Ultrasound-guided injection and aspiration of small joints: techniques, pearls, and pitfalls

Ultrasound (US)-guided musculoskeletal intervention of small joints or joints other than the shoulder, elbow, hip, knee, and ankle can be technically challenging. Small joints produce a narrower landing zone for the needle and a smaller target that may be made even more inaccessible by bulky osteophytes. Sonographic (US) guidance offers important advantages including near-field visualization of the joint and soft tissues, ease of access, portability, ability to compare with the contralateral side, and lack of ionization radiation. This review article focuses on the performance of US-guided injections and aspirations involving small joints (joint capacity < 2 mL and/or typically evaluated or injected with a compact linear transducer). For each joint (temporomandibular, acromioclavicular, sternoclavicular, distal radioulnar, symphysis pubis, and joints of the digits of the hands and feet), a brief overview of the relevant anatomy, indications, procedural description, pearls and pitfalls will be highlighted. This article demonstrates the various approaches to diagnostic or therapeutic injection and aspiration of small joints with the aid of US images, cines and graphic illustrations, emphasizing joint positioning, anatomic landmarks, and needle trajectory for a safe and efficacious procedure. A brief review of available literature for each joint will also be provided.

Dorsal Wrist Carpal Boss Impingement-Dynamic Ultrasound to the Rescue!

The "carpal boss" is a variant present in 19% of the population according to cadaveric studies but becomes symptomatic in only 1% of cases. With the rising popularity of "yoga," which includes prolonged hyperextension at the wrist joint with weight bearing, an increasing number of individuals with silent carpal boss present with dorsal wrist pain due to impingement over the dorsal soft tissues by this innocuous bony protuberance. This warrants the attention of radiologists and clinicians while dealing with wrist pain. It can be challenging to identify this bossing on routine radiographs, necessitating special views. We describe the use of dynamic ultrasound in diagnosing "symptomatic" carpal boss, the effects of which become even more evident on imaging during hyperextension-the triggering movement.

Clonal hematopoiesis related TET2 loss-of-function impedes IL1β-mediated epigenetic reprogramming in hematopoietic stem and progenitor cells

Clonal hematopoiesis (CH) is defined as a single hematopoietic stem/progenitor cell (HSPC) gaining selective advantage over a broader range of HSPCs. When linked to somatic mutations in myeloid malignancy-associated genes, such as TET2-mediated clonal hematopoiesis of indeterminate potential or CHIP, it represents increased risk for hematological malignancies and cardiovascular disease. IL1β is elevated in patients with CHIP, however, its effect is not well understood. Here we show that IL1β promotes expansion of pro-inflammatory monocytes/macrophages, coinciding with a failure in the demethylation of lymphoid and erythroid lineage associated enhancers and transcription factor binding sites, in a mouse model of CHIP with hematopoietic-cell-specific deletion of Tet2. DNA-methylation is significantly lost in wild type HSPCs upon IL1β administration, which is resisted by Tet2-deficient HSPCs, and thus IL1β enhances the self-renewing ability of Tet2-deficient HSPCs by upregulating genes associated with self-renewal and by resisting demethylation of transcription factor binding sites related to terminal differentiation. Using aged mouse models and human progenitors, we demonstrate that targeting IL1 signaling could represent an early intervention strategy in preleukemic disorders. In summary, our results show that Tet2 is an important mediator of an IL1β-promoted epigenetic program to maintain the fine balance between self-renewal and lineage differentiation during hematopoiesis.

Effects of Deposition Temperature and Working Pressure on the Thermal and Nanomechanical Performances of Stoichiometric Cu3N: An Adaptable Material for Photovoltaic Applications

The pursuit of efficient, profitable, and ecofriendly materials has defined solar cell research from its inception to today. Some materials, such as copper nitride (Cu3N), show great promise for promoting sustainable solar technologies. This study employed reactive radio-frequency magnetron sputtering using a pure nitrogen environment to fabricate quality Cu3N thin films to evaluate how both temperature and gas working pressure affect their solar absorption capabilities. Several characterization techniques, including X-ray diffraction (XRD), Rutherford backscattering spectrometry (RBS), Raman spectroscopy, scanning electron microscopy (SEM), nanoindentation, and photothermal deflection spectroscopy (PDS), were used to determine the main properties of the thin films. The results indicated that, at room temperature, it is possible to obtain a material that is close to stoichiometric Cu3N material (Cu/N ratio ≈ 3) with (100) preferred orientation, which was lost as the substrate temperature increases, demonstrating a clear influence of this parameter on the film structure attributed to nitrogen re-emission at higher temperatures. Raman microscopy confirmed the formation of Cu-N bonds within the 628-637 cm-1 range. In addition, the temperature and the working pressure significantly also influence the film hardness and the grain size, affecting the elastic modulus. Finally, the optical properties revealed suitable properties at lower temperatures, including bandgap values, refractive index, and Urbach energy. These findings underscore the potential of Cu3N thin films in solar energy due to their advantageous properties and resilience against defects. This research paves the way for future advancements in efficient and sustainable solar technologies.

Update from the 5th Edition of the WHO Classification of Nasal, Paranasal, and Skull Base Tumors: Imaging Overview with Histopathologic and Genetic Correlation

Sinonasal and skull base tumors are a heterogeneous group of neoplasms with considerable histologic variation and overlapping imaging features. In 2022, the World Health Organization updated the head and neck tumor classification, further emphasizing the importance of molecular data and genetic alterations in sinonasal neoplasms. The changes include the addition of new entities and discussion of emerging entities, as well as changes to the taxonomy and characterization of tumors. The new classification focuses on entities that develop in these sites either exclusively (eg, olfactory neuroblastoma) or most frequently. Another change includes reduction in the number of categories by creating separate category-specific chapters for soft-tissue, hematolymphoid, and neuroectodermal lesions. In this review, we briefly discuss the various categories in the new classification with a more detailed description of the 2 new entities (SWItch/Sucrose Non-Fermentable complex-deficient sinonasal carcinomas and human papillomavirus-related multiphenotypic sinonasal carcinoma). We also highlight the emerging entities including IDH-mutant sinonasal malignancies and DEK-AFF2 carcinoma, presently classified as sinonasal undifferentiated carcinoma and nonkeratinizing squamous cell carcinoma, respectively.

Comparative efficacy of Micropore™ surgical dressing, Tegaderm™ and Lockit plus® for lumbar epidural catheter fixation in children: a prospective parallel group randomized controlled trial

BACKGROUND

Proper fixation of an epidural catheter is necessary for desired drug effect and to prevent catheter displacement. Different techniques have been used for epidural catheter fixation. The aim of the study was to compare the relative efficacy of Micropore™ surgical dressing, Tegaderm™, and Lockit plus® in preventing lumbar epidural catheter migration in children.

METHODS

We studied 167 patients aged 5-16 years, for up to 48 h. After the elective abdominal or lower limb surgery. Patients were randomly assigned to one of three groups: (1) Micropore™ surgical dressing (group M), (2) Tegaderm™ (group T), or (3) Lockit plus® (group L). Incidence and extent of epidural catheter migration in centimetres (cm); was compared at 24 and 48 h post epidural fixation. Correlation between epidural catheter migration and patient characteristics, and relative incidence of complications in three groups was also analysed.

RESULTS

Incidence of catheter migration was 9.6% at 24 h (group M: 7.1%, group T: 21.1% and group L: 0%) and 45.5% at 48 h (group M: 66.1%, group T: 45.6% and group L: 24.1%). After 48 h, absolute migration (mean migration rounded off to the nearest 0.5 cm) was least in patients in group L: 0.34 cm (1.39) compared to group M 1.22 cm (SD: 1.85) group T: 0.94 cm (1.94) (p = <0.001).

CONCLUSION

Up to 48 h after surgery, the Lockit plus® device demonstrated the less epidural catheter migration when compared to micropore surgical dressing or tegaderm in children undergoing elective abdominal or lower limb surgery.

A Review of Materials and Medications with Religious or Dietary Significance in the Interventional Radiology Suite

A holistic approach to patient-centered care should include cultural and religious considerations. Certain cultural groups have beliefs that may restrict the use of particular animal-derived products and chemicals. A working knowledge of ingredients commonly used in the interventional suite with religious and cultural connotations may be helpful. This review article highlights medications and medical devices with cultural or religiously sensitive ingredients used in interventional radiology departments and provides a framework for addressing this common scenario.

Unpacking the CNS Manifestations of Epstein-Barr Virus: An Imaging Perspective

Epstein-Barr virus is a ubiquitous herpesvirus that may cause both infective (encephalitis, meningitis, and so forth) and postinfection inflammatory (such as Guillain-Barré syndrome, acute disseminated encephalomyelitis) manifestations in the CNS. Diagnosis of Epstein-Barr virus-related CNS pathologies is often complicated due to a nonspecific clinical presentation and overlap with other infectious and noninfectious causes, both clinically and on imaging. The Epstein-Barr virus is also implicated in several lymphoproliferative disorders in both immunocompromised and immunocompetent hosts. MR imaging is preferred for evaluating the extent of involvement and monitoring therapy response, given its high sensitivity and specificity, though imaging findings may be nonspecific. Herein, we review the imaging spectrum of Epstein-Barr virus-associated CNS disorders.

An Insight into Multisystem Inflammatory Syndrome in Adults Associated with Recent SARS-COV-2 Infection: A Case Series

IMPORTANCE

Multisystem inflammatory syndrome-adults (MIS-A) occur in the postacute coronavirus disease 2019 (COVID-19) period with a diverse clinical presentation. A high index of suspicion, early recognition, diagnosis, and treatment of MIS-A might alleviate COVID-19-related morbidity and mortality.

OBJECTIVE

To report seven cases of MIS-A with evidence of recent COVID-19 infection. This is a case series-based study and presents bona fide experiences in terms of main findings and treatment options.

MATERIALS AND METHODS

It is a retrospective observational study. We retrospectively collected data on all patients who were diagnosed and treated for MIS-A during the period after the second wave of COVID-19 in India, that is, from June 2021 to November 2021and who were hospitalized in the author's unit. All patients fulfilled the morbidity and mortality weekly report (MMWR) criteria for multisystem inflammatory syndrome in adults. The presenting symptoms, clinical and laboratory parameters, management, and outcome of these seen cases are discussed in this case series-based review..

RESULTS

Data from seven patients were analyzed. Six of them were male, and one patient was female. The median age was 65 years. Four patients had a history of vaccination for COVID-19, three had a history of COVID-19 symptomatic infection in the past, and one patient had contact with COVID-19 in the previous 12 weeks. None of them tested positive for COVID-19 real-time reverse transcription polymerase chain reaction (RT-PCR) test, and all had positive COVID-19 serology. The commonest extrapulmonary organ involved were the cardiovascular and renal systems, followed by the gastrointestinal and central nervous systems (CNS). All had evidence of hyperinflammation. Intravenous immunoglobulin (IVIg) was used in four patients, and steroids were used in all seven patients. The median length of stay (LOS) was 11 days. One patient succumbed to multiorgan failure.

CONCLUSIONS

Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) as well as adults (MIS-A). MIS-A is a serious, life-threatening, hyperinflammatory febrile syndrome associated with recent COVID-19 infection and involves multiple organs like the heart, lungs, kidneys, brain, gastrointestinal organs, skin, eyes etc. Clinical suspicion and testing for evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are needed to identify and treat adults suspected to have MIS-A. This case series demonstrates that even the elderly population can be affected and that administration of IVIg and steroids are effective options in management in addition to the usual "standard of care" treatment. Early recognition and prompt treatment of MIS-A could improve clinical outcomes and reduce the mortality rate.

Advances in Acute Ischemic Stroke Treatment: Current Status and Future Directions

The management of acute ischemic stroke has undergone a paradigm shift in the past decade. This has been spearheaded by the emergence of endovascular thrombectomy, along with advances in medical therapy, imaging, and other facets of stroke care. Herein, we present an updated review of the various stroke trials that have impacted and continue to transform stroke management. It is critical for the radiologist to stay abreast of the ongoing developments to provide meaningful input and remain a useful part of the stroke team.

CT-guided scapulothoracic bursal injection-technical considerations in planning needle trajectory and confirming bursal distribution

OBJECTIVE

To describe a technique of targeted CT-guided scapulothoracic bursal injections in an illustrated and step-wise manner.

MATERIALS AND METHODS

This technical report describes the authors' experience in using CT guidance for targeted scapulothoracic bursal injections in 8 patients with suspected scapulothoracic bursitis over an 18-month period.

RESULTS

The outcome of the image-guided injection was retrospectively assessed in 8 patients. None of the patients had any complications related to the procedure. Symptomatic improvement was achieved in 62.5% of the patients while 25% of patients did not report any benefit from the injection.

CONCLUSION

In providing a record of needle tip position and contrast distribution, CT-guided scapulothoracic bursal injections provide an objective record of the procedure, which may assist in further treatment planning.

Carbon nanosheets to unravel the production of bioactive compounds from microalgae: A robust approach in drug discovery

The conglomeration of active pharmaceutical ingredients (APIs) has influenced the development of life-saving drugs. These APIs are customarily synthetic products, albeit with adverse side effects. Thus, to overcome the bottlenecks associated with synthetically derived APIs, the approach of photocatalytically obtaining bioactive compounds from natural ingredients has emerged. Amid the pool of photoactive nanomaterials, this short review emphasizes the intelligent strategy of exploiting photoactive carbon nanosheets to photocatalytically derive bioactive compounds from natural algal biomass to treat many acute or chronic medical conditions. Carbon nanosheets result in phototrophic harvesting of bioactive compounds from microalgae as a result of their being an effective biocatalyst that increases the rate of photosynthesis. To understand the clinical translation of bioactive compounds, the pharmacodynamics of algal bioactive compounds are highlighted to determine the practicality and feasibility of using this green approach for pharmaceutical drug discovery.

High-Resolution 7T MR Imaging of the Trochlear Nerve

BACKGROUND AND PURPOSE

The trochlear nerve has traditionally been difficult to identify on MR imaging. The advent of 7T MR imaging promises to greatly benefit visualization of small structures due to gains in the signal-to-noise ratio allowing improved spatial resolution. We investigated the utility of a clinically feasible ultra-high-resolution 7T MR imaging protocol for identification of the trochlear nerve, as well as assessment of normal trochlear nerve anatomy.

MATERIALS AND METHODS

Coronal high-resolution 2D T2-weighted TSE images used in a 7T epilepsy protocol of 50 subjects at our institution were reviewed by 2 independent radiologists for visualization of the trochlear nerve at the nerve origin and cisternal, tentorial, and cavernous segments. The frequency of nerve visibility within these segments and their anatomy were documented, and disagreements were resolved by joint review.

RESULTS

Of the 100 nerves reviewed in 50 subjects, at least 2 segments of the trochlear nerve from the brainstem to the cavernous sinus were identified in 100% of cases. The origins from the brainstem and cisternal segment were visible in 65% and 93% of nerves, respectively. The trochlear nerve was identified at the trochlear groove in 100% of cases and in the posterior wall of the cavernous sinus in 74% of cases.

CONCLUSIONS

Coronal high-resolution 2D TSE at 7T reliably identified the trochlear nerve throughout its course and is a promising tool for imaging patients with suspected trochlear nerve pathology.

Ultrasound-guided cutaneous nerve chemo-ablation for severe access site neuropathic pain-A case report

Neuropathic pain at the cannulation site is challenging, both for the patient and the dialysis team. We present a case of a middle-aged man on chronic hemodialysis, who developed excruciating pain at the cannulation area without incident, limiting his dialysis sessions. Multidisciplinary collaboration allowed identification of the cutaneous nerve-the inferior lateral cutaneous nerve of the arm, relaying his pain. Subsequent ultrasound-guided phenol chemoablation resulted in the complete resolution of his pain and allowed continued use of the well-functioning fistula for dialysis.

It Is Not Only the Meniscus That Flips-A Case of TFCC Tear with a Flipped Fragment in the Distal Radioulnar Joint

Acute wrist injuries with ongoing ulnar-sided wrist pain warrant a magnetic resonance imaging (MRI) to diagnose ligamentous injuries. Triangular fibrocartilage complex (TFCC) tears have been classified and described in the literature but complex tear patterns have limited representation. Bucket-handle tears of the TFCC represent only 0.5% of TFCC tears and have recently been identified, posing a diagnostic and management challenge. Preoperative diagnosis is possible with MRI and necessary for optimal and early surgical management. The authors describe a unique case of a flipped tear of the central disc of the TFCC, where the fragment was flipped into the distal radioulnar joint, a site hidden during routine arthroscopy.

Feasibility and impact of a one-stop thyroid clinic in a low- and middle-income country

BACKGROUND

The study was done to evaluate the feasibility, safety and outcomes of a one-stop thyroid clinic (OSTC) in a low- and middle-income country (LMIC) setting.

METHODS

This was a prospective non-randomised case control study consisting of patients with thyroid nodules evaluated and managed at a tertiary referral centre in an LMIC between February 2019 and January 2020. Patients were divided into two groups based on the kind of preoperative evaluation protocol: OSTC group (n = 118) - OSTC protocol, and control group (CG, n = 108) - routine protocol.

RESULTS

Baseline clinical characteristics of the two groups including median age (p = 0.13) and gender distribution (p = 0.76) were comparable. The majority of patients in both groups belonged to a low-income group (46.6% vs 47.3%; p = 0.91), followed by a middle-income group (35.6% vs 30.5%; p = 0.41). The median number of outpatient department visits (1 vs 3 days; p = < 0.001), waiting time for neck ultrasonography (1 vs 3 days; p = < 0.0001), fine needle aspiration cytology (1 vs 2 days; p = < 0.0001), and out of pocket expenditure (INR 3 965 vs 6 624; p = < 0.001) was significantly less in the OSTC group compared to the CG. Patients in the OSTC group reported better satisfaction levels (p = < 0.0001). Accuracy of diagnosis did not differ between the two groups (p = 0.14).

CONCLUSION

OSTC practice is feasible, provides comparative clinical outcomes and seems cost effective in an LMIC. This protocol can be adopted as a routine practice in any health system.

Hydrogel Nanosheets Confined 2D Rhombic Ice: A New Platform Enhancing Chondrogenesis

Nanoconfinement within flexible interfaces is a key step towards exploiting confinement effects in several biological and technological systems wherein flexible 2D materials are frequently utilized but are arduous to prepare. Hitherto unreported, the synthesis of 2D Hydrogel nanosheets (HNS) using a template- and catalyst-free process is developed representing a fertile ground for fundamental structure-property investigations. In due course of time, nucleating folds propagating along the edges trigger co-operative deformations of HNS generating regions of nanoconfinement within trapped water islands. These severely constricting surfaces force water molecules to pack within the nanoscale regime of HNS almost parallel to the surface bringing about phase transition into puckered rhombic ice with AA and AB Bernal stacking pattern, which was mostly restricted to Molecular dynamics (MD) studies so far. Interestingly, under high lateral pressure and spatial inhomogeneity within nanoscale confinement, bilayer rhombic ice structures were formed with an in-plane lattice spacing of 0.31 nm. In this work, a systematic exploration of rhombic ice formation within HNS has been delineated using High-resolution transmission electron microscopy (HRTEM), and its ultrathin morphology was examined using Atomic Force Microscopy (AFM). Scanning Electron Microscopy (SEM) images revealed high porosity while mechanical testing presented young's modulus of 155 kPa with ~84% deformation, whereas contact angle suggested high hydrophilicity. The combinations of nanosheets, porosity, nanoconfinement, hydrophilicity, and mechanical strength, motivated us to explore their application as a scaffold for cartilage regeneration, by inducing chondrogenesis of human Wharton Jelly derived mesenchymal stem cells (hWJ MSCs). HNS promoted the formation of cell aggregates giving higher number of spheroid formation and a marked expression of chondrogenic markers (ColI, ColII, ColX, ACAN and S-100), thereby providing some cues for guiding chondrogenic differentiation.

Carbon Quantum Dots for Stem Cell Imaging and Deciding the Fate of Stem Cell Differentiation

Nanotechnology advancements and applications have paved the way for new possibilities in regenerative medicine and tissue engineering. It is a relatively new field that has the potential to improve stem cell differentiation and therapy greatly. Numerous studies have demonstrated that nanomaterials can function as a physiological niche for the formation and differentiation of stem cells. However, quantum dots (QDs), such as carbon quantum dots (CQDs) and graphene quantum dots (GQDs), have shown considerable promise in the field of regenerative medicine. To date, most research has focused on stem cell tracking and imaging using CQDs. However, their interaction with stem cells and the associated possibility for differentiation by selectively focusing chemical signals to a particular lineage has received scant attention. In this mini-review, we attempt to categorize a few pathways linked with the role of CQDs in stem cell differentiation.

Exploring the Role of Carbon-Based Nanomaterials in Microalgae for the Sustainable Production of Bioactive Compounds and Beyond

An enchanting yet challenging task is the development of higher productivity in plants to meet the ample food demands for the growing global population while harmonizing the ecosystem using front-line technologies. This has kindled the practice of green microalgae cultivation as a driver of key biostimulant products, targeting agronomic needs. To this end, a prodigious and economical strategy for producing bioactive compounds (sources of secondary metabolites) from microalgae using carbon-based nanomaterials (CNMs) as a platform can circumvent these hurdles. Recently, the nanobionics approach of incorporating CNMs with living systems has emerged as a promising technique to develop organelles with new and augmented functions. Herein, we discuss the importance of 2D carbon nanosheets (CNS) as an alternative carbon source for the phototrophic cultivation of microalgae. CNS not only aids in cost reduction for algal cultivation but also confers combinatorial innate or exogenous functions that enhance its programmed biosynthetic metabolism, proliferation, or tolerance to stress. Moreover, the inherent ability of CNS to act as efficient biocatalysts can enhance the rate of photosynthesis. The primary focus of this mini-review is the development of an economic route for enhanced yield of bioactive compounds while simultaneously serving as a heterogeneous platform for enhancing the sustainable production of biostimulants including bioactive compounds from algal biomass for pharmaceutical and nutraceutical applications.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

P-291 Positive effects of inactivated blood serum in stabilizing the activity of antioxidants in embryo-free culture media

Study question

Does addition of blood serum to embryo culture media supplemented with antioxidants (AOXs) helps maintain the AOX activity under in vitro culture conditions?

Summary answer

The addition of inactivated blood serum (IBS) before AOX supplementation resulted in AOX activity stabilization in embryo-free culture media (EFCM) for up to 48 hours.

What is known already

Supra-physiological levels of reactive oxygen species (ROS) in embryo culture medium (ECM) can disturb embryo development possible due to oxidative stress. Hence, AOX supplementation of ECM has been used to counteract the potential negative effects of high ROS on gametes and embryos. However, rapid consumption of AOXs via interaction with ROS may reduce the AOX protection capacity particularly during extended culture conditions. The aim of this study is to investigate the efficacy of IBS in stabilizing the AOX activity of a combination of AOXs (EmbryORP®) when added to EFCM.

Study design, size, duration

In this prospective study, oxidation reduction potential (ORP) was assessed in EFCM by MiOXSYS System (UAB Caerus Biotechnologies, Vilnius, Lithuania). The ORP results reflect the overall balance between oxidants and antioxidants. ORP levels in follicular fluid obtained from dominant follicles of 40 oocyte donors were used as control.

Participants/materials, setting, methods

All dishes containing culture medium (GlobalTotal®, LifeGlobal®, Connecticut, US) were incubated for 48 hours in 8% CO2, 20% O2, 37 °C. Culture dishes were divided into four groups: Group A: EFCM without AOX, Group B: EFCM+AOX, Group C: EFCM+AOX+IBS, and Group D: EFCM+IBS. Levels of ORP were assessed in EFCM before AOX supplementation (0), immediately after adding AOX (1) and 48 hours following AOX supplementation (2). ORP results are expressed as millivolts (mV).

Main results and the role of chance

At 48 hours of culture, ORP value in group C (96.7 mV) was significantly lower than group A (345 mV; p = 0.00001), and was found to be similar to the physiological ORP values found in follicular fluid from donors (89 mV±23.6 mV; p &gt; 0.05). Also, ORP value in group C (96.7 mV) was lower than group B (210 mV; p = 0.67) and group D (280.1 mV; p = 0.11).

Limitations, reasons for caution

This study only tested the efficacy of IBS as AOX stabilizer in EFCM over 48 hours. The efficacy and potential risks associated with the use of IBS during actual embryo culture were not examined.

Wider implications of the findings

The use of AOX stabilizers may represent an important novel finding to maintain sufficient AOX protective capacity during extended culture conditions.

Trial registration number

10112021-AOX

P-148 Denudation employing human recombinant hyaluronidase enzyme does not affect fertilization and blastocyst formation rates in sibling oocytes from patients undergoing ART: A prospective randomized study

Study question

Does human recombinant hyaluronidase (Cumulase®) improve fertilization and blastocyst formation rates in sibling human oocytes compared to bovine-derived hyaluronidase?

Summary answer

The use of Cumulase® for oocyte denudation does not appear to affect fertilization or usable blastocyst formation rate in patients undergoing intracytoplasmic sperm injection (ICSI).

What is known already

Bovine-derived hyaluronidase has been widely employed to denude the cumulus-oocyte complexes (COCs) prior to ICSI or oocyte vitrification. Nonetheless, the recent concern for its safety, due to its animal origin, has led to the development of alternatives ascertaining the enzyme’s purity. It has been reported that human recombinant hyaluronidase is not equally effective as its bovine-derived analogue, leading to a longer time required for complete denudation coupled by the subsequent toxicity risk for oocytes. This may result to lower fertilization and blastocyst formation rates. Although there are some studies on IVF outcomes with recombinant hyaluronidase, its use remains rather limited.

Study design, size, duration

This randomized double-blinded clinical trial was conducted at Citmer Reproductive Medicine, in Puebla and Monterrey, Mexico from February to December 2021. The impact of denudation on sibling oocytes from 103 patients employing bovine-derived hyaluronidase (InVitroCare®) or human recombinant hyaluronidase (ICSI Cumulase® (rHuPH20), CooperSurgical®) was evaluated. A total of 1237 oocytes were assigned as follows: The Hyaluronidase Group included 626 oocytes, while the Cumulase® Group included 611 oocytes. Preimplantation Genetic Testing was performed in 18 cycles.

Participants/materials, setting, methods

After retrieval, COCs were incubated for 2-4 h and placed in microdropets with 10 IU/mL bovine-derived hyaluronidase or Cumulase® in culture media GlobalTotal® (LifeGlobal®) for granulosa cells removal. COCs were gently pipetted up and down employing 20 μL and 150 μm tips. Metaphase II oocytes were injected and incubated for 17-20 hours in 8% CO2, 20% O2, 37°C. Normally fertilized zygotes were cultured to blastocyst stage and embryo development was evaluated. Seventy-nine blastocysts were biopsied.

Main results and the role of chance

The mean age of the patients was 32.12±1.11 years old. A total of 506 and 493 metaphase II oocytes from Groups 1 and 2 respectively were subjected to ICSI. Normal fertilization rates for oocytes treated with Hyaluronidase and Cumulase® were 71.34% (n = 361) and 72.41% (n = 357) respectively, with no statistically significant differences between the two groups (p = 0.35).

Usable blastocysts rate (selected for embryo transfer or blastocyst cryopreservation) did not differ with any statistical difference between the bovine-derived hyaluronidase (n = 170, 47.09%) and the Cumulase® treated oocytes (n = 158, 44.25%), (p = 0.44).

Preimplantation genetic testing for aneuploidies (PGT-A) was performed in 18 cycles. Seventy-nine blastocysts were biopsied and tested. Fourty-seven embryos from the bovine-derived hyaluronidase group were biopsied, presenting with a euploidy rate of 51.06% (n = 24), compared to 32 embryos from the recombinant hyaluronidase group with a euploidy rate of 50% (n = 16). Results indicated no statistically significant difference (p = 0.92). These data support that human recombinant hyaluronidase presents with similar efficacy to bovine-derived hyaluronidase. in terms of normal fertilization, embryo development as well as euploidy rates.

Limitations, reasons for caution

The small sample size regarding the euploidy outcome stands as a limitation of the study. Further studies should focus on the effect of recombinant hyaluronidase on genetic anomalies on blastocysts.

Wider implications of the findings

Fertilization, usable blastocyst and euploidy rates did not differ when employing bovine-derived or human recombinant hyaluronidase, rendering the latter a safe and efficient alternative. However, it is important to assess long-term effects, as only a limited number of studies report on perinatal and neonatal outcomes

Trial registration number

25-12-21MTYPUECIT

P-086 AZF Microdeletions: A New Look at Past Paradigms

Study question

To elucidate whether AZF screening is indicated in men with proven non-obstructive azoospermia (NOA) or severe oligozoospermia (&lt;5x106 sperm/mL) who concomitantly harbor chromosomal abnormalities.

Summary answer

Some chromosomal aberrations are concomitant with AZF microdeletions, and hence Y chromosome microdeletion (YCM) screening is necessary for these patients.

What is known already

In the era of assisted reproduction, finding cost-minimization strategies in infertility clinics without affecting the quality of diagnosis and treatment is becoming one of the top-priority topics for future research. Formulating definitive guidelines concerning the indications for paraclinical testing could be one of the strategies. Accordingly, definitive guidelines for AZF screening do not exist especially in men who also have chromosomal abnormalities. The current clinical practice is to decide per case whether to pursue further molecular testing, with the accompanying added psychological and socio-economic burden.

Study design, size, duration

An observational retrospective cohort study of 10,388 consecutive cases from a tertiary infertility referral center (Royan institute, Tehran, Iran) over the last 12 years. A comprehensive literature review was also performed to summarize scientific evidence.

Participants/materials, setting, methods

The study recruited the largest cohort of men with primary infertility (NOA or severe oligozoospermia) ever presented who underwent screening for cytogenetic abnormalities and YCMs using sequence-tagged sites-polymerase chain reaction (STS-PCR) with a primer set covering the AZF regions according to the EAA/EMQN guidelines, as part of the infertility workup prior to ART.

Main results and the role of chance

In total, one-third of men with YCMs concomitantly had an abnormal karyotype (excluding those with heteromorphisms) (169/565; 29.9%, 95% CI: 26.3-33.8). In respect to the frequency of YCMs, our findings suggest that the cases diagnosed with 46,X,add(X) with incidence of 1.8% (3/169; 95% CI: 0.6-5.1); 45,X and mosaic forms: 45,X/46,X,inv(Y)(p11.2q12); 45,X/46,X,del(Y); 45,X,der(Y;Autosome); 45,X/46,X,idic(Y)(p11.2); 45,X/46,XY,r(Y); and 45,X/46,X,idic(Y)(q11.2) (19/169; 11.2%, 95% CI: 7.3-16.9); and inv(Y)(p11.2q12) (2/169; 1.2%, 95% CI: 0.3-4.2) should also be referred for AZF deletion screening, as data suggests they are accompanied with YCMs.

Limitations, reasons for caution

The extension of the outcomes beyond the described population could introduce concerns on appropriate medical management. Confirmatory studies in other geographic/ethnic groups are still necessary to reach a consensus regarding the outcomes.

Wider implications of the findings

It has been recommended that all men with NOA who have chromosomal abnormalities, except those with 46,XY/45,X karyotype, do not need AZF testing. The results reflect a crucial need for reconsidering whether YCM testing is indicated in the population of men with certain karyotypic abnormalities.

Trial registration number

Not Applicable

P-012 Investigating the potential role of microRNAs as biomarkers in idiopathic non-obstructive azoospermia: A systematic review and in-silico analysis of the affected pathways

Study question

Is there an association between microRNA profiles in seminal plasma and microRNAs profiles in testicular tissue samples obtained from idiopathic non-obstructive azoospermia (NOA) patients?

Summary answer

This study identified common alterations in microRNA profiles and gene expression patterns between seminal plasma and testicular tissue samples obtained from NOA patients.

What is known already

Despite the significant advances in the field of reproductive medicine the exact infertility aetiology remains unidentified regarding 30-40% of infertile men. This fact highlights the need for more accurate and sensitive diagnostic tools and biomarkers, especially regarding the most severe cases of male infertility, such as idiopathic NOA patients. It has been voiced that microRNA profiling of seminal plasma and testicular tissue samples obtained from idiopathic NOA patients could be a powerful tool towards better understanding the underlined pathogenesis and towards developing novel diagnostic and individualized biomarkers. However, a collective analysis of these data has not been performed hitherto.

Study design, size, duration

A systematic review was performed in PubMed/Medline and Embase up to November 2020. Search strategy included a combination of keywords, namely non-coding RNA OR small non-coding RNA OR microRNA AND non-obstructive azoospermia. Following study selection, original data on altered microRNAs were analyzed aiming to underline differences between microRNA expression profiles in seminal plasma and testicular tissue samples of idiopathic NOA cases. Following this, in-silico analysis was performed to detect commonly affected gene expression pathways.

Participants/materials, setting, methods

Only full-length original retrospective or prospective human studies were included. Strict inclusion-exclusion criteria were applied. The studied population consisted of idiopathic NOA patients, while the control groups consisted of men with normal semen analysis. In-silico analysis was performed employing a combination of bioinformatic tools, namely the DIANA-TarBase, microT-CDS, the GTEx repository and the KEGG database. Statistical analysis was performed using the R-package-limma. The statistically significant threshold indicating altered gene pathways was set at 0.01 P-value.

Main results and the role of chance

Five studies were considered eligible, including 382 NOA cases and 412 controls (Finocchi et al., 2020; Song et al., 2017; Wu et al., 2013; Wu et al., 2012; Wang et al., 2011). Two studies co-evaluated the profile of microRNAs in both seminal plasma and testicular tissue samples (Wu et al., 2013; Wu et al., 2012), one study evaluated only testicular tissue (Song et al., 2017) and the other two only seminal plasma (Finocchi et al., 2020 and Wang et al., 2011). Data extraction revealed a total of 14 differentially expressed microRNAs between NOA patients and controls. The following microRNAs were found to be up-regulated in both seminal plasma and testicular tissue samples of NOA cases: hsa-miR-141-3p, hsa-miR-429, hsa-miR-7-1-3p, hsa-miR-19b-3p and hsa-let-7a-5p. The hsa-miR-188-3p was found to be down-regulated in testicular tissue samples. Finally, the following microRNAs were also downregulated only in seminal plasma: hsa-miR-34c-5p, hsa-miR-122-5p, hsa-miR-181a-5p, hsa-miR-146b-5p, hsa-miR-374b-5p, hsa-miR-509-5p, hsa-miR-513a-5p and hsa-miR-34b-3p. Despite the limited number of common microRNAs between seminal plasma and testicular tissue samples, in-silico analysis revealed 34 statistically significant dysregulated gene pathways, regarding both seminal plasma and testicular tissue samples, indicating that idiopathic NOA patients are sharing several common altered molecular mechanisms involved in NOA pathogenesis.

Limitations, reasons for caution

The limited number of the included studies as well as the small size population characterizing the great majority of them, constitute the main limitations of this systematic review. Moreover, great heterogeneity was observed among the studies regarding the molecular methods employed for microRNA profiling.

Wider implications of the findings

These collective findings indicate that microRNA profiling in seminal plasma could indeed be raised as a powerful non-invasive tool towards better understanding and diagnosing idiopathic NOA. Larger well-controlled studies employing state-of-the-art microRNAome techniques are needed to validate these conclusions. Moreover, the molecular network of targeted gene pathways also merits investigation.

Trial registration number

Not Applicable

P-226 Efficiency of different antioxidants in reducing the supra-physiological Oxidation Reduction Potential Levels in human embryo culture media

Study question

Does every antioxidant compounds perform similarly in reducing the excessive levels of Oxidation Reduction Potential (ORP) in IVF culture media?

Summary answer

Not all antioxidant compounds perform similarly in maintaining physiological ORP levels in IVF culture media.

What is known already

During assisted reproduction technologies (ART), several external factors are responsible for disturbing the ORP equilibrium in gametes and embryos. Therefore, antioxidant supplementation of culture media has been evaluated and reported. However, there is lack of consensus on the efficiency of antioxidant action in embryo culture media. Antioxidants are known to lower the levels of free radical concentration to physiological levels, preventing cellular damage caused by oxidative stress. Therefore, it is important to determine which antioxidant compound are the most effective in reducing ORP levels in embryo culture media.

Study design, size, duration

In this prospective study was performed at CITMER Reproductive Medicine, Mexico city. ORP levels were measured by MiOXSYS System (UAB Caerus Biotechnologies, Vilnius, Lithuania) in embryo-free culture medium (Global® Total®, LifeGlobal®, Connecticut, US). Embryo-free culture medium was supplemented with cumene hydroperoxide and seven different antioxidants were tested each day for 5 continuous days (n = 40). Follicular fluid ORP levels from dominant follicles of 40 oocyte donors were used as control and considered as a physiological target.

Participants/materials, setting, methods

Cumene hydroperoxide (CH) 1mM, was utilized to increase ORP values in culture media from 224 mV to 415 mV. The following compounds considered as antioxidants according to literature were supplemented at 2 mM to the CH culture media: Ascorbic acid (ASC), L-Carnitine (CAR), L-Cysteine (CYS), Glutathione (GLT), Curcumin (CU), Resveratrol (RSV) and b-Mercaptoethanol (BME). ORP levels were quickly evaluated each time.

Main results and the role of chance

In this study, CH was used as a culture media oxidant to measure the antioxidants capacity in lowering the excessive ORP values of CH culture media. ORP in CH solution was 415 mV ± 4.3. All antioxidants showed a statistically different capacity (p &lt; 0.05) to lower the ORP values when added to CH solution: RSV decreased the ORP to 348.3 mV ± 3.6 p = 0.0449, CAR to 316.32 mV ± 4.7 (p &lt; 0.0001), CU to 315.7 mV ± 4.4 (p &lt; 0.0001) and GLT to 258.4 mV ± 15.1 (p = 0.00002). The compounds that showed higher antioxidant capacity were CYS 158.4 mV ± 4.7 (p &lt; 0.00001), ASC 154.1 mV ± 3.1 (p &lt; 0.00001) and BME 136.1 mV ± 9.6 (p &lt; 0.00001). CYS, ASC and BME ORP values reached the physiological ORP values found in follicular fluid from donors, which are 89 mV±23.6 mV.

Limitations, reasons for caution

Further studies should focus on the comparison between physiological dynamics of antioxidant supplementation on culture media and molecular and biochemical effect of antioxidants on embryos and gametes.

Wider implications of the findings

According to our results, CYS, ASC and BME were significantly more potent antioxidants in lowering the ORP in culture medium to physiological levels. The measurement of antioxidant capacity in lowering excess of ROS in culture media may assist in developing the most effective antioxidant supplements, thus improving ART outcomes.

Trial registration number

none

The extrapyramidal syndromes of chronic kidney disease and dialysis (EPS-CKDD): diagnostic criteria, risk factors and prognosis

BACKGROUND

Acute extrapyramidal movement disorders in dialysis patients are rare, inconsistently defined and have uncertain aetiology and prognosis.

AIM

Define diagnostic criteria, prognosis and risk factors.

DESIGN AND METHODS

Retrospective case series review of 20 patients (14 female, mean age 62 years) receiving dialysis for a median of 15 (interquartile range 4-35) months who presented with acute parkinsonism (AP = 11) or chorea/athetosis (CA = 9).

RESULTS

All patients had type 2 diabetes (HbA1c 6.8 ± 1.0) and had received metformin. Lactic acidosis was present in 2 patients at presentation and serum lactate was elevated in 7/15 patients tested. No patient had abnormal copper or thyroid metabolism and 5/8 patients tested returned marginal abnormalities in heavy metal screening. Magnetic resonance imaging (MRI) revealed characteristic bilateral symmetric T2 hyperintensity of the basal ganglia (BG), predominantly putamen and globus pallidus (the lentiform nucleus) and more extensive involvement of the external and internal capsules in patients with AP presentation. Post-mortem demonstrated cytotoxic necrosis of the BG. Therapy included thiamine, intensive dialysis and cessation of metformin. Two patients died acutely, nine recovered and nine had residual symptoms. Median survival did not differ by presentation: AP 24 [95% confidence interval (CI) 21-27] and CA 33 (95% CI 32-35) months, P = 0.21.

CONCLUSIONS

There are two distinct clinical extrapyramidal movement disorders associated with specific diagnostic MRI imaging that support the diagnosis of the extrapyramidal syndromes of chronic kidney disease and dialysis. The associations with diabetes, metformin and metabolic acidosis suggest a common pathogenic mechanism but require additional study. Early recognition and treatment may improve outcomes.

Bony Cyst in a Ground Glass Matrix: A Rare Case Report of Craniofacial Fibrous Dysplasia with Secondary Aneurysmal Bone Cyst

Fibrous dysplasia has various ways of presentation including syndromic associations and secondary changes within the lesion. We present a case of a 21-year-old female with craniofacial fibrous dysplasia, presenting with proptosis and intermittent blurring of vision due to focal fibrous dysplasia involving the frontal bone with secondary aneurysmal bone formation that was provisionally diagnosed on imaging and confirmed on histopathology. This case demonstrates the typical imaging findings of fibrous dysplasia with seldom encountered secondary aneurysmal bone cyst formation and also discusses about the pathology and management of the craniofacial fibrous dysplasia.

Phosphonomethyl iminodiacetic acid functionalized metal organic framework supported PAN composite beads for selective removal of La(III) from wastewater: Adsorptive performance and column separation studies

The rare earth elements being toxic in nature are being accumulated in water bodies as their industrial usage is growing exponentially, thus their efficient separation holds an immense significance. Herein, ligand functionalized metal organic framework (MOF), Phosphonomethyl iminodiacetic acid coordinated at Fe-BTC, was synthesized post-synthetically and incorporated subsequently in polyacrylonitrile polymer to prepare the composite beads via nonsolvent induced-phase-inversion technique for selective adsorption of La(III) from the wastewater in batch and dynamic column mode. XPS NMR, and FTIR were used to establish the interaction between functionalized ligand and unsaturated metal nodes of MOF. The adsorption capacity was 232.5 mg/g and 77.51 mg/g at 298 K of the functionalized MOF and composite beads respectively. Adsorption kinetics followed a pseudo-second order rate equation, and isotherm indicated the best fitting with Langmuir model. The dynamic behavior of the adsorption column packed with MOF/Polymer beads was fairly described by the Thomas model. The breakthrough time of 23.2 h could be attained with 12 cm of bed height and 10 ml/min of flow rate. These MOF/Polymer beads shown the selectivity of La over transitional metals were recycled over 5 times with about 15% loss of adsorption capacity. The findings provide suggestive insights of the potential use of functionalized MOF towards the separation of the rare earth element.

Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study

The G arvan Fracture Risk Calculator predicts risk of osteoporotic fractures. We evaluated its predictive performance in 16,682 women and 2839 men from Manitoba, Canada, and found significant risk stratification, with a strong gradient across scores. The tool outperformed clinical risk factors and bone mineral density for fracture risk stratification.

INTRODUCTION

The optimal model for fracture risk estimation to guide treatment decision-making remains controversial. Our objective was to evaluate the predictive performance of the Garvan Fracture Risk Calculator (FRC) in a large clinical registry from Manitoba, Canada.

METHODS

Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women and men aged 50-95 years undergoing baseline BMD assessment from September 1, 2012, onwards. Five-year Garvan FRC predictions were generated from clinical risk factors (CRFs) with and without femoral neck BMD. We identified incident non-traumatic osteoporotic fractures (OFs) and hip fractures (HFs) from population-based healthcare data sources to March 31, 2018. Fracture risk was assessed from area under the receiver operating characteristic curve (AUROC). Cox regression analysis and calibration ratios (5-year observed/predicted) were assessed for risk quintiles. All analyses were sex stratified.

RESULTS

We included 16,682 women (mean age 66.6 + / - SD 8.7 years) and 2839 men (mean age 68.7 + / - SD 10.2 years). During a mean observation time of 2.6 years, incident OFs were identified in 681 women and 140 men and HFs in 199 women and 22 men. AUROC showed significant fracture risk stratification with the Garvan FRC. Tool predictions without BMD were better than from age or decreasing weight, and the tool with BMD performed better than BMD alone. Garvan FRC with BMD performed better than without BMD, especially for HF prediction (AUROC 0.86 in women, 0.82 in men). There was a strong gradient of increasing risk across Garvan FRC quintiles (highest versus lowest, hazard ratios women 5.75 and men 3.43 for any OF; women 101.6 for HF). Calibration differences were noted, with both over- and underestimation in risk.

CONCLUSIONS

Garvan FRC outperformed CRFs and BMD alone for fracture risk stratification, particularly for HF, but may require recalibration for accurate predictions in this population.

Graphene quantum dots-porphyrins/phthalocyanines multifunctional hybrid systems: from interfacial dialogue to applications

Engineered well-ordered hybrid nanomaterials are at a symbolically pivotal point, just ahead of a long-anticipated human race transformation. Incorporating newer carbon nanomaterials like graphene quantum dots (GQDs) with tetrapyrrolic porphyrins...

Anatomage - the virtual dissection tool and its uses: A narrative review

Advancement in technology has given students and institutes an educational, interactive, and diagnostic aid with virtual reality functionality known as the Anatomage table. This review analyses the various spheres of the medical field where the 3D virtual tool is being used and assesses its acceptability, convenience, and practical application. A search for relevant studies in various databases namely Pubmed, Embase, Wiley Library, and Google Scholar was performed, and the data was compiled to understand the use of the Anatomage table. The search yielded a total of 24 studies that focused on the use of the Anatomage table. Eleven articles focused on using Anatomage as a learning tool and 13 described the perception of the Table. Anatomage table offers an excellent tool for learning anatomy by virtual dissection. The tool is not only used as a teaching aid, but also as a diagnostic and planning tool in residency programs. Adding the tool as an educational aid boosts the existing curriculum and helps to counter the challenges with cadaveric dissection. The equipment cost and its maintenance charges may be a deciding factor for the underutilization of the tool in developing countries.

Molar Tooth in the Knee - A Case of Simultaneous Medial and Lateral Bucket Handle Tear with Arthroscopic Correlation and a Review of Literature

INTRODUCTION

Simultaneous bucket handle tear of both lateral and medial menisci is a rarely encountered entity. MR imaging helps in pre-operative diagnosis for optimal operative planning. However, as this condition is not seen in routine practice, awareness of various imaging signs is essential to identify this condition. Few signs on coronal and sagittal images have been described in the literature but none so far on axial images.

CASE PRESENTATION

We propose a novel "molar tooth sign" in the knee on axial MRI images, in which we identified in the case of a young male with recurrent knee locking after a fall from height.

CONCLUSION

Different modes of injury can lead to different patterns of meniscal and ligament tears. Having an allied sign which is, furthermore, easy to imagine will help, not only the radiologists but also the surgeons, to identify rare types of meniscal tears similar to the index case.

Unusual cause of urinary retention in a child: inflammatory pseudotumor of the urinary bladder

Background

Urinary bladder masses are uncommon in the pediatric age group and pose a diagnostic challenge, often necessitating histopathological differentiation and confirmation. An unusual mimic of neoplastic bladder mass is inflammatory pseudotumor, and timely identification and diagnosis of which prevents undue patient stress and radical treatment.

Case presentation

We present a case of a 7-year-old female child who presented with hematuria, and a urinary bladder mass was detected on ultrasound which was further characterized by magnetic resonance imaging (MRI) and diagnosed as an inflammatory pseudotumor (IPT) on histopathology.

Conclusions

This case report describes the imaging features of IPT along with a list of differential diagnoses emphasizing the need for radiologists to be aware of this surprising and rare entity.