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Introduction: Anterior orthopaedic approaches, much like the Modified Stoppa approach, target fractures of the anterior column of the pelvis and acetabulum. The approach is described as a minimally invasive technique that may lead to iatrogenic haemorrhage and fatality in patients. Such mortality is due to the inadvertent severing of the corona mortis vessels, a clinical term referring to the anastomosis between the obturator vessels and the external iliac vessels typically via an accessory obturator vessel that courses over the pelvic brim. Knowledge regarding the prevalence and clinical significance of the corona mortis, especially within the South African population is lacking, and therefore further investigation of this anomaly is necessary. Materials and methods: This study investigated the incidence and variations of the corona mortis vessels in a South African sample using 63 adult cadavers obtained from the Department of Anatomy, University of Pretoria. After careful dissection of the blood supply to the pelvis, the prevalence of corona mortis was investigated. Variations regarding the composition of the corona mortis and the incidence of aberrant obturator vessels were documented. Results: The incidence of corona mortis was observed in 67.5% of the study sample, with 91.6% being venous and 8.4% being arterial in composition. An incidence of 26.0% of aberrant obturator arteries and 8.1% of aberrant obturator veins were observed originating or draining directly into the external iliac system, respectively. A single rare instance of corona mortis was observed and involved an anastomosis with the superior vesical vein rather than the typical obturator vein. While variations amongst anomalous accessory vessels were observed which resulted in as many as 3 aberrant vessels coursing over the pelvic brim. No significant difference was concluded for the incidence of corona mortis between the left and right sides or between males and females. Conclusion: Mapping out the parameters of the corona mortis and examining the variation linked with the anomaly will aid orthopaedic surgeons in implementing anterior approaches with reduced vascular damage and iatrogenic deficit. Further understanding of its incidence in the South African population will in turn assist in interpreting its clinical significance.

Road traffic injuries and crashes are one of the major public concerns contributing to mortality and morbidity figures across the globe. Researchers estimated that around 90% of all causative factors for crashes are attributed to road users of which drivers are the principal controlling elements. Therefore, understanding complex human driver behavior and their possible violations or errors are necessary to control and prevent accident occurrence to a considerable extent. Studies on driver behavior of commercial vehicles such as trucks are scattered widely and scarcely explored hindering the possibility of road safety outcomes. This underscores the need to excavate and synthesize the past studies for an effective understanding of human factors causing truck crashes. In this paper, an attempt has been made to systematically review the pieces of literature and to identify the causative factors affecting truck driver behavior. The trend of studies shows a promising framework for improving truck driver safety on taking care of human factors influencing crashes. Most kinds of literature have cited unsafe driving behaviors as a predominant source of truck crashes. The outcomes of this research can be utilized by transportation firms and stakeholders for identifying the possible lags to develop pragmatic and possible effective preventive measures featuring truck driver safety.

Person-fit analyses are commonly used to detect aberrant responding in self-report data. Nonparametric person fit statistics do not require fitting a parametric test theory model and have performed well compared to other person-fit statistics. However, detection of aberrant responding has primarily focused on dominance response data, thus the effectiveness of person-fit statistics in detecting different aberrant behaviors in ideal point data is unclear. This study compares the performance of nonparametric person-fit statistics in unfolding and dominance model contexts. Results for dominance data indicate that increases in detection rates depend, among other factors, on type of aberrant responding and person-fit statistic used. The detection of aberrant responses in ideal point data was ineffective using four nonparametric person-fit statistics, with slightly higher type I error and power less than 0.25. Additional research is needed to identify or develop nonparametric or parametric person-fit statistics effective for aberrant behavior exhibited in ideal point data. [ABSTRACT FROM AUTHOR]

Road traffic injuries and crashes are one of the major public concerns contributing to mortality and morbidity figures across the globe. Researchers estimated that around 90% of all causative factors for crashes are attributed to road users of which drivers are the principal controlling elements. Therefore, understanding complex human driver behavior and their possible violations or errors are necessary to control and prevent accident occurrence to a considerable extent. Studies on driver behavior of commercial vehicles such as trucks are scattered widely and scarcely explored hindering the possibility of road safety outcomes. This underscores the need to excavate and synthesize the past studies for an effective understanding of human factors causing truck crashes. In this paper, an attempt has been made to systematically review the pieces of literature and to identify the causative factors affecting truck driver behavior. The trend of studies shows a promising framework for improving truck driver safety on taking care of human factors influencing crashes. Most kinds of literature have cited unsafe driving behaviors as a predominant source of truck crashes. The outcomes of this research can be utilized by transportation firms and stakeholders for identifying the possible lags to develop pragmatic and possible effective preventive measures featuring truck driver safety. [ABSTRACT FROM AUTHOR]

Aberrant T-cell phenotype or aberrant B-cell phenotype in B-cell non-Hodgkin's lymphoma or T-cell non-Hodgkin's lymphoma, respectively, are uncommon phenomenon and a diagnostic challenge. Multiple T-cell antigen, including CD3 expression in large B-cell lymphomas, which is considered a specific marker for T cells, is extremely rare and have scattered instances in the literature; however, none of those showed myc and bcl2 rearrangement. This is a case of stage IV NHL, previously diagnosed as T-cell NHL, which on detailed immunohistochemical and molecular diagnostic workup, later was confirmed as "Double hit" B-cell lymphoma with aberrant T-cell phenotype. With the 1st ever-reported case, we wish to bring into the notice of such aberrancy so as to not misdiagnose or wrongly classify high-grade lymphomas. [ABSTRACT FROM AUTHOR]

Introduction: Aberrant DNA methylation is one of the important molecular markers in acute lymphoblastic leukemia (ALL). Objectives: To determine Aberrant DNA methylation profiles of the CDKN2A and CDKN2B genes in ALL samples from T1DM cases. Results: Aberrant hypermethylation of CDKN2B gene and cytogenetic abnormalities were analyzed in >60% of subjected cases. Total cholesterol, triglycerides and low-density lipoprotein cholesterol were not significantly varied between experimental and control (p >0.05). Expression analysis of human peripheral blood mononuclear cells revealed decreased mRNA levels of CDKN2B. The decreased level of p21 and CDK4 expression in the T1DM cases than control. The number of monocytes, lymphocytes and neutrophils significantly varied in T1DM samples and control (p

Background: Arch of aorta is the continuation of ascending aorta and lies in the superior mediastinum. Normally three main branches arise from the aortic arch in humans- Brachiocephalic trunk (BCT), left Common Carotid artery (LCCA), and left Subclavian artery (LSCA). Brachiocephalic trunk is the first and largest branch of arch of Aorta (AoA). At the level of the upper edge of the right Sternoclavicular joint, it divides into right subclavian and right common Carotid artery. Significant variations are seen in branching pattern of arch of aorta which have been reported by different researchers from time to time. Aims: Anatomical knowledge of the arch of aorta and its branching pattern is important for surgeons and interventional radiologists and cardiologists as the variations in this region are not rare. The present study was aimed at to determine the variations of branching pattern of arch of aorta in humans by cadaveric dissection. Settings and Design: observational study. Materials and methods: The study was carried in 50 formalin fixed cadavers used for dissection training of medical students, at department of Anatomy, Government medical College Srinagar. Dissection was done following the guidelines of Cunningham's Manual of Practical Anatomy. The observations were recorded in the department for future references. All the data was retrieved and analysed. Data was also collected from pictures available in the department. Statistical analysis used: MS excel. Results: In this study, normal branching pattern of AoA was found to be present in 47(94%) cadavers. 3 (6%) showed variation in branching pattern of AoA. Out of these 3 cadavers, 2 (4%) had vertebral artery arising directly from AoA (Type C). One cadaver showed three branches (2%), BCT, LCCA and LSCA, but origin of BCT lied to the left of mid-vertebral line. Conclusions: The percentage of anomalous branching pattern of AoA was 6%, lower when compared with the previous studies. The most common variation found was four branch pattern of AoA. Left vertebral artery originated directly from AoA between LSA and LCCA. The most interesting finding was the occurrence of three branch pattern an aberrant pattern of BCT wherein its originlied on left side of mid-vertebral line. [ABSTRACT FROM AUTHOR]

Simple Summary: The surface of a human cell is coated by glycans, which play an important role in many of the physiological processes that include cell–cell communication, interaction, and adhesion. The aberration of the process of glycan synthesis plays a role in inflammatory conditions, tumour progression and metastasis. The process of O-glycosylation is complex and takes place in the Golgi apparatus, regulated by specific enzymes called ppGalNAc transferases. The incomplete synthesis or truncated forms of O-glycans such as Tn, STn, T and ST antigens are commonly seen in cancer states. The increased expression of these truncated glycans is associated with increased invasion potential, leading to metastasis and poor prognosis in a wide range of cancers. Understanding the expression of truncated glycans by cancers paves the way for targeted therapies, which have the potential to be used as serum biomarkers of disease progression and prognosis. Glycans are an essential part of cells, playing a fundamental role in many pathophysiological processes such as cell differentiation, adhesion, motility, signal transduction, host–pathogen interactions, tumour cell invasion, and metastasis development. These glycans are also able to exert control over the changes in tumour immunogenicity, interfering with tumour-editing events and leading to immune-resistant cancer cells. The incomplete synthesis of O-glycans or the formation of truncated glycans such as the Tn-antigen (Thomsen nouveau; GalNAcα- Ser/Thr), its sialylated version the STn-antigen (sialyl-Tn; Neu5Acα2–6GalNAcα-Ser/Thr) and the elongated T-antigen (Thomsen–Friedenreich; Galβ1-3GalNAcα-Ser/Thr) has been shown to be associated with tumour progression and metastatic state in many human cancers. Prognosis in various human cancers is significantly poor when they dedifferentiate or metastasise. Recent studies in glycobiology have shown truncated O-glycans to be a hallmark of cancer cells, and when expressed, increase the oncogenicity by promoting dedifferentiation, risk of metastasis by impaired adhesion (mediated by selectins and integrins), and resistance to immunological killing by NK cells. Insight into these truncated glycans provides a complimentary and attractive route for cancer antigen discovery. The recent emergence of immunotherapies against cancers is predicted to harness the potential of using such agents against cancer-associated truncated glycans. In this review, we explore the role of truncated O-glycans in cancer progression and metastasis along with some recent studies on the role of O-glycans in endocrine cancers affecting the thyroid and adrenal gland. [ABSTRACT FROM AUTHOR]

Ankylosing Spondylitis (AS) is an aberrant inflammatory chronic disorder characterized by an inflammation to joint particularly vertebrae of spine potentially instigates them to inter-fuse. This disease is also well known as Bekhtrev disease, Bechterew's disease or marie-strumpell disease. Symptoms such as pulmonary fibrosis, restrictive lung disease, aortitis often occur rarely and these are often misdiagnosed with some other disease condition. Although recent research and genomic studies suggests that there were many etiological factors that contributed to this disease onset and progression. Among these it's association with HLA B-27 gene is widely researched one or established one. Several genomic studies had also revealed the association of innate immunity with ankylosing spondylitis while other studies define K. pneumoniae infection as a perpetuating factor in AS. However this association has not been fully understood. One of the interesting mechanism by which this disease progress is the co-stimulation of TNF and IL-17 (interlukin-17) and the involvement of SOX9+ve (SRY Box Transcription Factor 9+ve). The probability of occurrence of HLA-B27 gene in general population is (~8%). [ABSTRACT FROM AUTHOR]

Arteria Lusoria, an aberrant or anomalous right subclavian artery is the most frequent anomaly of aortic arch. It may be associated with other congenital anomalies of the heart and great vessels – rarely including truncus bicaroticus and even more rarely-aneurysmal formation. Here we report the case of 50- year old male with complaints of chest pain, spread out toward chest bone, pain in the left region of neck, who had aneurysms of ascending aorta, aortic arch and a.lusoria and truncus bicaroticus too. A.Lusoria aneurysm was with 6h8 sm size and ostium from the side of thoracic aorta. We made one after another mediastinal aortic debranching with right and left carotid-subclavian artery baypass and endovascular treatment with two stent-grafts implantatipn in ascending aorta and aortic arch. The early postoperative period was uneventful, with stable hemodynamic without catecholamins usage. We didn’t have high level of enzymes for myocardial necrosis, without rhythm and heart conduction disorders and without ischemic disturbances of left upper limb with pulsatile flow to the distal artery and so too without neurological deficit from central nervous system. Aneurysm of arteria Lusoria should be suspected in the presence of a right superior mediastinal mass on X-Ray and should be considered as a cause of new-onset dyspnea, chest pain, or dysphagia. Despite disagreement among investigators regarding the need to restore pulsatile blood flow to the right arm, we recommend reconstructing that flow, when possible. [ABSTRACT FROM AUTHOR]

Flow cytometry of intestinal lymphocytes is discussed to be a stronger predictor of enteropathy-associated T-cell lymphoma development in refractory celiac disease than T-cell clonality analysis. To investigate possible associations between clinical characteristics of refractory celiac disease patients and aberrant intraepithelial lymphocytes and to evaluate the accuracy of immunophenotyping for the identification of high-risk refractory celiac disease. Flow cytometry of isolated lymphocytes from duodenal biopsies of controls and celiac disease patients was performed and results were compared to clinical data. Flow cytometry analysis was performed on 42 controls, 37 non-complicated celiac disease and 30 refractory celiac disease cases with or without T-cell receptor clonality. Elevated aberrant intraepithelial lymphocyte counts were significantly associated with severe malabsorption. A 15% cut-off (aberrant lymphocytes among all lymphocytes) had the best discriminatory ability to identify high-risk patients. However, this technique failed to identify some high-risk cases (sensitivity 63%, specificity 100%). The severity of malabsorption was added to the criteria for high-risk refractory celiac disease, improving the correct patients' allocation (sensitivity 100%, specificity 96%). Immunophenotyping of aberrant intraepithelial lymphocytes is a good predictor for high-risk refractory celiac disease. Furthermore, adding the evaluation of malabsorption to the diagnostic assessment of refractory celiac disease optimizes accuracy. [ABSTRACT FROM AUTHOR]

Leukocyte common antigen (LCA), or CD45, is classically thought of as a leukocyte-exclusive protein, and as such, CD45 immunohistochemistry (IHC) is often used as a key differentiator between non-Hodgkin lymphomas (NHLs) and morphologically similar neuroendocrine neoplasms (NENs). Herein, we report our experience regarding aberrant CD45 immunoreactivity in a series of NENs. A natural language search was used to retrieve desired archival patient files. All prior NENs which had a positive neuroendocrine diagnosis or IHC results (synaptophysin, chromogranin, CD56, and/or neuron-specific enolase), as well as CD45 staining performed, were reviewed for possible CD45 positivity (n = 686). Among these 686 NENs, 10 were aberrantly positive for CD45 staining. CD45 showed nuclear, cytoplasmic, and/or membranous staining in tumor cells. The significance of such staining is unclear. Albeit for a minority of patients, pathologists should be aware that NENs may aberrantly stain with CD45 and thereby pose a diagnostic pitfall. Therefore, broadening routine IHC panels is recommended to differentiate NENs more clearly from NHLs. [ABSTRACT FROM AUTHOR]

BACKGROUND: The identification of aberrant phenotypes in acute leukemia is crucial for treatment monitoring and minimal residual disease analysis. Flowcytometric immunophenotyping in acute leukemia is an important tool for the detection of these aberrancies. There is wide variation in the incidence of aberrant antigens in acute leukemia in different studies and its correlation with prognostic markers. AIMS AND OBJECTIVES: The aim and objective of this study is to assess the frequency of aberrant markers in acute leukemia and determine any association with hematological parameters. MATERIALS AND METHODS: A total of 150 newly diagnosed cases of acute leukemia during the period January 2018–December 2020 were included. The flowcytometric immunophenotyping of all the above cases was done using BD FACS Canto II. RESULTS: Out of the total 150 cases of acute leukemia, 56.7% expressed aberrant phenotype. The proportional frequency of aberrant antigen expression in B-acute lymphoid leukemia (ALL), T-ALL and acute myeloid leukemia (AML) was 56.6%, 50%, and 58.5%, respectively. CD13, CD13, and CD7 were the most common aberrancies in B-ALL, T-ALL, and AML, respectively. Aberrant myeloid phenotype in B-ALL was associated with lower mean total leukocyte count (TLC) and blast percentage in peripheral blood as compared to the B-ALL with conventional phenotypes. Aberrant lymphoid phenotype in AML was associated with a higher TLC and greater blast percentage in peripheral blood than the AML with conventional phenotypes. CONCLUSION: Aberrant lymphoid phenotype in AML is associated with unfavorable hematological features. However, aberrant myeloid phenotype in B-ALL is not associated with adverse features.

Background: Few studies have assessed interventions aimed at managing nonmedical opioid use (NMOU) behavior among patients with cancer. The authors developed the Compassionate High-Alert Team (CHAT) intervention to manage patients receiving opioids for cancer pain who demonstrate NMOU behavior. The objective of this study was to determine the change in frequency of NMOU behaviors, pain intensity, and opioid requirements among those who received the intervention.Methods: A total of 130 patients receiving opioids for cancer pain that had documented evidence of NMOU and received the CHAT intervention were reviewed. Demographic and clinical information such as NMOU behaviors, pain scores, and morphine equivalent daily dose at baseline, 3, and 6 months post-intervention was obtained.Results: NMOU behaviors significantly decreased from a median (interquartile range) of 2 (1-3) at baseline to 0 (0-1) at both 3 and 6 months post-intervention (p < .001). A total of 45 of 75 (60%) and 31 of 50 (62%) of CHAT recipients achieved complete response to the intervention at 3 and 6 months, respectively. Higher baseline number of NMOU behaviors was independently associated with patient response to the intervention (odds ratio [OR], 1.97; 95% confidence interval [CI],1.09-4.28, p = .049 at 3 months; OR, 2.5; 95% CI, 1.20-6.47, p = .03 at 6 months). The median pain score decreased from 7 at baseline to 6 at both 3 and 6 months (p = .01). Morphine equivalent daily dose did not significantly change during that same period (143 mg/day vs. 139 mg/day, p = .13).Conclusions: Most patients who received the CHAT intervention improved in their NMOU behaviors and pain intensity scores 3 and 6 months post-intervention. These preliminary findings support the efficacy of CHAT in managing patients receiving opioids for cancer pain who demonstrate NMOU behavior. [ABSTRACT FROM AUTHOR]

Abstract Background Dual left anterior descending (LAD) coronary artery is a rare congenital anomaly. To date, eleven variants of dual LAD have been described with three published reports of type X dual LAD. Here, we describe a new variant of type X dual LAD with a short LAD artery masquerading as type 1 LAD. Case presentation A 42-year hypertensive female presented with recent onset angina with a treadmill test positive for inducible ischemia. Coronary angiography showed a normal right coronary artery (RCA). The left main coronary artery (LMCA) originated from the left sinus of Valsalva (SOV), giving rise to a LAD and the left circumflex artery (LCX). Appearing a normal angiogram with type 1 LAD based on its length, the presence of a large bare area in LAD territory (especially at the apex) and lack of septal branches prompted a search for an additional vessel. Right SOV injection showed a vessel originating separately from RCA, which was confirmed to be a long LAD on selective injection, with a pre-pulmonic course and giving rise to septal branches exclusively before wrapping around the apex. Computed tomography coronary angiography (CTCA) confirmed the pre-pulmonic course of long LAD, defined its entry to the distal interventricular septum to the right of short LAD, and ruled out other coronary artery anomalies. In the absence of a stenotic lesion in the epicardial coronaries, angina in our case was presumed to be due to microvascular dysfunction. She was discharged on beta-blocker therapy for co-existing hypertension and is asymptomatic on follow-up at one year. Conclusions A short LAD artery of type X Dual LAD could be potentially misdiagnosed as type 1 LAD based on its length. However, an active search for a long LAD could properly diagnose the case as a variant of type X dual LAD, which has important clinical implications. Its awareness is critical for cardiologists and cardiac surgeons to correctly interpret the coronary angiogram and plan proper management.

A 9-year-old spayed female boxer suffered from lameness in both hindlimbs with a perforated paw wound. Additionally, a linear, worm-like creature was penetrating out from the wound. On examination, the dog was emaciated and infected with heartworms, detected through a fresh blood smear, echocardiography, and transabdominal ultrasonography. Adult heartworms were detected at the right atrium (RA), right ventricle (RV), and pulmonary artery (PA), including the distal abdominal aorta, external iliac, and femoral arteries. During the surgery, adults heartworms were removed from both the heart (n = 8) and the femoral arteries (n = 5). Unfortunately, not all heartworms could be removed from these locations due to the extent of the heartworm infection. The opened, ischemic wounds in the distal limbs progressively expanded and the dog subsequently died, possibly due to caval syndrome complications and septicemia. The necropsy showed no evidence of an atrial septal defect, and a total of 25 adult heartworms were collected from the perforated paw, heart, pulmonary, and femoral arteries. All worms collected during the necropsy process were molecularly confirmed to be Dirofilaria immitis.

BACKGROUND: Aberrant antigen expression is an unexpected antigen that is detected on lineage in question without alteration of lineage definition. Immunophenotypic aberrancies are thought to predict treatment outcome in acute myeloid leukemia (AML). Some studies reported an adverse prognostic association, while others failed to show any association. AIM: To determine percentage of lymphoid antigens expression in adult AML patients and correlate them with hematological parameters and response to induction chemotherapy protocol. SUBJECTS AND METHODS: Peripheral blood and bone marrow fresh samples from 81 cases of de novo AML were included in this study from November 2018 to October 2019. Hematological parameters were obtained from patients' medical records. Aberrant antigens expression was detected using flow cytometry at the diagnosis. Patients were evaluated after one cycle of chemotherapy regarding remission status. RESULTS: Out of 81 patients, 60 patients had completed data for evaluation. CD7, CD19 expression, and co-expression of CD7 and CD2 were found in 60%, 10.7%, and 10.7% of patients, respectively. Statistically significant associations were found between initial hemoglobin level and aberrant expression as patients with aberrant expression have higher hemoglobin level than patients without aberrant expression. Complete remission was achieved in 29 out of 60 patients (48.3%) with standard 3 and 7 protocol, whereas 31 patients did not achieve complete remission. There is no statistically significant association between aberrant expression and treatment response to the first cycle of chemotherapy protocol (P > 0.05). CONCLUSIONS: CD7 is the most frequent aberrant antigen expressed in this Iraqi AML patient group. Hemoglobin level was higher in patients with aberrant expression. No significant association between aberrant expression and response to the first cycle of induction.

Background: Pseudopterygium, also known as aberrant conjunctival growth, is poorly described in the literature, although it is known that this abnormality is uncommon and affects dwarf rabbits and their crossbreeds. The etiology of this disease is unknown, but there are hypotheses that the conjunctival growth cause may have its origins in immunological factors, inflammation, traumatic conditions, or cartilage dysplasias. Thus, this study reports the treatment efficacy applied in a rabbit, through the continuous use of tracolimus eye drops, after surgical procedure of conjunctival fold resection, as a way of controlling the pseudopterygium in rabbits. Case: This case report discusses the positive results from the surgical and therapeutic conduct of a clinical case attended by the Ophthalmology and Microsurgical Veterinary Service at the Hospital Veterinário Universitário (HVU) of the UFSM. The patient was a male rabbit, sterilized, approximately 2-year-old, crossed with a dwarf rabbit. The owner’s main complaint was the change in the aspect of the left eye, with progressive worsening in the previous four weeks. In the ophthalmological examination, the animal did not present impaired vision or discomfort, however, a vascularized pink membrane was noted, which consisted of a fold of the bulbar conjunctiva, that grew centripetally and covered 90% of the cornea in 360 degrees. The diagnosis was confirmed through visual inspection and the patient’s history. The eye alteration had a characteristic aspect, described as proliferation of the bulbar conjunctiva over the cornea, in a centripetal manner and without signs of inflammation. In addition, other ophthalmological alterations were ruled out during the patient’s physical and specific examination. The patient was referred for anesthetic evaluation and, in addition, pre-surgical blood tests were performed, which were normal, according to the expected ranges for the species. Subsequently, the animal was submitted to surgical treatment, which consisted of dividing the exuberant conjunctiva, followed by three radial incisions in equal portions. Next, the conjunctival fold was completely incised to the edge of the limbus, without the need of sutures. Anterior lamellar keratectomy was performed on the portion where the membrane was attached to the cornea. For home care, tobramycinbased eye drops (QID, for 7 days) and 0.02% aqueous tacrolimus eye drops (BID - continuous use) were prescribed. The animal was reevaluated 7, 14, 30, 60, 120 and 180 days after surgical correction, and no recurrence of pseudopterygium was observed during the follow-up period. The prognosis of patients with pseudopterygium is reserved, as it is known that the disease may recur after surgical treatment. Therefore, the continuous use of the chosen immunomodulating eye drops was recommended as well as periodic follow-up of the patient. Discussion: In the current study, it was not possible to increase knowledge regarding about the pseudopterygium etiology. Although the condition is not serious, it can cause partial impairment of vision and chronic discomfort. However, the vision field described in the rabbit in this current case remained unchanged, in accordance with other cases described in the literature. Furthermore, no signs of patient discomfort were detected. Some surgical techniques described in the literature for correction of pseudopterygium, shows membrane’s growth recurrence. The use of immunomodulatory drugs is suggested for relapses controlling. In this study, the tracolimus eye drops efficacy was tested, and presented good results in the patient’s evaluations for a long period after surgery. The use of immunomodulators is an option for adjuvant topical treatment for controlling pseudopterygium growth, which, associated with corrective surgical treatment, has shown positive results. [ABSTRACT FROM AUTHOR]

BACKGROUND: The identification of aberrant phenotypes in acute leukemia is crucial for treatment monitoring and minimal residual disease analysis. Flowcytometric immunophenotyping in acute leukemia is an important tool for the detection of these aberrancies. There is wide variation in the incidence of aberrant antigens in acute leukemia in different studies and its correlation with prognostic markers. AIMS AND OBJECTIVES: The aim and objective of this study is to assess the frequency of aberrant markers in acute leukemia and determine any association with hematological parameters. MATERIALS AND METHODS: A total of 150 newly diagnosed cases of acute leukemia during the period January 2018-December 2020 were included. The flowcytometric immunophenotyping of all the above cases was done using BD FACS Canto II. RESULTS: Out of the total 150 cases of acute leukemia, 56.7% expressed aberrant phenotype. The proportional frequency of aberrant antigen expression in B-acute lymphoid leukemia (ALL), T-ALL and acute myeloid leukemia (AML) was 56.6%, 50%, and 58.5%, respectively. CD13, CD13, and CD7 were the most common aberrancies in B-ALL, T-ALL, and AML, respectively. Aberrant myeloid phenotype in B-ALL was associated with lower mean total leukocyte count (TLC) and blast percentage in peripheral blood as compared to the B-ALL with conventional phenotypes. Aberrant lymphoid phenotype in AML was associated with a higher TLC and greater blast percentage in peripheral blood than the AML with conventional phenotypes. CONCLUSION: Aberrant lymphoid phenotype in AML is associated with unfavorable hematological features. However, aberrant myeloid phenotype in B-ALL is not associated with adverse features. [ABSTRACT FROM AUTHOR]

Background: Tortuosity of the internal carotid artery (ICA) is not a rare condition, but its clinical impact is underestimated. The differences in the course and shape of the ICA in the oropharynx just beneath the mucosa were investigated to determine the possible fatal bleeding for both major oropharyngeal tumor resection and less extensive procedures. We report two cases to reveal that the awareness of such an anatomical variation before performing oropharyngeal procedures. Methods and results: We report two different pathologies of retropharyngeal ICAs, which presented with otolaryngological symptoms. Case 1 Retropharyngeal right ICA. The vessel's minimum distance to the pharyngeal wall was 1 mm (very high risk of vascular injury) with a tortuous pathway. Case 2 Retropharyngeal right ICA. A tortuous ICA was in contact with the posterior pharyngeal wall (very high risk of vascular injury). Conclusion: The otolaryngologists surgeons must use caution in evaluating patients with masses in the pharynx and augment a careful and complete head and neck examination with appropriate imaging studies before operating. [ABSTRACT FROM AUTHOR]

Purpose: Aberrant hepatic artery anatomy is a considerable challenge during pancreatic surgery as it warrants extreme caution for the preservation of vascular supply as well as achievement of R0 resection margin. Method: We reviewed the literature about the aberrant anatomical variations of the hepatic artery and its relevance during pancreatoduodenectomy and distal pancreatectomy. Result: Preoperative deliberation of peri-pancreatic vascular anatomy using advanced imaging methods is crucial for surgeons. At the same time, intra-operative suspicion and early identification of aberrant anatomy may help to prevent vascular injury and related complications. Yet, vascular reconstruction may be needed in many situations; several techniques like pre-operative embolization provide new options for management in specific situations. Conclusion: We have provided here an overview of the anatomical variants of the hepatic artery and their implication during pancreatoduodenectomy and distal pancreatectomy. [ABSTRACT FROM AUTHOR]

Variations in vascular anatomy are of great concern to surgeons, as proper identification of aberrant arteries can reduce the risk of iatrogenic injury and improve patient outcomes. Several studies have highlighted the irregular branching pattern of pelvic arteries, with a recent focus on the obturator artery (OA). The OA has an inconstant origin from the internal iliac artery, external iliac artery, or inferior epigastric artery. Within the pelvis, the OA can give off muscular branches and nutrient vessels to the ilium and pubis. Though occasionally described in text, few resources employ images of human donors that depict branches arising from the OAs. Out of the 34 hemisected pelves studied, we identified 1 individual with a substantial nutrient vessel branching unilaterally from the OA. Herein, we present the first image of this unconventional nutrient artery. This vessel should be highlighted given that its size and course make it particularly vulnerable during intrapelvic surgeries such as pelvic lymph node dissection or in procedures requiring arterial embolization of the OA. [ABSTRACT FROM AUTHOR]

Abstract Background An aberrant right subclavian artery which arises from the proximal descending aorta may result in aortic dissection. The dissection may occur at either the site of the primary intimal tear or from an aortic branch. These conditions may lead to blood flow limitation and possible aneurysmal degeneration in the future. Case presentation We described the clinical presentation and management of a 54-year old patient diagnosed with a rare case of an aberrant right subclavian artery with Stanford Type B aortic dissection. A hybrid surgical approach was successfully performed and the patient had an uneventful recovery. Conclusion Even though aortic dissection is often an incidental finding, this case highlighted that in rare situations, it can be associated with an aberrant right subclavian artery. It is important to disseminate this association as it has profound diagnostic and therapeutic implications in safeguarding the clinical outcomes of patients with such condition.

Abstract Background The presentation of patients with knee injuries which can have a significant impact on their ability to work and perform activities of daily living is constantly rising. The posterolateral corner of the knee has a complex anatomy of muscles, tendons, and ligaments, with huge variation in the population. The fabella is one such structure, found in the posterolateral corner of the knee, which can serve as a common origin point of various ligaments. Case report We present a case report of a 53-year-old white man who presented with atraumatic, posterior knee pain and was found to have a congenital, anomalous band originating from the fabella, causing semimembranosus impingement. This was diagnosed with magnetic resonance imaging; he underwent division of the anomalous band, which resulted in complete resolution of his symptoms. Conclusion We propose that patients who present with posterior knee pain, without any history of trauma, and have no abnormalities on plain radiographs, should undergo magnetic resonance imaging of their knees. This will help in assessing the ligament complex in the posterior compartment of the knee, and exclude impingement of the semimembranosus as an, albeit rare, cause of posteromedial knee pain.

Variations in vascular anatomy are of great concern to surgeons, as proper identification of aberrant arteries can reduce the risk of iatrogenic injury and improve patient outcomes. Several studies have highlighted the irregular branching pattern of pelvic arteries, with a recent focus on the obturator artery (OA). The OA has an inconstant origin from the internal iliac artery, external iliac artery, or inferior epigastric artery. Within the pelvis, the OA can give off muscular branches and nutrient vessels to the ilium and pubis. Though occasionally described in text, few resources employ images of human donors that depict branches arising from the OAs. Out of the 34 hemisected pelves studied, we identified 1 individual with a substantial nutrient vessel branching unilaterally from the OA. Herein, we present the first image of this unconventional nutrient artery. This vessel should be highlighted given that its size and course make it particularly vulnerable during intrapelvic surgeries such as pelvic lymph node dissection or in procedures requiring arterial embolization of the OA.

The substantial clinical burden and disability after stroke injury urges the need to explore therapeutic solutions. Recent compelling evidence supports that neurogenesis persists in the adult mammalian brain and is amenable to regulation in both physiological and pathological situations. Its ability to generate new neurons implies a potential to contribute to recovery after brain injury. However, post-stroke neurogenic response may have different functional consequences. On the one hand, the capacity of newborn neurons to replenish the damaged tissue may be limited. In addition, aberrant forms of neurogenesis have been identified in several insult settings. All these data suggest that adult neurogenesis is at a crossroads between the physiological and the pathological regulation of the neurological function in the injured central nervous system (CNS). Given the complexity of the CNS together with its interaction with the periphery, we ultimately lack in-depth understanding of the key cell types, cell–cell interactions, and molecular pathways involved in the neurogenic response after brain damage and their positive or otherwise deleterious impact. Here we will review the evidence on the stroke-induced neurogenic response and on its potential repercussions on functional outcome. First, we will briefly describe subventricular zone (SVZ) neurogenesis after stroke beside the main evidence supporting its positive role on functional restoration after stroke. Then, we will focus on hippocampal subgranular zone (SGZ) neurogenesis due to the relevance of hippocampus in cognitive functions; we will outline compelling evidence that supports that, after stroke, SGZ neurogenesis may adopt a maladaptive plasticity response further contributing to the development of post-stroke cognitive impairment and dementia. Finally, we will discuss the therapeutic potential of specific steps in the neurogenic cascade that might ameliorate brain malfunctioning and the development of post-stroke cognitive impairment in the chronic phase.

Aberrant course of the internal carotid artery is a rare congenital malformation. Aberrant course of cervical internal carotid artery accounts for 5% of cases. Several cases of fatal hemorrhage due to an injury to the aberrant internal carotid artery have been observed in patients undergoing pharyngeal surgery procedures. This was associated with a lack of detection during surgery. Ear nose and throat (ENT) practitioner need to know it. We here report a case of aberrant internal carotid manifesting as chronic cough due to the contact of the epiglottis with the pharyngeal mass caused by the aberrant artery. The patient was treated for chronic lung disease without success. This particular anatomical condition should be suspected in patients with pharyngeal mass before any invasive procedure. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES The study objective was to describe the technique and outcomes of original coronary ostial slide plasty in patients with anomalous coronary artery origin (ACAO) localized in the aneurysmal ascending aorta (AA) being replaced because of its isolated pathology and otherwise non-pathological aortic root. METHODS A total of 23 patients (median age 52 years) with the ascending phenotype of proximal aorta aneurysm and ACAO of at least 1 coronary artery localized in the AA being replaced underwent ostial slide plasty to transpose the ACAO to the respective sinus of Valsalva and, consequently, to allow an AA replacement with placement of the proximal anastomosis at the level of the sinotubular junction (STJ). In 15 patients, the aortic valve was bicuspid, and all but 3 patients presented with a relevant valve defect. In addition to remodelling the STJs (all patients), valve-sparing repair or replacement was performed in 12 and 8 patients, respectively. RESULTS No patient died during the entire follow-up (median 72, range 3–183 months). One patient required replacement of a recurrently insufficient valve that was repaired primarily using cusp patch plasty, but there were no further cardiac reoperations nor any re-interventions on the proximal aorta, aortic valve and/or coronary artery ostia. Two patients received peripheral coronary stents (8 and 7 years after surgery, respectively) due to coronary heart disease. CONCLUSIONS Transposition of the ACAO from the replaced AA into the normal sinus of Valsalva using the ostial slide plasty offers a simple and safe surgical option enabling a recreation of a durable STJ at the level of the anastomosis between the root and the aortic graft. [ABSTRACT FROM AUTHOR]

Background  Harvest of the radial forearm flap (RFF) for reconstructive surgery is proceeded by the Allen test to assess for adequate contralateral perfusion of the hand, yet the Allen test may fail to detect anatomical variations in the radial artery such as aberrant branching. Therefore, the goal of this study was to systematically review the literature regarding anatomical abnormalities of the radial artery that can affect flap harvest and to perform a meta-analysis to estimate the prevalence of such abnormalities. Methods  A systematic review of the literature was conducted using five online databases to identify all instances of radial artery anatomical variations. Abstracts were reviewed and categorized into either (1) large cohort studies of anatomical variations identified by angiogram or (2) case reports specifically mentioning anomalous or accessory branches of the radial artery. Data from the large cohort studies were included in a random effect meta-analysis to estimate the prevalence of such variations. Results  Eighteen angiogram cohort studies containing a total of 18,115 patients were included in the meta-analysis. Accessory branches were the least common anatomical variant reported, with an estimated average prevalence of 0.5%. Prevalence estimates for more common anatomical variants, including radial artery loops (0.9%), stenosis (1.3%), hypoplasia (1.9%), tortuosity (4.3%), and abnormal origin (5.6%), were also calculated. Thirteen case reports detailing anomalous branches of the radial artery were identified, seven of which involved accessory branches encountered during RFF harvest with no incidence of flap loss. Conclusion  Radial artery accessory branches are exceedingly rare, but the prevalence of other anatomical variations that can affect harvest of the RFF warrants consideration. We recommend surgeons consider comprehensive screening prior to RFF harvest to avoid intraoperative discovery of anatomical variants and suggest a low threshold for repeat perfusion testing intraoperatively if radial artery accessory branches are encountered. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the influence of ectopic origin of bronchial arteries (BAs) on bronchial artery embolization (BAE) for hemoptysis. Methods: CT and angiography images of 50 consecutive sessions in 39 patients (aged 26–93 years; mean, 70.6 years) who underwent BAE for hemoptysis from April 2010 to December 2019 were reviewed. We defined ectopic BA as a systemic artery originating from other than the T5–T6 vertebral level of the descending aorta with course along the major bronchi. The background of patients, number of BAs, culprit arteries, and treatment outcomes were compared between the cases with and without ectopic BAs. Results: Seventeen patients (43.6%) demonstrated 19 ectopic BAs, originating from the subclavian artery (n = 7), aortic arch above the T5–T6 level (n = 6), internal mammary artery (n = 3), brachiocephalic trunk (n = 2) or lower descending thoracic aorta (n = 1). Total number of BAs in the cases with ectopic BA was significantly greater than those in cases without ectopic BA (p = 0.0062). Required sessions of embolization were similar in the two groups. No procedure-related significant complications were noted; however, four ectopic BAs caused unexpected filling of contrast media or migration of the embolic material from the orthotopic BA to ectopic BA originating from the arch vessels via tiny communication. Conclusion: Although BAE under the presence of ectopic BA is feasible and safe, detection of BAs with ectopic origin, even of small diameter, is needed to avoid risk of non-target coursing of embolic materials. [ABSTRACT FROM AUTHOR]

Aberrant subclavian artery (aSCA) is a rare anatomic variant whose association with other aortic branch variations and aortic pathology has yet to be established. Knowledge of such an association could be relevant to recommendations for screening and awareness as associated variations are important for operative planning. We describe the incidence of aSCA variations, its association with aortic pathology, and a proposed classification system. The thoracic cross-sectional imaging database at Keck Hospital of the University of Southern California from 2006 to 2018 was queried for presence of aSCA. Studies were evaluated for aSCA laterality, variant anatomy, and aortic and branch vessel disease. Medical records were reviewed for associated symptoms and diagnoses. The primary outcome was association of aSCA with aortic pathology (aneurysm or dissection). Secondary outcomes were comparison of right and left aSCA, comparison between the sexes, and creation of a proposed classification system. Of 98,580 axial imaging studies, 810 studies (0.82%) were identified with aSCA in 312 unique patients. Right aSCA made up the majority of cases (90.1%). All aSCAs had a retroesophageal course. Kommerell's diverticulum (KD) was present in 184 (59%) with an average diameter of 1.67 cm (range, 1.2-3.3 cm). KD was more frequent (84% vs 56%; P =.0003) and larger (2.05 cm vs 1.61 cm; P <.0001) in left aSCA patients. When present, KD was more often symptomatic in left aSCA compared with right aSCA (77.4% vs 49.1%; P =.005). Dysphagia, chest pain, reflux, and asthma were all more common in left aSCA patients. KD was also more common in men (73.3% vs 50%; P <.0001) and larger in men (1.81 cm vs 1.54 cm; P <.0001) but with no difference in symptoms between sexes. Our proposed classification system based on aortic arch branching is as follows: type 1, left arch with right aSCA (59.9%); type 2, left arch with common carotid trunk and right aSCA (30.1%); type 3, right arch with left aSCA (9.6%); and type 4, right arch with common carotid trunk and left aSCA (0.3%). Subtypes describe the right vertebral artery (RVA) and left vertebral artery (LVA) origin: subclavian (s, RVA 90.1%, LVA 96.8%), carotid (c, RVA 9.6%, LVA 0.3%), or arch (a, RVA 0.3%, LVA 2.9%). Overall, 9.9% (31/312) had associated aortic pathology, although the study was underpowered to detect a difference between right aSCA and left aSCA (9.3% vs 16.1%; P =.213). Type 3 and type 4 arches more often have associated aortic pathology, KD, and symptoms. aSCAs are frequently symptomatic and commonly associated with aortic dissection and aneurysm. Our proposed classification scheme depicts all four aSCA arch variants and accounts for vertebral artery origin variation. These variants are common, and vertebral anatomy can differ greatly. Knowledge of these anatomic variations is critical to planning for endovascular and open repair of aortic arch pathology. [ABSTRACT FROM AUTHOR]

Résumé: Nous rapportons deux cas d' arteria lusoria paucisymptomatiques, de découverte fortuite au scanner. Le premier cas était un jeune homme, âgé de 39 ans, sous traitements antituberculeux et antirétroviraux, présentant une dysphagie haute aux aliments solides depuis l'enfance, pour lequel la fibroscopie digestive avait objectivé une sténose œsophagienne et suspectait une fistule broncho-œsophagienne, motivant la réalisation d'un scanner thoracique. Le deuxième cas était un homme âgé de 58 ans, présentant une artère sous-clavière droite aberrante rétro-œsophagienne, découverte lors d'un scanner thoraco-abdomino-pelvien, demandé pour bilan d'extension d'un adénocarcinome gastrique et une dyspnée. Chez ces deux patients, la présence de cette variante anatomique de la naissance du trajet de l'artère sous-clavière droite était de découverte fortuite, lors d'une tomodensitométrie pour d'autres indications, bien que la dysphagie haute était présente dès leur jeune âge. We report two cases of paucisymptomatic arteria lusoria, discovered by chance on CT. The first case was a young man, aged 39, on antituberculosis and antiretroviral treatment, presenting high dysphagia on solid foods since childhood, for whom gastrointestinal fibroscopy had revealed esophageal stenosis and suspected a broncho-oesophageal fistula, motivating performing a chest scan. The second case was a 58-year-old man with an aberrant retro-oesophageal right subclavian artery, discovered during a thoraco-abdomino-pelvic CT scan, requested for assessment of extension of gastric adenocarcinoma and dyspnea. In these two patients, the presence of this anatomical of the birth of the course of the right subclavian artery is incidentally discovered, during a computed tomography for other indications, although the upper dysphagia was present from their young age. [ABSTRACT FROM AUTHOR]

Background: Aberrant phenotypes in acute leukemia have been reported with varying frequencies in independent studies and their association with prognostic factors is still a matter of debate.Aim: This study aims to identify the frequency of aberrant immunophenotypes in de novo acute myeloid leukemia (AML) and to evaluate their association with initial clinical and hematological features.Materials and Methods: A total of 181 patients of de novo AML were included during the time (July 2010-June 2012). The immunophenotype of all cases of AML was studied by using flow cytometry.Results: Aberrant lymphoid antigen expression was seen in 43.1% cases. Most frequent aberrant lymphoid antigen was CD7, seen in 26.5% cases. All French-American-British (FAB) subtypes except AML-M3 expressed aberrant lymphoid antigens. The expression was most common in AML-M4 in the current study. CD34 expression in AMLs was significantly associated with the expression of aberrant lymphoid antigens. Lymphoid antigen expression in adult AML was significantly associated with higher white blood cell (WBC) count (>50,000/mm3) and higher number of peripheral blasts (>70%).Conclusion: In summary, CD7 is the most common aberrant lymphoid antigen expressed in AML. FAB subtype AML-M3 is usually not associated with aberrant lymphoid antigen expression. AML cases with CD34 positivity are more likely to express aberrant lymphoid markers. The current study also supports that aberrant lymphoid antigen expression in adult AML is associated with adverse presenting hematological features (WBC count >50,000/mm3, peripheral blasts >70%). Pediatric Ly + AML cases are not associated with adverse presenting clinical and biological features. [ABSTRACT FROM AUTHOR]

To systematically assess available information about all variations of obturator vessels and to present the most surgically relevant types, their prevalence and calibre in order to provide a comprehensive overview for both anatomists and clinicians. A total of 2689 studies were found via searching the online databases. After applying exclusion criteria 44 studies were assessed. The cadaveric studies, CT angiographies, and clinical studies were included. Number of hemipelves, prevalence of each variation and calibre of identified vessels were studied. Each variation was classified as aberrant obturator artery/vein, aberrant accessory obturator artery/vein or anastomosis. In included studies the average incidence of the variant obturator artery was 26% with the aberrant obturator artery being the most frequent type (with the mean calibre 2.10 mm, SD = 0.35 mm), while the overall incidence of the variant obturator vein was 55%. Presented venous structures had the mean calibre of 2.98 mm (SD = 0.56 mm). According to reviewed studies, variant obturator vessels are present in a great number of patients. Due to their possible calibre larger than 3 mm they represent a structure of high clinical importance. It is important to unify the terminology and to stress out the significance to all clinicians. • Systematic review of 6113 hemipelves concerning variability of obturator vessels. • Incidence of arterial variants of corona mortis incidence is 26.06%. • Incidence of arterial variants of corona mortis incidence is 54.57%. • The most common is the aberrant obturator artery but anastomotic venous arrangement. • The mean length between the corona mortis and the pubic symphysis is 55 mm. [ABSTRACT FROM AUTHOR]

Purpose: Neck dissection is often performed in patients with oral cancer to both treat and reduce the risk of subsequent neck metastases. Injury to the hypoglossal nerve may result in dysarthria, dysphagia, and profound difficulty with upper airway control. Although surgical landmarks facilitate intra-operative identification of vital structures to be preserved, they should not be an absolute measure, due to anatomical variants. We present a rare case of unilateral aberrant anatomy of the hypoglossal nerve, passing superficial to the internal jugular vein. Methods: A 70-year-old female presented to the emergency department with an indurated and ulcerated floor of mouth lesion, later confirmed to be a squamous cell carcinoma. She was treated with wide local excision, bilateral selective neck dissection of levels I to III, surgical tracheostomy, anterior mandibulectomy and reconstruction with a left composite radial forearm free flap. Results: A nerve-like structure was identified crossing superficially and perpendicular to the internal jugular vein within the left neck, which was later determined to be an anatomical variant of the hypoglossal nerve. This was carefully dissected and preserved, and the remainder of the surgery completed uneventfully. On the right, the hypoglossal nerve followed its normal anatomical course. The patient made a good recovery and suffered no neurological complications. Conclusion: Identification, meticulous dissection and preservation of the hypoglossal nerve is essential in lymphadenectomy involving levels I and II. Detailed knowledge of both normal and variant anatomy is fundamental for surgeons, which will allow for identification and protection of important neurovascular structures, thereby minimising surgical morbidity. [ABSTRACT FROM AUTHOR]

Background: Leukemic blasts in acute lymphoblastic leukemia (ALL) may have immunological features of both lymphoid and myeloid lineages known as aberrant myeloid antigens expression in ALL, which are explained as abnormal genetic program of leukemic cells that lead to lineage infidelity. In this study, CD13, CD14, and CD33 (which are the most frequent myeloid antigens associated with aberrant antigens expression in ALL) were investigated. Objectives: To evaluate the occurrence of aberrant myeloid antigens expression in childhood ALL and its effects on complete remission and other parameters. Materials and Methods: This study was conducted on 31 pediatric patients with newly diagnosed de novo ALL (27 B-ALL, 4 T-ALL) in Children Welfare Teaching Hospital/Medical City of Baghdad; diagnosis of ALL based on morphology and cytochemistry, CD13, CD14, CD33 were investigated as myeloid antigens using four-color flow cytometry. Results: Five cases of ALL (16.13%) out of 31 cases were confirmed to have aberrant myeloid antigens expression (CD13 was expressed in all five cases, CD33 was expressed in three cases, and CD14 was not expressed in any of these five cases). Complete remission was achieved in 90.30% (28 patients) and all cases with aberrant myeloid antigens expression achieved complete remission; however, despite this, there was no significant difference in complete remission between myeloid-positive (MY+) and myeloid-negative (MY−) cases, P > 0.05. Regarding other parameters, there were significant statistical differences in lactate dehydrogenase (LDH), hemoglobin value, and bone marrow (B.M.) blasts percent at diagnosis between MY+ and MY− cases, P< 0.05; however, there was no significant differences in leukocytes count, platelets count, peripheral blood blast percent at diagnosis, age, and gender, P > 0.05. Conclusions: The most frequent aberrant myeloid antigens expression in childhood ALL is CD13 and less frequently is CD33 while CD14 showed no expression; myeloid antigens expression in ALL may have better prognosis as they have lower B.M. blast percent and LDH value.

Lacrimal fistula can occur due to trauma, iatrogenic or congenital. The most common presentation in patients with congenital lacrimal fistula is epiphora or purulent discharge due to cystic dilatation from secondary infection.

Flexible crinoids (subclass Flexibilia) likely originated from the cladid crinoid genus Cupulocrinus or one of its immediate ancestors in the Middle to Late Ordovician. A remarkably constant and clade-defining character of flexible crinoids is the possession of three plates in the infrabasal circlet of the calyx. This character was a significant morphological modification for the origin of the flexible clade, resulting from the reduction of the number of infrabasal plates from five plates in the ancestral cupulocrinid. Of 615 museum specimens of Cupulocrinus sp. for which the number of infrabasal plates could be determined, 21 specimens, or 3.4%, displayed a deviation from the normal five infrabasals. Of the aberrant specimens, fifteen have four infrabasal plates, and six have six infrabasal plates. An additional aberrant specimen has five infrabasals, with one significantly reduced in size. Although the number of infrabasals is typically thought to be constant within a species, this trait appears to have been variable in the immediate ancestor of flexible crinoids, in the time period just before the number of infrabasals became fixed at three for the Flexibilia. This paper documents the range of aberrations within the infrabasal circlet of Cupulocrinus and considers the implications for the origin of the flexible crinoids. Unlabelled Image • Flexible crinoids originated during the GOBE from the cladid crinoid Cupulocrinus. • A major flexible synapomorphy may have originated in aberrations of Cupulocrinus. • Cupulocrinus crinoids have a high incidence of aberrations in the infrabasal circlet. • The most common aberration was fusion of two adjacent infrabasal plates. • Other specimens possessed two infrabasal plates within the same ray. [ABSTRACT FROM AUTHOR]

Opinion Statement: Although clinical evidence supports the use of opioids for cancer-related pain, doing so amidst the current opioid crisis remains a challenge. A proportion of opioid-related deaths in the USA are attributable to prescription opioids, which implicates health care providers as one of the major contributors. It is therefore even more important now for all clinicians to follow safe and effective opioid prescribing practices. Oncologists are often in the frontline of cancer pain management. They are encouraged to use validated tools to screen all patients receiving opioids for high risk behaviors. Those identified as high risk for potential abuse of opioids should be monitored closely. When aberrant behavior is detected, the clinician will need to openly discuss the issue and its possible implications. Oncologists may then implement measures such as limiting the dose and quantity of opioids prescribed, shortening interval between follow-ups for refills to allow for increased monitoring, setting boundaries/limitations, weaning off opioid analgesics, or/and referring to a pain or palliative medicine or drug addiction expert for co-management when necessary. These efforts may aid oncologists in safely managing cancer pain in the environment of national opioid crisis. [ABSTRACT FROM AUTHOR]

Hodgkin/Reed-Sternberg (HRS) cells of classical Hodgkin lymphoma (CHL) are of B-cell origin. In a small number of CHL cases, the tumor cells can express T-cell antigens. CD8 expression in this setting is extremely rare. We identified 5 cases of CHL with aberrant CD8 expression from our database. The patients included 3 men and 2 women with a median age of 33 years (range = 20-59 years). All the patients initially presented with lymphadenopathy and variable number of RS cells. Two cases were classified as mixed cellularity type that showed prominent vascular proliferation mimicking peripheral T-cell lymphoma. Two cases represented nodular sclerosis type. The tumor cells in all cases were positive for CD8 and negative for CD2, CD3, CD4, and CD7 and carried germline T-cell receptor genes. Molecular studies revealed T-cell receptor genes to be in germline configuration in 4 cases with available information. Given the morphologic overlap with peripheral T-cell lymphoma and the rarity of this type of CHL, identifying more cases will help our better understanding of this entity. [ABSTRACT FROM AUTHOR]

Coronary artery anomalies have been reported in Bulldogs and present an increased risk when performing balloon valvuloplasty. Identification of coronary anomalies has been reported using multidetector‐row computed tomographic (MDCT) angiography with electrocardiographic gating. However, the utility of non‐electrocardiographic‐gated 16‐row computed tomographic for MDCT for the identification of coronary artery anatomy or anomalies to the authors' knowledge has not been fully investigated. The purpose of this study was to evaluate the feasibility of non‐electrocardiographic‐gated computed tomographic (CT) angiography to identify coronary anomalies in Bulldogs with pulmonary valve stenosis. In this prospective, observational study, Bulldogs with echocardiographically diagnosed pulmonary valve stenosis, an echocardiographically derived transpulmonic pressure gradient >70 mm Hg, and a clinician recommendation for balloon valvuloplasty were included. Anesthetized dogs underwent a 16‐row MDCT non‐electrocardiographic‐gated CT angiography. A board‐certified veterinary radiologist and board‐certified veterinary cardiologist reviewed the CT angiography studies and identified the coronary artery anatomy. When normal coronary artery anatomy was detected on CT angiography, a right ventricular outflow tract fluoroscopic angiogram was performed and evaluated during levophase to confirm normal coronary anatomy prior to balloon valvuloplasty. Dogs with coronary anomalies noted on CT angiography were recovered from anesthesia and balloon valvuloplasty was not performed. All dogs (10/10; 100%) had interpretable images from the non‐electrocardiographic‐gated CT angiography. Coronary anomalies were identified in six dogs based on non‐electrocardiographic‐gated CT angiography, five with type R2A anomaly and one had a single left coronary ostium. Four dogs had normal coronary anatomy based on non‐electrocardiographic‐gated CT angiography. Balloon valvuloplasty was performed without incident in these four dogs. We conclude that non‐electrocardiographic‐gated CT angiography represents a noninvasive method for diagnosing coronary anomalies in Bulldogs with pulmonary valve stenosis. [ABSTRACT FROM AUTHOR]

We present a rare case of an aberrant right vertebral artery originating from the arch of aorta distal to the origin of the left subclavian artery. The incidence of this particular variant of aberrant origin of the right vertebral artery is extremely uncommon with only seventeen cases reported in literature to date. This case was incidentally detected on a staging positron emission tomography-computerized tomography (PET-CT) scan for lung cancer. We review the incidence, embryological mechanism, and clinical importance of this aberrant course of the right vertebral artery. [ABSTRACT FROM AUTHOR]

Aberrant DNA methylation is one of the important molecular markers in acute lymphoblastic leukemia (ALL). To determine Aberrant DNA methylation profiles of the CDKN2A and CDKN2B genes in ALL samples from T1DM cases. Aberrant hypermethylation of CDKN2B gene and cytogenetic abnormalities were analyzed in >60% of subjected cases. Total cholesterol, triglycerides and low-density lipoprotein cholesterol were not significantly varied between experimental and control (p >0.05). Expression analysis of human peripheral blood mononuclear cells revealed decreased mRNA levels of CDKN2B. The decreased level of p21 and CDK4 expression in the T1DM cases than control. The number of monocytes, lymphocytes and neutrophils significantly varied in T1DM samples and control (p < 0.05). Aberrant methylation is one of the important mechanisms involved in the expression of CDKN2B genes and is an important prognostic marker for the early detection of ALL risks. [ABSTRACT FROM AUTHOR]

Aberrant internal carotid artery is a rare birth defect. It occurs when the artery takes an abnormal course, the discovery of which is fortuitous but in the presence of dysphonia or chronic cough; this anomaly remains a diagnosis of exclusion. Cervicothoracic CT scan with injection of contrast product confirms the diagnosis. We report the case of a 64-year-old patient who presented with an aberrant course of an aneurysmal internal carotid artery revealed by dysphonia and chronic cough. [ABSTRACT FROM AUTHOR]

Biliary anatomy and its common and uncommon variations are of considerable clinical significance when performing living donor transplantation, radiological interventions in hepatobiliary system, laparoscopic cholecystectomy, and liver resection (hepatectomy, segmentectomy). Because of increasing trend found in the number of liver transplant surgeries being performed, magnetic resonance cholangiopancreatography (MRCP) has become the modality of choice for noninvasive evaluation of abnormalities of the biliary tract. The purpose of this study is to describe the anatomic variations of the intrahepatic and extrahepatic biliary tree.

Background: Ectopic breast tissue (EBT) develops along the mammary line owing to incomplete embryologic regression of the mammary ridges. This includes supernumerary breasts and aberrant breast tissue, in which malignancy is rarely reported. The commonest site of ectopic breasts is at the axilla, and the subcutaneous axillary mass may pose a diagnostic challenge to the clinician. Case Report: We report the case of a 31-year-old multiparous Nigerian woman who presented with a painless left axillary mass of two months' duration. The anatomical breasts were grossly and radiologically normal. A diagnosis of aberrant breast carcinoma in her left axilla was confirmed by tissue biopsy. She had wide local excision and left axillary dissection, followed by one course of cytotoxic chemotherapy before she began radiotherapy. Conclusion: Malignancy of aberrant breast tissue is a rare entity. A high index of suspicion and a low threshold for biopsy of subcutaneous lesions in the periphery of the breast allows for early intervention and a better prognosis. Triple assessment with clinical, radiological and pathological assessment of lesions in the axilla or along the embryonic milk line can not be overemphasized