Sinus Area Research Articles

In vivo detection of venous sinus distension due to intracranial hypotension in small animal using pulsed-laser-diode photoacoustic tomography.

Intracranial hypotension (IH) is a pathophysiological condition of reduced intracranial pressure caused by low cerebrospinal fluid (CSF) volume due to dural injuries from lumbar puncture, surgery, or trauma. Understanding the prognosis of IH in small animal models is important to gain insights on the complications associated with it such as orthostatic headache, cerebral venous thrombosis, coma, and so forth. Photoacoustic tomography (PAT) offers a novel and cost-effective way to perceive and detect IH in small animal models. In this study, a pulsed laser diode (PLD)-based PAT imaging system was used to examine the changes in the venous sinuses of the rat brain due to IH, induced through CSF extraction. After the CSF extraction, an increase in the sagittal sinus area by ~30% and width by 40% ± 5% was observed. These results provide supportive evidence that the PLD-PAT can be employed for detecting changes in sagittal sinus due to IH in rat model.

Incidental findings in maxillary sinus area on cone-beam-computed-tomographic-scans: A retrospective study with emphasis on gender and ethnicity

AimThe aim was to assess the presence of incidental-findings (IFs) on cone-beam computed tomography (CBCT) scans of faciomaxillary region with emphasis on gender and ethnicity. Materials and methodsA retrospective analysis of incidental findings (IFs) in the maxillary sinus was performed. All CBCT-scans were performed using a Cone Beam 3D imaging system and examined using a software program. These images were taken for treatment planning for dental implant therapy of partially edentulous individuals. Four-hundred CBCT scans were retrospectively evaluated. Data regarding age, gender and ethnicity (Saudi Arabian, Egyptian, Filipino and Pakistani) of the patients was recorded. When P-value were lesser than 0.05, the difference was deemed significant. ResultsFour hundred CBCT-based scans were investigated. The IFs were seen in 30.2%, 32.1%, 35.1% and 34.4% individuals belonging to the Egyptian, Saudi Arabian, Pakistani and Filipino ethnicities, respectively. Mucosal-thickening was more often identified in Saudi-Arabian (P < 0.05), Pakistani (P < 0.05) and Filipino males (P < 0.05) than females in the respective ethnic group. There was no difference in the identification of IFs (mucous retention cysts, opacifications, sinus septa and sinus floor discontinuation) related to the maxillary sinus region among males belonging to the Egyptian, Saudi-Arabian, Filipino and Pakistani ethnic groups. Interpretations and conclusionThe CBCT-based technology is valuable resource for the identification of IFs.

Clinicopathological features of T-lymphoblastic lymphoma with Langerhans cell histiocytosis in the same lymph node

Objective: To investigate the clinicopathological features, immunophenotypes, genetics and prognosis of T-lymphocyte lymphoma/myeloid sarcoma combined with Langerhans cell histiocytyosis (coexistence of T-LBL/MS and LCH). Methods: Clinical and pathological data of the 6 patients with coexistence of T-LBL/MS and LCH were analyzed, who were diagnosed at the Foshan Hospital of Sun Yat-sen University and the Friendship Hospital of Capital Medical University, from December 2013 to April 2019. The hematoxylin and eosin stain, immunohitochemistry (EnVision) and in situ hybridization were used. Related literatures were reviewed. Results: Four patients were T-LBL combined with LCH, 1 was T-LBL/MS combined with LCH, and 1 was MS combined with LCH. There were 2 male and 4 female patients, with age ranged from 5 to 77 years old (median, 59 years old). Three patients represented with only multiple lymph node swelling. The other 3 displayed both multiple lymph node swelling, and skin/liver or spleen lesions. Lymph node structure was destroyed in 5 cases, while 3 cases had several residual atrophic follicles. Histologically, there were two types of tumor cells: one type of the abnormal lymphoid-cells exhibited small to medium-sized blast cells, typically showing a nested distribution, and these cells were mainly identified in residual follicles and paracortical areas; the other type of histiocytoid cells had a large cell size and abundant pale or dichromatic cytoplasm. Their nuclei were irregularly shaped, showing folded appearance and nuclear grooves. These cells were mainly present in marginal sinus, medullary sinus and interstitial area between follicles. Eosinophil infiltration in the background was not evident in any of the cases. The lymphoid-cells of medium size showed TdT+/CD99+/CD7+, with variable expression of CD34/MPO/CD2/CD3. Ki-67 index was mostly 30%-50%. However, the histiocytoid cells showed phenotype of CD1a+/S-100+/Langerin+/-, while CD163/CD68 were positive in some degree. These cells did not express any T or B cell markers. The Ki-67 index mostly ranged between 10%-20%. None of the cases had Epstin-Barr viral infection. Among the 6 patients, 4 patients were followed up (6-63 months, median time, 18.5 months), of whom 1 patient died of the disease and 3 patients were alive at the end of follow-up. Conclusions: T-LBL/MS combined with LCH is a rare mixed type of immature hematopoietic disease, and mainly occurs in lymph node and skin. The clinical course is overall aggressive. Therefore, it is helpful to recognize and identify the two pathologic components in the same tissue for accurate diagnosis and proper treatment.

The relationship between the roots of posterior maxillary teeth and adjacent maxillary sinus floor was associated with maxillary sinus dimension

Background: The dimension of maxillary sinus is dynamic and might complicate the dental practice. Therefore, the purpose of this study is to analyze maxillary sinus dimension with respect to different ages, genders, tooth sites, and relationships between root of posterior maxillary teeth (RPMT) and adjacent maxillary sinus floor, using cross-sectional images from cone-beam computed tomography (CBCT). Methods: The 320 qualified cross-sectional posterior maxillary images of CBCT from 50 patients retrieved from the database were used to analyze the maxillary sinus area. Five types of relationship between RPMT and adjacent maxillary sinus floor were classified accordingly. The associated factors, such as age, genders, and tooth sites, were also examined. The one-way analysis of variance with Tukey's post hoc test was performed to compare the maxillary sinus cross-sectional area in different classifications of RPMT relative to adjacent maxillary sinus floor. Results: There were significant differences of mean maxillary sinus area between different genders (P < 0.001) and age groups (P = 0.01). The mean sinus area measured from cross-sectional images was greater in Type 3 classification of RPMT relative to maxillary sinus, compared to Type 2, Type 1, and Type 0 (P < 0.001). Conclusions: The RPMT relative to adjacent sinus floor may be associated with area of maxillary sinus. The maxillary sinus with greater area in cross-sectional images of CBCT would be closer to the RPMT and might complicate the dental practice.

Лечение больных хроническим риносинуситом в условиях санатория и меры профилактики

The objective of the research is to study of clinical and functional disorders of the nasal mucosa and paranasal sinuses of patients with chronic rhino sinusitis, as well as to make the choice of the optimal treatment method in a sanatorium using natural factors. A survey of 145 patients (94 men and 51 women) with chronic rhinosinusitis at the age of 18 to 65 years was conducted. Of these, male accounted for 64.8%, female – 35.2%. In patients with pathology of the paranasal sinuses, functional disorders of the nasal mucosa and paranasal sinuses were revealed. Particularly, violations of mucociliary clearance, acid-base balance of the nasal mucosa, and a decrease in nasal patency according to the data of active anterior rhinomanometry were defined. The use of natural factors as a treatment: inhalation of natural mineral water Maibalyk and mud applications on the paranasal sinus area significantly improved the course of way of chronic rhinosinusitis and led to normalization of the functional parameters of the nasal mucosa, in contrast to the comparison group (60 people). The comparison group did not use with Maibalyk natural water inhalations and mud applications from Lake Maybalyk, but used only ordinary alkaline inhalations.

Anatomical Variations of Frontal Sinuses Among The Male and Female Genders Living in Karachi

Objective: To determine morphology and variation in dimensions of frontal air sinuses in male and female genders living in Karachi. Study Design and Setting: It was a cross sectional study and was conducted at Radiology Department, JPMC. Methodology: The total number of study participants were 216. The research subjects were divided into two equal groups of males and females each having 108 members. The mean age of the participants was calculated to be 35.14 ± 8.68 years. The study subjects were recruited from Radiology Department, JPMC, Karachi. After taking written informed consent, Water’s (occipito-mental) view radiography was done to measure the parameters of height, width and area of the frontal air sinuses. The included variables were the demographic data and the physical examination to exclude facial anomalies. All the measurements were recorded and the measurements were saved by the help of Radiant DICOM digital software. Results: The parameters of height, width and the area of frontal sinuses showed highly significant variability on both the right and the left sides. All the dimensions were highly significantly greater in the males as compared to the female study participants (p=0.000). The Independent-Samples T Test was applied to compare the two gender groups. Conclusion: The parameters of height, width and area of frontal sinuses were greater in the males as compared to the females on both the left and the right sides

Quantitative three-dimensional echocardiographic analysis of the bicuspid aortic valve and aortic root: A single modality approach.

Patients with bicuspid aortic valves (BAV) are heterogeneous with regard to patterns of root remodeling and valvular dysfunction. Two-dimensional echocardiography is the standard surveillance modality for patients with aortic valve dysfunction. However, ancillary computed tomography or magnetic resonance imaging is often necessary to characterize associated patterns of aortic root pathology. Conversely, the pairing of three-dimensional (3D) echocardiography with novel quantitative modeling techniques allows for a single modality description of the entire root complex. We sought to determine 3D aortic valve and root geometry with this quantitative approach. Transesophageal real-time 3D echocardiography was performed in five patients with tricuspid aortic valves (TAV) and in five patients with BAV. No patient had evidence of valvular dysfunction or aortic root pathology. A customized image analysis protocol was used to assess 3D aortic annular, valvular, and root geometry. Annular, sinus and sinotubular junction diameters and areas were similar in both groups. Coaptation length and area were higher in the TAV group (7.25 ± 0.98 mm and 298 ± 118 mm2 , respectively) compared to the BAV group (5.67 ± 1.33 mm and 177 ± 43 mm2 ; P = .07 and P = .01). Cusp surface area to annular area, coaptation height, and the sub- and supravalvular tenting indices did not differ significantly between groups. Single modality 3D echocardiography-based modeling allows for a quantitative description of the aortic valve and root geometry. This technique together with novel indices will improve our understanding of normal and pathologic geometry in the BAV population and may help to identify geometric predictors of adverse remodeling and guide tailored surgical therapy.

Synthetic CT Generation Based on T2 Weighted MRI of Nasopharyngeal Carcinoma (NPC) Using a Deep Convolutional Neural Network (DCNN).

Purpose: There is an emerging interest of applying magnetic resonance imaging (MRI) to radiotherapy (RT) due to its superior soft tissue contrast for accurate target delineation as well as functional information for evaluating treatment response. MRI-based RT planning has great potential to enable dose escalation to tumors while reducing toxicities to surrounding normal tissues in RT treatments of nasopharyngeal carcinoma (NPC). Our study aims to generate synthetic CT from T2-weighted MRI using a deep learning algorithm.Methods: Thirty-three NPC patients were retrospectively selected for this study with local IRB's approval. All patients underwent clinical CT simulation and 1.5T MRI within the same week in our hospital. Prior to CT/MRI image registration, we had to normalize two different modalities to a similar intensity scale using the histogram matching method. Then CT and T2 weighted MRI were rigidly and deformably registered using intensity-based registration toolbox elastix (version 4.9). A U-net deep learning algorithm with 23 convolutional layers was developed to generate synthetic CT (sCT) using 23 NPC patients' images as the training set. The rest 10 NPC patients were used as the test set (~1/3 of all datasets). Mean absolute error (MAE) and mean error (ME) were calculated to evaluate HU differences between true CT and sCT in bone, soft tissue and overall region.Results: The proposed U-net algorithm was able to create sCT based on T2-weighted MRI in NPC patients, which took 7 s per patient on average. Compared to true CT, MAE of sCT in all tested patients was 97 ± 13 Hounsfield Unit (HU) in soft tissue, 131 ± 24 HU in overall region, and 357 ± 44 HU in bone, respectively. ME was −48 ± 10 HU in soft tissue, −6 ± 13 HU in overall region, and 247 ± 44 HU in bone, respectively. The majority soft tissue and bone region was reconstructed accurately except the interface between soft tissue and bone and some delicate structures in nasal cavity, where the inaccuracy was induced by imperfect deformable registration. One patient example was shown with almost no difference in dose distribution using true CT vs. sCT in the PTV regions in the sinus area with fine bone structures.Conclusion: Our study indicates that it is feasible to generate high quality sCT images based on T2-weighted MRI using the deep learning algorithm in patients with nasopharyngeal carcinoma, which may have great clinical potential for MRI-only treatment planning in the future.

Granulomatous hypophysitis causing compression of the internal carotid arteries reversible with azathioprine and rituximab treatment.

Compression of the internal carotid artery (ICA) in the cavernous sinus area is a rare event and is mostly associated with pituitary adenomas and meningiomas. Other causes of ICA compression are less well known. We present a rare case of granulomatous hypophysitis causing compression of the ICA, which was treated successfully with immune-suppressive agents. The electronic database MEDLINE (PubMed) was searched systematically and other cases with ICA compression were identified and analyzed. A female patient with a history of two previous transsphenoidal operations for suspected pituitary adenoma and post-operative complete pituitary insufficiency presented with severe headaches, nausea, fatigue, and diplopia. Pituitary MRI scan suggested relapse of the pituitary lesion with atypical bilateral infiltration of cavernous sinuses and compression of ICAs. After histological reevaluation of her previous pituitary operations, granulomatous hypophysitis was diagnosed. Treatment was started with high doses of prednisolone. With decreasing doses of prednisolone, symptoms recurred, and azathioprine was started, followed by administration of rituximab resulting in clinical recovery and regression of ICA compression. Literature analysis disclosed 36 case reports with ICA compression in the cavernous sinus region (12 pituitary adenoma, 6 meningioma, 7 hypophysitis, 5 other tumors, and 4 other etiologies). Two cases of hypophysitis recovered completely; five cases improved only partly. In the case of ICA compression, clinical signs, onset of symptoms, radiological findings and pituitary insufficiencies should be thoroughly evaluated, and hypophysitis should be considered as a possible cause. In our patient, treatment with azathioprine and, finally, rituximab was successful.

Anatomical meningo-orbital band evaluation and clinical implications: a cadaveric dissection study.

The meningo-orbital band (MOB) is a dural structure which runs around the superior orbital fissure (SOF) tethering the frontotemporal basal dura to the periorbita, through the SOF. MOB division is important to expose and remove the anterior clinoid process, to access to proximal carotid artery and cavernous sinus area. The aim of this study was to measure how the MOB could be safely incised without cranial nerves and cavernous sinus injuries. Anatomical dissections and extradural exposure of the anterior clinoid process was performed on 20 cadavers (40 sides). Measurement of the MOB thickness was performed before its incision, after dura propria dissection, and retraction off the inner cavernous membrane, to expose the cranial nerves. We analyzed 20 cadaveric formalin-fixed heads injected with colored silicone, 11 man and 9 women of Caucasian race. The average length of a safe incision of the MOB was 10.6±1.1 mm on the right side, and 10.65±1.09 mm on the left side. In our study the average length of a safe incision of the MOB was 10.6±1.1 mm. Thus, the incision length of the MOB should not exceed 9 mm; the peeling of the anterior cavernous sinus and of the SOF, dissecting the two layers of the dura throughout the incision of the MOB, is a useful technique to avoid cranial nerves and cavernous sinus lesions.

Extraoral anatomy in CBCT – a literature review. Part 1: Nasoethmoidal region

Cone beam computed tomography has become a widely used imaging technique for dental indications. Depending on the selected size of the field of view, anatomical structures outside the dentomaxillary complex become visible. As a consequence, the clinician must be able to interpret also those anatomical regions. In this article, the anatomy of the nasoethmoidal region is presented based on a literature review. The nose is characterized by the nasal septum and the superior, middle, and inferior conchae. The turbinates may be pneumatized (concha bullosa), mainly the middle concha. The ethmoid bone has a complex morphology (ethmoid labyrinths) and contributes with its perpendicular plate to the nasal septum. Other structures of the septum include the vomer and the septal cartilage. The nasal meatuses stabilize the airflow and direct the inhaled air to the nasopharynx via the choanae. The middle nasal meatus, which is also a part of the so called ostiomeatal complex, serves as the major drainage area (semilunar hiatus) of the paranasal sinuses, i.e., maxillary sinus, anterior ethmoid cells, and frontal sinus. Posterior ethmoid cells empty into the superior meatus and the sphenoid sinus drains into the sphenoethmoidal recess, located above the superior concha. The nasolacrimal duct that is running along the middle portion of the lateral nasal wall opens into the inferior nasal meatus.

Maxillary sinus size and posterior tooth inclination in Japanese orthodontic patients with agenesis of maxillary second premolars.

The purpose of this study was to investigate the expansion of the maxillary sinus and the inclinations of posterior teeth in orthodontic patients with maxillary second premolar agenesis. A total of 30 subjects with one or two congenitally missing maxillary second premolars and retained maxillary deciduous second molars (a agenesis group) were selected and divided into a unilateral agenesis group (20 subjects with one maxillary second premolar missing) and a bilateral agenesis group (10 subjects with two maxillary second premolars missing). As controls, 30 sex- and age-matched subjects without agenesis of the maxillary second premolars were selected. Oblique cephalograms were used to investigate the association of maxillary second premolar agenesis and lower maxillary sinus size and posterior tooth inclinations. Agenesis of the maxillary second premolars induced significantly large lower maxillary sinus length, depth, area and mesial inclination of the maxillary first premolar, a significantly small anterior maxillary length, and a significantly more distal position for root apex of the maxillary first premolar. There were no significant differences in any measurements of the lower maxillary sinus and posterior teeth between the non-agenesis side in the unilateral agenesis group and the control group. Maxillary second premolar agenesis caused inferior and anterior expansion of the lower maxillary sinus and the mesial inclination of the maxillary first premolars with a distal position of root apex. Unilateral agenesis of the maxillary second premolar did not affect on the lower maxillary sinus size or posterior tooth inclinations of the unaffected antimere.

STUDY OF NORMAL ANATOMICAL VARIATIONS IN PARA-NASAL SINUSES USING COMPUTED TOMOGRAPHY SCAN: A CROSS SECTIONAL STUDY FROM CENTRAL INDIA

Background: The standard imaging in the assessment of the para-nasal sinuses is currently computed tomography scanning. This provides an applied anatomical view of the area as well as the common anatomical variants. The advancement and improvement of computed tomography scans has provided for a comprehensive evaluation of patients' para-nasal sinuses, allowing Functional Endoscopic Sinus Surgery surgeons to operate with a guide chart.&#x0D; Objectives: To study normal anatomical variations in para-nasal sinuses using Computed Tomography.&#x0D; Material and Methods: This research took place in a tertiary healthcare center's radiology department over the course of two years. Axial para-nasal sinuses cuts were taken using a multi-slice (128 slice scanner), followed by coronal and sagittal reconstruction.&#x0D; Results: The most common anatomic variation, according to the findings, was nasal septal deviation. The rarest variation in our sample was Haller cell and pneumatized septum. There was also a close connection between unilateral Concha bullosa and contra-lateral septal deviation, as evidenced by the research.&#x0D; Conclusion: A wide range of lesions can affect the para-nasal sinus area. Normal anatomical differences and congenital abnormalities in this area are significant because they can have pathological consequences or cause difficulty/complication during surgery.&#x0D; Keywords: Para-nasal sinuses, Computed Tomography, Functional Endoscopic Sinus Surgery.

Optimizing Burr Hole Placement for Craniotomy: A Technical Note.

Objective Usually, burr holes are placed along the line of a craniotomy. We describe a novel technique of burr hole placement to obtain smooth and beveled bony margin without any troughs and crests. Dural separation is obtained by minimizing the number of burr holes required. Methods Fifty craniotomies of diameter ranging from 3.5 to 11.5 cm were accomplished by placing burr hole in the center of bone flap rather than along the craniotomy line permitting 360 degrees of dura separation dependent on the length of dura separator. Craniotomy < 9 cm in diameter was performed by placing a single burr hole and a larger size craniotomy was performed with two burr holes. Parasagittal craniotomy was performedby placing burr hole not > 2.5 cm away from expected craniotomy site, namely superior sagittal sinus area enabling separation of adhered dura and venous sinuses. The bone cutter was used in a particular fashion to create smooth margin and beveled edges. Results Craniotomy < 9 cm in diameter was possible with single burr hole in 34 cases. Craniotomy larger than 9 cm in size was performed in 16 cases with double burr hole by strategically placing burr in the center of the desired bone flap. The craniotomy was achieved in all cases without damaging dura and venous structures. Conclusions An optimally placed single burr hole is sufficient for small to moderately large size craniotomy. Larger size craniotomy is possible with minimum numbers of burr holes. This achieves good cosmesis and avoids sinking of the bone flap.

Anatomical Variation in the Drainage Pattern of Frontal Sinus – A Cadaveric Study

Abstract Background A proper and detailed knowledge about the frontal sinus drainage pathway is essential for the radiologist to interpret the computed tomography scan of the paranasal air sinuses to find out normal and variant in the anatomy of frontal sinus ostium, and also for the surgeons to do endonasal sinus surgery particularly in the frontal sinus area with enough confidence and to give good postoperative result. With this background, the present study was focused to study the variation in the drainage pattern of frontal sinus in relation to uncinate process in cadaveric specimens. Materials and Methods The midsagittal section of head and neck portion of 40 cadaveric specimens with intact frontal sinus and frontal sinus drainage pattern were selected. By careful dissection, pattern of frontal sinus drainage was identified and pattern of drainage of frontal sinus in relation with uncinate process was studied. Result Frontal sinus drainage pattern is anteromedial to uncinate process (Type 1) in 28 specimens (70%) and posterolateral to uncinate process (Type 2) in 12 specimens (30%). Conclusion The results of our study show that the frontal sinus drainage pattern is more commonly present anteromedial to uncinate process compared with posterolateral position. This variation in the drainage pattern of frontal sinus should be kept in mind by the radiologist to give proper radiological interpretation and by the surgeons to avoid intraoperative complications and also to give good postoperative result.

Evaluation of maxillary sinus volume and surface area in children with β-thalassaemia using cone beam computed tomography

ObjectivesAmong children with β-thalassaemia, skeletal changes and abnormalities, such as decreased volume or obliteration of the sinus, result primarily from hypertrophy and expansion of the erythroid marrow due to ineffective erythropoiesis. This study evaluated the volumes and surface areas of the maxillary sinuses of children with β-thalassaemia using cone beam computed tomography (CBCT), and compared these findings with corresponding measurements in age- and sex-matched control children. MethodsCBCT images were retrospectively evaluated for 16 children with β-thalassaemia, 19 children with a class I skeletal pattern (class I group), and 18 children with a class II skeletal pattern (class II group). After three-dimensional analyses and segmentation of each maxillary sinus, the volumes and surface areas were calculated. ResultsThe volumes and surface areas of the right (p > 0.05 and p > 0.05) and left maxillary sinuses (p > 0.05 and p > 0.05) and SNA angles (p > 0.05) were not significantly different among the groups. The ANB (p < 0.05) and SNGoMe (p < 0.05) angles were significantly greater and the SNB (p < 0.05) angle was significantly smaller in the class II and thalassaemia groups than in the class I group. ConclusionChildren with thalassaemia tended to have lower maxillary sinus volumes and surface areas on both right and left sides, compared to those of children with class I and class II skeletal patterns; however, these differences were not statistically significant. In children with thalassaemia, a large intermaxillary discrepancy (ANB) indicated a tendency toward the class II skeletal pattern.

Comparison of accuracy of the maxillary sinus area and dimensions for sex estimation lateral cephalograms of Iranian samples

Abstract Background Sex estimation is a critical issue in forensic medicine. Since anthropologic evaluations on radiographs can contribute to more accurate sex estimation, this study measured the length and height, as well as area, of the maxillary sinus on lateral cephalometric radiography. Methods and materials In this descriptive-analytic study, 80 images obtained from 20 to 40-year-old individuals (40 males and 40 female) were selected. The height and anterior-posterior length of the maxillary sinus was performed using CATIA V5R20 (a software package for image analysis). Maxillary sinus area was determined using discriminant analysis in AutoCAD. Findings The mean maxillary sinus height was 40.48 mm in males and 38.7 mm in females. The mean maxillary sinus length was 40.31 mm in males and 37.31 mm in females. The area of the maxillary sinus was 1201.2 mm2 in males and 1043.4 mm2 in females. Two discriminant analysis models, one based on the height and length of the maxillary sinus and the other based on sinus area) were developed for sex estimation. The area under the receiver operating characteristic (ROC) curve was used for quality assessment of the fitted models and determination of their prediction ability. Conclusion The mean height, length and area of the maxillary sinus were significantly larger in males than in females (P

Method of Preventive Ultrasound Diagnosis of Venous Thrombosis

The objective of the study is to develop the method of preventive diagnosis of venous thrombosis using the ultrasound duplex scanning (USDS). A total of 306 persons were examined: 146 were patients with acute venous thrombosis, 108 patients with varicose veins, and 52 healthy persons (control group). All participants were examined using USDS, and D-dimer level was evaluated. As the result of the conducted research, an ultrasound phenomenon of echogenic particles in valvular sinus area (further referred to as spontaneous echo contrast) is described. A classification of this phenomenon is developed; 2 degrees of spontaneous echo contrast are documented. Spontaneous echo contrast of the first degree reflects the fact that the valvular sinus area is the most thrombogenic zone. Spontaneous echo contrast of the second degree is characterized as pathological; it is a prethrombotic state and can serve as one of the most early predictors of developing venous thrombosis. A high correlation phenomenon of spontaneous echo contrast of the second degree, venous thrombosis, and D-dimer level indicators is determined ( r = 0.89, P &lt; .01). An ultrasound study of valvular sinus is a simple, available, and reproducible method of screening and can be applied as a preventive diagnostics of acute venous thrombosis. The results of the investigations permit us to form risk groups of deep vein thrombosis and perform timely prevention of this pathology.

Are gait changes linked to CSF flow changes in the sagittal sinus?

To identify if specific findings on magnetic resonance imaging (MRI) cerebrospinal fluid (CSF) flow studies can be utilised to identify which patients with idiopathic normal pressure hydrocephalus (iNPH) will have improved gait following a CSF tap test (TT). Prospective study of patients undergoing a CSF TT for iNPH. Functional gait was assessed using the timed up and go (TUG) test before and after the CSF TT. MRI CSF flow studies accompanied the CSF TT. The minimum clinically important difference for the TUG (3.63s) was used as a cutoff value to categorise patients as responders to the CSF TT. Fifty-three patients underwent CSF TT and MRI CSF flow studies. Significant differences were identified between groups for (non-responder vs responder) superior sagittal sinus flow (47.10% vs 40.41%), sagittal sinus stroke volume (274 vs 176.5μl), sagittal sinus to arterial stroke volume ratio (0.203 vs 0.164), sagittal sinus area (42.2mm2 vs 36.2mm2) and circumference (27.7mm vs 24.95mm). No differences were present for aqueduct stroke volume, arterial stroke volume or aqueduct net flow. A link between gait improvement resulting from CSF drainage and sagittal sinus measurements indicates that the sagittal sinus may play a role in the manifestation of symptoms in iNPH. This may have implications for the diagnosis of iNPH and potentially inform clinical decision making regarding surgical intervention.

Gestational exposure to PM2.5 impairs vascularization of the placenta

The placenta is the bridge that connects the developing fetus and mother and is the place where nutrient uptake, waste elimination and gas exchange occurs. Epidemiological studies indicate that fetal stress, such as gestational PM2.5 (particulate matter (PM) with diameter ≤ 2.5 μm) exposure, is a risk factor for abnormal placenta development that could induce adverse effects on the fetus. In the present study, PM samples were collected in Taiyuan. Then, pregnant C57BL/6 mice were treated with 3 mg/kg b.w. PM2.5 every other day starting on GD0.5, and were sacrificed at embryonic day 13.5 (E13.5), E15.5 and E18.5, and placentas were collected for placenta histopathological analysis and gene expression evaluation at the transcription or translation level. Our results showed that gestational exposure to PM2.5 significantly reduced the ratio of the mean area of labyrinthine (lab) layer/total area of placentas at E18.5. However, no significant difference was observed at E13.5 and E15.5. Interestingly, genes essential for this process were altered at E13.5 and E18.5 but not E15.5. Furthermore, gestational PM2.5 exposure decreased the mean area of maternal blood sinuses and fetal blood vessels and suppressed protein expression of CD31 in the PM2.5 group only at E18.5, while protein expression of CD34 in the PM2.5 group was similar to that in the control group at all time points. Finally, gestational exposure to PM2.5 activated mitogen-activated protein kinase (MAPK) pathways at E13.5 and E18.5 but not E15.5. Taking these results together, gestational exposure to PM2.5 leads to histopathological changes and vascularization injuries of the placenta, and this response may be associated with activation of the MAPK pathway.