Comparison of imaging modalities for the accurate delineation of arteriovenous malformations (AVM) and evaluation of setup accuracy with reference to non-invasive LINAC-based stereotactic radiosurgery (SRS).

AIMS: To compare the accuracy of nidus delineation using magnetic resonance angiography (MRA) to digital subtraction angiography (DSA) and to evaluate setup accuracy of non-invasive frame SRS treatments. SETTINGS AND DESIGN: A prospective observational study of 16 patients who underwent non-invasive frame LINAC-based SRS for brain AVMs. MATERIALS AND METHODS: The nidus was separately delineated using DSA and MRA after co-registration onto CT simulation images and compared with respect to their volume and maximum diameters. During treatment, the setup errors observed in x-, y-, and z-directions were recorded. STATISTICAL ANALYSIS: Paired t-test (to compare volume and maximum diameter). Wilcoxon signed-rank test (for setup accuracy). RESULTS: The mean volume of nidus contoured in MRA was 4.16 cc compared to 3.11 cc in DSA (P 0.297). The mean maximum diameters using MRA and DSA, respectively, in antro-posterior, cranio- caudal, and transverse diameters were 21.97 cc vs. 19.46 cc (P 0.2380), 6.59 cc vs. 9.63 cc (P 0.161), and 18.87 cc vs. 16.81 cc (P 0.178). But these modalities can potentially misinterpret the nidus volume, warranting caution for use of either modality alone. The mean translational shift observed in the x-, y-, and z-directions were 0.06 mm, 0.13 mm, and 0.13 mm, respectively, when couch was brought to neutral position after clockwise couch rotation and 0.07, 0, and 0, respectively, after counterclockwise couch rotation. CONCLUSION: This study could not demonstrate any statistically significant differences in nidus delineation between MRA and DSA. Setup accuracy achieved with non-invasive thermoplastic mask-based immobilization is within acceptable limits for SRS.

Gender specific SNP markers in Coscinium fenestratum (Gaertn.) Colebr. for resource augmentation.

BACKGROUND: Unregulated extraction of highly traded medicinal plant species results in drastic decline of the natural resources and alters viable sex ratio of populations. Conservation and long-term survival of such species, require gender specific restoration programs to ensure reproductive success. However, it is often difficult to differentiate sex of individuals before reaching reproductive maturity. C. fenestratum is one of the medicinally important and overexploited dioecious woody liana, with a reproductive maturity of 15 years. Currently, no information is available to identify sex of C. fenestratum in seedling stage while augmenting the resources. Thus, the current study envisages to utilize transcriptomics approach for gender differentiation which is imperative for undertaking viable resource augmentation programmes. METHODS AND RESULTS: Gender specific SNPs with probable role in sexual reproduction/sex determination was located using comparative transcriptomics approach (sampling male and female individuals), alongside gene ontology and annotation. Nine sets of primers were synthesized from 7 transcripts (involved in sexual reproduction/other biological process) containing multiple SNP variants. Out of the nine primer pairs, only one SNP locus with no available information of its role in reproduction, showed consistent and accurate results (males-heterozygous and females-homozygous), in the analyzed 40 matured individuals of known sexes. Thus validated the efficiency of this SNP marker in differentiating male and female individuals. CONCLUSIONS: The study could identify SNPs linked to the loci with apparent role in gender differentiation. This SNP marker can be used for early sexing of seedlings for in-situ conservation and resource augmentation of C. fenestratum in Kerala, India.

The efficacy of machine learning algorithm for raw drug authentication in Coscinium fenestratum (Gaertn.) Colebr. employing a DNA barcode database.

Medicinal plants are a valuable resource for traditional as well as modern medicine. Consequently huge demand has exerted a heavy strain on the existing natural resources. Due to over exploitation and unscientific collection most of the commercially traded ayurvedic plants are in the phase of depletion. Adulteration of expensive raw drugs with inferior taxa has become a common practice to meet the annual demand of the ayurvedic industry. Although there are several recommended methods for proper identification varying from the traditional taxonomic to organoleptic and physiochemical, it is difficult to authenticate ayurvedic raw drugs available in extremely dried, powdered or shredded forms. In this regard, the study addresses proper authentication and illicit trade in Coscinium fenestratum (Gaertn.) Colebr. using CBOL recommended standard barcode regions viz. nuclear ribosomal-Internally Transcribed Spacer (nrDNA- ITS), maturase K (matK), ribulose-1,5-bisphosphate carboxylase/oxygenase large subunit (rbcL), and psbA-trnH spacer regions. Further, an integrated analytical approach employing Maximum Likelihood phylogenetic tree and Machine Learning Approach, Waikato Environment for Knowledge Analysis was employed to prove efficacy of the method. The automated species identification technique, Artificial Intelligence uses the ability of computers to build models that can receive the input data and then conduct statistical analyses which significantly reduces the human labour. Concurrently, scientific management, restoration, cultivation and conservation measures should be given utmost priority to reduce the depletion of wild resources as well as to meet the rapidly increasing demand of the herbal industries.

Role of chest X-ray in citing central venous catheter tip: A few case reports with a brief review of the literature.

Central venous catheter (CVC) insertions are increasingly performed in surgical patients and intensive therapy. A simple and invasive procedure performed under strict sterile precautions with complications ranging from arrhythmias; infections; and life-threatening complications such as pericardial tamponade, cardiac perforation and even death. A post-procedure chest X-ray (CXR), though does not accurately assess the tip of the catheter in relation to the superior vena cava (SVC) and right atrium (RA), can detect malpositions, safety of catheter tip, pneumothorax and kinking. We would like to share some of the malpositions we encountered in our centre, their management and a brief review of the literature on optimal catheter tip location.

Primary intravascular large B-cell lymphoma of pituitary.

A 68-year-old retired nurse, who was a known hypertensive on medication, presented with prolonged fever of 2-month duration without any clinical evidence of infection. On examination she had altered mental status. She also had other nonspecific complaints such as sleep disturbances, loss of weight, etc. On investigation, she was found to have anemia, thrombocytopenia, raised erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) values. She also had electrolyte imbalance. Radiological evaluation of brain showed mass lesion in the sella turcica, suggestive of pituitary adenoma. Biochemical evaluation showed hypopituitarism. Trans-sphenoidal biopsy was done. Based on histopathological and immunohistochemical findings a diagnosis of intravascular large B-cell lymphoma (IVLBCL) of pituitary was made. Our patient's condition deteriorated rapidly and she succumbed to her illness before therapy could be initiated. We are reporting this case because of the rare subtype of large B-cell lymphoma presenting at an extremely unusual primary site.