Assessment Modalities for Lower Extremity Edema, Lymphedema, and Lipedema: A Scoping Review.

Lower extremity swelling may be broadly characterized as due to edema, lymphedema, or lipedema. Differentiation between these three conditions is important for providing appropriate treatment. This review analyzes and compares different clinical diagnostic modalities for these conditions, with the aim of assisting in the process of choosing the most appropriate diagnostic modality by highlighting the advantages and limitations of each. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for a systematic search of peer-reviewed literature, the following diagnostic methods for lower extremity swelling were investigated: (1) ultrasound (US), (2) lymphoscintigraphy (LSG), (3) computed tomography (CT), (4) bioimpedance spectroscopy (BIS), (5) tissue dielectric constant (TDC), and (6) magnetic resonance imaging (MRI), including magnetic resonance lymphangiography (MRL). The databases used in the search were PubMed, ProQuest, CINAHL Complete, Web of Science, Embase, and Biomedical Reference Collection. After retrieving 115 studies based on predetermined inclusion criteria, a total of 31 studies were critically evaluated. The main results indicate the following: duplex US is the modality of choice to initially identify lower extremity edema such as deep venous thrombosis (DVT) and venous reflux due to its high sensitivity and specificity. CT venography of the lower extremity appears to bethe preferred option for gynecologic cancer patients with lower extremity swelling post-treatment, as it measures subcutaneous tissue volumes to look for DVTs, lymphoceles, and cancer recurrence. TDC is a recommended modality for a variety of conditions, including edema and lymphedema, in part, due to its noninvasive localized assessment capabilities and ease of use. LSG emerges as an effective imaging modality for lymphedema characterization with minimal invasiveness and high sensitivity and specificity. BIS is widely used to identify and monitor lower extremity lymphedema but has been reported to have low sensitivity and lacks the ability to account for changes in tissue composition such as fibrosis. US and MRL are favored for lipedema diagnosis, with MRL providing comprehensive anatomical and functional insights, albeit with cost and accessibility limitations compared to US. While CT, MRI, US, and TDC are all useful for differentiating lymphedema from lipedema, MRI is the preferred modality due to its anatomical and functional diagnostic capabilities. However, US is a pragmatic alternative for use with obese patients or when MRI is not an option.

A Prospective Study on the Anatomical Variations of the Frontal Recess and its Association with Computer Tomographic Signs of Sinusitis.

The frontal recess region has a complex anatomy and HRCT scans of the paranasal sinuses (PNS) are the gold standard in evaluating it. Classification systems have been established to identify the frontal recess cells. The objectives of this study are to describe the incidence of anatomical variations, classify the anatomy of the frontal recess using the IFAC & Kuhn's classification systems, find the association between the anatomical variations and the incidence of CT signs of sinusitis. A prospective study of patients undergoing HRCT-PNS was carried out. The frontal recess region was evaluated and classified as per both classification systems. The prevalence of each frontal cell was identified; presence of CT signs of sinusitis was noted and the correlation between the two was evaluated. 272 sides of HRCT scans were evaluated. Prevalence of cells as per IFAC classification showed ANC - 98.2%, SAC-43.4%, SBC-33.1%, SAFC- 28.3%, FSC -25%, SBFC- 3.7% and SOEC- 2.2%. Prevalence of cells as per Kuhn's classification showed ANC - 98.2%, Type 1- 38.2%, SBC-32.7%, FSC -24.3%, Type 3- 16.9%, Type 2- 12.9%, Type 4- 4.8%, FBC- 2.6% and SOEC-2.2%. Sinusitis was seen in 27.2% cases. A significant association was noted between the presence of SOEC, FSC and sinusitis as per both classification systems. (P=0.049 and P<0.001 respectively). In conclusion the cells which lead to an anteriorly based drainage pathway are more common, but the presence of posteriorly based SOEC and medially based FSC have a higher association with sinusitis.

Mitigating probe pulse deformation in Raman amplification in OTDR fiber sensing systems.

We report the numerical and experimental study of probe pulse deformation in a forward-pumped distributed Raman amplifier on a 40-km standard single mode fiber. Distributed Raman amplification can improve the range of OTDR-based sensing systems, but it could result in pulse deformation. A smaller Raman gain coefficient can be used to mitigate pulse deformation. The sensing performance can still be maintained by compensating for the decrease in the Raman gain coefficient by increasing the pump power. The tunability of the Raman gain coefficient and pump power levels are predicted while keeping the probe power below the modulation instability limit.

Interlay Cartilage Rim Augmented Fascia Tympanoplasty: An Effective Graft Model in Mucosal Chronic Otitis Media.

To study the efficacy of interlay cartilage rim augmented fascia tympanoplasty in mucosal chronic otitis media. A retrospective, observational study was conducted in a tertiary care hospital including charts of patients spanning a duration of one year, where 15 patients diagnosed with chronic otitis media-mucosal disease with large and subtotal perforations (with or without ossicular erosion), and had undergone interlay cartilage rim augmented fascia tympanoplasty, were analysed for morphological and functional improvement following surgery. Pre- and post-operative otomicroscopic examination and pure tone audiometry findings were the parameters considered. 86.6% had a well-healed, non-retracted, undisplaced mobile neotympanum, 6.7% who underwent a type III (minor columella) tympanoplasty had a medialised neotympanum and 1 subject (6.7%) who underwent a type I tympanoplasty had a residual pinpoint perforation which healed with conservative management. The overall morphological success rate was 93.3%. The mean hearing gain following surgery was 20.84 dB with a minimum gain of 10 dB and a maximum gain of 30 dB. The mean air-bone gap closure gain achieved was 19.2 dB with a minimum gain of 6.4 dB and a maximum gain of 30 dB. The interlay cartilage-fascia rim augmentation tympanoplasty is a novel, effective graft model suggested for large and sub-total central perforations. Future randomized studies with a larger sample size could be performed with longer follow-up to assess the outcome of this technique.

Broadband air-clad LP02 mode converter using a tapered mode transition.

Higher-order mode converters that work over a broad wavelength range are needed for various applications. A new, to the best of our knowledge, simple and cost-effective LP02 mode converter is fabricated by tapering a bundle of single-mode fibers. The device excites the LP02 mode in a four-mode step index fiber with a mode purity higher than 10 dB. The polarization-dependent cross talk of the device is measured using the S2 technique. The LP02 mode selectivity of the device is measured over the entire C and L bands by selectively launching different modes into the device using a spatial light modulator.

Characterization of few mode fiber components and connected systems.

Methods for measurement of polarization dependent loss and cross talk of individual few mode fiber components and connected systems are presented. A new method for determining the cross talk of the individual components, from the measurements on the connected system is presented and verified through simulations and measurements. The method is based on Fourier analysis of the wavelength dependent interference of the loss of the system.

Starch modified alginate nanoparticles for drug delivery application.

Natural polymers have been widely studied as vehicles that have gained much interest in the encapsulation and delivery of drugs and bioactive molecules. In this study, we developed starch-modified alginate nanoparticles using a green facile technique for drug delivery application. The potential of the prepared nanoparticles for controlled drug delivery applications is demonstrated using theophylline and bovine serum albumin as model drugs. The nanoparticles possessed the encapsulation efficiency of 60 to 75%. The results of in vitro drug release studies showed the pH dependent characteristics of the prepared nanoparticles. In vitro cytotoxicity test revealed the biocompatibility of the developed nanoparticles against L929 fibroblast cell lines. The in vitro cellular uptake of nanoparticles was visualized in L929 fibroblast cells using fluorescent microscopy. The preliminary investigation suggests the developed nanoparticle is a promising candidate for drug delivery application.

Air-cladded mode-group selective photonic lanterns for mode-division multiplexing.

We have fabricated an air-cladded mode-group selective photonic lantern, which can (de)multiplex the first two mode groups of a standard two-mode step-index fiber. Instead of relying on a low-index capillary tube, our simple solution uses air to form the surrounding "cladding" and thereby enable guiding at the end of the taper. Characterization of a 25-mm long lantern taper results in multiplexing crosstalk values between -20 dB and -12 dB for both modal inputs. The de-multiplexing values were around -12 dB for the fundamental mode, and slightly higher for the first higher-order (LP11) mode. Microscopic imaging of a taper cross section having a width of 30 µm reveals the presence of an uncollapsed airhole in the structure between the three fibers. The impact of such an airhole is numerically investigated using an eigenmode expansion method based on a full-vectorial mode solver, and is found to play an important role in assuring a more adiabatic mode conversion through the taper.

Three-Dimensional Control on Lingually Rolled in Molars using a 3D Lingual Arch.

The fixed lingual arches that are used for mandibular molar uprighting works in two dimensions, whereas the 3D lingual arch works in all the three dimensions. The 3D lingual arch was fabricated from a 0.028 "round S.S wire with parts consisting of an adaptor, activator, friction lock and extender. The friction lock was inserted into the vertical stubs welded on the molar bands of the lingually tipped molar. They provided greater stability and anchorage to the molars. Up righting of the lingually tipped mandibular molars was attained within one month after insertion of the Wilson's 3D lingual arch. Correction was attained in all three dimensions with a buccal crown torque and lingual root torque. Levelling and alignment of the anterior segment was also attained by this multipurpose modular appliance. The 3D lingual arch enabled the clinician to set up a more positive anchorage for a greater variety of treatment applications than earlier lingual arches. Quality treatment results were attained with less span of time and were cost effective.

Moulding Faces at an Early Age-A Case Series.

Certain malocclusions have to be treated at an early age to avoid surgeries for the correction in the future. Introduction of functional appliances has reduced the elimination and correction of skeletal as well as dental discrepancies. Proper case selection taking into consideration skeletal and dental age with the use of various diagnostic aids helps us to identify and treat the malocclusions before it is too late. In this case series, we report three patients with skeletal jaw malrelationship treated with functional and orthopaedic appliances.

Inverted papilloma of atypical origin with unusual extension into the oropharynx.

Inverted papilloma is a benign tumor with malignant potential that commonly arises from the lateral wall of the nose. We present a case of inverted papilloma, in a premalignant stage, of unusual origin and with oropharyngeal extension. The patient presented with complaints of a nasal mass arising from the left nasal cavity and progressively increasing in size since 2 years. On examination a fleshy, firm, sensitive mass was noted, which was attached to the medial wall, and extending posteriorly and inferiorly into the oropharynx. Diagnostic nasal endoscopy and complete excision of the mass was performed with a stable postoperative period. Histopathology of the mass revealed an inverted nasal papilloma of the septum with carcinoma in situ.

Nonfatal air embolism during shoulder arthroscopy.

An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms.