Contributions of Machine Learning in the Management of Stroke: A Bibliometric Analysis of the 50 Most Cited Articles

BACKGROUND

Though currently considered a 'black box,' machine learning (ML) has a promising future to ameliorate the health-care burden of stroke which is the second leading cause of mortality worldwide. Through this study, we sought to review the most influential articles on the applications of ML in stroke.

METHODS

Web of Sciences database was searched, and a list of the top 50 most cited articles, assessing the application of ML in stroke, was prepared by 2 authors, independently. Subsequently, a detailed analysis was performed to characterize the most impactful studies.

RESULTS

The total number of citations to the top 50 articles were 2959 (range 35-243 citations) with a median of 47 citations. Highest number of articles were published in the journal Stroke and the United States was the major contributing country. The majority of the studies focused on the utilization of ML to improve stroke risk prediction, diagnosis, and outcome prediction. Statistical analysis revealed an insignificant association between the total and mean number of citations and the impact factor of the journal (P = 0.516 and 0.987, respectively).

CONCLUSIONS

Recent years have witnessed a surge in the application of ML in stroke, with an enhancement in interest and funding over the years. ML has revolutionized the management of stroke and continues to aid in the neurosurgical decision-making and care in stroke patients.

Subdural Hematoma due to Dural Metastasis: A Systematic Review on Frequency, Clinical Characteristics, and Neurosurgical Management

BACKGROUND

 Subdural hematoma (SDH) occasionally accompanies dural metastasis and is associated with high recurrence rate, significantly impacting patient morbidity and mortality. This systematic review aims to evaluate the characteristics, management options, and outcomes of patients with SDH associated with dural metastasis.

METHODS

 A comprehensive search of the PubMed and Cochrane databases was conducted for English-language studies published from inception to March 20, 2023, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The authors reviewed cases of histopathologically confirmed SDH with non-central nervous system (non-CNS) tumor metastasis, focusing on therapeutic management of SDH. Statistical analysis was performed using SPSS software, with a significance level set at 0.05.

RESULTS

 This review included 32 studies comprising 37 patients with 43 SDH cases associated with dural metastasis. Chronic SDH was the most frequently observed presentation (n = 28, 65.12%). The systemic malignancies most commonly associated with SDH due to dural metastasis were prostate carcinoma (n = 9, 24.32%) and gastric carcinoma (n = 5, 13.51%). A statistically significant association was found between metastatic melanoma and subacute SDH (p = 0.010). The majority of patients were treated with burr holes (n = 15, 40.54%) or craniotomies (n = 14, 37.84%), with no statistically significant difference in mortality rates between the two techniques (p = 0.390). Adjuvant therapy was administered to a limited number of patients (n = 5, 13.51%), including chemotherapy (n = 2, 5.41%), whole brain radiotherapy (n = 1, 2.70%), a combination of chemotherapy and whole brain radiotherapy (n = 1, 2.70%), and transcatheter arterial chemoembolization (n = 1, 2.70%). The overall recurrence rate was 45.95% (n = 17), with burr holes being the most common management approach (n = 4, 10.81%). Within a median of 8 days, 67.57% (n = 25) of patients succumbed, primarily due to rebleeding (n = 3, 8.11%), disseminated intravascular coagulation (n = 3, 8.11%), and pneumonia (n = 3, 8.11%).

CONCLUSION

 This review highlights the need for improving existing neurosurgical options and exploring novel treatment methods. It also emphasizes the importance of dural biopsy in patients with suspected metastasis to rule out a neoplastic etiology.

The Call for Neuroendoscopy Cadaveric Workshops in Lower-Middle Income Countries

OBJECTIVE

This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in a lower-middle income country.

METHODS

Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and postworkshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using P < 0.05.

RESULTS

A total of 24 delegates (40%) consented to participate in the study, with only 1 female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (P < 0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (P = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (P < 0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in lower-middle income countries and integrated into residency curricula.

CONCLUSIONS

Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.

Reoperation rate and risk factors of reoperation for ossification of the posterior longitudinal ligament (OPLL): a systematic review and meta-analysis

Revision surgery for OPLL is undesirable for both patients and physicians. However, the risk factors for reoperation are not clear. Thus, we sought to review the existing literature and determine the factors associated with higher reoperation rates in patients with OPLL. A search was performed using Pubmed, Embase, Web of Sciences, and Ovid to include studies regarding the risk factors of reoperation for OPLL. RoBANS (Risk of Bias Assessment tool for Nonrandomized Studies) was used for risk of bias analysis. Heterogeneity of studies and publication bias was assessed, and sensitivity analysis was performed. Statistical analysis was performed with a p-value < 0.05 using SPSS software (version 23). Twenty studies with 129 reoperated and 2,793 non-reoperated patients were included. The pooled reoperation rate was 5% (95% CI: 4% to 7). The most common cause of reoperation was residual OPLL or OPLL progression (n = 51, 39.53%). An increased risk of additional surgery was found with pre-operative cervical or thoracic angle (Standardized mean difference = -0.44; 95% CI: -0.69 to -0.19; p = 0.0061), post-operative CSF leak (Odds ratio, OR = 4.97; 95% CI: 2.48 to 9.96; p = 0.0005), and graft and/or hardware failure (OR = 192.09; 95% CI: 6.68 to 5521.69; p = 0.0101). Apart from the factors identified in our study, the association of other variables with the risk of second surgery could not be ruled out, owing to the complexity of the relationship and significant bias in the current literature.

Endoscopic versus microscopic discectomy for pathologies of lumbar spine: A nationwide cross-sectional study from a lower-middle-income country

Objective

We conducted a cross-sectional study to assess the preference of spine surgeons between MD for microdiscectomy and endoscopic discectomy (ED) surgery for the management of lumbar pathologies in a lower-middle-income country (LMIC).

Methodology

An online survey assessing the preference of spine surgeons for various lumbar pathologies was developed and disseminated in "Neurosurgery Cocktail" a social media platform. Statistical analyses were performed using SPSS software with a level of significance <0.05.

Results

We received responses from 160 spine surgeons having a median experience of 6.75 years (range 0-42 years) after residency. Most of the spine surgeons preferred MD over ED, preference being homogeneous across all lumbar pathologies. In ED, the interlaminar approach was preferred more frequently than the transforaminal approach. The most commonly chosen contraindication for the interlaminar approach and transforaminal approach was ≥ 3 levels lumbar disc herniation (LDH) (n = 117, 73.1%) and calcified LDH (n = 102, 63.8%), respectively. There was no significant association between the type of approach preferred (MD vs. ED; and interlaminar vs. translaminar endoscopic approach) with the type of workplace and the level of experience.

Conclusion

Spine surgeons were inclined toward MD over ED, due to various reasons, such as a steep learning curve, lack of training opportunities, and upfront expenses. There is a pressing need for the upliftment of ED in LMICs which requires global action.

Highly correlated structural, local structural, Raman spectroscopic and magnetic properties of Mn-substituted Cu2V2O7

Low-dimensional quantum spin ½ system Cu2V2O7has been investigated in the framework of Mn-substitution at the Cu site, which is really un-investigated. The studied compounds Cu2 -xMnxV2O7(x= 0, 0.05, 0.1 and 0.15) have been synthesized and characterized structurally, spectroscopically, local structurally and magnetically via x-ray diffraction, Raman, x-ray absorption and temperature, field dependent magnetization measurements respectively. Although Cu2V2O7can be found inα, βandγ-phase, however all of the studied compounds are found in single orthorhombicα-phase which has crucial magneto-electric application potential. Temperature dependent Raman spectra indicated anharmonic phonon-phonon scattering but there is no spin-phonon coupling for VO4vibrational modes. The local structure probed via x-ray absorption near edge structure and extended x-ray absorption fine structure spectroscopy at 15 K, 300 K indicates Cu2+, V5+and mixed valent Mn2+and Mn3+ionic states and justified local structure for the probed ions. Magnetic measurements indicate long-range antiferromagnetic ordering with doping independent Neel temperature (32.5 K). Further observations are strong magnetic hysteresis at 5 K (due to canted spin structure), zero field exchange-bias and their noteworthy enhancement upon Mn-substitution. Interesting correlation between structural parameters and magnetic exchanges has been developed.

Learnings from Asia's first ever medical student neurosurgery Conference: NEUROFEST, 2022

The study lays out the design and learnings of Neurofest, Asia's first ever medical student Neurosurgery conference organized by Walter E Dandy Medical Student Neurosurgery Club, India. Neurofest was conducted in October 2022 inclusive of various events: workshops, talks and contests. An online post-conference questionnaire was disseminated among the delegates to record their experience and feedback for the conference. Statistical analysis was performed using SPSS with a level of significance p < 0.05. Of the 158 total delegates, 65.2% (n = 103) participated in this study. The majority of the responders were satisfied with the events at the conference. 85.4% (n = 88) of the respondents reported an increased interest in neurosurgery, probably due to the quality of workshops (p = 0.004), talks by faculty (p = 0.023), contacts with the faculty (p = 0.025) and confidence in approaching a faculty (p < 0.001). 92.2% (n = 95) of the respondents claimed to recommend Neurofest to their colleagues. The reasons for this were found to be the quality of workshops (p = 0.001) and confidence in approaching a faculty (p = 0.030). Nearly all respondents believed that such conferences are important in empowering medical students (n = 100, 97.1%). Similar conferences are required to provide medical students with early exposure to neurosurgery. In the future, continued research is required to optimize neurosurgical conferences and endorse the prospect of neurosurgery as a career option in Lower-Middle Income countries.

Utility of Machine learning in the Management of Normal Pressure Hydrocephalus (NPH): A Systematic Review

BACKGROUND

In the past decade many machine learning (ML) models have been utilized in the management of normal pressure hydrocephalus (NPH). This study aims at systematically reviewing those ML models.

METHODS

Pubmed, EMBASE and Web of Science databases were searched for studies reporting applications of ML in NPH. Quality assessment was performed using PROBAST and TRIPOD adherence reporting guidelines and statistical analysis was performed with level of significance <0.05.

RESULTS

A total of 22 studies with 53 models were included in the review of which convolutional neural network (CNN) was the most utilized model. Inputs used to train various models included clinical features, CT scan, MRI, intracranial pulse waveform characteristics and perfusion infusion. The overall mean accuracy of the models was 77% (highest for CNN, 98% while lowest for Decision tree (DT), 55% p=0.176). There was a statistically significant difference in the accuracy and AUC of diagnostic and interventional models (accuracy; 83.4% vs 69.4%, AUC; 0.882 vs 0.729, p <0.001). Overall, 59.09% (n = 13) and 81.82% (n = 18) of the studies had high-risk bias and high-applicability, respectively, on PROBAST assessment; however only 55.15% of the studies adhered to the TRIPOD statement.

CONCLUSIONS

Though highly accurate, there are many challenges to current ML models necessitating the need to standardize the ML models to enable comparison across the studies and enhance the NPH decision making and care.

Macrophages in Recurrent Glioblastoma as a Prognostic Factor in the Synergistic System of the Tumor Microenvironment

Glioblastoma (GBM) is a common and highly malignant primary tumor of the central nervous system in adults. Ever more recent papers are focusing on understanding the role of the tumor microenvironment (TME) in affecting tumorigenesis and the subsequent prognosis. We assessed the impact of macrophages in the TME on the prognosis in patients with recurrent GBM. A PubMed, MEDLINE and Scopus review was conducted to identify all studies dealing with macrophages in the GBM microenvironment from January 2016 to December 2022. Glioma-associated macrophages (GAMs) act critically in enhancing tumor progression and can alter drug resistance, promoting resistance to radiotherapy and establishing an immunosuppressive environment. M1 macrophages are characterized by increased secretion of proinflammatory cytokines, such as IL-1ß, tumor necrosis factor (TNF), IL-27, matrix metalloproteinase (MMPs), CCL2, and VEGF (vascular endothelial growth factor), IGF1, that can lead to the destruction of the tissue. In contrast, M2 is supposed to participate in immunosuppression and tumor progression, which is formed after being exposed to the macrophage M-CSF, IL-10, IL-35 and the transforming growth factor-ß (TGF-β). Because there is currently no standard of care in recurrent GBM, novel identified targeted therapies based on the complex signaling and interactions between the glioma stem cells (GSCs) and the TME, especially resident microglia and bone-marrow-derived macrophages, may be helpful in improving the overall survival of these patients in the near future.

Acute Disseminated Encephalomyelitis Following Typhoid Fever: A Case Report

The involvement of central nervous system in children with typhoid fever is common. Acute disseminated encephalomyelitis is a rare immune mediated and demyelinating disease of the central nervous system that usually affects children. We report a 7-year-old child with typhoid fever who developed acute cerebellar syndrome due to acute disseminated encephalomyelitis.Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-4, 55-58 DOI: http://dx.doi.org/10.3126/jcmsn.v9i4.10237

Generalised osteitis fibrosa cystica due to secondary hyperparathyroidism in chronic kidney disease

Secondary hyperparathyroidism is a frequent complication of patients with chronic kidney disease and is characterized by excessive serum parathyroid hormone levels and an imbalance in calcium and phosphorus metabolism. Secondary hyperparathyroidism is the leading cause of renal osteodystrophy and bone disease. Osteitis fibrosa cystica, the classic and former most common osteodystrophy, is mainly caused by high bone turnover secondary to high levels of circulating PTH. Its pathophysiology is mainly due to hyperphosphatemia and vitamin D deficiency and resistance. This condition has a high impact on the mortality and morbidity of dialysis patients Hyperparathyroidism develops early in the course of CKD and becomes more prominent as kidney function declines. However recently, with the technical development of imaging and laboratory screening methods, hypercalcemia due to primary or secondary hyperparathyroidism can often be detected early; as a result the frequency of osteitis fibrosa cystica has declined. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-1, 60-66 DOI: http://dx.doi.org/10.3126/jcmsn.v9i1.9676

Characterization of extremely thermostable enzymatic breakers (alpha-1,6-galactosidase and beta-1,4-mannanase) from the hyperthermophilic bacterium Thermotoga neapolitana 5068 for hydrolysis of guar gum

An alpha-galactosidase and a beta-mannanase produced by the hyperthermophilic bacterium, Thermotoga neapolitana 5068 (TN5068), separately and together, were evaluated for their ability to hydrolyze guar gum in relation to viscosity reduction of guar-based hydraulic fracturing fluids used in oil and gas well stimulation. In such applications, premature guar gum hydrolysis at lower temperatures before the fracturing process is completed is undesirable, whereas thermostability and thermoactivity are advantageous. Hyperthermophilic enzymes presumably possess both characteristics. The purified alpha-galactosidase was found to have a temperature optimum of 100-105 degrees C with a half-life of 130 minutes at 90 degrees C and 3 min at 100 degrees C, while the purified beta-mannanase was found to have a temperature optimum of 91 degrees C and a half-life of 13h at this temperature and 35 min at 100 degrees C.These represent the most thermostable versions of these enzymes yet reported. At 25 degrees C, TN5068 culture supernatants, containing the two enzyme activities, reduced viscosity of a 0.7% (wt) guar gum solution by a factor of 1.4 after a 1.5-h incubation period and by a factor of 2.4 after 5 h. This is in contrast to a viscosity reduction of 100-fold after 1.5 h and 375-fold after 5 h for a commercial preparation of these enzymes from Aspergillus niger. In contrast, at 85 degrees C, the TN5068 enzymes reduced viscosity by 30-fold after 1.5 h and 100-fold after 5 h compared to a 2.5-fold reduction after 5 h for the control. The A. niger enzymes were less effective at 85 degrees C (1.6-fold reduction after 1.5 h and a 4.2-fold reduction after 5 h), presumably due to their thermal lability at this temperature. Furthermore, it was determined that the purified beta-mannanase alone can substantially reduce viscosity of guar solutions, while the alpha-galactosidase alone had limited viscosity reduction activity. However, the alpha-galactosidase appeared to minimize residual particulate matter when used in conjunction with the beta-mannanase. This could be the result of extensive hydrolysis of the alpha-1,6 linkages between mannose and galactose units in guar, allowing more extensive hydrolysis of the mannan chain by the beta-mannanase. The use of thermostable enzymatic breakers from hyperthermophiles in hydraulic fracturing could be used to improve well stimulation and oil and gas recovery.

Pheochromocytoma: reporting of two cases with a brief review

Pheochromocytoma arise from the chromaffin cells of adrenal gland or cells of sympathetic ganglion. The tumors secrete excessive adrenaline and nor-adrenaline and may cause severe elevation of blood pressure. Cardinal symptoms of pheochromocytoms are headache, diaphoresis, palpitation and high blood pressure which may be paroxysmal in nature. However, 10% of pheochromocytomas are only incidentally discovered during investigation of the patient for other reasons not related to suprarenal disease. We have reported here two cases of suprarenal tumors (pheochromocytoma), one of which is incidentally found while investigating her chest and epigastric pains. Journal of College of Medical Sciences-Nepal,2011,Vol-7,No-4, 78-86 DOI: http://dx.doi.org/10.3126/jcmsn.v7i4.6817

USG in evaluation of patients with scrotal pain

Based on physical examination alone it is often difficult to accurately make a clinical diagnosis and decide whether a palpable scrotal pathology arises from the testis itself or from extratesticular elements within the scrotum. Clinical examination of the testis is especially difficult due to pain, tenderness or when obscured by a large hydrocele. The aim of the study was thus undertaken to evaluate the role of ultrasonography (USG) in patients presenting with scrotal pain. 50 patients who presented to the surgical department with scrotal pain were subjected to USG. The commonest cause for scrotal pain was epididymitis with or without orchitis (40 %), followed in descending order by cystic lesions of the epididymis (18 %), varicocele (12 %), trauma (8 %), torsion (4 %) and tumour (2 %). No abnormality was seen on USG in 7 patients ( 14 %). This study concludes that USG is a sensitive and specific examination in patients with scrotal pain. Besides differentiating testicular from extratesticular origin it can also differentiate solid from cystic masses. Colour flow imaging is especially helpful in varicocele and testicular torsion. Torsion of the testis remains the most urgent and important entity dependent on USG for diagnosis. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-1, 18-22 DOI: http://dx.doi.org/10.3126/jcmsn.v8i1.6821

Comparison of clinical examination and ultrasonography in the diagnosis of acute appendicitis

This study was undertaken to compare clinical examination and ultrasonography (USG) in the diagnosis of acute appendicitis and to establish their accuracy in the diagnosis of acute appendicitis. 100 patients who presented to the emergency department with a clinical diagnosis of acute appendicitis were subjected to USG. After USG a specific diagnosis was made. Patients underwent appendicectomy on the basis of the surgeon‘s final clinical impression after correlating with USG findings. Histopathological examination of the appendicectomy specimen was taken as the gold standard for the diagnosis of acute appendicitis. Appendicectomy was performed in 74 patients. Out of these 74 cases, only 66 had appendicitis on histopathological examination. Eight normal appendixes were removed. Twenty-six patients were prevented from surgery after USG had shown an alternative diagnosis for the cause of pain in right iliac fossa. Clinical examination thus had a sensitivity and Positive Predictive Value (PPV) of 66%. USG examination made a preoperative diagnosis of acute appendicitis in 62 of the 66 patients. However the remaining 4 cases with appendicitis were missed by USG. USG had a sensitivity of 93.93%, specificity of 100%, PPV of 100%, NPV of 89.47% and an overall accuracy of 96% in the diagnosis of acute appendicitis. USG is thus a sensitive and specific imaging modality in the diagnostic work up of patients with right iliac fossa pain. USG may improve the diagnostic accuracy in patients with suspected acute appendicitis.Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-2, 34-40DOI: http://dx.doi.org/10.3126/jcmsn.v7i2.6678

Evaluation of acute head injury by computed tomography scan in College of Medical Sciences-Teaching Hospital, Chitwan

This study was conducted to evaluate the computed tomography findings in patient with acute head injury and to emphasize the importance of computed tomography scan in head injury. One hundred consecutive patients presenting to the emergency department with head injury were evaluated by computed tomography scan of the head. Seventy five patients (75%) were male and twenty five (25%) were females. The age of the patients ranged from three to seventy years and the most affected age group was between thirty and forty (40%). The common causes of head injury were motor vehicle accident (70%), fall injury (25% ) and physical assault (5%). The most common computed tomographic findings were: cerebral contusions (52%), skull fractures (41%), intracerebral hematomas (24%), diffuse cerebral edema (23%), midline shift (18%), subdural hematomas (15%), subarachnoid hemorrhage (13%), diffuse axonal injury (8%), intraventricular hemorrhage (6%), extradural hemotomas (4%), pnemocephalus (2%) and normal scans were found in (5%). In conclusion, computed tomography is the mainstay in the imaging of head injury and helps in the patient management. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5971 JCMSN 2011; 7(1): 36-39

Ultrasonography in infantile hypertrophic pyloric stenosis

Infantile hypertrophic pyloric stenosis (IHPS) is usually seen among the first born male infants. In recent time, ultrasonography has become the investigation of choice and has almost completely replaced the radiographic upper gastrointestinal series for the diagnosis of the disease. Here we report a case of 31 days infant with hypertrophic pyloric stenosis. Our purpose of reporting this case is to show the importance of ultrasonography in diagnosing infantile hypertrophic pyloric stenosis. DOI: http://dx.doi.org/10.3126/jcmsn.v7i1.5978 JCMSN 2011; 7(1): 73-76

Penetrating foreign body neck: a case report

Penetrating neck wounds are potentially dangerous and require emergency management because of the presence of vital structures in the neck. Organic foreign bodies further carries a risk of wound infection. We present a case of penetrating broken branch of a tree traversing from zone II to zone III without any neurovascular injury. Neck exploration was done with midline mandibulotomy approach and foreign body was removed without any complication.

Initial experience with the use of intravenous eptifibatide bolus during endovascular treatment of intracranial aneurysms

BACKGROUND AND PURPOSE

Despite systemic heparinization, thromboembolic complications remain a major concern related to endovascular treatment of intracranial aneurysms. We assessed the safety of intravenous eptifibatide administered during aneurysm coiling procedures to prevent such complications.

METHODS

From August 2001 to November 2004, 298 coil embolization procedures were performed to treat intracranial aneurysms; eptifibatide was used in 84 endovascular coil embolization procedures to treat 79 aneurysms in 74 patients. We retrospectively reviewed medical charts, radiographic images, and procedure notes to evaluate periprocedural complications related to eptifibatide.

RESULTS

The mean age of the 74 patients in our cohort was 55 +/- 9 years (range, 31-84) harboring 79 aneurysms (32 ruptured/47 unruptured). Eptifibatide was given prophylactically in 77 procedures, whereas in 7 procedures, it was given for treatment of a thromboembolic event (visualization of an arterial branch occlusion). A total of 5 (5.9% [total cohort]) bleeding complications related to eptifibatide occurred during 84 procedures. Two patients (2.4% [total cohort]/6.3% [ruptured group]) developed intracerebral hemorrhagic complications exacerbated by eptifibatide. The other 3 (3.6% [total cohort]) patients had groin hematomas requiring blood transfusions but had no surgical intervention. One thromboembolic event occurred in the 77 patients receiving eptifibatide prophylactically.

CONCLUSIONS

Intravenous infusion of eptifibatide seems to be safe to administer in patients undergoing endovascular repair of an unruptured cerebral aneurysm. Caution must be used in patients harboring ruptured aneurysms as intracranial bleeding complications may occur. Further study is required to delineate the group of patients most likely to benefit from this therapy.

Urgent stenting of the M2 (superior) division of the middle cerebral artery after systemic thrombolysis in acute stroke

We report a case of a 54-year-old man who presented with a right middle cerebral artery territory infarct and was treated with systemic thrombolytics. He continued to fluctuate neurologically and, with the use of angiography, was found to have an occlusion of the right M2 artery (superior division). This occlusion was successfully revascularized with a coronary stent.

Production of very-high-amylose potato starch by inhibition of SBE A and B

High-amylose starch is in great demand by the starch industry for its unique functional properties. However, very few high-amylose crop varieties are commercially available. In this paper we describe the generation of very-high-amylose potato starch by genetic modification. We achieved this by simultaneously inhibiting two isoforms of starch branching enzyme to below 1% of the wild-type activities. Starch granule morphology and composition were noticeably altered. Normal, high-molecular-weight amylopectin was absent, whereas the amylose content was increased to levels comparable to the highest commercially available maize starches. In addition, the phosphorus content of the starch was increased more than fivefold. This unique starch, with its high amylose, low amylopectin, and high phosphorus levels, offers novel properties for food and industrial applications.

Gastric teratoma in infants--a report of two cases

Gastric teratoma is an exceeding rare lesion seen most often in male infants. Two cases of gastric teratoma, the first in a three and half month male, and the second in a one year old male child are reported. In the first case, the tumour was more solid, while in the second case it was a solid-cystic mass. These two cases represent the additions to the few, limited, known gastric teratomas reported in the world literature.

Congenital diaphragmatic hernia: a retrospective autopsy study

Congenital diaphragmatic hernia is one of the acute pediatric surgical emergencies and an important cause of perinatal mortality. Its incidence varies from 1 in 2000 to 1 in 5000 live-births, with a greater incidence in stillbirths and abortions. Non-operative mortality is generally reported as 100% and early diagnosis is imperative. A retrospective study of all infant and neonatal autopsies done during last 30 years (1960 to 1989) was conducted. Ten cases of congenital diaphragmatic hernia were encountered among 588 autopsies and its incidence was 1.7% of all infant and neonatal autopsies, dying due to varying causes. The male:female ratio was 7:3, while maternal factors showed no consistent relationship. All cases had left-sided posterolateral diaphragmatic defects. Dyspnea, cyanosis and dextrocardia was the classical triad present in more than 50% cases. The commonest herniated contents were the small intestinal loops and the left lobe of liver. Associated congenital multiple anomalies related to neural axis, skull, vertebral column and cardiovascular system were noted in 30% cases and were major contributory factors for perinatal mortality.