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Background The differentiation between the causes of cervical lymphadenopathy is of paramount importance as these have different modalities of treatment with varying prognosis. The aim of this study was to evaluate the efficacy of B Mode and colour Doppler ultrasound (CDUS) to differentiate between benign and metastatic lymph nodes. Methods 100 patients of clinically palpable lymph nodes were evaluated with B Mode and CDUS. B Mode assessment included short-long (S:L) axis ratio, hilum, nodal border, echogenicity, intranodal necrosis and ancillary features. CDUS assessment included distribution of vascularity, resistive index (RI) and pulsatility index (PI). Statistical analysis was carried out with histopathological or cytological diagnosis as gold standard. Results B-Mode US correctly diagnosed 22/25 (88%) of the reactive lymph nodes giving it a sensitivity of 88% and specificity of 97.3%. Colour Doppler US diagnosed 23/25 (92%) reactive lymph nodes with a sensitivity of 92% and specificity of 97.3%. B-Mode underdiagnosed one case each of granulomatous disease and metastasis as reactive node while CDUS missed out two cases of granulomatous disease as reactive lymph node. Conclusion Individual parameters of B Mode when used alone were not found to be very effective in differentiating benign and malignant lymph nodes. However features of B-Mode combined together as well as color Doppler ultrasound, help in the detection of reactive lymph nodes and can be used as a diagnostic tool with good accuracy. However, they cannot be used as a diagnostic method for metastatic or tubercular nodes and cytopathology/histopathology remains the gold standard in such situations. [ABSTRACT FROM AUTHOR]

Background Tuberculosis of spine is known as tubercular spondylitis or Pott's spine. The vertebral involvement leads to various pathological processes such as abscess formation, cord compression, and gibbus deformity. Magnetic Resonance Imaging (MRI) is the imaging modality of choice which not only helps in diagnosing a case of Pott's spine but also gives valuable information about its impending complications, thereby, aiding in management of these cases. Methods In this study, MRI scans of 80 proven cases of tubercular spondylitis were studied retrospectively for the various pathological processes affecting the spine. Results Of the 80 cases included in this study, 68.8% of cases were male and 31.2% of cases were females. Majority of cases were seen in 21–40 yrs age group. Lumbar vertebrae were more commonly affected than the dorsal vertebrae. Contiguous two vertebral involvement was the most common pattern, and skip lesions were seen in 5% of cases. Pre-, paravertebral and epidural soft tissue component was seen in 96.25% and 62.5% of cases, respectively. Intervertebral disc Involvement was noted in 95% of cases, and cord edema was seen in 15% of cases. Conclusion Tubercular spondylitis or Pott's spine is an extrapulmonary form of tuberculosis which affects the spine. MRI is the imaging modality of choice not only in diagnosing the condition but also in guiding the surgical management. The cases of spinal tuberculosis were systematically analyzed for various pathological lesions which are produced in the spine as the disease progresses. [ABSTRACT FROM AUTHOR]

Background Doppler indices form an integral component of noninvasive evaluation of fetal well-being. There is paucity of information about normal obstetric Doppler indices, particularly from the Indian subcontinent. The aim of the study was to find the values of pulsatility index (PI), resistive index (RI) of umbilical artery (UA), and fetal middle cerebral artery (MCA) and calculate cerebro-placental ratio (CP ratio) for 18–40 weeks of normal gestation so that a reference range of these Doppler values can be postulated. Methods 200 patients were enrolled in the study for color Doppler study of UA and MCA and were serially followed up at 4–6 weeks interval for Doppler indices. Angle-independent Doppler indices like PI and RI for MCA and UA were obtained during each examination. CP ratio was calculated in each case. All the cases were followed up till delivery and the perinatal outcome was recorded. Results & Conclusion The fetal MCA PI and RI showed a parabolic curve with plateau at 28–30 weeks of gestation. A significant correlation was noted between MCA PI and RI with gestational age. UA PI and RI showed a gradual fall over the gestational age with a strong negative correlation. There was a significant correlation between MCA PI and UA PI with their respective RI values. CP ratio has also shown a parabolic curve with turning point at 31–32 weeks of gestation. A significant correlation was noted between CP ratio and gestational age. CP ratio also showed a minimal positive correlation with MCA PI and a strong negative correlation with UA PI. [ABSTRACT FROM AUTHOR]

Headache disorders are among the most common presenting complaints in any neurology outpatient department. International Headache Society classifies headaches as “primary” or “secondary”. The causes of secondary headaches are varied and intracranial hypotension is one of them. It typically presents clinically with postural headaches but most of the times, its diagnosis is delayed, as it is an uncommon cause and there is poor awareness among the medical fraternity about this condition. Imaging, especially magnetic resonance imaging (MRI), plays a crucial role in the diagnosis of intracranial hypotension by not only confirming the diagnosis but also detecting the cause in some cases. This case series tries to highlight the MRI findings of intracranial hypotension in three cases with different etiologies. [ABSTRACT FROM AUTHOR]

Acute appendicitis (AA) is the commonest cause of pain abdomen requiring surgical intervention. Diagnosis as well as management of acute appendicitis is mired in controversies and contradictions even today. Clinicians often face the dilemma of balancing negative appendectomy rate and perforation rate if the diagnosis is based on clinical scoring alone. Laboratory results are often non-specific. Imaging has an important role not only in diagnosing appendicitis and its complication but also suggesting alternate diagnosis in appropriate cases. However, there is no universally accepted diagnostic imaging algorithm for appendicitis. Imaging of acute appendicitis needs to be streamlined keeping pros and cons of the available investigative modalities. Radiography has practically no role today in the diagnosis and management of acute appendicitis. Ultrasonography (USG) should be the first line imaging modality for all ages, particularly for children and non-obese young adults including women of reproductive age group. If USG findings are unequivocal and correlate with clinical assessment, no further imaging is needed. In case of equivocal USG findings or clinico-radiological dissociation, follow-up/further imaging (computed tomography (CT) scan/magnetic resonance imaging (MRI)) is recommended. In pediatric and pregnant patients with inconclusive initial USG, MRI is the next option. Routine use of CT scan for diagnosis of AA needs to be discouraged. Our proposed version of a practical imaging algorithm, with USG first and always has been incorporated in the article. [ABSTRACT FROM AUTHOR]

Background Coronary artery disease (CAD) is a common cause of morbidity and mortality worldwide. Although catheter coronary angiography (CCA) is the gold standard in the diagnosis and management of CAD, coronary CT angiography (CCTA) has shown promising results for the same. Methods CCTA was done using 40 slice multi-detector CT (Somatom Sensation, Siemens, Germany) machine in 220 patients of suspected CAD. Patients were classified as (a) normal (no calcific or soft plaque), (b) non-obstructive coronary disease (<50% stenosis), (c) obstructive coronary disease (>50% stenosis), or (d) a non-diagnostic study. Results 96 (43.6%) cases were found to have normal coronary arteries on CCTA, 41 (18.6%) patients were classified as having non-obstructive disease, 67 (30.5%) patients were defined to have obstructive CAD, and 16 cases (7.3%) were inconclusive. Significantly obstructive triple vessel disease was noted in 4 (6%) cases. Double vessel disease was seen in 25 (37.3%) cases and single vessel disease was seen in 38 (56.7%). Single most common vessel with obstructive CAD was left anterior descending artery and was noted in 30 (44.7%) out of 67 such cases. The least affected vessel was left circumflex in 15 cases (22.3%). Median calcium score for non-obstructive CAD was 60 (range 30–95), and for obstructive CAD 300 (range 120–780). Conclusion Key benefits of CCTA lie in the avoidance of CCA since it has a high negative predictive value. CCTA has a definite role in post-stent and post-coronary artery bypass graft patients. [ABSTRACT FROM AUTHOR]

Acute appendicitis (AA) is a common surgical emergency. Accurate and timely diagnosis of AA is essential for successful outcome. Imaging plays an important role in the diagnosis, exclusion of AA as well as diagnosing alternative clinical conditions which can closely simulate AA. A correct alterative diagnosis may obviate the need of unnecessary appendectomy or may even change the treatment regime altogether. This pictorial essay illustrates various clinical conditions which mimicked AA clinically during our day to day practice. [ABSTRACT FROM AUTHOR]

Nitrogen-doped porous carbon synthesised from garlic peel by a simple and cost-effective method has been employed as an anode material for the sodium ion (SIB) as well as lithium ion batteries (LIB). The synthesised material has been found to be mesoporous with a high specific surface area (SSA) ∼1710 m 2 g −1 , as calculated with Brunauer–Emmett–Teller (BET) isotherm. Further, Field Emission Scanning Electron Microscopy (FE-SEM) and Transmission Electron Microscopy (TEM) analysis reveal the existence of interconnected micro-pores and voids. The N-doped garlic peel carbon (GPC) exhibits excellent rate capability as well as steady state cycling performance towards sodium and lithium ion shuttlings. Discharge capacities of about 142, 89, 58, 37 mAh g −1 have been achieved at various current densities such as 0.5, 1.0, 2.0, 4.0 A g −1 respectively in a CR-2032 type Na-ion cell. Similarly, the Li-ion cell delivered reversible capacities of about 320, 280, 215 and 145 mAh g −1 at different current densities of 1.0, 2.0, 4.0 and 8.0 A g −1 respectively. The high electrochemical performance of the N-doped GPC is mainly attributed to the existence of nitrogen in the carbon matrix and mesoporous structure coupled with a high surface area for accommodating large number of Li/Na ions. [ABSTRACT FROM AUTHOR]

Background Empty sella (ES) has been regarded as an incidental finding. Recently, there have been studies documenting association of ES with hormonal and non-hormonal abnormalities. To detect the prevalence of empty sella in routine MRI brain study and to find associations with other diseases. Methods A retrospective study was carried out for patients undergoing MRI brain studies in the radiology department of a teaching institution. Patients with ES formed the study group. The rest formed the baseline population. Presence of nine select variables, viz. hormonal disturbances, headache, sensorineural hearing loss, seizures, vertigo, psychiatric disorders, visual disturbances, ataxia and raised intracranial tension, was analyzed amongst the study group, as well as the baseline population. Association of ES and the select variables was analyzed by determining means and proportions and using Chi-square test. Results During the study period, a total of 12,414 patients underwent MRI brain studies at our centre. ES was found in 241 (1.94%) patients. The proportion of patients in the ES and non-empty sella groups for each of the variables were as follows: hormonal disturbances (3.31% vs 0.56%, P = .000), headache (8.3% vs 7.4%, P = .596), SNHL (3.7% vs 1.3%, P = .0010), seizure (6.2% vs 13%, P = .002), vertigo (4.6% vs 1.6%, P = .000), psychiatric disorders (4.6% vs 1.3%, P = .000), visual disturbances (2% vs 1.1%, P = .166), ataxia (1.7% vs 1.2%, P = .519) and raised ICT (2% vs 0.5%, P = .002). Conclusion Hormonal disturbances, psychiatric disorders, raised ICT and SNHL have been found to be more often associated with ES as compared to general population. [ABSTRACT FROM AUTHOR]

Performance of nitrogen doped porous carbon, obtained from fish scale, has been investigated as an anode material for lithium ion battery in an ionic liquid (IL) electrolyte containing N-butyl,N,N,N-triethylammonium bis(trifluoromethanesulfonyl) imide (N 2224 -TFSI) and in conventional medium. The N-doped fish scale hierarchical carbon (FSHC) exhibits large surface area (1980 m 2 g −1 ) with uniform pore distribution. The representative anode material shows steady state reversible capacities of ∼500 and 480 mAh g −1 at a current density of 75 mA g −1 and discharge capacities of ∼224.7 and 232.5 mAh g −1 at 2000 mA g −1 in the IL and organic electrolytes respectively for the investigated 75 cycles. Such performance indicates a coulombic efficiency of ∼90 % coupled with a superior capacity retention of about 80%. Post-mortem of the cell containing N-doped FSHC electrode cycled at high current density shows excellent stability in both electrolytes, as confirmed by Field Emission Scanning Electron Microscopy (FE-SEM) and X-ray diffraction pattern (XRD). The enhanced electrochemical performance of the N-doped FSHC as a high capacity anode for lithium-ion batteries could be mainly attributed to the high specific surface area and hierarchical porous structure. [ABSTRACT FROM AUTHOR]

Background Most resectable pancreatic cancers are classified as T3, including those involving the porto-mesenteric vein. Survival and perioperative morbidity for venous resection have been found to be comparable to standard resection. We investigate factors associated with short and long term outcomes in pancreaticoduodenectomy with (PDVR) and without (PD) venous resection exclusively for T3 adenocarcinoma of the head of the pancreas. Methods This is a UK multicenter retrospective cohort study assessing outcomes in patients undergoing PD and PDVR. All consecutive patients with T3 only adenocarcinoma of the head of the pancreas undergoing surgery between December 1998 and June 2011 were included. Multivariable logistic and proportional hazards regression analyses were performed to determine the association between the surgical groups and in-hospital mortality (IHM) and overall survival (OS). Results 1070 patients were included of whom 840 (78.5%) had PD and 230 (21.5%) had PDVR. Factors independently associated with IHM were a high creatinine (aHR 1.14, p = 0.02), post-operative bleeding (aHR 2.86, p = 0.04) and a re-laparotomy (aHR 8.42, p = 0.0001). For OS, multivariable analyses identified R1 resection margin status (aHR 1.22, p = 0.01), N1 nodal status (aHR 1.92, p = 0.0001), perineural invasion (aHR 1.37, p = 0.002), tumour size >20mm (aHR 0.63, p = 0.0001) and a relaparotomy (aHR 1.84, p = 0.0001) to be independently associated with overall mortality. Conclusion This study on T3 adenocarcinoma of the head of the pancreas suggests that IHM is strongly associated with perioperative complications whilst OS is affected by histological parameters. Detailed pre-operative disease evaluation and advances in oncological treatment have the potential to improve OS. [ABSTRACT FROM AUTHOR]

High right atrial pressure (RAP) is associated with deranged renal function and mortality in patients with heart failure. We hypothesised that : 1.This effect may persist after heart transplantation 2. It is essentially mediated through a low organ perfusion pressure indexed to body surface area (OPPI). 3.That OPPI is more sensitive than organ perfusion pressure (OPP) alone in predicting survival. The data from 250 patients who had a heart transplant over a 8 period from October 2012 to march 2020 was analyzed for the effect of OPPI and OPP. OPP was calculated as :Mean arterial pressure (MAP) - RAP and OPPI as (MAP-RAP)/body surface area.OPPI value of 40 and OPP of 60 mm hg were chosen for analysis as they were close to the median values. There was a more significant negative correlation between OPPI and creatinine (r = -0.3551,p =0.000) than OPP and creatinine (r = -0.0688,p = 0.3414).The effect of OPPI on MELD score was more pronounced than OPP.(r = -0.3580, p = 0.000 vs r = -0.1504, p = 0.062). OPPI also had a more significant effect on 90 day mortality than OPP (odds ratio 0.89, p = 0.004 vs odds ratio 1.01 ,p = 0.677). The 90 day mortality for OPPI less than and more than 40 was 23.2 % vs 7.1 %, p = 0.001.This effect of OPPI and OPP on 90 day mortality was absent if RAP was less than 15 mm hg. The effect of OPPI on survival persisted at a follow up of beyond 5 years. (72 % vs 54 % , p = 0.0124).The effect was absent if the RAP was less than 15. The effect was more pronounced for OPPI than OPP. 90 day and 5 year survival after heart transplantation are worse in patients with low organ perfusion pressure indexed to BSA. OPPI less than 40 appears to be deleterious. Vasodilator drugs used to treat systolic left heart failure may adversely affect survival if RAP is high, to be used with caution. [ABSTRACT FROM AUTHOR]

Abstract: Spinel LiMo x Mn2− x O4 (x =0.01, 0.05, 0.10) samples are synthesized using solid state technique and characterized by thermo gravimetric analysis (TG/DTA), X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM), transmission electron microscopy (TEM) and galvanostatic cycling studies. Thermal studies depict that the formation of spinel compound proceeds in three stages. XRD peak reflections point out the formation of spinel phase. SEM studies confirm that LiMo0.01Mn1.99O4 calcined at 850°C are of 1μm grains. Among the dopant concentrations investigated, LiMo0.01Mn1.99O4 sample shows better cycling characteristics. LiMo0.01Mn1.99O4 spinel delivers a maximum discharge capacity of 66mAhg–1 during the first cycle corresponding to coulombic efficiency of 84% and exhibits a capacity fade of 0.2mAhg–1 cycle–1 over the investigated 10cycles. [Copyright &y& Elsevier]

Abstract: LiMn2O4 and LiMg x Sn y Al z Mn2−x−y−z O4 (x, y, z =Mg, Sn, Al) (x =0.01–0.09; y =0.04–0.1; z =0.35–0.20) powders have been synthesized via the sol–gel method for the first time using glutamic acid as the chelating agent. The synthesized samples have been subjected to physical and electrochemical characterization. SEM images of parent LiMn2O4 show that the majority of the grains are 1μm in size. The LiMg0.01Sn0.04Al0.35Mn1.6O4 and LiMg0.04Sn0.06Al0.30Mn1.6O4 particles present a low degree of agglomeration and the primary particles are 1μm in size. TEM images of the spinel LiMn2O4 and LiMg x Sn y Al z Mn2−x−y−z O4 ascertain that the synthesized particles are nano-sized with uniform surface morphology. The LiMn2O4 samples calcined at 850°C deliver a discharge capacity of 122mAhg−1 in the first cycle. Among the compositions investigated, LiMg0.01Sn0.06Al0.30Mn1.6O4 delivers 115mAhg−1 in the first cycle and exhibits stable cycling performance with a low capacity fade of 1mAhg−1 cycle−1 over the 10 cycles investigated. [Copyright &y& Elsevier]

Lunate dislocation is an uncommon injury occurring in young adults due to high-energy trauma. The volar displacement of the bone may result in compression of the median nerve within the carpal tunnel and is an uncommon cause of entrapment neuropathy. [ABSTRACT FROM AUTHOR]

Abstract: A large variety of aryloxy compounds and benzyloxy derivatives of Hf(IV) were synthesized from Hf(O-tBu)4 using the alcoholysis route. These compounds were completely characterized using various spectroscopic and analytical methods along with single crystal X-ray diffraction studies. Multinuclear NMR studies prove high degree of fluxional behavior of these compounds in solution. They adopt a dimeric structure in the solid-state as seen from X-ray diffraction studies on a few of them. These compounds are powerful catalysts for the ring-opening polymerization of ε-caprolactone (CL) and δ-valerolactone (VL) resulting in high number average molecular weight (Mn ) polymers and controlled molecular weight distributions (MWDs). Significant control in the polymerization was achieved with these compounds as initiators in comparison to their titanium and zirconium analogues. Kinetic studies reveal that the rates of such polymerizations are in general slower than the corresponding titanium and zirconium derivatives. 1H NMR and MALDI-TOF studies of low molecular weight oligomers suggest that these polymerizations proceed by the activated monomer mechanism. [ABSTRACT FROM AUTHOR]

Abstract: A variety of aromatic, aliphatic and conjugated aldehydes were converted to the corresponding carboxylic acid derivatives with 30% H2O2 as the oxidant in the presence of catalytic amounts of AgNO3. The method described has wide range of applicabilities, does not involve cumbersome work-up, exhibits chemoselectivity and proceeds under mild reaction conditions, and the resulting products are obtained in good yields within reasonable time. [Copyright &y& Elsevier]

Abstract: Aim: To compare the effects of preoperative chemotherapy on liver parenchyma morphology, as well as morbidity and mortality after liver resection for colorectal liver metastases. Methods: Prospectively collected data on 173 patients undergoing liver resection for CLM between 1/2003 and 9/2005 was analysed in three groups: A: preoperative oxaliplatin (Ox, n =70); B: other chemotherapeutic agents (OC, n =60); and C: surgery alone without chemotherapy (SA, n =43). Blood transfusion, hospital stay, operative procedure, peak postoperative bilirubin levels, complications and histopathology of the resected liver were compared. Results: Intra-operative blood transfusion requirement (34%) and biliary complications (16%) was higher in patients receiving oxaliplatin-based chemotherapy (p =0.01 and p =0.06, respectively). Oxaliplatin-based chemotherapy was also associated with sinusoidal dilatation of mild grade in 52.8% vs. 26.6% and 23.3% patients (p =0.007 and p =0.004) in other groups, respectively. Steatosis was similarly distributed across the study group. Postoperative mortality was 2, 1 and 4 patients, respectively (p =ns). Conclusion: Oxaliplatin-based preoperative chemotherapy is associated with vascular alterations in the liver parenchyma without significantly increasing the risk of steatosis, or postoperative morbidity and mortality. [Copyright &y& Elsevier]

Breast hamartomas are uncommon benign tumors of the breast. Imaging appearance of a breast hamartoma can vary widely. “Breast within a breast” sign on mammography is considered pathognomonic of this unusual entity. We describe mammographic and Magnetic Resonance Imaging (MRI) appearance of a case of hamartoma breast. [ABSTRACT FROM AUTHOR]

Septo-optic dysplasia is a rare congenital disorder involving brain and optic pathways. We present typical Magnetic Resonance Imaging (MRI) findings of a case of Septo-optic dysplasia in a 19 year old female patient. [ABSTRACT FROM AUTHOR]

Studies the role of vesicular-arbuscular mycorrhizae (VAM) in fungi symbiosis with bamboo seedling. Examples of some VAM species; Infection and growth parameters that have been studied in mycorrhizal and non-mycorrhizal infected plants.

To study the impact of severe right ventricular (RV) dysfunction on survival after heart transplantation Data from 250 patients was analyzed for the effect of severe RV dysfunction , categorized by high right atrial pressure (RAP), low pulmonary artery pulsatility index (PAPi) and the presence of ascites, on 90 day and medium term survival. Systemic afterload was estimated by arterial elastance (E a) (method given below) and systemic vascular resistance (SVR). Calculation of E a: End systolic pressure E sys) = (2* systolic blood pressure + diastolic pressure) / 3. (1) Stroke volume (SV) = (CO / HR). (2) Arterial Elastance (E a) = E sys / SV (3) Organ perfusion pressure index (OPPI) ((Mean arterial pressure - RAP) / BSA) and modified MELD score was calculated. 90 day survival was worse with RAP > 15 (p = 0.014) , PAPi < 0.9 (p= 0.104) ,with ascites (p = 0.005) , higher MELD score (odds ratio 1.07, p = 0.06) and lower OPPI (odds ratio 0.92,p = 0.004). The effect of RAP ,PAPi and MELD score on mortality was not seen if afterload was higher (Ea > 2.7,SVR >1600 dynes/cm-5/sec). 5 years survival was worse for RAP > 15 (p = 0.0059) , ascites (p = 0.009), PAPi < 0.9 (p= 0.1897) and MELD score > 20 (p= 0.022) This effect of RAP , PAPi and MELD score was absent if Ea > 2.7. Survival for OPPI < 40 was worse (p = 0.0124) but only if RAP was more than 15 mm hg. The relationship between RAP,Ea and OPPI and the effect on medium term survival is shown in a cox proportional hazard regression survival curve (Fig 1). 90 day and 5 year survival after heart transplantation are worse in patients with severe preoperative RV dysfunction but only if the systemic arterial afterload is low. Organ perfusion pressure index less than 40 appears to be deleterious in the short and medium term. Vasodilator drugs used to treat systolic left heart failure may adversely affect survival if RAP is high. Intra aortic balloon pump might be a more physiological alternative in patients awaiting transplantation. [ABSTRACT FROM AUTHOR]