Multi-modal medical image fusion using improved dual-channel PCNN.

This paper proposes a medical image fusion method in the non-subsampled shearlet transform (NSST) domain to combine a gray-scale image with the respective pseudo-color image obtained through different imaging modalities. The proposed method applies a novel improved dual-channel pulse-coupled neural network (IDPCNN) model to fuse the high-pass sub-images, whereas the Prewitt operator is combined with maximum regional energy (MRE) to construct the fused low-pass sub-image. First, the gray-scale image and luminance of the pseudo-color image are decomposed using NSST to find the respective sub-images. Second, the low-pass sub-images are fused by the Prewitt operator and MRE-based rule. Third, the proposed IDPCNN is utilized to get the fused high-pass sub-images from the respective high-pass sub-images. Fourth, the luminance of the fused image is obtained by applying inverse NSST on the fused sub-images, which is combined with the chrominance components of the pseudo-color image to construct the fused image. A total of 28 diverse medical image pairs, 11 existing methods, and nine objective metrics are used in the experiment. Qualitative and quantitative fusion results show that the proposed method is competitive with and even outpaces some of the existing medical fusion approaches. It is also shown that the proposed method efficiently combines two gray-scale images.

Insight of PBZ mediated drought amelioration in crop plants.

Water scarcity is a significant environmental limitation to plant productivity as drought-induced crop output losses are likely to outnumber losses from all other factors. In this context, triazole compounds have recently been discovered to act as plant growth regulators and multi-stress protectants such as heat, chilling, drought, waterlogging, heavy metals, etc. Paclobutrazol (PBZ) [(2RS, 3RS)-1-(4-chlorophenyl)- 4, 4-dimethyl-2-(1H-1, 2, 4-trizol-1-yl)-pentan-3-ol)] disrupts the isoprenoid pathway by blocking ent-kaurene synthesis, affecting gibberellic acid (GA) and abscisic acid (ABA) hormone levels. PBZ affects the level of ethylene and cytokinin by interfering with their biosynthesis pathways. Through a variety of physiological responses, PBZ improves plant survival under drought. Some of the documented responses include a decrease in transpiration rate (due to reduced leaf area), higher diffusive resistance, relieving reduction in water potential, greater relative water content, less water use, and increased antioxidant activity. We examined and discussed current findings as well as the prospective application of PBZ in regulating crop growth and ameliorating abiotic stresses in this review. Furthermore, the influence of PBZ on numerous biochemical, physiological, and molecular processes is thoroughly investigated, resulting in increased crop yield.

Isolation and characterization of drought and ABA responsive promoter of a transcription factor encoding gene from rice.

Water deficit is a significant impediment to enhancing rice yield. Genetic engineering tools have enabled agriculture researchers to develop drought-tolerant cultivars of rice. A common strategy to achieve this involves expressing drought-tolerant genes driven by constitutive promoters such as CaMV35S. However, the use of constitutive promoters is often limited by the adverse effects it has on the growth and development of the plant. Additionally, it has been observed that monocot-derived promoters are more successful in driving gene expression in monocots than in dicots. Substitution of constitutive promoters with stress-inducible promoters is the currently used strategy to overcome this limitation. In the present study, a 1514 bp AP2/ERF promoter that drives the expression of a transcription factor was cloned and characterized from drought-tolerant Indian rice genotype N22. The AP2/ERF promoter was fused to the GUS gene (uidA) and transformed in Arabidopsis and rice plants. Histochemical GUS staining of transgenic Arabidopsis plants showed AP2/ERF promoter activity in roots, stems, and leaves. Water deficit stress and ABA upregulate promoter activity in transformed Arabidopsis and rice. Quantitative PCR for uidA expression confirmed induced GUS activity in Arabidopsis and rice. This study showed that water deficit inducible Os-AP2/ERF-N22 promoter can be used to overcome the limitations of constitutive promoters. Transformants overexpressing Os-AP2/ERF-N22 showed higher relative water content, membrane stability index, total chlorophyll content, chlorophyll stability index, wax content, osmotic potential, stomatal conductance, transpiration rate, photosynthetic rate and radical scavenging activity. Drought tolerant (N22) showed higher expression of Os-AP2/ERF-N22 than the susceptible (MTU1010) cultivar. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-022-01246-9.

Surgery or Endovascular Therapy for Chronic Limb-Threatening Ischemia.

BACKGROUND: Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes. METHODS: In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event - which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) - or death from any cause. RESULTS: In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P<0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P = 0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts. CONCLUSIONS: Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).

On-farm hydro and nutri-priming increases yield of rainfed pearl millet through physio-biochemical adjustments and anti-oxidative defense mechanism.

Seed priming technique has a marvelous potential in enhancing seed germination and crop establishment under limited soil moisture conditions, which ultimately increases yield. Therefore, we investigated the effects of seed priming on physiology, growth, yield and antioxidant defense system of pearl millet (Pennisetum glaucum L.) under rain-fed condition. The experiments were conducted under laboratory as well as field conditions comprising three treatments i.e., non-primed seeds (control, T0), priming with tap water (hydropriming) (T1) and priming with 2% KNO3 2% for 6 hours at 25°C followed by shade drying (T2). The results showed that chlorophyll content (10.37-14.15%) and relative water content (RWC) (12.70-13.01%) increased whereas proline (-19.44 to -25%) and soluble sugar (-15.51 to -29.13%) contents decreased on account of seed priming in pearl millet under field conditions. The seed priming significantly improved the plant height, final plant stand and grain weight which resulted in increased yield. Enhanced activities of superoxide dismutase (SOD) (5.89 to 8.10 unit/g/seed/min), catalase (CAT) (22.54 to 39.67 µmol/min/g/seed) and ascorbate peroxidase (APX) (8.92 to 22.10 µmol/cm/min/g) and concomitant decrease in H2O2 and malondialdehyde (MDA) content suggests their role in imparting oxidative tolerance at initial stages of growth in primed seed. The lab studies suggest that the improved yield might be attributes to increased seed germination and seedling vigor. It is recommended that the hydropriming (tap water) or KNO3 (2%) priming of seeds for 6 hours under ambient conditions is effective to enhance growth and yield of pearl millet under rainfed conditions.

Can a signature molecular-profile define disparate survival in BRAF-positive Gliosarcoma and identify novel targets for therapeutic intervention?

Purpose: Gliosarcoma (GS) has a low incidence but is aggressively invasive, with poor-survival. Even though GS is recognized as a different subgroup from glioblastoma (GB), there is no molecular panel available to define its clinical outcome. The objective was to identify the molecular imprint of GS in terms of expression of human telomerase reverse transcriptase (hTERT), high mobility group A1 (HMGA-1), kinesin superfamily protein-14 (KIF-14), epidermal growth factor receptor (EGFR) markers with reference to disparate prognosis and identify plausible targets for intervention. Materials and Methods: We retrieved 9-GS samples from a cohort of 57-GB patients during a 36 months study period and compared them with 10 molecularly typed GB-samples and 15 controls. Conventional-immunohistochemistry (IHC) was used for histopathology of GS and immunofluorescence-IHC was performed for quantification of identified marker-panel. Statistical tools for non-parametric data were used for inferring results. Results: GS was confirmed by reticulin-staining and positivity for glial fibrillary acidic protein, Vimentin, smooth muscle actin. Immune-reactivity for BRAF-V600Ewas present in both glial and sarcomatous cells and negative expression of isocitrate dehydrogenase, ATRX, TP53.Comparison between GS, GB, and control tissues showed that the expression of markers reached significance (P < 0.0001), without the influence of confounders. Significant correlation of EGFR was found with hTERT (r = 0.77), HMGA-1 (r = 0.72), KIF-14 (r = 0.82) suggesting that their combined analysis can define prognosis. To establish the diagnostic accuracy (threshold ≥80% specificity), AUC for EGFR was 0.78 (>3.95), KIF-14 0.97 (>7.45), hTERT 0.63 (>23.86), and HMGA-1 0.53 (>15.45). Conclusion: This is the first evidence-based investigation presenting differential expression of proliferation and stemness markers hTERT, HMGA-1, KIF-14 in-correlation with EGFR, indicating a plausible-association between survival and disease-progression in individual GS-cases. It can serve as a model for further studies in this glioma-subgroup and the designing of a target panel for personalized treatment.

Impacts, Tolerance, Adaptation, and Mitigation of Heat Stress on Wheat under Changing Climates.

Heat stress (HS) is one of the major abiotic stresses affecting the production and quality of wheat. Rising temperatures are particularly threatening to wheat production. A detailed overview of morpho-physio-biochemical responses of wheat to HS is critical to identify various tolerance mechanisms and their use in identifying strategies to safeguard wheat production under changing climates. The development of thermotolerant wheat cultivars using conventional or molecular breeding and transgenic approaches is promising. Over the last decade, different omics approaches have revolutionized the way plant breeders and biotechnologists investigate underlying stress tolerance mechanisms and cellular homeostasis. Therefore, developing genomics, transcriptomics, proteomics, and metabolomics data sets and a deeper understanding of HS tolerance mechanisms of different wheat cultivars are needed. The most reliable method to improve plant resilience to HS must include agronomic management strategies, such as the adoption of climate-smart cultivation practices and use of osmoprotectants and cultured soil microbes. However, looking at the complex nature of HS, the adoption of a holistic approach integrating outcomes of breeding, physiological, agronomical, and biotechnological options is required. Our review aims to provide insights concerning morpho-physiological and molecular impacts, tolerance mechanisms, and adaptation strategies of HS in wheat. This review will help scientific communities in the identification, development, and promotion of thermotolerant wheat cultivars and management strategies to minimize negative impacts of HS.

Novel molecular panel for evaluating systemic inflammation and survival in therapy naïve glioma patients.

BACKGROUND: Inflammation is crucial to tumor progression. A traumatic event at a specific site in the brain activates the signaling molecules, which triggers inflammation as the initial response within the tumor and its surroundings. The educated immune cells and secreted proteins then initiate the inflammatory cascade leading to persistent chronic inflammation. Therefore, estimation of the circulating inflammatory indicators kynurenine (KYN), interleukin-6 (IL-6), tissue-inhibitor of matrix-metalloproteinase-1 and human telomerase reverse transcriptase (hTERT) along with neutrophil-lymphocyte ratio (NLR) has prognostic value. AIM: To assess the utility of chosen inflammatory marker panel in estimating systemic inflammation. METHODS: The chosen markers were quantitatively evaluated in 90 naive, molecularly sub-typed plasma samples of glioma. A correlation between the markers and confounders was assessed to establish their prognostication power. Follow-up on the levels of the indicators was done 3-mo post-surgery. To establish the validity of circulating KYN, it was also screened qualitatively by dot-immune-assay and by immunofluorescence-immunohistochemistry in tumor tissues. RESULTS: Median values of circulating KYN, IL-6, hTERT, tissue-inhibitor of matrix-metalloproteinase-1 and NLR in isocitrate-dehydrogenase-mutant/wildtype and within the astrocytic sub-groups were estimated, which differed from controls, reaching statistical significance (P < 0.0001). All markers negatively correlated with mortality (P < 0.0001). Applying combination-statistics, the panel of KYN, IL-6, hTERT and NLR achieved higher sensitivity and specificity (> 90%) than stand-alone markers, to define survival. The inflammatory panel could discriminate between WHO grades, and isocitrate-dehydrogenase-mutant/wildtype and define differential survival between astrocytic isocitrate-dehydrogenase-mutant/wildtype. Therefore, its assessment for precise disease prognosis is indicated. Association of KYN with NLR, IL-6 and hTERT was significant. Cox-regression described KYN, IL-6, NLR, and hTERT as good prognostic markers, independent of confounders. Multivariate linear-regression analysis confirmed the association of KYN and hTERT with inflammation marker IL-6.There was a concomitant significant decrease in their levels in a 3-mo follow-up. CONCLUSION: The first evidence-based study of circulating-KYN in molecularly defined gliomas, wherein the tissue expression was found to be concomitant with plasma levels. A non-invasive model for assessing indicators of chronic systemic inflammation is proposed.

Plant-Based Antioxidant Extracts and Compounds in the Management of Oral Cancer.

Oral cancer continues to be a leading cause of death worldwide, and its prevalence is particularly high in developing countries, where people chew tobacco and betel nut on a regular basis. Radiation-, chemo-, targeted-, immuno-, and hormone-based therapies along with surgery are commonly used as part of a treatment plan. However, these treatments frequently result in various unwanted short- to long-term side effects. As a result, there is an urgent need to develop treatment options for oral cancer that have little or no adverse effects. Numerous bioactive compounds derived from various plants have recently attracted attention as therapeutic options for cancer treatment. Antioxidants found in medicinal plants, such as vitamins E, C, and A, reduce damage to the mucosa by neutralizing free radicals found in various oral mucosal lesions. Phytochemicals found in medicinal plants have the potential to modulate cellular signalling pathways that alter the cellular defence mechanisms to protect normal cells from reactive oxygen species (ROS) and induce apoptosis in cancer cells. This review aims to provide a comprehensive overview of various medicinal plants and phytoconstituents that have shown the potential to be used as oral cancer therapeutics.

Modified Method of Multiple Cranial Burr Holes for Treatment of Total Scalp Avulsion.

Scalp avulsion is a rare but severe injury. It usually happens while using industrial or agriculture machinery. Scalp avulsion results from hair entrapment in a rotating machine. There are various options for treatment of scalp avulsion. Herein, the authors present a case of total scalp avulsion which was treated by multiple trephination technique using neurosurgical burr.

The "two-cut monorail" technique, for the over-the-wire removal of the Impella CP device.

The Impella is a percutaneously placed intra-arterial flow pump positioned across the aortic valve for circulatory support. A limitation of the Impella is that it lacks a central wire channel, to maintain intra-arterial wire access when removing the device. Open surgical arterial cutdown is needed for the removal of the Impella CP placed emergently, without the use of preclose sutures. This case review describes an alternative removal method for the aforementioned occasions.

Outcome of care in an apex tertiary care referral institute of North India - A study of 90,000 patients.

INTRODUCTION: Outcome of care is an important measure of quality in health care and also provides input for healthcare planning. It is an indicator which can be used for comparing performance of various hospital/Institute. AIMS: Study intended to analyze the morbidity and mortality pattern among admitted patients with respect to selected hospital indices. STUDY SETTINGS: All India Institute of Medical Sciences (AIIMS), New Delhi. SUBJECTS AND METHODS: A cross-sectional retrospective study was conducted in 93,223 patients admitted at AIIMS, New Delhi. Information provided in Management Information System (MIS) was used for analysing morbidity as per International Statistical Classification of Diseases (ICD)-10. RESULTS: Diseases related to the genitourinary system (14.25%) and neoplasms (14.18%) were the most common cause of admissions. Overall, predominance of adult age group (61.6%) followed by geriatric age group (20.5%) was observed. Male predominance was observed in diseases related to mental, behavioural, and neurodevelopmental disorders (89.2%). Overall, median length of stay was calculated to be 4 days (mean LOS-7 days), maximum for diseases related to mental, behavioural, and neurodevelopmental disorders (median 13 days). Gross and net death rate for admitted patients was calculated to be 4.3% and 3%, respectively, with maximum rate for diseases related to respiratory system (22.7% and 17%). CONCLUSIONS: Analysis of morbidity and mortality in high volume tertiary care centers and segregation of the patients according to their ailment and disease behaviour helps in establishing priorities in healthcare delivery system and thus allocating limited resources accordingly.

Renal salvage using stent graft placement after acute renal artery occlusion with prolonged ischemic time.

PURPOSE: To describe a patient with acute renal artery occlusion who underwent successful revascularization procedure after experiencing a protracted ischemic period, which resulted in successful retrieval of renal function. CASE REPORT: A 58-year-old male with a history of left renal artery stenosis and stent graft placement presented with symptoms of chest pain, shortness of breath, and flank pain. The patient was admitted to the Intensive Care Unit with the diagnosis of multiorgan failure and subsequent anuria that led to the initiation of hemodialysis. Computed tomography angiography demonstrated an aortic occlusion along with bilateral proximal renal artery occlusion with reconstitution of the mid to distal renal arteries via collateralization. The patient underwent angioplasty with bilateral renal artery stent-graft placement and successful revascularization of proximal renal arteries. Post-operatively, his renal function and urine output improved, and the patient was able to be weaned off hemodialysis along with the benefit of concurrent amelioration of his renovascular hypertension. CONCLUSION: For select patients with renal artery occlusion, revascularization of the renal arteries may result in dialysis independence and stabilization of renovascular hypertension, despite prolonged time of ischemia.

Cementoblastoma of a primary molar: A rare pediatric occurrence.

Cementoblastoma is a relatively uncommon, benign odontogenic mesenchymal tumor that is associated with and attached to the roots of teeth. It is considered to be the only true neoplasm of cemental origin. Its prevalence has been reported to vary from 0.69% to 8% of all odontogenic tumors. The tumor is frequently seen in the second and third decades of life and affects the molar and premolar regions of the mandible predominantly. We herein describe a case of cementoblastoma occurring in association with primary teeth in a 5-year-old male patient with a brief review of literature. Only 20 cases of cementoblastoma involving primary teeth were found after the English literature search, the current case being the 21st. Moreover, the deciduous teeth-associated cementoblastomas (14 out of 20) show a distinct predilection for the right side of the face. The current case is the seventh one to involve the left side.

Spontaneous resolution of idiopathic aortitis and pitfalls in diagnosis.

Idiopathic aortitis is an inflammatory disease of the aorta that is diagnosed after the less frequent infectious and rheumatologic variants are excluded. The etiology and natural history of the disease are poorly understood, and its presentation is variable; the need for exclusion of infectious, malignant, and rheumatologic causes can make its evaluation and diagnosis challenging. Treatment is tailored to the diagnosis and may include observation, antimicrobial therapies, and immunosuppressive agents when appropriate. Operative therapy is rarely needed and reserved for symptomatic patients or instances in which infection cannot be excluded. We present a case of idiopathic aortitis that resolved spontaneously with expectant management and discuss the pitfalls in the diagnosis and care of the disease.

Novel open technique for repair of endograft migration.

Widespread adoption of endovascular aneurysm repair has led to increased incidence of late complications, such as endograft migration. Treatment options have to be tailored to the patient's health, quality of proximal aorta, and extent of migration. Complete or partial endograft removal is associated with significant morbidity and mortality. We describe a case in which open repair with endograft preservation was employed, with the additional benefit of a sutured proximal anastomosis.

Lumbar Spine Surgeries Under Spinal Anesthesia in High-Risk Patients: A Retrospective Analysis.

OBJECTIVE: To determine outcomes of spinal anesthesia (SA) in high-risk patients undergoing lumbar spine surgery in whom general anesthesia (GA) was contraindicated. METHODS: A retrospective study was conducted in Bansal Hospital, Bhopal, India. SA was achieved with a heavy spinal dose of bupivacaine administered in the sitting position. After assessing sensory level, patients were placed into prone position. Throughout surgery, hemodynamic parameters were monitored. At the end of surgery, patients were placed into supine position and taken out of the operating room for monitoring in the recovery room. Postoperatively, time spent in the postanesthesia care unit, hemodynamic changes, incidence of nausea and vomiting, urinary retention, spinal headache, analgesic use, regression of sensory block, and length of hospital stay were documented. Patient and surgeon satisfaction was also assessed. RESULTS: The study included 18 high-risk patients with lumbar spine disease. Twelve patients were classified as American Society of Anesthesiologists IV, and 6 were classified as American Society of Anesthesiologists III. Ten patients underwent microdiscectomy, and 8 patients underwent canal and lateral recess decompression. None of the patients had anesthetic or surgical complications. Postoperative pain relief was excellent. There were no incidences of postoperative vomiting or urinary retention. Only 2 patients (11.11%) developed nausea. Both surgeons and patients reported a high level of satisfaction. SA was 12% cheaper than general anesthesia. CONCLUSIONS: SA is a safe, reliable, and satisfactory alternative to general anesthesia in high-risk lumbar spine surgeries. Postoperative morbidity and mortality can be reduced by SA and spinal analgesia techniques. SA allows good perioperative hemodynamic stability. It is also more cost-effective.

Midline Posterior Fossa Mature Teratoma in a Child.

Teratomas are germ cell tumors commonly composed of cell types derived from all of the three germ layers. Intracerebral teratomas typically present in midline or paraxial lesions located in the pituitary stalk or the pineal region. Teratoma in posterior fossa is a rare entity. We reported a case of midline posterior fossa mature teratoma in a 3-month-old child.

Clinical Experience of Autologous Blood Transfusion in Neurosurgery: Prospective Study in Central India.

OBJECTIVE: To evaluate the benefits of intraoperative autologous blood transfusion in intracranial procedures and to conserve precious homologous blood due to shortage of donor and associated complications. METHODS: This was a prospective study performed at Bansal Hospital, Bhopal. Predetermined autologous blood was collected in a well-labeled bag containing citrate phosphate dextrose adenine solution after induction of general anesthesia. Then appropriate amount of crystalloid solution was transfused in to the body. All collected autologous blood was transfused back to the patient at the end of the surgery or during the surgery if excessive blood loss occurred. Demographic data, hemodynamic changes (mean arterial pressure, heart rate) before and after donation, complications, and any additional homologous blood requirement were noted. Pre- and postoperative hemoglobin and hematocrit values were compared. RESULTS: In total, 32 patients were included in this study. In our study, mean age was 48.87 years; male-to-female ratio was 1:1.4. The mean amount of autologous blood collected was 461 mL, and the mean amount of blood loss during surgery was 1048 mL. In our study, there was no statistically significant difference was found in mean arterial pressure and heart rate before and after autologous blood collection (P > 0.05). When we compared pre- and postoperative mean hemoglobin and hematocrit levels, there was a statistically significant difference present (P < 0.05); this was due to the fact that many patients had meningiomas (15 of 32). Additional homologous blood was required only in 25% of cases (8/32). Of 8 patients, 5 were again cases of deep-seated meningiomas. No complications were observed during or after autologous blood collection. CONCLUSIONS: Autologous blood transfusion is a safe, effective, and affordable method of blood transfusion in patients undergoing intracranial surgery. Complications associated with homologous blood transfusion can be avoided with autologous blood transfusion.