Diagnostic Modalities Research Articles

Neuroanatomical alterations in brain disorder: A magnetic resonance imaging analysis

Background: Bipolar disorder is a serious mental disorder caused by strong mood fluctuations, affecting 2% of the world's population. People with bipolar disorder experience both manic and depressive episodes, which can lead to suicidal thoughts and changes in appetite, activity, and focus. There are different subtypes of bipolar disorder, with cyclothymic disorder being the milder of the two. Bipolar I is characterized by manic periods, while bipolar II is marked by hypomanic and significant depressive episodes. Bipolar disorder is a biological, genetic, and environmental condition that can affect anyone at any age. Methods: In this study, we enrolled a total of 49 bipolar disorder (BD) participants to 44 healthy control (HC) subjects. Bipolar disorder patients were enlisted with their consent using web portals, medical facilities, and local marketing. MRI contraindications, medical history, self-reported using a mood-altering medication, inadequate vision, and left-handedness were among the exclusion criteria. The various tissue structures which are: the gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were examined using voxel-based morphometry (VBM) to ascertain these changes. We employed statistical parametric mapping (SPM) for both image processing and statistical analysis. Results: Our findings demonstrate that individuals with bipolar disorder showed a substantial volume decrease in both gray matter (GM) and white matter (WM), with gray matter (GM) and white matter (WM) volume decreases being more noticeable in the frontal, temporal, parietal, and occipital lobes. Additionally, individuals with bipolar disorder showed no CSF volume in any of the brain regions. Conclusion: Our VBM research backs up earlier studies that link changes in brain structure, particularly gray matter and white matter, to bipolar disorder. These discoveries shed more information on the neurology of bipolar disorder and could guide the creation of more potent diagnostic and treatment modalities.

MRI and SPECT/CT demonstrate, with low certainty of evidence, the highest diagnostic accuracy for aseptic knee arthroplasty loosening: A systematic comparative diagnostic test review and meta-analysis.

The purpose of this study was to evaluate and compare the diagnostic accuracy of modalities used to aid the diagnosis of aseptic knee arthroplasty loosening. A comparative diagnostic test accuracy systematic review and meta-analysis was conducted following the Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASEand Cochrane databases were searched for original articles evaluating diagnostic modalities up to March 2024. Included studies compared the modality (index test) to the intraoperative finding as reference test. The QUADAS-C (Quality Assessment of Diagnostic Accuracy Studies-Comparative)tool was used to assess the quality of the included studies. The GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach was used to evaluate the certainty of evidence. Level of evidence was evaluated using the Oxford Levels of Evidence tool. The primary outcome wasthe summary of diagnostic accuracy metrics for each modality as demonstrated by a summary receiver-operating characteristic (SROC) curve. The search yielded 467 articles. Of these, 14 articles were included. These 14 articles evaluated a total of five different diagnostic modalities: bone scintigraphy (three studies, 146 cases), 18-fluorodeoxyglucose positron emission tomography(two studies, 50 cases), single-photon emission computed tomography combined with computed tomography (SPECT/CT) (seven studies, 371 cases), radionuclide arthrogram (three studies, 196 cases)and magnetic resonance imaging (MRI) (one study, 116 cases). Nine studies exhibited a high risk of bias in patient selection, and all studies showed a high risk of bias related to the reference test. The majority of the included studies were classified as Level III evidence, leading to an overall low level of certainty in the evidence. The most accurate tests, as demonstrated by the SROC analysis, were MRI and SPECT/CT, with sensitivities ranging from 0.00 to 1.00 and 0.33 to 1.00 and specificities between 0.31-1.00 and 0.00-1.00, respectively. This review and meta-analysis evaluated available diagnostic modalities to aid the diagnosis of knee arthroplasty loosening and based on a low certainty of evidence suggests that MRI and SPECT/CT are currently the most accurate modalities available to aid the diagnosis of aseptic loosening of knee arthroplasty components. Level III.

Endocardial Fibroelastosis: A Comprehensive Review of Pathogenesis, Clinical Manifestations, Diagnostic Modalities, and Management Strategies

Endocardial fibroelastosis (EFE) is a rare and enigmatic myocardial disease characterized by the abnormal accumulation of collagen and elastin fibers in the endocardium, predominantly affecting the left ventricle. This comprehensive review aims to elucidate the pathogenesis, clinical manifestations, diagnostic modalities, and management strategies of EFE. EFE typically presents in infants and young children, although adult cases have been reported. The etiology of EFE remains elusive, with theories implicating genetic, infectious, and autoimmune factors. Clinically, EFE may manifest with symptoms of heart failure, arrhythmias, or sudden cardiac death. Diagnosis often involves echocardiography, cardiac magnetic resonance imaging, and endomyocardial biopsy. Management strategies for EFE are primarily supportive, focusing on the management of heart failure symptoms and arrhythmias, with advanced cases necessitating heart transplantation. This review provides a comprehensive overview of EFE, highlighting the challenges in diagnosis and management and underscoring the need for further research to elucidate its pathogenesis and improve outcomes.

Transesophageal Echocardiography in Critical Care

Abstract Purpose of Review In this article we describe the utility, indications, contraindications, limitations, and clinical situations in which transesophageal echocardiography (TEE) examination can be instrumental in managing patients in the intensive care unit (ICU). Recent Findings TEE is a safe and semi-invasive diagnostic modality that can be used to differentiate pathologies, determine hemodynamic status, guide management, and determine response to therapy. Its presence has expanded beyond the operating rooms into the critical care world. Despite limited randomized trials, evidence indicates its significant benefits and potential for early diagnosis to reduce morbidity and mortality. Summary Patients in the ICU present with multifactorial form of shock, hypoxemia needing monitoring and mechanical circulatory support. TEE is a low-risk diagnostic and monitoring tool which is invaluable in the ICU. Its advantages include superior visualization of cardiac structures and accurate assessment of abnormalities. Judicious utilization of TEE holds the potential to significantly influence clinical decision-making in a favorable manner.

Photoacoustic/ultrasound dual-modal imaging of human nails: A pilot study

Traditional diagnostic techniques including visual examination, ultrasound (US), and magnetic resonance imaging (MRI) have limitations of in-depth information for the detection of nail disorders, resolution, and practicality. This pilot study, for the first time, evaluates a dual-modality imaging system that combines photoacoustic tomography (PAT) with the US for the multiparametric quantitative assessment of human nail. The study involved a small cohort of five healthy volunteers who underwent PAT/US imaging for acquiring the nail unit data. The PAT/US dual-modality imaging successfully revealed the fine anatomical structures and microvascular distribution within the nail and nail bed. Moreover, this system utilized multispectral PAT to analyze functional tissue parameters, including oxygenated hemoglobin, deoxyhemoglobin, oxygen saturation, and collagen under tourniquet and cold stimulus tests to evaluate changes in the microcirculation of the nail bed. The quantitative analysis of multispectral PAT reconstructed images demonstrated heightened sensitivity in detecting alterations in blood oxygenation levels and collagen content within the nail bed, under simulated different physiological conditions. This pilot study highlights the potential of PAT/US dual-modality imaging as a real-time, noninvasive diagnostic modality for evaluating human nail health and for early detection of nail bed pathologies.

Measurement of diamine oxidase (DAO) during low-histamine or ordinary diet in patients with histamine intolerance.

Quantification of diamine oxidase (DAO) concentrations in serum has been proposed as an adjunctive diagnostic modality for the evaluation of histamine intolerance (HIT). Limited empirical data exist concerning the influence of dietary patterns on DAO levels. In the context of a prospective study employing a crossover design, 18 individuals diagnosed with HIT were randomized to initiate either a low histamine diet (LHD) or a conventional mixed diet (MXD). Serum DAO concentrations were measured at the commencement of the study and following each dietary phase. A control group underwent analogous DAO assessments without imposition of dietary constraints. During the time when a diet restricted in histamine was implemented, noticeable differences in changes in DAO levels did not become apparent when compared to the changes observed during the mixed (MXD) phase. Specifically, among the group, 10 of the 18 patients exhibited elevated DAO values subsequent to the LHD regimen, while the remaining eight displayed either reduced or unchanging DAO levels. The prevalence of elevated DAO levels in the LHD group did not differ significantly from that observed in the control group during the MXD phase. Additionally, during the LHD phase, patients reported a significant reduction in gastrointestinal and cutaneous symptoms. This prospective investigation underscores the enduring utility of a histamine-restricted diet, coupled with structured dietary reintroduction, as an efficacious diagnostic approach for individuals presenting with suspected food-related histamine hypersensitivity. Notably, the measurement of DAO levels appears to furnish only a limited capacity to discern dietary-induced fluctuations. Notwithstanding, the dynamics of DAO alteration do not appear to exhibit a discernible association with specific dietary patterns, a finding consistent across both patient and control groups.

THE IMPORTANCE OF ULTRASONOGRAPHY IN THE DETECTION OF CONGENITAL HEART DISEASES IN CHILDREN

Over the last few years, remarkable progress has been made in the field of congenital heart diseases. Improvements considering diagnostic modalities, especially imaging, in surgical and interventional techniques, as well as in postoperative therapy and care, have contributed to a significant reduction in mortality and morbidity. One of the most important applications of medical imaging techniques in children is the detection and treatment of congenital heart anomalies. Objective of this article is to show the importance of ultrasonography in the detection of congenital heart diseases in children. The study was conducted on children with simple and complex congenital heart diseases and was conducted on the Pediatric Clinic, UKCS. The research is descriptive on a representative sample. In our study, 166 children were observed, of which 148 children (77 boys, 71 girls) with simple congenital heart diseases, and 18 children (8 boys, 10 girls) with complex congenital heart diseases. Out of the total number of observed children, 115 had a surgical correction, 97 children with simple congenital heart diseases (45 boys, 52 girls) and 18 children with complex congenital heart diseases (8 boys, 10 girls). The number of children monitored through the Cardiac Counseling Center who didn’t undergo surgical correction was 51, all with simple congenital heart diseases. Out of the total number of observed children who were frequently coming for follow-ups, 28 children had changes on the ECG, and 138 of them had no changes on the ECG, 93 were surgically treated, and 73 of them were on conservative therapy. Based on the results of the research, we conclude that ultrasonography is an important method in the detection and treatment of congenital heart diseases.

Taxonomy of Acute Stroke: Imaging, Processing, and Treatment

Stroke management employs a variety of diagnostic imaging modalities, image processing and analysis methods, and treatment procedures. This work categorizes methods for stroke imaging, image processing and analysis, and treatment, and provides their taxonomies illustrated by a state-of-the-art review. Imaging plays a critical role in stroke management, and the most frequently employed modalities are computed tomography (CT) and magnetic resonance (MR). CT includes unenhanced non-contrast CT as the first-line diagnosis, CT angiography, and CT perfusion. MR is the most complete method to examine stroke patients. MR angiography is useful to evaluate the severity of artery stenosis, vascular occlusion, and collateral flow. Diffusion-weighted imaging is the gold standard for evaluating ischemia. MR perfusion-weighted imaging assesses the penumbra. The stroke image processing methods are divided into non-atlas/template-based and atlas/template-based. The non-atlas/template-based methods are subdivided into intensity and contrast transformations, local segmentation-related, anatomy-guided, global density-guided, and artificial intelligence/deep learning-based. The atlas/template-based methods are subdivided into intensity templates and atlases with three atlas types: anatomy atlases, vascular atlases, and lesion-derived atlases. The treatment procedures for arterial and venous strokes include intravenous and intraarterial thrombolysis and mechanical thrombectomy. This work captures the stateoftheart in stroke management summarized in the form of comprehensive and straightforward taxonomy diagrams. All three introduced taxonomies in diagnostic imaging, image processing and analysis, and treatment are widely illustrated and compared against other state-of-the-art classifications.

The Utility of Intraluminal Therapies in Upper Tract Urothelial Carcinoma: A Narrative Review

Nephron sparing surgery (NSS) is considered for selected cases of upper tract urothelial carcinoma (UTUC) as it maintains renal function and avoids morbidity associated with radical nephroureterectomy (RNU). The appropriate selection of patients suitable for NSS without compromising oncological outcomes can sometimes be difficult, given the limitations of diagnostic modalities. Recurrence rates for UTUC can be as high as 36 to 54% after NSS. Intraluminal adjuvant therapy can be attempted following NSS to reduce recurrence, but delivery to the upper tract is more challenging than into the bladder. Bacillus Calmette-Guerin (BCG) and chemotherapy such as Mitomycin (MMC) have been administered via nephrostomy or ureteric catheter, which requires invasive/repeated instrumentation of the upper urinary tract. Drug delivery by reflux from bladder instillation along indwelling stents has also been tried but can potentially be unreliable. Recently, a gel formulation of mitomycin has been developed for the controlled exposure of the upper urinary tract to treatment over a number of hours. Drug-eluting stents to deliver chemotherapy to the upper urinary tract have been developed but have not yet entered clinical practice. Endoluminal phototherapy utilising an intravenous photosensitising agent is another novel approach that has recently been described. Intraluminal therapies may be beneficial in decreasing recurrence rates in UTUC, but currently have some limitations in their usage.

Tuberculous Otitis Media: A Mysterious Ailment

Abstract: Introduction: Tuberculous otitis media (TOM) is an infrequent ailment. As an uncommon form of extra-pulmonary Tuberculosis, it is often underestimated, leading to a delay in diagnosis and start of appropriate treatment. Case Series: We describe 3 cases of TOM diagnosed and treated in our institute. The typical presentation was prolonged ear discharge not responding to culture sensitive antibiotics, hard of hearing, perforation of tympanic membrane, pale whitish granulation tissue. Pure Tone Audiogram (PTA) done to evaluate the hearing loss. The granulation tissue from all the patients sent for Histopathology examination (HPE) and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) examination. CBNAAT results were positive in all three patients. HPE reported as chronic inflammatory pathology. PTA revealed sensorineural hearing loss in 2 patients and conductive hearing loss in 1 patient. Treatment with regular ATT 4FDC (Anti Tubercular Treatment- Four Drug Combination) regimen was started as per weight band for 6 months. Each of them was on follow up and symptomatically improving. Discussion: TOM requires recognition in refractory chronic otitis media. Early diagnosis and intervention are essential to prevent complications and optimise outcomes. The delay in initiating therapy may lead to complications such as facial nerve palsy. This case series aims to highlight the clinical presentation, effective diagnostic modalities and treatment of tuberculous otitis media and stresses the importance of awareness among otorhinolaryngologists regarding TOM and its timely management.

ERCP (endoscopic retrograde cholangiopancreatography) and EUS (endoscopic ultrasonography) in diagnosis of choledocholithiasis – battle or cooperation?

Introduction: Diagnosis of choledocholithiasis, a common manifestation of gallstone disease, is mainly based on advanced endoscopic techniques such as ERCP and EUS. Since the 1970s, ERCP has been a key method in the diagnosis and treatment of choledocholithiasis, allowing direct visualization and therapeutic interventions. However, technological developments have brought the emergence of EUS as a complementary tool, providing high-resolution imaging of the bile ducts. Understanding the diagnostic accuracy, therapeutic options and complications of both modalities is key to optimizing the care of patients with bile duct stones. Aim of the study: The aim of our study is to review and compare various diagnostic methods of bile duct stones, as well as to assess their effectiveness, accuracy, and potential complications. Materials and methods: We searched electronic sources, aspecially in the PubMed and Google Scholar databases, using keywords such as ,,endoscopic ultrasonography”, ,,endoscopic retrograde cholangiopancreatography” and ,,choledocholithiasis”. Conclusions: With the use of modern technologies, such as endoscopic ultrasonography (EUS) and retrograde choleangiopancreatography (ERCP), it has become possible to diagnose bile duct stones more accurately and introduce more effective and less invasive therapies. The development of the availability of diagnostic tests, especially those that do not require invasive procedures, has helped reduce the risk of complications. EUS may be the preferred tool of choice for patients with gallstones, as it is associated with a lower risk of complications compared to ERCP alone. Decisions regarding the use of specific diagnostic and therapeutic modalities should be made on a case-by-case basis, taking into account medical and economic considerations.

PAPILLARY FIBROELASTOMA: AN UNUSUAL CAUSE OF TRANSIENT ISCHEMIC ATTACK

Abstract Papillary fibroelastomas (PFEs) are small, avascular benign tumors. Despite that, PFEs could lead to important clinical consequences such as transient ischemic attack and myocardial infarction. A 65–year–old female patient was admitted to our ER presenting a transient ischemic attack characterized by retrograde amnesia lasting about an hour. She had a history of systemic scleroderma and left breast cancer treated with local radiotherapy. In our hospital she underwent a neurological examination and a head CT which were negative for ongoing acute pathologies. An electrocardiogram was performed which showed sinus rhythm at 65 bpm. A transthoracic echocardiogram was also performed revealing a floating mass arising from left ventricular outflow tract between aortic and mitral valves. The transesophageal echocardiogram confirmed a solitary lesion approximately 2 centimeters long localized between A2 and A3 mitral valve scallops. The patient was therefore referred for surgery. During surgery the mass was found to arise from anterior mitral annulus and was resected. The histopathological examination of the mass confirmed the morphologic diagnosis of papillary fibroelastoma. Histologically PFEs are made up of a single layer of endocardial cells covering a matrix of collagen. The main risk factors for the development of PFEs are iatrogenic causes, such as radiotherapy, and autoimmune diseases such as systemic scleroderma. In 54% of cases PFEs are asymptomatic at the time of diagnosis. Since over 95% of PFEs present on the left side of the heart, systemic embolism is the most frequent presentation typically as transient ischemic attacks. Initial evaluation is accomplished with echocardiography. PFEs appear as echo–dense and pedunculated masses. Cardiac computed tomography and magnetic resonance imaging are second line modalities in PFEs evaluation. Definitive diagnosis of PFE requires pathological confirmation. Surgical resection remains the treatment of choice for all symptomatic patients. For symptomatic patients who are not surgical candidate, long term antiplatelets or anticoagulation therapy should be initiated. Asymptomatic patients should have surgical resection if the size of the tumor is > 1 cm. PFEs are associated with significant morbidity and mortality. Echocardiography remains the most utilized diagnostic modality. Surgical treatment should always be considered. Antithrombotic therapy should be considered in non–surgical candidates.

Difficult diagnosis: Disseminated gonorrheal infection manifesting as septic arthritis.

Disseminated gonococcal infection is the causative agent of approximately 0.6%-1.2% of septic arthritis cases in North America and Europe. Typical presentations of this disorder include tenosynovitis, dermatitis, polyarthralgia, or oligoarticular purulent arthritis affecting the distal joints. Diagnosis is contingent on clinical presentation, with urine nucleic acid amplification testing as the preferred diagnostic modality. Synovial fluid cultures, along with imaging, can confirm diagnosis. The recommended treatment is a third-generation cephalosporin, such as intravenous ceftriaxone for 7-14 days and a dose of oral azithromycin.

Inflammatory myofibroblastic tumor of urinary bladder in young male: A case report and literature review

The objective of this study is to present a rare case of inflammatory myofibroblastic tumor (IMT) of the urinary bladder in young male, detailing its clinical presentation, diagnostic approach, treatment strategy, and outcome. Additionally, the objective includes conducting a literature review to provide insights into the characteristics, management, and prognosis of this uncommon tumor entity.A 20-year-old male presenting with dysuria and dribbling of urine underwent diagnostic workup including imaging studies, cystoscopy. On cystoscopy there was a presence of 5x4 cm sized pedunculated mass in the urinary bladder. Partial cystectomy is done and specimen is examined for histopathology. Histopathological examination and Immunohistochemistry study of the tumor specimen was performed to confirm the diagnosis of inflammatory myofibroblastic tumor. A thorough literature review was conducted to gather relevant studies on IMT of the urinary bladder, focusing on clinical presentations, diagnostic modalities, treatment approaches, and outcomes. Diagnostic evaluation revealed a mass lesion in the urinary bladder, and histopathological examination following partial cystectomy confirmed the diagnosis of inflammatory myofibroblastic tumor. The patient underwent surgical excision of the tumor followed by adjuvant therapy. Regular follow-up examinations showed no evidence of tumor recurrence. The literature review identified a limited number of reported cases of IMT of the urinary bladder in young male, emphasizing its rarity and diverse clinical presentations. Various diagnostic modalities and treatment options, including surgery, chemotherapy, and targeted therapy, were discussed in the reviewed literature. Inflammatory myofibroblastic tumor of the urinary bladder is a rare neoplasm at younger age that can present with nonspecific symptoms, making its diagnosis challenging. However, timely recognition and appropriate management, including surgical resection and adjuvant therapy, can lead to favorable outcomes with low recurrence rates. This case report highlights the importance of considering IMT in the differential diagnosis of bladder masses in young patient and underscores the need for further research to better understand the pathogenesis and optimal treatment strategies for this rare tumor entity.

The role of cell‐free DNA in non‐invasive diagnosis of urinary tract infection

AbstractUrinary tract infection (UTI) constitutes a pervasive health concern. UTIs are dichotomously classified into upper and lower strata, and further categorized as either complicated or uncomplicated. Upper UTIs predominantly afflict the renal and ureteral domains, typified by conditions exemplified in pyelonephritis, whereas lower UTIs manifest within the confines of the urethra and bladder. The conventional diagnosis of UTIs relies upon clinical manifestations and urine culture. Common symptoms encompass dysuria, frequent micturition, hematuria, and suprapubic discomfort. Urine culture serves to identify the specific pathogens instigating the infection and assess their antibiotic susceptibility. However, this procedural protocol generally necessitates an approximate duration of 24 h, coupled with an additional 24‐h interval for antibiotic susceptibility testing. In contradistinction, the detection of cell‐free DNA (cfDNA) in the circulatory system presents a potential avenue for non‐invasive diagnostic modalities. Notwithstanding, cfDNA emanates from deteriorating cells, affording insights into the extant cellular demise within the organism. Extensive scholarly inquiry has established a positive correlation between cfDNA concentration in the bloodstream and the incidence of cell death in conditions, such as severe traumas, sepsis, aseptic inflammation, myocardial infarction, and stroke. However, limited investigative effort has been devoted to elucidating the diagnostic potential of cfDNA in the context of UTIs. Consequently, the concentration and constitution of plasma cfDNA harbor substantial promise for non‐invasively diagnosing UTIs. In summation, the utilization of cfDNA in UTI diagnosis remains an incipient area of scholarly pursuit, underscoring the imperative for further research to elucidate the prospective role of plasma cfDNA in non‐intrusively discerning UTIs.

Systematic review of risk factors, prognosis, and management of colorectal signet-ring cell carcinoma.

Colorectal signet-ring cell carcinoma (CSRCC) is a rare clinical entity which accounts for approximately 1% of all colorectal cancers. Although multiple studies concerning this specific topic have been published in the past decades, the pathogenesis, associated risk factors, and potential implications on treatment are still poorly understood. Besides the low incidence, historically confusing histological criteria have resulted in confusing data. Nevertheless, the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis, highlight the actual interest to synthesize the known literature regarding CSRCC. To provide an updated overview of risk factors, prognosis, and management of CSRCC. A literature search in the MEDLINE/PubMed database was conducted with the following search terms used: 'Signet ring cell carcinoma' and 'colorectal'. Studies in English language, published after January 1980, were included. Studies included in the qualitative synthesis were evaluated for content concerning epidemiology, risk factors, and clinical, diagnostic, histological, and molecular features, as well as metastatic pattern and therapeutic management. If possible, presented data was extracted in order to present a more detailed overview of the literature. In total, 67 articles were included for qualitative analysis, of which 54 were eligible for detailed data extraction. CSRCC has a reported incidence between 0.1%-2.4% and frequently presents with advanced disease stage at the time of diagnosis. CSRCC is associated with an impaired overall survival (5-year OS: 0%-46%) and a worse stage-corrected outcome compared to mucinous and not otherwise specified adenocarcinoma. The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised. Surgery is the mainstay of treatment, although the rates of curative resection in CSRCC (21%-82%) are lower compared to those in other histological types. In case of peritoneal metastasis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients. CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation. As such, diagnostic modalities and therapeutic approach should be tailored accordingly.

Development of a Curriculum for Emergency Physicians to Teach Transesophageal Echocardiography for Cardiac Arrests: A Kern Six-Step Model

BACKGROUND: The Kern model facilitates the development, implementation, and evaluation of successful educational systems in medicine. It involves six steps that link curricular content to health care needs. One such need is the design of a curriculum to teach emergency physicians practical use of focused transesophageal echocardiography employing a limited number of views for management of out-of-hospital cardiac arrests. The objective of this analysis was to describe the components of such a curriculum based on a Kern model that could be employed to train emergency department providers in this diagnostic modality. METHODS: We predicated our analysis on the American College of Emergency Physicians’ recommendations and goals for use of transesophageal echocardiography to guide emergency department cardiac arrest resuscitation. We then detailed an asynchronous pre-didactic learning experience followed by a synchronous didactic and simulation-based curriculum to teach emergency physicians how to acquire and interpret images for this purpose based upon steps set forth by a Kern model. RESULTS: The component steps in designing a curriculum constructed to teach focused transesophageal echocardiography for out-of-hospital cardiac arrests to emergency physicians are rigorously outlined. These components based on a Kern model include problem identification and a general needs assessment, a targeted needs assessment, defining goals and objectives, choosing educational strategies, curricular implementation, and program evaluation. CONCLUSIONS: Use of a six-step Kern model as a template can facilitate the development and dissemination of a curriculum to teach emergency physicians successfully to employ focused transesophageal echocardiography in the treatment of cardiac arrests. In order to promote its widest dissemination, this model should be pursued in a “train-the-trainer” fashion. In so doing, appropriate education of emergency physicians and their use of transesophageal echocardiography to manage cardiac arrests likely can be rapid and impactful, especially among providers with training and experience in transthoracic echocardiography.

Assessing Regurgitation Severity, Adverse Remodeling, and Fibrosis with CMR in Primary Mitral Regurgitation.

This review offers an evidence-based analysis of established and emerging cardiovascular magnetic resonance (CMR) techniques used to assess the severity of primary mitral regurgitation (MR), identify adverse cardiac remodeling and its prognostic effect. The aim is to provide different insights regarding clinical decision-making and enhance the clinical outcomes of patients with MR. Cardiac remodeling and myocardial replacement fibrosis are observed frequently in the presence of substantial LV volume overload, particularly in cases with severe primary MR. CMR serves as a useful diagnostic imaging modality in assessing mitral regurgitation severity, early detection of cardiac remodeling, myocardial dysfunction, and myocardial fibrosis, enabling timely intervention before irreversible damage ensues. Incorporating myocardial remodeling in terms of left ventricular (LV) dilatation and myocardial fibrosis with quantitative MR severity assessment by CMR may assist in defining optimal timing of intervention.

Hotspots and trends of risk factors in gastric cancer: A visualization and bibliometric analysis.

The lack of specific symptoms of gastric cancer (GC) causes great challenges in its early diagnosis. Thus it is essential to identify the risk factors for early diagnosis and treatment of GC and to improve the survival rates. To assist physicians in identifying changes in the output of publications and research hotspots related to risk factors for GC, constructing a list of key risk factors, and providing a reference for early identification of patients at high risk for GC. Research articles on risk factors for GC were searched in the Web of Science core collection, and relevant information was extracted after screening. The literature was analyzed using Microsoft Excel 2019, CiteSpace V, and VOSviewer 1.6.18. A total of 2514 papers from 72 countries and 2507 research institutions were retrieved. China (n = 1061), National Cancer Center (n = 138), and Shoichiro Tsugane (n = 36) were the most productive country, institution, or author, respectively. The research hotspots in the study of risk factors for GC are summarized in four areas, namely: Helicobacter pylori (H. pylori) infection, single nucleotide polymorphism, bio-diagnostic markers, and GC risk prediction models. In this study, we found that H. pylori infection is the most significant risk factor for GC; single-nucleotide polymorphism (SNP) is the most dominant genetic factor for GC; bio-diagnostic markers are the most promising diagnostic modality for GC. GC risk prediction models are the latest current research hotspot. We conclude that the most important risk factors for the development of GC are H. pylori infection, SNP, smoking, diet, and alcohol.

Role of MRI in Evaluation of Post-Traumatic Knee Injuries: A Prospective Study

INTRODUCTIONThe knee joint is the largest and most complex joint in the human body. Therefore it is often affected by trauma. Magnetic Resonance Imaging (MRI) is a non-invasive imaging modality that provides detailed images of the soft tissue structures of the knee joint. The objective of this study was to evaluate MRI findings in patients with post-traumatic knee joint injuries. MATERIAL AND METHODSThis prospective study was carried out using a 3.0 Tesla MRI (Magnetom Lumina) scanner in the Department of Radiodiagno- sis and Medical Imaging at Universal College of Medical Sciences & Teaching Hospital, Bhairahawa, Nepal, involving 128 patients with knee injuries, from September 2023 to February 2024. Data were analyzed using SPSS version 20. RESULTSIn this study of 128 participants, 57.81% were male and 42.19% were female, with a mean age of 38.60±13.05 years. The majority of MRI findings were medial meniscus tear (51.56%), followed by anterior cruciate ligament tear (46.09%), medial collateral ligament sprain (44.53%), lateral meniscus tear (39.84%), lateral collateral ligament sprain (33.59%), and posterior cruciate ligament tear (17.97%). Our study also revealed various grades of collateral ligament injuries, including the medial and lateral ligaments. There were 59.65% of cases with a grade I medial collateral ligament sprain, followed by grade II at 33.33% and grade III at 7.02%. The grade I and grade II lateral collateral ligament sprains were 62.79% and 37.21%, respectively. CONCLUSIONMRI is a non-invasive and valuable diagnostic modality that can provide an accurate diagnosis. It is often preferred over arthroscopy.