Dual-energy CT in differentiating benign gallbladder wall thickening from wall thickening type of gallbladder cancer.

OBJECTIVE: To evaluate the performance of dual-energy computed tomography (DECT) in differentiating non-acute benign from malignant gallbladder wall thickening (GBWT). METHODS: This prospective study comprised consecutive adults with GBWT who underwent late arterial phase (LAP) and portal venous phase (PVP) DECT between January 2022 and May 2023. The final diagnosis was based on histopathology or 3-6 months follow-up imaging. DECT images in LAP and PVP were assessed independently by two radiologists. The demographic, qualitative, and quantitative parameters were compared between two groups Multivariate logistic regression was performed to determine the association between the aforementioned factors and malignant GBWT. RESULTS: Seventy-five patients (mean age 56 ± 12.8 years, 46 females) were included. Forty-two patients had benign, and 33 had malignant GBWT. In the overall group, female gender (p = 0.018), lymphadenopathy (p = 0.011), and omental nodules (p = 0.044) were significantly associated with malignant GBWT. None of the DECT features differed significantly between benign and malignant GBWT in overall group. In the xanthogranulomatous cholecystitis (XGC, n = 9) vs. gallbladder cancer (GBC) (n = 33) subgroup, mean attenuation value at 140 keV LAP VMI was significantly associated with malignant GBWT [p = 0.023, area under curve 0.759 (95%CI 0.599-0.919)]. CONCLUSION: DECT-generated quantitative parameters do not add value in differentiating non-acute benign from malignant GBWT. However, DECT may have a role in differentiating XGC from GBC in a selected subgroup of patients. Further, larger studies may be necessary to confirm these findings. CLINICAL RELEVANCE STATEMENT: In patients with non-acute gallbladder wall thickening in whom there is suspicion of xanthogranulomatous cholecystitis (XGC), DECT findings may allow differentiation of XGC from wall thickening type of gallbladder cancer. KEY POINTS: Differentiation of benign and malignant gallbladder wall thickening (GBWT) at CT is challenging. Quantitative dual energy CT (DECT) features do not provide additional value in differentiating benign and malignant GBWT. DECT may be helpful in a subgroup of patients to differentiate xanthogranulomatous cholecystitis from gallbladder cancer.

Long-term complications in patients with childhood-onset nephrotic syndrome.

BACKGROUND: Reports on long-term complications of childhood-onset nephrotic syndrome (NS), such as obesity, osteoporosis, growth failure, and hypertension, are mostly from developed countries not representing South Asian ethnicities. Furthermore, data on cardiovascular health among patients with childhood-onset NS are limited. METHODS: This was an observational study involving patients attending a tertiary care center. Patients aged 15 years and older were examined for long-term complications and remission of NS at their visit in December 2021. Childhood-onset NS meant onset of NS before 10 years of age. Long-term complications included obesity, growth failure, low bone mineral density (BMD) Z score, hypertension, and increased carotid intima-media thickness (cIMT). Long-term remission was defined as no relapse for the last [Formula: see text] 3 consecutive years without immunosuppressive medication to maintain remission. RESULTS: Of 101 patients studied (~ 80% with frequent relapsing (FR)/steroid-dependent (SD) NS), the mean age was 17.6 (± 2.4) years at the time of study. Long-term complications were noted in 89.1% of patients which included one or more of the following: obesity (22.7%), growth failure (31.7%), low BMD Z score (53.5%), hypertension (31.7%), and high cIMT (50.5%). Thirty-nine patients (38.6%) were in long-term remission at the time of the study. Growth failure and low BMD Z scores were less frequent in patients with long-term remission compared to those without long-term remission. CONCLUSIONS: In patients with childhood-onset NS (predominantly FR/SDNS) who were studied at [Formula: see text] 15 years of age, ~ 90% had long-term complications which included high cIMT in 50%. Only ~ 40% were in long-term remission. A higher resolution version of the Graphical abstract is available as Supplementary information.

Quality attributes and Chapatti making property of biofortified wheat as influenced by particle size.

Biofortified (PBW 1 Zn) wheat flour was fractionated into three fractions (355, 180 and 150 µm) and evaluated for physicochemical, functional, rheological, biochemical and chapatti making parameters. With decreasing flour particle size the ash, fat, fibre, phytic acid, antioxidant activity, total phenolic content and pasting properties decreased, whereas carbohydrates, zinc, lightness (L*) and functional parameters increased. Chapatti making quality of flour fraction (180 µm) was observed best on the basis of puffing height (7.64 cm), extensibility (1.83 N) and sensory quality with best overall sensory scores (8.75). The results indicate that reducing the particle size to 180 µm could improve the nutritional, functional and chapatti making quality of wheat flour.

Palliative Care for Hospitalized Patients With Stroke: Results From the 2010 to 2012 National Inpatient Sample.

BACKGROUND AND PURPOSE: Substantial variability exists in the use of life-prolonging treatments for patients with stroke, especially near the end of life. This study explores patterns of palliative care utilization and death in hospitalized patients with stroke across the United States. METHODS: Using the 2010 to 2012 nationwide inpatient sample databases, we included all patients discharged with stroke identified by International Classification of Diseases-Ninth Revision codes. Strokes were subclassified as ischemic, intracerebral, and subarachnoid hemorrhage. We compared demographics, comorbidities, procedures, and outcomes between patients with and without a palliative care encounter (PCE) as defined by the International Classification of Diseases-Ninth Revision code V66.7. Pearson χ2 test was used for categorical variables. Multivariate logistic regression was used to account for hospital, regional, payer, and medical severity factors to predict PCE use and death. RESULTS: Among 395 411 patients with stroke, PCE was used in 6.2% with an increasing trend over time (P<0.05). We found a wide range in PCE use with higher rates in patients with older age, hemorrhagic stroke types, women, and white race (all P<0.001). Smaller and for-profit hospitals saw lower rates. Overall, 9.2% of hospitalized patients with stroke died, and PCE was significantly associated with death. Length of stay in decedents was shorter for patients who received PCE. CONCLUSIONS: Palliative care use is increasing nationally for patients with stroke, especially in larger hospitals. Persistent disparities in PCE use and mortality exist in regards to age, sex, race, region, and hospital characteristics. Given the variations in PCE use, especially at the end of life, the use of mortality rates as a hospital quality measure is questioned.

Resurrection of Wheat Cultivar PBW343 Using Marker-Assisted Gene Pyramiding for Rust Resistance.

Wheat variety PBW343, released in India in 1995, became the most widely grown cultivar in the country by the year 2000 owing to its wide adaptability and yield potential. It initially succumbed to leaf rust, and resistance genes Lr24 and Lr28 were transferred to PBW343. After an unbroken reign of about 10 years, the virulence against gene Yr27 made PBW343 susceptible to stripe rust. Owing to its wide adaptability and yield potential, PBW343 became the prime target for marker-assisted introgression of stripe rust resistance genes. The leaf rust-resistant versions formed the base for pyramiding stripe rust resistance genes Yr5, Yr10, Yr15, Yr17, and Yr70, in different introgression programs. Advanced breeding lines with different gene combinations, PBW665, PBW683, PBW698, and PBW703 were tested in national trials but could not be released as varieties. The genes from alien segments, Aegilops ventricosa (Lr37/Yr17/Sr38) and Aegilops umbellulata (Lr76/Yr70), were later pyramided in PBW343. Modified marker-assisted backcross breeding was performed, and 81.57% of the genetic background was recovered in one of the selected derivative lines, PBW723. This line was evaluated in coordinated national trials and was released for cultivation under timely sown irrigated conditions in the North Western Plain Zone of India. PBW723 yields an average of 58.0 qtl/ha in Punjab with high potential yields. The genes incorporated are susceptible to stripe rust individually, but PBW723 with both genes showed enhanced resistance. Three years post-release, PBW723 occupies approximately 8-9% of the cultivated area in the Punjab state. A regular inflow of diverse resistant genes, their rapid mobilization to most productive backgrounds, and keeping a close eye on pathogen evolution is essential to protect the overall progress for productivity and resistance in wheat breeding, thus helping breeders to keep pace with pathogen evolution.

Endovascular Management of Renal Arteriovenous Fistula With Large Aneurysm Masquerading as a Renal Cyst.

Large renal aneurysms can masquerade as simple renal cysts on ultrasound, especially if Doppler examination is not routinely done to assess flow characteristics. We present a case report of a 26-year-old male, as a clinical challenge in urology, who had minimal symptoms, yet had an arteriovenous fistula with a large aneurysm which was diagnosed as a parapelvic cyst on ultrasound. Endovascular treatment of the arteriovenous fistula was done using a vascular plug with satisfactory outcomes.

Imaging of peripheral nerve tumors.

Recent advancements in the field of imaging, particularly magnetic resonance imaging, have improved the way peripheral nerve tumors are diagnosed, monitored, and treated both medically and surgically. When combined with the all-important clinical evaluation and electrodiagnostic studies, imaging permits a clinician to accomplish the following: identify the size, shape, location, and distribution of mass lesions; infer the risks in resecting a mass lesion by displaying its relationship to nearby nerve fascicles; determine growth rates when serial imaging studies are available; suggest the nature of the pathological entity; and visualize muscle denervation associated with nerve damage. The authors describe some of the commonly used imaging modalities and discuss their use in evaluating and treating peripheral nerve tumors and other mass lesions.

Stroke: Basic and Clinical.

Tissue plasminogen activator (tPA) was first approved in the USA 25 years ago for those who had experienced a recent occlusion (<3 h) of a cerebral vessel. Now, advances in clot retrieval (stentriever), in concert with tPA, heralds new optimism for ischemic stroke victims, but adds more pressure to identify therapies that will minimize hypoxic damage, protect compromised cells, and promote rehabilitation. In the past preclinical investigations have been poor at predicting potential clinical therapy, but they have contributed enormously to understanding post-stroke pathology. Current clinical trials ( www.strokecenter.org/trials ) anticipate a broad range of approaches: from hypothermia, to cell therapy, to neuroprotection.

A randomized, placebo-controlled, double-blind, crossover study to evaluate the efficacy of oral sildenafil therapy in severe pulmonary artery hypertension.

BACKGROUND: Severe pulmonary artery hypertension (PAH) is a disorder with limited treatment options. Recently, several newer drugs have recently been introduced to treat PAH. Sildenafil is one which has shown promise in several uncontrolled studies, but controlled trials have been few. In this randomized placebo-controlled study, we evaluated the efficacy of oral sildenafil in idiopathic PAH and PAH caused by Eisenmenger syndrome. METHODS: This was a randomized, double-blind, placebo-controlled crossover study. Twenty patients, 10 of each of idiopathic PAH and Eisenmenger syndrome, were randomized to receive placebo or sildenafil in a double-blind manner for 6 weeks and, after a washout period of 2 weeks, were crossed over. The primary end point of efficacy was the improvement in distance covered in 6-minute walk test. Secondary end points were reduction in pulmonary artery pressure as measured by Doppler echocardiography after 6 weeks of treatment, improvement in clinical condition, New York Heart Association (NYHA) class, and exercise duration and metabolic equivalents (Mets) achieved on modified Bruce exercise protocol. RESULTS: There was significant improvement in primary and secondary end points. The primary end point of distance covered in 6-minute walk test improved from 262 +/- 99 to 358.9 +/- 96.5 m (P < .0001) after treatment with sildenafil. Pulmonary artery pressure, the secondary end point, improved from the baseline of 98.8 +/- 20.5 to 78.3 +/- 15.3 mm Hg (P < .0001), NYHA class improved from 2.65 +/- 0.59 to 1.55 +/- 0.51 (P < .0001), exercise duration from 6.4 +/- 3.1 to 10.2 +/- 2.05 minutes (P < .0001), and Mets achieved from 3.32 +/- 1.57 to 6.04 +/- 1.87 (P < .0001) after treatment with sildenafil. There was no significant fall in blood pressure with placebo and sildenafil, and no serious side effects of drug were observed in the study. CONCLUSIONS: Sildenafil significantly improved the symptomatic status, exercise capacity, NYHA class, and hemodynamic parameters of patients with severe PAH and can be safely used as a primary or adjunctive treatment of the same.

Thyroid hormone concentrations in systemic circulation and ovarian follicular fluid of cows.

The aim of this study was to determine and compare the concentrations of total (T) and free (F) fractions of thyroid hormones (T(3)-triiodithyronine and T(4)-thyroxin) in peripheral circulation and follicular fluid of cows in relation to ovarian follicular status in vivo (Experiment 1), and in the follicles from the slaughterhouse ovaries (Experiment 2). In Experiment 1, estrus was synchronized in 15 cows using two Estrumate (cloprostenol sodium) injections (250 mg cloprostenol intramuscular), the time of ovulation (Day 0) was confirmed by ultrasonography, and ovarian antral follicles were ablated on Day 5. The ensuing superovulatory treatment consisted of eight Folltropin-V injections (50 mg intramuscular) administered twice daily from Day 6 to Day 9, followed by two injections of Estrumate (Day 10 am and pm) and a single dose of Lutropin Alfa (Day 11; 750 IU intramuscular). On Day 5, both TT(3) and FT(3) concentrations were greater (P < 0.05) in serum than follicular fluid from dominant (DFs) or subordinate antral follicles (SFs), and TT(4) concentrations were greater (P < 0.05) in DFs compared with SFs. Serum concentrations of FT(4) were greater (P < 0.05) on Day 12 than on Day 5, and TT(4) concentrations in follicular fluid collected on Day 12 were higher than those in DFs and SFs on Day 5. In Experiment 2, there were no differences (P > 0.05) in thyroid hormone concentrations between the largest and all remaining antral follicles visible on the surface of the ovary (n = 20 ovaries). We concluded that: (i) physiological status of bovine antral follicles (i.e. dominant versus subordinate) may impinge on the accumulation of TT(4) in follicular fluid; and (ii) hormonal ovarian superstimulation increases circulating levels of FT(4) and follicular fluid content of TT(4).