Radiographic Anatomy of the Common Carotid Artery for Direct Carotid Puncture.

BACKGROUND: Direct common carotid artery puncture (DCP) is conventionally used as a bailout technique in stroke patients. However, little is known about the relevant anatomy. OBJECTIVE: Examine the relationship of the common carotid artery (CCA) to surrounding structures based on different DCP trajectories passing through the artery's center. METHODS: Fifty randomly selected head/neck CTAs were analyzed. The trajectory of DCP and relationship to the internal jugular vein (IJV) and thyroid were analyzed at 1 cm intervals above the clavicle on 7 axial sections. Using the trans-carotid sagittal plane (TCSP) as the 0° trajectory, we plotted 3 additional trajectories at 30° intervals and the relationship with the IJV and thyroid proximity was graded as following: 0 = absent, 1 = adjacent, and 2 = crossing. The CCA tortuosity index (TI) was also analyzed for each vessel. RESULTS: Analysis of 2800 trajectories across 100 CCAs showed that the IJV and thyroid were least encountered on the axial sections 2 cm above the clavicle, at 0° on the right (9 thyroids and 6 IJV), and at 90° on the left (0 Thyroids and 14 IJVs). The TI of the CCA was significantly lower above the clavicle than its entire length (p<0.001). CONCLUSION: DCP performed 2 cm above the clavicle at 0° on the right, and 90° on the left appears to minimize encounters with the IJV and thyroid gland, reducing potential complications. However, despite these findings, ultrasound guidance remains vital for DCP safety. Further focus on endovascular device safety in DCP is needed.

Comparative evaluation of the effects of different torque settings on dentinal crack formation using single- and multi-file system: An in vitro study.

Context: To improve efficiency, biomechanical preparation in root canal treatment is shifting from manual SS to nickel-titanium (NiTi) rotary devices. While multi-file NiTi systems entail crack and fracture issues, modern single-file systems address these concerns. Aims: The aim of this study was to evaluate and compare the effects of different torque settings on dentinal crack formation using single-file systems (SFS) (One Curve [OC]) and multi-file systems (ProTaper Next [PTN]) at different levels of the tooth. Subjects and Methods: The study was conducted on 45 freshly extracted human mandibular premolars divided into groups: OC at minimal and maximal torque, PTN at minimal and maximal torque, and a control group. After canal preparation, teeth were horizontally sectioned at 3, 6, and 9 mm from the apex, and then examined for cracks using a stereomicroscope. Statistical Analysis Used: This was analyzed using Chi-square test. Results: PTN group: Highest crack rates at the middle (55.6%) and apical (77.8%) thirds with maximum torque; OC group: Highest rates at the middle (22.2%) with minimal torque and apical (11.1%) with maximum torque. Conclusions: Maximal torque settings had more incidence of cracks compared to minimal torque settings. It can be stated that SFS (OC) produced less cracks compared to multi-file system (PTN) at both minimal and maximal torque settings.

Potential Role of Bone Scintigraphy in the Diagnosis of Calciphylaxis.

Nonosseous abnormalities are often seen on bone scans and can be related to a wide variety of pathology ranging across vascular, infection, and inflammatory etiology. Diffuse soft tissue radiotracer uptake on bone scans is typically attributed to renal or metabolic derangements. Calciphylaxis is the deposition of calcium in small blood vessels, skin, and other organs leading to vascular obstruction and skin necrosis. It is a rare disorder with unknown pathophysiology. Diagnosis of calciphylaxis is challenging and requires an interdisciplinary approach including clinical findings, laboratory results, medical imaging, and skin biopsy. An early diagnosis is important as the disease is associated with high morbidity and mortality. The purpose of this review article is to highlight the role of bone scintigraphy in the evaluation of calciphylaxis and to correlate the findings with other imaging modalities and histopathology.

A Single-Center Study on the Clinical Profiles and Ultrasonographic Assessments of Living Kidney Donors in the Marathwada Region of Maharashtra.

Living donor kidney transplantation plays a vital role in renal replacement therapy, particularly in India, where a substantial increase in kidney transplants has been observed. Thorough assessments of living kidney donors are crucial, focusing on parameters such as kidney size and glomerular filtration rate (GFR). Despite the importance of GFR in donor assessments, there is a noticeable lack of data on normal GFR ranges in the Indian population. This study aims to address the gap in knowledge by establishing a reference range for GFR in healthy kidney donors from the Marathwada region of Maharashtra. The research also explores the clinical profiles and ultrasonographic features of living kidney donors. A retrospective analysis was conducted at the Mahatma Gandhi Mission (MGM) Medical College and Hospital in Aurangabad, involving 134 living kidney donors. Inclusion criteria encompassed healthy donors with a BMI of less than 30 kg/m², while donors with uncontrolled hypertension, diabetes, microalbuminuria, or a measured GFR below 70 mL/min/1.73 m² were excluded. Comprehensive medical histories, demographic parameters, and ultrasonographic assessments were conducted, with GFR measured using 99M technetium diethylenetriamine pentaacetate scans. The study reveals that the majority of donors were females (80.6%), and the highest number fell within the 41-50 age group. Parents constituted the primary donor category (68.7%), reflecting a familial inclination toward organ donation. Ultrasonographic assessments indicated larger kidney sizes compared to other studies, suggesting regional or population-specific differences. The mean GFR for the right and left kidneys, as well as the total GFR, was within the expected range. The negative correlation between age and GFR emphasizes the need to consider age in donor assessments. The findings emphasize the unique features of this population, including a higher average age, female preponderance, and larger kidney sizes. The study contributes to the understanding of living kidney donors' profiles in the region and highlights the importance of individualized assessments in the donor selection process.

SpatialData: an open and universal data framework for spatial omics.

Spatially resolved omics technologies are transforming our understanding of biological tissues. However, the handling of uni- and multimodal spatial omics datasets remains a challenge owing to large data volumes, heterogeneity of data types and the lack of flexible, spatially aware data structures. Here we introduce SpatialData, a framework that establishes a unified and extensible multiplatform file-format, lazy representation of larger-than-memory data, transformations and alignment to common coordinate systems. SpatialData facilitates spatial annotations and cross-modal aggregation and analysis, the utility of which is illustrated in the context of multiple vignettes, including integrative analysis on a multimodal Xenium and Visium breast cancer study.

Imaging 3.0: A scoping review.

We aim to provide a comprehensive summary of the current body of literature concerning the Imaging 3.0 initiative and its implications for patient care within the field of radiology. We offer a thorough analysis of the literature pertaining to the Imaging 3.0 initiative, emphasizing the practical application of the five pillars of the program, their cost-effectiveness, and their benefits in patient management. By doing so, we hope to illustrate the impact the Imaging 3.0 Initiative can have on the future of radiology and patient care.

7 T Lesion-Attenuated Magnetization-Prepared Gradient Echo Acquisition for Detection of Posterior Fossa Demyelinating Lesions in Multiple Sclerosis.

OBJECTIVES: Detection of infratentorial demyelinating lesions in multiple sclerosis (MS) presents a challenge in magnetic resonance imaging (MRI), a difficulty that is further heightened in 7 T MRI. This study aimed to assess the efficacy of a novel MRI approach, lesion-attenuated magnetization-prepared gradient echo acquisition (LAMA), for detecting demyelinating lesions within the posterior fossa and upper cervical spine on 7 T MRI and contrast its performance with conventional double-inversion recovery (DIR) and T2-weighted turbo spin echo sequences. MATERIALS AND METHODS: We conducted a retrospective cross-sectional study in 42 patients with a confirmed diagnosis of MS. All patients had 7 T MRI that incorporated LAMA, 3D DIR, and 2D T2-weighted turbo spin echo sequences. Three readers assessed lesion count in the brainstem, cerebellum, and upper cervical spinal cord using both DIR and T2-weighted images in one session. In a separate session, LAMA was analyzed alone. Contrast-to-noise ratio was also compared between LAMA and the conventional sequences. Lesion counts between methods were assessed using nonparametric Wilcoxon signed rank test. Interrater agreement in lesion detection was estimated by intraclass correlation coefficients. RESULTS: LAMA identified a significantly greater number of lesions than DIR + T2 (mean 6.4 vs 3.0; P < 0.001). LAMA also exhibited better interrater agreement (intraclass correlation coefficient [95% confidence interval], 0.75 [0.41-0.88] vs 0.61 [0.35-0.78]). The contrast-to-noise ratio for LAMA (3.7 ± 0.9) significantly exceeded that of DIR (1.94 ± 0.7) and T2 (1.2 ± 0.7) (all P 's < 0.001). In cases with no lesions detected using DIR + T2, at least 1 lesion was identified in 83.3% with LAMA. Across all analyzed brain regions, LAMA consistently detected more lesions than DIR + T2. CONCLUSIONS: LAMA significantly improves the detection of infratentorial demyelinating lesions in MS patients compared with traditional methods. Integrating LAMA with standard magnetization-prepared 2 rapid acquisition gradient echo acquisition provides a valuable tool for accurately characterizing the extent of MS disease.

Establishing the safety of phenobarbital treatment of alcohol withdrawal syndrome on general medical wards: A retrospective cohort study.

INTRODUCTION: Concern about adverse effects from phenobarbital limits its use in treating alcohol withdrawal syndrome (AWS) on general medical wards. Benzodiazepines are the recommended treatment for inpatient management of AWS, yet a subset of patients have an inadequate response or experience complications of AWS despite treatment with benzodiazepines. Data supporting an alternative treatment are needed. We set out to estimate the rate of serious adverse events (SAEs) of phenobarbital treatment for AWS on general medical wards. METHODS: Retrospective cohort study of all general medical ward patients hospitalized at a single tertiary urban VA Medical Center from October 2018-May 2021 who received phenobarbital for treatment of AWS. Primary outcomes were SAEs attributed to phenobarbital and treatment failure. SAEs were defined as ICU transfer or intubation for over-sedation, pneumonia, and death. Treatment failure was defined as progression of withdrawal resulting in seizure, ICU transfer, behavioral emergencies, or death. RESULTS: During the study period, phenobarbital was administered in 29% (244) of all AWS hospitalizations. Among them, 93% had a history of AWS hospitalization and 68% had a history of complicated AWS. Fifty-three percent of patients met criteria for moderate, severe, or complicated withdrawal prior to phenobarbital initiation. The mean cumulative dose of phenobarbital per patient was 966.5 mg (13.6 mg/kg). SAEs occurred in 1 of 244 hospitalizations (0.4%): there were no intubations, ICU transfers for oversedation, or deaths due to phenobarbital or AWS. One case of pneumonia was possibly attributable to phenobarbital. Treatment failures (6 ICU transfers, 9 behavioral emergencies) were identified during 12 of 244 hospitalizations (4.9%). CONCLUSIONS: SAEs and treatment failures were infrequent among 148 patients treated with phenobarbital across 244 hospitalizations with a mean cumulative dose of 966.5 mg per patient. Our findings suggest that phenobarbital is a safe alternative treatment of AWS in general medical ward patients.

Chronic hippocampal subfield damage in transient global amnesia revealed by 7T MRI: All is not reversible?

Transient global amnesia (TGA) is a neurological condition characterized by temporary memory loss and classically associated with a reversible unilateral punctate focus of restricted diffusion in the cornu ammonis 1 (CA1) region of the hippocampus. Historically, the lesions were considered to be transient in nature with no long-term imaging abnormality. However, more recent studies have challenged the concept that there are no long-term neurological sequelae. In line with this evidence, we explore the role of ultra-high-resolution imaging using 7 Tesla MRI to evaluate for long-term imaging abnormalities in a 63-year-old woman with a typical clinical course and acute TGA imaging findings. The 7 Tesla MRI revealed a residual lesion on susceptibility-weighted imaging (SWI) with evidence of gliosis and volume loss at the site of the acute lesion in CA1 eight months after the acute episode. This case challenges the traditional mantra of TGA as a fully reversible condition with no long-term imaging findings, suggesting the need for further research using ultra-high-field MRI to determine TGA's potential long-term imaging sequelae and any association with neurocognitive sequelae.

Alcohol-Related Hospitalizations During the Initial COVID-19 Lockdown in Massachusetts: An Interrupted Time-Series Analysis.

Background: The effect of initial COVID-19 pandemic-associated lockdowns on alcohol-related hospitalizations remains uncertain. This study compares alcohol-related hospitalizations at a US Department of Veterans Affairs (VA) system in Massachusetts before, during, and after the initial COVID-19 lockdown. Methods: This study is an interrupted time-series analysis at the VA Boston Healthcare System. Participants included all patients hospitalized on the medical, psychiatry, and neurology services at VA Boston Healthcare System from January 1, 2017, to December 31, 2020, excluding those under observation status. The period January 1, 2017, to March 9, 2020, was defined as prelockdown (the reference group); March 10, 2020, to May 18, 2020, was lockdown; and May 19, 2020, to December 31, 2020, was postlockdown. Alcohol-related hospitalizations were determined using International Statistical Classification of Diseases, Tenth Revision primary diagnosis codes. Results: We identified 27,508 hospitalizations during the study periods. There were 72 alcohol-related hospitalizations per 100,000 patient-months during the prelockdown period, 10 per 100,000 patient-months during the lockdown, and 46 per 100,000 patient-months in the postlockdown period. Compared with the prelockdown period, the adjusted rate ratio for daily alcohol-related hospitalizations during lockdown was 0.20 (95% CI, 0.10-0.39) vs 0.72 (95% CI, 0.57-0.92) after the lockdown. A similar pattern was observed for all-cause hospitalizations. Conclusions: Our results suggest that COVID-19 pandemic lockdown measures were associated with fewer alcohol-related hospitalizations. Proactive outreach for vulnerable populations during lockdowns is needed.

Quality of Life of Oral Squamous Cell Carcinoma Patients before and after Primary Treatment.

Background: HNSCC (head and neck squamous cell carcinoma) is a serious global health problem, with estimated more than 550,000 new cases and 300,000 deaths annually. More than 90% of these malignancies are oral squamous cell carcinoma (OSCC). Materials and Methods: Patients selected were asked to fill the detailed structured case history proforma and thorough clinical examination, structured, pre-designed, pre-evaluated (UW-QOL) UW Questionnaire version 4 on quality of life (QOL) of oral squamous cell carcinoma patients containing thirteen subjective questionnaires and three global questionnaires. All the patients of OSCC after one month (1 month) of radiation and chemotherapy were assessed for quality of life by questionnaire. Result: Post-treatment QOL assessment of OSCC patients reveals a number of problems such as chewing, swallowing, saliva, lack of activity, and mood disturbances. Preoperative clinical features including tumor site, tumor stage, and extent of mouth opening have a significant impact on post-treatment problems in different ways. Conclusion: The need to balance clinician's need and use of health-related quality of life (HRQOL) data against patient's burden should be considered in the selection process.

Evaluation of postoperative pain with new heat-treated rotary and reciprocating nickel-titanium files: A randomized controlled clinical trial.

Introduction: A special heat-treated endodontic file (TruNatomy) was recently introduced with the claim of superior flexibility to enhance dentin preservation. The aim of the present study was to assess postoperative pain in single-visit root canal treatment with this newly introduced file, comparing it with other contemporary reciprocating and rotary file systems. Materials and Methods: One hundred seventy patients with acute irreversible pulpitis in maxillary premolars were randomly assigned to four experimental file systems: TruNatomy, HyFlex EDM, EdgeFile, and ProTaper Gold. Pre- and postoperative pain scores were assessed with 10-point visual analog scale. Data were statistically analyzed using Kruskal-Wallis test. Results: TruNatomy file system had significantly the highest postoperative pain incidence (53.8%), while the EdgeFile system had significantly the least postoperative pain incidence (24%) and 24-h pain score. Conclusion: The present study demonstrated that the reciprocating multiple-file system, EdgeFile, had significantly reduced postoperative pain incidence compared to other heat-treated rotary nickel-titanium file systems.

Systematic Review on Magnetic Resonance Angiography with Vessel Wall Imaging for the Characterization of Symptomatic Carotid Artery Plaque.

BACKGROUND: To perform a systematic literature review to assess the usefulness of performing magnetic resonance angiography (MRA) with vessel wall imaging (VWI) sequences for the assessment of symptomatic carotid artery plaques and the identification of risky plaque features predisposing for stroke. METHODS: We performed a systematic review of the literature pertaining to MRA with VWI techniques in patients with carotid artery disease, focusing on symptomatic patients' plaque features and morphology. Independent reviewers screened and analyzed data extracted from eligible studies, and a modified Newcastle-Ottawa Scale was used to appraise the quality of the design and content of the selected manuscripts to achieve an accurate interpretation. RESULTS: This review included nineteen peer-reviewed manuscripts, all of them including MRA and VWI assessments of the symptomatic carotid artery plaque. We focused on patients' comorbidities and reviewed plaque features, including intraplaque hemorrhage, a lipid-rich necrotic core, a ruptured fibrous cap, and plaque ulceration. CONCLUSIONS: MRA with VWI is a useful tool in the evaluation of carotid artery plaques. This imaging technique allows clinicians to identify plaques at risk of causing a neurovascular event. The presence of intraplaque hemorrhage, plaque ulceration, a ruptured fibrous cap, and a lipid-rich necrotic core are associated with neurovascular symptoms. The timely identification of these features could have a positive impact on neurovascular event prevention.

Ectopic expression of pigeonpea Orf147 gene imparts partial sterility in Cicer arietinum.

Orf147, a cytotoxic peptide, has been found to cause cytoplasmic male sterility (CMS) in Cajanus cajanifolius (pigeonpea). In our study, Orf147 was introduced into self-pollinating Cicer arietinum (chickpea) using Agrobacterium-mediated transformation for induction of CMS. The stable integration and expression of the transgene has been assessed through PCR and qRT-PCR analysis. In addition, phenotypic sterility analysis has been performed, considering developmental parameters like flower development, pod formation and flower drop. Transgene inheritance analysis demonstrates that out of the five PCR positive events in the T0 generation, two events have segregated according to the Mendelian segregation ratio (3:1) in the T2 generation. Further, pollen viability test using microscopic analysis confirms the induction of partial CMS in transgenic chickpea. The study holds significant value regarding the heterosis of self-pollinating legumes like chickpea. As a part of the prospect, exploring inducible promoters of species-specific or related legumes would be the next step to developing a two-line hybrid system.

Genetic enhancement of Trichoderma asperellum biocontrol potentials and carbendazim tolerance for chickpea dry root rot disease management.

Advances in biocontrol potentials and fungicide resistance are highly desirable for Trichoderma. Thus, it is profitable to use mutagenic agents to develop superior strains with enhanced biocontrol properties and fungicide tolerance in Trichoderma. This study investigates the N-methyl-n-nitro-N-nitrosoguanidine (NTG) (100 mg/L) induced mutants of Trichoderma asperellum. Six NTG (3 each from 1st & 2nd round) induced mutants were developed and evaluated their biocontrol activities and carbendazim tolerance. Among the mutant N2-3, N2-1, N1 and N2-2 gave the best antagonistic and volatile metabolite activities on inhibition of chickpea F. oxysporum f. sp. ciceri, B. cinerea and R. bataticola mycelium under in vitro condition. Mutant N2-2 (5626.40 µg/ml) showed the highest EC50 value against carbendazim followed by N2-3 (206.36 µg/ml) and N2-1 (16.41 µg/ml); and succeeded to sporulate even at 2000 µg/ml of carbendazim. The biocontrol activity of N2-2 and N2 with half-dose of carbendazim was evaluated on chickpea dry root rot under controlled environment. Disease reduction and progress of the dry root rot was extremely low in T7 (N2-2 + with half-dose of carbendazim) treatment. Further, carbendazim resistant mutants demonstrated mutation in tub2 gene of ß-tubulin family which was suggested through the 37 and 183 residue changes in the superimposed protein structures encoded by tub2 gene in N2 and N2-2 with WT respectively. This study conclusively implies that the enhanced carbendazim tolerance in N2-2 mutant did not affect the mycoparasitism and plant growth activity of Trichoderma. These mutants were as good as the wild-type with respect to all inherent attributes.

Survival and success of composite resin restorations in endodontically treated maxillary incisors with minimal structure loss.

The primary aim of this study was to evaluate the clinical performance of nanofilled composite resin restorations in traumatized, endodontically treated maxillary incisors with structural loss of 40% or less. The performance of the restorations was assessed in terms of longevity (survival) and esthetics (success) over a 20-month period. The secondary objective was to employ a novel digital method to quantify preoperative tooth structure loss. Sixty-one fractured maxillary incisors in 55 patients were included in the study. The teeth were photographed with a digital single-lens reflex camera equipped with a macro ring flash. The amount of lost tooth structure was calculated with digital photography software. The teeth were restored with a nanohybrid composite resin and self-etching adhesive system bonding agent. To assess esthetics, color change in the blue-yellow axis (Δb*) of the composite resin restoration was evaluated digitally with the Commission Internationale de l'Eclairage (CIE) L*a*b color system. The Wilcoxon signed-rank test was used to assess Δb*, and a Kaplan-Meier survival analysis was used to assess the longevity of the restorations. The study findings showed a statistically significant difference between pretreatment and posttreatment b* values (P < 0.05), but the difference was too small to be clinically perceptible to the human eye. A total of 5 restorations (9.8%) failed. The remaining restorations survived for a mean (SD) period of 18.6 (4.4) months. The log-rank test did not show any significant association between the amount of residual tooth structure and success of the restoration. The results of this study showed that use of direct composite resin restorations in endodontically treated maxillary incisors resulted in acceptable survival and success rates. Trial registration: Clinical Trial Registry of India No. CTRI/2020/01/023019.