Regarding APCs in adjunct to bone grafting, a significant advantage was found only for HCAL . The sub-group analysis showed that both platelet-rich fibrin and platelet-rich plasma in adjunct with open flap debridement, yielded significantly favorable results. No meta-analysis was performed for APCs in combination with guided tissue regeneration (GTR) as only one study was found. Conclusion: For the treatment of furcation defects APCs may be beneficial as an adjunct to open flap debridement alone and bone grafting, while limited evidence of an effect of APCs when used in combination with GTR was found.Background: The aim of this review was to evaluate the adjunctive effect of autologous platelet concentrates (APCs) for the treatment of furcation defects, in terms of scientific quality of the clinical trials and regeneration parameters assessment. Methods: A systematic search was carried out in the electronic databases MEDLINE, SCOPUS, CENTRAL , and EMBASE, together with hand searching of relevant journals. Two independent reviewers screened the articles yielded in the initial search and retrieved the full-text version of potentially eligible studies. Relevant data and outcomes were extracted from the included studies. Risk of bias assessment was also carried out. The outcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss , horizontal and vertical furcation depth  were considered for meta-analysis. Results: Ten randomized trials were included in this review. Only one study was judged at high risk of bias, while seven had a low risk, testifying to the good level of the evidence of this review. The meta-analysis showed a favorable effect regarding all outcome variables, for APCs used in adjunct to open flap debridement ( Furcation involvement is defined as bone resorption and attachment loss in the inter-radicular space that results from plaque associated periodontal disease . The treVarious treatment modalities, including surgical and non-surgical therapy, have been proposed to improve the prognosis based on the degree of furcation involvement. Several classifications have been proposed over the years , based eRegenerative approaches are aimed at furcation closure by the formation of new bone, cementum and periodontal ligament in the involved inter-radicular space. Thorough debridement with adequate instrumentation following surgical exposure of furcation involved area, is one of the earliest and most well-documented treatment protocols to achieve regeneration in grade II furcation lesions . In addiThe use of biologic agents consisting of growth and differentiation factors like rhBMP2 (recombinant human bone morphogenetic protein-2), rhPDGF (recombinant human platelet-derived growth factor), and TGF-β (transforming growth factor beta), had proven to promote osteogenic induction in cases of furcation treatment, in animal studies ,9,10. Adp = 0.07) and bone fill . Another systematic review [A recent systematic review and meta-analysis , evaluatc review  includedThe aim of this systematic review is to evaluate the adjunctive effect of APCs in treatment of furcation defects both qualitatively and quantitatively, in terms of scientific quality of the clinical trials and regeneration parameters assessment.A total of ten studies were included in this systematic review after independent screening of titles and abstracts from a pool of 153 articles retrieved from the search platforms. The systematic flow chart of the study selection process is provided in The general comparison was between a group that received APC as an adjunct to surgical treatment , and a group that received surgical treatment alone (control group). Three different types of comparisons were assessed, based on the treatment type. Five studies reported the comparison of open flap debridement (OFD) + APC versus OFD alone . Four studies reported the comparison of bone graft (BG) + APC versus BG alone, and only one study reported the comparison of guided tissue regeneration (GTR) + APC versus GTR alone. The results of these studies were separated for types of platelet concentrate data to facilitate subgroup meta-analysis for OFD + APC versus OFD comparison. However, it was impossible to undertake the subgroup analysis for the other two comparisons due to the lack of enough studies for sub-grouping. The risk of bias of all included studies is synthesized in p < 0.001, mean difference 1.59, 95% CI 1.38, 1.80). The subgroup analysis is also favorable for both PRF  and PRP .The forest plot of the included studies evaluating the change in PPD shows evidence of an advantage of using APC in adjunct to OFD .The forest plot of the included studies evaluating the change in PPD in using APC in adjunct with BG favors the use of BG alone; however, the result is not statistically significant . The subgroup analysis is also favorable for both PRF  and PRP .The forest plot of the included studies evaluating the change in VCAL shows evidence of an advantage of using APC in adjunct to OFD .The forest plot of the included studies evaluating the change in VCAL in using APC in adjunct with BG is favorable; however, the result is not statistically significant . The subgroup analysis is also favorable for both PRF  and PRP .The forest plot of the included studies evaluating the change in HCAL shows evidence of an advantage of using APC in adjunct to OFD .The forest plot of the included studies evaluating the change in HCAL shows evidence of an advantage of using APC in adjunct with BG . The subgroup analysis is also favorable for both PRF  and PRP .The forest plot of the included studies evaluating the change in VFD shows evidence of an advantage of using APC in adjunct to OFD .The forest plot of the included studies evaluating the change in VFD in using APC in adjunct with BG favors the use of BG alone; however, the result is not statistically significant . No subgroup analysis was carried out for this outcome due to the lack of enough studies.The forest plot of the included studies evaluating the change in HFD shows evidence of an advantage of using APC in adjunct to OFD .The forest plot of the included studies evaluating the change in VFD shows evidence of an advantage of using APC in adjunct with BG , so that it seems difficult to indicate if there is really a superiority of some APCs over the others for specific conditions. In the present review, we were able to perform a meta-analysis with subgroups, keeping separate different APC (PRP and PRF), only in the group considering OFD alone. The outcomes using different APC was very similar as can be seen in In addition to the regenerative properties, platelet concentrates have also been demonstrated to carry further advantages in the postsurgical healing period. Evidence-based studies in different oral surgery procedures have reported that the adjunctive use of APC is associated with an improvement of patients’ quality of life and pain reduction in the post-surgical period ,57 UnforFinally, though specific clinical studies have not been performed so far, there is consistent preclinical evidence that APCs have an antimicrobial effect against a number of species commonly found in the oral cavity, which suggest they may potentially represent a beneficial tool for the control of postsurgical infection ,59. IndiThis systematic review and meta-analysis were carried out based on preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. The protocol of this systematic review was registered on the international prospective register of systematic reviews (PROSPERO) with registration number CRD42019100015.What is the effectiveness of autologous platelet concentrates used as an adjunct to different types of surgical techniques for the treatment of furcation defects, compared to the same surgical techniques alone?clinicaltrials.gov; searched 20 October 2018); World Health Organization International Clinical Trials Registry Platform . No language restrictions were applied.A systematic digitalized search was carried out in the following electronic databases: MEDLINE, SCOPUS, CENTRAL , and EMBASE, using a series of search terms combined with the Boolean Operators “AND”, “OR”, and “NOT”. The following search string was developed with the combination of relevant keywords: “(((Furcation Defects) OR Furcation Involvement)) AND (((((((Platelet Concentrates) OR Platelet-rich plasma) OR Platelet-rich fibrin) OR Growth factors) OR PRP) OR L-PRF) OR CGF)”. The last electronic search was carried out in October 2018. In addition, a hand search was performed in the following dental journals: British Dental Journal, British Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, Clinical Oral Investigations, European Journal of Oral Implantology, European Journal of Oral Sciences, Implant Dentistry, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, International Journal of Periodontics and Restorative Dentistry, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Dentistry, Journal of Implantology, Journal of Maxillofacial and Oral Surgery, Journal of Oral and Maxillofacial Surgery, Journal of Periodontal Research, Journal of Periodontology, and Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology. The reference citations of the eligible studies and other systematic reviews were also searched for possible additional eligible studies. Finally, the online trial registries were also searched for any ongoing studies: US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov , either of a parallel group or of a split-mouth design;Presence of at least one experimental group in which APCs were clinically applied as an adjunct to surgical procedures alone or in combination with bone grafting materials or GTR procedures for the therapy of furcation defects;Presence of an appropriate control group, in which the same therapeutic procedures as those employed in at least one experimental group were clinically applied for the treatment of furcation defects, without the adjunctive effect of APCs;Patients included in the RCT should present with maxillary/mandibular Grade 2 or 3 furcation defects;Patients included in the RCT should have no systemic diseases nor taking medications that could potentially influence the outcome of periodontal therapy;The follow-up period had to be at least 6 months.The criteria for the articles to be included in this present systematic review were as follows: Following the electronic search in all the respective databases, the records were imported into EndNote 13 software  and the duplicates were sorted to be removed from the pool of titles. A total of 153 titles and abstracts (if available) were independently screened by two reviewers  to exclude all articles clearly not meeting the inclusion criteria. Of all the eligible articles, full texts were obtained and were thoroughly assessed. Only articles fulfilling the inclusion criteria were considered. In cases of disagreement between the two reviewers, a third reviewer (LF) was consulted. Detailed reasons were stated for all excluded studies.The relevant data of the included studies were extracted using an Excel spreadsheet . Data were independently extracted by two review authors  and recorded on predetermined spreadsheets. In case of missing or unclear information, the authors of the included studies were contacted by email for providing clarification or missing information.Patients’ demographic characteristicsStudy design and sample sizeType of platelet concentrate used Follow up durationsource of funding and study settingOutcome variables, relative to baseline and post-operative defect characteristics (probing pocket depth (PPD), horizontal and vertical clinical attachment loss , horizontal and vertical furcation depth The following data were recorded for each included report:Risk of Bias was assessed by two independent reviewers  for all the included clinical trials and the discrepancies were resolved by discussion and in consent with a third reviewer (MK). The domains of the study were graded under high, unclear or low risk, based on the following categories: Selection bias , performance bias (blinding), detection bias (assessor blinding), attrition bias (incomplete outcome data), reporting bias (selective reporting), sample size calculation and number of surgeons involved. Based on the domains, the studies categorized as low risk of bias if all domains were at low risk; high risk of bias if two or more domains were at high risk; or medium risk of bias if one domain were at unclear or high risk.i2 < 60%, p > 0.05). When the heterogeneity was large , a random-effects model analysis was undertaken.Data of the various outcomes were extracted from each included study. Parallel group and split-mouth studies were combined in the meta-analysis of treatment effects. For all the outcomes, mean differences and 95% confidence interval (CI) were used to summarize the results for each included study. The meta-analysis was performed using Review Manager 5.3 software  using the fixed or random effects models, as appropriate. Fixed effects meta-analysis was used when the heterogeneity was small (In conclusion, the evidence available in the literature for the beneficial effects of platelet concentrates in periodontal furcation defects has been increasing in recent years. Platelet-rich plasma and platelet-rich fibrin may be advantageously used as an adjunct to open flap debridement alone and additional grafting procedures, while there is no evidence of an effect of APC when used in combination with GTR, for the treatment of furcation defects.


The dopant impurity is modeled by a Gaussian potential. The noise-BE interplay does not give rise to any new interesting feature in case of CF from that in absence of noise. However, the said interplay prominently influences the DCKE and EAC profiles. This is justified by the emergence of distinct qualitative characteristics in the DCKE and EAC profiles that evidently depend on the mode of introduction of noise.Present investigation focuses on analyzing the role of  The impetus for the said research has both technological and academic origins. The technological origin being the widespread application of LDSS in the manufacture of microelectronic and optoelectronic devices having very high efficacy such as QD lasers, solar cells, single electron transistors and quantum computers. And, from an academic perspective, study of LDSS physics refreshes many important concepts of quantum mechanics. Studies of LDSS physics earn further delicacy with the introduction of impurity (dopant) which induces a noticeable interaction between the original LDSS confinement potential and the newly arrived impurity potential. As a result, various physical properties of LDSS  are changed from that of an impurity-free condition. The changed values of these properties are quite encouraging from a technological viewpoint. Thus, we come across a plenty of relevant studies on LDSS physics with proper thrust on dopant contributions Kerr effect or Kerr nonlinearity corresponds to the alteration in the refractive index (RI) of a substance in presence of an external electric field. It is linked with the real part  of third-order optical susceptibility [DC-Kerr effect (DCKE)  deems importance in view of realizing photoemission and detection applications of QDs Electro-absorption coefficient (EAC) or electro-absorption frequency-dependent susceptibility is another notable third-order nonlinear optical (NLO) quantity to explore the photoemission and detection experiments of QDs n, α, I are total RI, linear RI, nonlinear RI, total AC, linear AC, nonlinear AC and intensity of electromagnetic wave, respectively. For systems where absorption is insignificant  for non-absorbing to absorbing media. Regulated doping of impurity to LDSS can tune the magnitudes of In case of Kerr-type nonlinearities the RI and absorption coefficient (AC) are given by noise influences the output of LDSS-based devices. Noise can enter the system through some external ‘modes’ or ‘pathways’. Two such pathways are usually called additive and multiplicative based on how system coordinates get coupled with noise. The physical properties of the system are modified as a result of ingression of noise and the extent of modification unveils conspicuous dependence on the particular mode. Therefore, it becomes obvious that the exploration of the noise effects on physical properties of LDSS is extremely important.Presence of interplay between noise and binding energy (BE) modulates the DCKE, EAC and CF of 2-d GaAs QD. Monitoring BE of LDSS deems importance as any change in BE heavily affects the physical properties of LDSS and therefore the designing of useful optoelectronic devices. The z-confinement is offered by a perpendicular magnetic field. In addition, an electric field of strength F is applied to the system in x and y-directions. The QD contains Gaussian impurity as dopant and at the same time is exposed to Gaussian white noise applied via additive and multiplicative pathways (modes). The inspection illuminates how the interplay between BE and noise governs the aforesaid quantities with sufficient emphasis on the role performed by the noise mode.In the current manuscript we inspect how the 2e is the electronic charge. Use of effective mass approximation givesA is the vector potential given by B is the strength of the magnetic field. y-direction and the cyclotron frequency, respectively. The Hamiltonian  which actually guide the size of system-noise interplay. Noise involves a spatially δ-correlated function ζ and is described by the set of conditionsδ-correlation condition. The additive and multiplicative pathways of introduction of noise can be written asself-originating. These fluctuations can be due to a fluctuating environment or can be consequence of an externally applied random force. Whereas additive noise does not interfere with the system coordinate the multiplicative analogue depends on the instantaneous value of the variables of the system. It does not scale with system size and is not necessarily small Now, the construction of Hamiltonian matrix  for six different values (given in the figure caption) of BE without noise effect [blue-shift of peaks as BE increases maximization at blue-shift of DCKE peaks with increase in BE is again observed. A better view of noise-BE interplay in the present context becomes available with the plot of DCKE against BE at We now monitor the DCKE profiles as a function of oscillation frequency (e effect a and whee effect b and mule effect c noise o=70.0meV d. The plν) for previously used values (given in the figure caption) of BE without noise effect [blue-shift and their height gradually decreases as BE increases maximization of the peak altitude at blue-shift of EAC peaks as BE increases is again envisaged. The observation reflects that introduction of multiplicative noise causes maximization of mixing between the eigenstates around We now focus on exploring the influence of noise-BE interplay on EAC. EAC profiles are now plotted as a function of oscillation frequency  also affect the effective BE mentioned above. All these things invariably influence the above optical properties in diverse ways that may have important practical relevance. In absence of noise we could not expect such diversities in the above optical properties and we stress to mention that herein lies the ‘new physics’. Already we have discussed in detail the findings of our study which amply reveal the important outcomes of noise-BE interplay/‘new physics’. Thus, now, we are not discussing it again for the brevity of the manuscript.Present investigation is believed to offer some 4GaAs QD has been rigorously explored. The noise-BE interplay does not qualitatively affect the CF as under all situations CF declines with enhancement of BE. The said interplay, however, displays some noticeable role in case of DCKE and EAC. For these two properties the mode of introduction of noise modulates the said interplay. Both of these properties exhibit steady drop and blue-shift as BE increases; without noise and when additive noise operates. Presence of multiplicative noise, though does not affect the general trend of peak shift, but causes maximization of peak height at The influence of noise-BE interplay on CF linked with Kerr nonlinearity, DCKE and EAC of doped Anuja Ghosh, Sk. Md. Arif, Manas Ghosh: Conceived and designed the experiments; Performed the experiments; Analyzed and interpreted the data; Contributed reagents, materials, analysis tools or data; Wrote the paper.This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.The authors declare no conflict of interest.No additional information is available for this paper.


The urinary tract is a common site of tuberculosis, which causes significant morbidity in the form of chronic renal disease. T uberculosis is not only common in developing countries but with the spurt in the number of immune-suppressed patients and the increasing incidence of drug -resistant strains, an increase in the number of patients suffering from genitourinary tuberculosis is expected even in developed countries. Genitourinary tuberculosis occurs owing to haematogenous dissemination of tubercular bacilli. Urinary tract tuberculosis can result in complications such as ureteric stricture, chronic pyelonephritis and papillary necrosis, resulting in compromised renal function. This renal compromise makes it prudent to avoid contrast- enhanced studies if other alternatives are available. There is a dearth of-cases of papillary necrosis reported on static MR urogram. The authors report a case of tuberculosis complicated by papillary necrosis on both CT urogram and static MR urogram. It is important to suspect and diagnose tuberculosis on imaging to direct the clinician to perform appropriate investigations such as culture for Mycobacteria. Appropriate treatment is necessary to prevent complications such as ureteric strictures, putty kidney, thimble bladder and tubercular renal abscesses.Urogenital tuberculosis is the most common cause of extrapulmonary tuberculosis, affecting about 27% of patients suffering from it.Many patients with renal tuberculosis have compromised renal function. This makes it prudent to avoid the use of contrast in such patients. This case report aims to show that static MR urogram can be used to make the diagnosis of renal tuberculosis without the risks of contrast or radiation dose administration. This case report describes the findings of renal tuberculosis with papillary necrosis on static MR urogram.A 60-year-old male presented with left flank pain and weight loss. Because of clinical suspicion of urolithiasis the patient was referred for imaging. On clinical examination there was no flank tenderness. A few enlarged cervical and inguinal lymph nodes were found.Clinical and Laboratory Evaluation: Routine urine analysis showed albuminuria 2+, numerous leucocytes in urine and negative nitrite test. On urine microscopy 227 RBCs/hpf, 314 WBCs/hpf and 239 bacteria/hpf were found (hpf = high power field). However, there was no growth on bacterial culture. This was indicative of sterile pyuria. A diagnosis of renal tuberculosis was considered with a differential diagnosis of chronic pyelonephritis.Initial evaluation on plain CT showed disproportionately dilated upper pole calyces and urothelial thickening with narrowing of the pelvis with papillary calcifications in the lower pole. Significant perinephric and periureteric fat stranding with locoregional lymphadenopathy was noted . This wa2The most common extrapulmonary site of tuberculosis is the urinary tract, with almost all cases resulting from haematogenous seeding. Despite the presumed route of spread from the lungs to the kidney, less than half the patients who have genitourinary tuberculosis have abnormal chest radiographs.5The tubercular bacilli form granulomas within the kidney and remain indolent for many years. Tuberculosis has a predilection for the upper and lower poles of the kidney. Imaging findings of renal tuberculosis result from the combination of papillary necrosis and parenchymal destruction. These papillary lesions caseate and cavitate, forming ulcerocavernous lesions as they erode into the pelvicalyceal system. Extensive papillary necrosis may develop with the formation of cavities and destruction of the renal parenchyma. They may also rupture into the collecting system, or cause parts of the papillae to become necrotic and slough. The collecting system shows thickening, ulceration and fibrosis, often with stricture formation. Along with papillary necrosis, the above spectrum is highly suggestive of tuberculosis.5 stated that pelvic- infundibular strictures, papillary necrosis, cortical low-attenuation masses, scarring and calcification may be seen in other conditions, but the combination of three or more of these findings is highly suggestive of tuberculosis, even in the absence of documented pulmonary disease.In a comprehensive review of the pathophysiology and imaging of renal tuberculosis, Merchant et al6 Few studies have reported the features of genitourinary tuberculosis on MRI. Loss of interface between the infection and the adjacent renal parenchyma, the surrounding tissue oedema, the asymmetric perinephric fat stranding and the thickening of Gerota’s fascia may be clues indicating that the focal pyelonephritis has a tuberculous origin.5However, CT is still limited in the identification of granulomas of about 3 mm size, minimal urothelial thickening and subtle papillary necrosis.Mycobacterium tuberculosis. The patient was started on antitubercular chemotherapy and put on follow-up with a plan to perform ureteric stenting. Cystoscopy confirmed the finding of a thickened and narrowed left ureteric opening, which was characteristic of tuberculosis.Urine culture was done for the patient, which showed growth of In this case report, the authors describe the calyceal findings of urinary tract tuberculosis causing papillary necrosis on both CT and static MR urogram with greater emphasis on the calyceal and ureteral findings of the disease. The finding of terminal ureteric narrowing was more easily seen on MR urogram. The findings seen on contrast-enhanced CT urogram could also be seen on static MR urogram without administration of contrast. Thus, in patients with renal dysfunction static MR urogram can be used instead of contrast-enhanced CT urogram.MR urogram can detect the calyceal and ureteric findings of tuberculosis with papillary necrosis without contrast administration.The signs of papillary necrosis are blunting of calyces, filling defects in the calyces, ring sign, presence of clefts and infundibular pelvic stenosis, which can be seen both on CT and MR urogram.MRI may be better than CT for detecting terminal ureteric strictures.Informed consent to publish this case (including images and data) was obtained and is held on record.


The tumors derived of the ceruminous gland in the external auditory canal are rare. Here, we report a case of a ceruminous adenoma (apocrine adenoma) with refractory chronic inflammation in the external auditory canal. A 46-year-old man presented with otorrhea, itching, and a foreign body sensation in his right ear. A soft reddish protruding lesion was revealed at the posterosuperior portion of the entry to the right external auditory canal by otoscopy. The skin lesion was endaurally resected; histopathology showed luminal structures in the middle to deep layer of the epidermis and inflammatory granulation below pseudoepitheliomatous hyperplasia. The walls of the luminal structures consisted of inner luminal secretory cells featuring apical decapitation secretion and outer myoepithelial cells. The patient was diagnosed with an apocrine adenoma. Three years after surgery, there has been no evidence of recurrence. Complete resection, including the deep layer of the epidermis, is necessary. Ceruminous gland tumors of the external auditory canal are rare and are derived from sweat gland tumors in the external auditory canal. Sweat glands are classified as eccrine or apocrine glands. Eccrine sweat glands are absent from the external auditory canal, whereas apocrine sweat glands are distributed in the outer one-third of the external auditory canal . TherefoA 46-year-old man presented with otorrhea, itching, and a foreign body sensation in his right ear. Otoscopic examination revealed a soft reddish protruding lesion at the posterosuperior portion of the entry to the right external auditory canal . ComputeThe patient was diagnosed with an apocrine adenoma and pseudoepitheliomatous hyperplasia with inflammatory granulation. After surgery, otorrhea due to slight inflammatory granulation was prolonged. Therefore, additional resection of the posterosuperior portion of the ear auditory canal entry, including the cartilage over the bone, was conducted. The skin defect of the posterosuperior portion of the auditory canal was reconstructed using a postauricular island pedicle skin flap. The otorrhea and inflammation resolved. Three years after surgery, there has been no evidence of recurrence.The most characteristic macroscopic feature of a ceruminous adenoma is a polypoid mass with a reddish to reddish brown appearance, and most cases show surface ulceration . AsymptoA difference between eccrine and apocrine sweat glands is that apocrine glands consist of columnar cells containing eosinophilic cytoplasm with apical decapitation secretion, whereas eccrine glands do not demonstrate apical decapitation secretion , 4. In 1The features of ceruminous neoplasms derived from apocrine glands include existence of the walls of the luminal structures consisting of inner luminal secretory cells and outer myoepithelial cells. The apical decapitation secretion of inner luminal secretory cells strongly suggests origination from the apocrine glands . The difThe pathology of our case shows accumulation of inflammatory cells below the pseudoepitheliomatous hyperplasia. The inflammation probably caused otorrhea and itching. The preoperative tissue biopsy did not demonstrate an apocrine adenoma, but granulation as the tumor was not located in the deep layer of the epidermis at the biopsy site.Treatment for an apocrine adenoma is complete surgical resection. The ceruminous glands are placed in the deep layer of the dermis close to the cartilage . TherefoApocrine adenomas of the external auditory canal occur in the deep layer of the epidermis; there is inadequate tissue biopsy for diagnoses, and wide resection, including the deep layers of the epidermis, is required. Otherwise, recurrence is inevitable.Apocrine adenomas should be treated as potentially malignant. Apocrine adenomas are difficult to distinguish from well-differentiated apocrine adenocarcinomas, as the presence or absence of invasion into the tumor margin is the differentiating feature; the high incidence of malignancy has been pointed out as well .


Despite the fact that distal radius fractures are the most common, open fractures are relatively uncommon. The aim of this study is to present the case with severe malunion of extra-articular left distal radius after open fracture grade IIIB (Gustillo). The treatment was done with open correctuve osteotomy and ostosynthesis with volar low profile plate.A 32-years old man was admitted to our departement because of severely malunited left distal radius extra-articular metaphyseal fracture after treatment of an open fracture. He was primary treated in a Regional Hospital with irrigation, debridement, antimicrobial cover, and immediate skeletal management through fixation with Kirschner’s wires. No external fixator was used. He developed volar metaphyseal angulation after loss of primary reduction of K-wires fixation; therefore it required corrective surgical treatment. Because of malunion, open corrective osteotomy and bone grafting of distal radius with volar plating were done. Follow-up 20 months after surgery show deformity correction of radial volar inclination, height, and restitution of distal radioulnar joint.This case report offers an informative overview on this uncommon case of distal radius open fracture malunion treated successfully with volar approach corrective osteotomy. Corrective surgery is the primary therapy of choice in the this case. This method have shown to be safe and effective in treatment of distal radius malunion with volar angulation. Open frUnstable and extra articular open fractures of the distal radius remain a challenging problem in management. A good primary management is very important especially due to the possibility of multiple type of complications. Several methods of treatment have been described in the management of these conditions, such as reduction and pinning, external fixation etc. ,4. A keyThis study is reported in line with the SCARE criteria  and was 2A 32-year - old man sustained an open distal radius fracture . Primary treatment was done at the Emergency Department of a Regional Hospital, where the patient received intravenous antibiotics, sterile dressing and cast longuette immobilization. Within 4 h, the patient underwent debridement, reduction and operative fixation with three Kirschner’s wires and plaster immobilization. The extrenal fixator was not used. Following the fixation of the fragmented fractures, myorrhaphy-tenorrhaphy on the injured tendons was done .Fig. 1PrThe patient was presented in our department, in University Clinical Center after 8 months of injury. After loosening of the primary reduction and fixation, redislocation occurred and malunion was developed. The patient lost normal volar tilt, radial inclination, and radial length relative to the ulna and complained of pain, limited motion, decreased grip strength, and cosmetic deformity Fig. 2A: The distal radioulnar joint was also dislocated and therefore prono-supination was limited. Because of the conflict of the ulnar head with the carpus, patient developed an ulnar painful wrist. CT images with 3D reconstructions were used for pre-operative planning A–C and cSurgical techniqueThe aim of corrective osteotomy was to achieve anatomic relation in the wrist joint obtaining stable fixation with minimal disruption of supporting ligaments and with maintance of the vascularity of the fragments. The contralateral unaffected radius was used as a reference in planning of a corrective osteotomy procedure of a malunited distal radius. The planning was arranged with a volar approach and using a volar plate as a fixation device after the osteotomy.The patient was placed in the supine position on operating table with the forearm on a hand table in supinated position and the palm faced upward. Exsanguinating bandage was used. A 6-cm longitudinal incision was made over the flexor carpi radialis tendon proximal to the wrist flexion crease. The exposure was done with a great care, atraumatic and respect soft tissues. Fluoroscopy images were taken to assure appropriate position of the plate and for planning of the osteotomy. The position of the plate and osteotomy were marked but the distal holes were not predrilled. The plate was then removed and an osteotomy was performed closely to the original fracture site and just proximally to the sigmoid notch. It was attempted to place the transverse metaphyseal osteotomy at the site of deformity and roughly perpendicular to the shaft of the radius. Trapezoidal corticocancellous autologous appropriate size and shape from the iliac crest was used and placed in the bone gap for its osteoinductive potential. The plate was then fixed to the distal fragment to allow appropriate correction of volar tilt and radial inclination. Image intensifier fluoroscopy was then used to assess plate position, and adjustments to radial and volar inclination and height. The patient postoperatively was placed into a well-padded, above-elbow splint.3In order to have a better post operative evaluation, the objective measurements, examination of the wrist range of motion (ROM) and grip strength (with a dynamometer-Jamar) were done . The quaAlso, 20 months postoperative X - rays of the left wrist show complete healing of the left distal radius after corrective osteotomy and restoring proper anatomic parameters comparing to the normal right side.4Anatomical reduction after extra-articular open fracture of distal radius is the principal aim of treatment but cannot achieve long term retention of fragments with simple fixation with Kirschner wiring.Kurylo and colleagues  reportedNyquist and Stern reported decreased range of motion and wrist pain with activity for all of their patients with open fractures at final follow-up . RozentaThere doesn’t exist a conclusion about the difference between external fixation and plating. Many surgeons likely feel comfortable with plating at the time of initial debridement, based on both experience and the literature supporting immediate internal fixation after initial debridement in open forearm and hand fractures ,11.An important issue in the treatment of open radius distal metaphyseal fractures is redislocation and malunion.Distal radius malunions frequently have an unappreciated rotational component that may affect distal radioulnar joint (DRUJ) motion and stability. In a study that examined computed tomography (CT) scans of both affected and normal wrists, Prommesberger et al. reported a rotational component to the malunion in 23 of 37 patients . When vo5In conclusion, we can say that this surgical technique to address distal radius malunions allows excellent correction of deformity, with low morbidity and no need of hardware removal.Also, mechanical advantages offered by locking plates for treatment of acute fractures of the distal are attractive for corrective osteotomies as well.Outcome scores as well as pre- and postoperative range of motion and grip strength tests document significant improvements in function.No conflict of interest.No source of funding.The study is exempt from ethical approval in our institution.The patient was informed and agreed that his clinical data will be used for research purposes.Cen Bytyqi: Data Curation, Conceptualization and Supervision.Hasime Qorraj: has drafted the manuscript and contributed to the literature review.Arber Tolaj : Data Curation.Rrahman Hajdari: Data Curation.researchregistry465.Cen Bytyqi.Not commissioned, externally peer-reviewed.


This year’s annual Symposium highlights specific topics in the field of Pediatric Radiology and Neuroradiology and will again host a parallel session organized by the Young Radiologists Section. Besides dealing with useful emergency situations the lectures will be of interest to both general and specialized radiologists. The session will be chaired by Prof. Philippe Demaerel (Dutch speaking Catholic University of Leuven) and by Prof. Niloufar Sadeghi .“Imaging an Orbital Mass: the essentials” is presented by Prof. Françoise Dreyfus-Héran, a well-known radiologist specializing in neuro-ophtalmological imaging. Dr. Héran is a full-time radiologist at the Ophtalmological Fondation Rothschild in Paris, who is a member of the SFNR Executive Committee and has beena member of the Executive Committee of the SFR IDF since 2012. She published extensively in the field of neuro-ophtalmology and salivary glands. During her lecture she will focus on adapting the technique to the clinical question and present the typical radiological aspects of orbital pathology. Attention will also be given to lesser-known techniques such as Color Doppler imaging and Diffusion-MRI.The first lecture “Neuroimaging of Adult Gliomas,” Prof.Niloufar Sadeghi will explain how to deal with adult brain gliomas, a topic that is close to her heart since she dedicated her PhD thesis to biomarkers in the in-vivo evaluation of human brain gliomas in 2010. Prof. Sadeghi holds diagnostic and teaching positions at ULB-Erasme Hospital in Brussels and has recently been appointed as Head of the Clinic of Diagnostic Neuroradiology at ULB. The classification of brain tumors has evolved tremendously in recent years due to advances in research with new genetic and molecular markers. Anatomic and functional imaging now have a truly complementary role in the diagnosis of brain masses, in the planning of the surgical approach and in monitoring response to treatment.In her lecture Imaging the Spinal Cord. Graduate of the University of Leuven (KUL) and holder of a European Diploma in Neuroradiology, Dr. Didier De Surgeloose is actively involved in adult and pediatric neuroradiology in Antwerp. Close interaction with the neurologist and knowledge of laboratory findings will guide the diagnosis in spinal cord lesions. State-of-the-art imaging of the spinal cord nowadays includes Diffusion MRI. In recent years, research led to a better understanding of complex pathologies such as MS, ADEM and Neuromyelitis Optica Spectrum Disorder (NMOSD). In NMOSD Aquaporin-4 antibodies and Myelin Oligodendrocyte Glycoprotein (MOG) antibodies present with distinct radiological and prognostic features.Dr. Didier De Surgeloose, Director of the Radiology Department at ZNA Middelheim in Antwerp since 2004, will highlight the difficulties encountered when “Dose optimization in CT examinations of the Brain,” is dedicated to the necessary efforts in limiting the dose when performing CT examinations of the head. Timo De Bondt studied Physics at the University of Antwerp and wrote his PhD thesis entitled “Cyclical changes in the female brain – assessment with advanced MRI techniques” under the supervision of Prof. Paul Parizel. He coordinated the DoseWatch project at the department of Radiology of the University of Antwerp Hospital. He also completed a Master Degree in Medical Radiation Physics at the University of Leuven. In his lecture, Timo De Bondt will explain how dose management software can help radiologists to avoid excessive dosing in CT, which is of high importance especially in the pediatric population.The last lecture of this session,


If attracting, retaining and motivating eye care professionals to give their best is challenge in cities it is a seemingly impossible task in remote rural areas. Sadguru Nethra Chikitsalaya (SNC) at Chitrakoot is one of the few hospitals that have turned its rural setting to its advantage. Strategies and details described in this article will help countless other institutions that are struggling with similar issues.Chitrakoot is an important Hindu pilgrimage centre in the state of Madhya Pradesh, India. All throughout the year, thousands of pilgrims throng this small town from various parts of India. Apart from the religious significance of this town, Chitrakoot is also famous for its quality eye care services. From only a few camps a year during winter many years ago, to a state-of-the-art eye hospital, Chitrakoot has come a long way.Shri Sadguru Seva Sangh Trust engaged in eye care delivery to the socially neglected communities in Chitrakoot since the 1950s. The organisation had conducted occasional eye camps, especially during winters, as patient turnout was huge compared to other seasons of the year. With the patronage of the founder of the Trust, Ranchhoddasji Maharaj, such programmes managed to serve people even in Chtirakoot's challenging terrain.Surgical services were mainly organised and provided by voluntary ophthalmologists and nurses from various parts of India, while local volunteers were also involved. Huge tents were laid out to perform eye surgeries and facilitate pre- and post-operative care. Seeing that the annual camps had a huge turnout and a large number of beneficiaries, the Trust management decided to extend the services around the year and established a full-fledged eye hospital in the year 2000, named Sadguru Netra Chikitsalaya (SNC).With the infrastructure in place, ensuring availability of human resources for provision of services throughout the year was a key challenge. Chitrakoot is a rural area and lacks proper connections with other major towns, good educational institutions for children or even a social life. These were significant barriers for hiring and retaining people. Surgeries were limited to the winter season, and so ophthalmologists were reluctant to join the organisation for a long-term career or training. As a result, till 2002, almost 98% of the workload was taken up during the winter months with support from volunteers.Dr B K Jain, an ophthalmologist and an ardent supporter of the Trust's mission, joined the eye care division in 1973. Dr Jain was newly married and had to face several challenges convincing his wife to shift from a cosmopolitan city like Mumbai to rural Chitrakoot. However, his passion for service drove Dr Jain to survive and build the organisation. His unique style of leadership ensured others in the team felt valued and brought together people from diverse backgrounds.The Trust was unable to afford permanent staff as there were almost no work during summers. This led to concerns around plans for further expansion of services. As a majority of surgeries were done without IOL implants, quality of the cataract surgery was a big concern. Surgical follow-up among the patients was also poor. Financial constraints added to the list of challenges as the funds came entirely from donors. It limited the hospital's ability to provide adequate financial remuneration and amenities to employees. This even made it difficult to afford state-of-the-art facilities and technical advancements for the patients.To tackle the seasonal imbalance in patient inflow, the organisation initiated many community-based approaches including cataract screening camps and the establishment of vision centers in remote areas. Collaborations with several eye care hospitals such as Aravind Eye Care System, non-governmental organisations (NGOs) and iNGOs such as SEVA and Orbis provided the exposure and expertise to add speciality services.To assure quality in cataract surgical services, a policy of ‘intraocular lenses (IOL) for everyone’ was implemented with capacity improvement. With the establishment of the School of Paramedical Science at Chitrakoot in the year 1999, the Trust ensured availability of qualified and trained allied ophthalmic staff to the organisation. This was a huge opportunity for ophthalmologists to enhance their productivity without compromising on quality.To cope with rising financial requirements, in the year 2002 the Trust created a fully paid and a subsidised wing for patients who could afford to pay for the services. The Trust offered the choice of opting for free, subsidised or paid services to the patient themselves. As the patient inflow to paid and subsidised segments increased, it helped to provide adequate financial benefits and better living conditions for the employees on the campus. Professional growth of ophthalmologists and other essential cadres was ensured by offering them tiered training courses for all cadres of eye care staff. Continuing medical education (CME) sessions and workshops with visiting faculty helped in keeping the knowledge current and improved the prestige of the hospital.An overhaul of the information technology (IT) infrastructure was done to improve data management and global connectivity. A dedicated broadband connection made it possible to include tele-ophthalmology at SNC and also considerably improved communication and entertainment for the employees.Mahila (women's) wing for gainful employment of wives of employees were some of the measures taken by the management that were helpful in retention of employees in the long run. These strategies not only ensured an increase in retention of ophthalmologists, but also helped in the establishment of super-speciality departments including a paediatric eye care centre and a vitreo-retinal department at Chitrakoot.Provision of good quality living quarters, shopping facilities, an English-medium school for children and strengthening the Today, SNC is one of the largest rural eye care providers In India with more than 85 ophthalmologists working round the year with the support from 600 para-clinical and support staff. It is also considered as one of the pioneer institutes in the field of community ophthalmology. Its successful engagement with the community to tackle seasonal imbalances is well recognised resulting in more than 35,000 surgeries in summer months. As an organisation committed to its community, today SNC helps various other eye hospitals to tackle such issues and improve overall performance through a continued consultancy programme.The cataract surgical volume grew year on year with 100% IOL implants, and today it is one of the few organisations in the world to perform more than 100,000 cataract surgeries each year. The establishment of 40 primary eye care centres (vision centres) spread across Madhya Pradesh and Uttar Pradesh ensures an increased cataract follow-up rate.With increased retention of ophthalmologists, improved systems and quality assurance, the hospital today is able to provide comprehensive eye care services in appreciable volumes.The institute is also a recognised centre for training government surgeons and ophthalmic assistants from various parts of India. A large number of private organisations within India and other countries also enrol for the post-graduate training programme. Affiliation with the International Council of Ophthalmology (ICO), has so far enabled ophthalmologists from 12 countries enrol into different programmes. The paramedical wing also provides quality training to several rural youth through its structured courses that include diplomas in ophthalmic assistance, vision technicians, health care workers, operation theatre assistants and lab assistants.To cope with the high volume and ensure quality, modern infrastructure and equipment were added including 25 state-of-the art modular operation theatres and a world-class central sterile supply department (CSSD). These advancements help us perform 600- 800 surgeries each day.Leadership with long-term vision is the key to bringing people together in difficult rural areas.The value-based transparent system gives people the confidence to be a part of the system, tackle difficulties and grow together.Continuous focus on improvement coupled with partnerships with similar organisations can help build sustainable systems with high volume, quality and increased financial viability.Training programmes promote a continued inflow of aspiring workforce and improve the overall functioning and quality.Involving employees in decision making for continuous improvement builds a team that is effective and efficient.An encouraging work environment and extending support for social life can enhance overall contribution and loyalty of employees towards the organisation.


Wastewater treatment can consume a large amount of energy to meet discharge standards. However, wastewater also contains resources which could be recovered for secondary uses under proper treatment. Hence, the goal of this paper is to review the available green energy and biomass energy that can be utilized in wastewater treatment plants. Comprehensive elucidation of energy-efficient technologies for wastewater treatment plants are revealed. For these energy-efficient technologies, this review provides an introduction and current application status of these technologies as well as key performance indicators for the integration of green energy and energy-efficient technologies. There are several assessment perspectives summarized in the evaluation of the integration of green energy and energy-efficient technologies in wastewater treatment plants. To overcome the challenges in wastewater treatment plants, the Internet of Things (IoT) and green chemistry technologies for the water and energy nexus are proposed. The findings of this review are highly beneficial for the development of green energy and energy-efficient wastewater treatment plants. Future research should investigate the integration of green infrastructure and ecologically advanced treatment technologies to explore the potential benefits and advantages. According to the treatment scale, the environmental function of the discharged water body, and the local environmental protection requirements, there are three processes which can be selected for water treatment: the first-level strengthening treatment process, the secondary treatment process, and the secondary strengthening treatment process. First-level strengthening treatments usually utilize materialized strengthening treatment methods , such as3/day in China, and the most common method applied are the activated sludge method and the improved Anoxic Oxic method and Anaerobic-Anoxic-Oxic method [At present, there are dozens of urban sewage treatment plants with a processing scale of more than 200,000 mc method . Large-sc method . The larc method . If the Small and medium-sized sewage treatment plants are mainly located in small- and medium-sized cities and small towns. The investment is relatively low, and the number of existing wastewater treatment plants is relatively large . AccordiThe energy consumption of wastewater treatment plants can be generally classified into direct energy consumption and indirect energy consumption. Direct energy consumption is the electrical energy required for operation of aeration blowers, lift pumps, return pumps, etc. Indirect energy consumption includes chemicals used for chemical phosphorus removal and sludge dewatering . For powIn this paper, the energy-saving technologies and capacity technologies in wastewater treatment are reviewed and introduced through a literature review, and the green energy sources available in wastewater treatment plants are also introduced. Through the review and summary of this article, it is hoped that the energy savings and technological progress of wastewater treatment plants can be promoted. The main key research contents of this paper are as follows: (1) The implementation of green energy and energy-efficient technologies for wastewater treatment plants are reviewed. Green energy and biomass energy utilized in WWTPs are addressed. (2) The challenges and perspectives of the water and energy nexus for WWTPs are presented. (3) Key performance indicators for the integration of green energy and energy-efficient technologies are developed. Comprehensive elucidation of energy-efficient technologies for WWTPs are revealed. (4) The Internet of Things (IoT) and green chemistry technologies are introduced for system optimization of WWTPs. The water and energy nexus of wastewater treatment plants in China are also revealed and discussed.At present, the designed sewage volume of urban sewage treatment plants in China only calculates the amount of sewage and a small amount of groundwater infiltration . The amoAccording to the chemical oxygen demand (COD) analysis results of sewage treatment plant influents, the influent COD of urban sewage treatment plants in China is low. The main reasons are as follows: (1) Part of the sewage treatment plant is not complete. Sewage pipe networks are affected by various factors during operation, such as ruptures, leakages, and staggering. (2) In the areas with high groundwater levels, the above factors would cause infiltration of groundwater and dilution of sewage .3 of reclaimed water which is being used every year [Many cities are lacking in water safety to drink and the ecological environmental water cannot be guaranteed. In addition, the tail water of sewage treatment plants that have been treated with high standards cannot be effectively utilized. In this case, the reclaimed water has become a veritable second water source. In Beijing, there is more than 1 billion mery year . At presery year .Large amounts of sludge are not being stabilized in sewage treatment plants, and they are potentially dangerous secondary sources of pollution in the transportation and disposal processes. Unsafe sludge disposal would largely negatively affect the environmental benefits from sewage treatment facilities . Sludge It has been proposed to construct an energy self-sufficient sewage treatment plant that is carbon neutral . AdminisWith the operation of a large number of sewage treatment plants, the problem of sludge disposal has become an imminent and difficult problem in the water treatment industry and the social environment . In orde(a) Wastewater and Anaerobic Treatment System Heated by Solar EnergyThere are enough solar energy resources in Northern China to use solar energy instead of traditional energy. Solar energy is able to increase the anaerobic treatment temperature of sewage to achieve higher sewage treatment efficiency. Based on the design of solar energy anaerobic wastewater treatment systems, it can solve the energy problem in sewage anaerobic treatment heating systems for the solar energy-rich areas. The use of solar pre-heated sewage in anaerobic pools can solve the low temperature and freezing problems of wastewater, which are caused by the large temperature differences in plateau areas. Yiannopoulos  used Ana(b) Sludge Drying Technology by Greenhouse-Type Solar EnergyA greenhouse-type solar drying device has the advantages of a simple structure and easy operation. In order to obtain more solar radiation, materials used on the drying device usually have high transmittance. However, a large enough space is needed for the construction of the drying chamber to make sure sludge can receive enough sun radiation to reach low water content. Luboschik  already (c) Heat Collector and Storage Solar Sludge Drying TechnologyIn order to improve the stability of the drying system, a collector solar drying system can be used. The solar collector is used to convert solar energy into electricity which is able to heat water with a constant water temperature, so that the sludge can be thermally dried by hot water through floor radiation . Mathiou(d) Heat-Pump Solar Greenhouse Sludge Drying TechnologySludge drying technology combining solar energy and a heat pump fully utilizes the heat-pump system to reach high evaporation temperatures with high efficiency. A solar collector has the advantages of good heat collecting performance at low temperatures . ThroughSome researchers have suggested that photovoltaic power generation that provides electricity for sewage biological treatment can reduce the energy consumption of sewage treatment plants . Sewage The basic principle of solar photocatalysis is that by exciting the electrons in the semiconductor, the electrons are excited from the valence band to the conduction band to generate photogenerated electrons, thereby generating photogenerated holes in the valence band, and the electrons and holes are respectively diffused to the semiconductor surface . The surAlthough the distribution of wind energy has certain limitations, it is a widely distributed energy source compared to other renewable energy such as mineral energy, water energy, and geothermal energy. All regions can make rational use of renewable energy sources, like wind and solar conditions. According to local conditions, different wind turbines are used depending on different loads, so that wind energy can be converted into mechanical energy to the maximum extent . The powWind energy and solar energy can be applied without emitting pollutants or exhausting gas into the atmosphere . They arThe sewage source heat pump uses sewage as an energy source to exchange heat between the sewage and the heat pump, and the internal heat pump was derived by electric power to achieve cooling or heating. Urban sewage has the characteristics of large sewage volume, stable water quality, and relatively stable internal temperature . Therefo2 emissions by 68% and SO2 emissions by 75% compared with the air-source heat pump system [Compared with common air-source heat pumps, sewage-source heat pumps have a higher coefficient of performance . In addip system . The secp system . The recp system . Developp system .The influent of the sewage treatment plant is at the end-pipe network system, and it has relatively low elevation. Therefore, it is necessary to use a lifting pump to lift the sewage into the treatment system . This prSecondly, it is necessary to select the appropriate pump according to the combination of sewage lifting amount and changing characteristics. According to the variation curve of the pipeline system, especially the sewage flow rate , approprThe removal of pollutants in sewage is mainly achieved through microbial biochemical metabolic processes. Wastewater treatment biochemical processes mainly include the Anaerobic-Anoxic-Oxic process, oxidation ditch process, and the SBR process . The proFor aeration methods, the A2O and SBR processes generally use microporous aeration, while oxidation ditch generally uses rotary brush aeration or inverted umbrella aeration . MicropoIn addition to aeration devices and aeration methods, the supply of aeration is a key research object for energy conservation and consumption reduction. If the amount of aeration is too small, the quality of the effluent from the sewage treatment would be affected; if the aeration is too large, it will cause waste of energy, change in sludge floc structure, and effect sedimentation of the activated sludge . The corWith the in-depth study of the functional bacteria in the wastewater treatment process, new wastewater treatment processes that can realize energy savings from the technical point of view are gradually proposed. Those technologies mainly include wastewater denitrification processes based on short-cut nitrification, denitrifying, phosphorus removal processes, and anaerobic ammonium oxidation processes. Short-cut nitrification processes can save energy by 25% because ammonia nitrogen is only converted into nitrite instead of nitrate . At the The organic matter contained in the sewage is the energy carrier, so in addition to the energy savings of the sewage treatment, the realization of the energization of the wastewater can be considered . In addiThis method does not occupy a large proportion of energy consumption in wastewater treatment, but it takes a certain proportion in the stage of sludge disinfection, phosphorus removal, and sludge conditioning . First oHeat-pump drying technology is a green drying technology that has the advantages of energy savings and low-environmental impact. Among them, the sewage source heat pump is highly feasible, and thus widely used. The principle of the sewage-source heat pump is to extract the low-level heat energy, store it in the urban sewage, and then convert it into a high-level energy source for outward output. The heat energy converted by the sewage-source heat pump can be output in various forms with a high heating temperature (up to 40 °C). In the sludge treatment process , the heaSludge is a by-product of sewage treatment and a new source of environmental pollution, which contains a large amount of organic matter. Therefore, sludge treatment and disposal are the final guarantee process for the whole sewage treatment. Sludge from sewage treatment can be used to prepare biogas and extract nitrogen, phosphorus, and organic matter. Biogas can be used to produce compressed natural gas or used for power generation while organic substances, such as nitrogen and phosphorus, are recovered in the form of struvite . In addi3), so the calorific value of the digested biogas is generally 22,000 kJ/m3. In the anaerobic digester, the decomposition of 1 kg volatile suspended solids can produce 0.75–1.25 m3 of biogas, and the commonly used value is 0.8m3/kg corresponding to a heating value of 17,000 kJ/kg VSS.Renewable energy includes biomass, solar energy, wind energy, etc. Biogas in biomass energy is an ideal renewable energy source . Biogas Some of the general uses of biogas are shown in Solar photovoltaic power generation which has the remarkable advantages of cleanness, high efficiency, safety, and renderability has become one of the environmentally friendly alternative energy sources . DevelopUrban wastewater is an excellent waste heat source. It has the characteristics that the wastewater temperature is higher than the atmospheric temperature in winter and lower than the atmospheric temperature in summer . It is aThe overall energy-saving optimization operation strategy of the whole process is based on the rational deployment of wastewater treatment. From the energy balance analysis of the sewage treatment plant, the thermal energy of the sewage can be reduced with the process of the sewage treatment unit, which combined with the changing characteristics of various material components under various treatment conditions, rational distribution of the flow direction of the sewage energy substance can be achieved . The oveThe daily operation management of the sewage treatment plant also has a very important impact on energy conservation and consumption reduction . For exaWith the continuous improvement of the sewage treatment process and the increasing complexity of the project, traditional methods of manual operation and judgment by the operators are increasingly unable to meet the requirements of sewage treatment . TherefoCompared to traditional manual operations, automated theory and control technology have become powerful tools and measures in wastewater treatment processes . The appDue to the dispersion of sewage treatment facilities, it will take a lot of manpower and material resources to carry out daily supervision of sewage treatment equipment . It is nNowadays, the aeration control mode mainly controls DO or ammonia nitrogen, and feedback is performed according to its concentration to achieve automatic control . In the At present, the detailed calculation of energy consumption in urban sewage treatment plants has been done. With the rapid development of China’s sewage treatment industry, the industry management and the operational performance  in urban sewage treatment systems has become an important factor for urban operational safety, the water environment safety, the investment efficiency, and the impact of drainage . The majConstructing a performance evaluation index system for water systems and carrying out stylized performance evaluation can make comparison of wastewater supply performance in different periods and different enterprises. There are several indexes are used to evaluate the unit energy consumption of wastewater treatment plant, such as device indicators, specific energy consumption indicators, pollution emission indexes, recycling and utilization of resources, operation, and management and management and sustainability . The det7 kWh of electricity to satisfy the total energy demand of 1.23 × 107 kWh. The Joint Water Pollution Control Plant with 95,000 ton/day treatment capacity uses sludge (91%) and food waste (9%) as feedstock to produce biogas. This resulting 1.75 × 108 kWh/year electricity production makes the WWTP reach 97% energy self-sufficiency. Similarly, the Davyhulme plant in the UK with 63,000 ton/day treatment capacity can generate 96% of the total energy consumption through biogas power generation technology. For the Achill Island Central WWTP in Ireland, the implementation of wind power technology produces 7.6 × 104 kWh, which can satisfy 50% of annual energy use. The Aquaviva WWTP in France is a successful example for energy self-sufficiency. Through the application of sewage- and water-source heat-pump technology and solar power technology, the produced energy fully fills the demand of the process, providing 100% energy self-sufficiency.In practice, renewable energy and green technology have become increasingly popular due to their potential to achieve the carbon neutral goal. The sewage treatment process is a process of purification by physical, chemical or biological treatment methods, so that sewage can meet the required water quality before discharging into a certain water body or being reused . It can With the development of scale and resource utilization of sewage treatment, sewage treatment needs to reduce energy consumption, greenhouse gas emissions, and sludge deposal . TherefoThe sewage ecological engineering treatment technology refers to the application of ecological engineering principles and engineering methods to control sewage in a controlled manner . The phy(a) Sewage Land Treatment SystemsSewage land treatment systems are an emerging ecological engineering technology used for sewage treatment . This pr(b) Constructed WetlandsConstructed wetlands are artificially constructed and regulated wetland systems that perform wastewater treatment through an optimized combination of physical, chemical, and biological interactions in their ecosystems . Constru(c) Ecological Treatment SystemThe initial energy source of the ecological pond system is solar energy. Through the aquatic crops planted in the pond, the aquatic products and waterfowl culture are carried out, artificial ecosystems are established, and the biological treatment of sewage is completed through natural biochemical self-purification under natural conditions . In the The energy consumption of the biological treatment unit in an urban sewage treatment plant accounts for about 60% of the total energy consumption of the process system, the pretreatment makes up about 25%, and the sludge treatment takes about 10% . The powThe energy consumption in the biological treatment stage accounts for more than 50% of the total energy consumption, which is the most important energy-savings part for the wastewater treatment plant . The maiWith the increase of sludge discharge standards and the state’s emphasis on sludge treatment and disposal, the proportion of energy consumption in the sludge treatment section has increased . Energy Sewage treatment plants generally have the problem that the actual water inflow is less than the design scale, so that most of the equipment in the sewage plant cannot be operated efficiently, resulting in a waste of energy consumption. In order to achieve energy savings and consumption reduction, the design of water quantity and quality is a problem that must be taken seriously .


Although overall life expectancy in the US has improved rapidly over the course of the 20th century and the racial gap in all-cause mortality has declined in recent decades, geographical disparities in mortality have increased in the last three decades. This research aims to study racial and geographical disparities by comparing the race and sex-specific mortality trends of the US rural and urban populations. We created a longitudinal county level analytic file of the US population 65 years and older, over the period of 1968 to 2015 obtained from CDC-WONDER and Area Health Resources Files. First, we used an OLS regression of age-adjusted mortality rate onto year indicators interaction with race and gender to depict the race and sex-specific trend in age-adjusted mortality rates. We also estimated the change in in mortality rate over time, for each race and gender, relative to values in 1968. Finally, we estimated race and sex specific trend in rural-urban mortality gap using state fixed effects regression. Our results indicate that racial gap in mortality rates has only declined in urban areas. Mortality rates of the whites in rural areas declined more rapidly than their Black counterparts, resulting in a gap that has been widening in the last three decades. The racial gap has increased considerably for males residing in rural counties not adjacent to an urban county. Thus, racial disparity in mortality has increased in rural areas, with a considerable widening between white and black male population living in the more remote rural areas.


Hence, these findings provide a fundamental understanding of formation mechanisms and structuring of mesocrystals built up from superparamagnetic nanoparticles and how a magnetic field can be used to design anisotropic mesocrystals with different structures.This letter describes the formation and detailed characterization of iron oxide mesocrystals produced by the directed assembly of superparamagnetic iron oxide-truncated nanocubes using the slow evaporation of the solvent within an externally applied homogeneous magnetic field. Anisotropic mesocrystals with an elongation along the direction of the magnetic field can be produced. The structure of the directed mesocrystals is compared to self-assembled mesocrystalline films, which are formed without the influence of a magnetic field. The remarkable structural difference of mesocrystals produced within the external magnetic field from those self-assembled without field indicates that the specific nanoparticle ordering within the superstructure is driven by competing of two types of anisotropic interactions caused by particle shape  and orientation of the magnetic moment (i.e., easy axes: <111> In materials science, nanoparticles and their assemblies belong to the hot research topics nowadays –7. One rThis can be useful to obtain increased magnetization while retaining the superparamagnetic properties of magnetite nanocrystals . Additiomagnetite give an extraordinary opportunity to investigate the assembly processes directed by an external magnetic field SL || [310]magnetite, [001]SL || [301]magnetite, [001]SL || [100]magnetite magnetite, [001]SL || [130]magnetite, [001]SL || [310]magnetite, [001]SL || [112]magnetite, while for the mesocrystal in SL || [130]magnetite, [001]SL || [310]magnetite, [001]SL || [112]magnetite, [001]SL || [114]magnetite.Unfortunately, the available data cannot provide the complete description of the 3D structures of the mesocrystals, since the symmetry of the superlattices is unknown. However, based on the results of the wide-angle ED patterns and FFTs of the superlattices obtained from the same position of the selected mesocrystals, the orientations of nanoparticles relative to the crystallographic direction of the superlattice running perpendicular to the imaged plane can be retrieved. In case of mesocrystals shown in magnetite easy axis of magnetite in relation to the mesocrystal elongation and the direction of the external magnetic field. It is also expected that “directed mesocrystals” formed under external magnetic field should demonstrate enhanced anisotropic magnetic properties compared with mesocrystals assembled from the same nanoparticles but without the applied magnetic field.In total, 25 of such “directed mesocrystals” were analysed and have shown the same structural variation as described above. These structural features of “directed mesocrystals” indicate that complex interactions between anisotropically shaped superparamagnetic nanoparticles occur during the assembly processes under an external magnetic field. The formation of mesocrystals by solvent evaporation reduces the space of the dispersion volume at the beginning and the mesocrystals form by face-to-face interaction at the end. However, in addition, the magnetic field affects the superparamagnetic nanocrystals. The magnetic field induces the alignment of the magnetic dipole between the nanocrystals and the nanocrystals will then tend to orient their easy axis along the direction of the magnetic field. The magnetic dipole of each nanocrystal will interact with those of the surrounding nanocrystals and they attract to each other with specific crystallographic orientation. Furthermore, during the assembly process, the magnetic field around the nanocrystals might be changed. That, in addition to the particle shape, can be the reason of the misalignment of the <111>magnetite). Future work applying varying magnetic field strength will show the structural variety of the mesocrystals, which is possible by defined balancing of spatial and magnetic nanoparticle interactions. The formation of superstructures of superparamagnetic nanoparticles using a magnetic field is, therefore, a highly interesting approach to form tailor-made materials with outstanding anisotropic structures, morphologies and magnetic properties.In summary, we presented a way to form “directed mesocrystals” from superparamagnetic iron oxide nanoparticles using a homogeneous magnetic field. These directed mesocrystals are elongated along the magnetic field and their structure differs from regular self-assembled mesocrystals produced under the same conditions but without the external magnetic field. It is shown that the morphology and magnetic properties of the superparamagnetic nanoparticles are crucial for understanding the packing arrangement and the orientational order in superlattices. Furthermore, the magnetic field restricts the diffusion of nanoparticles in the dispersion. This might significantly influence the morphology of the growing mesocrystals. The specific ordering of nanoparticles induced during the assembly process is controlled by competition of two types of anisotropic interactions: the face-to-face alignment is caused by the particle shape , while the alignment along the magnetic field lines is driven by the orientation of the magnetic moment of the nanoparticles (i.e., easy axis: <111>6 emitter and a Koehler illumination system and was operated at an accelerated voltage of 120 kV.The nanocrystals and the self-assembled mesocrystals were synthesised according to literature . The dir


BackgroundCardiac monitoring (telemetry) is a common over-utilized hospital resource in the United States. Previous studies have shown that telemetry does not improve outcomes for low-risk patients. Inappropriate utilization occurs because of lack of awareness of guideline-based indications or non-adherence to known indications.ObjectiveA quality improvement study was conducted to reduce telemetry overutilization during the transition of care from the intensive care unit (ICU) by 15% through increasing awareness of indications for telemetry.MethodsThe study cohort included patients originally admitted to the ICU for sepsis who had improved and were stable for transfer to a non-ICU setting. Subjects were identified and included during pre-intervention (six weeks) and intervention (six weeks) periods. Resident physicians and nurse practitioners were targeted using multiple modalities of education: didactic lectures during week one, poster demonstrations during week three, and video presentations during week five.ResultsA total of 246 study subjects during the pre-intervention and 94 study subjects in the intervention period were studied; 187 of the 246 subjects in the pre-intervention arm (76%) and 58 of the 94 subjects in the intervention arm (61.7%) were transferred with telemetry. Telemetry utilization dropped by 23.1% at the end of the intervention period.ConclusionEducating the caregivers about the indications for telemetry led to a decrease in over-utilization of telemetry on the transition of care from the ICU to the regular nursing floor. Repetitive and multi-modality educational interventions were effective tools and associated with increased adherence to established guidelines for telemetry usage. Inpatient cardiac monitoring (telemetry) was introduced in the 1950s for the detection of arrhythmias. Since then, it has been widely utilized in the hospital setting. It has also helped monitor patients with acute coronary syndromes, titrate anti-arrhythmic medications, and determine the QTc interval. However, overutilization of telemetry causes alarm fatigue for nurses, increases the risk of delirium in elderly patients due to frequent awakenings and breaks in the sleep cycle, and raises the cost burden on patients, hospitals and the entire healthcare system . HoweverSolutions for the value enhancement (SolVE) cohort is a continuous quality improvement training program sponsored by graduate medical education of the Cleveland Clinic to pursue excellence in medical education. This 12-week program trains caregivers on how to successfully lead future quality improvement initiatives. Our SolVE team identified that telemetry is frequently ordered when the patients are transferred from the intensive care unit (ICU)  to the floor. Sepsis is a common admitting diagnosis to the ICU, and thus we decided to target this patient population. According to the recent recommendations, patients who have recovered from sepsis and are hemodynamically stable do not require cardiac telemetry when they are transferred from the ICU to the medical floors in the hospital . We aim A team of five Internal Medicine residents participated in the SolVE project at the Cleveland Clinic Fairview Hospital. Data extraction using electronic medical records confirmed that telemetry is ordered in excess when transferring sepsis patients to the regular nursing floor. Study subjects included patients with sepsis who were stable and ready for transfer to a non-ICU setting. A process map was prepared to evaluate the telemetry order placement during the transition from the ICU Figure .A pre-implementation electronic survey was sent to the resident physicians, hospitalists, and intensivists to evaluate the familiarity of the caregivers with the indications of cardiac monitoring.Tools usedDidactic LecturesA PowerPoint presentation was prepared to emphasize the current status of telemetry utilization in the hospital, cardiac monitoring indications, and cost and the repercussion of its overuse on patients and nurses. Resident physicians, nurse practitioners, ICU nurses, and hospitalists were targeted during the first two weeks.PostersDuring the third week of the intervention, posters were distributed in the ICU and the residents’ and physicians’ lounges. The posters highlighted appropriate indications for telemetry, the positive impact of proper utilization, and the negative impact of overutilization of telemetry.Video PresentationA short video was prepared and featured two nurses narrating the patients’ discomfort caused by carrying the telemetry device and highlighting their increased risk for delirium because of frequent awakening at nights. They also spoke about the nursing alarm fatigue because of frequent artifacts and accidental disconnection of leads.MethodologyChart review and data abstraction for study patients were performed using the electronic medical record. In-hospital mortality was collected in intervention arm with and without telemetry. A measure of appropriateness of telemetry usage was calculated by dividing the number of study patients transferred from the ICU with a telemetry order by the total number of study patients transferred from the ICU to the regular nursing floor.Pre-intervention resultsA total of 246 study subjects who were transitioned from ICU to the regular nursing floor were identified in the six weeks before the intervention; 187 (76%) of these patients were transferred with telemetry. A pre-implementation online survey showed that 86% of caregivers were not familiar with the indications for telemetry on the regular nursing floor, which most likely contributed to the excessive orders for telemetry.Intervention resultsDuring the six-week intervention period, a total of 94 study subjects were transferred from ICU to the medical floor; 58 (61.7%) study subjects were transferred with telemetry during the intervention period. An incremental decrease in the telemetry utilization was noted in the consecutive weeks of the intervention period. During the first two weeks, there was a 2% reduction in telemetry use. In the following two weeks, there was a 21% reduction in telemetry use due to education reinforcement of appropriate indications for telemetry with poster illustrations. During the last two weeks, there was a 57% reduction in telemetry use after the video presentations.The mean percentage of study subjects transferred with telemetry was 74.57% before the intervention over a six-week period and 57.33% during the intervention over six weeks . There was no in-hospital mortality among study subjects in either group.In 2004, the “American Heart Association Scientific Statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young” published guidelines regarding telemetry use, with class I indications recommending telemetry, class II indications favoring telemetry in certain conditions, and class III indications not endorsing cardiac monitoring . AlthougLimitations of our study are small sample size, the focus on subjects with sepsis, and short duration of the study to predict the outcome. Also, because this a single-center study with a small sample size, we could not assess for possible confounders.Other interventions such as incorporating the guidelines in the electronic medical record ordering system, removing the unnecessary telemetry order from order sets, and limiting the duration of the active telemetry order have proven to be beneficial in decreasing overutilization ,10, and In the future, our team will need to establish longitudinal education campaigns to maintain adherence to established guidelines for telemetry use. We will need to broaden our educational efforts to include patients with additional diagnoses/conditions that do not require the use of non-ICU cardiac monitoring and extend our educational efforts to the emergency department. Finally, we would like to formally demonstrate that reducing inappropriate use of cardiac telemetry does not result in any compromise of patient safety or quality of care.Multiple education modalities that improve awareness of the appropriate indications for telemetry use is effective in decreasing inappropriate telemetry ordering during transfer from the ICU. This will result in reducing patient discomfort, nursing alarm fatigue, and hospital costs.


Objective: This paper presents a systematic review of diffusion MRI (dMRI) and tractography of cranial nerves within the posterior fossa. We assess the effectiveness of the diffusion imaging methods used and examine their clinical applications.Methods: The Pubmed, Web of Science and EMBASE databases were searched from January 1st 1997 to December 11th 2017 to identify relevant publications. Any study reporting the use of diffusion imaging and/or tractography in patients with confirmed cranial nerve pathology was eligible for selection. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) tool.Results: We included 41 studies comprising 16 studies of patients with trigeminal neuralgia (TN), 22 studies of patients with a posterior fossa tumor and three studies of patients with other pathologies. Most acquisition protocols used single-shot echo planar imaging (88%) with a single b-value of 1,000 s/mm2 (78%) but there was significant variation in the number of gradient directions, in-plane resolution, and slice thickness between studies. dMRI of the trigeminal nerve generated interpretable data in all cases. Analysis of diffusivity measurements found significantly lower fractional anisotropy (FA) values within the root entry zone of nerves affected by TN and FA values were significantly lower in patients with multiple sclerosis. Diffusivity values within the trigeminal nerve correlate with the effectiveness of surgical treatment and there is some evidence that pre-operative measurements may be predictive of treatment outcome. Fiber tractography was performed in 30 studies (73%). Most studies evaluating fiber tractography involved patients with a vestibular schwannoma (82%) and focused on generating tractography of the facial nerve to assist with surgical planning. Deterministic tractography using diffusion tensor imaging was performed in 93% of cases but the reported success rate and accuracy of generating fiber tracts from the acquired diffusion data varied considerably.Conclusions: dMRI has the potential to inform our understanding of the microstructural changes that occur within the cranial nerves in various pathologies. Cranial nerve tractography is a promising technique but new avenues of using dMRI should be explored to optimize and improve its reliability. Diffusion magnetic resonance imaging (dMRI) is a non-invasive magnetic resonance imaging (MRI) technique that is able to provide a quantitative assessment of a tissue's microstructure. dMRI is sensitive to the displacement of water subject to thermally driven Brownian motion and can reveal a tissue's orientational organization  that typically relay information between the brain and regions of the head and neck and are numbered according to their rostral-caudal position when viewing the brain. The first two cranial nerves—the olfactory [CN I] and optic nerves [CN II] are both sensory nerves, composed of afferent fibers relaying smell and vision, respectively, entering the brain within the anterior and middle cranial fossae. The remaining ten cranial nerves  emerge from the brainstem and course through the posterior fossa and fluid cisterns before exiting the skull . Its aim is to inform clinical readers who are unfamiliar with this imaging modality of the technique's clinical potential, but technical readers with an interest in diffusion imaging form a secondary readership. To aid the reader's understanding, we begin with a brief summary of the biological and physical basis of diffusion MRI and tractography. This is followed by a critical summary and appraisal of different imaging techniques employed that will be of interest to both clinical and technical readers. Finally, we review the effectiveness of these advanced imaging techniques in the context of cranial nerve imaging, examining the various clinical applications for this emerging technology.isotropic diffusion). However, the diffusion of water molecules inside organic tissues is often anisotropic  of the tensor represent the diffusion coefficients measured in a frame of reference along each of the principal  directions. The off-diagonal terms reflect correlation between each pair of principal directions. Conceptually, a diffusion tensor may be visualized as an ellipsoid where the principal major axis is orientated in the direction of maximum diffusivity  and its shape determined by three eigenvalues . The eigenvectors represent the major, medium, and minor principal axes of the ellipsoid and the eigenvalues represent the diffusivities in these three directions, respectively . These maps are generated by mapping the major eigenvector's directional components in the x-, y-, and z-planes into RGB color channels and weighting the color brightness by FA.Specific quantitative diffusivity metrics may be calculated from the tensor including axial (AD), radial (RD), and mean diffusivities (MD), as well as a composite metric, fractional anisotropy (FA). The local fiber orientation may also be visualized in a directionally-encoded color (DEC) map of the diffusion tensor that is based on the orientation of the diffusion tensor's first eigenvector  and myelin damage (RD)  is a measure of the coherence of the underlying microstructure and has been shown to correlate both with axonal counts ; continued propagation of the track along the estimated fiber orientation; and the termination of the track when appropriate criteria are met  Statement was used in the preparation of this manuscript AND2 Reference lists of included articles were also reviewed, and expert opinion sought, to identify further eligible publications.Eligibility for inclusion in the systematic review included peer-reviewed publications in which English-language manuscripts were available through electronic indexing comprising:Clinical studies of patients with associated cranial nerve pathology.Diffusion MRI and/or fiber tractography of lower cranial nerve(s) has been performed.The diffusion imaging technique used has been described.The imaging success rate is reported.Full articles were obtained and further assessed for eligibility and any discrepancy was resolved through mutual review and involvement of the senior author.In total, 805 articles were identified through the database searches and an additional record was identified through other sources. Following removal of duplicate and non-English language studies, 534 manuscript titles and abstracts were screened. After applying the eligibility criteria 48 full text articles were reviewed and a further 7 articles were excluded. In all, 41 studies satisfied the inclusion criteria and were included in further qualitative analysis .Data extraction was performed using a table with a predefined set of criteria including:Study design.Study group characteristics, including the number of patients, duration of symptoms , tumor characteristics (where applicable), and treatment modality.Imaging acquisition details, including hardware, data specifics (including sequence(s), number of directions , acquired voxel size, b-value(s), scan time), and software.Diffusion processing methods, including region of interest, fiber tractography method , Fractional anisotropy threshold.Effectiveness of dMRI analysis, including success rate in generating tractography results and diffusivity measurements of the target cranial nerve(s). In surgical cases, the method and results of any intraoperative validation was also noted.Key findings.The methodological quality of the included studies was assessed by using the Methodological Index for Non-Randomized Studies (MINORS) scoring system for observational studies , if multiple studies form a single institution did not include overlapping patient groups. Twenty-two studies focused on imaging the cranial nerves in relation to a posterior fossa tumor  but the number of gradient directions, in-plane resolution, and slice thickness varied considerably (http://www.medimg.info.hiroshima-cu.ac.jp/dTV.II.15g/about.htm)      , FSL (http://www.fmrib.ox.ac.uk/fsl)     were performed using 3T machines with the remaining 4 studies using 1.5T scanners. Most acquisition protocols used single-shot echo planar imaging (88%) with a single b-value of 1,000 s/mmiderably –3. The aiderably . VariousFriston, , iPLAN  . Twelve In the 10 studies that measured the FA in the REZ of patients with TN caused by neurovascular compression, 8 (80%) found significantly lower FA values on the affected side compared to the unaffected side  examined changes in ADC values within TN-affected nerves; four (57%) found ADC to be significantly higher in the REZ of affected nerves  reported RD and AD values in the affected and unaffected nerves of patients with idiopathic TN  . All 22 studies involving patients with brain tumors focused on generating tractography of the surrounding cranial nerves. Eighteen of those (82%) involved patients with a vestibular schwannoma  but cranA deterministic method of generating fiber tractography was used in the majority of studies (93%). The reported success rate in generating fiber tracts of the cranial nerves within the posterior fossa varied considerably (0–100% success) but was not lower in those studies imaging smaller nerves [100% success rate was reported in all studies imaging trochlear  but the reported accuracy of facial nerve tractography was extremely variable (17–100%) . The accThere is a clinical need to improve the visualization of cranial nerves within the posterior fossa, particularly in the context of pathology, and to enable detailed analysis of the affected nerves' microstructure. In normal anatomy, the visualization of cranial nerves from the brainstem to the skull base is currently optimized on high contrast T2 sequences  but it iForty-one studies met the study's inclusion criteria and were qualitatively analyzed. The methodological quality of the included studies varied considerably but the available evidence demonstrates that it is possible to acquire diffusion MRI data using a variety of clinical scanners and process this data with various software packages, none of which were shown to be more, or less, effective in this respect. Most clinical studies examining the use of diffusion MRI in patients with cranial nerve pathologies have either focused on performing DTI analyses of the trigeminal nerve in patients with trigeminal neuralgia or generating DTI-based tractography of the cranial nerves in patients with posterior fossa tumors.Sixteen studies evaluated diffusivity changes in the trigeminal nerve of patients suffering from trigeminal neuralgia. The trigeminal nerve is the largest cranial nerve within the posterior fossa and all studies successfully managed to acquire diffusion MRI data of adequate quality for tractography and/or quantitative DTI analysis. Ten studies examined changes in FA within the REZ of the trigeminal nerve compared to the patient's unaffected side; lower FA values demonstrated within the REZ of TN-affected nerves in all ten studies and a statistically significant decrease observed in 80% . HoweverInteresting observations were noted in the studies that compared diffusivity values in different segments of the nerve , and a fiber orientation distribution-based method   Behan e. They foIn a separate article, Zolal et al. used probabilistic tracking to generate preoperative tractography of the facial-cochlear complex in 21 patients undergoing vestibular schwannomas surgery with the accuracy determined intraoperatively by surgical inspection and the use of qualitative electrophysiological monitoring (Zolal et al., The present systematic review was limited by various factors. Firstly, given the variety of ways diffusion data was presented and the small numbers of available studies, it was not possible to perform a meta-analysis and quantitatively analyse the data to draw any firm conclusions concerning diffusivity changes observed in the trigeminal nerve of patients with TN. Secondly, studies evaluating cranial nerve tractography were of mixed methodological quality and used a variety of acquisitions, limiting our discussion to a qualitative report of a small number of higher quality studies.Current work suggests that fiber tractography has the ability to delineate the course of individual nerves within the posterior fossa. Further work is required to incorporate cranial nerve tractography into the intraoperative workflow and new avenues of using diffusion MRI should be explored to optimize and improve its reliability. In particular, new techniques of delineating the facial nerve from the VII-VIII complex should be examined and validated with the use of quantitative intraoperative electrophysiological measurements. Diffusion MRI has the potential to inform our understanding of the microstructural changes that occur within the cranial nerves in various pathologies and may eventually be able to assist clinicians to deliver individualized treatment plans.JS conceived the manuscript. JS and SV performed the systematic literature search. JS drafted the initial manuscript. SV, TV, RB, SS, SB, and SO reviewed the final manuscript.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.