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The diagnosis of severe COVID-19 lung infection is important because it carries a higher risk for the patient and requires prompt treatment with oxygen therapy and hospitalization while those with less severe lung infection often stay on observation. Also, severe infections are more likely to have long-standing residual changes in their lungs and may need follow-up imaging. We have developed deep learning neural network models for classifying severe vs. non-severe lung infections in COVID-19 patients on chest radiographs (CXR). A deep learning U-Net model was developed to segment the lungs. Inception-v1 and Inception-v4 models were trained for the classification of severe vs. non-severe COVID-19 infection. Four CXR datasets from multi-country and multi-institutional sources were used to develop and evaluate the models. The combined dataset consisted of 5748 cases and 6193 CXR images with physicians’ severity ratings as reference standard. The area under the receiver operating characteristic curve (AUC) was used to evaluate model performance. We studied the reproducibility of classification performance using the different combinations of training and validation data sets. We also evaluated the generalizability of the trained deep learning models using both independent internal and external test sets. The Inception-v1 based models achieved AUC ranging between 0.81 ± 0.02 and 0.84 ± 0.0, while the Inception-v4 models achieved AUC in the range of 0.85 ± 0.06 and 0.89 ± 0.01, on the independent test sets, respectively. These results demonstrate the promise of using deep learning models in differentiating COVID-19 patients with severe from non-severe lung infection on chest radiographs.

Background: To determine the superiority of the combination of endoscopic retrograde cholangiopancreatography (ERCP) and digital single-operator cholangioscopy (DSOC) in the same sitting over the individual modality alone in patients with indeterminate biliary strictures. Materials and Methods: A randomized study enrolled 60 adult patients with biliary strictures who were randomized into two groups: ERCP + DSOC and ERCP/DSOC. Histopathologic or cytologic assessment was performed in terms of benign, indeterminate, or malignant nature of the strictures. Procedural adverse events were documented. Accuracy in terms of sensitivity (Sn), specificity (Sp), and predictive value [positive (PPV) and negative (NPV)] were noted. Results: As per final diagnosis, in ERCP/DSOC group, there were 12 (40%) benign cases and 18 (60%) malignant cases, and in group ERCP + DSOC, there were 8 (26.67%) benign cases and 22 (73.33%) malignant cases. ERCP/DSOC labeled 16 (53.33%) patients as benign, 8 (26.67%) as malignant, and 6 (20%) as indeterminate, while ERCP + DSOC labeled 8 (26.67%) as benign, 17 (56.67%) as malignant, and 5 (16.67%) as indeterminate. The Sn, Sp, PPV, and NPV of ERCP/DSOC were 44.4%, 75%, 100%, and 56.25%, and for ERCP + DSOC was 77.27%, 62.50%, 100%, and 62.5%, respectively (P = 0.033). Side effects were statistically similar in both the groups (P > 0.05). Conclusion: To conclude, the combination of ERCP with DSOC is safe and effective with higher diagnostic sensitivity (77.27%) in comparison to standard ERCP or DSOC alone (44.4%) for the diagnosis of biliary strictures.

The diagnosis of severe COVID-19 lung infection is important because it carries a higher risk for the patient and requires prompt treatment with oxygen therapy and hospitalization while those with less severe lung infection often stay on observation. Also, severe infections are more likely to have long-standing residual changes in their lungs and may need follow-up imaging. We have developed deep learning neural network models for classifying severe vs. non-severe lung infections in COVID-19 patients on chest radiographs (CXR). A deep learning U-Net model was developed to segment the lungs. Inception-v1 and Inception-v4 models were trained for the classification of severe vs. non-severe COVID-19 infection. Four CXR datasets from multi-country and multi-institutional sources were used to develop and evaluate the models. The combined dataset consisted of 5748 cases and 6193 CXR images with physicians' severity ratings as reference standard. The area under the receiver operating characteristic curve (AUC) was used to evaluate model performance. We studied the reproducibility of classification performance using the different combinations of training and validation data sets. We also evaluated the generalizability of the trained deep learning models using both independent internal and external test sets. The Inception-v1 based models achieved AUC ranging between 0.81 ± 0.02 and 0.84 ± 0.0, while the Inception-v4 models achieved AUC in the range of 0.85 ± 0.06 and 0.89 ± 0.01, on the independent test sets, respectively. These results demonstrate the promise of using deep learning models in differentiating COVID-19 patients with severe from non-severe lung infection on chest radiographs. [ABSTRACT FROM AUTHOR]

Background: As per national policy, all diagnosed tuberculosis patients in India are to be tested using Xpert® MTB/RIF assay at the district level to diagnose rifampicin resistance. Regardless of the result, samples are transported to the reference laboratories for further testing: first-line Line Probe Assay (FL-LPA) for rifampicin-sensitive samples and second-line LPA(SL-LPA) for rifampicin-resistant samples. Based on the results, samples undergo culture and phenotypic drug susceptibility testing. We assessed among patients diagnosed with tuberculosis at 13 selected Xpert laboratories of Karnataka state, India, i) the proportion whose samples reached the reference laboratories and among them, proportion who completed the diagnostic algorithm ii) factors associated with non-reaching and non-completion and iii) the delays involved. Methods: This was a cohort study involving review of programme records. For each TB patient diagnosed between 1st July and 31st August 2018 at the Xpert laboratory, we tracked the laboratory register at the linked reference laboratory until 30th September (censor date) using Nikshay ID (a unique patient identifier), phone number, name, age and sex. Results: Of 1660 TB patients, 1208(73%) samples reached the reference laboratories and among those reached, 1124(93%) completed the algorithm. Of 1590 rifampicin-sensitive samples, 1170(74%) reached and 1104(94%) completed the algorithm. Of 64 rifampicin-resistant samples, only 35(55%) reached and 17(49%) completed the algorithm. Samples from rifampicin-resistant TB, extra-pulmonary TB and two districts were less likely to reach the reference laboratory. Non-completion was more likely among rifampicin-resistant TB and sputum-negative samples. The median time for conducting and reporting results of Xpert® MTB/RIF was one day, of FL-LPA 5 days and of SL-LPA16 days. Conclusion: These findings are encouraging given the complexity of the algorithm. High non-reaching and non-completion rates in rifampicin-resistant patients is a major concern. Future research should focus on understanding the reasons for the gaps identified using qualitative research methods. [ABSTRACT FROM AUTHOR]

Computer‐aided diagnosis (CAD) has been a major field of research for the past few decades. CAD uses machine learning methods to analyze imaging and/or nonimaging patient data and makes assessment of the patient's condition, which can then be used to assist clinicians in their decision‐making process. The recent success of the deep learning technology in machine learning spurs new research and development efforts to improve CAD performance and to develop CAD for many other complex clinical tasks. In this paper, we discuss the potential and challenges in developing CAD tools using deep learning technology or artificial intelligence (AI) in general, the pitfalls and lessons learned from CAD in screening mammography and considerations needed for future implementation of CAD or AI in clinical use. It is hoped that the past experiences and the deep learning technology will lead to successful advancement and lasting growth in this new era of CAD, thereby enabling CAD to deliver intelligent aids to improve health care. [ABSTRACT FROM AUTHOR]

Aims We used contrast-enhanced cardiac magnetic resonance (CMR) to evaluate differences in myocardial fibrosis measured at the year-10 examination between participants with and without cardiovascular (CV) events accrued in a large population based study over the preceding 10-year follow-up period in this retrospective study. Methods and results The MESA study enrolled 6814 participants free of CV disease at baseline (2000–2002). We included MESA participants who underwent contrast-enhanced CMR at the MESA year-10 exam (N  = 1840). We defined a composite CV endpoint of coronary heart disease, heart failure, atrial fibrillation, stroke, and peripheral artery disease. Using CMR, we characterized myocardial fibrosis with late-gadolinium enhancement for scar and T1 mapping indices of diffuse fibrosis. Demographic and CV-risk adjusted logistic (presence of scar) and linear regression (pre-contrast T1, T1 at 12 and 25 min post-contrast, and extracellular volume fraction or ECV) models were used to assess the relationship between fibrosis and events. The mean values of T1 indices were—pre-contrast T1: 977 ± 45 ms; T1 at 12': 456 ± 40 ms; T1 at 25': 519 ± 41 ms; ECV: 27.1 ± 3.2%. One-hundred and forty-six (7.9%) participants had myocardial scar. The presence of scar was strongly associated with prior CV events (adjusted coeff: 1.36, P  < 0.001). Lower post-contrast T1 times and higher ECV, indicative of greater diffuse fibrosis were strongly associated with CV events (T1 at 12': coeff = −10.0 ms, P  = 0.004; T1 at 25': coeff =−9.2 ms, P  = 0.008; ECV: coeff = 1.31%, P  < 0.001). Conclusion Individuals who suffered prior CV events have greater likelihood of diffuse myocardial fibrosis when compared with event-free individuals living in the same community. [ABSTRACT FROM AUTHOR]

Aims To compare the diagnostic performance of a reduced-order computed tomography-derived fractional flow reserve (CT-FFR) technique derived from luminal deformation and static CT stress myocardial perfusion (CTP). Methods and results Forty-six patients (84 vessels) with suspected coronary artery disease from a single institution planned for elective coronary angiography prospectively underwent research indicated invasive fractional flow reserve (FFR) and 320-detector CT coronary angiography (CTA) and static CTP. Analyses were performed in separate blinded core laboratories for CT-FFR and CTP. CT-FFR was derived using a reduced-order model with dedicated software on a standard desktop computer. CTP was assessed visually and quantitatively by transmural perfusion ratio (TPR). Invasive FFR was significant in 33% (28/84) of vessels. Overall per-vessel sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy for CT-FFR were 81%, 84%, 71%, 90%, and 83%, respectively, those of visual CTP were 54%, 92%, 79%, 77%, and 78%, respectively, and TPR were 64%, 48%, 42%, 70%, and 54%, respectively. Per-vessel receiver operator curve analysis demonstrated a significantly larger area under the curve (AUC) for CT-FFR (0.89) with that for visual CTP (0.72; P  = 0.016), TPR (0.55; P  < 0.0001), and CTA (0.76; P  = 0.04). The addition of CT-FFR to CTA provided superior improvement in performance (AUC 0.93; P  < 0.0001) compared with CTA alone, a combination of CTA with visual CTP (AUC 0.82; P  = 0.007) and CTA with TPR (AUC 0.78; P  = 0.0006). Conclusion Based on this selected cohort of patients, a reduced-order CT-FFR technique is superior to visual and quantitatively assessed static CTP in detecting haemodynamically significant coronary stenosis as assessed by invasive FFR. [ABSTRACT FROM AUTHOR]

Hypervascular pancreatic lesions/masses can arise due to a variety of causes, both benign and malignant, leading to a wide differential diagnosis. Accurate differentiation of these lesions into appropriate diagnoses can be challenging; however, this is important for directing clinical management. This manuscript provides a multimodality imaging review of hypervascular pancreatic lesion, with emphasis on an imaging-based algorithmic approach for differentiation of these lesions, which may serve as a decision support tool when encountering these uncommon lesions. Additionally, we stratify these lesions into three categories based on malignant potential, to help guide clinical management. [ABSTRACT FROM AUTHOR]

Current projections are that by 2050 the numbers of people aged 65 and older with Alzheimer’s disease (AD) in the US may increase threefold while dementia is projected to double every 20 years reaching ~115 million by 2050. AD is clinically characterized by progressive dementia and neuropathologically by neuronal and synapse loss, accumulation of amyloid plaques, and neurofibrillary tangles (NFTs) in specific brain regions. The preclinical or presymptomatic stage of AD-related brain changes may begin over 20 years before symptoms occur, making development of noninvasive biomarkers essential. Distinct from neuroimaging and cerebrospinal fluid biomarkers, plasma or serum biomarkers can be analyzed to assess (i) the presence/absence of AD, (ii) the risk of developing AD, (iii) the progression of AD, or (iv) AD response to treatment. No unifying theory fully explains the neurodegenerative brain lesions but neuroinflammation (a lethal stressor for healthy neurons) is universally present. Current consensus is that the earlier the diagnosis, the better the chance to develop treatments that influence disease progression. In this article we provide a detailed review and analysis of the role of the blood-brain barrier (BBB) and damage-associated molecular patterns (DAMPs) as well as coagulation molecules in the onset and progression of these neurodegenerative disorders. [ABSTRACT FROM AUTHOR]

Secondary achalasia may result from diseases that either infiltrate or compress the lower esophageal sphincter to create an increased high-pressure zone and subsequent esophageal body changes. With bariatric surgery, a potential high-pressure zone is created by a sleeve, band, or bypass just distal to the esophagus. We report four patients who years after a bariatric procedure developed dysphagia followed by esophageal body radiographic and/or manometric features of achalasia. In addition, each of these patients responded symptomatically to endoscopic or surgical therapy either which lowered this high-pressure zone. Furthermore, review of prior cases in the literature suggests this has occurred before. Physicians should be aware of this association but further study is needed on its true prevalence. [ABSTRACT FROM AUTHOR]

High-resolution manometry identifies three subtypes of achalasia. However, type 3 differs from classic achalasia. Although opiates affect esophageal motility, opiate use and achalasia have not been studied. Patients with a new diagnosis of achalasia at Mayo Clinic Rochester between June 1, 2012 and January 3, 2014 were identified. Clinical records were reviewed to assess symptoms, opiate use, and therapy. Fifty-six patients with achalasia were identified, 14 (25%) were on opiates. Opiate prescription was unrelated to achalasia in all cases, with chronic back and joint pain constituting the majority. Of patients on opiates, five (36%) had type 3 achalasia compared with four (10%) not on opiates ( P = 0.02). No patients on opiates had type 1 achalasia. Clinical presentation did not differ with opiates, although those on opiates were more likely to report chest pain (39 vs. 14%, P = 0.05) and less likely to have esophageal dilation (62 vs. 82%, P = 0.13), none with greater than 5-cm diameter. Contractile vigor was greater with opiate use, with distal contractile integral of 7149 versus 2615.5 mm Hg/cm/second ( P = 0.08). Treatment response was inferior on opiates, with persistent symptoms in 22% compared with 3% without opiates ( P = 0.06). Opiate use is common in type 3 achalasia, with the majority of patients on opiates. No patients on opiates were diagnosed with type 1 achalasia. Manometric findings of type 3 achalasia mimic those induced by opiates, suggesting a physiologic mechanism for opiate induced type 3 achalasia. Treatment outcome is inferior with opiates, with opiate cessation perhaps preferable. Further studies assessing opiate use and achalasia are needed. [ABSTRACT FROM AUTHOR]

Barium esophagrams are a frequently performed test, and radiological observations about potential abnormal esophageal motility, such as tertiary contractions, are commonly reported. We sought to assess the correlation between tertiary waves, and in particular isolated tertiary waves, on esophagrams and findings on non-synchronous high-resolution esophageal manometry. We retrospectively reviewed reports of esophagrams performed at a tertiary referral center and identified patients in whom tertiary waves were observed and a high-resolution esophageal manometry had been performed. We defined two groups; group 1 was defined as patients with isolated tertiary waves, whereas group 2 had tertiary waves and evidence of achalasia or an obstructing structural abnormality on the esophagram. We collected data on demographics, dysphagia score, associated findings on esophagram, and need for intervention. We reviewed the reports of 2100 esophagrams of which tertiary waves were noted as an isolated abnormality in 92, and in association with achalasia or a structural obstruction in 61. High-resolution manometry was performed in 17 patients in group 1, and five had evidence of a significant esophageal motility disorder and 4 required any intervention. Twenty-one patients in group 2 underwent manometry, and 18 had a significant esophageal motility disorder. An isolated finding of tertiary waves on an esophagram is rarely associated with a significant esophageal motility disorder that requires intervention. All patients with isolated tertiary waves who required intervention had a dysphagia to liquids. Tertiary contractions, in the absence of dysphagia to liquids, indicate no significant esophageal motility disorder. [ABSTRACT FROM AUTHOR]

The article focuses on the increased incidence of coccidioidomycosis in Missouri from 2004-2013. Topics discussed include the causes of the increase in the number of coccidioidomycosis incidence, the potential acquisition of the disease, the analysis of the coccidioidomycosis case in the state, and the disease's serology using diagnostic tests.

Achalasia is an important but relatively uncommon disorder. While highly effective therapeutic options exist, esophageal cancer remains a long-term potential complication. The risk of esophageal cancer in achalasia remains unclear, with current guidelines recommending against routine endoscopic screening. However, given limited data and conflicting opinion, it is unknown whether consensus regarding screening practices in achalasia among experts exists. A 10-question survey to assess screening practices in achalasia was created and distributed to 28 experts in the area of achalasia. Experts were identified based on publications and meeting presentations in the field. Survey responses were received from 17 of 28 (61%) experts. Wide geographic distribution was seen among respondents, with eight (47%) from Europe or Australia, seven (41%) from the United States, and two (12%) from Asia. Screening for esophageal cancer was inconsistent, with nine (53%) experts endorsing the practice and eight (47%) not. Screening practices did not differ among geographic regions. No consensus regarding the risk for esophageal cancer in achalasia was seen, with three experts reporting no increased risk compared with the general population, eight experts a lifetime risk of 0.1-0.5%, three experts a 0.5-1% risk, two experts a 1-2% risk, and one expert a 3-5% risk. However, these differences in perception of risk did not influence screening practices. Upper endoscopy was utilized among all experts who endorsed screening. However, practices still varied with screening commencing at or within 1 year of diagnosis in two practices compared with 5 and 10 years in three respective practices each. Surveillance intervals also varied, performed every 2 years in four practices, every 3 years in four practices, and every 5 years in one practice. Practice variation in the management of achalasia itself was also seen, with initial treatment with Heller myotomy endorsed by eight experts, pneumatic dilation by five experts, and two each endorsing peroral endoscopic myotomy or no specific preference. In addition, while 82% (14/17) of experts endorsed long-term follow up of patients, no consensus regarding long-term follow up existed, with annual follow up in eight practices, every 3-6 months in three practices, and every 2 years in three practices. Large practice variation in the long-term management of achalasia exists among experts in the field. Only a slight majority of experts endorse screening for esophageal cancer in achalasia, and no consensus exists regarding how surveillance should be structured even among this group. Interestingly, the lack of consensus on cancer screening parallels a lack of agreement on initial treatment of achalasia. These findings suggest a need for greater homogeneity in the management of longstanding achalasia and cancer screening. Further, this study highlights the need for more data on this topic to foster greater agreement. [ABSTRACT FROM AUTHOR]

Background: Hepatic encephalopathy (HE), which may be categorized as minimal or overt, is a serious and progressive neuropsychiatric condition that oc-curs in patients with liver disease or portosystemic shunting. Overt HE (OHE) presents as a wide spec-trum of clinical signs and symptoms, ranging in severity from mild confusion to life-threatening coma. Minimal HE (MHE) is a more subtle form of the condition; it is characterized by deficits in cognitive function in patients with a normal clinical examination. Objective: The purpose was to review the effect of MHE on patients and caregivers, as well as its currently available diagnostic and treatment options. Methods: A MEDLINE search of published diag-nostic assessments, clinical trials, and guidelines from 1985 to 2012 were reviewed and analyzed to assess the potential effect of MHE in the clinical practice setting. Results: Accumulating evidence suggests that MHE has a substantial negative effect on patient quality of life, particularly in activities that require attention, motor skills, and visuospatial ability. Because MHE lacks obvious clinical signs, specialized testing is required for diagnosis, although there is no consensus on the most appropriate assessment tools or treatment algorithms. Compounds derived from bacterial activ-ities in the gut can cause neurochemical changes in the brain. These gut-derived toxins (eg, ammonia, benzodiazepine-like substances) are implicated in the pathophysiology of OHE. In patients with liver dis-ease or portosystemic shunting, these toxins are inefficiently detoxified, accumulate in the blood, cross the blood-brain barrier, and result in abnormalities such as altered neurotransmission, astrocyte swelling, and impaired energy metabolism. Therefore, treat-ments have focused on toxin removal and the manage-ment of gut flora levels. Several studies have indicated that probiotics, nonabsorbable disaccharides, and nonsystemic antibiotics can all be effective in improv-ing the symptoms of MHE. Furthermore, prophylaxis for MHE in patients with cirrhosis could serve to improve patient quality of life while preventing its transition to OHE. Conclusions: Although MHE detection and treat-ment is not currently the standard of care, several therapies have been reported to improve cognitive function and quality of life. Interest is increasing in the proactive diagnosis and management of MHE in the clinical practice setting. However, research is required to determine the conditions under which the putative benefits of prophylactic MHE therapy outweigh the costs. [ABSTRACT FROM AUTHOR]

Purpose: The purpose was to determine if birth weight (BW) alone can be the sole criterion for screening infants at risk for retinopathy of prematurity (ROP). Materials and Methods: In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Guidelines (1997). Variables examined included gestational age (GA), birth weight (BW), and a composite variable BWGA Index [(grams × weeks)/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW ⩾1250 g, and Group 2, BW >1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic (ROC) curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Results: Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve (AUC) of 0.797 (standard error [SE] = 0.0329, P < 0.0001); for GA, AUC was 0.801 (SE = 0.0340, P < 0.0001) and for the BWGA Index, the AUC was 0.808 (SE = 0.0324, P < 0.0001). Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Conclusion: Data from our neonatal intensive care unit suggest that birth weight = 1250 g alone is an adequate parameter to identify premature infants at risk for ROP. [ABSTRACT FROM AUTHOR]

Mesenteric ischemia is a complex and devastating disease which still remains a diagnostic challenge to the clinicians due to non-specific clinical and laboratory findings. Several imaging features have been described with multidetector computed tomography which allows the diagnosis of mesenteric ischemia with high sensitivity and specificity. However, there are imaging features which overlap with other pathologies including benign inflammation and infection. Knowledge of imaging findings in mesenteric ischemia and its potential mimics is important in early and definitive diagnosis. [ABSTRACT FROM AUTHOR]

Aortopulmonary (AP) window is an extremely rare congenital anomaly involving a communication between the ascending aorta and pulmonary artery. Two-dimensional transthoracic echocardiography is traditionally used in the diagnosis but has limitations. We report the usefulness of three-dimensional transthoracic echocardiography in the assessment of AP window in two newborns studied by us. [ABSTRACT FROM AUTHOR]

Objective Iliopsoas abscess (IPA) is a rare condition with a reported worldwide incidence of 12 new cases per year with primary abscesses now predominating. The presentation is often vague and the diagnosis not considered. Method The medical records of 15 consecutive patients presenting to our hospital in a 3-year period with IPA were reviewed. Demographic data, presenting features, predisposing factors and the investigations performed were recorded. Abscesses were classified as primary or secondary and the treatment provided and eventual outcomes were analysed. Results Fifteen patients (eight males) were included. Nine patients were pyrexial on admission, 14 were anaemic and all had raised inflammatory markers. Only five patients presented with the classical triad of pain, fever and limp. The median time to diagnosis was 3 days with a median hospital stay of 27 days (range 7–243 days). Fourteen patients were diagnosed by computed tomographic scan. Three patients were treated with antibiotics alone whilst 11 received percutaneous drainage (PCD) as well. Of these, five had recurrence following initial drainage, needing further PCD procedures but none needed open drainage. Only one patient underwent open drainage initially. The mortality rate was 20%. Conclusion The incidence of IPA is probably under-reported. The vague presentation leads to delays in diagnosis and increases morbidity and a high index of suspicion is the key to early diagnosis. Percutaneous drainage with antibiotics is the first line of treatment although recurrence rate is high. Open drainage allows simultaneous treatment of underlying pathology in secondary abscesses. [ABSTRACT FROM AUTHOR]

Abstract: As part of a program to design rational, mechanism-based inhibitors of guanase, we report here the synthesis and biochemical screening of two analogues of azepinomycin (1 and 2), a naturally occurring inhibitor of guanase, known to mimic the transition-state of the enzyme-catalyzed reaction. Our biochemical results show that compounds 1 and 2 are competitive inhibitors with K i of 2.01±0.16×10−5 and 5.36±0.14×10−5 M, respectively. [Copyright &y& Elsevier]

Despite numerous attempts at devising algorithms for diagnosing broad complex tachycardia (BCT) on the basis of the electrocardiogram (ECG), misdiagnosis is still common. The reason for this may lie with difficulty in implementing existent algorithms in practice, due to imperfect ascertainment of ECG features within them. An attempt was made to approach the problem afresh with the Bayesian inference by the construction of a diagnostic algorithm centered around the likelihood ratio (LR). Previously studied EGG features most effective in discriminating ventricular tachycardia (VT) from supraventricular tachycardia with aberrant conduction (SVTAC), according to their LR values, were selected for inclusion into a Bayesian diagnostic algorithm. A test set of 244 BCT ECGs was assembled and shown to three independent observers who were blinded to the diagnoses made at electrophysiological study. Their diagnostic accuracy by the Bayesian algorithm was compared against that by clinical judgement with the diagnoses from EPS as the criteria! standard. Clinical judgement correctly diagnosed 35% of SVTAC, 85% of VT, and 47% of fascicular tachycardia. In comparison, by the Bayesian algorithm devised, 52% of SVTAC, 95% of VT, and 97% of fascicular tachycardia were correctly diagnosed. The Bayesian algorithm devised has proved to be superior to the clinical judgement of the observers who participated in this study, and theoretically will obviate the problem of imperfect ascertainment of ECC features. Hence, it holds the promise for being an effective tool for routine use in clinical practice. [ABSTRACT FROM AUTHOR]

Aim: To ascertain a definitive treatment modality for a frequently recurring condition, pseudocyst of pinna in the form of deroofing and compression. Materials and Methods: Thirty patients were diagnosed with pseudocyst of pinna from July 2011 to March 201. All 30 patients underwent surgical deroofing of the pseudocyst along with compression by buttoning. The patients were followed up for a period of six months. Results: No recurrence was seen in 29 patients in the follow up period of six months (96.7%). One patient had recurrence 15 d following the procedure. The recurrence in the case could be attributed to the usage of improper buttons for compression. Conclusion: Despite numerous treatment options for pseudocyst of pinna, there remains high recurrence rate in patients. Additionally, some treatments carry the risk of cartilage damage or visible distortion of the auricle. Surgical deroofing followed by compression using buttons can be considered as first line treatment of this entity as it is associated with very less rate of recurrence and gives a cosmetically acceptable result. [ABSTRACT FROM AUTHOR]

Background: Optic nerve head drusen (ONHD) are white calcareous deposits, seen either superficially on the optic nerve head or buried within it. Diagnosis of ONHD is made by one or more ways: clinical exam, autofluorescence, ultrasound of the optic nerve, CT scan and/or visual field examination. The present study describes features of ONHD based on another diagnostic modality, the spectral-domain OCT (Spectralis). Methods: This is a retrospective case series of 5 patients with bilateral ONHD with a best-corrected visual acuity of 20/ 20 and no other posterior segment pathology. All the patients underwent fundus photography, fundus autofluorescence, B-scan ultrasonography, Spectralis OCT and Humphrey 30-2 threshold visual fields. Results: All 5 patients had surface ONHD which were autofluorescent and echodense on B-scan ultrasonography. Spectralis OCT findings in the corresponding areas include 'scattered spots with high reflectivity' casting a shadow underneath. The reflectivity can be distinctly differentiated from the blood vessels on the optic nerve. Two patients had an arcuate scotoma on the Humphrey visual fields. No correlation was found between the changes on Spectralis OCT with that of visual field. Conclusions: Spectralis OCT is another useful ancillary investigation in the diagnosis of ONHD and we describe the features in the present study. [ABSTRACT FROM AUTHOR]

This article illustrates and discusses the applications and value of magnetic resonance imaging (MRI) in the evaluation of sinonasal disease. There are several clinical scenarios where MRI can add value over conventional computed tomography (CT) evaluation of the sinonasal spaces. Specifically, MRI can provide insight through better depiction of the anatomy of certain sinonasal sub-sites including the olfactory structures. It can aid in evaluating anosmia, sinusitis (fungal sinusitis and complications), benign and malignant lesions, CSF leaks and pathology extending into sinonasal spaces. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective review.Objective: To evaluate key risk factors for the development of C5 palsy after cervical corpectomy, including resection of the posterior longitudinal ligament (PLL).Summary Of Background Data: Postoperative C5 palsy is a well-known complication after cervical spine surgery. It is unknown whether resection of the PLL affects the incidence of C5 palsy.Methods: We performed a retrospective review of 459 consecutive patients undergoing anterior cervical corpectomies over a 15-year period. Medical records were reviewed to gather demographic data, operative details, and the incidence of C5 palsy. We performed regression analyses to identify variables that predicted the development of C5 palsy.Results: Our final analysis included 397 patients (females 51.4%, mean age 55.6 ± 11.6 yrs). Anterior corpectomy alone was performed in 255 (64.2%) patients, and combined anterior and posterior fusion was performed in 142 (35.8%) patients. Twenty-four patients (6.0%) developed C5 nerve palsy. Univariable regression demonstrated age greater than 65 (odds ratio, OR 2.7, 95% confidence interval, CI 1.2 to 6.3), corpectomy of three or more levels (OR 6.3, 95% CI 2.1 to 18.9), presence of ossification of the PLL (OR 4.3, 95% CI 1.6 to 11.7), and complete or partial resection of the PLL (OR 2.6, 95% CI 1.0 to 6.7) predicted development of C5 palsy. Multivariable regression demonstrated that the odds of getting C5 palsy with complete or partial resection of the PLL is 4.0 times (95% CI 1.5 to 10.5) higher compared with patients with an intact PLL. There were no significant differences in C5 palsy rates based on surgical approach (anterior vs. anterior plus posterior), sex, smoking status, or diabetes.Conclusion: Age greater than 65 years, corpectomy of three or more levels, presence of ossification of the PLL, and complete or partial resection of the PLL significantly predicted the development of C5 palsy.Level Of Evidence: 4. [ABSTRACT FROM AUTHOR]

BACKGROUND: Effective therapeutic agents for the prevention and treatment of acute kidney injury (AKI) after cardiac surgery remain elusive despite the tremendous advances in surgical techniques, technology, and understanding of disease processes. Recent developments and their effect on the incidence of AKI after cardiac surgery are discussed. DATA SOURCES: Published clinical trials in PubMed, strength of evidence assessed by the guidelines of the American Family Physicians CONCLUSIONS: The definition of AKI has changed, and the focus of interventions has shifted from treatment to prevention to recovery from AKI. Antioxidants and biological agents have been added to classic armaments of hydration and diuretics in addition to tighter metabolic control to prevent AKI. Although the treatment options remain unsatisfactory, a lot of progress nevertheless continues to be made in the prevention and treatment of AKI. [ABSTRACT FROM AUTHOR]