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Objective: To identify CT findings predictive of surgical management in non-emergency small bowel obstruction (SBO).Methods: Contrast-enhanced abdominal CT of 129 patients with non-emergency SBO were evaluated for small bowel luminal diameter, wall thickness, presence of the small bowel faeces sign (intraluminal particulate matter in a dilated small bowel) and length, transition point, submucosal oedema, mesenteric stranding, ascites and degree of obstruction (low grade partial, high grade partial and complete obstruction). Medical records were reviewed for age, gender, management and history of abdominal surgery, abdominal malignancy, or SBO. Statistical analyses were performed with Stata Release 9.2.Results: Degree of obstruction was the only predictor of need for surgery. Whereas 18.0% of patients with low-grade partial obstruction (n = 50) underwent surgery, 32.5% of patients with high-grade partial obstruction (n = 77) and 100% of patients with complete obstruction (n = 2) required surgery (P = 0.004). The small bowel faeces sign was inversely predictive of surgery (P = 0.018).Conclusion: In non-emergency SBO patients with contrast-enhanced CT imaging, grade of obstruction predicts surgery, while the small bowel faeces sign inversely predicts need for surgery. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to assess the status and perception of work from home (WFH) in three academic musculoskeletal radiology divisions., Materials and Methods: A 17-item anonymous online survey related to WFH was administered to all musculoskeletal (MSK) faculty (n = 27) of three academic radiology divisions between April and July 2023. Survey items included demographics, clinical work environment, presence of a WFH policy, number of days WFH and desired WFH days, commute, perceived benefits and drawbacks of WFH, and symptoms of burnout. Statistical analysis included the Cochrane-Armitage trend test and Fisher exact test. The study was exempt from IRB approval., Results: The survey response rate was 85% (57% men, 57% white, 57% established career, defined by > 10 years in practice). In 47%, an informal policy allowed WHF on certain rotations including moonlighting/call. Seventeen percent had no opportunity to WFH. WFH 1-2 days/week was reported in 73% of respondents while 27% did not WFH. None of the respondents worked from home more than 2 days/week. Women worked from home more compared to men (p = 0.02). Perceived advantages of WFH included efficiency (no commute/parking) (76%), flexibility (52%), autonomy (33%), and increased productivity (29%). Fifty-seven percent preferred in-person read out particularly for first year trainees, with 52% preferring a virtual or hybrid model., Conclusion: WFH is common in academic MSK practices and perceived to be beneficial to MSK faculty. These findings should be taken into consideration when designing WFH policies., (© 2024. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

Objective: To determine the inter-reader reliability and diagnostic performance of classification and severity scales of Neuropathy Score Reporting And Data System (NS-RADS) among readers of differing experience levels after limited teaching of the scoring system., Methods: This is a multi-institutional, cross-sectional, retrospective study of MRI cases of proven peripheral neuropathy (PN) conditions. Thirty-two radiology readers with varying experience levels were recruited from different institutions. Each reader attended and received a structured presentation that described the NS-RADS classification system containing examples and reviewed published articles on this subject. The readers were then asked to perform NS-RADS scoring with recording of category, subcategory, and most likely diagnosis. Inter-reader agreements were evaluated by Conger's kappa and diagnostic accuracy was calculated for each reader as percent correct diagnosis. A linear mixed model was used to estimate and compare accuracy between trainees and attendings., Results: Across all readers, agreement was good for NS-RADS category and moderate for subcategory. Inter-reader agreement of trainees was comparable to attendings (0.65 vs 0.65). Reader accuracy for attendings was 75% (95% CI 73%, 77%), slightly higher than for trainees (71% (69%, 72%), p = 0.0006) for nerves and comparable for muscles (attendings, 87.5% (95% CI 86.1-88.8%) and trainees, 86.6% (95% CI 85.2-87.9%), p = 0.4). NS-RADS accuracy was also higher than average accuracy for the most plausible diagnosis for attending radiologists at 67% (95% CI 63%, 71%) and for trainees at 65% (95% CI 60%, 69%) (p = 0.036)., Conclusion: Non-expert radiologists interpreted PN conditions with good accuracy and moderate-to-good inter-reader reliability using the NS-RADS scoring system., Clinical Relevance Statement: The Neuropathy Score Reporting And Data System (NS-RADS) is an accurate and reliable MRI-based image scoring system for practical use for the diagnosis and grading of severity of peripheral neuromuscular disorders by both experienced and general radiologists., Key Points: • The Neuropathy Score Reporting And Data System (NS-RADS) can be used effectively by non-expert radiologists to categorize peripheral neuropathy. • Across 32 different experience-level readers, the agreement was good for NS-RADS category and moderate for NS-RADS subcategory. • NS-RADS accuracy was higher than the average accuracy for the most plausible diagnosis for both attending radiologists and trainees (at 75%, 71% and 65%, 65%, respectively)., (© 2024. The Author(s), under exclusive licence to European Society of Radiology.)

Shoulder strength is reduced in older adults but has only been assessed in planar motions that do not reflect the diverse requirements of daily tasks. We quantified the impact of age on strength spanning the three degrees of freedom relevant to shoulder function, referred to as the feasible torque space. We hypothesized that the feasible torque space would differ with age and expected this age-effect to reflect direction-specific deficits. We measured strength in 32 directions to characterize the feasible torque space of the shoulder in participants without shoulder pain or tendinous pathology (n = 39, 19-86 years). We modeled the feasible torque space for each participant as an ellipsoid, computed the ellipsoid size and direction-specific metrics (ellipsoid position, orientation, and shape), and then tested the effect of age on each metric. Age was negatively associated with ellipsoid size (a measure of overall strength magnitude; -0.0033 ± 0.0007 (Nm/kg)/year, p < 0.0001). Contrary to our expectation, the effect of age on the direction-specific metrics did not reach statistical significance. The effect of age did not differ significantly between male and female participants. Three-dimensional strength measurements allowed us to constrain the direction of participants' maximum torque production and characterize the entire feasible torque space. Our findings support a generalized shoulder strengthening program to address age-related shoulder weakness in those without pain or pathology. Clinical exam findings of imbalanced weakness may suggest underlying pathology beyond an effect of age. Longitudinal studies are needed to determine the positive or negative impact of our results., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Solution-processed CuInSe 2 films have generally relied on sulfide or sulfoselenide precursor films that, during the grain growth process, hamper the growth of thicker films and lead to the formation of a fine-grain layer. However, recent research has indicated that sulfur reduction in the precursor film modifies the grain growth mechanism and may enable the fabrication of thicker absorbers that are free of any fine-grain layer. In this work, we pursue direct solution deposition of sulfur-free CuInSe 2 films from the molecular precursor approach. To this end, we tune the amine-thiol reactive solvent system and study the changes to the resulting soluble complexes through a combination of analytical techniques. We show that by reactively dissolving indium(III) selenide and selenium in solutions of n -butylamine and 1,2-ethanedithiol, a metal thiolate species is formed, and that this metal thiolate can be modified by isolation from the thiol-containing solvent via precipitation. As the quantity of selenium in the ink increases, the thiol content in the complex decreases, eventually producing soluble [InSe x ] - species. Extending this method to be used with copper selenide as a copper source, molecular precursor inks can be made for solution-processed, sulfur-free CuInSe 2 films. We then show that these CuInSe 2 precursor films can be fully coarsened without a fine-grain layer formation, even at the desired thicknesses of 2 μm and greater., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Tumors of the ear can be benign or malignant. They can occur on the external ear or in the ear canal, the middle ear, and inner ear. Tumors in different areas of the ear behave differently. They are rare which causes several problems in diagnosis and appropriate treatment. The purpose of this study was to analyze retrospectively the patients with malignant neoplasm of the ear. The main objectives of this study were to study the clinicopathological presentation of ear and temporal bone malignancy and to study the management of different types of malignancy of ear and temporal bone. This study is conducted at our tertiary care cancer hospital from Feb 2015 to Jan 2020. This study includes 15 patients treated for malignancy of the external and middle ear. The entire patient was thoroughly examined for malignancy. Details ENT examination was done. History of smoking and tobacco chewing asked. The patient factors considered in this study were age, sex, diagnosis, treatment (surgery, radiotherapy, and chemotherapy), complications, follow-up, and recurrence. This study includes [n = 15] patients. Due to a variety of malignant lesions of the ear and temporal bone they were classified into two groups, Superficial location lesions [n = 5] 3 of disease limited to pinna and 2 cases of primary of parotid origin involving pinna. Deep location involving external auditory meatus and middle ear [n = 12]. In this study of [n = 15] cases lowest age was 18 years. male and highest age was 75 years. male and most common age group was 56-65 years in which [n = 7] patients present. In this study we studied [n = 11] male patients and [n = 4] female patients. The most common symptom present was ear discharge [n = 8], the next common symptom was hard of hearing [n = 7]. A less common symptom was facial weakness [n = 3]. In sign, mastoid tenderness was commonest in [n = 5], and less common was facial palsy in [n = 3]. In our study of [n = 15] patients we did lateral temporal bone resection in [n = 5] patients, wide local excision of lesion in [n = 4] patients, lateral temporal bone resection with postero-lateral neck dissection with PMMC flap done in [n = 2] patients. In our study of [n = 15] cases of ear malignancy most common histopathology is squamous cell carcinoma [n = 12] cases, least were basal cell carcinoma [n = 1], melanoma [n = 1], and Rhabdomyosarcoma [n = 1]. Malignant tumors of the ear and temporal bone are rare. Neoplasm's of the external and middle ear constitutes a group of various histopathological and clinical tumors that differ in diagnostic difficulties, treatment, and prognosis. Surgery is the mainstay of treatment followed by reconstruction. Radiotherapy and chemotherapy play an adjuvant role in post-operative management in the high-risk category. Prognosis is worst as the tumor stage advances. And most of the cases diagnosis was often made in the advanced stage especially for middle ear tumors that diminished the possibility of effective treatment., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2021.)

A standardized guideline and scoring system should be used for the MR imaging diagnosis of peripheral neuropathy. The MR imaging-based Neuropathy Score Reporting and Data System (NS-RADS) is a newly devised classification system (in press in AJR) that can be used to communicate both type and severity of peripheral neuropathy in the light of clinical history and examination findings. The spectrum of neuropathic conditions and peripheral nerve disorders covered in this system includes nerve injury, entrapment, neoplasm, diffuse neuropathy, and post-interventional states. This classification system also describes the temporal MR imaging appearances of regional muscle denervation changes. This review article is based on the multicenter validation study pre-published in American journal of Roentgenology and discusses technical considerations of optimal MR imaging for peripheral nerve evaluation and discusses the NS-RADS classification and its severity scales with illustration of conditions that fall under each classification. The readers can gain knowledge of the NS-RADS classification system and learn to apply it in their practices for improved inter-disciplinary communications and timely patient management., (© 2022. The Author(s), under exclusive licence to International Skeletal Society (ISS).)

BACKGROUND. A standardized guideline and scoring system would improve evaluation and reporting of peripheral neuropathy (PN) on MRI. OBJECTIVE. The objective of this study was to create and validate a neuropathy classification and grading system, which we named the Neuropathy Score Reporting and Data System (NS-RADS). METHODS. This retrospective study included 100 patients with nerve imaging studies and known clinical diagnoses. Experts crafted NS-RADS using mutually agreed-on qualitative criteria for the classification and grading of PN. Different classes were created to account for the spectrum of underlying pathologies: unremarkable (U), injury (I), neoplasia (N), entrapment (E), diffuse neuropathy (D), not otherwise specified (NOS), and postintervention state (PI). Subclasses were established to describe the severity or extent of the lesions. Validation testing was performed by 11 readers from 10 institutions with experience levels ranging from 3 to 18 years after residency. After initial reader training, cases were presented to readers who were blinded to the final clinical diagnoses. Interobserver agreement was assessed using correlation coefficients and the Conger kappa, and accuracy testing was performed. RESULTS. Final clinical diagnoses included normal ( n = 5), nerve injury ( n = 25), entrapment ( n = 15), neoplasia ( n = 33), diffuse neuropathy ( n = 18), and persistent neuropathy after intervention ( n = 4). The miscategorization rate for NS-RADS classes was 1.8%. Final diagnoses were correctly identified by readers in 71-88% of cases. Excellent inter-reader agreement was found on the NS-RADS pathology categorization (κ = 0.96; 95% CI, 0.93-0.98) as well as muscle pathology categorization (κ = 0.76; 95% CI, 0.68-0.82). The accuracy for determining milder versus more severe categories per radiologist ranged from 88% to 97% for nerve lesions and from 86% to 94% for muscle abnormalities. CONCLUSION. The proposed NS-RADS classification is accurate and reliable across different reader experience levels and a spectrum of PN conditions. CLINICAL IMPACT. NS-RADS can be used as a standardized guideline for reporting PN and improved multidisciplinary communications.

TLRs mediate the recognition of microbial and endogenous insults to orchestrate the inflammatory response. TLRs localize to the plasma membrane or endomembranes, depending on the member, and rely critically on ER-resident chaperones to mature and reach their subcellular destinations. The chaperone canopy FGF signaling regulator 3 (CNPY3) is necessary for the proper trafficking of multiple TLRs including TLR1/2/4/5/9 but not TLR3. However, the exact role of CNPY3 in inflammatory signalling downstream of TLRs has not been studied in detail. Consistent with the reported client specificity, we report here that functional loss of CNPY3 in engineered macrophages impairs downstream signalling by TLR2 but not TLR3. Unexpectedly, CNPY3-deficient macrophages show reduced IL-1ß and IL-18 processing and production independent of the challenged upstream TLR species, demonstrating a separate, specific role for CNPY3 in inflammasome activation. Mechanistically, we document that CNPY3 regulates caspase-1 localization to the apoptosis speck and autoactivation of caspase-1. Importantly, we were able to recapitulate these findings in macrophages from an early infantile epileptic encephalopathy (EIEE) patient with a novel CNPY3 loss-of-function variant. Summarizing, our findings reveal a hitherto unknown, TLR-independent role of CNPY3 in inflammasome activation, highlighting a more complex and dedicated role of CNPY3 to the inflammatory response than anticipated., (© 2022 The Authors. European Journal of Immunology published by Wiley-VCH GmbH.)

Background: Antimullerian hormone (AMH) is a key marker of ovarian reserve and predictor of response to fertility treatment., Aim: To understand the prevalence of low ovarian reserve in Indian women seeking infertility treatment, compare their AMH with age-matched fertile Indian controls and understand ethnic differences with Caucasian women., Setting and Design: Retrospective observational study done as collaboration between our in vitro fertilization centre and a laboratory with Pan-India presence., Materials and Methods: Women aged 20-44 years were selected as Group A (seeking infertility treatment n = 54,473), Group B (conceived naturally in the past; n = 283) and Group C (data of Caucasian women; n = 718). Serum AMH levels were measured and descriptive analysis done., Statistical Analysis: Descriptive statistics and Chi-square test., Results: In Group A, 28.7%, 48.7% and 70.6% of women aged <30 years, 30-34 years and 35-39 years had serum AMH levels ≤2 ng/mL and the proportions were higher than Group B. The rate at which median AMH decreased was 1.1-2 times faster in Group B as compared to Group C. The decrease in median AMH across age groups in Group A was similar to Group B., Conclusions: Indian women in their late twenties and early thirties visiting fertility centers showed a worrisome trend of low AMH. Our study can be used as a reference for those women considering postponing pregnancy. It may be time to look at intangible cultural factors linked to social habits, ethnicity, diet, genetic predispositions, and environmental factors like endocrine disrupting chemicals contributing to premature ovarian senescence., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Human Reproductive Sciences.)

We demonstrate the synthesis of micron-sized assemblies of lead chalcogenide nanoparticles with controlled morphology, crystallinity, and composition through a facile room-temperature solution phase reaction. The amine-thiol solvent system enables this synthesis with a unique oriented attachment growth mechanism of nanoparticles occurring on the time scale of the reaction itself, forming single-crystalline microcubes of PbS, PbSe, and PbTe materials. Increasing the rate of reaction by changing reaction parameters further allows disturbing the oriented attachment mechanism, which results in polycrystalline microassemblies with uniform spherical morphologies. Along with polycrystallinity, due to the differences in reactivities of each chalcogen in the solution, a different extent of hollow-core nature is observed in these microparticles. Similar to morphologies, the composition of such microparticles can be altered through very simplistic room-temperature solution phase coprecipitation, as well as ion-exchange reactions. While coprecipitation reactions are successful in synthesizing core-shell microstructures of PbSe-PbTe materials, the use of solution phase ion-exchange reaction allows for the exchange of not only Te with Se but also Ag with Pb inside the core of the PbTe microparticles. Despite exchanging one Pb with two Ag cations, the hollow-core nature of particles aids in the retention of the original uniform microparticle morphology., Competing Interests: The authors declare no competing financial interest., (© 2021 The Authors. Published by American Chemical Society.)

Inflammatory caspase sensing of cytosolic lipopolysaccharide (LPS) triggers pyroptosis and the concurrent release of damage-associated molecular patterns (DAMPs). Collectively, DAMPs are key determinants that shape the aftermath of inflammatory cell death. However, the identity and function of the individual DAMPs released are poorly defined. Our proteomics study revealed that cytosolic LPS sensing triggered the release of galectin-1, a β-galactoside-binding lectin. Galectin-1 release is a common feature of inflammatory cell death, including necroptosis. In vivo studies using galectin-1-deficient mice, recombinant galectin-1 and galectin-1-neutralizing antibody showed that galectin-1 promotes inflammation and plays a detrimental role in LPS-induced lethality. Mechanistically, galectin-1 inhibition of CD45 (Ptprc) underlies its unfavorable role in endotoxin shock. Finally, we found increased galectin-1 in sera from human patients with sepsis. Overall, we uncovered galectin-1 as a bona fide DAMP released as a consequence of cytosolic LPS sensing, identifying a new outcome of inflammatory cell death.

The brachial plexus is an intricate anatomic structure with an important function: providing innervation to the upper extremity, shoulder, and upper chest. Owing to its complex form and longitudinal course, the brachial plexus can be challenging to conceptualize in three dimensions, which complicates evaluations in standard orthogonal imaging planes. The components of the brachial plexus can be determined by using key anatomic landmarks. Applying this anatomic knowledge, a radiologist should then be able to identify pathologic appearances of the brachial plexus by using imaging modalities such as MRI, CT, and US. Brachial plexopathies can be divided into two broad categories that are based on disease origin: traumatic and nontraumatic. In the traumatic plexopathy group, there are distinct imaging findings and management methods for pre- versus postganglionic injuries. For nontraumatic plexopathies, having access to an accurate patient history is often crucial. Knowledge of the timing of radiation therapy is critical to diagnosing post-radiation therapy brachial plexopathy. In acute brachial neuritis, antecedent stressors occur within a specific time frame. Primary and secondary tumors of the brachial plexus are not uncommon, with the most common primary tumors being peripheral nerve sheath tumors. Direct extension and metastasis from primary malignancies such as breast and lung cancer can occur. Although diagnosing a brachial plexus anomaly is potentially perplexing, it can be straightforward if it is based on foundational knowledge of anatomy, imaging findings, and pathologic features. © RSNA, 2020.

The amine-thiol solvent system has been used extensively to synthesize metal chalcogenide thin films and nanoparticles because of its ability to dissolve various metal and chalcogen precursors. While previous studies of this solvent system have focused on understanding the dissolution of metal precursors, here we provide an in-depth investigation of the dissolution of chalcogens, specifically Se and Te. Analytical techniques, including Raman, X-ray absorption, and NMR spectroscopy and high-resolution tandem mass spectrometry, were used to identify pathways for Se and Te dissolution in butylamine-ethanethiol and ethylenediamine-ethanethiol solutions. Se in monoamine-monothiol solutions was found to form ionic polyselenides free of thiol ligands, while in diamine-monothiol solutions, thiol coordination with polyselenides was predominately observed. When the relative concentration of thiol is increased to that of Se, the chain length of polyselenide species was observed to shorten. Analysis of Te dissolution in diamine-thiol solutions also suggested the formation of relatively unstable thiol-coordinated Te ions. This instability of Te ions was found to be reduced by codissolving Te with Se in diamine-thiol solutions. Analysis of the codissolved solutions revealed the presence of atomic interaction between Se and Te through the identification of Se-Te bonds. This new understanding then provided a new route to dissolve otherwise insoluble Te in butylamine-ethanethiol solutions by taking advantage of the Se 2- nucleophile. Finally, the knowledge gained for chalcogen dissolutions in this solvent system allowed for controlled alloying of Se and Te in PbSe n Te 1- n material and also provided a general knob to alter various metal chalcogenide material syntheses.

Background & Aims: Peritoneal macrophages (PMs) regulate inflammation and control bacterial infections in patients with decompensated cirrhosis. We aimed to characterize PMs and associate their activation with outcomes of patients with spontaneous bacterial peritonitis (SBP)., Methods: We isolated PMs from ascites samples of 66 patients with decompensated cirrhosis (19 with SBP) and analyzed them by flow cytometry, quantitative real-time polymerase chain reaction, functional analysis, and RNA microarrays. We used ascites samples of a separate cohort of 111 patients with decompensated cirrhosis (67 with SBP) and quantified the soluble form of the mannose receptor (CD206) and tumor necrosis factor by enzyme-linked immunosorbent assay (test cohort). We performed logistic regression analysis to identify factors associated with 90-day mortality. We validated our findings using data from 71 patients with cirrhosis and SBP. Data from 14 patients undergoing peritoneal dialysis for end-stage renal disease but without cirrhosis were included as controls., Results: We used surface levels of CD206 to identify subsets of large PMs (LPM) and small PMs (SPM), which differed in granularity and maturation markers, in ascites samples from patients with cirrhosis. LPMs vs SPMs from patients with cirrhosis had different transcriptomes; we identified more than 4000 genes that were differentially regulated in LPMs vs SPMs, including those that regulate the cycle, metabolism, self-renewal, and immune cell signaling. LPMs had an inflammatory phenotype, were less susceptible to tolerance induction, and released more tumor necrosis factor than SPMs. LPMs from patients with cirrhosis produced more inflammatory cytokines than LPMs from controls. Activation of PMs by Toll-like receptor agonists and live bacteria altered levels of CD206 on the surface of LPMs and release of soluble CD206. Analysis of serial ascites fluid from patients with SBP revealed loss of LPMs in the early phase of SBP, but levels increased after treatment. In the test and validation cohorts, patients with SBP and higher concentrations of soluble CD206 in ascites fluid (>0.53 mg/L) were less likely to survive for 90 days than those with lower levels., Conclusions: Surface level of CD206 can be used to identify mature, resident, inflammatory PMs in patients with cirrhosis. Soluble CD206 is released from activated LPMs and increased concentrations in patients with cirrhosis and SBP indicate reduced odds of surviving for 90 days., (Copyright © 2020 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Acute systemic Gram-negative bacterial infections are accompanied by release of lipopolysaccharide (LPS) endotoxins into the bloodstream and an innate immune host response via the well-known toll like receptor 4 (TLR4) pathway. In this, LPS associates non-covalently with TLR4 to form an activated heterodimer (LPS/MD2/TLR4) 2 complex in vivo , assisted by a coreceptor CD14. This complexation process has been illustrated ex vivo using indirect methods such as cytokine, interleukin, TNF-α measurements and by direct demonstration of sequential binding events on a surface using advanced optics. We are the first ones to carry out homogeneous self-assembly of LPS-rTLR4-MD2 conjugates in vitro in a single step, and further demonstrate the role of CD14 as a catalyst during this process. The assay comprises of LPS, MD2, CD14, and recombinant TLR4-conjugated magnetic particles co-incubated in a buffer at room temperature. The complexes are removed by magnetic separation and the extent of binding is estimated by quantifying the unbound biomolecules in the supernatant using standard biophysical techniques. Our results show that rTLR4-MD2-LPS complexes form in an hour and follow a 1:1:1 stoichiometry, in agreement with the in vivo/ex vivo studies. The assay is also highly specific; addition of known LPS-binding ligands decreased the LPS-rTLR4 complexation, allowing its use as a rapid tool for molecular inhibitor screening., (Copyright © 2020 Jagtap, Prasad, Pateria, Deshmukh and Gupta.)

The buccal fat pad (BFP) originally described as an anatomic structure without any obvious function. For long period it was considered to be surgical nuisance. However during the last four decades buccal fat is successively used tool for maxillofacial surgery for reconstruction of small to medium sized acquired or congenital soft tissue and bony defect in oral cavity. The aim of present article is to review the database available regarding BFP including its anatomy, clinical usage in oral malignancy as tool of reconstruction after ablative procedures it's success and its adoptability with other loco-regional flap for oral reconstruction in different scenario and our experience with it in tertiary cancer centre in India., Competing Interests: Conflict of interestNone., (© Association of Otolaryngologists of India 2018.)

Traumatic peripheral nerve injury occurs more frequently in the pediatric population than previously recognized. High-resolution magnetic resonance (MR) imaging in the form of MR neurography can serve as a powerful noninvasive tool for detecting and characterizing peripheral nerve injury in children. In this review article we briefly discuss optimal methods of MR neurography image acquisition, highlighting core MR sequences necessary to characterize peripheral nerve injury. In addition, we illustrate the MR neurography appearance of normal and abnormal peripheral nerves in children, with emphasis on commonly used Seddon and Sunderland classification schemes to characterize peripheral nerve injury severity. The primary and secondary features associated with peripheral nerve injury including skeletal muscle denervation are reviewed in addition to key distinctive features that can impact operative versus nonoperative management of children. We include a checklist approach to interpreting MR neurography for the assessment of peripheral nerve injury.

Objective: Our purpose was to determine whether dual-energy CT (DECT), specifically the bone marrow setting of the virtual noncalcium (VNCa) algorithm, could be used to identify and accurately biopsy suspected bone malignancies that were visible on magnetic resonance imaging (MRI), nuclear bone scintigraphy, or positron-emission tomography/computed tomography (PET/CT), but occult on monoenergetic computed tomography (CT) by virtue of being either isodense or nearly isodense to surrounding normal bone., Materials and Methods: We present 4 cases in which DECT was used to detect various malignant bone lesions and was successfully used to direct percutaneous DECT-guided bone biopsies., Results: Two of the lesions were solid tumor metastases (breast and prostate carcinoma), whereas two others were hematological malignancies (leukemia and lymphoma). This technique enabled us to confidently and accurately direct the biopsy needle into the target lesion., Conclusion: The authors demonstrate that the DECT VNCa bone marrow algorithm may be helpful in identifying isodense bone lesions of various histologies and may be used to guide percutaneous bone biopsies. This technique may help to maximize diagnostic yield, minimize the number of passes into the region of concern, and prevent patients from undergoing repeat biopsy.

We investigate theoretically the kinetics of chemical reactions in polar solvents in the vicinity of charged porous membranes. When the pore charge (or potential) exceeds a critical value, the pores undergo a filling transition that can be first or second order depending on the ambient temperature, mixture composition, and other parameters. This filling transition leads to a dramatic acceleration or slowing down of the reaction. Such control of reaction kinetics by an external potential may be useful in applications where catalysts are absent or when fast spatiotemporal response is required.

Prolonged exposure to microbial products such as lipopolysaccharide can induce a form of innate immune memory that blunts subsequent responses to unrelated pathogens, known as lipopolysaccharide tolerance. Sepsis is a dysregulated systemic immune response to disseminated infection that has a high mortality rate. In some patients, sepsis results in a period of immunosuppression (known as 'immunoparalysis') 1 characterized by reduced inflammatory cytokine output 2 , increased secondary infection 3 and an increased risk of organ failure and mortality 4 . Lipopolysaccharide tolerance recapitulates several key features of sepsis-associated immunosuppression 5 . Although various epigenetic changes have previously been observed in tolerized macrophages 6-8 , the molecular basis of tolerance, immunoparalysis and other forms of innate immune memory has remained unclear. Here we perform a screen for tolerance-associated microRNAs and identify miR-221 and miR-222 as regulators of the functional reprogramming of macrophages during lipopolysaccharide tolerization. Prolonged stimulation with lipopolysaccharide in mice leads to increased expression of miR-221 and mir-222, both of which regulate brahma-related gene 1 (Brg1, also known as Smarca4). This increased expression causes the transcriptional silencing of a subset of inflammatory genes that depend on chromatin remodelling mediated by SWI/SNF (switch/sucrose non-fermentable) and STAT (signal transducer and activator of transcription), which in turn promotes tolerance. In patients with sepsis, increased expression of miR-221 and miR-222 correlates with immunoparalysis and increased organ damage. Our results show that specific microRNAs can regulate macrophage tolerization and may serve as biomarkers of immunoparalysis and poor prognosis in patients with sepsis.

Analytical formulas for the electric birefringence response of interacting polar and anisotropically polarizable molecules due to a uniform alternating electric field are derived using Berne's forced rotational diffusion model [B. J. Berne, J. Chem. Phys. 62, 1154 (1975)] in the nonlinear version described by Warchol and Vaughan [J. Chem. Phys. 71, 502 (1979)]. It is found for noninteracting molecules that the signal consists of a frequency-dependent DC component superimposed on an oscillatory part with a frequency twice that of the AC driving field. However, unlike noninteracting molecules, the AC part strongly deviates from its dilute counterpart. This suggests a possible way of motivating new experimental studies of intermolecular interactions involving electro-optical methods and complementary nonlinear dielectric relaxation experiments.

Granulomas are immune cell aggregates formed in response to persistent inflammatory stimuli. Granuloma macrophage subsets are diverse and carry varying copy numbers of their genomic information. The molecular programs that control the differentiation of such macrophage populations in response to a chronic stimulus, though critical for disease outcome, have not been defined. Here, we delineate a macrophage differentiation pathway by which a persistent Toll-like receptor (TLR) 2 signal instructs polyploid macrophage fate by inducing replication stress and activating the DNA damage response. Polyploid granuloma-resident macrophages formed via modified cell divisions and mitotic defects and not, as previously thought, by cell-to-cell fusion. TLR2 signaling promoted macrophage polyploidy and suppressed genomic instability by regulating Myc and ATR. We propose that, in the presence of persistent inflammatory stimuli, pathways previously linked to oncogene-initiated carcinogenesis instruct a long-lived granuloma-resident macrophage differentiation program that regulates granulomatous tissue remodeling., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: Paragangliomas (PGLs) are rare tumours that arise in sympathetic and parasympathetic paraganglia and are derived from neural crest cells. Presence of metastasis is the only absolute criterion for malignancy. There is no single histo-morphological feature indicating malignant potential and multiple parameters have been proposed to prognosticate the individual case. This includes studies conducted using Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Immunohistochemical (IHC) markers., Aim: We have studied ten cases of paraganglioma and attempted to correlate the prognosis with multiple clinicopathological variables., Materials and Methods: This study was done in a tertiary care general hospital over a period of five years. Available clinical records and histopathology slides of all patients were reviewed. Using Pheochromocytoma of the Adrenal Gland Scaled Score (PASS), we divided the cases into two groups-tumours showing high risk behaviour (PASS≥4) and tumours showing benign behaviour (PASS<4). IHC analysis was done using synaptophysin, chromogranin, S100 and Ki67. We correlated S100 immunoreactivity and Ki67 proliferative index with PASS score. Both PASS score and IHC markers were also correlated with clinical outcome., Results: There were six Pheochromocytomas (PHC) and four Paragangliomas (PGL). Two paragangliomas were retroperitoneal and one each was located in ear (HNPGL) and broad ligament. PASS score was ≥4 in five cases and <4 in five cases. Out of five cases in which PASS was ≥4, three cases showed clinical evidence of malignancy and two cases were benign. All the cases in which PASS was <4 were clinically benign. S100 immunoreactivity was grade 1 in two cases, grade 2 in six cases and grade 3 in two cases. The cases in which S100 immunoreactivity was grade 1 were malignant. One case in which S100 was grade 2 was clinically malignant. Ki67 labeling index was raised (>3%) in two cases, which were malignant correlated with malignant PASS score., Conclusion: We conclude that the following clinicopathological parameters should be taken into account for risk assessment of malignant behaviour of paragangliomas- location, size, PASS score, S100 immunoreactivity and Ki67 labeling index.

We examine theoretically a new idea for spatial and temporal control of chemical reactions. When chemical reactions take place in a mixture of solvents, an external electric field can alter the local mixture composition, thereby accelerating or decelerating the rate of reaction. The spatial distribution of electric field strength can be non-trivial and depends on the arrangement of the electrodes producing it. In the absence of electric field, the mixture is homogeneous and the reaction takes place uniformly in the reactor volume. When an electric field is applied, the solvents separate and the reactants are concentrated in the same phase or separate to different phases, depending on their relative miscibility in the solvents, and this can have a large effect on the kinetics of the reaction. This method could provide an alternative way to control runaway reactions and to increase the reaction rate without using catalysts.

Sensing of lipopolysaccharide (LPS) in the cytosol triggers caspase-11 activation and is central to host defense against Gram-negative bacterial infections and to the pathogenesis of sepsis. Most Gram-negative bacteria that activate caspase-11, however, are not cytosolic, and the mechanism by which LPS from these bacteria gains access to caspase-11 in the cytosol remains elusive. Here, we identify outer membrane vesicles (OMVs) produced by Gram-negative bacteria as a vehicle that delivers LPS into the cytosol triggering caspase-11-dependent effector responses in vitro and in vivo. OMVs are internalized via endocytosis, and LPS is released into the cytosol from early endosomes. The use of hypovesiculating bacterial mutants, compromised in their ability to generate OMVs, reveals the importance of OMVs in mediating the cytosolic localization of LPS. Collectively, these findings demonstrate a critical role for OMVs in enabling the cytosolic entry of LPS and, consequently, caspase-11 activation during Gram-negative bacterial infections., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Streptococci are common human colonizers with a species-specific mucocutaneous distribution. At the same time, they are among the most important and most virulent invasive bacterial pathogens. Thus, site-specific cellular innate immunity, which is predominantly executed by resident and invading myeloid cells, has to be adapted with respect to streptococcal sensing, handling, and response. In this article, we show that TLR13 is the critical mouse macrophage (MΦ) receptor in the response to group B Streptococcus, both in bone marrow-derived MΦs and in mature tissue MΦs, such as those residing in the lamina propria of the colon and the dermis, as well as in microglia. In contrast, TLR13 and its chaperone UNC-93B are dispensable for a potent cytokine response of blood monocytes to group B Streptococcus, although monocytes serve as the key progenitors of intestinal and dermal MΦs. Furthermore, a specific role for TLR13 with respect to MΦ function is supported by the response to staphylococci, where TLR13 and UNC-93B limit the cytokine response in bone marrow-derived MΦs and microglia, but not in dermal MΦs. In summary, TLR13 is a critical and site-specific receptor in the single MΦ response to β-hemolytic streptococci., (Copyright © 2016 by The American Association of Immunologists, Inc.)

Re-emergence of resistance in different pathogens including viruses are the major cause of human disease and death, which is posing a serious challenge to the medical, pharmaceutical and biotechnological sectors. Though many efforts have been made to develop drug and vaccines against re-emerging viruses, researchers are continuously engaged in the development of novel, cheap and broad-spectrum antiviral agents, not only to fight against viruses but also to act as a protective shield against pathogens attack. Current advancement in nanotechnology provides a novel platform for the development of potential and effective agents by modifying the materials at nanolevel with remarkable physicochemical properties, high surface area to volume ratio and increased reactivity. Among metal nanoparticles, silver nanoparticles have strong antibacterial, antifungal and antiviral potential to boost the host immunity against pathogen attack. Nevertheless, the interaction of silver nanoparticles with viruses is a largely unexplored field. The present review discusses antiviral activity of the metal nanoparticles, especially the mechanism of action of silver nanoparticles, against different viruses such HSV, HIV, HBV, MPV, RSV, etc. It is also focused on how silver nanoparticles can be used in therapeutics by considering their cytotoxic level, to avoid human and environmental risks.