Faint Shadow Research Articles

Clinical characteristics of Mycoplasma pneumoniae infection and factors associated with co-infections in children

Objective: To describe the clinical characteristics of Mycoplasma pneumoniae infection and analyze the factors associated with co-infections with other pathogens in children, and provide evidence for improvement of community acquired pneumonia (CAP) prevention and control in children. Methods: Based on the surveillance of hospitalized acute respiratory infections cases conducted in Soochow University Affiliated Children's Hospital (SCH), the CAP cases aged <16 years hospitalized in SCH between 2018 and 2021 were screened. The pathogenic test results of the cases were obtained through the laboratory information system, and their basic information, underlying conditions, and clinical characteristics were collected using a standardized questionnaire. The differences in clinical characteristics between M. pneumoniae infection and bacterial or viral infection and the effect of the co-infection of M. pneumoniae with other pathogens on clinical severity in the cases were analyzed; logistic regression was used to analyze the factors associated with the co-infections with other pathogens. Results: A total of 8 274 hospitalized CAP cases met the inclusion criteria. Among them, 2 184 were positive for M. pneumoniae (26.4%). The M. pneumoniae positivity rate increased with age (P<0.001), and it was higher in girls (P<0.001) and in summer and autumn (P<0.001). There were statistically significant differences in the incidence of wheezing, shortness of breath, wheezing sounds and visible lamellar faint shadow on chest radiographs, as well as fever and hospitalization days among M. pneumoniae, bacterial, and viral infection cases (all P<0.05). In the cases aged <60 months years, co-infection cases had higher rates of wheezing, gurgling with sputum and stridor; and in the cases aged ≥60 months, co-infection cases had a higher rate of shortness of breath (all P<0.05). Multifactorial logistic regression analysis showed that being boys (aOR=1.38,95%CI:1.15-1.67), being aged <6 months (aOR=3.30,95%CI:2.25-4.89), 6-23 months (aOR=3.44,95%CI:2.63-4.51), 24-47 months (aOR=2.50,95%CI:1.90-3.30) and 48-71 months (aOR=1.77,95%CI:1.32-2.37), and history of respiratory infection within 3 months (aOR=1.28,95%CI:1.06-1.55) were factors associated with co-infections of M. pneumoniae with other pathogens. Conclusions: M. pneumoniae was the leading pathogen in children hospitalized due to CAP. M. pneumoniae infections could cause fever for longer days compared with bacterial or viral infections; M. pneumoniae was often co-detected with virus or bacteria. Being boys, being aged <72 months and history of respiratory infection within 3 months were associated factors for co-infections.

Melanoma: Morphological essays of energetic tumor death under the influence of live mitochondria.

e21561 Background: Global trials form a new mitochondrial paradigm for suppressing the growth of malignant tumors. The unique role of mitochondria (MC) in the processes of metabolism, proliferation, and cell death was proven by the establishment of signaling pathways and critical conditions for the self-organization and degradation of MC. There are still many unsolved problems in the development of a new strategy, including the absence of an integral picture of morphological changes in the tumor under the influence of mitochondrial therapy (MCT), and this determined the purpose of the study. Methods: The study included male and female Balb/c Nude mice weighing 21-22 g. B16/F10 melanoma was transplanted to mice subcutaneously, and suspension of live liver MC was injected intraperitoneally. MC were isolated by differential centrifugation (Avanti J-E high-speed centrifuge, BECKMAN COULTER, USA). After an MCT cycle, the melanoma structure was examined with hematoxylin and eosin staining and light microscopy (LEICA DM LS2). Results: Control samples of melanoma (without MCT) showed abundant vascularization with dense growth of epithelial-like cells with branched cytoplasm, an eccentric nucleus and a moderate content of melanin pigment. Massive hypoxic death, autolysis and autoxidation of tumor cells were registered in male mice after MCT, as well as matrix hyalinosis, pronounced subcutaneous tissue edema with segregation and necrotization of fat accumulations. The formation of a large cavity filled with detritus indicated signs of total tumor necrosis and ischemia. The accumulation of hyperchromic granules indicated the activation of granulocytic and phagocytic elements in the mechanism of tumor regression. Female mice showed rare small areas of necrosis, as well as pronounced fragmentation of nuclei and cytoplasm of cells in most fields of view induced by bioenergetic hypoxia, with the formation of apoptotic bodies. Along the edge of the cells subjected to autophagocytosis, melanin accumulated as it left the cells and accumulated as large granules, while small ones filled the space of the vessels. The process of melanoma regression was confirmed by a significant increase in free fibrous areas, where only faint cell shadows remained. Conclusions: The initial state of melanoma degrades under the influence of MCT inducing bioenergetic hypoxia in male and female Balb/c Nude mice in different ways. Gender, in fact, hormonal differences determine the dominance of different ways of cell death, necrosis (in males) and apoptosis (in females), while maintaining the MCT access to the processes of preventing tumor growth.

Ground glass opacity detection and segmentation using CT images: an image statistics framework

Lung cancer is one of the most profound causes of cancer-related deaths in the world. Early detection is known to significantly improve the chances of survival. Several detection and diagnostic methods are used for this purpose. CT is one of the most widely used non-invasive medical imaging modalities in this domain. The biggest challenge faced by radiologists in this case is detection and diagnosis of cancerous lung nodules. The growth of ground glass opacity (GGO) lesions is an indication of malignancy. However, GGO is difficult to capture for physicians as it manifests in the form of tiny, faint shadows. This research paper proposes an approach for aiding GGO identification in CT lung images for improved lung cancer prognosis. In the proposed approach, morphological reconstruction is used for segmentation. Once the region of interest (ROI) is extracted, statistical analysis using mean, standard deviation, variance, entropy, skewness, kurtosis, minimum grey scale value, maximum grey scale value and range is performed. The same statistical measures are determined for normal lung and distribution plot is drawn for comparison. It is observed that maximum grey-scale value demonstrates minimum overlap of approximately 7.4%. To reduce this, a joint feature by summing values of feature mean, skewness, and maximum grey-scale value was used. This approach reduced the overlap to approximately 1.32%. Lastly, ANN was used for classification of GGO and non-GGO lung tissue with an achieved accuracy of 99.5%.

The Visual, Auditory, and Physical Environment of Livestock Handling Facilities and Its Effect on Ease of Movement of Cattle, Pigs, and Sheep

The visual, auditory, and physical environment livestock are handled in will have an effect on the ease of movement through races and corrals that are used for veterinary treatment, loading trucks or at slaughter houses. When livestock refuse to move easily through a handling facility, people are more likely to use electric goads (prods) or other aversive methods to move them forward. This is a major animal welfare concern. Modification of the environment can improve livestock movement and reduce aversive handling methods. In existing facilities used for handling cattle, pigs or sheep, simple changes such as, adding a light to a dark race entrance or reducing loud intermittent noise may improve livestock movement. Eliminating distractions such as, a noisy truck near a lairage can also facilitate cattle movement and reduce stopping or turning back. In an outdoor facility, sharp shadows on the floor were more likely to be associated with cattle stopping compared to no shadows or soft faint shadows. The installation of small solid walls to prevent approaching animals from seeing either moving equipment, vehicles or people in front of them may also improve forward livestock movement. Non-slip flooring is essential to prevent slipping and falling during handling. Rebuilding or completely redesigning an existing facility is often not required. Outcome based indicators should be used to assess continuous improvements in handling. Some of the commonly used measurable of handling are slipping and falling, stopping, turning back, vocalization during handling and electric prod use. Collecting data both before and after an environmental modification can be used to determine its effectiveness.

EU Dieselgate: unveiling the weirdness of the EU’s attitude to compliance on environmental matters

“Google fined €4.34bn by EU over Android antitrust violations”. June 2018: the European Commission imposes a record penalty, after a 39-month investigation into Google’s Android operating system. This worldwide level news confirms the power of the European Union and its Commission in relation to competition and antitrust issues: a direct power to investigate and a power to sanction. By contrast, European environmental law looks like a ‘parent pauvre’. In this area, the European Commission does not enjoy a similar centralized investigative power, not even a faint shadow of it. No European Union institution or agency has such power in environmental matters, not even the European Environmental Agency. While the Commission’s role is to ensure the full application of Community legislation on the environment, enforcement of environmental law is and has always been primarily a responsibility of the Member States. The present paper wants to address the question whether the current inspection landscape, as applicable in the European Union and as far as environmental matters (and emissions into the environment in particular) are concerned, could have taken hold of what is now called ‘dieselgate’ and if both aspects (dieselgate and inspection) are, somehow, interrelated.

Increasing confidence in reef interpretation using dip angle gathers analysis

The uncertainty associated with the seismic interpretation of carbonate reef boundaries primarily relates to the generally limited difference between the velocities characterizing the reef body, and those of the encasing strata. In addition, the carbonate overburden section also generates strong multiple waves, whose physical characteristics are similar to those of the primary reflections, hindering the unequivocal identification of the latter. As a result, through conventional processing, it is often difficult to achieve a high signal-to-noise ratio and to confidently define the reef boundaries. Even employing industry-established, traditional seismic attributes a reef may just appear as a faint shadow or even not be visible. For a more confident interpretation of the reef we propose the adoption of an advanced methodology, based on analysis of dip angle gathers. Such an approach allows for a straightforward and reliable identification of the reef edges, reducing the uncertainties connected with their interpretation and possibly highlighting areas of different reservoir properties.

Ampurias en la Antigüedad Tardía. Una nueva perspectiva

La historiografía tradicional ha venido sosteniendo que durante la Baja Antigüedad la ciudad de Ampurias no era otra cosa que el fantasma apenas tangible de su lejana grandeza. Sin embargo, una lectura atenta de los datos y un conjunto de nuevas evidencias, textuales y arqueológicas, permiten plantear los hechos de manera bien distinta y reconocer, para esta etapa histórica, un período de gran importancia para la ciudad. sede episcopal y el puerto más activo de un vastísimo territorio.

Radiographic Morphology and Method for Localization of the Adductor Tubercle on Anterior-Posterior Knee Radiographs.

The adductor tubercle (AT) is a landmark for joint line identification in knee arthroplasty. Up to now, there has not been a dedicated study to define its morphology on an anterior-posterior (AP) radiograph. As a result, radiographic localization of the AT has been inconsistent and confusing. Ten bone specimens, each with the AT labeled with a metal marker, were radiographed to demonstrate the AT appearance on AP radiographs. Based on this knowledge, a method to locate the AT was developed. A total of 200 clinical radiographs were examined to further confirm the observed radiographic morphology with emphasis on the visibility of the AT and its association with the rotational status of the knee on radiographs. One hundred of them were used to test the reliability of this method of AT identification. Of the 200 ATs, 153 (76%) were clearly visible on radiographs as a faint pyramid-shaped shadow protruding outward from the inflexion point of the concave-convex silhouette over the femoral shaft-condylar junction, allowing direct identification. For invisible ATs (24%), this inflexion point was found to be a useful surrogate landmark for their identification. Locating the AT using this technique showed a good intra- and interobserver reliabilities. The proposed method may be valuable for the consistent use of this landmark in joint line identification on radiographs.

The Celestial Virgin

Traditional woman has been the custodian of pleasure, and the dis-pensing of pleasure has been a large part of her glory and power. Too often, in these later days, womankind has been disposed to discredit her own natural glories and powers by becoming an imitator of man. This is really giving to man-power and man-function a greater tribute than they deserve. That essence the outer embodiment of which is woman in a peculiar sense constitutes a need of this world today that is especially poignant. There is too great an over-balance of harsh willfulness abroad in the world. Consequently, there is a need for the counter-balancing forces, and these woman, alone, is really competent to exercise. Among these essentially feminine qualities the following stand out: Beauty, Mercy, Tenderness, Charm, Ecstasy, preservation of proven values, etc. It is a grave mistake to regard these powers as inferior to the Creative Will, the Will to Power, the Daring of the Unknown, and the Judgment that peculiarly mark the masculine principle. The latter powers are unques-tionably indispensable both in the world-field and for Inward Penetra¬tion, but by themselves they are unbalanced and can easily drop from a constructive to a destructive level. The isolated masculine principle cannot check this tendency and, so, right here is where the feminine quality is grievously needed. The feminine powers are just as strong as the mas-culine, although they function in a more subtle way. We greatly need more women who justly appreciate the ancient and natural feminine powers and arts. Man is Siva, the formless Light; woman is Shakti, the Current which opposes and embodies the Light. Without embodiment, the Light of Consciousness remains void of self-consciousness. Since self-consciousness is the one great achieved value, it is easy to see how vitally important the Shakti principle is. In Her highest aspect, Woman is the Celestial Virgin, and this is none other than the Current of Bliss. The Current is a Virgin, because of the quality of ever-becoming-new. Though impregnated by the Fire of Wis¬dom, yet She remains a Virgin because She is ever-changing within Her own Self-identity. The union of Wisdom and the Virgin gives birth to the Christ, and this is the real Immaculate Conception. This union is the untellable Joy of which all lesser ecstasies are but faint shadows. So, deep and lasting Joy is the true sign of the genuine and noble religiosity. Aus¬tere gloom in the name of religion is a sacrilege and sign of failure. Only false religion is dreary. The Holy is Free and Joyful.

"I Mistook the Faint Shadow": The Tractarian Ethos in Felicia Skene's Sensational Realism

"I Mistook the Faint Shadow": The Tractarian Ethos in Felicia Skene's Sensational Realism

Friedensgesänge 1628–1651: Musik zum Dreissigjährigen Krieg. Werke von Johannes Werlin, Sigmund Theophil Staden, Melchior Franck und Andreas Berger by Stefan Hanheide (review)

MUSIC FROM THE THIRTY YEARS' WAR Friedensgesange 1628-1651: Musik zum Dreissigjahrigen Krieg. Werke von Johannes Werlin, Sigmund Theophil Staden, Melchior Franck und Andreas Berger. Herausgegeben von Stefan Hanheide. (Denkmaler der Tonkunst in Bayern: Neue Folge, Bd. 22.) Wiesbaden: Breitkopf & Hartel, 2012. [Pref. in Ger., p. ix; introd. in Ger., p. xi-l; sources and statistics in Ger., p. li-lxxviii; crit. report in Ger., p. lxxix-civ; texts, p. cv-cxviii; facsims., p. cxix-cxxxiv; scores, p. 1-118. ISMN 979-0-00480293-9; pub. no. SON 252. i152.]The Thirty Years' War (1618-48) was a tragic period in German history. Numerous military conflicts played out in rotation across the German landscape, leaving a swath of death and destruction unmatched in scope until the twentieth century. Complete cities were razed, untold thousands died at the hands of rapacious mercenary armies, while countless others succumbed to starvation and disease. The lyric poet Andreas Gryphius (1616-1664), who in 1636 knew his homeland only a battleground, described the atrocities in grim detail in his sonnet Threnen des Vatterlandes. The country was impoverished, and everywhere the arts suffered never before. Heinrich Schutz, the Electoral Saxon Kapellmeister in Dresden, in the dedication of his Kleine geistliche Konzerte (1639) lamented the woeful state of music and the arts as if suffocated under military arms and trampled in the mud (A Heinrich Schutz Reader: Letters and Documents in Translation, ed. Gregory S. Johnston [Oxford: Oxford University Press, 2013], 111). Once-illustrious court ensembles that had previously performed lavish works for multiple choirs of singers and instrumentalists were reduced to faint shadows of their former glory. Other courts and towns were forced to disband their Kapellen and civic ensembles altogether. Publishers who were able still to produce music in print were few in number, and faced chronic shortages of paper and customers. One hoped and prayed for the return of peace and prosperity.The music contained in the present volume reflects this hope for peace, represented by the works of four composers from southern Germany and what is modern-day Bavaria: the Lindau Kantor Johannes Werlin's Irenodiae Oder Friedensgesang (1644), the Nuremberg organist and composer Sigmund Theophil Staden's Musikalische Friedensgesange (1651), the Coburg Kapellmeister Melchior Franck's Suspirium Germaniae Publicum (1628), and a concluding ten-voice Da pacem Domine (1635) by Andreas Berger, Kapellmeister to Graf Ludwig Eberhard von Oettingen. The first two works are significantly more ambitious in scope, whereas the latter two are modest compositions published individually. Together, though, especially if one pays particular attention to the texts, they reveal an optimism for a better future, if not in this world then in the next.At more than 250 pages and printed in large format (27 cm x 34 cm), this is a critical edition ideally suited initially for scholarly study, but the works inside deserve to be heard. The front matter, running to 134 page in length, is exhaustive, rich in information, painstaking in detail, and abundantly referenced throughout. The first 60 pages or so are devoted to biographical entries on each of the four composers, the general historical background and context of the music, the origins and specific occa- sion of the works, full transcriptions of title pages and dedicatory poetry and texts, the authorial sources of the poetic texts, and issues of genre and formal characteristics of the compositions. It is also in these pages that the editor elaborates in great detail on aspects of the musical style and the original printed edition: notation, time signatures, barlines and other indications of meter, tempo indications, slurs and ties, accidentals, mode, and so forth. Statistical data on text, metric changes, voicing, mode, ambitus, and even whether or not the basso continuo part includes a textual incipit occupy a further fifteen pages of fine print (pp. …

A Planetary Order (Terrestrial Cloud Globe)

A Planetary Order is a terrestrial globe showing clouds from one single moment in time, thereby subtly highlighting the fragility and interdependence of the Earth’s environmental systems. Showing the earth’s cloud cover from one second in time, the shimmering white cloud globe freeze-frames the entire operation of the global atmospheric regime, and highlights how fragile the environmental (and informational) systems are that operate across the world. For the globe is created from raw information, being a physical visualization of real-time scientific data. One second’s worth of readings from all six cloud-monitoring satellites that are currently overseen by NASA and the European Space Agency was transformed into a virtual 3-D computer model, which was ‘3-D drawn’, or rather, laser melted, at the Digital Manufacturing Centre at the UCL Bartlett Faculty of the Built Environment. It was the largest object ever created by the Digital Manufacturing Centre, and it took two full days to build, the delicate outlines and profiles of the clouds emerging slowly as the laser carved gently across the compacted nylon powder surface of the sphere. Unlike most of NASA’s own data visualizations, the globe features no added colour, only the sculpted whiteness of the raw material that throws a maze of faint shadows across the structure. From out of these shadows, in the right angles of light, emerge the global cloud patterns taken on 2 February 2009 at 0600 UTC precisely, and, under them, the implied outlines of the continents below, seen as though glimpsed through mist, or rather, through the mystifying quantity of atmospheric data that is currently being collected from the silent fleet of satellites in orbit some 36,000 kilometres out in space — an increasingly hertzian environment, where an electronic Babel of satellites, radio signals, text messages and security frequencies vibrate with an invisible stream of man-made weather.Though far from earth’s surface, we have nevertheless made it back to something resembling Borges’s 1:1 scale Map of the Empire, for, by taking a single second’s worth of transmitted information, our entire world has been made anew, pristine, white, and wreathed in the haze of an artificial atmosphere, held aloft like the fossilized egg of a long-extinct species that is about to be brought back to life from a single rescued strand of DNA. Text from the book Data Soliloquies

Sunyaev-zeldovich effect

Soon after the discovery of the cosmic background radiation, Zeldovich and Sunyaev proposed that hot gas in galaxy clusters should cast a faint shadow because of the interaction between energetic electrons and the radiation photons. Sunayev-Zeldovich effect is now routinely observed, and it has become an important tool for studying the history of the universe.

Plexiform neurofibroma: A rare tumor of submandibular salivary gland

A 15-year-old boy presented with swelling in the submandibular region. X-ray of the swollen part showed faint radio opaque shadow. A provisional diagnosis of sialadenitis with sialolithiasis was made. Excised mass was reported histopathologically as plexiform neurofibroma of submandibular salivary gland.Plexiform neurofibroma of the salivary gland is a rare benign tumor often present in the parotid gland. It is very rare in submandibular salivary gland. It is a slow growing, locally infiltrating tumor.

Ability of chest X-ray to detect faint shadows documented as ground-glass attenuation in images of computed tomography: A comparison between flat-panel detector radiography and film-screen radiography

Purpose To compare flat-panel detector (FPD) radiography and film-screen (FS) radiography in detectability of faint shadows documented as ground-glass attenuation (GGA) areas in images of computed tomography (CT). Materials and methods Study population was comprised of 50 patients who underwent FS and another 50 patients who underwent FPD. Standard of reference (SOR) was determined on the basis of area of GGA in all cross-sections of CT, in terms of GGA extent and presence or absence of GGA in each trisected lung fields (GGA distribution). Eight radiologists assessed the GGA extent with the 5-grade scale and the GGA distribution. Inter-observer variances of the GGA extents and distributions, degree of divergences and correspondence in the GGA extent and distributions with SOR, were compared between the FS and FPD by the jackknife method and Fisher's exact test. Results Inter-observer variance in the GGA extent and distribution were slightly larger in the FS than in the FPD. The GGA extent scale corresponded with SOR in the FS statistically significantly better ( p = 0.001), as the correct ratio was 0.428 in the FS and 0.310 in the FPD. Divergence in the GGA extent scale with SOR was smaller in the FS, as average kappa pseudo-value of Kendall's rank correlation coefficient was 0.474 in the FS and 0.433 in the FPD. Conclusion These results indicate that some lesions of GGA documented in CT may not be reflected and are difficult to be detected in chest X-ray radiographs with the FPD.

Observations on Biology

Biology is often referred to as an observational science almost as a slur, with the implication that biologists simply look at the living world without the strong theoretical and mathematic underpinnings of a science like physics. There is the suggestion that observation is easy. Thus biology is viewed as a lightweight science--anyone can do it: just go out and start looking, at birds, at grass, at cells under the microscope. Benjamin Bloom's taxonomy of learning tasks puts observation at the lowest level, with recall of information (http://www.coun.uvic.ca/learn/program/ hndouts/bloom.html). This denigration of observation has long bothered me because I see it as often difficult and complex, a skill that needs to be learned and a talent that is much more developed in some. Barbara McClintock, for example, was a master of observation (Keller, 1983). All her great discoveries, from the behavior of chromosomes in corn to the transposition of genes, were the result of close observation, both of intact organisms and of their cells. George Beadle asked her to visit his lab in California because he was stuck in trying to figure out the behavior of chromosomes in the mold Neurospora. Within a couple of weeks, McClintock solved the puzzle, but only after hours of close observation. However, this isn't the entire story. Nathaniel Comfort (2001) describes how she took a break from her work, went for a walk, and sat down to think about what she had been seeing. That's when the solution came to her. So this is a story about careful observation and deep thinking, which brings me to the argument I want to present here: that observation is not to be belittled, that it is a complex process and can involve profound depths of thought. First there is the question of what will be observed, which brings up a key point: it is difficult to make useful observations without some idea about what you are looking for. Even if you are on vacation and just out to look at the scenery, you have a goal, an idea: You want to see beautiful landscapes. You may drive through miles of forest, but when an open vista appears, you put on the brakes; this is what you've been looking for. It has become commonplace to say that the old formulation of the scientific method--something along the lines of observation, followed by formulation of a hypothesis, then testing and evaluation--doesn't reflect the way science is actually done. In reality, researchers usually begin with an idea, which they use as the basis for their hypotheses and tests. They need ideas to guide their observations. X-Rays Seeing cannot be divorced from thought at any level. Processing visual information is itself complex and involves the cerebral cortex where it is linked to cognition. The eye may be doing something comparable to what a camera does, but seeing that picture requires a great deal of brain function; perception and cognition are inseparable, which means that the brain must learn to see. This occurs at several levels, from learning to invert the images that come in from the eye to learning to attend to particular aspects of a view more than to others. For example, untrained observers have a difficult time reading X-rays. The elements of the image that seem most obvious are usually not those that are of importance to a radiologist who is often looking for faint shadows, slight differences in visual texture. It can take months or even years to become proficient at this, and there is evidence that the more experience in reading X-rays, the better the reader. Jerome Groopman (2007) writes that accuracy depends on a number of factors. A study of diagnostic accuracy confirmed the difficulty of discovering when something is not present. One of the 60 chest X-rays came from a patient with a missing clavicle. Sixty percent of the radiologists missed this anomaly, but that number decreased to 17% when the doctors were told that the X-rays were taken to detect cancer. …

Double‐Barrel Coronary Sinus

A 78-year-old woman with severe nonischemic cardiomyopathy (EF 25%), congestive heart failure (persistent NYHA class III symptoms), left bundle branch block, and intermittent Mobitz Type II second-degree heart block with a previously implanted dual-chamber pacemaker was referred for upgrade to a biventricular defibrillator system. After the coronary sinus was selectively engaged, a balloon-occluding catheter was placed in the mid-portion of the vessel and an angiogram was performed in orthogonal views. Initial images showed retrograde opacification of the main coronary sinus, great cardiac, and anterior interventricular veins, but there appeared to be a complete absence of posterolateral branches from the left ventricular free wall. After manipulation of the catheter, contrast injection closer to the ostium identified a faint shadow of a second coronary sinus lumen. An ostial injection confirmed an anomalous “double-barrel” coronary sinus, with the second vessel running parallel to the main coronary sinus and terminating into two posterolateral branches (see Fig. 1), one of which was successfully used for left ventricular lead placement. Right anterior oblique view taken after catheter manipulation and contrast reinjection from the coronary sinus ostium. An anomalous “double-barrel” coronary sinus was revealed, with the second vessel running parallel to the main coronary sinus. Off this second lumen, two posterolateral branches were clearly visualized, one of which is seen with a guide wire in place. A left ventricular lead was then successfully placed. Comprehensive understanding of coronary venous anatomy and its anomalies is becoming increasingly important as more biventricular devices are being placed. Catheter manipulation and reinjection of contrast may be needed multiple times to ensure accurate visualization of the coronary venous system. Our case demonstrates that posterolateral venous branches may arise selectively from one “barrel” of a “double-barrel” coronary sinus. This anomaly of the coronary sinus should be considered when there is apparent angiographic lack of posterolateral branches.

Huge Gingival Cyst of the Adult: a Case Report and Review of the Literature

Gingival cysts of adults are uncommon gingival lesions that are usually found within attached or unattached soft tissues. They are commonly seen in the canine and premolar regions of the mandible, and are sometimes confused with lateral periodontal cysts. Gingival cyst lesions in adults may appear bluish due to fluid and cause pressure resorption of the labial bone. Gingival swelling and the faint shadow of radiolucency are a characteristic of the gingival cysts of adults. We report here the case of a large gingival cyst in an adult, which was unlike most other reported cases that have cyst sizes of less than 0.6 cm. The incidence of gingival cysts of adults shows a racial predilection, with Asians revealing a much lower prevalence of the lesion than Caucasians; however, there is no gender difference in the incidence of the disease. The case was treated with simple surgical excision and has shown no tendency for recurrence.

Religion in the modern American West

When Americans migrated west, they carried with them not only their hopes for better lives but their religious traditions as well. Yet the importance of religion in the forging of a western identity has seldom been examined. In this first historical overview of religion in the modern American West, Ferenc Szasz shows the important role that organized religion played in the shaping of the region from the late-nineteenth to late-twentieth century. He traces the major faiths over that time span, analyzes the distinctive response of western religious institutions to national events, and shows how western cities became homes to a variety of organized faiths that cast only faint shadows back east. While many historians have minimized the importance of religion for the region, Szasz maintains that it lies at the very heart of the western experience. From the 1890s to the 1920s, churches and synagogues created institutions such as schools and hospitals that shaped their local communities; during the Great Depression, the Latter-day Saints introduced their innovative social welfare system; and in later years, Pentecostal groups carried their traditions to the Pacific coast and Southern Baptists (among others) set out in earnest to evangelize the Far West. Beginning in the 1960s, the arrival of Asian faiths, the revitalization of evangelical Protestantism, the ferment of post-Vatican II Catholicism, the rediscovery of Native American spirituality, and the emergence of New Age sects combined to make western cities such as Los Angeles and San Francisco among the most religiously pluralistic in the world. Examining the careers of key figures in western religion, from Rabbi William Friedman to Reverend Robert H. Schuller, Szasz balances specific and general trends to weave the story of religion into a wider social and cultural context. Religion in the Modern American West calls attention to an often overlooked facet of regional history and broadens our understanding of the American experience.

Sonographic findings of rotator cuff calcifications.

We studied the findings and value of sonography in the diagnosis of rotator cuff calcifications in comparison to plain radiographs. Sonograms were correlated with plain radiographs in 951 patients. The diagnosis of rotator cuff calcifications was made by ultrasonography in 87 and with plain films in 93 of 951 patients. Sonography displayed two additional bursal slurry calcifications were found on plain films. Three types of calcifications were found with ultrasonography: (1) a hyperechoic focus with a well-defined shadow (79%); (2) a hyperechoic focus with a faint shadow (14%); and, (3) a hyperechoic focus with no shadow (7%). Large and slurry calcifications and bursal calcifications were better seen with ultrasonography, but small and more scattered deposits were better found on plain radiographs. Sonography proved to be reliable in the detection and localization of rotator cuff calcifications, but classification into a formative or resorptive phase could not be done. Because of this and the possibility of pathologic conditions of bone, plain radiographs should always be obtained prior to doing sonography.