peritoneal space contrary to the widely practiced intra-peritoneal placement. This approach can be easily coupled with a component separation in the form of transversus abdominis release (TAR) for large herniae. We conducted a midterm analysis of 'eTEP' approach to ventral hernia at a high-volume tertiary care centre and present our results of over 3 years of employing this technique. Methodology: A retrospective study of 150 cases of ventral hernia repaired using eTEP approach from January 2018 to February 2021 at a tertiary care centre by a team of three surgeons. The procedures were performed by a single team of three members headed by the first author. Results: Out of total 150 cases, incisional hernia occurred in 73 cases (48.7%), primary hernia occurred in 48 cases (32%) and recurrent hernia in 29 cases (19.3%). Although the majority of incisional (87.7%) and recurrent (79.3%) ventral hernias occurred in female, the incidence of primary ventral hernia was equal at 24 cases in both genders. The majority of the cases (80.7%) underwent eTEP RS procedure, and the rest were W3 hernias, which were managed by including a component separation in the form of eTEP TAR. The operating time for eTEP TAR (222.24 min ± 32.56) compared to eTEP RS (124.33 ± 23.68) was significantly longer. The mean length of stay was significantly shorter for primary hernias (3.75 days ± 1.62) compared to recurrent (5.21 days ± 2.51) and incisional hernias (4.36 days ± 2.19) (F = 4.376) (P = 0.014). The peri-operative period was uneventful in majority of the cases. We experienced a seroma rate of 5.8% in our series. At follow-up of 1 year, 3.3% of patients complained of discomfort/bulge in the upper abdomen. There were no other surgical site occurrences (SSO) in the form infection, posterior rectus sheath disruption and skin necrosis. We observed no recurrences till date with a minimum follow-up of 1 year. Conclusion: eTEP approach to ventral hernia is a promising abdominal wall reconstruction technique. It is safe and offers good functional outcomes with restoration of abdominal wall dynamics. It is a reproducible and safe technique for tackling various types of ventral hernia. It is specifically useful in managing unusual lateral hernias, incisional and recurrent hernias with ease.

Exploring the Possibility of Machine Learning for Predicting Ionic Conductivity of Solid-State Electrolytes.

Unlike conventional liquid electrolytes, solid-state electrolytes (SSEs) have gained increased attention in the domain of all-solid-state lithium-ion batteries (ASSBs) due to their safety features, higher energy/power density, better electrochemical stability, and a broader electrochemical window. SSEs, however, face several difficulties, such as poorer ionic conductivity, complicated interfaces, and unstable physical characteristics. Vast research is still needed to find compatible and appropriate SSEs with improved properties for ASSBs. Traditional trial-and-error procedures to find novel and sophisticated SSEs require vast resources and time. Machine learning (ML), which has emerged as an effective and trustworthy tool for screening new functional materials, was recently used to forecast new SSEs for ASSBs. In this study, we developed an ML-based architecture to predict ionic conductivity by utilizing the characteristics of activation energy, operating temperature, lattice parameters, and unit cell volume of various SSEs. Additionally, the feature set can identify distinct patterns in the data set that can be verified using a correlation map. Because they are more reliable, the ensemble-based predictor models can more precisely forecast ionic conductivity. The prediction can be strengthened even further, and the overfitting issue can be resolved by stacking numerous ensemble models. The data set was split into 70:30 ratios to train and test with eight predictor models. The maximum mean-squared error and mean absolute error in training and testing for the random forest regressor (RFR) model were obtained as 0.001 and 0.003, respectively.

Cancer trends and burden among Armed Forces personnel, veterans and their families: Cancer registry data analysis from tertiary care hospital.

Background: Cancer incidence is rising across the globe. The incidence and patterns of various cancers among Armed Forces Personnel and Veterans is not known. We did the analysis of registry data maintained at our hospital. Methods: A retrospective analysis was performed of all patients registered at our hospital cancer registry between 01st January 2017 and 31st December 2019. Patients were registered with unique identification number. Baseline demographics and cancer subtype data were retrieved. Patients with histopathologically proven diagnosis and age ≥18 years were studied. Armed Forces Personnel (AFP) were defined as those who are in active service, and Veterans as those who had retired from service at the time of registration. Patients with Acute and Chronic Leukemias were excluded. Results: New cases registered were 2023, 2856 and 3057 in year 2017, 2018, 2019 respectively. AFP, Veterans and dependents among them were 9.6%, 17.8%, and 72.6% respectively. Haryana, Uttar Pradesh and Rajasthan represented 55% of all cases with male to female ratio 1.14:1 and median age was 59 years. The median age among AFP was 39 years. Among AFP as well as veterans, Head and Neck cancer was the most common malignancy. Cancer incidence was significantly higher in adults >40 years as compared to <40 years. Conclusion: Seven percent rise per year of new cases in this cohort is alarming. Tobacco-related cancers were the most common. There is an unmet need to establish a prospective centralized Cancer Registry to better understand the risk factors, outcomes of treatment and strengthen the policy matters.

A prospective study of 'circumferential purse-string approximation' vs. primary linear skin closure in stoma reversal.

Introduction: surgical site infection (SSI) is one of the most common complications that can occur after stoma closure. To date, there is no consensus on the ideal closure technique of the stoma wound to minimize postoperative SSI and multiple techniques have been proposed. We performed this study to assess the clinical outcome of wound healing after 'Primary Linear Closure' (PC) and 'Circumferential Purse-String Approximation' (CPA) techniques. Methods: this prospective observational study included all patients admitted to our tertiary care center, fulfilling the inclusion criteria for elective stoma closure from 1st March 2018 to 1 March 2020 and prospective study was conducted on wound healing after stoma closure to compare difference in SSI rate between the PC group and the CPA group and to discuss the differences in patient satisfaction with wound healing. The following study was carried out with 36 patients in purse-string group and 66 patients in linear closure group. Results: surgical site infection (SSI) was observed only in primary linear closure group in 24% patients as opposed to 0% in purse string closure group. (p=0.039). Although the mean healing time of wound in linear closure group was significantly less than the purse string group (10.76 ± 5.68 days and 14.17 ± 2.04 days respectively), the overall total satisfaction score was higher in the purse string group. The purse string closure group showed significantly higher satisfaction score for expectations regarding appearance of scar/cosmesis, level of postoperative pain and difficulty of wound care (p>0.05). Conclusion: in our study, 'Circumferential Purse-String Approximation' is a superior technique than Primary Linear Closure for Stoma reversal in terms of rate of SSI and better overall patient satisfaction. CPA is a good alternative option, but further prospective randomized trials involving more patients are necessary before a definitive conclusion can be drawn.

Clinical Diagnosis, Management and Microbiological Profiling of Necrotizing Soft Tissue Infections - A Prospective Study of North India Region.

Background: Necrotizing Soft Tissue Infections (NSTIs) are rapidly progressive, potentially fatal illnesses characterized by necrosis of soft tissue. The disease is highly lethal if left untreated. However, its early diagnosis and management can result in significant decrease in mortality, saving the life of patient and preventing limb loss ; but its diagnosis in early stage is difficult. Therefore, the present work describes a step-by-step protocol for early diagnosis of NSTIs and its application for successful management of NSTIs (type III) in the North Indian population. Methods: This prospective study was conducted over a period of 1 year and 9 months (December 2017 to September, 2019) in a single tertiary center (Dayanand Medical College and Hospital, Ludhiana, Punjab, India) with 115 patients suffering from NSTIs. Demographic, symptomatic and clinical features were recorded. After initial resuscitation, debridement or amputation was done and collected samples were subjected to microbial profiling and drug sensitivity tests. Based on results, suitable pharmacological treatment was started to minimize the risk of mortality and fasten the recovery of patient. Results: The present work showed that in the selected population, monomicrobial gram negative infections are more prominent, more so, among diabetic males. The most prominent pathogen was found to be "Escherichia coli" (40% of cases). Enrolled patients had NSTIs in stage 1 and had no blood infection which means they sought medical attention in the early stages of the disease and the clinician was able to detect it. Debridement or amputation resulted in a significant decrease in the mortality rate (10.4%) even when the selected population had lethal Type III NSTIs. Conclusion: The presented approach can aid in early detection and management of NSTIs, thus, helping in saving patient's life and limb.

Citrullinemia, a rare cause of recurring encephalopathy.

An infant presented with recurrent episodes of encephalopathy, responding to nonspecific management of sepsis. High index of suspicion helped uncover underlying error of metabolism.

Evaluation of muscle strain injury severity in active human body models.

Even though significant efforts in the field of injury detection with finite element active human body models (FE AHBMs) have been made, injuries of the muscle-tendon unit (MTU) have not yet been taken into consideration. Therefore, the goal of this study was to define a muscle strain injury criterion (MSIC) to evaluate the damage sustained by the musculature during muscle driven movement scenarios. The MSIC was derived from biomechanical tests found in the literature and the proposed threshold values were substantiated through a comparison to an estimate of the ultimate tensile strength of human skeletal muscle and the forces acting on the biceps femoris long head muscle during one sprinting gait cycle. The application of the MSIC to state-of-the-art FE AHBMs was demonstrated by evaluating the strain injury severity of selected neck muscles of a full-body AHBM during two seat rotation load cases. The results of the MSIC substantiation suggest that all three injury threshold values proposed in this work fall in a plausible corridor of forces acting on the MTU. The combined results of the AHBM simulations indicate that neither of the two examined seat rotations are likely to cause strain injury to the neck muscles and that the proposed MSIC can easily be applied to current AHBMs without further modification of the model architecture or the muscle parameters. The MSIC was also used to formulate a hypothesis on the aetiology of muscle strain injuries, through which it was demonstrated that material inhomogeneities in the MTU might be the cause for strain injuries sustained during otherwise physiological movements. This work is a first step in the direction of the definition of a wholistic injury criterion for the human skeletal muscle fibre.

Video-Assisted Thoracoscopic Surgery (VATS) for Spontaneous Pneumothorax and Emphysematous Bullous Lung Disease: A Study From Northern India.

INTRODUCTION: Bullous lung disease is the most common cause of spontaneous pneumothorax. The management of the same is primarily surgical, aiming at the bullectomy, which was earlier performed by standard postero-lateral thoracotomy. The last two decades have seen more frequent use of video-assisted thoracoscopic surgery (VATS) for the same and has been shown to be a low morbidity, efficacious, and cost-effective method. In this study we assess the role of VATS in the spectrum of bullous lung disease. METHOD: The study was conducted in the Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, for a period of three years from January 1, 2016 to December 31, 2019 in which patients with bullous lung diseases were enrolled and the role of video-assisted thoracoscopic surgery was assessed in them. RESULTS: The study included a total of 75 patients who were managed operatively either by VATS or open thoracotomy. In the study group, the average age of patients was 35.6 years (range 16-68 years). The most common presentation was only bullous lung disease (BLD) in 40% of patients followed by 32% of patients having both BLD and broncho-pleural fistula (BPF). Apical segmentectomy/non-anatomical wedge resection was done in 36% of patients whereas VATS bullectomy was done in 36% of patients. Elective conversion to thoracotomy was planned in six patients because of dense adhesions and thick pleural peel. We performed pleurodesis in almost all cases (96%). Mean blood loss in the VATS procedure was 48.7 ml and mean operative time was 67.2 minutes. Mean duration of hospital stay was 4.8 days. Forced expiratory volume (FEV1) increased significantly from a mean of 65.80% to 77.60%. There was significant increase in forced vital capacity (FVC) mean from 70.30% to 79.50%. CONCLUSION: VATS can be used as a safe, feasible and effective procedure in patients presenting with spontaneous pneumothorax and bullous lung disease with or without a broncho-pleural fistula or parenchymal leak. It should be preferred over the traditional open thoracotomy procedure, whenever feasible to do so, in view of decreased perioperative morbidity and better functional outcome.

The Safety and Long-Term Efficacy of Carotid Artery Stenting: An All-Comers Registry.

Background Carotid artery stenting (CAS) has emerged as a less invasive alternative to carotid endarterectomy (CEA) for the prevention of future cerebrovascular events in patients with carotid artery stenosis. Despite multiple randomized controlled trials (RCTs) comparing CAS and CEA for carotid disease, real-world data outside the rigorous environment of trials is scarce. Methods The present study is a prospective observational study conducted at a tertiary care center, wherein all patients who underwent CAS between January 2007 and December 2019 were included. All patients were followed up for one year of the last enrolled patient at an interval of one, six, and 12 months and then yearly thereafter. The primary composite outcome was defined as a combination of periprocedural (until 30 days of procedure) major adverse cardiac and cerebrovascular events (MACCEs) and the long-term incidence of ipsilateral stroke. The secondary outcome included the rate of restenosis. Results A total of 115 patients (86 males and 29 females) (147 lesions) who underwent CAS between 2007 and 2019 were followed up for a median of 80.5 months. Seventy-seven (67.27%) patients were symptomatic, and 38/115 (33%) were asymptomatic. Periprocedural MACCEs were noted in six patients, and four patients had ipsilateral stroke on long-term follow-up; hence, the primary composite outcome was observed in 10 (8.7%) patients. Higher age was found to be significantly associated with the primary composite outcome (p-value = 0.005). Five (4.34%) patients were lost to follow-up, while four (3.48%) patients developed restenosis. Conclusion CAS is a safe and less invasive intervention in patients with significant carotid artery stenosis and is equally effective in preventing future strokes. The incidence of primary outcome rises with an increase in age.

Coil assisted glue embolization to improve safety and accuracy in endovascular management of Vein of Galen patients.

BACKGROUND: Vein of Galen malformation (VOGM) patients present in neonatal age with cardiac failure or significant neurologic consequences. The most established method of treatment has been transarterial embolization with high concentration glue (N-Butyl Cyano Acrylate) which may be difficult to control due to very high flow rates and may migrate to the venous side with undesirable consequences. We describe our experience in four patients in whom initial coil placement in prominent feeding arteries helped inflow reduction thereby facilitating controlled glue injection with a good result and no incidence of non-target embolization. MATERIALS AND METHODS: Four neonates who had presented during the last three years with cardiac failure were included in the study. Prominent feeders identified on imaging or DSA were treated with transarterial helical coil placement in the terminal segment just before the VOGM sac followed by controlled glue injection. The outcome was assessed by detailed clinical and imaging follow-up. RESULTS: A total of 10 most prominent feeders were embolized in four patients. Complete embolization of the VOGM was achieved in two patients in a single session. One patient with residual small feeders showed subsequent thrombosis of these feeders, possibly secondary to flow reduction in the sac. One patient still shows thin residual feeders but good clinical improvement and is being planned for follow-up and a second session at one year of age. No complications were observed. All patients showed immediate improvement in cardiac failure and good neurological development on follow-up. On imaging, the VOGM sac regressed completely (3 patients) or significantly in size (1 patient). CONCLUSION: Planned coil placement in the terminal part of prominent feeding arteries reduced the flow and provided lattice on which glue deposits in a controlled manner without any incidence of non-target embolization in our study. This relatively less described technique increases the safety and accuracy of the endovascular treatment in VOGM patients.

Gastropleural Fistula in a Child with Acute Lymphoblastic Leukemia Due to Perforated Gastric Ulcer.

Gastropleural fistula (GPF) is a pathological communication between stomach and pleural cavity. GPF is described rarely in adults following bariatric surgery, iatrogenic perforations, complicated empyema thoracis, penetrating chest trauma, perforated malignant gastric ulcers, and invasive tumors. GPF in children is extremely rare. The authors describe a female child with leukemia, who presented with left-sided pneumonia and chylothorax. After a delay of around 3 wk she was diagnosed with GPF, which was due to a perforated gastric ulcer induced by high-dose steroids which she was receiving as chemotherapy. She was managed with repair of GPF and had a favorable outcome.

Selecting the Appropriate First-Line Strategy Based on Hyperdense Vessel Sign in Acute Ischemic Stroke Increases First Pass Recanalization: A Tertiary Center Experience.

Background: The data pertaining to selecting an optimal first-line strategy (stent retriever [SR] vs. contact aspiration [CA]) based on noncontrast computed tomography (NCCT) in cases of acute ischemic stroke consequent to large vessel occlusion (LVO) is lacking. Aims: This article studies the influence of hyperdense vessel sign (HVS) in selecting optimal first-line strategy, with intention of increasing first-pass recanalization (FPR). Methods: Upfront approach at our center is SR technique with rescue therapy (CA) adoption consequent to three failed SR attempts to achieve successful recanalization. Data of patients with acute LVO who underwent mechanical thrombectomy from June 2017 to May 2020 was retrospectively analyzed. Patients were classified into HVS (+) and HVS (-) cohort. Rate of successful recanalization (first pass, early, and final) and efficacy of rescue therapy was assessed between the two cohorts. Results: Of 52 patients included, 28 and 24 were assigned to the HVS (+) and HVS (-) cohort, respectively. FPR was observed in 50% of HVS (+) and 20.9% of HVS (-) ( p = 0.029). Early recanalization was documented in 64.2% of HVS (+) and 37.5% of HVS (-) ( p = 0.054). Rescue therapy need was higher in patients not demonstrating HVS ( p = 0.062). Successful recanalization was achieved with rescue therapy in 50% of HVS (-) group. Conclusion: A higher FPR is achievable following individualized first-pass strategy (based on NCCT appearance of clot), instead of a generalized SR first-pass approach. This CT imaging-based strategy is a step closer to achieving primary angiographic goal of FPR.