Spectroscopic characterization of fluorite of Amba Dongar, Gujarat, India: Linking chemical composition with color.

This work addresses the long-standing debate surrounding the origin of color variation in fluorite (CaF2) through a novel quantitative approach. By examining eight carefully selected fluorite samples having different hue of colors from the Amba Dongar mine in Gujarat, India, a rigorous quantitative analysis was conducted. This approach combined chemical compositional data and optical spectroscopic features to elucidate the relationship between elemental composition, concentration, and color variation in fluorite. Precise elemental concentration data for trace transition metals, alkali metals, and rare earth elements (REEs) were obtained through inductively coupled plasma mass spectroscopy (ICP-MS) analysis of powdered fluorite samples. Optical spectroscopic techniques, including UV-visible absorption, emission (photoluminescence and fluorescence), and Raman spectroscopy, were employed to capture characteristic spectral signatures for specific color of the study sample. The work unveils a strong correlation between specific elemental concentrations and observed spectral features, particularly influenced by alkaline metals, transition group elements, and REEs. Fluorite's optical absorption behavior lacks a clear pattern in UV and infrared wavelength ranges but correlates well with transition metal, alkaline element, and REE concentrations in visible wavelength regions, influencing coloration. Luminescent centers in the study fluorite samples correspond to specific REE concentrations, indicating a strong linkage between emission wavelengths with the presence of specific REE. UV-visible and fluorescence in fluorite result from trivalent REE or Eu2+ ions, with emission intensity affected by REE concentration and specific REE or combinations thereof. Raman spectroscopy identifies characteristic modes related to F-substitution and REE impurities, providing insights into fluorite's structural composition. This quantitative correlation between elemental composition and spectroscopic characteristics represents a novel contribution for understanding color variation mechanisms in fluorite. The comprehensive analysis of this present work underscores the intricate interplay of mineral composition, and element concentration particularly alkaline metals, transition group elements, and REEs, for variation in spectral signatures with variation in fluorite's visual attributes.

High-Efficiency Rechargeable Fe-CO2 Battery: A Route for Effective CO2 Conversion and Energy Storage.

Because of their high theoretical energy density, metal-CO2 batteries based on Li, Na, or K have attracted increasing attention recently for meeting the growing demands of CO2 recycling and conversion into electrical energy. However, the scarcity of active anode material resources, high cost, as well as safety concerns of Li, Na, and K create obstacles for practical applications. Herein, we demonstrate for the first time a high-efficiency (η = 77.2%) rechargeable Fe-CO2 battery that is composed of iron (Fe) anode and MoS2-catalysts deposited carbon cathode. MoS2 catalysts are crucial to the successful acceleration of reaction kinetics of Fe during charge and discharge with a minimum overpotential of the cell. The Fe-CO2 cell has a higher initial specific capacity of 12,500 mA h g-1 with an average discharge potential of 0.65 V and operates reversibly with a lower overpotential than that of Li-CO2 batteries with a cutoff capacity of 500 mA h g-1. Our Fe-CO2 battery can effectively convert CO2 greenhouse gas into electrical energy by consuming 1 ton of CO2 with usage of 1.23 tons of iron.

Texture feature analysis of MRI-ADC images to differentiate glioma grades using machine learning techniques.

Apparent diffusion coefficient (ADC) of magnetic resonance imaging (MRI) is an indispensable imaging technique in clinical neuroimaging that quantitatively assesses the diffusivity of water molecules within tissues using diffusion-weighted imaging (DWI). This study focuses on developing a robust machine learning (ML) model to predict the aggressiveness of gliomas according to World Health Organization (WHO) grading by analyzing patients' demographics, higher-order moments, and grey level co-occurrence matrix (GLCM) texture features of ADC. A population of 722 labeled MRI-ADC brain image slices from 88 human subjects was selected, where gliomas are labeled as glioblastoma multiforme (WHO-IV), high-grade glioma (WHO-III), and low-grade glioma (WHO I-II). Images were acquired using 3T-MR systems and a region of interest (ROI) was delineated manually over tumor areas. Skewness, kurtosis, and statistical texture features of GLCM (mean, variance, energy, entropy, contrast, homogeneity, correlation, prominence, and shade) were calculated using ADC values within ROI. The ANOVA f-test was utilized to select the best features to train an ML model. The data set was split into training (70%) and testing (30%) sets. The train set was fed into several ML algorithms and selected most promising ML algorithm using K-fold cross-validation. The hyper-parameters of the selected algorithm were optimized using random grid search technique. Finally, the performance of the developed model was assessed by calculating accuracy, precision, recall, and F1 values reported for the test set. According to the ANOVA f-test, three attributes; patient gender (1.48), GLCM energy (9.48), and correlation (13.86) that performed minimum scores were excluded from the dataset. Among the tested algorithms, the random forest classifier(0.8772 ± 0.0237) performed the highest mean-cross-validation score and selected to build the ML model which was able to predict tumor categories with an accuracy of 88.14% over the test set. The study concludes that the developed ML model using the above features except for patient gender, GLCM energy, and correlation, has high prediction accuracy in glioma grading. Therefore, the outcomes of this study enable to development of advanced tumor classification applications that assist in the decision-making process in a real-time clinical environment.

CT-Based Screening for Pulmonary Metastases in Head and Neck Squamous Cell Cancers: Diagnostic Accuracy and Cost Comparison with PET-CECT.

This study's objective was to compare detection rates of radiograph, computed tomography (CT), and positron emission tomography-contrast-enhanced computed tomography (PET-CECT) for pulmonary metastasis/synchronous primary lung tumors in head and neck squamous cell cancer (HNSCC) and its association with clinico-radio-pathological factors. Our retrospective study included 837 HNSCC patients from January 2012 to December 2017. Lung nodules were characterized on CT as benign, indeterminate, and metastatic. The true detection rate and statistical significance of associated risk factors were calculated. Risk factors for metastasis were determined using univariate and multivariate logistic regression models. Seventy-five (8.9%) patients had pulmonary metastasis and 3 (0.3%) had second lung primary. Detection rate of pulmonary metastasis by CT was higher (sensitivity-97.3%, specificity-97.2%) as compared to radiograph (sensitivity 49% and specificity 89%). Correlation was found between pulmonary and extra-pulmonary metastasis and N classification (P = 0.01, P = 0.02) and positive low jugular node (P = 0.001, P = 0.001). Using PET-CECT in place of CT costed an extra outlay of 7,033,805 INR (95,551.85 USD) while detecting distant metastasis in only 4 (0.47%) extra cases. Chest CT is a useful pulmonary metastases screening tool in advanced HNSCC patients with reasonable imaging cost as compared to PET-CT.

The efficacy of patient specific instrumentation (PSI) in total hip arthroplasty (THA): A systematic review and meta-analysis.

Background: Patient-specific instrumentation (PSI) has been suggested to reduce improper component positioning, though the effectiveness of PSI in total hip arthroplasty (THA) remains inconclusive. The purpose of this study was to evaluate the radiographic parameters and clinical outcomes comparing PSI and standard instrumentation (SI). Methods: This systematic review and meta-analysis was conducted in accordance with the 2020 PRISMA statement and was registered on PROSPERO. PubMed, Embase, Scopus, Google Scholar, and ClinicalTrials.gov were searched for relevant studies pertaining to the use of PSI in THA. Inclusion criteria included PSI used in THA, PSI was directly compared to SI, and publication in English. Exclusion criteria included non-primary THA, review articles, abstracts, book chapters, and animal models. Results: 2,458 studies were initially identified, with 13 studies (677 THAs: 338 controls, 339 PSI) meeting all criteria. PSI was favored for the deviation from the preoperative plan for acetabular cup position for anteversion (p = 0.04) and inclination (p = 0.0002); risk of acetabular cup positioning outside the Lewinnek safe zone for anteversion (p = 0.005) and inclination (p < 0.0001); and postoperative Harris Hip Score (p = 0.0002). No significant differences were found for the deviation from the preoperative plan for femoral stem position for anteversion (p = 0.74) or varus/valgus (p = 0.15); intraoperative time (p = 0.55); or intraoperative blood loss (p = 0.62). Conclusion: The use of PSI in THA is effective in improving acetabular component positioning and postoperative functional outcomes, without increasing intraoperative time or blood loss, compared to SI.

In Situ/Operando Characterization Techniques: The Guiding Tool for the Development of Li-CO2 Battery.

In recent times, the Li-CO2 battery has gained significant importance arising from its higher gravimetric energy density (1876 Wh kg-1 ) compared to the conventional Li-ion batteries. Also, its ability to utilize the greenhouse gas CO2 to operate an energy storage system and the prospective utilization on extraterrestrial planets such as Mars motivate to practicalize it. However, it suffers from numerous challenges such as (i) the reluctant CO2 reduction/evolution; (ii) solid/liquid/gas interface blockage arising from the deposition of Li2 CO3 discharge product on the cathode; (iii) high overpotential to decompose the stable discharge product Li2 CO3 ; and (iv) instability of the electrolytes. Numerous efforts have been undertaken to tackle these challenges by developing catalysts, improving the stability of electrolytes, protecting the anode, etc. Despite these efforts, due to the lack of a decisive confirmation of the reaction mechanisms of the discharging/charging reactions occurring in the system, the progress of the Li-CO2 battery system has been slow. In situ characterization techniques help overcome ex-situ techniques' limitations by monitoring the processes with the progress of a reaction. The current review focuses on bridging the gap in the understanding of the Li-CO2 batteries by exploring the various in situ/operando characterization techniques that have been employed.

A quantitative and qualitative investigation of the impact of irradiation on the physico-chemical of pointed gourd during storage.

Irradiation effect on the physico-chemical characteristics and shelf stability of pointed gourd was investigated in research. It was estimated that moisture content, total phenol and total carotenoids was significantly (p≤0.05) decreased while physiological loss in weight, total soluble solids, lutein and α-cryptoxanthin were increased during the completion of study. The three carotenoid pigments (ß-carotene, lutein, α-cryptoxanthin) were identified by Thin Layer Chromatography (TLC) and spectrophotometric method and its changes reported during storage in control and irradiated sample. The principal component analysis showed that b* value, Physiological Loss Weight (PLW), adhesiveness and acidity have negative correlation with rest of the parameters during storage. The research will present a progressive strategy for increasing the storage stability of pointed gourd during transportation and storage in India's government and private mandis. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-022-05395-3.

Feature extraction from MRI ADC images for brain tumor classification using machine learning techniques.

BACKGROUND: Diffusion-weighted (DW) imaging is a well-recognized magnetic resonance imaging (MRI) technique that is being routinely used in brain examinations in modern clinical radiology practices. This study focuses on extracting demographic and texture features from MRI Apparent Diffusion Coefficient (ADC) images of human brain tumors, identifying the distribution patterns of each feature and applying Machine Learning (ML) techniques to differentiate malignant from benign brain tumors. METHODS: This prospective study was carried out using 1599 labeled MRI brain ADC image slices, 995 malignant, 604 benign from 195 patients who were radiologically diagnosed and histopathologically confirmed as brain tumor patients. The demographics, mean pixel values, skewness, kurtosis, features of Grey Level Co-occurrence Matrix (GLCM), mean, variance, energy, entropy, contrast, homogeneity, correlation, prominence and shade, were extracted from MRI ADC images of each patient. At the feature selection phase, the validity of the extracted features were measured using ANOVA f-test. Then, these features were used as input to several Machine Learning classification algorithms and the respective models were assessed. RESULTS: According to the results of ANOVA f-test feature selection process, two attributes: skewness (3.34) and GLCM homogeneity (3.45) scored the lowest ANOVA f-test scores. Therefore, both features were excluded in continuation of the experiment. From the different tested ML algorithms, the Random Forest classifier was chosen to build the final ML model, since it presented the highest accuracy. The final model was able to predict malignant and benign neoplasms with an 90.41% accuracy after the hyper parameter tuning process. CONCLUSIONS: This study concludes that the above mentioned features (except skewness and GLCM homogeneity) are informative to identify and differentiate malignant from benign brain tumors. Moreover, they enable the development of a high-performance ML model that has the ability to assist in the decision-making steps of brain tumor diagnosis process, prior to attempting invasive diagnostic procedures, such as brain biopsies.

Active Surveillance of Low-Risk Papillary Microcarcinoma of the Thyroid in Indian Scenario: Are we Ready for it? A Narrative Review.

Papillary microcarcinoma (PMC) is defined as papillary thyroid carcinoma (PTC) measuring ≤1 cm, irrespective of the presence or absence of the high-risk features. PMCs without any high-risk features referred to as the low-risk PMCs are generally indolent, and most of them remain latent without progression or with very slow progression. Active surveillance (observation without immediate surgery) could identify the small minority of PMCs that progress and rescue surgery for these PMCs should be effective resulting in no influence on the patients' prognosis than performing immediate surgery which might result in more harm than good due to associated morbidity. So, with proper patient selection, organization, and patient counselling, active surveillance has the potential to be a long-term management strategy for patients with PMC. The recent update of the ATA guidelines (2015) incorporated active surveillance as an option within the management protocol of PTC, making it an considerable rather than an experimental treatment option. The cost for immediate surgery is higher than the medical costs of active surveillance for 10 years in most scenarios. Developing countries like India may have certain limitations like lack of understanding, financial constraints and lack of adequate radiology services; hence, we propose additional recommendations along with standard surveillance strategy.

A rare case of ectopic retrosternal goiter.

It is important for the clinician to be familiar with interpreting a variety of radiological modalities that provide vital information that will aid in the preoperative planning, counseling, and subsequent management of patients with retrosternal goiter.

Seroprevalence of anti-SARS-CoV-2 antibodies in Indore, Madhya Pradesh: A community-based cross-sectional study, August 2020.

BACKGROUND: In India, laboratory diagnosis of SARS - CoV-2 infection has been mostly based on real-time reverse transcriptase-polymerase chain reaction (RT-PCR). Studies have shown that Viral titres peak within the first week of symptoms but may decline later hampering RT-PCR-based diagnostic strategies. Exact estimate is difficult under high-risk screening strategy with evidences of having large number of asymptomatic cases. This has prompted a call for adoption of antibody testing as potential source of data. MATERIALS AND METHODS: A cross-sectional study with a sample size of 7000 was conducted for 15 days including all the 85 wards under Indore Municipal Corporation. Stratified Random Sampling was used to collect the samples. Trained teams collected basic sociodemographic information and serum samples which were tested for the presence of specific antibodies to COVID-19 using ICMR-Kavach IgG ELISA kits. The data collected was compiled and analysed using appropriate statistical software. RESULTS: Overall weighted seroprevalence of the study population was found to be 7.75%. The prevalence in males and females was comparable (7.91% vs 7.57%). Highest seropositivity (10.04%) was seen among individuals aged more than 60 years. Total number of infections in the population were estimated to be 2,03,160. Overall Case Infection Ratio was found to be 27.43. CONCLUSION: The current seroprevalence study provides information on proportion of the population exposed, but the correlation between presence and absence of antibodies is not a marker of total or partial immunity. It must also be noted that more than 90 percent of the population is still susceptible for COVID-19 infection. Hence, non-pharmaceutical interventions like respiratory hygiene, physical distancing, hand sanitization, usage of personal protective equipment such as masks and implementation of public health measures need to be continued.

Neuroprotective Effects of Asparagus officinalis Stem Extract in Transgenic Mice Overexpressing Amyloid Precursor Protein.

To mimic Alzheimer's disease, transgenic mice overexpressing the amyloid precursor protein (APP) were used in this study. We hypothesize that the neuroprotective effects of ETAS®50, a standardized extract of Asparagus officinalis stem produced by Amino Up Co., Ltd. (Sapporo, Japan), are linked to the inhibition of the apoptosis cascade through an enhancement of the stress-response proteins: heat shock proteins (HSPs). APP-overexpressing mice (double-transgenic APP and PS1 mouse strains with a 129s6 background), ages 6-8 weeks old, and weighing 20-24 grams were successfully bred in our laboratory. The animals were divided into 5 groups. APP-overexpressing mice and wild-type (WT) mice were pretreated with ETAS®50 powder (50% elemental ETAS and 50% destrin) at 200 mg/kg and 1000 mg/kg body weight. Saline, the vehicle for ETAS®50, was administered in APP-overexpressing mice and WT mice. ETAS®50 and saline were administered by gavage daily for 1 month. Cognitive assessments, using the Morris Water Maze, demonstrated that memory was recovered following ETAS®50 treatment as compared to nontreated APP mice. At euthanization, the brain was removed and HSPs, amyloid ß, tau proteins, and caspase-3 were evaluated through immunofluorescence staining with the appropriate antibodies. Our data indicate that APP mice have cognitive impairment along with elevated amyloid ß, tau proteins, and caspase-3. ETAS®50 restored cognitive function in these transgenic mice, increased both HSP70 and HSP27, and attenuated pathogenic level of amyloid ß, tau proteins, and caspsase-3 leading to neuroprotection. Our results were confirmed with a significant increase in HSP70 gene expression in the hippocampus.

Minimally invasive video-assisted thyroidectomy in Asian patients: experience from Singapore.

BACKGROUND: Minimally invasive video-assisted thyroidectomy (MIVAT) although well established in Europe has not yet gained widespread acceptance in Asia. We describe our learning experience in the first reported series of 105 cases from Singapore. METHODS: A retrospective analysis of outcomes in 105 patients who underwent MIVAT from April 2011 to 2018 was performed. The inclusion criteria were - symptomatic benign thyroid pathologies and follicular lesions or neoplasms needing a hemi-thyroidectomy. A thyroid lobe volume less than 35 mL was used as cut-off. Patients underwent surgeon-performed thyroid ultrasound with biopsy of solid nodules. All cases were operated by one surgeon using standard Miccoli technique with energy device used in all cases. RESULTS: From a total of 424 patients with nodular goitres undergoing thyroidectomy, 105 (24%) symptomatic eligible patients underwent the MIVAT procedure (M:F - 23:82). The mean incision lengths at start and completion were 1.7 cm (range 1.5-2 cm) and 2.4 cm (range 2-2.7 cm), respectively. Mean operating time was 97 min (range 59-160 min). There were four conversions (3.8%) in the first 25 cases and four patients (3.8%) experienced transient hoarseness with full recovery. Visual analogue pain scores at 6 and 24 h post-operatively were 2.7 and 1.1, respectively. Scar satisfaction was reported as excellent (75%), satisfactory (23%) and poor (2%). CONCLUSION: Although technically more demanding, MIVAT is a safe and useful operation in a thyroid surgeon's armamentarium. The limitation of goitre size, however, allows only a small percentage of symptomatic patients to undergo this procedure.

New Thiourea-Based Ionic Liquid as an Electrolyte Additive to Improve Cell Safety and Enhance Electrochemical Performance in Lithium-Ion Batteries.

Our society is critically dependent on lithium-ion batteries (LIBs) as a power source for portable electronic gadgets. One of the major problems with these batteries is the degradation of the materials inside them. In addition to the reduced cell life, building-up of these degraded products inside the cells is very detrimental to the safe operation. Herein, we report the synthesis and characterization of a novel thiourea-based room temperature ionic liquid (IL), 3-heptyl-1-(3-(3-heptyl-3-phenylthioureido)propyl)-1H-imidazole-3-ium hexafluorophosphate. Its electrochemical and thermal properties including transport phenomena have been studied. It is proposed to be used as a nominal additive to commercially used electrolytes, ethylene carbonate and di-methyl carbonate mixtures. The comparative performance characteristics of the LIBs in the presence and the absence of this IL additive have been demonstrated with a traditional lithium nickel cobalt manganese oxide cathode (NMC111), a graphite anode, and an ethylene carbonate and di-methyl carbonate (1:1, v/v) electrolyte. It is further demonstrated that use of this electrolyte additive in batteries helps to address some of the major concerns of the conventional electrolytes such as safety issues and cycling performance as well as coulombic efficiency with enhanced discharge capacities.

Synthesis, characterization and application of a non-flammable dicationic ionic liquid in lithium-ion battery as electrolyte additive.

A novel dicationic room temperature ionic liquid, 1,1'-(5,14-dioxo-4,6,13,15-tetraazaoctadecane-1,18-diyl) bis(3-(sec-butyl)-1H-imidazol-3-ium) bis((trifluoromethyl)-sulfonyl) imide has been synthesized and fully characterized. Its thermal and electrochemical analyses along with transport properties have been studied. We propose it as a potential nominal additive to the commonly used conventional organic carbonate electrolyte mixture and study its adaptability in Lithium-ion batteries which are the prime power sources for ultraportable electronic devices. We have compared the performance characteristics of the full cells made without and with this ionic liquid. The cells comprise lithium nickel cobalt manganese oxide cathode, graphite anode and ethylene carbonate - dimethyl carbonate (1:1, v/v + LiPF6) mixture electrolyte with nominal amount of ionic liquid as additive. The major concern with conventional electrolytes such as degradation of the materials inside batteries has been addressed by this electrolyte additive. Additionally, this additive is safer at relatively higher temperature. In its presence, the overall battery life is enhanced and it shows good cycling performance and coulombic efficiency with better discharge capacities (22% higher) after 100 cycles. Even after the increase in current rate from 10 mA/g to 100 mA/g, the cell still retains around 73% of capacity.

Perioperative Probiotics or Synbiotics in Adults Undergoing Elective Abdominal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To define the impact of perioperative treatment with probiotics or synbiotics on postoperative outcome in patients undergoing abdominal surgery. BACKGROUND: Postoperative surgical infection accounts for a third of all cases of sepsis, and is a leading cause of morbidity and mortality. Probiotics, prebiotics, and synbiotics (preparations that combine probiotics and prebiotics) are nutritional adjuncts that are emerging as novel therapeutic modalities for preventing surgical infections. However, current evidence on their effects is conflicting. METHODS: A comprehensive search of the PubMed, Embase, and WHO Global Index Medicus electronic databases was performed to identify randomized controlled trials evaluating probiotics or synbiotics in adult patients undergoing elective colorectal, upper gastrointestinal, transplant, or hepatopancreaticobiliary surgery. Bibliographies of studies were also searched. The primary outcome measure was incidence of postoperative infectious complications. Secondary outcomes included incidence of noninfectious complications, mortality, length of hospital stay, and any treatment-related adverse events. Quantitative pooling of the data was undertaken using a random effects model. RESULTS: A total of 34 randomized controlled trials reporting on 2723 participants were included. In the intervention arm, 1354 patients received prebiotic or symbiotic preparations, whereas 1369 patients in the control arm received placebo or standard care. Perioperative administration of either probiotics or synbiotics significantly reduced the risk of infectious complications following abdominal surgery [relative risk (RR) 0.56; 95% confidence interval (CI) 0.46-0.69; P < 0.00001, n = 2723, I = 42%]. Synbiotics showed greater effect on postoperative infections compared with probiotics alone (synbiotics RR: 0.46; 95% CI: 0.33-0.66; P < 0.0001, n = 1399, I = 53% probiotics RR: 0.65; 95% CI: 0.53-0.80; P < 0.0001, n = 1324, I = 18%). Synbiotics but not probiotics also led to a reduction in total length of stay (synbiotics weighted mean difference: -3.89; 95% CI: -6.60 to -1.18 days; P = 0.005, n = 535, I = 91% probiotics RR: -0.65; 95% CI: -2.03-0.72; P = 0.35, n = 294, I = 65%). There were no significant differences in mortality (RR: 0.98; 95% CI: 0.54-1.80; P = 0.96, n = 1729, I = 0%) or noninfectious complications between the intervention and control groups. The preparations were well tolerated with no significant adverse events reported. CONCLUSIONS: Probiotics and synbiotics are safe and effective nutritional adjuncts in reducing postoperative infective complications in elective abdominal surgery. The treatment effects are greatest with synbiotics.

On the existence of a perennial river in the Harappan heartland.

The legendary river Saraswati of Indian mythology has often been hypothesized to be an ancient perennial channel of the seasonal river Ghaggar that flowed through the heartland of the Bronze Age Harappan civilization in north-western India. Despite the discovery of abundant settlements along a major paleo-channel of the Ghaggar, many believed that the Harappans depended solely on monsoonal rains, because no proof existed for the river's uninterrupted flow during the zenith of the civilization. Here, we present unequivocal evidence for the Ghaggar's perennial past by studying temporal changes of sediment provenance along a 300 km stretch of the river basin. This is achieved using 40Ar/39Ar ages of detrital muscovite and Sr-Nd isotopic ratios of siliciclastic sediment in fluvial sequences, dated by radiocarbon and luminescence methods. We establish that during 80-20 ka and 9-4.5 ka the river was perennial and was receiving sediments from the Higher and Lesser Himalayas. The latter phase can be attributed to the reactivation of the river by the distributaries of the Sutlej. This revived perennial condition of the Ghaggar, which can be correlated with the Saraswati, likely facilitated development of the early Harappan settlements along its banks. The timing of the eventual decline of the river, which led to the collapse of the civilization, approximately coincides with the commencement of the Meghalayan Stage.

Bilateral Carotid-cavernous Fistulas Treated with Partial Embolization and Radiosurgery.

Bilateral carotid-cavernous fistulas (CCFs) are rare. In this paper, we report the case of an 88-year-old woman who presented with a two-month history of worsening visual symptoms and was subsequently found to have bilateral Barrow grade D CCFs. Cannulation and complete embolization of the offending vessels during angiography proved unsuccessful, and so the patient underwent adjuvant radiosurgery as salvage therapy with a good clinical outcome. This case adds to the limited but growing literature on the multi-modal management of CCFs.