Explore the vast range of titles available.

Ductal stenting in late presenters with transposition of great arteries with intact ventricular septum retrains the left ventricle before arterial switch operation. However, the experience is limited for its efficacy and safety. This study aims to highlight the efficacy and safety of ductal stenting for retraining the left ventricle. Eight children with transposition of great arteries-intact ventricular septum and regressed left ventricle underwent ductal stenting. Serial echocardiographic measurements of left ventricle shape, mass, volume, free wall thickness, and function were done, and arterial switch operation was performed once the left ventricle was adequately prepared. Post-operative outcome in terms of duration of mechanical ventilation, ICU stay, and improvement in left ventricle function were monitored. The procedure was successful in all patients. Babies were divided into two groups on basis of age at ductal stenting (group 1 age less than 90 days and group 2 age more than 90 days) and were evaluated for the degree of left ventricle retraining as evidenced by echocardiographic parameters and post-operative variables. The left ventricle posterior wall thickness and mass index after ductal stenting increased significantly in both the groups. Postoperatively, one baby of group two expired after seven days due to severe left ventricle dysfunction. Rest babies had an uneventful post-operative ICU stay with no statistical difference in the duration of invasive mechanical ventilation or ICU stay. On six-month follow-up, all surviving babies were doing well with normal left ventricle function. Ductal stenting is a good alternative measure as compared to surgical procedures for left ventricle retraining in transposition of great arteries with regressed left ventricle.

Background: The standard first stage palliation for univentricular heart with unrestricted pulmonary blood flow (PBF) is surgical pulmonary artery (PA) banding for which the ideal age is within the first 8 weeks of life. This study aimed to look for the utility of PA band done beyond 3 months of age for patients presenting beyond the stipulated period. Materials and Methods: This is a retrospective analysis of the outcome of twenty patients with single ventricle (SV) physiology with unrestricted PBF who presented late and were selected on the basis of clinical, radiological, and echocardiographic parameters for PA banding. Results: The median age of the patients was 5.5 months (3.5-96 months), and the median body weight was 4.7 kg (3.2-22.0 kg). The patients were divided into three groups as follows: ten patients between 3 and 6 months of age (Group A), seven patients between 6 months to 1 year of age (Group B), and three patients > 1 year of age with additional features of pulmonary venous hypertension (Group C). The mean reduction of PA pressures following PA band was 60.9%, 48.8%, and 58.3% and the mean fall in oxygen saturation was 10.4%, 8.0%, and 6.6% in the three groups, respectively. The postoperative mortality rate was 10%. The mean follow up duration was 13.5 months (7-23 months). There was a statistically significant improvement in weight for age Z scores following PA band (P = 0.0001). On follow up cardiac catheterization, the mean PA pressures were 16.6 (±3.6), 22.7 (±5.7), and 33.3 (±12.4) mmHg, respectively, in the three groups, and the mean pulmonary vascular resistance index was 1.86 (±0.5), 2.45 (±0.7), and 3.5 (±1.6) WU.m2, respectively. Subsequently, seven patients in Group A, three patients in Group B, and one patient from Group C underwent successful bidirectional Glenn (BDG) surgery. Conclusions: Late PA band in selected patients with SV physiology can have definite benefit in terms of correction of heart failure symptoms and subsequent conversion to BDG and can potentially change the natural history of disease both in terms of survival and quality of life.

Peripheral arterial disease (PAD) is caused by atherosclerosis in the major extremity vessels. Incidence of PAD ranges from 3 to up to 20%. The most common symptom of the disease is intermittent claudication, mainly affecting the calf muscles. These patients usually present for surgeries extending from bypassing the blocked vascular segment to amputations. Successful outcome of these surgeries require a well-planned preoperative testing, controlled intraoperative environment and adequate postoperative management. We present an interesting case of a PAD patient who underwent a re-do surgery complicated by graft thrombosis, electrolyte disturbances and renal dysfunction, which, managed appropriately, resulted in best surgical outcomes.

Graph neural networks (GNNs) present a promising alternative to CNNs and transformers in certain image processing applications due to their parameter-efficiency in modeling spatial relationships. Currently, a major area of research involves the converting non-graph input data for GNN-based models, notably in scenarios where the data originates from images. One approach involves converting images into nodes by identifying significant keypoints within them. Super-Retina, a semi-supervised technique, has been utilized for detecting keypoints in retinal images. However, its limitations lie in the dependency on a small initial set of ground truth keypoints, which is progressively expanded to detect more keypoints. Having encountered difficulties in detecting consistent initial keypoints in brain images using SIFT and LoFTR, we proposed a new approach: radiomic feature-based keypoint detection. Demonstrating the anatomical significance of the detected keypoints was achieved by showcasing their efficacy in improving registration processes guided by these keypoints. Subsequently, these keypoints were employed as the ground truth for the keypoint detection method (LK-SuperRetina). Furthermore, the study showcases the application of GNNs in image matching, highlighting their superior performance in terms of both the number of good matches and confidence scores. This research sets the stage for expanding GNN applications into various other applications, including but not limited to image classification, segmentation, and registration.

ABSTRACT Natural vaccination against pathogens are known to be achieved by herd-immunity i.e. infected human host provide immunity to the community by spreading the pathogen. Whether, infected human hosts transmit vesicle packed aerosols of pathogen’s antigen for natural vaccination of the community has not yet been considered. We have explored a traditional healing method of aerosol-inoculation against small pox and tuberculosis in the Sualkuchi-Hajo cultural complex of Kamarupa, an ancient Indian region known for tantra-based healing and spirituality. In the aerosol-inoculation method against TB, selected persons with TB (later identified as smear negative TB subject) are encouraged to spread good nigudah in the community by Kirtan chanting; the good Nigudah are thought to be present within bad-nigudah or invisible krimis (tiny flesh eating living being mentioned in ancient India’s medicinal text Caraka Samhita and Atharva Veda). A 15-years of contact TB investigation study, as well as laboratory study of aerosol obtained from smear negative PTB (SN-PTB) subjects led to the identification of good Nigudah as extracellular vesicles (EVs) filled with Mtb-antigen ESAT-6. We then developed a mouse model of aerosol-inoculation using SN-PTB subject derived aerosol EVs, and identified Mtb infected mesenchymal stem cells (MSCs) of the lung as the putative source of the ESAT-6+ EVs. These Mtb infected MSCs reprogram to altruistic stem cell (ASC) phenotype, which then secrete ESAT-6+ EVs to the aerosols; healthy mice receiving the aerosol develop Mtb specific herd immunity. These results expedite our ongoing work on the innate defense mechanism of ASCs against pathogen, and provide a novel mechanism of natural vaccination, where the host extracts appropriate antigens from a pathogen, and then spread it in the community via aerosols. Competing Interest Statement The authors have declared no competing interest. Footnotes * The author affiliation were not correctly shown. This time, I have added one institute for each author, as previously when we added more than one institute for the author, it didn't show as separate institute. * Abbreviations SN-PTB smear-negative Pulmonary tuberculosis AESN-PTB Aerosol derived extracellular vesicles of smear negative PTB subject SP-PTB smear positive pulmonary tuberculosis FGD focused group discussion JUT Jiva Upakar Tantra (Vedic Altruism)