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Sonoelastography is a comparatively new and developing technology in the field of salivary gland imaging. Nevertheless, it has the potential to distinguish between various types of lesions by calculating the degree of strain-related deformation under the externally applied force. With this background, the present study was undertaken to evaluate the role of sonoelastography in characterising salivary gland lesions as benign or malignant. The aim: To evaluate and characterize salivary Gland lesions on the Gray scale and Colour doppler ultrasonography and sonoelastography and to correlate these findings with the clinico-pathological diagnosis. Methodology: This prospective cross-sectional study was conducted in the Department of Radiodiagnosis, Teerthanker Mahaveer Medical College & Research Centre, Moradabad (U.P.), from Aug 2021 to Nov 2022. All patients referred to the radiology department for imaging with clinical suspicion of having salivary gland lesions were enrolled in the study and evaluated on the SIEMENS ACUSON S3000 machine. Gray scale USG was done first to assess various morphological features of lesions, and then a Doppler assessment was done to determine vascularity within the lesion. Subsequently, real-time strain elastography (eSie touch) was performed to assess the tissue stiffness. The elastogram image of the detected lesions was evaluated using colour coding ranging from blue (soft) through green (intermediate/average hardness) and red (hard). After strain elastography, shear wave elastography of the lesion was also performed using Virtual Touch Quantification (VTQ) and Virtual Touch Imaging Quantification (VTIQ) software. The sonographic findings were correlated with histopathological diagnosis. The acquired data were subjected to statistical analysis using the software SPSS version 20. Sensitivity, specificity, PPV and NPV were calculated for conventional ultrasound techniques alone & in combination with elastography. Results: Out of the 50 salivary gland lesions included in the study, 44 (88 %) were benign, whereas 6 (12 %) were malignant on cytology. The age of the study population ranged from 16 to 75 years, with a mean age of 38.82 years. Pleomorphic adenoma (60 %) was the most frequent lesion, followed by Warthin's tumour (28 %). The Conventional USG showed 66.67 %, sensitivity, 52.27 %, specificity, 16.00 %, PPV, 92.00 % NPV and 54.00 % accuracy in differentiating benign from malignant lesions while USG- Elastography combined showed higher diagnostic performance with 83.33 %, sensitivity, 79.55 %, specificity, 35.71 % PPV, 97.22 % NPV and 80.00 %, accuracy. The specific cut-off scores for the sonoelastography score, eSie touch, VTQ, and VTIQ were also determined to diagnose a lesion as malignant or benign, and the difference was found to be statistically significant. Conclusions: Sonoelastography alone cannot be solely relied upon to distinguish between malignant & benign salivary gland abnormalities. However, it can be combined with conventional USG for better differentiation and characterization of these lesions, Соноеластографія є відносно новою технологією, що розвивається, у сфері візуалізації слинних залоз. Тим не менш, вона має потенціал для розрізнення різних типів пошкоджень шляхом розрахунку ступеня деформації, пов’язаної з деформацією під дією зовнішньої сили. З огляду на це, наше дослідження було проведено для оцінки ролі соноеластографії в характеристиці уражень слинних залоз як доброякісних, так і злоякісних. Мета: оцінити та охарактеризувати ураження слинних залоз за сірою шкалою, кольоровою доплерівською ультрасонографією та соноеластографією, і співвіднести ці дані з клініко-патологічним діагнозом. Методологія: це проспективне перехресне дослідження було проведено у відділенні променевої діагностики Медичного коледжу та дослідницького центру Teerthanker Mahaveer, Морадабад (U.P.), із серпня 2021 року по листопад 2022 року. Усіх пацієнтів направили до відділення радіології для візуалізації з клінічною підозрою на наявність ураження слинних залоз, всі вони були включені до дослідження та оцінені на апараті SIEMENS ACUSON S3000. Спочатку було проведено УЗД за сірою шкалою для оцінки різних морфологічних особливостей уражень, а потім було проведено допплерографію для визначення васкуляризації всередині ураження. Згодом була проведена деформаційна еластографія в реальному часі (eSie touch) для оцінки жорсткості тканини. Зображення еластограми виявлених уражень оцінювали за допомогою колірного кодування в діапазоні від синього (м’який) до зеленого (середня/середня жорсткість) і червоного (жорсткий). Після деформаційної еластографії також проводили еластографію зсувної хвилі ураження за допомогою програм Virtual Touch Quantification (VTQ) і Virtual Touch Imaging Quantification (VTIQ). Результати УЗД корелювали з гістопатологічним діагнозом. Отримані дані були піддані статистичному аналізу за допомогою програмного забезпечення SPSS версії 20. Чутливість, специфічність, PPV і NPV були розраховані для традиційних ультразвукових методів окремо та в поєднанні з еластографією. Результати: із 50 уражень слинних залоз, включених у дослідження, 44 (88 %) були доброякісними, тоді як 6 (12 %) були злоякісними за результатами цитологічного дослідження. Вік досліджуваної популяції коливався від 16 до 75 років із середнім віком 38,82 роки. Найчастішим ураженням була плеоморфна аденома (60 %), за нею йшла пухлина Вартіна (28 %). Традиційне УЗД показало 66,67 %, чутливість, 52,27 %, специфічність, 16,00 %, PPV, 92,00 % NPV і 54,00 % точність у диференціації доброякісних утворень від злоякісних, тоді як комбінована УЗД з еластографією продемонструвала вищу ефективність діагностики з 83,33 %, чутливості, 79,55 %, специфічності, 35,71 % PPV, 97,22 % NPV і 80,00 %, точністю. Специфічні граничні показники для оцінки соноеластографії, eSie touch, VTQ і VTIQ також були визначені для діагностики ураження як злоякісного або доброякісного, і різниця виявилася статистично значущою. Висновки: не можна покладатися лише на соноеластографію, щоб розрізнити злоякісні та доброякісні аномалії слинних залоз. Однак його можна поєднувати зі звичайним УЗД для кращої диференціації та характеристики цих уражень

Background Prospective evaluation of the effect of physical parameters like height, weight and abdominal girth on different skin entry points in transforaminal endoscopic lumbar discectomy (TELD) in lower lumbar discs. Methods This prospective study involved 174 patients with unilateral radicular pain or discogenic back pain, central, paracentral disc herniations and lateral canal stenosis at the level from L3 to S1 radiologically confirmed by magnetic resonance imaging (MRI) and failed conservative trial for 6 weeks. All patients underwent measurements of height, weight, body mass index (BMI), and abdominal girth preoperatively. All the four possible entry points, i.e., 45 to 45, posterolateral (PL), tip of spinous process (TOSP), and dorsum of the facet joint, were marked and point midway between PL and TOSP (PL-TOSP) skin entry was used. Results The change in the value, i.e., distance from midline of all the entry points with physical parameters like height, weight, BMI, and abdominal circumference was statistically significant. The visual analog scale score decreased from a preoperative value of 7.98 to 1.84 at 6 months follow-up. The Oswestry disability index score improved from 72.53 to 16.26. Conclusion The entry point in TELD is not a fixed value as it varies with the physical parameters like weight and abdominal girth of the patient. PL-TOSP is a safe entry point for common pathologies like central, paracentral herniations and lateral canal stenosis in lower lumbar levels and can be predicted preoperatively by proposed formula.

COVID-19 pandemic has affected the mental health of individuals, particularly young adults. Using the ‘strength and difficulty questionnaire 17+ extended version’, we studied the severity of psychological problems and the resultant distress in young adults; the relationship between the ‘difficulty’ and ‘impact’ scores; and the effect of distress in terms of a number of day-to-day activities affected during a pandemic. Data was collected from 743 college/university students (December 2020-February 2021) in India. Descriptive, relative frequencies, and nonparametric tests are applied here. Females were facing more psychological behavioral problems as compared to males as the p-value is less than 0.001. Males with age

Background: A definitive diagnosis of spinal tuberculosis (TB) remains challenging. The “gold standard” is to obtain histopathological confirmation of the lesion. This analysis highlights how to avoid missing the diagnosis of an extramedullary myeloid sarcoma (EMS) versus TB. Case Description: A 25-year-old male presented with paraparesis. Although this was first attributed to TB spondylodiscitis, a PET-CT and reevaluation of the biopsy specimen both confirmed the diagnosis of an EMS. Conclusion: Nontubercular spinal disease should be suspected when a patient deteriorates despite the institution of antitubercular therapy for a reasonable duration. Further, microbiological and/or pathological confirmation is warranted to direct appropriate treatment and differentiate spinal TB from other entities as, in this case, an EMS.

Background: Approach to the L5–S1 level with transforaminal access can be challenging. Some surgeons employ the interlaminar or paraspinal endoscopic approach as an alternative apart from the other minimally invasive posterior surgical options. To precisely target and safely access disc herniations at L5–S1, the authors attempted to stratify patients into trans and supra iliac approach groups and propose a simple surgical classification based on the radiographic findings. Methods: A prospective study was performed on a cohort of 90 patients with L5–S1 disc herniation who underwent transforaminal endoscopic discectomy through suprailiac or transiliac approach depending on the best trajectory to access the herniated disc. Preoperative radiological assessment was done on anteroposterior and lateral radiographs of the lumbosacral spine by two independent observers. The proposed classification and approach guidelines were used to stratify patients for the preferred access route. The outcome was measured as mean VAS and ODI scores pre-operative and at 6 months post-operative and compared using the null hypothesis (P value) and the paired t -test. The interrater reliability was calculated as the percentage agreement between different observers. Results: The L5–S1 disc herniation was treated with the transforaminal approach in 46 patients via the suprailiac and in the remaining 44 patients via the transiliac approach. There were statistically significant VAS and ODI reductions in patients of both groups (P

STUDY QUESTION Does cord blood androgen level obtained at birth affect the AGD in human newborns? SUMMARY ANSWER In human newborns, though males have a significantly longer AGD compared to females (as early as 22 weeks of gestation) the AGD is not affected by androgen levels at birth in both the sexes. WHAT IS KNOWN ALREADY Animal studies have reported a critical time period in early fetal life, termed the masculinization programming window (MPW) during which AGD is fixed by in utero androgen action and is unaffected by testosterone levels later during gestation. Thus, AGD may serve as a lifelong biomarker of androgen exposure during this window. This MPW is hypothesized to occur in humans at 8-14 weeks of gestation during which AGD is fixed. The effect of androgens (testosterone) on AGD after the MPW in humans is not known. Furthermore, altered AGD has been associated with various human reproductive health disorders in both males and females. STUDY DESIGN, SIZE, DURATION A prospective descriptive cohort study was performed using data from randomly selected neonates (n = 205) born at a single center over a period of 1 year (August 2015 to August 2016). PARTICIPANTS/MATERIALS, SETTING, METHODS AGDs in male (n = 117) and female infants (n = 88) together with penile width, glans girth and stretched penile length were measured by trained caregivers. Gestation ranged from 22 to 41 weeks and infants were examined within 24 h of birth (within 48-72 h in very sick preterm infants after clinical stabilization). AGD-1 was measured from the center of the anus to the posterior base of scrotum in males or to the posterior fourchette in females. AGD-2 was measured from the center of the anus to the anterior base of the penis in males or to the clitoris in females. Sex steroid hormones (testosterone, 17-OH progesterone (17-OHP) and androstenedione) were measured in serum prepared from umbilical cord blood samples taken at birth, using liquid chromatography-tandem mass spectrometry. MAIN RESULTS AND THE ROLE OF CHANCE Males had a significantly lower gestational age (mean ± SD; 34.6 ± 4.9 versus 36.1 ± 4.1 weeks, P = 0.04), and a significantly longer AGD-1 (mean ± SD; 21.6 ± 6.0 versus 12.7 ± 3.8 mm, P < 0.001) and AGD-2 (41.9 ± 8.7 versus 33.9 ± 7.1 mm, P = 0.004) compared to female infants, respectively. The cord serum testosterone levels were significantly higher for male than female infants [median, interquartile range; 13.0 (7.3, 20.5) versus 4.1 (2.5, 5.9), ng/dl, P < 0.001]. There was no difference in levels of 17-OHP (P = 0.697) or androstenedione (P = 0.601) between the two sexes. On multiple regression analysis after adjusting for potential confounders, none of the AGD's in both males and females correlated with any sex steroid hormonal levels. We also provide normative charts for penile length, penile width and glans girth in preterm and term infants. LIMITATIONS, REASONS FOR CAUTION No data were collected on family history of genital malformation, infertility or hormonal disorders, parental endocrine-disrupting chemical exposure or diet pattern, any of which might have influenced the AGD and/or sex steroid hormone levels in the offspring. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that AGD in humans, like animals, is fixed in early gestation (likely during the hypothesized MPW) and is unaffected by androgen levels thereafter. Thus, AGD can serve as a biomarker of in utero androgen action during early gestation (likely 8-14 weeks) in humans. As such, causes of human newborn and adult reproductive health disorders, such as endocrine disruptors, should be explored during early gestation. However, further larger studies are needed to help corroborate these findings. STUDY FUNDING/COMPETING INTERESTS No specific funding was obtained for this study, and all authors have no conflict of interest to declare.

The three currently used methods of treatment: namely open reduction plate osteosynthesis (ORPO), Minimally invasive plate osteosynthesis (MIPO), antegrade intramedullary nailing(IMN) are all reported as satisfactory procedures for treatment of humeral shaft fractures. However none of the published reports have a comparison of superiority of one procedure over the other. We evaluated the clinical, radiological and functional outcome of the three procedures.We studied adult patients with humerus shaft fractures over a period of 2 years from May 2014 to May 2016 in a level 1 trauma center. Forty-four were treated with IMN, 34 treated with ORPO, and 34 with MIPO. The null hypothesis tested in this study is that there is no difference between IMN, ORPO, MIPO with respect to union time, surgical time, complication rate, non-union rate and functional outcome. Functional outcome was studied by comparing the UCLA shoulder and MEP scores in the three groups.112 patients were studied consisting of 83 males and 29 females with mean age of 39 years (range 18-70). IMN group showed early union with mean of 12.73 weeks compared to MIPO (14.45 weeks) and ORPO(13.58 weeks), (p0.05). MIPO had no events of non-union, as compared to ORPO (5 non-unions) and IMN (10 non-unions), (p=0.04). The range of movement at the shoulder with the UCLA score was significantly better with a score of 32.26 in MIPO as compared to 27.54 in IMN and 28.82 in ORPO (p0.05). The difference in MEPS score in the three groups was not significant (p=0.31). IMN required a mean of 117.95 minutes intraoperatively as compared to 131 and 150.58 mins in MIPO, ORPO respectively.MIPO is overall better with respect to non-union, functional outcome and complications rate. The surgical time depends on the surgeons' skill and learning curve. Thus considering the advantages and risks involved in the various procedure and surgical acumen, each case should be individualized to have a good outcome. We advocate that MIPO can be safely used as an alternative in treating these fractures.

In present works authors have developed a computerized classification procedure for tumor mass in breasts using digital mammogram. The process implements genetic algorithm and hybrid neuro-fuzzy approaches to classify tumor masses into benign and malignant group in order to assist the physicians for treatment planning. The classification process is based on accurate analysis of shape and margin of tumor mass appearing in breast. The shape features using Fourier descriptors introduce a large number of feature vectors. Thus, to classify different boundaries, a standard multilayer preceptor needs large number of inputs. Simultaneously, to train the network, a large number of training cycles and huge memory are also required. It is obvious that a complicated structure invites the problem of over learning and misclassification. In proposed methodology genetic algorithm (GA) has been used for the searching of effective input feature vectors. Adaptive neuro-fuzzy model has been used for final classification of different boundaries of tumor masses. The proposed technique is an innovative soft computing approach that removes the limitation of conventional neural networks and indicates a promising direction of adaptation in a changing environment. The classification system utilizes a Euclidean distance function to detect the belongingness of masses in benign and in malignant classes along with degree of benignancy/malignancy. Presently 200 digitized mammograms from MIAS and other databases have been considered for the experiment and which have shown an average of approximately 86% correct classification as compared with clinical data with a highest rate of 88.9%.

Purpose To correct for spatial misregistration of multi-breath-hold short-axis (SA), two-chamber (2CH), and four-chamber (4CH) cine cardiac MR (CMR) images caused by respiratory and patient motion. Materials and Methods Twenty CMR studies from consecutive patients with separate breath-hold 2CH, 4CH, and SA 20-phase cine images were considered. We automatically registered the 2CH, 4CH, and SA images in three dimensions by minimizing the cost function derived from plane intersections for all cine phases. The automatic alignment was compared with manual alignment by two observers. Results The processing time for the proposed method was