Primary Pulmonary Primitive Neuroectodermal Tumor of Lung in a Child

Introduction: Peripheral primitive neuroectodermal tumor (pPNET) arising from lung without involvement of chest wall is very rare. Peripheral primitive neuroectodermal tumor are poorly differentiated, highly aggressive tumor of undetermined histogenesis with a tendency toward early metastasis. Diagnosis needs to be established conclusively by histopathology, immunohistochemistry and molecular studies.Presentation of the cases: A 2 year 10-month old child was investigated for fever, cough and cold and was detected to have right intrathoracic cystic mass on imaging. The mass was excised with possibility of pleuropulmonary blastoma. After excision child was referred to our center for decision on further management. Histopathological examination, immunohistochemistry and molecular study for EWSR gene rearrangement proved the diagnosis of Ewing sarcoma. Metastatic work up for our case was negative. Child is currently undergoing chemotherapy and is asymptomatic.Conclusion: Primitive neuroectodermal tumor (PNET) of lung without chest wall involvement in pediatric age group is a rare occurrence. Available literature suggests highly aggressive nature of such tumor. This case report summarizes the differential diagnosis of such rare pulmonary neoplasm in children and role of immunohistochemistry and molecular studies to establish the diagnosis conclusively

TMJ ankylosis: Management with reconstruction and interpositional arthroplasty

Temporomandibular joint (TMJ) ankylosis is a very desolating structural condition that involves fusion of the 1 mandibular condyle to the base of the skull. It causes difficulty in mastication and breathing.Trauma and Infections are usually responsible.If trauma occurs in young age,it leads to disturbance in growth & facial asymmetry.Treatment of temporomandibular joint (TMJ) ankylosis usually requires adequate excision of the involved ankylotic 2 block (arthroplasty)or interpositional arthroplasty using autogenous or alloplastic materials. Early mobilization, 3 physiotherapy & strict follow up are essential to prevent postop adhesions.In our cases fascia lata was used as an interpositional grafting material. One case was treated bygap arthroplasty, second case by costochondral graft & third case was managed with titanium condylar prosthesis.Keywords: Temporomandibular joint ankylosis, costochondral graft, titanium condylar prosthesis, gap arthroplast

To Implant or not to Implant?: The Role of Imaging

Missing teeth are best replaced by implants, provided the implant is placed in a way that it fulfills esthetic, functional and biomechanical requirements. The assessment of the proposedimplant site requires a very specific and accurate data. This could be accomplished by various imaging modalities starting from two-dimensional traditional radiographs to three-dimensional computed tomography and cone beam computed tomography. The purpose of this article is to provide an overview of different imaging modalities, the type of imaging best suited at different time frames of implant placement and effective radiation dose to the patient in these imaging modalities

What Can Legacy Patient-Reported Outcome Measures Tell Us About Participation Bias in Patient-Reported Outcomes Measurement Information System Scores Among Lumbar Spine Patients?

Objective Patient-Reported Outcomes Measurement Information System (PROMIS) is a validated tool for assessing patient-reported outcomes in spine surgery. However, PROMIS is vulnerable to nonresponse bias. The purpose of this study is to characterize differences in patient-reported outcome measure scores between patients who do and do not complete PROMIS physical function (PF) surveys following lumbar spine surgery. Methods A prospectively maintained database was retrospectively reviewed for primary, elective lumbar spine procedures from 2015 to 2019. Outcome measures for Patient Health Questionnaire-9 (PHQ-9), visual analogue scale (VAS) back & leg, Oswestry Disability Index (ODI), and 12-item Short Form health survey physical composite summary (SF-12 PCS) were recorded at both preoperative and postoperative (6 weeks, 12 weeks, 6 months, 1 year, 2 years) timepoints. Completion rates for PROMIS PF surveys were recorded and patients were categorized into groups based on completion. Differences in mean scores at each timepoint between groups was determined. Results Eight hundred nine patients were included with an average age of 48.1 years. No significant differences were observed for all outcome measures between PROMIS completion groups preoperatively. Postoperative PHQ-9, VAS back, VAS leg, and ODI scores differed significantly between groups through 1 year (all p < 0.05). SF-12 PCS differed significantly only at 6 weeks (p = 0.003). Conclusion Patients who did not complete PROMIS PF surveys had significantly poorer outcomes than those that did in terms of postoperative depressive symptoms, pain, and disability. This suggests that patients completing PROMIS questionnaires may represent a healthier cohort than the overall lumbar spine population

Effects of Anterior Plating on Achieving Clinically Meaningful Improvement Following Single-Level Anterior Cervical Discectomy and Fusion

Objective The clinical utility of anterior cervical plating for anterior cervical discectomy and fusion (ACDF) procedures remains controversial. This study aims to compare the impact of cervical plating on achievement of minimum clinically important difference (MCID) up to 2 years following ACDF. Methods Patients undergoing primary, single-level ACDF procedures were grouped based on whether their procedure included application of an anterior cervical plate. Demographics, preoperative spinal diagnoses, operative characteristics, and patient-reported outcome measures (PROMs) were compared between plating groups. Achievement of an MCID was assessed using the following previously established thresholds: 12-item Short Form health survey physical component summary (SF-12 PCS) 8.1, visual analogue scale (VAS) neck 2.6, VAS arm 4.1, Neck Disability Index (NDI) 8.5. Rates of MCID achievement were compared between groups. Results The cohort included 192 patients of whom 102 received plating and 90 received no plating. Plating status was significantly associated with Charlson Comorbidity Index and insurance status. Operative duration and estimated blood loss were significantly greater for the plating group. Both groups demonstrated significant improvements at the majority of postoperative timepoints. Significant intergroup differences in PROM improvement were demonstrated for VAS neck and NDI at 6 weeks. Rates of MCID achievement differed significantly between groups for NDI at 6 weeks, and 12 weeks, and SF-12 PCS overall. Conclusion Patients improved significantly in terms of pain, disability and physical function, regardless of plating status, and with the exception of early neck pain and disability, these improvements were similar between groups. Patients that underwent plating as part of their ACDF procedure achieved an MCID for physical function at lower rates overall

Using Swallowing Quality of Life to Compare Oropharyngeal Dysphagia Following Cervical Disc Arthroplasty or Anterior Cervical Discectomy and Fusion

Objective To evaluate dysphagia outcomes using the swallowing quality of life (SWAL-QOL) questionnaire between patients undergoing cervical disk arthroplasty (CDA) or anterior cervical discectomy and fusion (ACDF). Methods Patient-reported outcome measures (PROMs) were collected using SWAL-QOL, VAS, NDI, and SF-12 PCS. All measures were recorded preoperatively to 6-month postoperatively. Patients were grouped according to cervical procedure and instrumentation used. Differences in PROMs and SWAL-QOL domains were evaluated by t-test and one-way ANOVA with post-hoc testing, respectively. Simple linear regression was employed to evaluate the relationship between number of levels operated on and postoperative outcomes. Results 161 patients were included. CDA patients had significantly worse SWAL-QOL scores at 6-months. Preoperative VAS neck was significantly worse for patients who underwent either an ACDF procedure with a stand-alone cage or CDA as compared to patients who underwent an ACDF with anterior plating. At 6-months postoperatively, CDA patients reported a significantly worse “fatigue” score compared to ACDF patients. At 6-months postoperatively, ACDF patients reported a significantly better “sleep” scores compared to CDA patients with both recipients of an anterior plate and stand-alone cage reporting significantly better scores compared to the CDA cohort (p=0.024; p<0.001). The SWAL-QOL domain of symptom frequency at 6-weeks postoperatively was significantly associated with number of levels operated (p=0.032). Conclusion Patients undergoing either an ACDF or CDA procedure largely did not demonstrate differences in pain, disability, and dysphagia scores. However, at more longitudinal timepoints CDA patients reported worse fatigue and sleep scores compared to ACDF patients

ELIXR: Towards a general purpose X-ray artificial intelligence system through alignment of large language models and radiology vision encoders

Our approach, which we call Embeddings for Language/Image-aligned X-Rays, or ELIXR, leverages a language-aligned image encoder combined or grafted onto a fixed LLM, PaLM 2, to perform a broad range of tasks. We train this lightweight adapter architecture using images paired with corresponding free-text radiology reports from the MIMIC-CXR dataset. ELIXR achieved state-of-the-art performance on zero-shot chest X-ray (CXR) classification (mean AUC of 0.850 across 13 findings), data-efficient CXR classification (mean AUCs of 0.893 and 0.898 across five findings (atelectasis, cardiomegaly, consolidation, pleural effusion, and pulmonary edema) for 1% (~2,200 images) and 10% (~22,000 images) training data), and semantic search (0.76 normalized discounted cumulative gain (NDCG) across nineteen queries, including perfect retrieval on twelve of them). Compared to existing data-efficient methods including supervised contrastive learning (SupCon), ELIXR required two orders of magnitude less data to reach similar performance. ELIXR also showed promise on CXR vision-language tasks, demonstrating overall accuracies of 58.7% and 62.5% on visual question answering and report quality assurance tasks, respectively. These results suggest that ELIXR is a robust and versatile approach to CXR AI

Effect of Plant Growth Regulators and Spacing on Growth and Yield of Chickpea (Cicer arietinum L.)

Background: Chickpea is leguminous crop, which offers a good nutrition to people across the world. As a rich source of vitamins, minerals, and fiber, chickpeas may offer a variety of health benefits, such as aiding weight management, improving digestion, and reducing your risk of disease. Objectives: To evaluate the effect of Plant growth regulators and spacing in growth and yield of Chickpea. Methods: With the goal of studying the effect of plant growth regulators and spacing on growth and yield of Chickpea under a Randomized block design with 9 treatments (T1-T9) The experimental results revealed that GA3@10ppm+30cmx10cm produced maximum plant height (56.84), plant dry weight (17.45g/plant) no of nodules per plant (23.33) and yield parameters no of pods per plant (65.50) no of seeds per pod (1.84) seed yield (2.07 ta/ha) and stover yield (3.11ta /ha). Conclusion: The combination of GA3@10ppm and 30cmx10cm proved to be the most advantageous to farmers, resulting in 56.84cm plant height, 17.45-gm plant dry weight, no of nodules per plant (23.33) and yield parameters no of pods per plant (65.50) no of seeds per pod (1.84) seed yield (2.07 ta/ha) and stover yield (3.11ta /ha), respectively

Parotid Sialocele and Fistulae: Current Treatment Options

Parotid gland and duct injuries are rare complications following surgery of parotid gland and temporomandibular joint. Various other causes of parotid injury are rupture of parotid abscess, inadvertent incision of parotid abscess, complication of superficial Parotidectomy, gunshot wounds and trauma. Injury to the parotid duct may be difficult to diagnose and treat. If not recognized will lead to salivary fistula and sialocele formation which will not heal spontaneously because of continuous flow of saliva. Persistent salivary fistula may be most troubling to the patient. Successful treatment depends on early recognition and appropriate early intervention