Endovascular Thrombectomy vs Best Medical Management for Late Presentation Acute Ischaemic Stroke with Large Vessel Occlusion Without CT Perfusion or MR Imaging Selection: A Systematic Review and Meta-Analysis.

BACKGROUND: The efficacy and safety of endovascular thrombectomy (EVT) beyond 6 hours from stroke onset for patients with large vessel occlusion (LVO) selected without CT perfusion(CTP) or MR imaging(MRI) is undetermined. We conducted a systematic review and meta-analysis of the current literature comparing outcomes for late presenting patients with LVO treated by best medical management (BMM) with those selected for EVT based only on non-contrast CT(NCCT)/CT angiography(CTA) (without CTP or MRI). METHODS: PRISMA guidelines were employed. The primary outcome was functional independence (modified Rankin Scale 0-2) at 3 months. Secondary outcomes were symptomatic intracranial haemorrhage (sICH) and mortality at 3 months. Data were analysed using the random-effects model. RESULTS: Six studies of 2083 patients, including three randomised controlled trials, were included; 1271 patients were treated with EVT and 812 patients with BMM. Compared to BMM, patients treated with EVT demonstrated higher odds of achieving functional independence (39.0% EVT vs 22.0% BMM; OR=2.55, 95%CI 1.61-4.05,p<0.0001, I2=74%). The rates of sICH (OR=2.09, 95%CI 0.86-5.04,p=0.10) and mortality (OR=0.62, 95%CI 0.35-1.10,p=0.10) were not significantly different between each cohort. CONCLUSION: Compared to BMM, late presenting stroke patients selected for EVT eligibility with NCCT/CTA only and treated with EVT achieved significantly higher rates of functional independence at 90 days, without increasing the incidence of sICH or mortality. Whilst these findings indicate that NCCT/CTA only may be used for EVT eligibility selection for patients who present beyond 6 hours from stroke onset, the results should be interpreted with caution due to the substantial heterogeneity between studies.

A comprehensive investigation of geoenvironmental pollution and health effects from municipal solid waste landfills.

This study investigates human health risks associated with heavy metals (HMs) occurrence in municipal solid waste (MSW) landfills. For testing of selected MSW landfills steps were involved, including site characterization, soil sampling and chemical testing, statistical analysis, as well as health risk assessment, carcinogenic and non-carcinogenic effects. For the Polish landfill (Radiowo) the average HMs concentrations were found in the following order: Zn (52.74 mg/kg DM) > Pb (28.32 mg/kg DM) > Cu (12.14 mg/kg DM) > Ni (4.50 mg/kg DM) > Cd (3.49 mg/kg DM), while for the Czech landfill (Zdounky): Zn (32.05 mg/kg DM) > Cu (14.73 mg/kg DM) > Ni (4.73 mg/kg DM) > Pb (0.10 mg/kg DM) = Cd (0.10 mg/kg DM). Strong positive correlations between selected HMs demonstrated identical origins. Principal component analysis (PCA) performed for the Radiowo landfill transferred the soil parameters into three principal components (PCs), accounting for 87.12% of the total variance. The results of the PCA analysis for the Zdounky landfill revealed three PCs responsible for 95.16% of the total variance. The exposure pathways of HMs for landfills were in the following order: ingestion > dermal absorption > inhalation. For both landfills, the values of hazard quotient were lower than 1, indicating no potential negative health effects. In terms of the hazard index (HI), for both landfills, no adverse human health effects occur (HI < 1). The incremental lifetime cancer risk (ILCR) values indicated negligible or acceptable carcinogenic risk of HMs (average ILCR in the range from 5.01E-10 to 5.19E-06).

Antiplatelet Therapy in Neurointervention.

The aim of this review is to provide an overview of the use of antiplatelet medication in neurointervention, with a focus on the clinical indications for antiplatelet use in both preventing and reducing platelet aggregation. This review will cover current antiplatelet medications, pharmacokinetics, and pharmacodynamics. We will provide an overview of different endovascular devices and discuss the antiplatelet regimes in neurointervention, highlighting gaps in evidence and scope for future studies.Two randomized controlled trials have evaluated antiplatelet use in the setting of acute large vessel occlusion stroke, with neither demonstrating benefit in their overall cohorts. Evidence on antiplatelet medication for both acute and elective stenting for acute stroke and treatment of cerebral aneurysms is currently based on large case series, and practice in neurointervention has increasingly utilized dual antiplatelet regimes with clopidogrel and second-line agents like prasugrel and ticagrelor. Clopidogrel function testing has an increasing role in neurointerventional procedures, particularly for high metal surface area stents such as the braided flow diverter type stents. Intravenous glycoprotein IIB/IIIA inhibitors have been utilized for both acute bridging and rescue therapy.Antiplatelet decision making is complex, and there are few randomized control trials to guide clinical practice. Comparative trials to guide decision making remain important in both the acute and elective settings. Standardised protocols incorporating platelet function testing may play a role in assisting decision making until more robust clinical evidence is available, particularly in the context of acute neurointerventional stenting for stroke and ruptured cerebral aneurysms.

Four-factor risk score for the prediction of interstitial lung disease in rheumatoid arthritis.

OBJECTIVE: Interstitial lung disease (ILD) is one of the commonest systemic complications in patients with rheumatoid arthritis (RA) and carries a significant morbidity and mortality burden. We aimed to identify key variables to risk-stratify RA patients in order to identify those at increased risk of developing ILD. We propose a probability score based on the identification of these variables. METHODS: A retrospective, multicentre study using clinical data collected between 2010 and 2020, across 20 centres. RESULTS: A total of 430 RA (210 with ILD confirmed on high-resolution computed tomography (HRCT)) patients were evaluated. We explored several independent variables for the risk of developing ILD in RA and found that the key significant variables were smoking (past or present), older age and positive rheumatoid factor/anti-cyclic citrullinated peptide. Multivariate logistic regression models were used to form a scoring system for categorising patients into high and low risk on a scale of 0-9 points and a cut-off score of 5, based on the area under the receiver operating characteristic curve of 0.76 (CI 95% 0.71-0.82). This yielded a sensitivity of 86% and a specificity of 58%. High-risk patients should be considered for investigation with HRCT and monitored closely. CONCLUSION: We have proposed a new model for identifying RA patients at risk of developing ILD. This approach identified four simple clinical variables: age, anti-cyclic citrullinated peptide antibodies, Rheumatoid factor and smoking, which allowed development of a predictive scoring system for the presence of ILD in patients with RA.

Incidence and predictors of poor functional outcome despite complete recanalisation following endovascular thrombectomy for acute ischaemic stroke.

BACKGROUND: Numerous ischaemic stroke patients experience poor functional outcome despite successful recanalisation following endovascular thrombectomy (EVT). We aimed to identify the incidence and predictors of futile complete recanalisation (FCR) in a national stroke registry. METHODS: Patients who achieved complete recanalisation (mTICI 3) following EVT, between October 2015 and March 2020, were included from a United Kingdom national stroke registry. Modified Rankin Scale of 4-6 at discharge was defined as a 'poor/futile outcome'. Backward stepwise multivariable logistic regression analysis was performed with FCR as the dependent variable, incorporating all baseline characteristics, procedural time metrics and post-procedural events. RESULTS: We included 2132 of 4383 patients (48.8%) with complete recanalisation post-EVT, of which 948 patients (44.4%) developed FCR. Following multivariable regression analysis adjusted for potential confounders, patients with FCR were associated with multiple baseline patient, imaging and procedural factors: age (p=0.0001), admission NIHSS scores (p=0.0001), pre-stroke disability (p=0.007), onset-to-puncture (p=0.0001) and procedural times (p=0.0001), presence of diabetes (p=0.005), and use of general anaesthesia (p=0.0001). Although not predictive of outcome, post-procedural events including development of any intracranial haemorrhage (ICH) (p=0.0001), symptomatic ICH (sICH) (p=0.0001) and early neurological deterioration (END) (p=0.007) were associated with FCR. CONCLUSION: Nearly half of patients in this national registry experienced FCR following EVT. Significant predictors of FCR included increasing age, admission NIHSS scores, pre-stroke disability, onset-to-puncture and procedural times, presence of diabetes, atrial fibrillation, and use of general anaesthesia. Post procedural development of any ICH, sICH, and END were associated with FCR.

Characteristics and pollution potential of leachate from municipal solid waste landfills: Practical examples from Poland and the Czech Republic and a comprehensive evaluation in a global context.

The formation of leachate is mainly due to the percolating of rainwater through the body of the landfill and the physical, chemical, and biological processes taking place inside the body of the landfill. The characteristics and pollution potential of leachate from the municipal solid waste (MSW) landfills in Poland (Lubna) and the Czech Republic (Zdounky) is presented. The objectives of this study are: 1) to evaluate and compare physicochemical characteristics of leachate, 2) to demonstrate the variability of leachate parameters in time, concerning stabilization phase of the landfill, 3) to present existing relationships between the characteristics of the leachate, 4) to indicate the factors determining the variability of the leachate composition. The Leachate Pollution Index (LPI) was applied to indicate temporal changes in leachate pollution, to assess polluting ability of leachate, and to compare the pollution potential of leachate. For the Lubna landfill, the minimum, maximum, and average values of LPI were: 6.10, 39.41, and 18.44, respectively. The LPI for the Lubna landfill tends to decrease in time due to stabilization of wastes. For the Zdounky landfill, temporal decreasing of LPI was not observed. The minimum, maximum, and average values of LPI were: 6.25, 14.25, and 10.11, respectively. Alkaline characteristics of leachate from both landfills indicate the mature stage of waste storage. This phenomenon was also evidenced by the Chemical Oxygen Demand (COD), ammonium (NH4+), and cadmium (Cd). For both landfills, pH was negatively correlated with most of the leachate parameters. It is the task for environmental engineers to confront existing knowledge (supplemented by the results of this work) about the properties of leachate, its changes over time and its polluting potential with the possibilities of treating and managing it properly.

Perfusion Imaging for Endovascular Thrombectomy in Acute Ischemic Stroke Is Associated With Improved Functional Outcomes in the Early and Late Time Windows.

BACKGROUND: The impact on clinical outcomes of patient selection using perfusion imaging for endovascular thrombectomy (EVT) in patients with acute ischemic stroke presenting beyond 6 hours from onset remains undetermined in routine clinical practice. METHODS: Patients from a national stroke registry that underwent EVT selected with or without perfusion imaging (noncontrast computed tomography/computed tomography angiography) in the early (<6 hours) and late (6-24 hours) time windows, between October 2015 and March 2020, were compared. The primary outcome was the ordinal shift in the modified Rankin Scale score at hospital discharge. Other outcomes included functional independence (modified Rankin Scale score ≤2) and in-hospital mortality, symptomatic intracerebral hemorrhage, successful reperfusion (Thrombolysis in Cerebral Infarction score 2b-3), early neurological deterioration, futile recanalization (modified Rankin Scale score 4-6 despite successful reperfusion) and procedural time metrics. Multivariable analyses were performed, adjusted for age, sex, baseline stroke severity, prestroke disability, intravenous thrombolysis, mode of anesthesia (Model 1) and including EVT technique, balloon guide catheter, and center (Model 2). RESULTS: We included 4249 patients, 3203 in the early window (593 with perfusion versus 2610 without perfusion) and 1046 in the late window (378 with perfusion versus 668 without perfusion). Within the late window, patients with perfusion imaging had a shift towards better functional outcome at discharge compared with those without perfusion imaging (adjusted common odds ratio [OR], 1.45 [95% CI, 1.16-1.83]; P=0.001). There was no significant difference in functional independence (29.3% with perfusion versus 24.8% without; P=0.210) or in the safety outcome measures of symptomatic intracerebral hemorrhage (P=0.53) and in-hospital mortality (10.6% with perfusion versus 14.3% without; P=0.053). In the early time window, patients with perfusion imaging had significantly improved odds of functional outcome (adjusted common OR, 1.51 [95% CI, 1.28-1.78]; P=0.0001) and functional independence (41.6% versus 33.6%, adjusted OR, 1.31 [95% CI, 1.08-1.59]; P=0.006). Perfusion imaging was associated with lower odds of futile recanalization in both time windows (late: adjusted OR, 0.70 [95% CI, 0.50-0.97]; P=0.034; early: adjusted OR, 0.80 [95% CI, 0.65-0.99]; P=0.047). CONCLUSIONS: In this real-world study, acquisition of perfusion imaging for EVT was associated with improvement in functional disability in the early and late time windows compared with nonperfusion neuroimaging. These indirect comparisons should be interpreted with caution while awaiting confirmatory data from prospective randomized trials.

How a thrombectomy service can reduce hospital deficit: a cost-effectiveness study.

BACKGROUND: There is level 1 evidence for cerebral thrombectomy with thrombolysis in acute large vessel occlusion. Many hospitals are now contemplating setting up this life-saving service. For the hospital, however, the first treatment is associated with an initial high cost to cover the procedure. Whilst the health economic benefit of treating stroke is documented, this is the only study to date performing matched-pair, patient-level costing to determine treatment cost within the first hospital episode and up to 90 days post-event. METHODS: We conducted a retrospective coarsened exact matched-pair analysis of 50 acute stroke patients eligible for thrombectomy. RESULTS: Thrombectomy resulted in significantly more good outcomes (mRS 0-2) compared to matched controls (56% vs 8%, p = 0.001). More patients in the thrombectomy group could be discharged home (60% vs 28%), fewer were discharged to nursing homes (4% vs 16%), residential homes (0% vs 12%) or rehabilitation centres (8% vs 20%). Thrombectomy patients had fewer serious adverse events (n = 30 vs 86) and were, on average, discharged 36 days earlier. They required significantly fewer physiotherapy sessions (18.72 vs 46.49, p = 0.0009) resulting in a median reduction in total rehabilitation cost of £4982 (p = 0.0002) per patient. The total cost of additional investigations was £227 lower (p = 0.0369). Overall, the median cost without thrombectomy was £39,664 per case vs £22,444, resulting in median savings of £17,221 (p = 0.0489). CONCLUSIONS: Mechanical thrombectomy improved patient outcome, reduced length of hospitalisation and, even without procedural reimbursement, significantly reduced cost to the thrombectomy providing hospital.

Leachate characteristics: Potential indicators for monitoring various phases of municipal solid waste decomposition in a bioreactor landfill.

Leachate is a contaminated liquid generated during the bio-chemical decomposition processes of municipal solid waste (MSW) that occurred at semi-solid or solid-state in a bioreactor landfill (BLF). Conceptually, leachate from a BLF is analogous to the urine generated in the 'human body', on which the medical practitioners rely to diagnose and remediate ailments. In line with this practice, to monitor the complex MSW decomposition processes, prolonged investigations were performed to establish the temporal variation of different chemical parameters (such as pH, electrical conductivity, chemical oxygen demand, organic- and inorganic carbon, nitrate- and ammonium-nitrogen, sugars and volatile fatty acids) of the leachate collected from different cells (age≈ 6-48 months) of a fully functional BLF in Mumbai, India. Furthermore, to understand the effect of the climate, MSW composition and landfill operating conditions on the rate of the decomposition process, chemical parameters of the leachate obtained from a landfill located in the central part of Poland were compared with the BLF. The study reveals that the chemical parameters, except for the pH, evince a rapid reduction with time and attain a constant value, which indicates the 'stabilized MSW'. Also, native microorganisms that are an integral part of MSW consume volatile fatty acids within a year in the BLF, which facilitate the rapid transformation of the decomposition process from acidogenesis and acetogenesis to the methanogenesis phase. It is worth iterating here that based on the long-term field study, a convenient and efficient methodology, which is currently missing from the literature, has been established to understand the kinetics of different phases of anaerobic decomposition. This study would be very helpful to the landfill operators, who are interested in accelerating MSW decomposition by augmenting leachate properties.

Sinapis alba L. and Triticum aestivum L. as biotest model species for evaluating municipal solid waste leachate toxicity.

The volume of municipal solid waste (MSW) inputs is rapidly increasing with a growing human population, and its composition is changing due an increased diversity of materials being deposited. There is an associated increase in leachate, a common toxic byproduct of MSW facilities that must be collected and treated prior to its release into the environment. There is growing interest in plant-based methods that are economical and efficient for leachate toxicity assessment such as biological tests that use indicator species. In the present study, the tolerance thresholds of two herbaceous species, Sinapis alba L. (mustard) and Triticum aestivum L. (wheat) to increasing shares of leachate sourced from an MSW facility in the Czech Republic were assessed through a variety of physiological parameters. Soil-based biotests showed a stimulation in the shoot biomass, leaf expansion, primary root elongation and carbon assimilation rate of the selected plant species to leachate concentrations between 20 and 50 %. Higher leachate concentrations led to reductions in most physiological parameters, especially the elongation of seedling roots when growth solutions with >50 % leachate were applied. While S. alba was more sensitive to increasing proportions of leachate in terms of growth parameters of the shoot tissues, photosystem II efficiency and chlorophyll pigment concentrations were more responsive in T. aestivum, indicating species-dependent differences. The present biotests provide further support for the use of both Sinapis alba L and Triticum aestivum L. as indicator species of phytotoxicity.

Municipal solid waste landfill: Evidence of the effect of applied landfill management on vegetation composition.

Proper management of municipal solid waste (MSW) is crucial to avoid pollution, environmental impacts and threat to public health. The problem of MSW is mainly arising from inadequate landfill site management. The objective of this study was to evaluate the impact of management practices and environmental risks at two landfill sites. The landfills were subject to long-term (10 years) vegetation monitoring. The vegetation was assessed using a floristic survey of identified plant species. The vegetation analysis showed that significant differences existed between the two landfill locations, with neophytes, invasive and expansive species dominating on one of the landfill sites, which may be attributed to climatic and geomorphological differences between the two sites, but also to variations in landfill management. These environmentally problematic species can potentially spread from the landfill into adjacent ecosystems, displace native plants and degrade adjacent farmland areas. The study of vegetation monitoring data suggests that, in addition to other types of monitoring, landfills should be subjected to regular vegetation biomonitoring, too. Landfill management practices should target the regulation of unwanted species, create conditions that are favourable to native plant species and provide as early as possible the restoration of filled cells.

Analytical Modelling of MSW Landfill Surface Displacement Based on GNSS Monitoring.

Displacements of landfills play an important role in the reclamation process and geotechnical safety improvement of such sites. Landfill settlements are defined as a vertical displacement of waste body due to compression, degradable nature of the waste, and creep phenomenon of the waste particles. Waste composition is more diverse than natural soil. Thus, it has to be properly placed and compacted since the landfill body will continuously settle down. Several models of the landfill displacement estimation have already been developed. The aim of the present study was: (i) to review the methods of landfill settlements computation and (ii) to propose the model allowing landfill body displacements simulation based on monitoring datasets applying a Global Navigation Satellite Systems (GNSS) measurement. The new model employs Gauss-Newton iteration and Runge-Kutta methods to estimate landfill surface displacements. The objectives were to analyse and mathematically describe the landfill body displacements. The GNSS geodetic survey and computations allowed concluding that the landfill body has been transformed over the years. The results revealed that the curves of waste displacement are in agreement with the measured total displacement of the landfill, and all curves corresponding to waste displacement are perpendicular to the active edge of the landfill. In the period of a maximum of 4.5 years after the waste deposition with a layer of up to 16.2 m thickness, the phenomenon of expansion was observed, which then disappears, and more settlement occurs due to the gravity of upper layers. The analysed landfill as a whole does not experience significant displacements. Neither of the slope failures are observed, even for large inclination.

Factors Associated With the Decision-Making on Endovascular Thrombectomy for the Management of Acute Ischemic Stroke.

Background and Purpose- Little is known about the real-life factors that clinicians use in selection of patients that would receive endovascular treatment (EVT) in the real world. We sought to determine patient, practitioner, and health system factors associated with therapeutic decisions around endovascular treatment. Methods- We conducted a multinational cross-sectional web-based study comprising of 607 clinicians and interventionalists from 38 countries who are directly involved in acute stroke care. Participants were randomly allocated to 10 from a pool of 22 acute stroke case scenarios. Each case was classified as either Class I, Class II, or unknown evidence according to the current guidelines. We used logistic regression analysis applying weight of evidence approach. Main outcome measures were multilevel factors associated with EVT, adherence to current EVT guidelines, and practice gaps between current and ideal practice settings. Results- Of the 1330 invited participants, 607 (45.6%) participants completed the study (53.7% neurologists, 28.5% neurointerventional radiologists, 17.8% other clinicians). The weighed evidence approach revealed that National Institutes of Health Stroke Scale (34.9%), level of evidence (30.2%), ASPECTS (Alberta Stroke Program Early CT Score) or ischemic core volume (22.4%), patient's age (21.6%), and clinicians' experience in EVT use (19.3%) are the most important factors for EVT decision. Of 2208 responses that met Class I evidence for EVT, 1917 (86.8%) were in favor of EVT. In case scenarios with no available guidelines, 1070 of 1380 (77.5%) responses favored EVT. Comparison between current and ideal practice settings revealed a small practice gap (941 of 6070 responses, 15.5%). Conclusions- In this large multinational survey, stroke severity, guideline-based level of evidence, baseline brain imaging, patients' age and physicians' experience were the most relevant factors for EVT decision-making. The high agreement between responses and Class I guideline recommendations and high EVT use even when guidelines were not available reflect the real-world acceptance of EVT as standard of care in patients with disabling acute ischemic stroke.

Collateral Automation for Triage in Stroke: Evaluating Automated Scoring of Collaterals in Acute Stroke on Computed Tomography Scans.

Computed tomography angiography (CTA) collateral scoring can identify patients most likely to benefit from mechanical thrombectomy and those more likely to have good outcomes and ranges from 0 (no collaterals) to 3 (complete collaterals). In this study, we used a machine learning approach to categorise the degree of collateral flow in 98 patients who were eligible for mechanical thrombectomy and generate an e-CTA collateral score (CTA-CS) for each patient (e-STROKE SUITE, Brainomix Ltd., Oxford, UK). Three experienced neuroradiologists (NRs) independently estimated the CTA-CS, first without and then with knowledge of the e-CTA output, before finally agreeing on a consensus score. Addition of the e-CTA improved the intraclass correlation coefficient (ICC) between NRs from 0.58 (0.46-0.67) to 0.77 (0.66-0.85, p = 0.003). Automated e-CTA, without NR input, agreed with the consensus score in 90% of scans with the remaining 10% within 1 point of the consensus (ICC 0.93, 0.90-0.95). Sensitivity and specificity for identifying favourable collateral flow (collateral score 2-3) were 0.99 (0.93-1.00) and 0.94 (0.70-1.00), respectively. e-CTA correlated with the Alberta Stroke Programme Early CT Score (Spearman correlation 0.46, p < 0.001) highlighting the value of good collateral flow in maintaining tissue viability prior to reperfusion. In conclusion, -e-CTA provides a real-time and fully automated approach to collateral scoring with the potential to improve consistency of image interpretation and to independently quantify collateral scores even without expert rater input.

Urgent Direct Access to Diagnostic Services for General Practitioners: Bridging the Gap in Cancer Diagnosis.

Urgent direct access to diagnostic services for general practitioners (GPs) is a new pathway to capture any cancer diagnoses that may have been missed due to vague symptom presentations. Hence, GPs should look out for the key symptoms mentioned by NHS England that should prompt urgent direct access referrals for chest X-ray (CXR), computed tomography (CT) chest, MRI brain, ultrasound (US) abdomen and pelvis, and CT abdomen and pelvis. By implementing this approach, we can significantly reduce the time to diagnosis, while minimizing the number of visits to GP and specialist appointments prior to initiating investigations. However, the use of this pathway can only improve if access to diagnostic scans is improved. This needs to be done by ensuring all GPs in the country have access to directly request MRI brains, CT chest, abdomen, and pelvis. Further research into the impact of the urgent direct access pathway as well as investigating the number of GPs without access to these vital diagnostic services is required to fully improve and measure the progress of this referral pathway.

A Pictorial Essay of Coronary Artery Anomalies on Coronary CT Angiography: A Single-Centre Observational Study.

Background Congenital anomalies of the coronary artery anatomy (CAAs) encompass a spectrum of disorders, often asymptomatic but potentially carrying severe clinical implications such as arrhythmia, chest pain, myocardial infarction, or sudden death. The estimated prevalence of CAAs in the general population ranges from 0.3% to 1.3%, with underdiagnosis in asymptomatic individuals. Multidetector computed tomography angiography (CTA) has emerged as a vital non-invasive tool for diagnosing and characterising CAAs, offering improved visualisation and aiding in appropriate management decisions. This study aims to analyse the spectrum of CAAs in a tertiary care setting, focusing on imaging features, prevalence, and potential clinical significance, utilising data from patients who underwent multidetector CTA. Methodology A single-centre, retrospective analysis of consecutive coronary angiograms over a five-year period identified patients with CAAs, with imaging conducted using a 128-slice, single-source CT scanner. Detailed imaging evaluation was performed by experienced radiologists, with anomalies classified according to established criteria. Results Among 756 coronary CTA examinations analysed, 37 instances of anomalous coronary vessels were identified. The study revealed a diverse range of anomalies, including myocardial bridging, anomalous origin of coronary arteries, and extracardiac abnormalities. Conclusions This study contributes valuable insights into the prevalence and imaging features of CAAs, enhancing our understanding of these anomalies and guiding improved patient outcomes in cardiovascular care. Future research should focus on elucidating pathophysiological mechanisms and establishing multicenter registries to address the challenges associated with studying these infrequent but clinically significant anomalies.

Can Short Tau Inversion Recovery (STIR) Imaging Be Used as a Stand-Alone Sequence To Assess a Perianal Fistulous Tract on MRI? A Retrospective Cohort Study Comparing STIR and T1-Post Contrast Imaging.

INTRODUCTION: Perianal fistulas demand precise preoperative assessment for optimal surgical outcomes. MRI, using Short Tau Inversion Recovery (STIR) and T1-post contrast sequences, plays a crucial role in this evaluation.This retrospective cohort study compared STIR imaging's diagnostic efficacy with T1-post contrast sequences in identifying perianal fistulous tracts. The study investigated whether STIR imaging could serve as the sole diagnostic sequence, simplifying clinical practice. METHODS: In a tertiary care hospital, 100 patients underwent pelvic MRI for suspected perianal fistulas. Radiologists independently evaluated STIR and T1-post contrast sequences for internal openings, tract extent, distinction, abscess presence, and tract type. Sensitivity, specificity, area under the curve (AUC), and Cohen's kappa analysis were used for diagnostic assessment. RESULTS: STIR imaging showed notable sensitivity (79.8-97.9%) and specificity (100%) for identifying internal openings and tracts. Combined with T1-post contrast, diagnostic accuracy improved significantly, with near-perfect AUC values. Kappa values indicated moderate to substantial agreement between radiological assessments and clinical diagnosis. The combined sequences achieved 100% sensitivity and specificity for tract visualization. CONCLUSION: STIR imaging presents promise as a singular diagnostic tool for perianal fistulas, especially when combined with T1-post contrast sequences. While offering potential clinical diagnosis simplifications, further studies are warranted to validate its utility and ensure comprehensive diagnostic accuracy.

Potentially toxic elements (PTEs) and ecological risk at waste disposal sites: An analysis of sanitary landfills.

This study presents an analysis of soil contamination caused by Ni, Zn, Cd, Cu, and Pb at municipal solid waste (MSW) landfills, with a focus on ecological risk assessment. The approach aims to assess how different landfill practices and environmental conditions affect soil contamination with potentially toxic elements (PTEs) and associated environmental risks. Soil samples were collected from MSW landfills in Poland and the Czech Republic. The research included a comprehensive assessment of PTEs in soils in the context of global environmental regulations. The degree of soil contamination by PTEs was assessed using indices: Geoaccumulation Index (Igeo), Single Pollution Index (Pi), Nemerow Pollution Index (PN), and Load Capacity of a Pollutant (PLI). The ecological risk was determined using the Risk of PTEs (ERi) and Sum of Individual Potential Risk Factors (ERI). The maximum values of the indicators observed for the Radiowo landfill were as follows: Igeo = 4.04 for Cd, Pi = 24.80 for Cd, PN = 18.22 for Cd, PLI = 2.66, ERi = 744 for Cd, ERI = 771.80. The maximum values of the indicators observed for the Zdounky landfill were as follows: Igeo = 1.04 for Cu, Pi = 3.10 for Cu, PN = 2.52 for Cu, PLI = 0.27, ERi = 25 for Cd, ERI = 41.86. The soils of the tested landfills were considered to be non-saline, with electrical conductivity (EC) values less than 2,000 µS/cm. Varying levels of PTEs were observed, and geostatistical analysis highlighted hotspots indicating pollution sources. Elevated concentrations of Cd in the soil indicated potential ecological risks. Concentrations of Cu and lead Pb were well below the thresholds set by the environmental legislation in several countries. In addition, Ni concentrations in the soils of both landfills indicated that the average levels were within acceptable limits. Principal Component Analysis (PCA) revealed common sources of PTEs. The identification of specific risk points at the Radiowo and Zdounky sites contributes to a better understanding of potential hazards in landfill environments. By establishing buffer zones and implementing regular maintenance programs, emerging environmental problems can be addressed in a timely manner.

Exploring symptomatology and innovative treatment modalities for prefrontal cortex lesions: a systematic review.

BACKGROUND: Pre-frontal cortex operates a combination of emotional, cognitive and behavioural functions. Understanding the symptoms of pre-frontal cortex lesions serves as paramount for accurate diagnosis and management. AIMS: This review aims to determine an association between the causes of prefrontal cortex lesions and the resulting symptoms, as well as the ideal form of treatment. STUDY DESIGN: A systematic review through utilisation of 3 databases was done using the keywords "Prefrontal cortex lesions," "dysfunction," "symptoms," &" treatment". METHODOLOGY: RCTs, observational studies, and systematic reviews were searched using Cochrane/EMBASE, PubMed/Medline, and Pedro between 1948 and2024. Studies published in English only were included, and two reviewers were involved in the data extraction process. RESULTS: Results showed a notable correlation between right-handed individuals and prefrontal cortex lesions with cognition impairment, particularly executive dysfunction, being the most prevalent symptom. Emotional instability followed as the second most common issue, while aphasia remained the primary language deficit. Noninvasive brain stimulation emerged as an effective treatment option for various prefrontal cortex-related disorders. CONCLUSION: Further investigation is needed to understand the mechanism linking handedness to lesion occurrence. Noninvasive brain stimulation should be prioritised for treating prefrontal injuries.