Search results for: velocity map slice imaging

Authors: Christian Skowronski, Andrew Shanholtzer, Brent Yelton, Muayad Almahariq, Daniel J. Krauss

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Prostate cancer has the third highest incidence rate and is the second leading cause of cancer death for men in the United States. Of the diagnostic tools available for intermediate-risk prostate cancer, magnetic resonance imaging (MRI) provides superior soft tissue delineation serving as a valuable tool for both diagnosis and treatment planning. Currently, there is minimal data regarding the practical utility of MRI for evaluation of intermediate-risk prostate cancer. As such, the National Comprehensive Cancer Network’s guidelines indicate MRI as optional in intermediate-risk prostate cancer evaluation. This project aims to elucidate whether MRI affects radiation treatment decisions for intermediate-risk prostate cancer. This was a retrospective study evaluating 210 patients with intermediate-risk prostate cancer, treated with definitive radiotherapy at our institution between 2019-2020. NCCN risk stratification criteria were used to define intermediate-risk prostate cancer. Patients were divided into two groups: those with pretreatment prostate MRI, and those without pretreatment prostate MRI. We compared the use of external beam radiotherapy, brachytherapy alone, brachytherapy boost, and androgen depravation therapy between the two groups. Inverse probability of treatment weighting was used to match the two groups for age, comorbidity index, American Urologic Association symptoms index, pretreatment PSA, grade group, and percent core involvement on prostate biopsy. Wilcoxon Rank Sum and Chi-squared tests were used to compare continuous and categorical variables. Of the patients who met the study’s eligibility criteria, 133 had a prostate MRI and 77 did not. Following propensity matching, there were no differences between baseline characteristics between the two groups. There were no statistically significant differences in treatments pursued between the two groups: 42% vs 47% were treated with brachytherapy alone, 40% vs 42% were treated with external beam radiotherapy alone, 18% vs 12% were treated with external beam radiotherapy with a brachytherapy boost, and 24% vs 17% received androgen deprivation therapy in the non-MRI and MRI groups, respectively. This analysis suggests that pretreatment MRI does not significantly impact radiation therapy or androgen deprivation therapy decisions in patients with intermediate-risk prostate cancer. Obtaining a pretreatment prostate MRI should be used judiciously and pursued only to answer a specific question, for which the answer is likely to impact treatment decision. Further follow up is needed to correlate MRI findings with their impacts on specific oncologic outcomes.

Keywords: magnetic resonance imaging, prostate cancer, definitive radiotherapy, gleason score 7

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Authors: Deniz Erçelen, Özlem Selcuk Bozkurt

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The course of daily human life calls for the need for memories and remembering the time and place for certain events. Recalling memories takes up a substantial amount of time for an individual. Unfortunately, scientists lack the proper technology to fully understand and observe different brain regions that interact to form or retrieve memories. The hippocampus, a complex brain structure located in the temporal lobe, plays a crucial role in memory. The hippocampus forms memories as well as allows the brain to retrieve them by ensuring that neurons fire together. This process is called “neural synchronization.” Sadly, the hippocampus is known to deteriorate often with age. Proteins and hormones, which repair and protect cells in the brain, typically decline as the age of an individual increase. With the deterioration of the hippocampus, an individual becomes more prone to memory loss. Many memory loss starts off as mild but may evolve into serious medical conditions such as dementia and Alzheimer’s disease. In their quest to fully comprehend how memories work, scientists have created many different kinds of technology that are used to examine the brain and neural pathways. For instance, Magnetic Resonance Imaging - or MRI- is used to collect detailed images of an individual's brain anatomy. In order to monitor and analyze brain functions, a different version of this machine called Functional Magnetic Resonance Imaging - or fMRI- is used. The fMRI is a neuroimaging procedure that is conducted when the target brain regions are active. It measures brain activity by detecting changes in blood flow associated with neural activity. Neurons need more oxygen when they are active. The fMRI measures the change in magnetization between blood which is oxygen-rich and oxygen-poor. This way, there is a detectable difference across brain regions, and scientists can monitor them. Electroencephalography - or EEG - is also a significant way to monitor the human brain. The EEG is more versatile and cost-efficient than an fMRI. An EEG measures electrical activity which has been generated by the numerous cortical layers of the brain. EEG allows scientists to be able to record brain processes that occur after external stimuli. EEGs have a very high temporal resolution. This quality makes it possible to measure synchronized neural activity and almost precisely track the contents of short-term memory. Science has come a long way in monitoring memories using these kinds of devices, which have resulted in the inspections of neurons and neural pathways becoming more intense and detailed.

Keywords: brain, EEG, fMRI, hippocampus, memories, neural pathways, neurons

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Authors: Selena Ferrian, Erin Mccaffrey, Toshie Saito, Aiqin Cao, Noah Greenwald, Mark Robert Nicolls, Trevor Bruce, Roham T. Zamanian, Patricia Del Rosario, Marlene Rabinovitch, Michael Angelo

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Recent experimental and clinical observations are advancing immunotherapies to clinical trials in pulmonary arterial hypertension (PAH). However, comprehensive mapping of the immune landscape in pulmonary arteries (PAs) is necessary to understand how immune cell subsets interact to induce pulmonary vascular pathology. We used multiplexed ion beam imaging by time-of-flight (MIBI-TOF) to interrogate the immune landscape in PAs from idiopathic (IPAH) and hereditary (HPAH) PAH patients. Massive immune infiltration in I/HPAH was observed with intramural infiltration linked to PA occlusive changes. The spatial context of CD11c+DCs expressing SAMHD1, TIM-3 and IDO-1 within immune-enriched microenvironments and neutrophils were associated with greater immune activation in HPAH. Furthermore, CD11c-DC3s (mo-DC-like cells) within a smooth muscle cell (SMC) enriched microenvironment were linked to vessel score, proliferating SMCs, and inflamed endothelial cells. Experimental data in cultured cells reinforced a causal relationship between neutrophils and mo-DCs in mediating pulmonary arterial SMC proliferation. These findings merit consideration in developing effective immunotherapies for PAH.

Keywords: pulmonary arterial hypertension, vascular remodeling, indoleamine 2-3-dioxygenase 1 (IDO-1), neutrophils, monocyte-derived dendritic cells, BMPR2 mutation, interferon gamma (IFN-γ)

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Authors: Gabriel Cucato, Marilia Correia, Wagner Domingues, Aline Palmeira, Paulo Longano, Nelson Wolosker, Raphael Ritti-Dias

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Women with peripheral arterial disease (PAD) present lower walking capacity in comparison with men. However, whether cardiovascular regulation is also different between genders is unknown. Thus, the aim of this study was to compare walking capacity and cardiovascular regulation between men and women with PAD. A total of 23 women (66±7 yrs) and 31 men (64±9 yrs) were recruited. Patients performed a 6-minute test and the onset claudication distance and total walking distance were measured. Additionally, cardiovascular regulation was assessed by arterial stiffness (pulse wave velocity and augmentation index) and heart rate variability (frequency domain). Independent T test or Mann-Whitney U test were performed. In comparison with men, women present lower onset claudication distance (108±66m vs. 143±50m; P=0.032) and total walking distance (286±83m vs. 361±91 m, P=0.007). Regarding cardiovascular regulation, there were no differences in heart rate variability SDNN (72±160ms vs. 32±22ms, P=0.587); RMSSD (75±209 vs. 25±22ms, P=0.726); pNN50 (11±17ms vs. 8±14ms, P=0.836) in women and men, respectively. Moreover, there were no difference in augmentation index (39±10% vs. 34±11%, P=0.103); pulse pressure (59±17mmHg vs. 56±19mmHg, P=0.593) and pulse wave velocity (8.6±2.6m\s vs. 9.0±2.7m/s, P=0.580). In conclusion, women have impaired walking capacity compared to men. However, sex differences were not observed on cardiovascular regulation in patients with PAD.

Keywords: exercise, intermittent claudication, cardiovascular load, arterial stiffness

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Authors: J. S. Rudas, J. M. Gutiérrez Cabeza, A. Corz Rodríguez, L. M. Gómez, A. O. Toro

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The prediction of the wear rate of rubbing pairs has attracted the interest of many researchers for years. It has been recently proposed that the sliding wear rate can be inferred from the calculation of the energy rate dissipated by the tribological pair. In this paper some of the dissipative mechanisms present in a pin-on-disc configuration are discussed and both analytical and numerical calculations are carried out. Three dissipative mechanisms were studied: First, the energy release due to temperature gradients within the solid; second, the heat flow from the solid to the environment, and third, the energy loss due to abrasive damage of the surface. The Finite Element Method was used to calculate the dynamics of heat transfer within the solid, with the aid of commercial software. Validation the FEM model was assisted by virtual and laboratory experimentation using different operating points (sliding velocity and geometry contact). The materials for the experiments were Ti6Al4V alloy and Tungsten Carbide (WC-Co). The results showed that the sliding wear rate has a linear relationship with the energy dissipation flow. It was also found that energy loss due to micro-cutting is relevant for the system. This mechanism changes if the sliding velocity and pin geometry are modified though the degradation coefficient continues to present a linear behavior. We found that the less relevant dissipation mechanism for all the cases studied is the energy release by temperature gradients in the solid.

Keywords: degradation, dissipative mechanism, dry sliding, entropy, friction, wear

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Authors: Reza Behmanesh, Mohammad Nasrolahzadeh-Masouleh, Ehsan Khaksar, Saeed Bokaie

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Domestic rabbits (Oryctolagus cuniculus) are an excellent model for cardiovascular research because the size of these animals is more suitable for study and experimentation than smaller animals. One of the most important diagnostic imaging methods is echocardiography, which is used today to evaluate the anatomical and functional cardiovascular system and is one of the most accurate and sensitive non-invasive methods for examining heart disease. Ventricular function indices can be assessed with cardiac imaging techniques. One of these important cardiac parameters is the ejection fraction (EF), which has a valuable place along with other involved parameters. EF is a measure of the percentage of blood that comes out of the heart with each contraction. For this study, 100 adult and young standard domestic rabbits, six months to one year old and of both sexes (50 female and 50 male rabbits) without anesthesia and sedation were used. In this study, the mean EF in domestic rabbits studied in males was 58.753 ± 6.889 and in females, 61.397 ± 6.530, which are comparable to the items mentioned in the valid books and the average size of EF measured in this study; there is no significant difference between this research and other research. There was no significant difference in the percentage of EF between most weight groups, but there was a significant difference (p < 0.05) in weight groups (2161–2320 g and 2481–2640 g). Echocardiographic EF reference values for domestic rabbits (Oryctolagus cuniculus) non-anesthetized are presented, providing reference values for future studies.

Keywords: echocardiography, ejection fraction, rabbit, heart

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Authors: I. Wiemann, N. Weiß, E. Schlücker, M. Wensing, A. Kölpin

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Chemical storage of hydrogen by liquid organic hydrogen carriers (LOHC) is a very promising alternative to compression or cryogenics. These carriers have high energy density and allow at the same time efficient and safe storage of hydrogen under ambient conditions and without leakage losses. Another benefit of LOHC is the possibility to transport it using already available infrastructure for transport of fossil fuels. Efficient use of LOHC is related to a precise process control, which requires a number of sensors in order to measure all relevant process parameters, for example, to measure the level of hydrogen loading of the carrier. The degree of loading is relevant for the energy content of the storage carrier and represents simultaneously the modification in chemical structure of the carrier molecules. This variation can be detected in different physical properties like viscosity, permittivity or density. Thereby, each degree of loading corresponds to different viscosity values. Conventional measurements currently use invasive viscosity measurements or near-line measurements to obtain quantitative information. Avoiding invasive measurements has several severe advantages. Efforts are currently taken to provide a precise, non-invasive measurement method with equal or higher precision of the obtained results. This study investigates a method for determination of the viscosity of LOHC. Since the viscosity can retroactively derived from the degree of loading, permittivity is a target parameter as it is a suitable for determining the hydrogenation degree. This research analyses the influence of common physical properties on permittivity. The permittivity measurement system is based on a cavity resonator, an electromagnetic resonant structure, whose resonation frequency depends on its dimensions as well as the permittivity of the medium inside. For known resonator dimensions, the resonation frequency directly characterizes the permittivity. In order to determine the dependency of the permittivity on temperature and flow velocity, an experimental setup with heating device and flow test bench was designed. By varying temperature in the range of 293,15 K -393,15 K and flow velocity up to 140 mm/s, corresponding changes in the resonation frequency were measured in the hundredths of the GHz range.

Keywords: liquid organic hydrogen carriers, measurement, permittivity, viscosity., temperature, flow process

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Authors: Thaer Khaleel Swaid, Maryam Al Ahmad, Ishtiaq Ahmad

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47-year-old female, known to have a liver cyst and hemangiomas, presented to the gastroenterology clinic for chronic moderate postprandial epigastric pain, which is aggravated by food, leaning forward and relieved on lying flat. The pain was associated with nausea, vomiting, heartburn and excessive burping. She opened her bowel daily, having well-formed stools without blood or mucus. The patient denied NSAID intake, smoking or alcohol. On physical examination during the episode of pain abdomen revealed a soft, lax abdomen and mild tenderness in the epigastric region without organomegaly. Bowel sounds were audible. Her routine hematological and biochemical parameters were within normal, including CBC, Celiac serology, Lipase, Metabolic profile and H pylori stool antigen. The patient underwent an Ultrasound of the abdomen which showed multiple liver cysts, hemangioma, normal GB and biliary tree. Based on the clinical picture and to narrow our differential diagnosis, an ultrasound Doppler for the abdomen was ordered, and it showed celiac artery peak systolic velocity in expiration is 270cm/s, suggestive of median arcuate ligament syndrome. She Had computerized tomography abdomen done and showed a Narrowing of the celiac artery at the origin, likely secondary to low insertion of the median arcuate ligament. Furthermore, Gastroscopy and, later on colonoscopy were done, which was unremarkable. A laparoscopic decompression of the celiac trunk was indicated, for which the patient was referred to vascular surgery. This case confirms that Median Arcuate Ligament syndrome is an unusual diagnosis and is always challenging. Usually, patients undergo extensive workups before a final diagnosis is achieved. Our case highlights the challenge of diagnosing MALS since this entity is rare. It is a good choice to perform abdominal ultrasound with Doppler imaging on a patient with symptoms such as postprandial angina.

Keywords: Unveiling the Mystery, MALS, rare entity, Rare vascular phenomenon

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Authors: Ines Oliveira, Ana Reis

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Magnetic Pulse Welding (MPW) is a cold solid-state welding process, accomplished by the electromagnetically driven, high-speed and low-angle impact between two metallic surfaces. It has the same working principle of Explosive Welding (EXW), i.e. is based on the collision of two parts at high impact speed, in this case, propelled by electromagnetic force. Under proper conditions, i.e., flyer velocity and collision point angle, a permanent metallurgical bond can be achieved between widely dissimilar metals. MPW has been considered a promising alternative to the conventional welding processes and advantageous when compared to other impact processes. Nevertheless, MPW current applications are mostly academic. Despite the existing knowledge, the lack of consensus regarding several aspects of the process calls for further investigation. As a result, the mechanical resistance, morphology and structure of the weld interface in MPW of Al/Cu dissimilar pair were investigated. The effect of process parameters, namely gap, standoff distance and energy, were studied. It was shown that welding only takes place if the process parameters are within an optimal range. Additionally, the formation of intermetallic phases cannot be completely avoided in the weld of Al/Cu dissimilar pair by MPW. Depending on the process parameters, the intermetallic compounds can appear as continuous layer or small pockets. The thickness and the composition of the intermetallic layer depend on the processing parameters. Different intermetallic phases can be identified, meaning that different temperature-time regimes can occur during the process. It is also found that lower pulse energies are preferred. The relationship between energy increase and melting is possibly related to multiple sources of heating. Higher values of pulse energy are associated with higher induced currents in the part, meaning that more Joule heating will be generated. In addition, more energy means higher flyer velocity, the air existing in the gap between the parts to be welded is expelled, and this aerodynamic drag (fluid friction) is proportional to the square of the velocity, further contributing to the generation of heat. As the kinetic energy also increases with the square of velocity, the dissipation of this energy through plastic work and jet generation will also contribute to an increase in temperature. To reduce intermetallic phases, porosity, and melt pockets, pulse energy should be minimized. The bond formation is affected not only by the gap, standoff distance, and energy but also by the mandrel’s surface conditions. No correlation was clearly identified between surface roughness/scratch orientation and joint strength. Nevertheless, the aspect of the interface (thickness of the intermetallic layer, porosity, presence of macro/microcracks) is clearly affected by the surface topology. Welding was not established on oil contaminated surfaces, meaning that the jet action is not enough to completely clean the surface.

Keywords: bonding mechanisms, impact welding, intermetallic compounds, magnetic pulse welding, wave formation

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Authors: Alastair Hales, Xi Jiang

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Numerical methods are used to evaluate the operation of confined face-to-face piezoelectric fan arrays as pitch, P, between the blades is varied. Both in-phase and counter-phase oscillation are considered. A piezoelectric fan consists of a fan blade, which is clamped at one end, and an extremely low powered actuator. This drives the blade tip’s oscillation at its first natural frequency. Sufficient blade tip speed, created by the high oscillation frequency and amplitude, is required to induce vortices and downstream volume flow in the surrounding air. A single piezoelectric fan may provide the ideal solution for low powered hot spot cooling in an electronic device, but is unable to induce sufficient downstream airflow to replace a conventional air mover, such as a convection fan, in power electronics. Piezoelectric fan arrays, which are assemblies including multiple fan blades usually in face-to-face orientation, must be developed to widen the field of feasible applications for the technology. The potential energy saving is significant, with a 50% power demand reduction compared to convection fans even in an unoptimised state. A numerical model of a typical piezoelectric fan blade is derived and validated against experimental data. Numerical error is found to be 5.4% and 9.8% using two data comparison methods. The model is used to explore the variation of pitch as a function of amplitude, A, for a confined two-blade piezoelectric fan array in face-to-face orientation, with the blades oscillating both in-phase and counter-phase. It has been reported that in-phase oscillation is optimal for generating maximum downstream velocity and flow rate in unconfined conditions, due at least in part to the beneficial coupling between the adjacent blades that leads to an increased oscillation amplitude. The present model demonstrates that confinement has a significant detrimental effect on in-phase oscillation. Even at low pitch, counter-phase oscillation produces enhanced downstream air velocities and flow rates. Downstream air velocity from counter-phase oscillation can be maximally enhanced, relative to that generated from a single blade, by 17.7% at P = 8A. Flow rate enhancement at the same pitch is found to be 18.6%. By comparison, in-phase oscillation at the same pitch outputs 23.9% and 24.8% reductions in peak downstream air velocity and flow rate, relative to that generated from a single blade. This optimal pitch, equivalent to those reported in the literature, suggests that counter-phase oscillation is less affected by confinement. The optimal pitch for generating bulk airflow from counter-phase oscillation is large, P > 16A, due to the small but significant downstream velocity across the span between adjacent blades. However, by considering design in a confined space, counterphase pitch should be minimised to maximise the bulk airflow generated from a certain cross-sectional area within a channel flow application. Quantitative values are found to deviate to a small degree as other geometric and operational parameters are varied, but the established relationships are maintained.

Keywords: piezoelectric fans, low energy cooling, power electronics, computational fluid dynamics

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Authors: Wei-Po Wu, Wen-Yu Liu, Wei−Ting Lin, Hen-Yu Lien

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Introduction: Improving balance function for individuals after stroke is a crucial target in physiotherapy. Aquatic therapy which challenges individual’s postural control in an unstable fluid environment may be beneficial in enhancing balance functions. The purposes of the systematic review with meta-analyses were to validate the effects of aquatic therapy in improving balance functions for individuals with strokes in contrast to conventional physiotherapy. Method: Available studies were explored from three electronic databases: PubMed, Scopus, and Web of Science. During literature search, the published date of studies was not limited. The study design of the included studies should be randomized controlled trials (RCTs) and the studies should contain at least one outcome measurement of balance function. The PEDro scale was adopted to assess the quality of included studies, while the 'Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence' was used to evaluate the level of evidence. After the data extraction, studies with same outcome measures were pooled together for meta-analysis. Result: Ten studies with 282 participants were included in analyses. The research qualities of the studies were ranged from fair to good (4 to 8 points). Levels of evidence of the included studies were graded as level 2 and 3. Finally, scores of Berg Balance Scale (BBS), Eye closed force plate center of pressure velocity (anterior-posterior, medial-lateral axis) and Timed up and Go test were pooled and analyzed separately. The pooled results shown improvement in balance function (BBS mean difference (MD): 1.39 points; 95% confidence interval (CI): 0.05-2.29; p=0.002) (Eye closed force plate center of pressure velocity (anterior-posterior axis) MD: 1.39 mm/s; 95% confidence interval (CI): 0.93-1.86; p<0.001) (Eye closed force plate center of pressure velocity (medial-lateral) MD: 1.48 mm/s; 95% confidence interval (CI): 0.15-2.82; p=0.03) and mobility (MD: 0.9 seconds; 95% CI: 0.07-1.73; p=0.03) of stroke individuals after aquatic therapy compared to conventional therapy. Although there were significant differences between two treatment groups, the differences in improvement were relatively small. Conclusion: The aquatic therapy improved general balance function and mobility in the individuals with stroke better than conventional physiotherapy.

Keywords: aquatic therapy, balance function, meta-analysis, stroke, systematic review

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Authors: Deva Kanta Phukan

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An investigation is made to carry out to study the thermal-diffusion and diffusion thermo-effects in hydro-magnetic unsteady flow by a mixed convection boundary layer past an impermeable vertical stretching sheet embedded in a conducting fluid-saturated porous medium in the presence of a chemical reaction effect. The velocity of stretching surface, the surface temperature and the concentration are assumed to vary linearly with the distance along the surface. The governing partial differential equations are transformed in to self similar unsteady equations using similarity transformations and solved numerically by the Runge kutta fourth order scheme in association with the shooting method for the whole transient domain from the initial state to the final steady state flow. Numerical results for the velocity, temperature, the concentration, the skin friction , and the Nusselt and Sherwood numbers are shown graphically for various flow parameters. The results reveal that there is a smooth transition of flow from unsteady state to the final steady state. A special case of our results is in good agreement with an earlier published work.

Keywords: heat and mass transfer, boundary layer flow, porous media, magnetic field, Soret number, Dufour’s number

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Authors: Sirisak Choedkiatphon, Tanya Niyamapa

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This research aimed to indeed understand the soil-rotary blade interaction of the newly-design rotary blade for Thai walking tractor. Therefore, this study was carried out to clarify the characteristics of the horizontal and the vertical forces and the moment around a rotary shaft of prototype rotary blade 15 lengthwise slice angle. It was set up and tested in laboratory soil bin at Kasetsart University under sandy loam and clay soil at soil dry bulk density and soil specific weight of 9.81 kN/m3 and 11.3% (d.b.), respectively. The tests were conducted at travel speeds of 0.069 and 0.142 m/s and rotational speeds of 150, 250 and 350 rpm. The characteristic of pushing-forward and lifting-up forces and moment around a rotor shaft were obtained by using the EOR transducer. Also, the acting point of resultant force of these soil-blade reaction forces was determined. The pushing-forward and lifting-up forces, moment around a rotor shaft and resultant force increased at higher travel speed and higher soil moisture content. In tilling stage, the acting points of resultant force located inside the circumstance of the blade locus. The results showed that the variation of magnitude and direction of pushing-forward, lifting-up and resultant forces corresponded to soil-blade interaction of the newly-design in tilling stage.

Keywords: rotary blde, soil-blade interaction, walking tractor, clay, sandy loam

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Authors: Murat Durucu

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Glaucoma is a condition of irreversible blindness, early diagnosis and appropriate interventions to make the patients able to see longer time. In this study, it addressed that the importance of developing a decision support system for glaucoma diagnosis. Glaucoma occurs when pressure happens around the eyes it causes some damage to the optic nerves and deterioration of vision. There are different levels ranging blindness of glaucoma disease. The diagnosis at an early stage allows a chance for therapies that slows the progression of the disease. In recent years, imaging technology from Heidelberg Retinal Tomography (HRT), Stereoscopic Disc Photo (SDP) and Optical Coherence Tomography (OCT) have been used for the diagnosis of glaucoma. This better accuracy and faster imaging techniques in response technique of OCT have become the most common method used by experts. Although OCT images or HRT precision and quickness, especially in the early stages, there are still difficulties and mistakes are occurred in diagnosis of glaucoma. It is difficult to obtain objective results on diagnosis and placement process of the doctor's. It seems very important to develop an objective decision support system for diagnosis and level the glaucoma disease for patients. By using OCT images and pattern recognition systems, it is possible to develop a support system for doctors to make their decisions on glaucoma. Thus, in this recent study, we develop an evaluation and support system to the usage of doctors. Pattern recognition system based computer software would help the doctors to make an objective evaluation for their patients. It is intended that after development and evaluation processes of the software, the system is planning to be serve for the usage of doctors in different hospitals.

Keywords: decision support system, glaucoma, image processing, pattern recognition

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Authors: Mokhtar Djeddou, Amine Mehel, Georges Fokoua, Anne Tanière, Patrick Chevrier

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Commuters' exposure to air pollution, particularly to particle matter, inside vehicles is a significant health issue. Assessing particles concentrations and characterizing their distribution is an important first step to understand and propose solutions to improve car cabin air quality. It is known that particles dynamics is intimately driven by particles-turbulence interactions. In order to analyze and model pollutants distribution inside the car the cabin, it is crucialto examine first the single-phase flow topology and turbulence characteristics. Within this context, Computational Fluid Dynamics (CFD) simulations were conducted to model airflow inside a full-scale car cabin using Reynolds Averaged Navier-Stokes (RANS)approach combined with the first order Realizable k- εmodel to close the RANS equations. To validate the numerical model, a campaign of velocity field measurements at different locations in the front and back of the car cabin has been carried out using hot-wire anemometry technique. Comparison between numerical and experimental results shows a good agreement of velocity profiles. Additionally, visualization of streamlines shows the formation of jet flow developing out of the dashboard air vents and the formation of large vortex structures, particularly in the back seats compartment. These vortex structures could play a key role in the accumulation and clustering of particles in a turbulent flow

Keywords: car cabin, CFD, hot wire anemometry, vortical flow

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Authors: Azita Ramezani, Ghazal Mashhadiagha, Bahareh Sanabakhsh

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This study researches the combination of Random. Forest classifiers with large language models (LLMs) and natural language processing (NLP) to improve diagnostic accuracy in chest X-ray analysis using the Indiana University dataset. Utilizing advanced NLP techniques, the research preprocesses textual data from radiological reports to extract key features, which are then merged with image-derived data. This improved dataset is analyzed with Random Forest classifiers to predict specific clinical results, focusing on the identification of health issues and the estimation of case urgency. The findings reveal that the combination of NLP, LLMs, and machine learning not only increases diagnostic precision but also reliability, especially in quickly identifying critical conditions. Achieving an accuracy of 99.35%, the model shows significant advancements over conventional diagnostic techniques. The results emphasize the large potential of machine learning in medical imaging, suggesting that these technologies could greatly enhance clinician judgment and patient outcomes by offering quicker and more precise diagnostic approximations.

Keywords: natural language processing (NLP), large language models (LLMs), random forest classifier, chest x-ray analysis, medical imaging, diagnostic accuracy, indiana university dataset, machine learning in healthcare, predictive modeling, clinical decision support systems

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Authors: Iyad Al-Attar

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Air filters installed in HVAC equipment and gas turbine for power generation confront several atmospheric contaminants with various concentrations while operating in different environments (tropical, coastal, hot). This leads to engine performance degradation, as contaminants are capable of deteriorating components and fouling compressor assembly. Compressor fouling is responsible for 70 to 85% of gas turbine performance degradation leading to reduction in power output and availability and an increase in the heat rate and fuel consumption. Therefore, filter design must take into account face velocities, pleat count and its corresponding surface area; to verify filter performance characteristics (Efficiency and Pressure Drop). The experimental work undertaken in the current study examined two groups of four filters with different pleating densities were investigated for the initial pressure drop response and fractional efficiencies. The pleating densities used for this study is 28, 30, 32 and 34 pleats per 100mm for each pleated panel and measured for ten different flow rates ranging from 500 to 5000 m3/h with increment of 500m3/h. This experimental work of the current work has highlighted the underlying reasons behind the reduction in filter permeability due to the increase in face velocity and pleat density. The reasons that led to surface area losses of filtration media are due to one or combination of the following effects: pleat-crowding, deflection of the entire pleated panel, pleat distortion at the corner of the pleat and/or filtration medium compression. It is evident from entire array of experiments that as the particle size increases, the efficiency decreases until the MPPS is reached. Beyond the MPPS, the efficiency increases with increase in particle size. The MPPS shifts to a smaller particle size as the face velocity increases, while the pleating density and orientation did not have a pronounced effect on the MPPS. Throughout the study, an optimal pleat count which satisfies initial pressure drop and efficiency requirements may not have necessarily existed. The work has also suggested that a valid comparison of the pleat densities should be based on the effective surface area that participates in the filtration action and not the total surface area the pleat density provides.

Keywords: air filters, fractional efficiency, gas cleaning, glass fibre, HEPA filter, permeability, pressure drop

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Authors: L. José, S. Vieira, E. Melo, A. R. Pinheiro

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Objectives: This study aims to characterize the stroke profile and the health care provided for people with a stroke in Luanda, Angola. Methods: A prospective longitudinal study was conducted at two Health centers, from March to November 2023, enrolling stroke patients. Data was gathered using a survey created by the researchers and validated by a health panel of experts from Angola. The analysis focused on demographic and stroke characteristics, as well as the care provided. Ethical approval and informed consent were obtained. Results: Preliminary results of a total of 186 patients are described, 122 from a Central Acute Care Hospital, with a mean age of 51.3±14.35 years old, a BMI of 26.7±4.15 kg/m2, 41% male, and 64 patients from a Rehabilitation Center, with 55.6±11.55 years old, a BMI of 27.0±3.8 kg/m2, 53% male. Ischemic stroke was reported as the most representative type in both centers (71.3% and 70.3%, respectively), though 100% of patients had no imaging diagnosis confirmation, neither data about the subtype was given. For patients admitted to the Hospital, discharge occurred before rehabilitation, and no follow-up was possible. No rehabilitation care was delivered in the first 7 days after the stroke. In the Rehabilitation Center, patient’s rehabilitation started in the late subacute phase, after a mean of 171.8±11.5 days. Conclusions: Stroke diagnosis lacks imaging confirmation, which is decisive for proper treatment, and rehabilitation starts during the late subacute phase, which is too late considering the international guidelines and the best window of opportunity for neuroplasticity and recovery. These results highlight the urgent need for the definition of Stroke-directed Health Care Policies in Angola.

Keywords: stroke, personalized health care, functional recovery, quality of life, health policies

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Authors: Julia Wimmers-Klick

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At the Canadian University of British Columbia's Faculty of Medicine, anatomy has traditionally been taught through a combination of lectures and dissection labs in the first two years, with radiology taught separately through lectures and online modules. However, this separation may leave students underprepared for medical practice, as medical imaging is essential for diagnosing anatomical and pathological conditions. To address this, a pilot project was initiated aimed at integrating radiological imaging into anatomy dissection labs from day one of medical school. The incorporated radiological images correlated with the current dissection areas. Additional stations were added within the lab, tailored to the specific content being covered. These stations focused on bones, and quiz questions, along with light-box exercises using radiographs, CT scans, and MRIs provided by the radiology department. The images used were free of pathologies. Examples of these will be presented in the poster. Feedback from short interviews with students and instructors has been positive, particularly among second-year students who appreciated the integration compared to their first-year experience. This low-budget approach was easy to implement but faced challenges, as lab instructors were not radiologists and occasionally struggled to answer students' questions. Instructors expressed a desire for basic training or a refresher course in radiology image reading, particularly focused on identifying healthy landmarks. Overall, all participants agreed that integrating radiology with anatomy reinforces learning during dissection, enhancing students' understanding and preparation for clinical practice.

Keywords: quality improvement, radiology education, anatomy education, integration

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Authors: Adrian Szczyrba, Aneta Halka-Grysinska, Tomasz Baj, Tadeusz H. Dzido

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Since prehistory, plants were constituted as an essential source of biologically active substances in folk medicine. One of the examples of medicinal plants is Ruta graveolens L. For a long time, Ruta g. herb has been famous for its spasmolytic, diuretic, or anti-inflammatory therapeutic effects. The wide spectrum of secondary metabolites produced by Ruta g. includes flavonoids (eg. rutin, quercetin), coumarins (eg. bergapten, umbelliferone) phenolic acids (eg. rosmarinic acid, chlorogenic acid), and limonoids. Unfortunately, the presence of produced substances is highly dependent on environmental factors like temperature, humidity, or soil acidity; therefore standardization is necessary. There were many attempts of characterization of various phytochemical groups (eg. coumarins) of Ruta graveolens using the normal – phase thin-layer chromatography (TLC). However, due to the so-called general elution problem, usually, some components remained unseparated near the start or finish line. Therefore Ruta graveolens is a very good model plant. Methanol and petroleum ether extract from its aerial parts were used to demonstrate the capabilities of the new device for gradient thin-layer chromatogram development. The development of gradient thin-layer chromatograms in the reversed-phase system in conventional horizontal chambers can be disrupted by problems associated with an excessive flux of the mobile phase to the surface of the adsorbent layer. This phenomenon is most likely caused by significant differences between the surface tension of the subsequent fractions of the mobile phase. An excessive flux of the mobile phase onto the surface of the adsorbent layer distorts the flow of the mobile phase. The described effect produces unreliable, and unrepeatable results, causing blurring and deformation of the substance zones. In the prototype device, the mobile phase solution is delivered onto the surface of the adsorbent layer with controlled velocity (by moving pipette driven by 3D machine). The delivery of the solvent to the adsorbent layer is equal to or lower than that of conventional development. Therefore chromatograms can be developed with optimal linear mobile phase velocity. Furthermore, under such conditions, there is no excess of eluent solution on the surface of the adsorbent layer so the higher performance of the chromatographic system can be obtained. Directly feeding the adsorbent layer with eluent also enables to perform convenient continuous gradient elution practically without the so-called gradient delay. In the study, unique fingerprints of methanol and petroleum ether extracts of Ruta graveolens aerial parts were obtained with stepwise gradient reversed-phase thin-layer chromatography. Obtained fingerprints under different chromatographic conditions will be compared. The advantages and disadvantages of the proposed approach to chromatogram development with controlled solvent velocity will be discussed.

Keywords: fingerprints, gradient thin-layer chromatography, reversed-phase TLC, Ruta graveolens

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Authors: Rajendra Roul

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The main objective of the project is to bring attention towards the performance of an aerofoil when exposed to the fluid medium inside the wind tunnel. This project aims at involvement of civil as well as mechanical engineering thereby making itself as a multidisciplinary project. The airfoil of desired size is taken into consideration for the project to carry out effectively. An aerofoil is the shape of the wing or blade of propeller, rotor or turbine. Lot of experiment have been carried out through wind-tunnel keeping aerofoil as a reference object to make a future forecast regarding the design of turbine blade, car and aircraft. Lift and drag now become the major identification factor for any design industry which shows that wind tunnel testing along with software analysis (ANSYS) becomes the mandatory task for any researchers to forecast an aerodynamics design. This project is an initiative towards the mitigation of drag, better lift and analysis of wake surface profile by investigating the surface pressure distribution. The readings has been taken on airfoil model in Wind Tunnel Testing Machine (WTTM) at different air velocity 20m/sec, 25m/sec, 30m/sec and different angle of attack 00,50,100,150,200. Air velocity and pressures are measured in several ways in wind tunnel testing machine by use to measuring instruments like Anemometer and Multi tube manometer. Moreover to make the analysis more accurate Ansys fluent contribution become substantial and subsequently the CFD simulation results. Analysis on an Aerofoil have a wide spectrum of application other than aerodynamics including wind loads in the design of buildings and bridges for structural engineers.

Keywords: wind-tunnel, aerofoil, Ansys, multitube manometer

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Authors: Julien Deborde, Thomas Milcent, Stéphane Glockner, Pierre Lubin

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A fully Eulerian method is developed to solve the problem of fluid-elastic structure interactions based on a 1-fluid method. The interface between the fluid and the elastic structure is captured by a level set function, advected by the fluid velocity and solved with a WENO 5 scheme. The elastic deformations are computed in an Eulerian framework thanks to the backward characteristics. We use the Neo Hookean or Mooney Rivlin hyperelastic models and the elastic forces are incorporated as a source term in the incompressible Navier-Stokes equations. The velocity/pressure coupling is solved with a pressure-correction method and the equations are discretized by finite volume schemes on a Cartesian grid. The main difficulty resides in that large deformations in the fluid cause numerical instabilities. In order to avoid these problems, we use a re-initialization process for the level set and linear extrapolation of the backward characteristics. First, we verify and validate our approach on several test cases, including the benchmark of FSI proposed by Turek. Next, we apply this method to study the wave damping phenomenon which is a mean to reduce the waves impact on the coastline. So far, to our knowledge, only simulations with rigid or one dimensional elastic structure has been studied in the literature. We propose to place elastic structures on the seabed and we present results where 50 % of waves energy is absorbed.

Keywords: damping wave, Eulerian formulation, finite volume, fluid structure interaction, hyperelastic material

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Authors: Saman Mostafazadeh-Fard, Zohrab Samani, Kenneth Suazo

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Agricultural ditch liners are used to prevent soil erosion and reduce seepage losses. This paper introduced an approach to validate a computational fluid dynamics (CFD) platform FLOW-3D code and its use to design a flow-regulating corrugated agricultural ditch liner system (Smart Ditch (SM)). Hydrodynamic and sediment transport analyses were performed on the proposed liner flow using the CFD platform FLOW-3D code. The code's hydrodynamic and scour and sediment transport models were calibrated and validated using lab data with an accuracy of 94 % and 95%, respectively. The code was then used to measure hydrodynamic parameters of sublayer turbulent intensity, kinetic energy, dissipation, and packed sediment mass normalized with respect to sublayer flow velocity. Sublayer turbulent intensity, kinetic energy, and dissipation in the SM flow were significantly higher than CR flow. An alternative corrugated liner was also designed, and sediment transport was measured and compared to SM and CR flows. Normalized packed sediment mass with respect to average sublayer flow velocity was 27.8 % lower in alternative flow compared to SM flow. CFD platform FLOW-3D code could effectively be used to design corrugated ditch liner systems and perform hydrodynamic and sediment transport analysis under various corrugation designs.

Keywords: CFD, hydrodynamic, sediment transport, ditch, liner design

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Authors: Ole-Christian Galbo Engstrøm, Erik Schou Dreier, Birthe Møller Jespersen, Kim Steenstrup Pedersen

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Grain quality analysis is a multi-parameterized problem that includes a variety of qualitative and quantitative parameters such as grain type classification, damage type classification, and nutrient regression. Currently, these parameters require human inspection, a multitude of instruments employing a variety of sensor technologies, and predictive model types or destructive and slow chemical analysis. This paper investigates the feasibility of applying near-infrared hyperspectral imaging (NIR-HSI) to grain quality analysis. For this study two datasets of NIR hyperspectral images in the wavelength range of 900 nm - 1700 nm have been used. Both datasets contain images of sparsely and densely packed grain kernels. The first dataset contains ~87,000 image crops of bulk wheat samples from 63 harvests where protein value has been determined by the FOSS Infratec NOVA which is the golden industry standard for protein content estimation in bulk samples of cereal grain. The second dataset consists of ~28,000 image crops of bulk grain kernels from seven different wheat varieties and a single rye variety. In the first dataset, protein regression analysis is the problem to solve while variety classification analysis is the problem to solve in the second dataset. Deep convolutional neural networks (CNNs) have the potential to utilize spatio-spectral correlations within a hyperspectral image to simultaneously estimate the qualitative and quantitative parameters. CNNs can autonomously derive meaningful representations of the input data reducing the need for advanced preprocessing techniques required for classical chemometric model types such as artificial neural networks (ANNs) and partial least-squares regression (PLS-R). A comparison between different CNN architectures utilizing 2D and 3D convolution is conducted. These results are compared to the performance of ANNs and PLS-R. Additionally, a variety of preprocessing techniques from image analysis and chemometrics are tested. These include centering, scaling, standard normal variate (SNV), Savitzky-Golay (SG) filtering, and detrending. The results indicate that the combination of NIR-HSI and CNNs has the potential to be the foundation for an automatic system unifying qualitative and quantitative grain quality analysis within a single sensor technology and predictive model type.

Keywords: deep learning, grain analysis, hyperspectral imaging, preprocessing techniques

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Authors: M. J. Gibbons, A. J. Robinson

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Increasing expectations on small form factor electronics to be more compact while increasing performance has driven conventional cooling technologies to a thermal management threshold. An emerging solution to this problem is electrospray (ES) cooling. ES cooling enables two phase cooling by utilising Coulomb forces for energy efficient fluid atomization. Generated charged droplets are accelerated to the grounded target surface by the applied electric field and surrounding gravitational force. While in transit the like charged droplets enable plume dispersion and inhibit droplet coalescence. If the electric field is increased in the cone-jet regime, a subsequent increase in the plume spray angle has been shown. Droplet segregation in the spray plume has been observed, with primary droplets in the plume core and satellite droplets positioned on the periphery of the plume. This segregation is facilitated by inertial and electrostatic effects. This result has been corroborated by numerous authors. These satellite droplets are usually more densely charged and move at a lower relative velocity to that of the spray core due to the radial decay of the electric field. Previous experimental research by Gomez and Tang has shown that the number of droplets deposited on the periphery can be up to twice that of the spray core. This result has been substantiated by a numerical models derived by Wilhelm et al., Oh et al. and Yang et al. Yang et al. showed from their numerical model, that by varying the extractor potential the dispersion radius of the plume also varies proportionally. This research aims to investigate this dispersion density and the role it plays in the local heat transfer coefficient profile (h) of ES cooling. This will be carried out for different extractor – target separation heights (H2), working fluid flow rates (Q), and extractor applied potential (V2). The plume dispersion will be recorded by spraying a 25 µm thick, joule heated steel foil and by recording the thermal footprint of the ES plume using a Flir A-40 thermal imaging camera. The recorded results will then be analysed by in-house developed MATLAB code.

Keywords: electronic cooling, electrospray, electrospray plume dispersion, spray cooling

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Authors: Jairson Barbosa Rodrigues, Paulo Romero Martins Maciel, Germano Crispim Vasconcelos

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This paper presents an investigation of the performance impacts regarding the variation of five factors (input data size, node number, cores, memory, and disks) when applying a distributed implementation of Naïve Bayes for text classification of a large Corpus on the Spark big data processing framework. Problem: The algorithm's performance depends on multiple factors, and knowing before-hand the effects of each factor becomes especially critical as hardware is priced by time slice in cloud environments. Objectives: To explain the functional relationship between factors and performance and to develop linear predictor models for time and cost. Methods: the solid statistical principles of Design of Experiments (DoE), particularly the randomized two-level fractional factorial design with replications. This research involved 48 real clusters with different hardware arrangements. The metrics were analyzed using linear models for screening, ranking, and measurement of each factor's impact. Results: Our findings include prediction models and show some non-intuitive results about the small influence of cores and the neutrality of memory and disks on total execution time, and the non-significant impact of data input scale on costs, although notably impacts the execution time.

Keywords: big data, design of experiments, distributed machine learning, natural language processing, spark

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Authors: A. W. J. Wong, I. H. Ibrahim

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Increasing urbanisation has driven building designers to incorporate natural ventilation in the designs of sustainable buildings. This project utilises Computational Fluid Dynamics (CFD) to investigate the natural ventilation of an academic building, SIT@SP, using an assessment criterion based on daily mean temperature and mean velocity. The areas of interest are the pedestrian level of first and fourth levels of the building. A reference case recommended by the Architectural Institute of Japan was used to validate the simulation model. The validated simulation model was then used for coupled simulations on SIT@SP and neighbouring geometries, under two wind speeds. Both steady and transient simulations were used to identify differences in results. Steady and transient results are agreeable with the transient simulation identifying peak velocities during flow development. Under a lower wind speed, the first level was sufficiently ventilated while the fourth level was not. The first level has excessive wind velocities in the higher wind speed and the fourth level was adequately ventilated. Fourth level flow velocity was consistently lower than those of the first level. This is attributed to either simulation model error or poor building design. SIT@SP is concluded to have a sufficiently ventilated first level and insufficiently ventilated fourth level. Future works for this project extend to modifying the urban geometry, simulation model improvements, evaluation using other assessment metrics and extending the area of interest to the entire building.

Keywords: buildings, CFD Simulations, natural ventilation, urban airflow

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Authors: Mahdi Farajzadeh Ajirlou

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The detailed serious adverse effects raised the stresses around the safety of individuals who have gotten COVID-19 vaccines. Numerous verification referrers that disease with COV-19 causes neurological dysfunction in a significant proportion of influenced patients, where these side effects show up seriously amid the disease, and still less is known approximately the potential long-term results for the brain, where the loss of olfaction could be a neurological sign and simple indications of COVID-19. Since publishing effective clinical trial results of mRNA coronavirus disease 2019 (COVID-19) and injecting it to the volunteers in 2020, numerous reports have emerged approximately about cardiovascular complications followed by the mRNA vaccination. Vaccination-associated adenopathy could be a constant imaging finding after the organization of COVID-19 antibodies that will lead to a symptomatic problem in patients with shown or suspected cancer, in whom it may be vague from dangerous nodal inclusion. In spite of all the benefits and viability of the coronavirus infection 2019 (COVID-19) antibodies specified in later clinical trials, a few other post-vaccination side impacts, such as lymphadenopathy (LAP), were observed. Also, numerous variables, including financial conditions, have played a critical part in expanding the number of people with COVID-19 infection and also much more side effects in that country. Amid the Coronavirus widespread, Iran has been experiencing extreme sanctions, which has faced this nation with an extreme financial crisis. Additionally, with COVID-19 widespread, there was a developing concern around the abuse of imaging exams extraordinarily within the pediatric populace, which highlights the issues pointed out by this review.

Keywords: radiology, vaccines, COVID-19, side effect

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Authors: Erjola Reufi, Thomas Beer

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Plain, unreinforced concrete is a brittle material, with a low tensile strength, limited ductility and little resistance to cracking. In order to improve the inherent tensile strength of concrete there is a need of multi directional and closely spaced reinforcement, which can be provided in the form of randomly distributed fibers. Fiber reinforced concrete (FRC) is a composite material consisting of cement, sand, coarse aggregate, water and fibers. In this composite material, short discrete fibers are randomly distributed throughout the concrete mass. The behavioral efficiency of this composite material is far superior to that of plain concrete and many other construction materials of equal cost. The present experimental study considers the effect of steel fibers and polypropylene fiber on the modulus of elasticity of concrete. Hook end steel fibers of length 5 cm and 3 cm at volume fraction of 0.25%, 0.5% and 1.% were used. Also polypropylene fiber of length 12, 6, 3 mm at volume fraction 0.1, 0.25, and 0.4 % were used. Fifteen mixtures has been prepared to evaluate the effect of fiber on modulus of elasticity of concrete. Ultrasonic pulse velocity (UPV) and resonant frequency methods which are two non-destructive testing techniques have been used to measure the elastic properties of fiber reinforced concrete. This study found that ultrasonic wave propagation is the most reliable, easy and cost effective testing technique to use in the determination of the elastic properties of the FRC mix used in this study.

Keywords: fiber reinforced concrete(FRC), polypropylene fiber, resonance, ultrasonic pulse velocity, steel fiber

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Authors: Cecilia Moreira, Rita Paiva, Daniela Macedo, Leonor Ribeiro, Isabel Fernandes, Luis Costa

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Background: Head and neck paragangliomas are a rare group of tumors with a large spectrum of clinical manifestations. The approach to evaluate and treat these lesions has evolved over the last years. Surgery was the standard for the approach of these patients, but nowadays new techniques of imaging and radiation therapy changed that paradigm. Despite advances in treating, the growth potential and clinical outcome of individual cases remain largely unpredictable. Objectives: Characterization of our institutional experience with clinical management of these tumors. Methods: This was a cross-sectional study of patients followed in our institution between 01 January and 31 December 2017 with paragangliomas of the head and neck and cranial base. Data on tumor location, catecholamine levels, and specific imaging modalities employed in diagnostic workup, treatment modality, tumor control and recurrence, complications of treatment and hereditary status were collected and summarized. Results: A total of four female patients were followed between 01 January and 31 December 2017 in our institution. The mean age of our cohort was 53 (± 16.1) years. The primary locations were at the level of the tympanic jug (n=2, 50%) and carotid body (n=2, 50%), and only one of the tumors of the carotid body presented pulmonary metastasis at the time of diagnosis. None of the lesions were catecholamine-secreting. Two patients underwent genetic testing, with no mutations identified. The initial clinical presentation was variable highlighting the decrease of visual acuity and headache as symptoms present in all patients. In one of the cases, loss of all teeth of the lower jaw was the presenting symptomatology. Observation with serial imaging, surgical extirpation, radiation, and stereotactic radiosurgery were employed as treatment approaches according to anatomical location and resectability of lesions. As post-therapeutic sequels the persistence of tinnitus and disabling pain stands out, presenting one of the patients neuralgia of the glossopharyngeal. Currently, all patients are under regular surveillance with a median follow up of 10 months. Conclusion: Ultimately, clinical management of these tumors remains challenging owing to heterogeneity in clinical presentation, the existence of multiple treatment alternatives, and potential to cause serious detriment to critical functions and consequently interference with the quality of life of the patients.

Keywords: clinical outcomes, head and neck, management, paragangliomas

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