High-precision and wide-range feature wavelength quantitative analysis (FWQA) method for fluorescent substances based on IFE-induced CDRS.

Introduction: Scrotal masses, encompassing a range of benign and malignant conditions, present a significant clinical challenge due to their varied etiology and potential impact on male reproductive health. The evaluation and management of these masses require a comprehensive approach, integrating clinical, radiological, and histopathological assessments to ensure accurate diagnosis and optimal treatment. Aim: To evaluate the histomorphological spectrums of neoplastic and non neoplastic lesions of the scrotum. Materials and Methods: A retrospective, five-year crosssectional study was conducted at the Department of Pathology at Hindu Hridaysamrat Balasaheb Thackeray (H.B.T) Medical College and Dr. Rustom Narsi Cooper Municipal General Hospital, Mumbai, Maharashtra, India, over a period of one year from January 2018 to December 2022. A sample size of 129 cases was obtained according to the inclusion and exclusion criteria. The specimens received in the Pathology laboratory were examined grossly and microscopically. Special stains were performed as per the requirement. Relevant clinical data (age, presenting complaints, duration, clinical diagnosis, laterality, nature of specimen, whether biopsy or resection) were obtained from the requisition forms submitted with the surgical specimens. All the findings were entered into a master chart, which was later used for further statistical evaluation with the help of Microsoft Excel 2007. Results: A total of 129 cases of testicular and scrotal lesions were received in the surgical histopathology section from 21787 cases over five years, which accounts for 0.59%. Only one case was with genital ambiguity, while the rest of the cases (n=128) were males. Out of 129 cases, 115 cases (89.14%) were non neoplastic, while only 14 cases (10.85%) were neoplastic. The maximum number of cases (50 cases, 38.75%) was seen in the age group of 16 to 35 years. Seventy seven cases (59.68%) had lesions of the testicular parenchyma and epididymis, 28 cases (21.7%) from the paratestis and the tunica and 24 cases (18.6%) from the scrotal sac. Right-sided involvement (63cases, 48.83%) was more common than the left side (57 cases, 44.18%). Conclusion: Non neoplastic lesions are commoner than neoplastic masses. Most of the non neoplastic lesions present similarly on physical examination, so radiological findings help in differentiating various lesions and guide further treatment. At times, neoplastic masses can mimic non neoplastic lesions. Accurate radiological intervention, history taking and clinical details can aid in diagnosis and appropriate surgical management.

Surgical dominance and alignment accuracy: Do sides matter in bilateral total knee arthroplasty?

Pneumatisation patterns surrounding the internal acoustic meatus.

Microneedling is one of the cost-efficient and safe procedures for treatment of atrophic scars. Previous studies have shown variable results regarding the increased efficacy of platelet-rich plasma (PRP) when combined with microneedling. The aim of this split-face study was to compare the efficacy of PRP combined with microneedling versus microneedling alone in acne scars in type 3-6 skin in South Indian patients. The primary objective was to compare the mean reduction in acne scar using Goodman Baron quantitative scale on the side of the face treated with PRP and microneedling, with the side of the face treated with microneedling alone. A total of 64 patients were recruited, and three sessions of microneedling with PRP on the right side and microneedling on the left side were done with an interval of 4 weeks between the sittings. Results were evaluated after 1 month of the last sitting using Goodman and Baron's score and physician and patient satisfaction score. There was significant improvement in atrophic acne scars on both sides of the face before and after treatment. While comparing efficacy between sides, the side treated additionally with PRP had significantly more improvement than the side treated with microneedling alone. The trial was non-randomized, and complete blinding was not done. The study had a shorter follow -up interval. We did not analyze results based on the site of scar. PRP combined with microneedling is more effective than microneedling alone for the treatment of atrophic acne scars. Larger studies with longer follow-up are needed to confirm this result.

The zygomaticofacial foramen (ZFF) serves as a critical anatomical landmark in zygomatic implant surgery and facial flap procedures. This study aimed to compare the effectiveness of computed tomography (CT) and cone-beam computed tomography (CBCT) in visualizing the ZFF, and to determine which imaging modality provides greater reliability for clinical and surgical planning. A total of 100 CT and 100 CBCT scans were retrospectively analyzed, providing radiological data from 400 zygomatic bones. The number and location of ZFFs were assessed by 2 independent observers. The relationship between ZFF number and variables such as side, sex, and age was statistically analyzed. Computed tomography and CBCT detected a comparable number of foramina (270 and 267, respectively), with no statistically significant difference between the modalities (P > 0.05). A significant correlation between right and left sides was observed (r = 0.672, P < 0.001), indicating a tendency for bilateral symmetry. The most common finding was the presence of a single foramen (48%), followed by 2 foramina (31.2%). Females exhibited a significantly greater number of foramina than males (P = 0.012), whereas age showed no significant correlation. Both CT and CBCT provide comparable accuracy in detecting the ZFF. This finding is clinically significant as it provides an evidence-based rationale for selecting CBCT, a modality with a lower radiation dose and reduced cost, for preoperative evaluation. These results confirm that clinicians can confidently use CBCT for individualized, imaging-based surgical planning to minimize neurovascular complications without sacrificing diagnostic reliability.

With increased mobility, people carry laptops as part of their daily routine. Based on personal preference, they are held as handbags, shoulder bags, or cross-body bags. However, regardless of the carry style, their unilateral nature can affect skeletal health and cause discomfort, potentially leading to long-term injuries and high societal costs. This study examines the effects of carrying styles on joint movements. Twenty-five participants aged 21 to 24 walked on a treadmill under four conditions: without a laptop; while holding a 5 kg laptop case as a handbag in the dominant hand; as a shoulder bag hanging on their dominant side; and as a cross-body bag worn on their dominant side. Joint motions were recorded. Range of motion (ROM) and average angles (RMS values) of the joints were measured in the sagittal, frontal, and transverse planes. Kinematic analysis revealed that spinal joint movements were restricted under load, and these restrictions were asymmetric between the right and left sides (p

This study develops and tests a MATLAB program for neutralising systems with upper triangular coefficient matrices. Augmented matrices for systems of linear equations are reduced to produce a neutral (identity matrix) left hand side, at which point the right hand side has the solutions for the system. A strategy for minimal error is pursued, where elimination operations must be completed in one step for each number. The strategy was expressed in pseudocode, a flowchart developed, and then the program was coded in MATLAB. The program was tested for four sample augmented matrices of varying sizes. The results demonstrated that the program was 100% accurate. The technique can be applied to any square matrix system, since any square matrix can be expressed as an upper triangular matrix. The automation of matrix operations and achievement of 100% accuracy allows for the use of the program for very large data sets, extending the potential for research with accurate finding.

BACKGROUND Transcatheter atrial septal defect closure is currently the standard approach. In addition, minimally invasive cardiac surgery is preferable over median sternotomy. However, ensuring safe and reliable surgery is essential. The conventional right atrial approach is limited in its ability to ensure a clear surgical field and is associated with bleeding and postoperative arrhythmia. Herein, we describe atrial septal defect patch closure using a left atrial side approach in totally endoscopic minimally invasive cardiac surgery. CASE REPORT A 61-year-old man was admitted for heart failure caused by atrial fibrillation. Echocardiography revealed an atrial septal defect (27×17 mm; Qp/Qs ratio, 2.5). Given the relatively small aortic rim (1 mm), surgery after ablation of atrial fibrillation was selected. Complete pulmonary vein antrum isolation was performed using a catheter, followed by confirming sinus rhythm restoration. Two years later, the patient underwent atrial septal defect closure in a totally endoscopic minimally invasive cardiac surgery via the right axillary mini-thoracotomy under moderate hypothermia. The defect was accessed using a standard right-sided left atrial incision; brief circulatory arrest allowed secure suturing of the lower defect margin adjacent to the inferior vena cava, with minimal blood loss. The patient had an uneventful recovery. Postoperative echocardiography confirmed complete closure without residual shunting. CONCLUSIONS Compared with conventional right atriotomy, the left atrial side approach provided improved exposure, reduced bleeding, and easier air evacuation, potentially lowering the risk of long-term arrhythmias. This technique could offer a familiar and useful approach for enhancing the safety of atrial septal defect closures.

This longitudinal study investigated the differential impacts of maternal speech on early socio-communicative development in infants at low likelihood (LL) and elevated likelihood (EL) of Autism Spectrum Disorder (ASD). Using functional near-infrared spectroscopy, we measured cortical responses and connectivity in 6-month-old infants while they listened to their mother's voice and an unfamiliar female voice. LL infants exhibited extensive cortical activation and robust connectivity in temporal and frontal regions, particularly in areas associated with voice processing, reward, and language functions. In contrast, EL infants showed minimal activation and weaker connectivity in these regions. Specifically, LL infants demonstrated significant connectivity between the superior temporal gyrus and the inferior frontal gyrus on the left side, and between the orbitofrontal cortex and language areas, facilitating language processing and reward-related responses to maternal speech. These neural patterns were absent in EL infants, highlighting a neural basis for subsequent language delays. Furthermore, many of these reward-related or language-related networks predicted subsequent language development. Our findings underscore the importance of neural sensitivity to familiar human voices, regarding them as rewards that will eventually facilitate the acquisition of speech.

To describe the epidemiology and clinical presentation of children with pectus carinatum; and the outcome of their first hospital clinic appointment. A single surgeon, retrospective cohort study of children presenting between 1998 and 2022. Demographic and clinical data were collected from the medical record. We present 430 children with pectus carinatum; 364 boys and 66 girls. Their asymmetry was identified at a median age of 11 years (range 0-16years). Girls developed carinae earlier than boys (10 vs 14 years, p = 0.003), were more likely to present with pain (44% vs 26%, p = 0.041) and were more likely to have a family history of chest wall deformity (33% vs 20%, p = 0.070). The majority (342, 69%) had an asymmetrical, isolated carinatum. Isolated carinae were mainly right dominant (174, 57%), conversely, mixed carinatum/ excavatum were typically left side dominant (10/15 vs 2/15, p = 0.008). The clinical presentation of carinatum is heterogenous with apparent differences between males and females. A detailed history and examination are required; if clinicians record, in detail, the clinical context and morphology of the carinatum, a comparison of phenotype and outcome would become feasible. Simply stating "Carinatum" is not enough.

Objective: To investigate the dimensions of the maxillary sinus measured on maxillofacial computed tomography (CT) scans and estimate the volume of the maxillary sinus. This study aims to evaluate the differences in maxillary sinus size between males and females, as well as between the left and right sides of the normal maxillary sinus in Vietnamese adults. Materials and methods: This is a cross-sectional, descriptive case series study. A total of 196 maxillary sinuses were examined using maxillofacial computed tomography (CT) scans from 98 Vietnamese individuals aged 18 and older, with no related sinonasal pathology, conducted at Can Tho University of Medicine and Pharmacy Hospital. The vertical, transverse, and anteroposterior diameters of the maxillary sinus were measured using the bone window on non-contrast maxillofacial CT scans. The sinus volume was estimated using a formula based on these measurements. Statistical analysis was performed to compare differences in the obtained parameters. Results: The mean age of the study sample was 47.02 ± 12.076 years. The smallest measured sinus volume was 6.17 cm³, the largest was 40.62 cm³, and the average volume was 22.4672 ± 7.651 cm³. The maxillary sinus volume in males was larger than in females, with a statistically significant difference (p = 0.04 &lt; 0.05). No statistically significant difference was found in the maxillary sinus volume between the right and left sides. Conclusion: Using computed tomography to evaluate maxillary sinus volume provides valuable insights into the morphological characteristics of the Vietnamese population, enhancing knowledge for clinical and anthropological applications.

Background: Pulled elbow (Nursemaid’s elbow) or radial head subluxation is a common upper extremity injury in young children and a frequent reason for visiting the Emergency Department. Supination flexion and hyperpronation are two methods described in the literature for reducing this subluxation. The purpose of this study was to identify the most effective method of reduction for pulled elbow in our setting. Method: This was an observational cross-sectional study including children below 5 years with a provisional diagnosis of pulled elbow and divided into two groups based on the type of reduction method used. The success at the first attempt of the reduction and pain perceived during the reduction using the Wong Baker Faces Pain Rating Scale score were taken as indicators of effectiveness, and age, gender, laterality, and mechanism of injury as demographic indicators were calculated. Result: Among 84 patients included in the study, the mean age of presentation was 2.92 ± 1.27 years, girls were 51.2%, left side involvement was 66.6% and pulling of the arm (80.95%) was the most common mechanism of injury. The hyperpronation mechanism was more successful than supination flexion during the first attempt reduction (88.1% vs 76.2%) but was not statistically significant (p=0.15). Pain levels perceived during reduction were also less (5.762 ± 1.1 vs 7.33 ± 1.3) in the hyperpronation group as compared to the supination flexion group, and this was statistically significant (p &lt;0.001). Conclusion: The hyperpronation method is more effective than the supination flexion method for the reduction of pulled elbow in children in our setup.

IntroductionAcetabular dysplasia (AD) is defined as insufficient coverage of the femoral head by the acetabulum and results in instability of the hip joint. Periacetabular osteotomy (PAO) improves hip joint stability and function and is considered the gold standard for treatment of symptomatic AD. Although hip joint kinematics during activities of daily living (ADLs) have been investigated in asymptomatic young adults, hip kinematics in individuals with symptomatic AD before and after PAO remains elusive. The present study is an interim analysis of an ongoing study comparing hip kinematics before and after PAO in individuals with AD to hip kinematics in a healthy asymptomatic cohort.MethodsFour patients (4F, age 22.9±4.7 years) scheduled to undergo PAO to correct symptomatic AD were included in this IRB-approved study. A dataset of healthy control participants was used as a reference for this analysis, comprised of 24 asymptomatic adults (13F, 11M; age 21.9±2.2 years). Synchronized biplane radiographs were collected at 50 images/sec for 1 second during treadmill walking at a self-selected pace. CT scans were manually segmented to create subject-specific bone models for each hip. These models were then matched to the biplane radiographs by a validated volumetric model-based tracking technique to determine bone motion with submillimeter accuracy. Anatomic coordinate systems were placed in each right femur and hemi-pelvis and mirrored to the left side to produce identical coordinate systems for each hip. Translation of the center of the femoral head relative to the center of the acetabulum was calculated to dynamically measure hip instability, using the static standing position as a reference.ResultsAcross dysplastic hips during gait (n=4), the average magnitude of femoroacetabular translation was 1.3±0.7mm, with a minimum translation of 0.7±0.5mm and a maximum translation of 2.3±1.1mm. Among asymptomatic hips (n=47), the average magnitude of femoroacetabular translation was 1.0±0.6mm, with a minimum translation of 0.3±0.3mm and a maximum translation of 2.3±2.0mm.DiscussionThese interim findings suggest that dysplastic hips experience a range of dynamic translation comparable to that of healthy hips during gait.

Objective: To determine the success rate between two different surface treated miniscrews and conventional miniscrews during fixed orthodontic treatment. Methodology: This prospective, split-mouth, comparative clinical study was conducted at Orthodontics Department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) Dow university Hospital karachi, from October 2024 to March 2025. Patient with fixed orthodontic therapy with requirement of absolute anchorage, patients with good oral hygiene and healthy periodontal status, aged 15 to 30 years of either gender were included. Individuals assigned to two groups, with Group A receiving sandblasted miniscrews on the right side and conventional miniscrews on the left, whereas Group B received acid-etched miniscrews on the right side and conventional miniscrews on the left side. The success was defined as the ability to maintain anchorage throughout orthodontic treatment without clinically detectable mobility. SPPS-26 version was used for data analysis. Results: The success rate was significantly higher in Sandblasted miniscrew 80% as compared to 56.6% in conventional group (0.047). The success rate of Acid-Etched miniscrew was also found significantly higher 86.6% compared to conventional group 53.3% (p=0.010). However, the success rate was compared between Acid-Etched miniscrew and Sandblasted miniscrew, no significant difference was observed as p-value &lt; 0.05. Conclusion: Success rate of acid-etched surface miniscrews and Sandblasted miniscrews differed significantly. However, significant difference has been found in success rate between surface treated miniscrews with conventional miniscrews.

Dear Editor, This letter explores the considerations involved in performing an Awake craniotomy (AC) on a patient with a history of long-standing goiter, highlighting the utility of AC after careful patient selection, multidisciplinary collaboration, and prevention of potential complications. AC is a specialized surgical procedure that allows resection of brain tumors while patient remains conscious. It facilitates in intraoperative neurological monitoring of motor, sensory and speech functions. The potential benefits are maximizing tumor resection, minimizing post-operative neurological defects and better recovery profile 2. However, potential complications require careful consideration and anticipation. Amongst them, airway related events are at the top and, commonly associated with failure of technique and conversion to general anaesthesia3. Our patient was elderly female with history of Diabetes, Hypertension, and Hypothyroidism. She presented with a frontal lobe space occupying lesion. Physical examination revealed, swelling in front of neck because of large goiter predominantly on the left side, but showed no signs of respiratory distress. A thorough examination, including Pemberton's sign, was negative for thoracic inlet obstruction. Chest X-ray confirmed the presence of a large thyroid gland. ENT consultation was done revealed no airway involvement a part from having tracheal deviation. There was no airway obstruction and patient were able to lie supine without any signs &amp; symptoms of respiratory distress. We opted for awake throughout approach. A regional scalp block was performed for perioperative analgesia. To mitigate the associated risks, surgical position was modified so that patient remained. comfortable in terms of breathing. Supplemental oxygen was also given via nasal prong. Close communication was maintained throughout the procedure and conscious sedation was maintained with low dose of Dexmedetomidine infusion (0.1-0.2mcg/Kg/hr.). Procedure was done successfully and patient was shifted to recovery unit. In conclusion, AC presents unique challenges in patients with history of goiter and neck swelling. Through careful patient selection, preoperative evaluation, and a multidisciplinary approach, it is possible to achieve successful outcomes while minimizing risks associated with general anaesthesia.

Lung ultrasound (LUS) detection of B-lines is a useful bedside tool for evaluating pulmonary congestion in acute heart failure. This study aimed to assess the diagnostic performance of LUS compared to clinical assessment, N-terminal pro-B-type natriuretic peptide, chest X-ray, and echocardiography in patients with systolic heart failure. A cross-sectional study was conducted on 50 patients diagnosed with heart failure based on Framingham criteria and confirmed by echocardiography at Al Yarmook General Teaching Hospital, Baghdad (May–October 2021). LUS was performed across 16 lung zones to detect B-lines. Diagnostic validity was assessed using receiver operating characteristic curve analysis, referencing ejection fraction ≤ 30%, mitral inflow to annular velocity ratio (E/eé) ≥ 15, and N-terminal pro-B-type natriuretic peptide > 450 pg/mL. From the 16 lung zones, zone number 1 in the left side was with B lines findings in all (46) ultrasound positive patients, followed by zone number 1 in the right side were with positive B lines in (44) patients. Using ≥10 lung zones with B-lines as the diagnostic cutoff for acute heart failure, LUS demonstrated a sensitivity of 64.7% and specificity of 63.6% when ejection fraction ≤30% was used as the reference standard, and a sensitivity of 63.6% and specificity of 88.2% when E/e′ ≥ 15 was used as the reference. While using pro-B-type natriuretic peptide > 450 pg/mL as reference for acute heart failure it showed that 4 lung zones with B lines will be the cutoff value with a sensitivity of 86.67% and specificity of 80.00%. Lung sonography could be considered a reliable tool for the assessment of pulmonary congestion in patients with acute heart failure. Using 10 lung zones with B-lines by ultrasound as a cutoff value for the diagnosis of acute heart failure. However, its accuracy may be limited by operator dependency and small sample size.

Objectives: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of vasculitides sharing a common pathophysiology, which affects small and medium blood vessels. Sinonasal involvement is one of the most common manifestations of AAV. The goal of this study was to find the most suitable method to assess paranasal sinus changes in a group of patients with ANCA-associated vasculitis and renal involvement. Subjective scales like Lund–Mackay and Zinreich were compared with a three-dimensional (3D) volumetric method. Pre- and post-treatment computer tomography were compared. Methods: Computer tomography, nasal symptoms, and endoscopy of 28 patients hospitalized at the Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute were assessed retrospectively. Paranasal sinus tomography was performed during treatment induction and after achieving disease remission (BVAS = 0) to assess treatment effectiveness. Radiological analysis was performed with the Lund–Mackay scoring system, Zinreich scoring system, and 3D volumetric scoring system with the usage of Slicer 3D analysis. The radiologic scoring systems were compared. Results: The statistically significant differences in treatment effectiveness were observed for the Zinreich scale on both the right and left side. Similar to the 3D volumetric scoring system, the right and left maxillary sinuses demonstrated statistically significant differences. On the other hand, no statistically significant differences were found between the first and second visits for the Lund–Mackay or total Global Osteitis scores on either side. The strongest correlation was achieved between the Zinreich scoring system and 3D volumetric scale. Conclusions: The three-dimensional CT volumetric analysis demonstrated higher SRM (standardized response mean) values than the Zinreich score on both sides, but the differences were not statistically significant. The Zinreich scoring system should be used instead of the Lund–Mackay scale in everyday clinical practice.

Primary Progressive Aphasias (PPA) are a group of neurodegenerative disorders characterized by the gradual decline of language abilities. They are typically divided into three major clinical variants: the non-fluent (nfvPPA), the semantic (svPPA) and the logopenic (lvPPA) variant. Even with an extensive clinical examination, a correct differential diagnosis among variants can be difficult due to the overlapping of dysfunctional language features. In this context, the combination of Transcranial Magnetic Stimulation and Electroencephalography (i.e., TMS-EEG) could extend our understanding of nfvPPA pathophysiology, given the possibility to non-invasively and directly measure cortical reactivity of brain speech networks to external perturbations. Twenty PPA patients (7 nfvPPA, 13 lvPPA) and 8 elderly controls underwent a TMS-EEG session targeting the left dorsal premotor cortex (Brodmann area 6). A subset of 9 patients (8 lvPPA, 1 nfvPPA) were additionally stimulated in the right homologous region. We automatically detected the EEG channel under the stimulator with the highest peak-to-peak amplitude of the early TMS-evoked response and computed the following measures: (i) natural frequency; (ii) normalized evoked spectral power in the alpha, low-beta, high-beta and gamma range. Non-fluent PPA patients showed a slower and simplified TMS-evoked response as compared to healthy elderly subjects, namely a reduction in high-beta power and natural frequency coupled with higher low frequencies (i.e., alpha) intrusion. No significant differences were detected between lvPPA and controls or nfvPPA and lvPPA. The speech rate was positively correlated with TMS-EEG measures (the high-beta power and the natural frequency). Furthermore, compared to the left side, the stimulation of the right hemisphere elicited TMS-evoked responses with higher natural frequency and high-beta power in both lvPPA and nfvPPA patients. This study first shows that TMS-EEG may provide useful neurophysiological biomarkers for characterizing the nfvPPA variant and monitor disease progression across variants. These findings might be employed in the future to stratify patients and eventually inform the application of variant-specific stimulation protocols tailored to individual neurophysiological profiles.

Background: Airway management forms the most important component of pre-hospital trauma patients’ care. In such a setting, the definitive airways may be difficult to establish. This study aimed to evaluate four newer supraglottic airway devices in a simulated condition of an entrapped trauma patient with restricted access. Methods: An intubation manikin with a cervical collar on was placed on the driver’s seat of a passenger car, which was positioned on its left side. The access to the manikin was only allowed from the front. The insertion to successful ventilation (Tiv) time was recorded. First-pass success and the ease of use were also evaluated. Results: The AuraGain device required the shortest median Tiv at 7.5 s (Interquartile Range, IQR 4) vs. 9.5 s (IQR 11), p < 0.001. The AuraGain achieved the highest first-pass success—90%. The Baska mask was the most user-friendly, achieving a mean score of 8.6. Conclusions: The AuraGain outperformed other studied devices concerning the Tiv as well as the first-pass success. The Baska mask was the easiest to use.