A comparative study of clinical outcome in ALT free flap reconstruction using superficial or deep and single or dual recipient vein anastomosis in different sites.

BACKGROUND: During the free flap surgery obtaining a suitable recipient vein is an important factor for successful outcome. As in all other flaps even in ALT flap, single or double venous anastomosis, superficial or deep venous anastomosis is still a matter of debate among the micro vascular surgeons. Though dual vein anastomosis is a time-tested method, single vein anastomosis has the advantage of reducing the operative time and hospitalization cost. Similarly, in situation where the deep veins are dubious superficial veins are savior. This study explores the outcome of ALT flap using different system of recipient veins. PATIENTS AND METHODS: Retrospective analysis of the 54 free ALT flaps performed over a period of 5 years from June 2017 till June 2022, was carried out. Out of 54, 38 (63%) were male patients and 16 (37%) were females. The outcome of the flaps was evaluated in single or dual anastomosis group. Similarly, the outcome of the flaps with deep or superficial vein anastomosis was also evaluated. The flaps outcomes are evaluated as favorable (successful as well as partial loss are considered as favorable) and unfavorable (complete loss of the flap). RESULTS: Among the 54 flaps, 31 patients had lower limb reconstruction, majority were post-traumatic defects. Twenty patients had head and neck reconstruction following post malignancy excision. Three patients had upper-limb reconstruction for post traumatic and burn injury defects. The outcome was analyzed. Twenty patients had dual vein anastomosis, 90% (18 out of 20) of patients had favorable outcome and 10% (2 out of 20) had unfavorable outcome. Thirty-four patients underwent single vein anastomosis, 94% had favorable outcome and 6% had unfavorable outcome. The result was not statistically significant as p < .05. Seven patients underwent superficial vein recipient anastomosis, and all flaps were (100%) successful and no failure, whereas out of 27 patients who had undergone deep vein anastomosis 25 (92%) had favorable outcome and 2 (8%) had unfavorable outcome. The results were not statistically significant as p > .05. CONCLUSION: As in other free flaps venous anastomosis compromise is the cause for flap failure in majority of the times. Whenever possible, dual vein anastomosis should be considered. But when impervious, single vein anastomosis can be resorted to without any hesitation. Similarly, unavailability of deep veins should not deter the surgeons. Superficial veins were a savior in such situation and can be advantageous too.

Treatment algorithm for post sternotomy wound infection - our experience.

INTRODUCTION: Median sternotomy is the most commonly used approach in open cardiac surgery. As in any other surgery, surgical site infections are a known phenomenon, but morbidity depends on the depth of infection. Superficial wound infections can be managed conservatively; however, deep sternal wound infections need an aggressive approach to prevent disastrous consequence like mediastinitis. Hence, this study was conducted with the aim to classify sternotomy wound infection and to develop a treatment algorithm for superficial and deep sternotomy wound infections. MATERIAL AND METHODS: Between January 2016 to August 2021, 25 patients who had sternotomy wound infections were studied. These wound infections were classified as superficial or deep sternal wound infections. RESULTS: Superficial wound infections underwent treatment with diluted vinegar dressings and deep infections underwent treatment with bilateral pectoralis major muscle advancement flaps. Patients were followed up till the wounds healed completely without complications. Patient characteristics, comorbidities, duration of treatment and outcomes of treatment were analyzed. Superficial sternal wound infection patients responded favorably to diluted vinegar dressings and deep sternal wound infection patients to pectoralis major muscle advancement flaps. Average time duration of healing for superficial and deep wound infections was 66.2 days and 18 days respectively. None of the patients had an increased severity of infection or re-dehiscence following treatment and during follow-up. CONCLUSION: Relatively conservative approach using diluted vinegar (1% acetic acid) dressing for superficial sternal wound infections was efficacious, whereas aggressive debridement and bilateral pectoralis major advancement muscle flaps for deep sternal wound infections are necessary for favorable outcomes. However, more studies are needed to ascertain this treatment algorithm.

Atomic Layer Deposited Ti2 O3 Thin Films.

Ti2 O3 thin films have been prepared through atomic layer deposition and subjected to electrical resistivity measurements as a function of temperature. The as-prepared films were stable for up to three weeks. In Ti2 O3 thin films, the insulator-metal transition is observed at ∼80 K, with nearly 3-4 orders of magnitude change in resistivity. The anomalous increase in electrical resistivity in the films is in accordance with the two-band model. However, the energy interval between the bands depending on the crystallographic c/a ratio leads to a change in electrical resistivity as a function of temperature.

Multilocus sequence analysis and identification of mating-type idiomorphs distribution in Magnaporthe oryzae population of Karnataka state of India.

AIMS: To investigate the genetic diversity, population structure and mating-type distribution among the eco-distinct isolates of Magnaporthe oryzae from Karnataka, India. METHODS AND RESULTS: A set of 38 isolates of M. oryzae associated with leaf blast disease of rice were collected from different rice ecosystems of Karnataka, India, and analysed for their diversity at actin, ß-tubulin, calmodulin, translation elongation factor 1-α (TEF-1-α), and internal transcribed spacer (ITS) genes/region. The isolates were grouped into two clusters based on the multilocus sequence diversity, the majority being in cluster-IA (n = 37), and only one isolate formed cluster-IB. Population structure was analysed using 123 SNP data to understand the genetic relationship. Based on K = 2 and ancestry threshold of >70%, blast strains were classified into two subgroups (SG1 and SG2) whereas, based on K = 4 and ancestry threshold of >70%, blast strains were classified into four subgroups (SG1, SG2, SG3 and SG4). We have identified 13 haplotype groups where haplotype group 2 was predominant (n = 20) in the population. The Tajima's and Fu's Fs neutrality tests exhibited many rare alleles. Further, the mating-type analysis was also performed using MAT1 gene-specific primers to find the potentiality of sexual reproduction in different ecosystems. The majority of the isolates (54.5%) had MAT1-2 idiomorph, whereas 45.5% of the isolates possessed MAT1-1 idiomorph. CONCLUSIONS: The present study found the genetically homogenous population of M. oryzae by multilocus sequence analysis. Both mating types, MAT1-1 and MAT1-2, were found within the M. oryzae population of Karnataka. SIGNIFICANCE AND IMPACT OF STUDY: The study on the population structure and sexual mating behaviour of M. oryzae is important in developing region-specific blast-resistant rice cultivars. This is the first report of MAT1 idiomorphs distribution in the M. oryzae population in any Southern state of India.

Morpho-molecular diversity and avirulence genes distribution among the diverse isolates of Magnaporthe oryzae from Southern India.

AIMS: To investigate the diversity of eco-distinct isolates of Magnaporthe oryzae for their morphological, virulence and molecular diversity and relative distribution of five Avr genes. METHODS AND RESULTS: Fifty-two M. oryzae isolates were collected from different rice ecosystems of southern India. A majority of them (n = 28) formed a circular colony on culture media. Based on the disease reaction on susceptible cultivar (cv. HR-12), all 52 isolates were classified in to highly virulent (n = 28), moderately virulent (n = 11) and less-virulent (13) types. Among the 52 isolates, 38 were selected for deducing internal transcribed spacer (ITS) sequence diversity. For deducing phylogeny, another set of 36 isolates from other parts of the world was included, which yielded two distinct phylogenetic clusters. We identified eight haplotype groups and 91 variable sites within the ITS sequences, and haplotype-group-2 (Hap_2) was predominant (n = 24). The Tajima's and Fu's Fs neutrality tests exhibited many rare alleles. Furthermore, PCR analysis for detecting the presence of five Avr genes in the different M. oryzae isolates using Avr gene-specific primers in PCR revealed that Avr-Piz-t, Avr-Pik, Avr-Pia and Avr-Pita were present in 73.68%, 73.68%, 63.16% and 47.37% of the isolates studied, respectively; whereas, Avr-Pii was identified only in 13.16% of the isolates. CONCLUSIONS: Morpho-molecular and virulence studies revealed the significant diversity among eco-distinct isolates. PCR detection of Avr genes among the M. oryzae population revealed the presence of five Avr genes. Among them, Avr-Piz-t, Avr-Pik and Avr-Pia were more predominant. SIGNIFICANCE AND IMPACT OF THE STUDY: The study documented the morphological and genetic variability of eco-distinct M. oryzae isolates. This is the first study demonstrating the distribution of the Avr genes among the eco-distinct population of M. oryzae from southern India. The information generated will help plant breeders to select appropriate resistant gene/s combinations to develop blast disease-resistant rice cultivars.

Efficacy of pedicled anterolateral thigh flap for reconstruction of regional defects - a record analysis.

BACKGROUND: The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as a pedicled and/or free flap. Majority of the free flaps are harvested as a fasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as a myocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as a chimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of a free flap. Since it has a long vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. METHODS: A retrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. RESULTS: All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. CONCLUSION: The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in a very short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after a maximum arc of rotation (up to 170°) all the flaps survived without any major complications.

New dual peroxisome proliferator activated receptor agonist-Saroglitazar in diabetic dyslipidemia and non-alcoholic fatty liver disease: integrated analysis of the real world evidence.

BACKGROUND: Saroglitazar, a novel dual peroxisome proliferator activated receptor (PPAR) agonist, in clinical trials, has shown an improvement in lipid and glycemic parameters through the PPAR-α and γ agonist actions, respectively. It was granted marketing authorization in India in 2013 for diabetic dyslipidemia. This review was conducted to summarize the effects of Saroglitazar in patients with diabetic dyslipidemia in real world clinical studies conducted after marketing authorization in India. METHODS: In this review, we selected real world clinical studies of Saroglitazar published as manuscripts and abstracts presented at scientific conferences. In all these studies, patients with diabetic dyslipidemia were treated with Saroglitazar 4 mg once daily for at least 12 weeks and different lipid and glycemic parameters were measured at the baseline and end of the study. RESULTS: In 18 selected studies (5 published manuscripts and 13 abstracts), a total of 5824 patients with diabetic dyslipidemia were prescribed Saroglitazar 4 mg for a duration ranging from 12 to 58 weeks. Across all the studies, mean age of patients ranged from 49.6 to 59.1 years and the proportion of female patients ranged from 22% to 42%. Across all the studies, there was a consistent mean reduction in triglyceride levels (~ 45% to 62%), total cholesterol levels (~ 17% to 26%), non-high-density lipoprotein cholesterol levels (~ 21% to 36%), low-density lipoprotein cholesterol levels (~ 11% to 27%), and glycosylated hemoglobin levels (~ 0.7% to 1.6%) with an increase in mean high-density lipoprotein cholesterol levels (up to 9%) from baseline to end of the study. Saroglitazar also improved alanine aminotransferase levels and fatty liver (evaluated by FibroScan™) in non-alcoholic fatty liver disease patients with diabetic dyslipidemia. Body weight remained unchanged and no significant adverse events (AEs) were reported in the studies. CONCLUSION: Saroglitazar effectively improved lipid and glycemic parameters without significant AEs in patients with diabetic dyslipidemia in real-world clinical studies of up to 58 weeks duration.

Allele-specific analysis of single parent backcross population identifies HOX10 transcription factor as a candidate gene regulating rice root growth.

Understanding the molecular and physiological mechanisms of trait diversity is crucial for crop improvement to achieve drought adaptation. Root traits such as high biomass and/or deep rootedness are undoubtedly important drought adaptive traits. The major aim of this investigation was to functionally characterize a set of ethyl methane sulfonate-induced rice mutants for root traits. We report the identification of a high-root biomass mutant through a novel screening strategy for yield and Δ13 C measurements. The high-root mutant (392-9-1) thus identified, had a 66% higher root biomass compared to wild-type (Nagina-22). Better maintenance of leaf turgor and carbon assimilation rates resulted in lower drought susceptibility index in 392-9-1. Targeted resequencing revealed three non-synonymous single nucleotide variations in 392-9-1 for the genes HOX10, CITRATE SYNTHASE and ZEAXANTHIN EPOXIDASE. Segregation pattern of phenotype and mutant alleles in a single parent backcross F2 population revealed a typical 3:1 segregation for each of the mutant alleles. The number of F2 progeny with root biomass equal to or greater than that of 392-9-1 represented approximately one-third of the population indicating a major role played by HOX10 gene in regulating root growth in rice. Allele-specific Sanger sequencing in contrasting F2 progenies confirmed the co-segregation of HOX10 allele with the root biomass. The non-synonymous mutations in the other two genes did not reveal any specific pattern of co-segregation with root phenotype, indicating a strong role of HOX10, an upstream transcription factor, in regulating root biomass in rice.

Distal major pedicle of sartorius muscle flap: Anatomical study and its clinical implications.

BACKGROUND: Reconstruction of the popliteal region has limited option in terms of muscle flaps or myocutaneous flaps. Gastrocnemius muscle or the myocutaneous flaps are the option for majority of cases. However, reach of Gastrocnemius is limited if the wound is on the distal one-third thigh or the lateral aspect of knee region. Similarly, if the wound injures the muscle, then coverage becomes all the more difficult. Although inferiorly based fasciocutaneous flaps can cover the wound in case of bony injuries, muscle flaps are beneficial as they help in fracture healing. However, in cases with direct gastrocnemius muscle injury or if the wound on the distal one-third thigh or the lateral aspect then the options of muscle flaps is limited. An inferiorly based sartorius muscle can be one suitable alternative to cover this region. AIMS AND OBJECTIVE: The aim is to devise an inferiorly based sartorius muscle flap for coverage of lower thigh, popliteal and upper one-third leg region. OBJECTIVES: (1) To identify the location of distal major (largest diameter) pedicle in cadavers and its clinical application. (2) To determine the arc of rotation with distal major pedicle as pivot point. METHODS: Ten Cadavers and 20 sartorius muscle dissected out. Prior silicone injection onto the femoral vessels was done to identify the location of the perforators for the sartorius muscle. The distance of perforators from anterior superior iliac spine (ASIS) measured and the diameter of each perforator by transverse cut measured using callipers. In clinical cases, the arc of rotation was measured by keeping the distal perforator intact as pedicle (detaching the muscle from the ASIS without detaching from the insertion and then rotating it). RESULTS: Out of the 10 cadavers analysed, 6 were male and 4 were female. The mean location of the distal major pedicle was at 35.25 cm from ASIS and range was between 30.4 cm to 38.3 cm. There was no significant variation between right and left limbs in individual cadaver (range 0.2 cm-1.6 cm). The mean diameter of the arterial component of distal major pedicle was 1.54 mm. In three clinical cases where this flap was harvested the arc of rotation were 95°, 110°, 125°. In one of the cases where flap was used to cover the tibial plateau (arc of rotation 155°), distal end of the muscle necrosed. CONCLUSION: This cadaver study supported by various other studies show that it has sizeable distal pedicle based on which whole muscle can be harvested as flap. In our study, the usual location of this pedicle is at 35 cm from ASIS. The mean diameter of the widest pedicle in distal one-third was 1.54 mm which along with other small diameter pedicle can support the entire muscle. This flap reached up to the infrapatellar region without any vascular compromise.

Synthesis and antimicrobial evaluation of novel 4-amino-6-(1,3,4-oxadiazolo/1,3,4-thiadiazolo)-pyrimidine derivatives.

A series of novel 4-amino-6-(1,3,4-oxadiazolo/1,3,4-thiadiazolo)-pyrimidine derivatives of biological interest were prepared by sequential amination, hydrazide formation, and hydrazine carbothioamidination followed by cyclization. All the synthesized compounds (6a-6h and 7a-7f) were screened for antibacterial and antifungal activity. From this group, compound 7f (MIC (µg/mL µg/mL )/Inhibition (mm): 6.25/23-30) showed good antibacterial and antifungal activity. Reagents and conditions: (a) Ethyl acetoacetate, 60% NaH, 1,4-dioxane, 60°C, 6 h; (b) DIPEA, 1,4-dioxane, 100°C, 14 h; (c) NH2NH2 ⋅ H2O, EtOH, reflux, 14 h; (d) Tolyl isothiocyanatobenzene, DMF, RT, 2 h; (e) (if X = O) EDC⋅ HCl, TEA, DMF, RT, 14 h; (f) (if X = S) Conc. H2O4, RT, 14h.

Sexuality generates diversity in the aflatoxin gene cluster: evidence on a global scale.

Aflatoxins are produced by Aspergillus flavus and A. parasiticus in oil-rich seed and grain crops and are a serious problem in agriculture, with aflatoxin B1 being the most carcinogenic natural compound known. Sexual reproduction in these species occurs between individuals belonging to different vegetative compatibility groups (VCGs). We examined natural genetic variation in 758 isolates of A. flavus, A. parasiticus and A. minisclerotigenes sampled from single peanut fields in the United States (Georgia), Africa (Benin), Argentina (Córdoba), Australia (Queensland) and India (Karnataka). Analysis of DNA sequence variation across multiple intergenic regions in the aflatoxin gene clusters of A. flavus, A. parasiticus and A. minisclerotigenes revealed significant linkage disequilibrium (LD) organized into distinct blocks that are conserved across different localities, suggesting that genetic recombination is nonrandom and a global occurrence. To assess the contributions of asexual and sexual reproduction to fixation and maintenance of toxin chemotype diversity in populations from each locality/species, we tested the null hypothesis of an equal number of MAT1-1 and MAT1-2 mating-type individuals, which is indicative of a sexually recombining population. All samples were clone-corrected using multi-locus sequence typing which associates closely with VCG. For both A. flavus and A. parasiticus, when the proportions of MAT1-1 and MAT1-2 were significantly different, there was more extensive LD in the aflatoxin cluster and populations were fixed for specific toxin chemotype classes, either the non-aflatoxigenic class in A. flavus or the B1-dominant and G1-dominant classes in A. parasiticus. A mating type ratio close to 1∶1 in A. flavus, A. parasiticus and A. minisclerotigenes was associated with higher recombination rates in the aflatoxin cluster and less pronounced chemotype differences in populations. This work shows that the reproductive nature of the population (more sexual versus more asexual) is predictive of aflatoxin chemotype diversity in these agriculturally important fungi.

Antifungal and antimycotoxigenic potency of Solanum torvum Swartz. leaf extract: isolation and identification of compound active against mycotoxigenic strains of Aspergillus flavus and Fusarium verticillioides.

AIMS: The main objective of this study was to investigate the antifungal effect of Solanum torvum leaves against different field and storage fungi, and to identify its active compound. In addition, to evaluate in vitro and in vivo inhibitory efficacy on toxigenic strains of Aspergillus flavus and Fusarium verticillioides. METHODS AND RESULTS: Leaves of S. torvum were sequentially extracted with petroleum ether, toluene, chloroform, methanol and ethanol. The antifungal compound isolated from chloroform extract was identified as torvoside K based on spectral analysis. The antifungal activity of chloroform extract and torvoside K was determined by broth microdilution and poisoned food techniques. The minimum inhibitory concentration (MIC), minimum fungicidal concentration (MFC) and zone of inhibition (ZOI) were recorded. Further, inhibitory effects of chloroform extract and torvoside K on growth of A. flavus and F. verticillioides, and their toxin productions were evaluated using in vitro and in vivo assays. Torvoside K showed the significant activity against tested fungi with ZOIs and MICs ranging from 33·4 to 87·4% and 31·25-250 µg ml(-1) , respectively. Further, torvoside K showed concentration-dependent antimycotoxigenic activity against aflatoxin B1 and fumonisin B1 production by A. flavus and F. verticillioides, respectively. CONCLUSIONS: It was observed that the compound torvoside K significantly inhibited the growth of all fungi tested. Growth of A. flavus and F. verticillioides, and aflatoxin B1 and fumonisin B1 productions were completely inhibited in vitro and in vivo by torvoside K with increasing concentration. SIGNIFICANCE AND IMPACT OF THE STUDY: Control of mycotoxigenic fungi requires compounds that able to inhibit both fungal growth and mycotoxin production. The antimycotoxigenic potential of torvoside K of S. torvum is described in this study for the first time. The results indicate the possible use of S. torvum as source of antifungal agents against postharvest fungal infestation of food commodities and mycotoxin contaminations.

Evaluation of radiological methods of assessing cup anteversion in total hip replacement.

STUDY DESIGN: Prospective clinical study. BACK GROUND: In total hip replacement, the placement of the cup is critical as inaccurate placement can cause impingement, accelerated wear and dislocations. The position of the cup is assessed by abduction and anteversion. There are many radiological methods available for this purpose, while the reliability and validity of the methods have not been adequately done. Calculation by CT method is a gold standard. The aim of study was to evaluate the reliability and validity of all the methods. METHODS: In 30 hips of 25 consecutive patients, 13 females and 12 males who underwent primary total hip replacement in our institution, the component version in all the five radiological methods was calculated and compared with CT evaluation of angles. The intra- and interobserver reliabilities were assessed. RESULTS: Average CT measurement was 23.28 for anteversion. Lewinnek, Liaw, Hassan, Widmer and Ritun methods had average deviation of 4.330, 4.390, 4.880, 6.840 and 6.220, respectively. All the radiographic and CT methods had excellent intra- and interobserver reliabilities (C.I. 0.894-0.960 and 0.861-0.953). All the methods except Widmer had a significant validity against CT. CONCLUSION: Plain X-rays (AP) are reliable for measuring cup anteversion. Lewinnek, Liaw, Riten and Hassans methods for calculation of cup anteversion are closer to CT in accuracy (p value >0.05). Widmer method varies significantly (p value <0.05) from CT.

Evaluation of alignment in total knee arthroplasty: a prospective study.

BACKGROUND: Successful results of knee arthroplasty demand precise surgical technique, sound implant design, kinematics, appropriate materials and patient compliance with rehabilitation. The precision with which the implants are placed directly affects patient outcome as implant position and alignment influence the stability, durability and patellar tracking. Evaluating the alignment in total knee arthroplasty and functional outcome with respect to the alignment is the need of the hour. AIM AND OBJECTIVE OF THE STUDY: (1) To evaluate the accuracy of the overall limb alignment and component alignment in jig-assisted TKR. (2) To evaluate the functional outcome with respect to the alignment parameters. METHODOLOGY: This is a prospective study of 120 knees in 80 patients that underwent total knee replacement at Victoria and Bowring and Lady Curzon hospitals. Patients were selected according to the inclusion and exclusion criteria and evaluated using knee society score at regular follow-up. Preoperative and postoperative standing 'long-leg radiographs' and postoperative CT scans were taken from all the patients. In our study, we had 54 female patients and 26 male patients. Indications were OA in 72 and RA in 48 knees. The average follow-up period was 36 months. RESULTS: Preoperatively, all the patients had moderate to severe pain. Mechanical and tibiofemoral axes were outside the acceptable range. Postoperatively, with respect to mechanical axis, the inliers had significantly better knee score (p = 0.026) compared to the outliers. But the functional score did not show any significant difference between these two groups (p = 0.2093). Inliers in tibiofemoral axis alignment parameter had extremely significant better knee score (p = 0.0001) and also functional score (p = 0.0082) compared to outliers group. Sagittal and rotational femoral component angles in all 120 cases were coming within the 'inliers group'. Similarly, the sagittal, the coronal and the rotational component angles of tibia were also coming under inliers group in all 120 replaced knees. CONCLUSION: Aligning the mechanical axis, tibiofemoral angle within (0° ± 3°) and placement of prostheses within (0° ± 3°) to the normal alignment in all the three planes significantly produce excellent result with respect to functional outcome.

Segmentation and Volumetric Analysis of Heart from Cardiac CT Images.

PURPOSE: Cardiac CT is a valuable diagnostic tool in evaluating cardiovascular diseases. Accurate segmentation of the heart and its structures from cardiac CT and MRI images is essential for diagnosing functional abnormalities, treatment plans and cardiovascular diseases management. Accurate segmentation and quantitative assessments are still a challenge. Manual delineation of the heart from the scan images is labour-intensive, time-consuming, and error prone as it depends on the radiologist's experience. Thus, automated techniques are highly desirable as they can significantly improve the efficiency and accuracy of image analysis. METHOD: This work addresses the above problems. A new, image-driven, fast, and fully automatic segmentation method was developed to segment the heart from CT images using a processing pipeline of adaptive median filter, multi-level thresholding, active contours, mathematical morphology, and the knowledge of human anatomy to delineate the regions of interest. RESULTS: The algorithm proposed is simple to implement and validate and requires no human intervention. The method is tested on the 'Image CHD' DICOM images (multi-centre, clinically approved single-phase de-identified images), and the results obtained were validated against the ground truths provided with the dataset. The results show an average Dice score, Jaccard score, and Hausdorff distance of 0.866, 0.776, and 33.29 mm, respectively, for the segmentation of the heart's chambers, aorta, and blood vessels. The results and the ground truths were compared using Bland-Altmon plots. CONCLUSION: The heart was correctly segmented from the CT images using the proposed method. Further this segmentation technique can be used to develop AI based solutions for segmentation.

Commercial suitability and characterization of newly developed Erucastrum canariense (Can) sterile cytoplasm based cytoplasmic male sterile (CMS) lines in Indian cauliflower.

The study presents the first to characterize novel Erucastrum canarianse Webb and Berthel (or Can) sterile cytoplasm-based CMS lines in Indian cauliflower (Brassica oleracea var. botrytis L.) and investigating their commercial suitability. Eleven Can-based CMS lines were examined for 12 agro-morphological and yield traits,18 floral traits, four seed yield traits together with three each of the Ogura (source: wild Japanese Radish) and Tour (Source: Brassica tournefortii) cytoplasms. All of the recorded floral and seed traits showed significant (P > 0.05) differences between the CMS lines of each group. Agro-morphological and yield traits in CMS lines and their maintainers, however, were non-significantly different. All the Can- and Ogura-based CMS lines showed flowering and appropriate seed formation by natural cross-pollination. Only two Tour cytoplasm-based CMS lines, Tour (DC-41-5) and Tour (DC-67), produced the smallest malformed flowers and stigma. The highest seed yield per plant in CMS lines was in Ogu (DC-98-4) and the lowest in Tour (DC-67). P14 and P15, two polymorphic mtDNA markers, were discovered for the Can CMS system for early detection. Five primers (ITS5a-ITS4, atpF-atpH, P16, rbeL and trnL), along with their maintainers, were sequenced and aligned to detect nucleotide changes including as additions and or deletions at different positions. The newly introduced E. canariense sterile cytoplasm-based CMS system in cauliflower is the subject of the first comprehensive report, which emphasises their potential as a further stable and reliable genetic mechanism for hybrid breeding.

Ingestion or aspiration of foreign bodies by children.

Ingestion and aspiration of foreign bodies are common reasons for children presenting to emergency departments. A significant proportion of such events are often unnoticed by the children's parents or carers. Emergency nurses should become suspicious of foreign body ingestion or aspiration if they see symptoms such as stridor, gagging, wheeze and difference in air entry on auscultation ( Hilliard et al 2003 , Paul et al 2010 ). If they suspect airway compromise, or bowel problems such as perforation or obstruction, the children concerned should be dealt with immediately. Definitive management for foreign body removal is generally available at tertiary centres and children should be transferred to specialist services as soon as possible after stabilisation ( McConnell 2013 ). Before discharge, their parents should be educated about possible signs of deterioration and advised about home-safety measures ( Paul and Wilkinson 2012 ).

Localization of lung abnormalities on chest X-rays using self-supervised equivariant attention.

Chest X-Ray (CXR) images provide most anatomical details and the abnormalities on a 2D plane. Therefore, a 2D view of the 3D anatomy is sometimes sufficient for the initial diagnosis. However, close to fourteen commonly occurring diseases are sometimes difficult to identify by visually inspecting the images. Therefore, there is a drift toward developing computer-aided assistive systems to help radiologists. This paper proposes a deep learning model for the classification and localization of chest diseases by using image-level annotations. The model consists of a modified Resnet50 backbone for extracting feature corpus from the images, a classifier, and a pixel correlation module (PCM). During PCM training, the network is a weight-shared siamese architecture where the first branch applies the affine transform to the image before feeding to the network, while the second applies the same transform to the network output. The method was evaluated on CXR from the clinical center in the ratio of 70:20 for training and testing. The model was developed and tested using the cloud computing platform Google Colaboratory (NVidia Tesla P100 GPU, 16 GB of RAM). A radiologist subjectively validated the results. Our model trained with the configurations mentioned in this paper outperformed benchmark results. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-022-00249-5.

Modified Technique of Pectoralis Major Myocutaneous Flap Inset for Buccal Mucosa Reconstruction.

BACKGROUND: Conventional technique of flap inset in buccal mucosa reconstruction is by direct suturing of cutaneous margin of Pectoralis Major Myocutaneous (PMMC) flap to hard and soft palate mucosa and margin of floor of mouth with simple interrupted sutures. We have done a prospective study of the efficacy of anchoring the upper margin of PMMC flap to the hard palate by a modified method in reconstruction of buccal mucosa defects following tumour excision. This is to prevent disruption of suture line from the mucoperiosteum of hard palate and resultant oro-cutaneous fistula. METHODS: This hospital-based prospective study was carried out in the Department of Plastic Surgery at Bangalore, India for a period of 18 months (2015-2017). Patients (N=48) with buccal mucosa defects requiring reconstruction with PMMC flap either with conventional (n=24) or modified method (n=24) following tumour excision were included. Clinico-demographic profile of the patients including age, gender, size of defect, staging of illness, site and type of reconstruction, disruption of suture margin in the hard palate, development of oro-cutaneous fistula (OCF), day of starting oral feeds, removal of Ryle's tube and post-operative average length of stay in the hospital were recorded. RESULTS: Disruption of suture line in hard palate and Oro-cutaneous fistula were statistically significant in study group in both the variables (P-0.033, P-0.033). The median days on which patients were started with oral clear liquids and removal of Ryle's tube were also statistically significant between study and control groups. Post-operative average length of hospital stay which is the outcome of favourable results in the study group was found to be statistically significant (P-0.021) between the groups. CONCLUSION: Overall, modified technique of anchorage of PMMC flap can be considered as a reliable technique in buccal mucosa reconstruction because of its stability, lower complication rates and shorter length of hospital stay.

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears.

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.