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Large adrenal pheochromocytomas encasing the renal artery are a rare entity. The management of such challenging cases is surgical resection. The involvement of renal tissue and renal artery may necessitate meticulous dissection and concomitant nephrectomy. Here, we present a case of 41-year-old man diagnosed with left adrenal pheochromocytoma with complete encasement of left renal artery and partial encasement of aorta. Open left adrenalectomy and nephrectomy was performed after adequate preoperative optimisation. The patient is doing well at 6-month follow-up. Large adrenal pheochromocytoma with renal involvement is a rare presentation and requires optimal preoperative imaging, adequate preoperative alpha and beta blockade and meticulous surgical technique.

BACKGROUND: There remains controversy regarding the outcomes resulting from treatment versus conservative management of patent ductus arteriosus (PDA) among preterm infants. The effects of extreme prematurity, hemodynamic status of the PDA, and age at treatment remain poorly defined. STUDY DESIGN: This retrospective case-control study including infants

BACKGROUND: Recidivism in patients who underwent liver transplantation for alcohol-related liver disease (ALD) is shown to be associated with poor survival in some studies. METHODS: Living donor liver transplantation (LDLT) recipients for ALD with at least 2 years of follow-up and history of significant alcohol relapse were included. The recipients underwent LDLT from June 2010 to December 2016, and data were analyzed until June 2019. The cohort had a median follow-up of 54 (33–78 IQR) months. Recidivism (significant alcohol intake) was defined as >21 units per week. RESULTS: A total of 27 of 463 (5.8%) LDLT recipients (all men), aged 43.5 ± 9.6 years, had significant alcohol intake. A liver biopsy was performed on demand in 14 patients (in the presence of raised levels of liver enzymes or jaundice). The histological diagnoses in these patients were as follows: alcoholic hepatitis in 7 (50%), alcoholic hepatitis and acute cellular rejection or chronic rejection in 4 (28.5%), cirrhosis in 2 (14.2%), and acute cellular rejection and cirrhosis in 1 (7.1%) patient. Four of 5 patients with a biopsy diagnosis of acute or chronic rejection were noncompliant with immunosuppression. Six of these patients died. The mortality after 1 year of transplant was significantly more in patients with recidivism. CONCLUSION: Recidivism was associated with significant morbidity and mortality after liver transplantation.

The gender gap is a significant concern facing the software industry as the development becomes more geographically distributed. Widely shared reports indicate that gender differences may be specific to each region. However, how complete can these reports be with little to no research reflective of the Open Source Software (OSS) process and communities software is now commonly developed in? Our study presents a multi-region geographical analysis of gender inclusion on GitHub. This mixed-methods approach includes quantitatively investigating differences in gender inclusion in projects across geographic regions and investigate these trends over time using data from contributions to 21,456 project repositories. We also qualitatively understand the unique experiences of developers contributing to these projects through a survey that is strategically targeted to developers in various regions worldwide. Our findings indicate that gender diversity is low across all parts of the world, with no substantial difference across regions. However, there has been statistically significant improvement in diversity worldwide since 2014, with certain regions such as Africa improving at faster pace. We also find that most motivations and barriers to contributions (e.g., lack of resources to contribute and poor working environment) were shared across regions, however, some insightful differences, such as how to make projects more inclusive, did arise. From these findings, we derive and present implications for tools that can foster inclusion in open source software communities and empower contributions from everyone, everywhere., 19 pages, 16 tables, 3 figures, Includes appendices

Statement of problem Flapless implant placement with immediate functional loading has been reported in anterior locations. However, data on posterior locations are lacking. Purpose The purpose of this randomized controlled trial was to determine and compare clinical outcomes of flap versus flapless surgically placed single posterior mandibular dental implants subjected to immediate functional loading. Material and methods Participants with missing mandibular first molar teeth were recruited and randomized into 2 groups (n=51): flapped and flapless. Dental implants were surgically placed and loaded immediately with interim restorations following implant protective occlusion. Outcome measures were implant failure, crestal bone loss, and periodontal parameters: modified plaque index, modified sulcus bleeding index, and pocket depths. Outcome data were recorded at baseline, 6-month, and 12-month follow-up visits. Cone beam computed tomography scans were used to calculate crestal bone loss, and periodontal outcomes were recorded by using a resin covered periodontal probe (α=.05). Results After 12 months, similar implant failure rates (P>.05) were found between the groups. Crestal bone loss in the flapped group was statistically higher than in the flapless group at 6 months (0.83 ±0.21 mm versus 0.75 ±0.23 mm) and at 12 months (1.04 ±0.27 mm versus 0.90 ±0.24 mm) from the baseline. The modified plaque index, modified sulcus bleeding index, and peri-implant probing depths (PDs) in both groups increased from the baseline to 6-month follow-ups (Baseline modified plaque index: 0.82 ±0.54 versus 0.79 ±0.21; Baseline modified sulcus bleeding index: 0.74 ±0.21 versus 0.70 ±0.43; Baseline PD: 1.25 ±0.37 mm versus 1.20 ±0.22 mm; 6 months modified plaque index: 1.54 ±0.70 versus 1.21 ±0.45; 6 months modified sulcus bleeding index: 1.93 ±0.54 versus 1.51 ±0.61; 6 months PD: 3.20 ±0.73 mm versus 2.80 ±0.43 mm). At 12-month follow-ups after repeated oral hygiene reinforcements, periodontal parameters had improved (decreased) significantly. Conclusions Flapless implant insertion with immediate functional loading could be considered as an appropriate treatment option for providing functional restorations on the day of implant placement with minimal surgical intervention, reducing crestal bone loss, and periodontal complications.

In handwriting recognition, traditional systems have relied heavily on handcrafted features and a massive amount of prior data and knowledge. Deep learning techniques have been the focus of research in the field of handwriting digit recognition and have achieved breakthrough performance in the last few years for knowledge extraction and management. KM and knowledge pyramid helps the project with its relationship with big data and IoT. The layers were selected randomly by which the performance of all the cases was found different. Data layers of the knowledge pyramid are formed by the sensors and input devices, whereas knowledge layers are the result of knowledge extraction applied on data layers. The knowledge pyramid and KM helps in making the use of IoT and big data easily. In this manuscript, the knowledge management principles capture the handwritten gestures numerically and get it recognized correctly by the software. The application of AI and DNN has increased the acceptability significantly. The accuracy is better than other available software on the market.

Background Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding Bill & Melinda Gates Foundation.

Adolescents and young adults (AYA) with sickle cell disease (SCD) experience high rates of acute care utilization and increased morbidity. At this high-risk time, they also face the need to transition from pediatric to adult services, which, if poorly coordinated, adds to heightened morbidity and acute care utilization. The study objective was to characterize the feasibility, acceptability, and short-term efficacy of a protocolized transition navigator (TN) intervention in AYA with SCD.We developed a protocolized TN intervention that used ecological assessment and motivational interviewing to assess transition readiness, identify goals, and remove barriers to transition, and to provide disease and pain management education and skills to AYAs with SCD.Ninety-three percent (56/60) of enrolled individuals completed the intervention. Participation in the TN program was associated with significant improvement in mean transition readiness scores (3.58-4.15, P.0001), disease knowledge scale (8.91-10.13, P.0001), Adolescent Medication Barriers Scale (40.05-35.39, P = .003) and confidence in both disease (22.5-23.96, P = .048) and pain management (25.07-26.61, P = .003) for youth with SCD.The TN intervention was acceptable to youth with SCD, feasible to implement at an urban academic medical center, and addressed barriers to transition identified by the youth. Longer-term assessment is needed to determine if the TN intervention improved successful transfer to and retention in adult care.

Machine learning (ML) algorithms play a vital role in brain age estimation frameworks. The impact of regression algorithms on prediction accuracy in the brain age estimation frameworks have not been comprehensively evaluated. Here, we sought to assess the efficiency of different regression algorithms on brain age estimation. To this end, we built a brain age estimation framework based on a large set of cognitively healthy (CH) individuals (N = 788) as a training set followed by different regression algorithms (18 different algorithms in total). We then quantified each regression-algorithm on independent test sets composed of 88 CH individuals, 70 mild cognitive impairment patients as well as 30 Alzheimers disease patients. The prediction accuracy in the independent test set (i.e., CH set) varied in regression algorithms (mean absolute error (MAE) from 4.63 to 7.14 yrs, R2 from 0.76 to 0.88). The highest and lowest prediction accuracies were achieved by Quadratic Support Vector Regression algorithm (MAE = 4.63 yrs, R2 = 0.88, 95% CI = [-1.26, 1.42]) and Binary Decision Tree algorithm (MAE = 7.14 yrs, R2 = 0.76, 95% CI = [-1.50, 2.62]), respectively. Our experimental results demonstrate that prediction accuracy in brain age frameworks is affected by regression algorithms, indicating that advanced machine learning algorithms can lead to more accurate brain age predictions in clinical settings.

Purpose The systematic review study aimed to investigate the following details in the clubfoot children treated with the Ponseti technique: (1) to review the various designs and prescriptions of unilateral limb orthosis described in literature (2) to find the outcome following use of this orthosis, especially patient adherence and recurrence (3) comparison with standard bilateral limb foot abduction orthosis. Material and methods A literature search was performed for articles published in 'Pubmed (includes Medline indexed journals)' electronic databases for broad key words: 'Clubfoot or CTEV or congenital talipes equinovarus', 'orthosis or brace or splint'. Included were studies that addressed the treatment of idiopathic clubfoot in children up to 2 years of age using the Ponseti technique and use of unilateral limb orthosis for the subsequent maintenance phase. We excluded studies reporting Ponseti technique for nonidiopathic clubfoot, child age older than 2 years at the time of primary treatment, studies where unilateral limb orthosis was used as a tool for primary correction of all or some components of clubfoot and design descriptions of orthosis without practical usage data. Results Of the 1537 articles from the database, 10 articles were included in the final review. Most studies were retrospective, underpowered and had a short term follow-up. In some series, the use of this orthosis was driven by personal experiences and regional preferences rather than a just scientific explanation. The tested designs were variable and nonstandardized. Being less restrictive, unilateral limb orthosis may have an edge over bilateral limb orthosis in terms of patient adherence. The available comparative studies however showed inferiority of unilateral orthoses when compared to the bilateral limb orthosis in preventing recurrences in clubfoot treatment. Conclusions There is insufficient evidence to support use of unilateral limb orthosis for maintenance of deformity correction following treatment of clubfoot with the Ponseti technique. Their use was found associated with high recurrence rates.

The mantra becomes more powerful when that sound is chanted in front of purified fire and light; sound and heat energy mixtures are converted into high level of energy and spread around the atmosphere. Through this paper, the well experienced author team of various domains is continuously working in experimenting in joint collaboration with different GoI departments. They have observed the slow but continuous progress in different ails on many subjects through scientific study and approach. The main case studies where the patients got significant benefits through this alternate therapy have been systematically presented here. The power of yajna and mantra has attracted the intellectuals of this era. In the future, we may expect some automated intelligent healthcare expert system using this way of life. Yagya science and its treatment power of different diseases is surprising; the need is that current science should accept it logically with an open mind and heart and let the humanity take the complete benefit of it.

PURPOSE: Results from adjuvant trials evaluating 6 cycles of epirubicin-based chemotherapy regimens suggested these programs may be more effective than 4 cycles of doxorubicin-based chemotherapy. METHODS: NSABP B-36 was a phase III clinical trial originally designed as a 2x2 factorial study comparing 6 cycles of FEC-100 (5-FU, epirubicin, cyclophosphamide) to 4 cycles of conventional AC (Adriamycin/cyclophosphamide) with celecoxib or placebo. Shortly after activation, concerns regarding increased cardiovascular risks among selective COX-2 inhibitors resulted in a decision to remove the celecoxib/placebo from the trial. Women with histologically node-negative invasive breast cancer who had undergone primary surgery with a lumpectomy or total mastectomy were eligible. Primary endpoint was disease-free survival (DFS).RESULTS: Between May 2004-July 2008, 2,722 patients were enrolled. Administration of FEC-100 did not result in improvement in DFS compared to AC (HR=1.09; 95% CI 0.92-1.29, p-value=0.31). The effect of FEC-100 compared to AC on DFS was significantly different for receptor-positive (HR=1.32, 95% CI=1.05-1.66) compared to receptor-negative patients (HR=0.86, 95% CI=0.66-1.11) (treatment-by-receptor status interaction p-value=0.02). There was no statistically significant difference in the effect of treatment on overall survival (OS) with FEC-100 compared to AC (HR=1.06; 95% CI 0.84-1.35, p-value=0.61). Overall, Grade 3 and 4 adverse events were more frequent in the FEC-100 group.CONCLUSIONS: The results of B-36 do not support use of six-cycle anthracycline-based regimens in node-negative breast cancer. Prolongation of anthracycline-based therapy with FEC-100 does not improve DFS or OS, relative to AC for 4 cycles, and was associated with expected increases in toxicity. A statistically significant interaction between treatment and hormone receptor status favoring AC in hormone-receptor-positive breast cancers is consistent with the hypothesis that optimal duration of chemotherapy may be four cycles in these patients. Late cardiac events and deaths prior to recurrence or second cancer were infrequent on both arms, but slightly higher with FEC-100.ClinicalTrials.gov: NCT00087178

Objective The present study aimed to evaluate gestational diabetes mellitus (GDM) incidence in pregnant women following the Mediterranean diet with additional extra virgin olive oil (EVOO) and pistachios. Methods 560 pregnant patients were enrolled in the present study. The Mediterranean diet (MedDiet) was introduced in both the interventional group (IG) and control group (CG). The females received 40 ml of extra virgin olive oil (EVOO) every day along with 25 - 30 gm of roasted pistachios in the interventional group. The incidence of Gestational Diabetes Mellitus (GDM) was recorded along with specific maternal and neonatal outcomes. Materials and Methods The nutritional and MEDAS scores were not statistically different among the groups at baseline, but the difference was statistically significant and higher in IG at 24–28 weeks (p = 0.001) and 36–38 weeks (p = 0.001). GDM was diagnosed in 51(20.4%) females in the Control group and 34 (13.6%) females in the Interventional group. The MedDiet significantly reduced the GDM incidence (p=0.02) after adjusting the confounding factors. Conclusion The present study depicts that dietary intervention in pregnant women, including MedDiet and increased consumption of EVOO and pistachios, decreased the incidence of GDM.

During Covid-19, manufacturing industries have faced problems due to lack of Remote Access system for manufacturing operation whereas IT sector has had a tremendous increase by leveraging the Remote Access system. In this paper, a Remote Access system is formed by integrating the existing technology such as SCADA (Supervisory Control and Data Acquisition), Microcontroller, OPC server, Internet, Sensor, and Actuator which facilitate controlling and monitoring manufacturing operation remotely. Sensor send operation data to Cloud via microcontroller (Arduino). Cloud computing processes the data and provides information to user in analytical form such as chat, graph, table etc., via HMI (Human Machine Interface). Through HMI the user monitors and controls the manufacturing operation by sending signal to actuator via microcontroller. This process integrated Human intelligent with machine capability. Viability of the proposed methodology is validated through simulation model design on Proteus and Wonderware Intouch. To find features and issues of Remote Access system we have done analysis of the simulation model and work done by different author in similar field. From this study, we realise that the Remote Access system is possible but it will not be effective until the infrastructure of IIoT (Industry Internet of Things) is developed.

Aircraft infrared (IR) signature studies are complex, due to their dependence on several parameters, e.g., line of sight (LOS) and viewing aspect (LOS^). There is no equivalent counterpart of the w...

The prevalence of sleep-disordered breathing (SDB) is higher in older adults compared with younger individuals. The increased propensity for ventilatory control instability in older adults may contribute to the increased prevalence of central apneas. Reductions in the cerebral vascular response to CO(2) may exacerbate ventilatory overshoots and undershoots during sleep. Thus, we hypothesized that hypercapnia-induced cerebral vasodilation (HCVD) will be reduced in older compared with younger adults. In 11 older and 10 younger adults with SDB, blood flow velocity in the middle cerebral artery (MCAV) was measured using Doppler transcranial ultrasonography during multiple steady-state hyperoxic hypercapnic breathing trials while awake, interspersed with room air breathing. Changes in ventilation, MCAV, and mean arterial pressure (MAP) via finger plethysmography during the trials were compared with baseline eupneic values. For each hyperoxic hypercapnic trial, the change (Δ) in MCAV for a corresponding change in end-tidal CO(2) and the HCVD or the change in cerebral vascular conductance (MCAV divided by MAP) for a corresponding change in end-tidal CO(2) was determined. The hypercapnic ventilatory response was similar between the age groups, as was ΔMCAV/Δ [Formula: see text]. However, compared with young, older adults had a significantly smaller HCVD (1.3 ± 0.7 vs. 2.1 ± 0.6 units/mmHg, P = 0.004). Multivariable analyses demonstrated that age and nadir oxygen saturation during nocturnal polysomnography were significant predictors of HCVD. Thus, our data indicate that older age and SDB-related hypoxia are associated with diminished HCVD. We hypothesize that this impairment in vascular function may contribute to breathing instability during sleep in these individuals. NEW & NOTEWORTHY This study demonstrates, for the first time, in individuals with sleep-disordered breathing (SDB) that aging is associated with decreased hypercapnia-induced cerebral vasodilation (HCVD). In addition to advanced age, the magnitude of nocturnal oxygen desaturation due to SDB is an equal independent predictor of HCVD.

Summary Background India faces a high burden of diabetes and hypertension. Currently, there is a dearth of economic evidence about screening programmes, affected age groups, and frequency of screening for these diseases in Indian settings. We assessed the cost effectiveness of population-based screening for diabetes and hypertension compared with current practice in India for different scenarios, according to type of screening test, population age group, and pattern of health-care use. Methods We used a hybrid decision model (decision tree and Markov model) to estimate the lifetime costs and consequences from a societal perspective. A meta-analysis was done to assess the effectiveness of population-based screening. Primary data were collected from two Indian states (Haryana and Tamil Nadu) to assess the cost of screening. The data from the National Health System Cost Database and the Costing of Health Services in India study were used to determine the health system cost of diagnostic tests and cost of treating diabetes or hypertension and their complications. A total of 962 patients were recruited to assess out-of-pocket expenditure and quality of life. Parameter uncertainty was evaluated using univariate and multivariable probabilistic sensitivity analyses. Finally, we estimated the incremental cost per quality-adjusted life-year (QALY) gained with alternative scenarios of scaling up primary health care through a health and wellness centre programme for the treatment of diabetes and hypertension. Findings The incremental cost per QALY gained across various strategies for population-based screening for diabetes and hypertension ranged from US$0·02 million to $0·03 million. At the current pattern of health services use, none of the screening strategies of annual screening, screening every 3 years, and screening every 5 years was cost-effective at a threshold of 1-time per capita gross domestic product in India. In the scenario in which health and wellness centres provided primary care to 20% of patients who were newly diagnosed with uncomplicated diabetes or hypertension, screening the group aged between 30 and 65 years every 5 years or 3 years for either diabetes, hypertension, or a comorbid state (both diabetes and hypertension) became cost-effective. If the share of treatment for patients with newly diagnosed uncomplicated diabetes or hypertension at health and wellness centres increases to 70%, from the existing 4% at subcentres and primary health centres, annual population-based screening becomes a cost saving strategy. Interpretation Population-based screening for diabetes and hypertension in India could potentially reduce time to diagnosis and treatment and be cost-effective if it is linked to comprehensive primary health care through health and wellness centres for provision of treatment to patients who screen positive. Funding Department of Health Research, Government of India.

Background/Purpose This research aimed to compare the effects of systemically prescribed Lycopene as a monotherapy and as an alternative to scaling and root planing in patients with chronic gingivitis. Materials and methods The participants were randomly assigned to one of two treatment groups: the experimental group (n = 50), which received 10 mg of Lycopene a day for two weeks, or the control group (n = 50) received a placebo for two weeks. For each category, quadrant distribution was randomized, with two quadrants receiving oral prophylaxis (OP) and two quadrants receiving no care (non-OP). At baseline, 1st, and 2nd weeks, the sulcus bleeding index, plaque index, gingival index, and salivary uric acid level were measured. Results All clinical criteria, including SBI, PI, GI, and salivary uric acid levels, showed a statistically significant decline in all patient types. Both clinical parameters were significantly reduced (p

Our entire body, including the brain and nervous system, works with the help of various kinds of biological stuff which includes positively charged ions of elements like sodium, potassium, and calcium. The different body parts have different energy levels, and by measuring the energy level, we can also measure the fitness of an individual. Moreover, this energy and fitness are directly related to mental health and the signals being transmitted between the brain and other parts of the body. Various activities like walking, talking, eating, and thinking are performed with the help of these transmission signals. Another critical role played by them is that it helps in examining the mechanisms of cells present at various places in the human body and signaling the nervous system and brain if they are properly functioning or not. This manuscript is divided into two parts where, in the first part, it provides the introduction, background, and extensive literature survey on Kirlian experiments to measure the human's organ energy.

BACKGROUND: The recurrence score based on the 21-gene breast-cancer assay has been clinically useful in predicting a chemotherapy benefit in hormone-receptor–positive, human epidermal growth factor receptor 2 (HER2)–negative, axillary lymph-node–negative breast cancer. In women with positive lymph-node disease, the role of the recurrence score with respect to predicting a benefit of adjuvant chemotherapy is unclear. METHODS: In a prospective trial, we randomly assigned women with hormone-receptor–positive, HER2-negative breast cancer, one to three positive axillary lymph nodes, and a recurrence score of 25 or lower (scores range from 0 to 100, with higher scores indicating a worse prognosis) to endocrine therapy only or to chemotherapy plus endocrine (chemoendocrine) therapy. The primary objective was to determine the effect of chemotherapy on invasive disease–free survival and whether the effect was influenced by the recurrence score. Secondary end points included distant relapse–free survival. RESULTS: A total of 5083 women (33.2% premenopausal and 66.8% postmenopausal) underwent randomization, and 5018 participated in the trial. At the prespecified third interim analysis, the chemotherapy benefit with respect to increasing invasive disease–free survival differed according to menopausal status (P = 0.008 for the comparison of chemotherapy benefit in premenopausal and postmenopausal participants), and separate prespecified analyses were conducted. Among postmenopausal women, invasive disease–free survival at 5 years was 91.9% in the endocrine-only group and 91.3% in the chemoendocrine group, with no chemotherapy benefit (hazard ratio for invasive disease recurrence, new primary cancer [breast cancer or another type], or death, 1.02; 95% confidence interval [CI], 0.82 to 1.26; P = 0.89). Among premenopausal women, invasive disease–free survival at 5 years was 89.0% with endocrine-only therapy and 93.9% with chemoendocrine therapy (hazard ratio, 0.60; 95% CI, 0.43 to 0.83; P = 0.002), with a similar increase in distant relapse–free survival (hazard ratio, 0.58; 95% CI, 0.39 to 0.87; P = 0.009). The relative chemotherapy benefit did not increase as the recurrence score increased. CONCLUSIONS: Among premenopausal women with one to three positive lymph nodes and a recurrence score of 25 or lower, those who received chemoendocrine therapy had longer invasive disease–free survival and distant relapse–free survival than those who received endocrine-only therapy, whereas postmenopausal women with similar characteristics did not benefit from adjuvant chemotherapy. (Funded by the National Cancer Institute and others; RxPONDER ClinicalTrials.gov number, NCT01272037.)

Objective: Examine whether caregiver depressive symptoms at baseline predict longitudinal child asthma outcomes in the two populations with the largest asthma disparities: Mexicans and Puerto Ricans. Methods: 267 Hispanic caregiver-child dyads (Mexican =188, Puerto Rican =79; children 5-12 years) were recruited from clinics and hospitals in Phoenix, AZ and the Bronx, NY. The Center for Epidemiological Studies Depression Scale assessed caregiver depressive symptoms; higher scores indicate greater depressive symptomology. Medical records verified child asthma diagnosis. Assessments for outcome variables occurred at baseline, 3, 6, 9, and 12-month follow-ups. Pulmonary function was measured by spirometry, asthma control was measured by the Asthma Control Test, steroid bursts and acute healthcare utilization were assessed by caregiver report and medical records, and adherence was measured by doser devices on controller medications. Structural equation modeling analyzed baseline caregiver depressive symptoms as a predictor of longitudinal child asthma outcomes, and differences between subgroups. Results: Higher caregiver depressive symptoms predicted better pulmonary function (β = 0.02, p=.001) in Mexican children, and fewer steroid bursts (β= -0.41, p=.01) and better medication adherence (β = 0.02, p=.07) in Puerto Rican children. Caregiver depressive symptoms did not predict pediatric asthma control or acute healthcare utilization in either subgroup. Conclusions: Caregiver depressive symptomology had unexpected effects on child asthma outcomes. Results may be explained by the Hispanic paradox, caregiver resilience, acculturation, and the study's longitudinal nature. Further research is needed on social determinants of health that may influence differences in child asthma outcomes in heterogeneous Hispanic communities.

The paper aims to examine the effects of financial technology (Kisan Credit Card and ATM) on India's Poverty and empirically analyze the influence of financial technology on poverty scores. We consider data from twenty-two Indian states for three fiscal years, i.e., from 2018 to 2020. The current study uses panel data analysis to test the hypothesis. Results suggest a negative association between financial technology (Kisan credit card and ATM) and its influence on the poverty score in India. The current study suggests that the government should pay more attention to expanding financial technology, including increasing economic growth and financial stability and eliminating poverty by investing in infrastructure that would enhance banking services.

The accurate gland segmentation from digitized H&E (hematoxylin and eosin) histology images with a wide range of histologic grades of cancer is quite challenging. The methodologies proposed in recent researches have performed well in segmenting glands from benign subjects but have not given satisfactory results when segmenting glands from malignant cases. The methodology proposed in this paper is based on the symmetric encoder-decoder network which works remarkably well in detecting and segmenting glands in the case of malignant subjects and overall. The proposed pipelines harness the power of multilevel CNN architecture to capture contextual information and concatenation of features from skip connections with upsampled feature maps to improve the localization accuracy thereby improving the precise segmentation accuracy. The raw predicted map is further refined using morphological operators as a post-processing tool. The method is trained and evaluated on the Warwick-QU dataset. The final segmentation results have been compared with the performance of top-performing teams of gland challenge (GlaS) MICCI 2015 along with the recent researches. The final predicted segmentation maps have achieved the F1 score of 0.81 for gland detection, object dice score of 0.82 for segmentation, and Hausdorff distance of 84.18 for gland shape similarity which is akin to or higher than the existing models for the malignant subject. The model has done affably well on the overall dataset too.

Background (1) To determine the prevalence of hepatopancreatic injury in coronavirus disease 2019 (COVID-19) patients. (2) To correlate hepatopancreatic injury in COVID-19 with mortality, disease severity, and length of stay in this cohort. Results Forty-five thousand three hundred sixty patients were included in the analysis, 62.82% of which had either hepatic or pancreatic injury. There was a significant upward trend in transaminases, alkaline phosphatase, prothrombin time, bilirubin, lactate dehydrogenase, and lipase and a downward trend in albumin with an increase in disease severity. COVID-19-positive patients with hepato-pancreatic injury have a significantly higher mortality (OR 3.39, 95%CI 3.15–3.65) after controlling for the differences in age, sex, race/ethnicity, liver cirrhosis, and medication exposures. They also have increased disease severity (OR 2.7, 95%CI 2.5–2.9 critical vs mild/moderate; OR 1.4, 95% CI 1.3–1.5 severe vs mild/moderate) and longer hospital length of stay (2 days). Conclusion COVID-19 can cause liver injury. Mortality, disease severity, and hospital length of stay are increased in COVID-19 patients with hepatopancreatic injury. Graphical Abstract

Introduction: Smoking is associated with the occurrence and progression of cardiovascular diseases, inflammatory disorders and malignancies. Objective: To study the platelet indices, neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) in smokers and their correlation with smoking pack-years. Method: A total of 110 smokers and 110 non-smokers were included. The smokers were grouped into three groups: mild (10 pack-years). The platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) were noted. The NLR and PLR were calculated and the statistical analysis was made using the Student’s T-test, Analysis of Variance (ANOVA) and Spearman’s correlation coefficient. Results: The platelet count, PCT and PDW were significantly higher with mean values: 218.56 ± 121.31 vs 203.23 ± 80.35 (p-value = 0.038), 0.27 ± 0.10 vs 0.26 ± 0.10 (p-value = 0.041) and 12.54 ± 1.45 vs 11.99 ± 1.70 (p-value = 0.001) in smokers and non-smokers, respectively. The PLR differed significantly with mean values: 119.40 ± 84.81 in smokers and 181.99 ± 313.09 in non-smokers, with a p-value of 0.045. A significant positive correlation was found between pack-years of smoking and platelet count and PLR with the Pearson correlation coefficient of 0.250 and 0.198 and p-values, 0.008 and 0.037, respectively. The Platelet Count, PCT, MPV and PDW varied significantly between mild, moderate and heavy smoker groups, with p-values of 0.045, 0.010, 0.015 and 0.017, respectively. Conclusion: The platelet indices and inflammatory markers NLR and PLR are derived from routine blood investigations, which are easily available and inexpensive. The monitoring of platelet indices, along with the PLR, can be used as early predictors of morbidity in smokers.

Diverse ethnic genetic populations display variability in the risk regarding anti-seizure medicine (ASM)-induced severe cutaneous adverse reactions (SCARs). However, clinical and epidemiological data on ASM-induced SCARs in Asians is limited.We conducted a retrospective, post-market study until April 30, 2020 using VigiBase® for demographic characteristics, causative ASMs, complications and mortality. The study included adverse events as classified by Standardized Medical Dictionary for Regulatory Activities (MedDRA) queries of SCARs, mainly Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and SJS/TEN overlap reported for ASMs.A total of 694,811 adverse events were reported across the world while using ASMs. Of this, skin and subcutaneous tissue adverse events were 122,885 (17.6%). Among ASM-induced skin and subcutaneous tissue adverse events, SJS, TEN, DRESS and SJS/TEN overlap represented 11,181 (9.1%), 3,645 (3.0%), 5,106 (4.1%) and 6 (0.004%) cases, respectively. Female SJS/TEN/DRESS patients were 54.1%, and 75% of them were adults (18Y). Nearly 64% of the ASM-induced SCARs were serious and culminated in death (3.5%), life-threatening conditions (11.5%), and hospitalization/prolonged hospitalization (43.5%) of patients on ASM therapy. Carbamazepine (31.6%), phenytoin (29.6%), lamotrigine (24.3%), valproic acid (6.4%) and phenobarbital (5.7%) are the most commonly used ASMs linked with SCARs. ASMs associated with significantly higher risk of SCARs in Asians were carbamazepine [n = 3265, ROR 3.55 (95% CI 3.38-3.72, P 0.0001)], lamotrigine [n = 1253, ROR 3.90 (95% CI 3.63-4.18, P 0.0001)], gabapentin [n = 85, ROR 3.58 (95% CI 2.79-4.60, P 0.0001)], pregabalin [n = 68, ROR 3.16 (95% CI 2.40-4.16, P 0.0001)], clonazepam [n = 53, ROR 3.19 (95% CI 2.31-4.41, P 0.0001)], lorazepam [n = 31, ROR 3.07 (95% CI 2.06-4.59, P 0.0001)] and acetazolamide [n = 28, ROR 3.90 (95% CI 2.45-6.21, P 0.0001)].Based on our study, carbamazepine, lamotrigine, gabapentin, pregabalin, clonazepam, lorazepam, and acetazolamide are the most common causative ASMs for SCARs in the Asian population.

The ability for ground vehicles to identify terrain types and characteristics can help provide more accurate localization and information-rich mapping solutions. Previous studies have shown the possibility of classifying terrain types based on proprioceptive sensors that monitor wheel-terrain interactions. However, most methods only work well when very strict motion restrictions are imposed including driving in a straight path with constant speed, making them difficult to be deployed on real-world field robotic missions. To lift this restriction, this letter proposes a fast, compact, and motion-robust, proprioception-based terrain classification method. This method uses common on-board UGV sensors and a 1D Convolutional Neural Network (CNN) model. The accuracy of this model was further improved by fusing it with a vision-based CNN that made classification based on the appearance of terrain. Experimental results indicated the final fusion models were highly robust with strong performance, with over 93% accuracy, under various lighting conditions and motion maneuvers.

Continued rise in incidence and prevalence of diabetes globally warrants an effective strategy for its prevention and control. Prevention of diabetes seems more logical to attempt seeing its health care burden, long dormancy, systemic affliction and poor general awareness. Pre-diabetes is the intermediate state of erratic glucose metabolism without overt features of diabetes. This state seems to be a crossroad having a possibility to either convert into clinical diabetes, remain dormant or return to normal glucose control depending upon the efforts made. Unfortunately, due to the paucity of apparent clinical symptoms, this state embedded with reversal possibility, remains unexplored. Ayurveda account of prameha purvarupa (subclinical features of diabetes) may be proposed as the foundation upon which clinic-based pre-diabetes identification and subsequent prevention may be explored. Knowing the symptoms for their reliable proximity with upcoming diabetes may turn to be sensible sensitizers prompting the people to abort the disease process in an effective and timely manner. Considering diabetes from its purvarupa to complications as disease continuum and exploring the opportunities to intervene in order to prevent, or manage the disease on the basis of shada kriyaa kaala therefore, has a huge translational potential warrants an urgent exploration.

Contains fulltext : 249977.pdf (Publisher’s version ) (Closed access) BACKGROUND: It is important to evaluate whether a new treatment for heart failure with reduced ejection fraction (HFrEF) provides additive benefit to background foundational treatments. As such, we aimed to evaluate the efficacy and safety of empagliflozin in patients with HFrEF in addition to baseline treatment with specific doses and combinations of disease-modifying therapies. METHODS: We performed a post-hoc analysis of the EMPEROR-Reduced randomised, double-blind, parallel-group trial, which took place in 520 centres (hospitals and medical clinics) in 20 countries in Asia, Australia, Europe, North America, and South America. Patients with New York Heart Association (NYHA) classification II-IV with an ejection fraction of 40% or less were randomly assigned (1:1) to receive the addition of either oral empagliflozin 10 mg per day or placebo to background therapy. The primary composite outcome was cardiovascular death and heart failure hospitalisation; the secondary outcome was total heart failure hospital admissions. An extended composite outcome consisted of inpatient and outpatient HFrEF events was also evaluated. Outcomes were analysed according to background use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) or angiotensin receptor neprilysin inhibitors (ARNIs), as well as β blockers and mineralocorticoid receptor antagonists (MRAs) at less than 50% or 50% or more of target doses and in various combinations. This study is registered with ClinicalTrials.gov, NCT03057977. FINDINGS: In this post-hoc analysis of 3730 patients (mean age 66·8 years [SD 11·0], 893 [23·9%] women; 1863 [49·9%] in the empagliflozin group, 1867 [50·1%] in the placebo group) assessed between March 6, 2017, and May 28, 2020, empagliflozin reduced the risk of the primary outcome (361 in 1863 participants in the empagliflozin group and 462 of 1867 in the placebo group; HR 0·75 [95% CI 0·65-0·86]) regardless of background therapy or its target doses for ACE inhibitors or ARBs at doses of less than 50% of the target dose (HR 0·85 [0·69-1·06]) and for doses of 50% or more of the target dose (HR 0·67 [0·52-0·88]; p(interaction)=0·18). A similar result was seen for β blockers at doses of less than 50% of the target dose (HR 0·66 [0·54-0·80]) and for doses of 50% or more of the target dose (HR 0·81 [0·66-1·00]; p(interaction)=0·15). Empagliflozin also reduced the risk of the primary outcome irrespective of background use of triple therapy with an ACE inhibitor, ARB, or ARNI plus β blocker plus MRA (given combination HR 0·73 [0·61-0·88]; not given combination HR 0·76 [0·62-0·94]; p(interaction)=0·77). Similar patterns of benefit were observed for the secondary and extended composite outcomes. Empagliflozin was well tolerated and rates of hypotension, symptomatic hypotension, and hyperkalaemia were similar across all subgroups. INTERPRETATION: Empagliflozin reduced serious heart failure outcomes across doses and combinations of disease-modifying therapies for HFrEF. Clinically, these data suggest that empagliflozin might be considered as a foundational therapy in patients with HFrEF regardless of their existing background therapy. FUNDING: Boehringer Ingelheim and Eli Lilly and Company.

All of us are aware that the modern mechanical and electrical systems in collaboration with AI, CPS, and IoT have affected our lives drastically. At one end, they have provided ease and comfort. On the other end, the electrical and magnetic radiations emitted by them have threatened the mental and physical fitness. Surprisingly, the Asian Agnihotra process effectively reduces the electrical, magnetic radiations emitting from electronic devices. The chapter deals with the computational analysis of electrical, magnetic radiation, and power density measurement of environmental effects and gadgets after the Homa therapy. In the gap of a specific time, readings were recorded, and it was observed that drastic reduction occurred at the place where Yajna was performed. This gap was curtailed gradually as time increased. The phenomenon can undoubtedly be used to address human health threats due to electronic gadgets in the 21st century. Also, it supports the concepts of smart cities where one can quickly identify the numerous effects of the Yajna process.

Medical literature continues to get enriched through various researches and observations related to SARS CoV-2 infection leading to COVID-19. Case reports play crucially to understand a novel clinical condition where much is yet to be known. Current pandemic is unique for the reason that its impacts upon front line health care workers (HCWs) are much higher than general population. In this situation, how an Ayurvedic physician has handled his own case leading to a cure from COVID-19 may furnish important information regarding mitigation and cure from the disease. This is also an unprecedented writing in medical literature as a physician reporting his own case is a rare phenomenon in medical history. This case report puts strongly the prophylactic and disease modifying potential of Ayurvedic interventions in COVID-19.

BACKGROUND Acute kidney injury (AKI) in preterm neonates is associated with poor outcomes that may worsen in the setting of recurrent episodes of AKI. This study defines and studies the incidence, risk factors, and outcomes of recurrent AKI (rAKI). METHODS Retrospective chart review of the neonates born at a gestational age of ≤28 weeks admitted to the neonatal intensive care unit (NICU) between January 2014 and December 2018. We identified AKI based on the serum creatinine (Scr) concentrations using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. rAKI was defined as the occurrence of AKI after Scr from the prior AKI had returned to baseline. RESULTS Forty-nine of the 205 (24%) preterm neonates developed rAKI. An earlier diagnosis (

Background: Scrub typhus (ST) is a rickettsial infection caused by Orientia tsutsugamushi, which presents with flu like symptoms. This disease has been reported from all over India but with slight variations in its pattern. For decreasing the prevalence, preventing new incidences, and predicting the course of the ST, therefore, it is crucial to gain knowledge and perception of local risk components associated with the disease. The present study aimed to investigate the epidemiological distribution and potential risk factors of O. tsutsugamushi Infection in Eastern Uttar Pradesh (EUP), India. Methods: The serums of 211 samples were collected from the suspected cases along with the detailed information about the participants such as age, location, and place recorded in case history form (CRF). IgM estimation was performed using enzyme-linked immunosorbent assay (ELISA) assay. Results: A total of 58 samples (27.4%) out of 211 ones were found to be positive for IgM antibodies against O. tsutsugamushi bacterium. Furthermore, the results were correlated with epidemiological data such as gender, rural or urban background, pets, and occupation. The results showed that 76.7% of the study participants were from rural areas or had bushes around their houses, 88.3% of them had pets/cattle or frequent encounter with rodents at their houses, and 30.3% of them had no toilet facilities at home. Conclusions: It was concluded that the proximity to pets/cattle, having rodents in closer vicinity, residing in places surrounded by vegetation/farm/bushy areas, and following occupations involving field work increased the chances of getting bitten by mites/chiggers. Overall, Orientia tsutsugamushi prevalence increased in EUP, with respect to clinical features, disease presentation, and laboratory diagnosis can help our community to reduce the mortality caused by this infectious disease.

Type 2 diabetes is a chronic metabolic disease characterized by vascular complications, the prevalence of which varies widely. Determine the prevalence of microvascular and macrovascular complications in type-2 diabetes in North India and their correlation with various risk factors. Prospective observational study Tertiary referral centres A total of 6400 patients attending diabetes clinic were screened, out of which 6105 patients were enrolled during April 2018 to February 2021. Data were collected using a standardized electronic case record form. Prevalence estimates of microvascular and macrovascular complications were performed, and multivariate regression was applied for the analysis of correlation with known modifiable and non-modifiable risk factors. ROC analysis was done to find the best cut-offs for predictors of diabetic vascular complications. The mean age of the participants was 58.3 ± 9.1 years (57% males). The mean duration of diabetes was 11.3 ± 7 years and HbA1c was 8.4 ± 4%. Prevalent diabetic neuropathy was observed in 30.1%, nephropathy in 18.8% and retinopathy in 13.7%. Coronary artery disease (CAD) was prevalent in 15.7%, cerebrovascular accident (CVA) in 3.6% and foot complications in 2.9%. In the multivariate regression model, all microvascular complications significantly correlated with the longer duration of diabetes but the same was not observed for macrovascular complications. Obesity [BMI cut-off>26.4 kg/m2 (AUC 0.51, p=0.04) and waist circumference>94 cm (male) and >98 cm (female)] significantly predicted prevalent diabetic neuropathy and nephropathy. A BMI of >25.7 kg/m2 had a sensitivity of 55.2% (AUC 0.57), p

At present, food industries are considering rapid and reliable methods for maintaining quality and safety of foods for complying with the demands of regulatory authorities. Novel sensing methods like nanosensors are being used as effective methods of sensing for various applications in the food industries. Extensive research has been carried out on the gold nanoparticles (AuNP) for nanosensing applications. The use of its unique properties such as aggregation, fluorescence quenching, broad absorption at surface plasmon band, and biocompatibility is finding its place ensuring food safety. They hold the key to replace the existing conventional method used for detection of contaminants, pesticides, heavy metals, adulterants and other contaminants which are major threat to safety of food. This review provides an insight about research on the development of AuNP-based nanosensors and nanobiosensors for various applications in food industry. In addition, regulatory concerns as well as challenges and opportunities related to adoption of nanosensors in the field of food safety have been briefly discussed.

Objective Literature regarding utility of 68 Ga-DOTATATE PET/CT in insulinoma localization across various subgroups [benign/malignant/multiple endocrine neoplasia-1 (MEN-1) syndrome associated] remains scarce. In this study, the performance of 68 Ga-DOTATATE PET/CT was compared with contrast-enhanced computed tomography (CECT) and 68 Ga-NODAGA-Exendin-4 PET/CT (whenever available) in an endogenous hyperinsulinemic hypoglycemia (EHH) cohort. Design Retrospective audit. Patients EHH patients [N = 36, lesions (n) = 49, final diagnosis: benign sporadic insulinoma (BSI) (N = 20), malignant insulinoma (N = 4, n = 14), MEN-1 syndrome associated insulinoma (N = 9, n = 15), Munchausen syndrome (N = 2) and drug-induced hypoglycemia (N = 1)] having both preoperative imaging modalities (CECT and 68 Ga-DOTATATE PET/CT). Measurements Per-lesion sensitivity (Sn) and positive predictive value (PPV) for histopathological diagnosis of insulinoma. Results Sn and PPV of 68 Ga-DOTATATE PET/CT were 67.3% and 89.2%; 55% and 100%; 85.7% and 100%; and 66.7% and 77% for overall EHH, BSI, malignant, and MEN-1 syndrome associated insulinoma cohorts respectively. Despite having comparatively lower sensitivity in BSI cohort, 68 Ga-DOTATATE PET/CT localized a pancreatic tail lesion missed by other modalities. 68 Ga-DOTATATE PET/CT had comparatively higher sensitivity in malignant insulinoma than BSI cohort. 68 Ga-DOTATATE PET/CT also paved the way for successful response to 177 Lu-based peptide receptor radionuclide therapy (PRRT). In MEN-1 cases, lower PPV as compared with BSI was due to uptake in non-insulinoma pancreatic neuroendocrine tumours (Pan-NET). Conclusions 68 Ga-DOTATATE PET/CT has supplemental role in selected cases of BSI with negative and/or discordant results with CECT and 68 Ga-NODAGA-Exendin-4 PET/CT. In malignant insulinoma, 68 Ga-DOTATATE-PET/CT has an additional theranostic potential. Interference due to uptake in non-insulinoma Pan-NET in MEN-1 syndrome may hinder insulinoma localization with 68 Ga-DOTATATE-PET/CT.

Management of cancers of oral cancers has remained a major challenge in India and globally. Radiotherapy and chemotherapy are mostly employed for treatment which inflicts changes in oral mucosa and makes it vulnerable for bacterial colonization and eventual infections. This study aims at evaluating the changes in oropharyngeal flora (bacteria and yeast) in oral cancer patients treated by a combination of chemo-radiotherapy with the control groups comprising of non-cancerous patients living in the same environment. This prospective evaluation included Seventy-seven patients with oral squamous cell carcinomas in the study group. Whereas the control group comprised of twenty-five non-cancerous patients. Saliva samples were collected from patients with oral carcinomas and those of the control group for bacteriological examination, and were transported within 2 hours to the laboratory and immediately inoculated and incubated. The oral microflora samples collected were evaluated for the presence of bacteria in saliva in both study and control group of patients. We evaluated the change in salivary oral flora during chemo-radiotherapy treatment. A statistically significant increase in growth of normal as well as abnormal oral flora was observed post-radiation. Escherichia coli showed a significant decrease in post-RT and also near to significant in control. Various changes in salivary oral flora were observed during the course of chemo-radiotherapy in study and controls groups. This shows that there are some sensitive spots in the oral cavity where the occurrence of oral cancer is more.

Context Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor most commonly occurring in deep intramuscular plane of lower extremities of adolescents and young adults. It is a highly vascular, slow growing tumor with malignant potential having lung as the most common site of metastases at the time of presentation. Aims The aim is to review the imaging findings of ASPS and determine characteristic imaging features of this rare tumor. Materials and Methods Sixteen patients having histopathological diagnosis and preoperative imaging of ASPS attending the dedicated sarcoma clinic at our institute were included in the study. The demographic, clinical, and imaging data were retrieved from the case records and then evaluated for characteristic imaging features which may raise suspicion of ASPS. Results The patients ranged from 3 to 72 years of age and with a slight male preponderance. Of the eight CECTs evaluated, 62.5% tumors showed well-defined lobulated margins, 87.5% cases showed intense enhancement with presence of feeder vessels. On CEMRI of 10 patients, 70% had well circumscribed lobulated margins with intense enhancement and tortuous flow voids in most of them. All cases showed T2 hyperintense signal. Fourteen of 16 (87.5%) patients had metastatic disease with lung as the most common site (92.8%). Conclusion ASPS is a rare soft tissue sarcoma seen in children and young adults. Imaging may mimic a vascular malformation due to the presence of tortuous feeders. Misdiagnosis at an early stage may lead to later metastatic presentation of the disease, thus emphasizing the need to suspect it on imaging.