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A search is presented for baryon number violating interactions in top quark production and decay. The analysis uses data from proton-proton collisions at a center-of-mass energy of 13 TeV, collected with the CMS detector at the LHC with an integrated luminosity of 138 fb^{-1}. Candidate events are selected by requiring two oppositely charged leptons (electrons or muons) and exactly one jet identified as originating from a bottom quark. Multivariate discriminants are used to separate the signal from the background. No significant deviation from the standard model prediction is observed. Upper limits are placed on the strength of baryon number violating couplings. For the first time the production of single top quarks via baryon number violating interactions is studied. This allows the search to set the most stringent constraints to date on the branching fraction of the top quark decay to a lepton, an up-type quark (u or c), and a down-type quark (d, s, or b). The results improve the previous bounds by 3 to 6 orders of magnitude based on the fermion flavor combination of the baryon number violating interactions.
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Covid-19 was first detected on 8th March of 2020 in Bangladesh after the global pandemic being started. As a new virus and disease there are scarcity of data of SARS-CoV-2 and Covid-19 respectively in our country. Aim of this study is to assess the demographic characteristics, clinical profiles, underlying co-morbid conditions, treatment pattern and outcome of the SARS-CoV-2 positive patients in Jashore, Bangladesh. This retrospective study recruited 208 RT-PCR positive Covid-19 patients from 1st April 2020 to 15th May 2020 who appeared at Flu corner centre, 250 Bedded General Hospital, Jashore, Bangladesh. Data was collected online through telephone, mobile and email due to the high contagious property of Covid-19. Out of total 208 Covid-19 patients, the mean age of the participants was 37.0±15.0 years with a male and female ratio of 2.06:1. Underlying comorbidities were documented in 36.5% of total Covid-19 patents of which hypertension in 16.3%, diabetes in 14.4%, respiratory diseases in 8.7% and pre-existing coronary arterial diseases in 6.3% patients. Though 17.8% Covid-19 patients were asymptomatic, the most common symptoms were fever (68.8%), cough (30.8%), myalgia (30.8%), sore throat (22.1%), vertigo (21.6%), respiratory distress (20.7%), anorexia (17.8%), nasal congestion (16.3%), nausea or vomiting (13.9%) and diarrhoea (13.0%). Whereas, the symptomatic patients were classified as flu-like illness (77.9%), mild to moderate pneumonia (2.4%) and severe pneumonia (1.9%). Many patients (19.2%) recovered spontaneously and 22.1% patients cured by the only simple symptomatic treatment. The most commonly received antibiotics were Azithromycin and Doxycycline. Home stay management was demonstrated in 73.1% patients, whereas, 26.0% patients required general ward admission and only 0.9% patients required referral for the HDU or ICU management with an average duration of hospital stay of 16±6 days. A high satisfactory outcome was found as evident by complete recovery in 98.08% of Covid-19 patients, complications (0.48%) and fatality (1.44%) even in this secondary care center. Therefore, we can conclude that the disease was well managed with highly satisfactory outcomes even in the low resource health care setting in the early stage of Covid-19 pandemic era. Hence, the early case detection, identification of the high-risk groups and proper management may mitigate to develop complications and fatalities of Covid-19.
Subject(s)
COVID-19 , Humans , Male , Female , Young Adult , Adult , Middle Aged , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Retrospective Studies , Pandemics , Bangladesh/epidemiology , Secondary Care , HospitalsABSTRACT
ABSTRACT: A femoral hernia is an uncommon and acquired hernia in the groin. Its incidence in adults is 2%-8% of all abdominal wall hernias, and it has a female-to-male ratio of 1.8:1. It is usually found in elderly patients and is associated with increased morbidity due to delays in diagnosis leading to a high incidence of incarceration and strangulation. Accurate preoperative diagnosis of femoral hernia is challenging, especially in obese patients in whom a small femoral hernia can be hidden under the groin fat. Unlike an inguinal hernia, it rarely reduces on its own and if asymptomatic and small, is often unnoticed by the elderly obese patient. Femoral hernia is often unsuspected and overlooked in males as it is predominant among females. Delay in diagnosis can lead to intestinal gangrene and high morbidity. We present a case of an incarcerated left femoral hernia in an elderly obese male who presented with acute intestinal obstruction. He was managed with resection of the gangrenous segment and double barrel ileostomy. Although uncommon in males, a femoral hernia has a high incidence of strangulation, and therefore should always be ruled out as a cause of acute intestinal obstruction in elderly patients. Therefore, never forget to examine the groin in case of intestinal obstruction.
Subject(s)
Hernia, Femoral , Intestinal Obstruction , Humans , Hernia, Femoral/surgery , Hernia, Femoral/diagnosis , Hernia, Femoral/complications , Male , Intestinal Obstruction/etiology , Intestinal Obstruction/diagnosis , Intestinal Obstruction/surgery , Aged , Tomography, X-Ray Computed , Obesity/complications , Gangrene/diagnosis , Gangrene/surgery , Diagnosis, DifferentialABSTRACT
Functional constipation (FC) is a common condition in childhood in the United Kingdom and worldwide. Various radiological approaches have been established for diagnostic purposes. The radiopaque marker study (ROMS) is universally accepted and used to assess colonic transit time (CTT) in children with FC. Despite being widely used, there is a lack of standardization with various technical protocols, reproducibility of different populations, the purpose for using investigation, variance in the number of markers used, the amount of study days and calculations, the need to empty the colon before performing the test, and whether to perform on medication or off, or the use of specific diets. As part of the British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) motility working group (MWG), we decided to explore further into the evidence, in order to provide guidance regarding the use of ROMS in dealing with FC in the pediatric population.
Subject(s)
Colon , Constipation , Gastrointestinal Transit , Child , Humans , Colon/diagnostic imaging , Consensus , Constipation/diagnostic imaging , Constipation/physiopathology , Gastrointestinal Motility/physiology , Gastrointestinal Transit/physiologyABSTRACT
Interferon regulatory factor 8 (IRF8), a transcription factor expressed in immune cells, functions as a negative regulator of osteoclasts and helps maintain dental and skeletal homeostasis. Previously, we reported that a novel mutation in the IRF8 gene increases susceptibility to multiple idiopathic cervical root resorption (MICRR), a form of tooth root resorption mediated by increased osteoclast activity. The IRF8 G388S variant in the highly conserved C-terminal motif is predicted to alter the protein structure, likely impairing IRF8 function. To investigate the molecular basis of MICRR and IRF8 function in osteoclastogenesis, we generated Irf8 knock-in (KI) mice using CRISPR/Cas9 technique modeling the human IRF8G388S mutation. The heterozygous (Het) and homozygous (Homo) Irf8 KI mice showed no gross morphological defects, and the development of hematopoietic cells was unaffected and similar to wild-type (WT) mice. The Irf8 KI Het and Homo mice showed no difference in macrophage gene signatures important for antimicrobial defenses and inflammatory cytokine production. Consistent with the phenotype observed in MICRR patients, Irf8 KI Het and Homo mice demonstrated significantly increased osteoclast formation and resorption activity in vivo and in vitro when compared to WT mice. The oral ligature-inserted Het and Homo mice displayed significantly increased root resorption and osteoclast-mediated alveolar bone loss compared to WT mice. The increased osteoclastogenesis noted in KI mice is due to the inability of IRF8G388S mutation to inhibit NFATc1-dependent transcriptional activation and downstream osteoclast specific transcripts, as well as its impact on autophagy-related pathways of osteoclast differentiation. This translational study delineates the IRF8 domain important for osteoclast function and provides novel insights into the IRF8 mutation associated with MICRR. IRF8G388S mutation mainly affects osteoclastogenesis while sparing immune cell development and function. These insights extend beyond oral health and significantly advance our understanding of skeletal disorders mediated by increased osteoclast activity and IRF8's role in osteoclastogenesis.
Subject(s)
Bone Resorption , Interferon Regulatory Factors , Root Resorption , Animals , Humans , Mice , Bone Resorption/genetics , Bone Resorption/metabolism , Cell Differentiation , Interferon Regulatory Factors/genetics , Interferon Regulatory Factors/metabolism , Mutation , NFATC Transcription Factors/genetics , Osteoclasts/metabolism , RANK Ligand/metabolism , Root Resorption/genetics , Root Resorption/metabolismABSTRACT
Mineral francisites Cu3Bi(SeO3)2O2Cl are unique compounds with interesting quasi two-dimensional structure along with fascinating magnetic properties. The magnetic properties can be fine-tuned when non-magnetic Bi is replaced by a suitable rare earth (RE) metal. It is because of the inclusion of additional magnetic sub-centre RE apart from Cu. Temperature dependent Raman spectroscopy measurements in RE based francisites [Cu3RE(SeO3)2O2Cl, shortly RECufr] were performed in the range of 11 K-295 K. Among the three studied RECufr (LaCufr, NdCufr, and DyCufr) compounds, the properties of phonon vibration vary from moderate (in DyCufr) to weak (in LaCufr) spin phonon coupled and the absence of spin phonon coupling (SPC) (i.e. strictly anharmonic in nature) was observed in NdCufr and the reason for this observation has been provided. More specifically, two Raman-active phonons soften below the antiferromagnetic ordering temperature ofTN≈ 39 K in DyCufr compound, indicating the existence of moderate SPC. This trend of phonon vibration is correlated with magnetic properties, particularly field induced metamagnetic transition (MMT). Strong MMT enabled DyCufr develops SPC, while weak MMT enabled NdCufr is unable to develop SPC.
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Bacterial infections are a major cause of mortality in preterm babies, yet our understanding of early-life disease-associated immune dysregulation remains limited. Here, we combine multi-parameter flow cytometry, single-cell RNA sequencing and plasma analysis to longitudinally profile blood from very preterm babies (<32 weeks gestation) across episodes of invasive bacterial infection (sepsis). We identify a dynamically changing blood immune signature of sepsis, including lymphopenia, reduced dendritic cell frequencies and myeloid cell HLA-DR expression, which characterizes sepsis even when the common clinical marker of inflammation, C-reactive protein, is not elevated. Furthermore, single-cell RNA sequencing identifies upregulation of amphiregulin in leukocyte populations during sepsis, which we validate as a plasma analyte that correlates with clinical signs of disease, even when C-reactive protein is normal. This study provides insights into immune pathways associated with early-life sepsis and identifies immune analytes as potential diagnostic adjuncts to standard tests to guide targeted antibiotic prescribing.
Subject(s)
C-Reactive Protein , Sepsis , Infant , Infant, Newborn , Humans , Infant, Extremely Premature , Sepsis/diagnosis , Plasma , Anti-Bacterial AgentsABSTRACT
The polarization of Λ and Λ[over ¯] hyperons along the beam direction has been measured relative to the second and third harmonic event planes in isobar Ru+Ru and Zr+Zr collisions at sqrt[s_{NN}]=200 GeV. This is the first experimental evidence of the hyperon polarization by the triangular flow originating from the initial density fluctuations. The amplitudes of the sine modulation for the second and third harmonic results are comparable in magnitude, increase from central to peripheral collisions, and show a mild p_{T} dependence. The azimuthal angle dependence of the polarization follows the vorticity pattern expected due to elliptic and triangular anisotropic flow, and qualitatively disagrees with most hydrodynamic model calculations based on thermal vorticity and shear induced contributions. The model results based on one of existing implementations of the shear contribution lead to a correct azimuthal angle dependence, but predict centrality and p_{T} dependence that still disagree with experimental measurements. Thus, our results provide stringent constraints on the thermal vorticity and shear-induced contributions to hyperon polarization. Comparison to previous measurements at RHIC and the LHC for the second-order harmonic results shows little dependence on the collision system size and collision energy.
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BACKGROUND: A common and debilitating complication of low anterior resection for rectal cancer is low anterior resection syndrome (LARS). As a multifactorial entity, LARS is poorly understood and challenging to treat. Despite this, prevention strategies are commonly overlooked. Our aim was to review the pathophysiology of LARS and explore current evidence on the efficacy and feasibility of prophylactic techniques. METHODS: A literature review was performed between [1st January 2000 to 1st October 2023] for studies which investigated preventative interventions for LARS. Mechanisms by which LARS develop are described, followed by a review of prophylactic strategies to prevent LARS. Medline, Cochrane, and PubMed databases were searched, 189 articles screened, 8 duplicates removed and 18 studies reviewed. RESULTS: Colonic dysmotility, anal sphincter dysfunction and neorectal dysfunction all contribute to the development of LARS, with the complex mechanism of defecation interrupted by surgery. Transanal irrigation (TAI) and pelvic floor rehabilitation (PFR) have shown benefits in preventing LARS, but may be limited by patient compliance. Intraoperative nerve monitoring (IONM) and robotic-assisted surgery have shown some promise in surgically preventing LARS. Nerve stimulation and other novel strategies currently used in treatment of LARS have yet to be investigated in their roles prophylactically. CONCLUSIONS: To date, there is a limited evidence base for all preventative strategies including IONM, RAS, PFP and TAI. These strategies are limited by either access (IONM, RAS and PFP) or acceptability (PFP and TAI), which are both key to the success of any intervention. The results of ongoing trials will serve to assess acceptability, while technological advancement may improve access to some of the aforementioned strategies.
Subject(s)
Rectal Neoplasms , Robotic Surgical Procedures , Humans , Anal Canal/surgery , Low Anterior Resection Syndrome , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Quality of Life , Rectal Neoplasms/surgery , Rectal Neoplasms/complications , Robotic Surgical Procedures/adverse effectsABSTRACT
Cervical cancer is the fourth most common cancer in women in the world and is the second leading malignancy among Bangladeshi women. Persistent infection with high risk human papillomavirus (HPV) is an important cause of development of cervical intraepithelial neoplasia (CIN) followed by cancer. Bacterial vaginosis (BV), a common treatable vaginal infection which can disrupt the balanced vaginal ecosystem and its innate protective mechanisms against infection, can play an essential role in the acquisition and persistence of high risk human papillomavirus (HR-HPV) infection. This cross sectional study was conducted to detect the HR-HPV (HPV-16 and HPV-18) infection among bacterial vaginosis positive patient in the Department of Microbiology, Mymensingh Medical College (MMC), Bangladesh, from March 2018 to February 2019. A total of 300 endocervical swabs and high vaginal swabs were collected from the VIA (Visual inspection with acetic acid) outdoor clinic of Obstetrics and Gynaecology Department of Mymensingh Medical college Hospital. HPV DNA was tested among all 300 cases by nested PCR. Typing of HPV 16 and HPV 18 was done among HPV DNA positive cases with BV and intermediate flora by multiplex PCR. BV was diagnosed according to Nugent criteria by using the gram stained smear of high vaginal swab. A total of 57/300 (19.0%) samples were positive for HPV DNA by nested PCR. Of the total 300 cases 78(26.0%) had BV, 38(13.0%) had intermediate flora and 184(61.0%) had normal vaginal flora. HPV DNA was more positive in patients having intermediate flora 08/38 (21.05%) followed by the patients having normal vaginal flora 37/184 (20.11%) and BV 12/78 (15.38%). Among the 12 BV patients who were also HPV DNA positive (83.33%) were belong to high risk HPV (type 16 and 18) group and among them 08(66.67%) were HPV-16 and 02(16.67%) were HPV-18. But among 08 HPV DNA positive intermediate flora containing patients only 01(12.5%) were belong to HR-HPV (type 16 and no type 18 was detected).
Subject(s)
Papillomavirus Infections , Uterine Cervical Neoplasms , Vaginosis, Bacterial , Female , Humans , Pregnancy , Cross-Sectional Studies , Human papillomavirus 16/genetics , Human papillomavirus 18/genetics , Human Papillomavirus Viruses , Papillomaviridae/genetics , Papillomavirus Infections/diagnosis , Tertiary Care Centers , Uterine Cervical Neoplasms/diagnosisABSTRACT
OBJECTIVES: To determine the relationship between Food Environment Index (FEI) and Preterm Birth (PTB) rate at the county level of the United States of America (USA) (primary), while evaluating the interaction of multiple factors within a framework of sociodemographic, maternal health, maternal behavioral, and environmental factors. METHODS: This is a population-based retrospective cohort ecological study from 2015-2018. The study compares the characteristics of the population of the counties of the USA. All counties with complete data on their PTB rate and the independent variables were included in the study. Independent variables with greater than 20% missing data were excluded from the study. Purposive sampling technique was applied. A total of 2983/3142 counties were included in the study. RESULTS: The median PTB rate of all counties was 9.90%. The highest PTB rate (23.3%) was in Tallapoosa County, Alabama and the lowest (3.4%) in San Juan County, Washington State. After adjusting for variables, PTB rate had a significant association with FEI (coefficient of correlation - 0.36, pâ<â0.01, 95% CI - 0.19 to - 0.04). Increase in the rate of unemployment, African American race, adult smoking, obesity, uninsured rate, sexually transmitted diseases (STD), high school education and air pollution was associated with an increase in PTB rate, while an increase in FEI and alcohol abuse rates was associated with a decrease in PTB rate. CONCLUSIONS: FEI can predict the PTB rate in USA counties after adjusting for sociodemographic, health, behavioral and environmental factors. Future studies are needed to confirm these associations and consider them when making policies to reduce PTBs.
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Moyna of Purba Medinipur district is widely known as an aquaculture hub of West Bengal, India. Though very good production is achievable from this fish culture system, management practices are inappropriate, which could create the sustainability problem of this culture system. The present study was thus undertaken for the estimation of plankton population, water quality, carbon footprint and carbon sequestration of this intensive aquaculture practices. Information on spawn to fry, fry to fingerlings and grow-out culture were collected through the structured questionnaire from the fish farmers. The plankton density, primary productivity, carbon footprint and carbon sequestration were analyzed using standard procedures. The phytoplankton, zooplankton and primary productivity were maximum at the stocking period and minimum during the middle of culture period. The lowest feed conversion ratio (FCR) was noticed with the minimum amount of feed applied in the pond. The CO2-e emission ranged from 0.56 to 4.89 kg CO2-e/kg fish (av. 2.13) for the production levels of 5.0 to 10.7 t/ha/yr. The pond water developed salinity and ammonium-N increased from 0.01 to 0.50 mg/l. The ponds with high feed loading (28 to 32 t/ha/yr) had the highest average sediment accumulation rate (11.0 ± 3.0 cm/yr) and carbon sequestration (704 ± 30 g C/m2/yr).
Subject(s)
Carbon Footprint , Carbon Sequestration , Animals , Carbon Dioxide , Aquaculture , India , PlanktonABSTRACT
Low-dimensional quantum spin ½ system Cu2V2O7has been investigated in the framework of Mn-substitution at the Cu site, which is really un-investigated. The studied compounds Cu2 -xMnxV2O7(x= 0, 0.05, 0.1 and 0.15) have been synthesized and characterized structurally, spectroscopically, local structurally and magnetically via x-ray diffraction, Raman, x-ray absorption and temperature, field dependent magnetization measurements respectively. Although Cu2V2O7can be found inα, ßandγ-phase, however all of the studied compounds are found in single orthorhombicα-phase which has crucial magneto-electric application potential. Temperature dependent Raman spectra indicated anharmonic phonon-phonon scattering but there is no spin-phonon coupling for VO4vibrational modes. The local structure probed via x-ray absorption near edge structure and extended x-ray absorption fine structure spectroscopy at 15 K, 300 K indicates Cu2+, V5+and mixed valent Mn2+and Mn3+ionic states and justified local structure for the probed ions. Magnetic measurements indicate long-range antiferromagnetic ordering with doping independent Neel temperature (32.5 K). Further observations are strong magnetic hysteresis at 5 K (due to canted spin structure), zero field exchange-bias and their noteworthy enhancement upon Mn-substitution. Interesting correlation between structural parameters and magnetic exchanges has been developed.
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The elliptic (v_{2}) and triangular (v_{3}) azimuthal anisotropy coefficients in central ^{3}He+Au, d+Au, and p+Au collisions at sqrt[s_{NN}]=200 GeV are measured as a function of transverse momentum (p_{T}) at midrapidity (|η|<0.9), via the azimuthal angular correlation between two particles both at |η|<0.9. While the v_{2}(p_{T}) values depend on the colliding systems, the v_{3}(p_{T}) values are system independent within the uncertainties, suggesting an influence on eccentricity from subnucleonic fluctuations in these small-sized systems. These results also provide stringent constraints for the hydrodynamic modeling of these systems.
Subject(s)
Hydrodynamics , Male , Humans , Anisotropy , MotionABSTRACT
We report here the first observation of directed flow (v_{1}) of the hypernuclei _{Λ}^{3}H and _{Λ}^{4}H in mid-central Au+Au collisions at sqrt[s_{NN}]=3 GeV at RHIC. These data are taken as part of the beam energy scan program carried out by the STAR experiment. From 165×10^{6} events in 5%-40% centrality, about 8400 _{Λ}^{3}H and 5200 _{Λ}^{4}H candidates are reconstructed through two- and three-body decay channels. We observe that these hypernuclei exhibit significant directed flow. Comparing to that of light nuclei, it is found that the midrapidity v_{1} slopes of _{Λ}^{3}H and _{Λ}^{4}H follow baryon number scaling, implying that the coalescence is the dominant mechanism for these hypernuclei production in the 3 GeV Au+Au collisions.
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We report the triton (t) production in midrapidity (|y|<0.5) Au+Au collisions at sqrt[s_{NN}]=7.7-200 GeV measured by the STAR experiment from the first phase of the beam energy scan at the Relativistic Heavy Ion Collider. The nuclear compound yield ratio (N_{t}×N_{p}/N_{d}^{2}), which is predicted to be sensitive to the fluctuation of local neutron density, is observed to decrease monotonically with increasing charged-particle multiplicity (dN_{ch}/dη) and follows a scaling behavior. The dN_{ch}/dη dependence of the yield ratio is compared to calculations from coalescence and thermal models. Enhancements in the yield ratios relative to the coalescence baseline are observed in the 0%-10% most central collisions at 19.6 and 27 GeV, with a significance of 2.3σ and 3.4σ, respectively, giving a combined significance of 4.1σ. The enhancements are not observed in peripheral collisions or model calculations without critical fluctuation, and decreases with a smaller p_{T} acceptance. The physics implications of these results on the QCD phase structure and the production mechanism of light nuclei in heavy-ion collisions are discussed.
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We report the beam energy and collision centrality dependence of fifth and sixth order cumulants (C_{5}, C_{6}) and factorial cumulants (κ_{5}, κ_{6}) of net-proton and proton number distributions, from center-of-mass energy (sqrt[s_{NN}]) 3 GeV to 200 GeV Au+Au collisions at RHIC. Cumulant ratios of net-proton (taken as proxy for net-baryon) distributions generally follow the hierarchy expected from QCD thermodynamics, except for the case of collisions at 3 GeV. The measured values of C_{6}/C_{2} for 0%-40% centrality collisions show progressively negative trend with decreasing energy, while it is positive for the lowest energy studied. These observed negative signs are consistent with QCD calculations (for baryon chemical potential, µ_{B}≤110 MeV) which contains the crossover transition range. In addition, for energies above 7.7 GeV, the measured proton κ_{n}, within uncertainties, does not support the two-component (Poisson+binomial) shape of proton number distributions that would be expected from a first-order phase transition. Taken in combination, the hyperorder proton number fluctuations suggest that the structure of QCD matter at high baryon density, µ_{B}â¼750 MeV at sqrt[s_{NN}]=3 GeV is starkly different from those at vanishing µ_{B}â¼24 MeV at sqrt[s_{NN}]=200 GeV and higher collision energies.
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We report on measurements of sequential Ï suppression in Au+Au collisions at sqrt[s_{NN}]=200 GeV with the STAR detector at the Relativistic Heavy Ion Collider (RHIC) through both the dielectron and dimuon decay channels. In the 0%-60% centrality class, the nuclear modification factors (R_{AA}), which quantify the level of yield suppression in heavy-ion collisions compared to p+p collisions, for Ï(1S) and Ï(2S) are 0.40±0.03(stat)±0.03(sys)±0.09(norm) and 0.26±0.08(stat)±0.02(sys)±0.06(norm), respectively, while the upper limit of the Ï(3S) R_{AA} is 0.17 at a 95% confidence level. This provides experimental evidence that the Ï(3S) is significantly more suppressed than the Ï(1S) at RHIC. The level of suppression for Ï(1S) is comparable to that observed at the much higher collision energy at the Large Hadron Collider. These results point to the creation of a medium at RHIC whose temperature is sufficiently high to strongly suppress excited Ï states.
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BACKGROUND: Accurate preoperative localisation of parathyroid adenoma is imperative for the success of minimally invasive parathyroidectomy (MIP). OBJECTIVE: Our study aimed to evaluate the role of four-dimensional computer tomography (4D-CT) scan as an imaging modality in patients with failed and discordant localisation reported in the first-line imaging modalities (ultrasonography and 99mTc-MIBI-SPECT/CT). METHODS: This is a prospective cohort study performed at a university teaching centre from March 2013 to July 2021. All patients with primary hyperparathyroidism who had failed localisation by ultrasonography and 99mTc-MIBI-SPECT/CT (SpCT), or discordance between them, had 4D-CT performed in this study. RESULTS: One hundred and two sporadic cases of pHPT with failed/discordant first-line imaging had 4D-CT imaging prior to parathyroidectomy. In 102 patients, 105 parathyroid adenomas were reported on histopathology. 4D-CT was able to localise 78% of them to the correct side and 64% to the correct quadrant in 102 patients, as compared with US (correct side 21%, correct quadrant 16%) and 99mTc-MIBI-SPECT/CT (correct side 36%, correct quadrant 31%). 4D-CT had a sensitivity, precision, accuracy and F1 score for correct quadrant localisation as 79%, 81%, 66% and 80%; and for correct side localisation as 82%, 98%, 80% and 89%, respectively. 4D-CT was able to identify three ectopic adenomas (two in superior mediastinum and one in the oesophageal wall) which were not detected on US or SpCT. CONCLUSION: 4D-CT was found to be sensitive and accurate in preoperative localising of the diseased parathyroid glands after failed/discordant US and SpCT. This led to more patients being offered MIP as the primary surgery and improved operative outcomes.
Subject(s)
Hyperparathyroidism, Primary , Parathyroid Neoplasms , Humans , Hyperparathyroidism, Primary/diagnostic imaging , Hyperparathyroidism, Primary/etiology , Hyperparathyroidism, Primary/surgery , Four-Dimensional Computed Tomography , Technetium Tc 99m Sestamibi , Prospective Studies , Parathyroid Glands/diagnostic imaging , Parathyroid Glands/surgery , Parathyroid Neoplasms/diagnostic imaging , Parathyroid Neoplasms/surgery , Parathyroidectomy , Ultrasonography , RadiopharmaceuticalsABSTRACT
PURPOSE: To identify the risk factors associated with the development of ocular surface exposure and severe visual impairment (SVI) in patients with facial nerve palsy (FNP). METHODS: Ocular data of all consecutive FNP patients (N = 1870) presenting to an eye-care network over the past 10 years were reviewed. Risk factors associated with SVI (best-corrected visual acuity <20/200) and ocular surface exposure at presentation were evaluated using multivariate analysis and odds ratios (OR). RESULTS: The prevalence of SVI was 15%, and 47% had ocular surface exposure at the first presentation. The presence of corneal scar (28% vs. 10.2%, p < .001; OR 3.05), corneal ulcer (12.9% vs. 2.3%, p < .001; OR 4.67), older age at presentation (p < .001; OR 1.02), >10 mm lagophthalmos (p < .001; OR 8.7), male sex, and duration of FNP (p = .021; OR 1) were independent risk factors for developing SVI. Of the 893 eyes with ocular surface exposure, 75 (3.9%) had a corneal ulcer, and 11 (0.6%) were perforated, with the rest having epithelial defects and punctate keratopathy. Patients with neoplastic etiology (15.9% vs. 5.7%; p < .001; OR 2.39), lagophthalmos (49% vs. 29.7%; p < .001; OR 2.25) and poor Bell's phenomenon (9.4% vs. 4.2%; p = .005; OR 1.8) had twofold risk for developing ocular surface exposure. CONCLUSION: Eyes with lagophthalmos, poor Bell's phenomenon, and FNP of neoplastic etiology have a higher risk of developing ocular surface exposure. Male sex, increasing age, longer duration of FNP, and >10 mm lagophthalmos are associated with SVI in FNP patients; hence, early and timely intervention is necessary.