Persistent median artery on computed tomographic arteriovenous fistulograms in patients on haemodialysis.

INTRODUCTION: Cadaveric studies suggest an increasing prevalence of the persistent median artery (PMA) over a prolonged timeframe. The aim of this retrospective cross-sectional study was to evaluate the PMA prevalence in haemodialysis patients who had computed tomographic fistulograms (CTFs), and if present, their calibres and origins. METHODS: All consecutive adult patients referred for an upper limb CTFs for assessment of arteriovenous fistula (AVF) dysfunction from 2006 to 2021 were included. Patients whose CTF did not include the forearm were excluded. PMA was identified as an artery running alongside the median nerve between flexor digitorum superficialis and flexor digitorum profundus. Patient demographics, presence of PMA including size and origin were recorded. RESULTS: A PMA was found in 91/170 (53.5%) CTFs (7:3 male-to-female ratio, mean age 71-years). When stratified by age, prevalence increased with decreasing age; 51% in >70-year-olds, 54% in 50-70-year-olds and 67% in <50-year-olds. The average PMA diameter was 2.2 mm proximally and 1.8 mm distally. No stenosis was observed in the PMAs. CONCLUSION: The PMA prevalence appears to increase with decreasing age and is a frequently encountered anatomical variant. Radiologists assessing forearm vasculature need to be aware of this anatomical variant and potentially include it in their future reports. Further research into the PMA may make its potential use as arterial conduits for AVF, potential donor grafts for coronary artery bypass surgery or additional vascular access options possible. Whether the reducing prevalence with age reflects an overall increasing prevalence is yet to be determined.

Granulomatosis with polyangiitis: Common and uncommon presentations.

Granulomatosis with polyangiitis (GPA) is a multisystemic autoimmune small vessel vasculitis predominantly affecting the respiratory and renal systems. Other systems such as the central nervous system, orbital, cardiac and gastrointestinal systems may also be involved to a lesser degree. Although there are no imaging features that are pathognomonic for GPA, there are known radiological patterns suggestive of the disease and imaging plays an important role in diagnosis, assessment and monitoring of disease activity. This is more evident when combined with clinical features, biochemical values and histopathology results. This pictorial review aims to present both common and uncommon radiological features of GPA.

Intracranial pure arterial malformations.

Pure arterial malformations (PAMs) are rare vascular lesions often detected incidentally on brain imaging. They are characterised by a mass of arterial loops containing arteries that are tortuous, overlapping and dilated without any associated arteriovenous shunting. The incidence of PAMs have been rising due to the increasing use of non-invasive angiographic imaging for the diagnosis of neurovascular disorders. This article will present the clinical course of two cases of PAM, both of which demonstrated a stable appearance on surveillance imaging despite the lack of surgical or endovascular intervention.

Cooled radiofrequency ablation for pain related to Perthes' disease: a novel application.

Perthes' disease is a rare paediatric condition involving idiopathic avascular necrosis of the femoral head, leading to degenerative hip joint disease. While joint replacement surgery is considered as the definitive surgical choice of managing degenerative hip disease, alternative methods of pain relief are available, especially for young patients, to defer joint replacement to a later date. One method of reducing pain for 18-24 months is cooled radiofrequency ablation (CRFA). CRFA has been gaining recognition as an effective treatment option for chronic musculoskeletal-related pain in multiple joints. This is the first case report describing the successful use of CRFA in the non-surgical management of Perthes' disease-related osteoarthritic hip pain in a man in his 40s. CRFA treatment led to a reported subjective improvement in pain of 60%-70%, with a documented objective improvement in the Oxford Hip Score from 18 to 40 within 6 weeks of the CRFA procedure.

Error and cognitive bias in diagnostic radiology.

Errors in diagnostic radiology are not infrequent. Patient harm related to these errors is however less common and may be avoided via various preventative mechanisms within the medical system including, but not limited to, multidisciplinary meetings, second opinions, subspecialty expertise and clinician experience. Failure at a number of points in the system is often required to result in patient harm. Radiologists, and in particular departmental leaders, should proactively address the known underlying root causes of diagnostic errors and cognitive biases, ensure systems are in place to promptly discover and control unmitigated root causes as they arise and ensure an unbiased 'blameless' or 'just' culture of error investigation and proces sing including the implementation of non-punitive peer feedback and peer learning. This article provides an overview of errors in diagnostic radiology including the causes and potential ramifications and how we might reduce their frequency and impact.

Mindfulness-based psychological interventions for improving mental well-being in medical students and junior doctors.

BACKGROUND: Mindfulness interventions are increasingly popular as an approach to improve mental well-being. To date, no Cochrane Review examines the effectiveness of mindfulness in medical students and junior doctors. Thus, questions remain regarding the efficacy of mindfulness interventions as a preventative mechanism in this population, which is at high risk for poor mental health.  OBJECTIVES: To assess the effects of psychological interventions with a primary focus on mindfulness on the mental well-being and academic performance of medical students and junior doctors. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and five other databases (to October 2021) and conducted grey literature searches.  SELECTION CRITERIA: We included randomised controlled trials of mindfulness that involved medical students of any year level and junior doctors in postgraduate years one, two or three. We included any psychological intervention with a primary focus on teaching the fundamentals of mindfulness as a preventative intervention. Our primary outcomes were anxiety and depression, and our secondary outcomes included stress, burnout, academic performance, suicidal ideation and quality of life.  DATA COLLECTION AND ANALYSIS: We used standard methods as recommended by Cochrane, including Cochrane's risk of bias 2 tool (RoB2).  MAIN RESULTS: We included 10 studies involving 731 participants in quantitative analysis.  Compared with waiting-list control or no intervention, mindfulness interventions did not result in a substantial difference immediately post-intervention for anxiety (standardised mean difference (SMD) 0.09, 95% CI -0.33 to 0.52; P = 0.67, I2 = 57%; 4 studies, 255 participants; very low-certainty evidence). Converting the SMD back to the Depression, Anxiety and Stress Scale 21-item self-report questionnaire (DASS-21) showed an estimated effect size which is unlikely to be clinically important. Similarly, there was no substantial difference immediately post-intervention for depression (SMD 0.06, 95% CI -0.19 to 0.31; P = 0.62, I2 = 0%; 4 studies, 250 participants; low-certainty evidence). Converting the SMD back to DASS-21 showed an estimated effect size which is unlikely to be clinically important. No studies reported longer-term assessment of the impact of mindfulness interventions on these outcomes.  For the secondary outcomes, the meta-analysis showed a small, substantial difference immediately post-intervention for stress, favouring the mindfulness intervention (SMD -0.36, 95% CI -0.60 to -0.13; P < 0.05, I2 = 33%; 8 studies, 474 participants; low-certainty evidence); however, this difference is unlikely to be clinically important. The meta-analysis found no substantial difference immediately post-intervention for burnout (SMD -0.42, 95% CI -0.84 to 0.00; P = 0.05, I² = 0%; 3 studies, 91 participants; very low-certainty evidence). The meta-analysis found a small, substantial difference immediately post-intervention for academic performance (SMD -0.60, 95% CI -1.05 to -0.14; P < 0.05, I² = 0%; 2 studies, 79 participants; very low-certainty evidence); however, this difference is unlikely to be clinically important. Lastly, there was no substantial difference immediately post-intervention for quality of life (mean difference (MD) 0.02, 95% CI -0.28 to 0.32; 1 study, 167 participants; low-certainty evidence). There were no data available for three pre-specified outcomes of this review: deliberate self-harm, suicidal ideation and suicidal behaviour. We assessed the certainty of evidence to range from low to very low across all outcomes. Across most outcomes, we most frequently judged the risk of bias as having 'some concerns'. There were no studies with a low risk of bias across all domains.  AUTHORS' CONCLUSIONS: The effectiveness of mindfulness in our target population remains unconfirmed. There have been relatively few studies of mindfulness interventions for junior doctors and medical students. The available studies are small, and we have some concerns about their risk of bias. Thus, there is not much evidence on which to draw conclusions on effects of mindfulness interventions in this population. There was no evidence to determine the effects of mindfulness in the long term.