This is FDA Patient Safety News. In this edition, a new product to correct facial wasting in HIV-AIDS patients, a recall of certain software for metronic and planted infusion pumps, avoiding fatalities during blood transfusions, and clearing up some confusion about kaopectate labeling. These stories and more on this edition of FDA Patient Safety News. Welcome to the program. For the U.S. Food and Drug Administration, I'm Mark Barnett. And I'm Anita Rainer. Let's start with some medical products FDA recently approved. FDA recently approved the first injectable filler that's used to correct facial wasting in people with HIV-AIDS. The condition called lipoatrophy is caused by subcutaneous fat loss, and that results in a sinking of the cheeks and the eyes and the temples. The new product called Sculptra contains polyelactic acid, a synthetic polymer from the alpha-hydroxy acid family. It's manufactured by dermic laboratories. Sculptra is injected into the deep dermis or the subcutaneous layer around the area of fat loss in the face. The effect can take several weeks to become evident, and three to six treatment sessions may be needed to achieve the desired result. The treatment can last up to two years. Touch-up treatments may be needed from time to time to maintain the effect. Sculptra should be injected by health professionals who are expert in correcting volume deficiencies in HIV-AIDS patients. They should avoid injecting the product into the superficial layers of the skin and take special care when they're injecting into areas where the skin is thin. The most common adverse events have been hematoma, bruising, discomfort, inflammation, and edema. The long-term safety and effectiveness of Sculptra haven't been investigated yet, and so FDA is requiring the manufacturer to conduct a study to evaluate safety and effectiveness beyond two years. Medtronic is recalling certain software application cards. They're used in the company's Model 8840 Envision Clinician Programmers. These handheld devices are used to program a number of implantable devices, including the Synchromed and Synchromed EL implantable infusion pumps. The recall is prompted by reports of data entry errors that have led to serious drug overdoses, including two patient deaths. The overdoses occurred when clinicians who were programming the pump entered the wrong time duration or the wrong interval. For example, mistakenly putting the time interval between periodic drug boluses in the minutes field instead of the hours field. The recalled software may have contributed to these errors because one part of the screen did not have labels on the fields for hours and minutes and seconds. Medtronic is now distributing replacement software that adds time labels to the screen to help reduce the risk of these kinds of programming errors. If you use the Model 8840 Envision Programmer with Synchromed or Synchromed EL infusion pumps, the company says you should pay particular attention to selecting the appropriate time field when entering time duration or time intervals. You should also be sure to check your software application card for your Envision Programmer. If you have the older software version, that's AAA02, Medtronic says you should order the newer version, which is AAD02. Go to our website for more information on this recall and for instructions on how to contact the company. Boston Scientific has sent a safety alert to health professionals about the use of Enterix, which is a permanently implanted product that's used to treat patients with GERD symptoms. It's a liquid copolymer that's injected endoscopically into the muscle layer of the lower esophageal sphincter to help prevent acid reflux. The alert describes the death of a patient who had been treated with Enterix three weeks earlier. During the procedure, the needle may have penetrated the patient's esophageal wall. The cause of death is believed to be hemorrhage. Autopsy results indicated a fistula from the aorta to the esophagus and inflammation and evidence of Enterix material in the superficial layer of the aorta. The letter reinforces the importance of closely following the product directions for use and it reiterates the following points on proper injection technique. First, the Enterix solution should only be injected at or just below the squamo-columner junction. The needle should be inserted into the muscle of the esophagus with the needle angled towards the stomach and fluoroscopy should always be used during the injection to help identify a possible transmural injection. The firm will also be updating the product labeling with a warning statement and additional recommendations for close patient follow-up in cases of transmural injection or suspected transmural injection. You can find a copy of Boston Scientific's letter on our website. In a previous program, we reported on the importance of looking out for a potentially fatal condition called trally or transfusion-related acute lung injury in patients who've recently received a transfusion. We now know that in the year 2003, trally was the most frequent cause of transfusion-related deaths and so this is a good time to remind people of how important it is to recognize and treat trally promptly. Trally is caused by an antigen antibody reaction. Well, it is but it's not what you'd expect in a typical allergic reaction. In an allergy, the patient's own antibodies are reacting to a foreign antigen and trally, the antibodies come from the blood donor. In other words, they're in the transfused blood that the patient receives and these are antibodies to human leukocytes and once they're received by the patient through the transfusion, they attach to the patient's white blood cells and form micro-aggregates that end up in the lungs where they can cause life-threatening vascular permeability and pulmonary edema. Some blood donors are more likely to carry these antibodies. That's true when it comes to trally, not all blood donors are created equal. Women who've had multiple births and people who've received previous transfusions are thought to be more likely to have these antibodies. You mentioned how important it is to recognize trally in patients who've recently received a transfusion. What should you be looking for? Well, you'd look for what you'd expect to see if there were an antigen antibody reaction in the lungs. So you'd watch for shortness of breath, hypoxemia, hypotension, fever, and severe bilateral pulmonary edema and those things usually begin within one to two hours after the transfusion and they're fully present within six hours. Depending on the severity of the symptoms, patients may require respiratory support. By the way, diuretics are not effective in treating trally since the underlying pathology involves microvascular injury, not fluid overload. So what should people do? Well, there are three keywords here. It's vigilance, prompt treatment, and reporting. First, be alert that any respiratory distress experienced by a patient during or following a transfusion could potentially be trally. If you observe respiratory distress, discontinue the transfusion immediately and begin oxygen and supportive therapy. Second, notify your transfusion service. They'll arrange for any remaining product to be returned to the blood collecting facility and for the donor to be tested for the antibodies. And finally, report any cases of trally to the FDA. You can find out how to do that by going to our website. Determining the dose of medication to give a child in an emergency can be a challenge. In most cases, the dose is based on the child's weight and this can be very difficult to estimate. Even parents can be far off the mark when they're asked about their child's weight. And even if the estimate is accurate, there's the added chore of looking up the dose for a child of that weight. Some clinicians avoid these difficulties by using a braslow tape, which measures the child from head to toe and uses this measurement to estimate the child's weight and thus the dose. The tape is divided into color-coded segments based on the child's length and each of the colored segments shows the approximate weight for that length child, along with the dose for commonly used emergency drugs for children of that weight. But errors are often made using braslow tapes. In a recent medication safety alert, the Institute for Safe Medication Practices notes that the tapes can be placed alongside the child upside down, which would give the wrong length for the child and thus the wrong dose. ISMP also says that the 1998 edition of the tape can be confusing in several respects and that some of these problems were corrected in the newer 2002 version. They also point out that errors can occur if physicians wrongly assume that the listings of drugs on the tape means that they're to be given in sequence. Here are some of the measures ISMP recommends to prevent errors when using braslow tapes. First of all, replace outdated braslow tapes with the most recent edition that was issued in 2002. To prevent using the tapes upside down, hang them with the red arrow that says measure from this end at the top. Teach the staff to remember red to head when placing the tape alongside the child's body. And if the tape is laminated in plastic, be sure that the plastic doesn't extend beyond the red arrow because that could change the measurement starting point. You'll find the full ISMP safety alert on our website. And if you're interested in providing in-service training on how to properly use braslow tapes, you should know that the Duke University Medical Center has a comprehensive programed instruction course under its program for enhancing pediatric safety. You'll find a link to this program on our website. Which of the following products does FDA regulate? Home pregnancy tests, X-ray machines, implantable defibrillators, contact lenses, catheters, or all of the above? FDA regulates all of them as medical devices. In fact, FDA regulates nearly 2,000 kinds of medical devices. If a medical product is used in your facility and it's not a drug, it's not a vaccine, and it's not a blood product, it's probably a medical device. Recent articles by FDA staff and the USP point out how reformulations of kaopectate, the commonly used OTC anti-diaryl, may be confusing for patients. Many years ago, kaopectate was made with kaolin and pectin. Since then, two changes in the formulation of kaopectate have been necessary because of changes in FDA regulations. About 15 years ago, the product was reformulated to contain adipolgite. And then in 2003, it was modified again to contain business sub-soliculate as the active ingredient. So what's the source of the confusion? Well, first off, supplies of kaopectate that contain adipolgite will remain on store shelves until they're sold. So the patient may be faced with two products of two formulations of kaopectate, one without a polgite and one without. What's the problem? Why is there a concern about this? Well, most of the concern has to do with the fact that the newest formulation, the one that's labeled new and improved, contains a salicylate. And like aspirin, business sub-soliculate products have the potential for many drug-to-drug and drug-to-disease interactions. And in particular, salicylates are not generally recommended for children because of the risk of RISE syndrome, salicylate allergies, and salicylate overdose. So does the label now say, give instructions for using it in children or not? Well, there's more to the confusion. When the product was reformulated in 2003 with business sub-soliculate, the dosing instructions on the label included children. But just this year, FDA said that anti-diarrheals containing business sub-soliculate can only be labeled for use by adults and children 12 years and older. So the most recent version of the Kaopectate label doesn't have the pediatric dosing information at all. So there can now be three versions of this product out there, the old one without a pull guide, then two versions with business sub-soliculate, one of them that has dosing instructions for children under 12, and one of them that doesn't. That's right, and there is a salicylate warning statement that is on the label now, but it could be easily overlooked. So a consumer who doesn't know about the reformulation could unknowingly ingest a salicylate containing product or give it to a child, particularly because some of the new and improved Kaopectate bottles on the shelf may have pediatric dosing information on the label. Well, and other than making patients more aware of the difference between these formulations, what else can be done to kind of minimize the confusion? FDA suggests that pharmacists physically separate the different formulations to help to minimize the confusion for consumers. They also suggest using shelf talkers or some other visual aid to alert consumers about the change in ingredient. Also, advise patients not to remove the peel-up label from the back panel, which contains all the drug facts. Without this label, important information such as drug warnings, dosing directions, and detailed salicylate warnings could be lost. Well, that's all for this edition of FDA Patient Safety News. Remember, you can get more information on all the stories you've seen here today by visiting our website. We also urge you to use the website to report problems you've encountered with medical products. That's how we learn about problems so we can alert others. We'll be back next month with another edition, so watch for us. Until then, for the U.S. Food and Drug Administration, I'm Mark Barnett. I'm Anita Rayner. See you next time.


The first thing I do after a new release of KD Plasma is published is go see the reviews like the people talking about it, the articles, the videos. And what I expect from the videos are all the videos saying what's new, the good parts of what's new and the bad parts of the new version of KD Plasma. However, most of the times, most of the videos, even if they come out like weeks later, are not about like doing reviews with opinions, but rather just a list of the good stuff and a lot of praising, which is nice. I'm always very happy to hear some praising. However, sometimes I also look for some criticism, like how did my new feature that I implemented do with the users? Do they like them? Sorry. Do they like it? Do they don't? And sometimes you don't quite see that. So some other times I actually managed to see some very well-put criticism, because of course there's also the bad-put criticism with insults and stuff. Hello, baby bugger. And that's bad. But sometimes it's like super nice and I love hearing about some well-done criticism. So today I want to talk about some of the stuff that's highlighted in this video by the Linux experiment. I've used KDE for a month and what's the video, well, go see it, but in a nutshell. Hey guys, this is Nick and welcome to my Linux experiment. I've been using Elementorio as for the best part of three years now. And while I gave a fair shake to KDE Plasma in the past, making a full dedicated video series about it, it's been a while since I used it in production. Well, to be fair, Elementorio is pretty good, so I can understand that. And I've been secretly using it on my new desktop, which I'll definitely make a video about for a month now. So I think it's time we take a look at what I liked, what I disliked, and if I'm going to keep using it. Skillshare is an online... Okay, so let's go actually learn about that and where's the button. Let's see what's the first thing he says about KDE Plasma. He's emulating some kind of Elementorio. So head over there and start learning. So to begin with, I used KDE Plasma on Manjaro for the past month. I customized the interface. He customized the interface. And that's what a lot of people do. And that's very fair. Of course, all the work that I put on the full theme is gone wasted. But I'm just kidding because I've used so many cool third party themes that I would probably personally use a third party theme if I wasn't developing for Plasma. Not because Breeze is bad, but because there's such a wide range to choose from that it's like there's a higher chance to find your secret love in the third parties than just Breeze, even though Breeze, I think is a pretty strong contestor. To my liking, emulating some kind of Elementorio. Let me try to guess. It's Lattedock. That was a easy guess. And although Lattedock was at the time of that video, the only application that could do a floating panel, now that I've done the patch, maybe in the next Plasma version, we'll actually get the floating panels by default. And the reason why that's particularly important is that I think it says something along the lines of like. It was layout. If you want to have this kind of customization, Linux Scoop made a dedicated video. See, there are like all of the videos and the articles on how to do this customization, which says, OK, install Lattedock, set things, change the this applet with this other applet. And maybe it's like three hours long and you have to do all of these things to get to your desired look. However, if floating is implemented in the default panels, one can just do a global theme with a layout that's floating and a Plasma theme that allows that floating. So you can just go in the global themes, choose that theme and apply it. And that's it, which I definitely followed to make this. And I left a link to that video on the description below. So take it out if you want something that looks like this. It kind of looks even better what he did. But I didn't want to go to the trouble to do all of these customizations. And see, that's important because it says there were a lot of things and I didn't want to go through all the trouble to do all of them. But if it was a global theme, it was just a matter of clicking it and clicking apply. And that's why we should allow third party themes as much as possible to be just global themes. Of course, you can't do that if it's like Kvantum. Kvantum cannot be a third party theme. But if maybe in the future, we'll be able to have Plasma, sorry, application themes just in the Get Hot New Stuff store. And that you can actually install on the fly. Then maybe we'll be able to do that. And instead of three hours long videos, you can you could just have one global theme. That would be very nice. Now, I think at this point it starts praising Plasma, saying all the good things. But if you watch my channel, you know why Plasma is good. Let's hear why it's bad. However, let me address quickly one thing first. So this video might be lagging. It might be lagging right now because right there there's this encoding overloaded text. Also, it's not a 1080p, but just 720p because my computer is not fast enough to render all of this live, which saves a lot of time in editing.  So if you want to become a patron or send me a tip over people, this is the best time. I'm just saying. I'm just saying. Let's get back to the video. The bad stuff. But well, especially since the elementary US notification system is between your phone and your desktop, love it. Now, of course, not everything is roses and rainbows. And there are some things that I really don't like about KDE. But the default theme in light mode is pretty bland and looks a bit old, especially the buttons. OK, the context of that, of course, is the blue ocean redesign. For quite some time, KDE developers and the VDG has worked on this redesign of the interface, which is blue ocean. Of course, that doesn't mean that all will be fixed. And a good part of blue ocean is actually already shipped on KDE Plasma. And the buttons, as an example, since he mentioned that, were redone. The old ones were actually feeling a bit old. And hopefully, the new ones are better. But maybe he's using the new versions of the buttons already, and he still doesn't like them, which is fair. And at this point, we can't really make, like at this point in time, we can't really make super big changes. Because we need to make sure that Breeze feels like Breeze, maybe in the future that could change. But right now, we can't do a revolution. However, there are some very good third party themes, which is why we have customization in the first place. Maybe you don't like Breeze. And if you don't, by the way, try to understand why and try to write a good comment suggesting changes. Because we can, that way, understand regarding what part of Plasma we should be focusing on. And an example of a good third party theme that I would totally suggest is, lightly, a bit hard to understand. Maybe I'll do a video about that. Sorry, to install. And maybe I'll do a video about that. It changes the appearance of the buttons. And maybe one would prefer that. But for the default ones, we did the redesign in Blue Ocean. I think it landed for the buttons, I mean. But I'm not sure about that. But anyway, it will either get better or it already got better. And it wasn't enough. That could be an explanation. I'm using the dark theme, which kind of resolves the issue. But the default applications theme really needs an update, in my opinion. Of course, that's only an issue if you don't change it. Now, my main issue with KDE is the applications. Those are very inconsistent. They don't. Okay, that's very fair. I'm the leader of the consistency goal. And that's why I've done the consistency goal. So the biggest issue there is KDE is not a company. And because it is not a company, we cannot just go around and say, hey, maintainer of application X, do this or you'll get fired. The maintainer is probably like 100% volunteer and they've done the application. So they have the right to say, no, this is fine. I like it like this. And of course, what the VDG has to do is not like go around saying, no, you're wrong. You're destroying KDE plus and that's not a good approach. But rather, we can try to do a reusable component that's pretty and try to convince other maintainers to use it. And I think we're doing a pretty good job lately. As an example, the new hamburger menu component was done and it's a very cool component. Like you add stuff to the hamburger menu and it disappears from toolbar. You remove it and then it appears on the toolbar. It's like adaptive, pretty cool I think. And of course, we try to add this component throughout KDE applications. And some accepted it as is. And some like, I think, Ocular said, okay, not by default, we can have it, but not by default. Some people say that it's a bad component. We're doing our best to design the components. And if you're against hamburger menus, many developers, like many designers actually like it inside of the VDG. So that's what you get. But we're trying our best to make sure that it's at least consistent. We can do like 100% of it. So as an example, Inocular is off by default, but it's there and that's the best I think we could currently do. And look or feel the same at all. On the one hand, you have apps that have really simple defaults and a lot of power under the hood if you need it. Well, that's Dolphin and Dolphin is so simple. I think my personal opinion, because of the hamburger menu, if you add a local menu or a crowded toolbar, he wouldn't be saying the same, I think. So I'm biased, but I think the hamburger menu does at least a good job even in the usability concerns of making the application simpler. Like Dolphin. On the other hand, you have applications that really want you to see every single feature, panel and option available right out of the box, like the calendar. Yeah, KOrganizer, if I had never used it, it would be like the first day and if I was an average user, I would panic. Too many stuff thrown at my face and I think that's the reason people like use Google Calendar or Google Mail that are super simple and widely used. And especially because people use so much, most of the people I think use Google Mail, there's not much interest in like developing KOrganizer and Camille. I do know people that work on them and that's very nice, but because the code base is so big, it would require so many people working on it and sometimes there's just not enough interest. Now Dolphin is a great example of how you can get an app super simple and still have a lot of power under the hood. By default, there is no menu bar, very few toolbar icons and a simple layout. But if you live... See, he said it. By default, there is no menu bar, not too many toolbars because there's hamburger menu. He said that. In your file manager, you can show a folder list, an info panel and even a terminal. That's what I'd like... Yep, that's actually my Dolphin setup but with the terminal on the right. All KD apps to be. A simple layout without too many panels, but for users who really need something more powerful, just keep the options to show more panels, more toolbars, the menu bar, everything, but other bugs, please make simple layout. That's a few requests and I think that we're moving towards that direction. I'll make an example, take the new system monitor. The new system monitor is pretty simple by default. You look at it and it doesn't like scream options at you but it's actually extremely customizable. You can add all sorts of stuff and you can customize the pages, customize the layout. It's amazing how many things you can do with it even though it never makes you anxiety because of all the options. So that's a good application doing it and it's KuriGami. And I think that KuriGami does a good job of providing some basic consistency between applications and also making sure that they are not overcrowded by default but also leaves some space for them to be customizable. So I think that's the direction we're going to or slowly writing new applications in KuriGami as an example, K calendar instead of K organizer which is not to say that K organizer will disappear tomorrow but maybe over the course of years calendar will slowly get all of the features that they need. In theory, K organizer is actually like a suite of the application but I'm simply fine. Maybe in the future calendar will reach the point where it has all of the features and the layout is simpler to use so it will have more users. So we're moving towards KuriGami because I think it does a better job at doing this so we're trying to address this concern. It's really, really a better experience for somebody who gets used to your app to add features instead of trying to remove them because you don't use them. That's a nice way to put it. I think that's a very nice way to put it. Simple by default but powerful when needed because if it was like powerful by default but simple when needed it would be a mess. And it said it very nicely. Now there also seems to be a less sizable community of application developers for KDE than for GNOME or at least GDK applications. A lot of apps look pretty old like K organizer or K mail. They don't look updated visually to look like something like that. Again, he mentioned K organizer and K mail. I talk about that already and luckily there's not enough interest to have so many developers working on that. That's a bit sad but that's how it goes. It's a very good application I think once you really use it but as it is now it's very hard to get into it. Dolphin or Discover? I also couldn't find it. It's much easier I think at this point in time to do that applications from scratch like calendar rather than trying to adapt this old application. It's not old but the previous application to a completely new concept. To the least application along the lines of getting things GNOME or PLANNER? And I couldn't find an equivalent. Calendar, calendar, calendar does that. equivalent of Audacity for the KDE desktop? There's none, let's be honest, there's none. Now generally all the smaller utility... Which is not a bad thing. Like Audacity works very nicely on the KDE desktop. We are not trying to do things that we don't know how to do. I think if there's nobody that understand these kind of things and would want to make this application it makes no sense for us to try to provide it. Cities like a very simple one-purpose image resizer or file format converter don't seem to exist on KDE. You have big monolithic applications with ton of options but if you want a simple one-purpose two-clicks application then you're out of luck. And that's fair, you're indeed out of luck because the concept in KDE, the philosophy is really you have one monolithic, sorry, hard word monolithic application that has everything. Maybe it's a bit hidden, not very hidden but you need to know what you're looking for. Again, simple by default and powerful when needed and sometimes maybe it would be better to have simple application for very simple things but on the other hand I gotta say that there is something very nice of having like one view which does a lot of things and does them well in a very nicely organized UI. You open it up, you have a left sidebar with all of the operations. You can resize it, you can rotate it. You can also save as a different format. So I understand this concern but I don't think that KDE's philosophy is really allied with what he's saying. I think that here at KDE we do prefer like application that do more stuff rather than many applications that do less if I understood what he meant. Now, of course you can always install non-KDE apps on KDE and that's what I did with the GIMP planner audacity. I also installed the GNOME disks app because for some reason the KDE partition manager just wouldn't want to let me restore an disk image into an SD card which GNOME disks did in two clicks. Now that's where KDE grabs the advantage again. It integrates GDK apps a lot better than GNOME integrates Qt apps. Yeah, the GDK integration I think it's so nice. Like I think it's like just one person right now working on it in the past years and they've done a pretty good job I think. And however, there's an however. I think I haven't looked much into it but because of some politics stuff, let's call it political even though I don't like the word and maybe the new GDK 4 being not very open to theming, to third party themes and there was some talk about dropping it which would make me sad but on the other hand it's a bit difficult from what I've gathered to maintain and GNOME isn't doing the same for Qt applications. So even though me personally, I would absolutely, absolutely want to keep it if the maintainer says, okay, no, I'm actually dropping this thing entirely. I would understand them but I would be sad inside but I would understand. The fact that you can choose anything you want for GDK applications under KDE is great because it means that these things will look a lot better integrated and not feel so alien.  I didn't say that. I said that it was once mentioned in one discussion that means nothing, let's be clear. It's just that I was recalling that particular discussion. Using KDE apps on GNOME or Elementor iOS is a weird experience. Those applications do not look integrated and they do not look native. But using GNOME apps on KDE is a more simpler experience and it honestly looks good to the. Yeah, it's a bit sad, I think. Points that I was wondering if I could just run a Plasma desktop with GNOME apps behind instead of the KDE ones. You could, you could also, and this is pretty cool, I think, use Lattidoc to have your Plasma panel with all of the Plasma plus, like kick off the application launcher in GNOME. So you have GNOME with the GNOME or KDE apps, whatever you prefer, and the Plasma panel. Like, that's crazy. But you can do that if you want. I'll just put that there. Now, I praised the other launch of settings before and I'm not going to apologize for it, but it's also a bit of a hassle sometimes to find a specific thing you're looking for. Yes, we've been working on this for, I think, years. Like, when I joined KDE, KDE had just redesigned the system settings and it's very hard to convey all of the options to the user. I do think that we should remove some options, not all of them, but some. And we are not doing that right now, but we are trying to reorganize, and with we, I don't mean me, I mean other people in KDE, trying to reorganize better some of the layout, sorry, the theme, the categories, I can do this. The categories in system settings and there's like usability testing going on. I think they're preparing a usability testing test and that's pretty good. So slowly we are getting better and better at this. Hopefully we'll get to one point where we're like happy about the result and we will stop tweaking all of the categories. The system settings have a handy search feature, but it looks for the cat. Sometimes I just wish we would get rid of all categories in the sidebar and just put a bigger search bar. That would be easier. Category names and not the settings inside. If, for example, I want to know where I can enable the fact that I can move my window to an edge of the screen to move it to another virtual desktop, I was trying to type sliding, I was trying to type moving or virtual desktop. It only showed me categories that were named using one of these words. About this, this is actually a great way to start contributing to GD Plasma because every system setting category is called KCM and I think, I'm not an expert, but I think each KCM has somewhere, just ask me and I'll find out if you want, but has somewhere a list of strings that are associated with that KCM. So if you think that a search result should pop up a certain KCM, but it doesn't, you can just add it to the list of strings as far as I know it. And that's actually really easy to do and you can either open up a bug request and send me the link just for sure and I'll try to work on that, but you can also try to start helping KD Plasma become better just by doing this, adding the right strings in the right places. Hopefully they're localized as well somehow. I don't know how this works. Well, that had subcategories that matched this request. The setting I was looking for is in screen edges, but it could just as easily have been in window behavior or virtual desktops. Now, these settings are awesome, but finding them, if you don't know where they are, can be a bit of a hassle. And that's about it for what I didn't like. Now, if I needed to conclude, I'd say I really enjoyed using KDE. Thank you. And I think you went on saying other good stuffs about KD Plasma. So that's where the good criticism to talk about here ends. And that's where my video also ends. I already put the ending scene with all the patterns. By the way, a new one, thank you. And again, I begged for money already. So let's ignore that. And the only thing I have to say is... That's it for this video, guys. If you enjoyed, don't hesitate to like or dislike if you didn't. You can also subscribe and turn on notifications. One last thing I want to say is, I just showed the parts where he like criticizes KD Plasma, although there's some good inside of them too. But he also spends a lot of time praising it. So I don't think that if you haven't seen the video, it's just something... Someone, sorry, that's hating on Plasma, he's not. And go watch all of it if you want to see all of his opinions. Right now, I was more interested in the criticism because that's actually what I'm looking forward most of the time. Also, the good parts, of course, and it makes me really happy to hear like, Plasma is great, I am going to use it. But sometimes I also wish to hear about, yes, Plasma is great, but I think you could improve in that era or that area. That's it, bye. I'm becoming a super cool YouTuber, I'm in tie, I'm in tie.


Hello everyone and welcome to our talk FastTrack Amber with FastBoot and Embroider. I am Suchita. Hey there, I'm Thomas. So first let us do a little bit introduction for ourselves. My name is Thomas. I work at LinkedIn web framework team and during my work I interact a lot with Amber and I also enjoy contributing to the Amber community. Outside of my coding life, I enjoy making special drinks at home and I'm also practicing latte arts. I also love playing games. My all-time favorite is the game Transistor and I'm currently playing Final Fantasy 7 Remake and has been loving it. And next I'll hand it over to Suchita. Oh, thank you so much Thomas. I'm definitely going to ping you after this for the latte art. And hi everyone, I'm Suchita. I'm a senior engineer at LinkedIn and I'm also working with the web infrastructure team like Thomas and outside of work I'm a core member of the FastBoot working group and in my free time, I love playing cricket. It's a game very similar to baseball and super popular in India. And I'm a huge keyboard, mechanical keyboard fanatic and here is my latest creation where I switched my Gator and Brown Switch to Holy Pandas and updated with new keycaps and also during the pandemic since we all were working from home I uncovered a newly found passion which is gardening. Let me share a few creations of mine that I did last fall. I sliced up the tomato and planted it and on day 67, I started seeing the first blooms of tomatoes showing up and rest is history. We had so many tomatoes that we had tomatoes in almost all of our recipes and I also grew some Thai chilies in the last fall. So this is about us, what we do and what we did in our free time. So now let's get back to our main topic which is fast-tracking amber with FastBoot and Embroider. So last year I presented the journey of amber from 1.x to Octane where we saw the paradigm shift that Octane introduced in the amber community. This year, we will take you through a story of a team that migrated to Octane and are now looking to further improve their app with various aspects. We will first get to know the team and their requirements. We will then move on to understand how FastBoot powers the server-side rendering experience for the users. And then we will talk about how we can optimize at the build time with Embroider to further improve the user experience and also develop her experience. And last, we will talk a little bit on what is on the roadmap for FastBoot and Amber. Alright, Sushita, should we get started? For sure. So now let's begin the story. So Zoe is an amber developer who is super enthusiastic about amber and is leading the web team of an awesome team at an awesome company that uses AmberJS as its framework. The current status of this team is that they recently migrated to amber Octane and are super happy with it. However, soon after, they got a few new requirements which is very normal in our industry, right? Once we finish one feature requirement, we get a new one. So that's what happened with these people and let's see what were the requirements. So first requirement was to deliver faster content to the page. The next requirement is to improve the user engagement, especially for the countries with slower networks. The last requirement is to improve the SEO or the search indexing factor for a specific route. So looking at these requirements, the first thing that comes into our mind is server-side rendering. So what is server-side rendering? To give you a brief overview, let's take a step back and see how client-side rendering works. So when a client makes a request or when a browser makes a request for a page to the server, the server returns the HTML shell along with the JavaScript and CSS tags. Like you can see here, the body of the HTML returned by the server is empty. And once the JavaScript executes on the client-side, it renders the HTML on the client. On the other side, with SSR, when a user makes a request for a page to the server, the server takes in the request, runs the app in the server, builds the HTML, and returns the HTML to the client as a by-product. Hence, instead of an empty HTML shell or empty body shell, you will see a page source filled fully with a statically rendered HTML. In Amber, this is possible with a library known as Fastboot. So Fastboot has been there for a while and most of us know that it provides an SSR solution for Amber apps. But today, let me showcase what makes Fastboot so special and fast. So you can imagine the Amber application container as a stateless container that does not contain any specific data, user-specific information. Instead, it only contains the parsed classes, components, routes, registry information, etc. of your app. So when a user request comes in, it is associated with an application instance. So what is an application instance? You can think of an application instance as a stateful container as opposed to the stateless one that contains information like user data, services, models, etc. which is very specific to the user request or this request that came in. In the meanwhile, if there are other requests coming in, then instead of blocking the entire thread for serving the initial request, we put this app instance in the background using the async.io and spin up new app instances using the same app container that you see in the background. This is huge since we are cutting down the cost of revaluating the whole app for every request. Instead, we are just reusing the same application container and that is how we can serve multiple requests at the same time for different app instances concurrently. And once a request has finished serving, we destroy the app instance and the state itself. But one thing to note here is because these app instances are running inside of a sandbox, we prevent the state leakage between the app instances which is great. But with that being said, one thing to be mindful about is since the application instances leverage the same container, we should avoid putting anything on the global scope or on the class scope because it might end up leaking in between the instances otherwise. So that's one thing that we should be careful about. So now that we understand the mental model of how fast boot works and what are its benefits and how fast it is, let us see how we can measure the success of leveraging fast boot in our app. So Google recently announced a few core web vital metrics that provide the guidance around determining the quality of user experience on the web where LCP which is the largest contentful paint is used for measuring the loading performance, FID which is the first input display is used for measuring interactivity and CLS which is cumulative layout shift which is used for measuring visual stability. So for the purposes of this talk, we will be focusing on the LCP metric since that's where fast boot really helps. So what is exactly LCP measuring? It basically measures how much time it takes before the user sees the most important content on the screen or you can say the hero element of the screen. Anything that is not in the viewport will not be a part of the calculation. So if you see the scale carefully on the left that measures this metric anything above four seconds is considered to be poor. Now just imagine if a user has to like stare at a blank screen or a loading screen for more than four seconds, it's certainly not ideal and not a good user experience and it might potentially lead to the user abandoning the page. But if we could improve the time it takes to paint the content then we can certainly improve the user experience and give them faster feedback and of course better experience. So now let's see the role that fast boot plays in improving the LCP metric and connect these two aspects together with a side by side comparison of a world before fast boot that you can see on the left and after fast boot that you can see on the right. And here for demonstration purposes, both of these apps are simulated on a slower network just to show you the impact. So let's see what happens when the user hits the same route at the same time before and after fast boot. So here you can see on the right that clearly that the fast boot enabled app is already showing up the content whereas we are still waiting for the non fast boot app to show up. Now it is showing up. So the LCP measurement for the after fast boot use case was 2.9 seconds whereas in opposition the non fast boot, I mean the non fast boot at case is 9.5 seconds. This clearly shows the value that fast boot brings to the table. This would not only give users a better experience but will also help retain the number of users who left the page due to seeing a blank screen. So now let us understand why did we see such a shift of amount of time taken before and after fast boot to load the initial paint. To do that, let's see the timeline of the before fast boot world first. Before fast boot, it first waits for the HTML and CSS required for the page to load. It then loads the JavaScript required for the page and then it makes any required API requests. Here the articles call like you can see in the example to make the first page load and that's where you see the LCP or the first content showing up on the screen. However, with fast boot, the timeline is a little bit different. Here we can see that as soon as the HTML and CSS is loaded and the browser has finished the parsing, that's where immediately you'll see the content showing up on the screen or the LCP is marked. This is happening while the JavaScript files are still getting loaded. This means that we are not blocking on the render until the JavaScript loads but rather we are showing the content or flushing out the content as soon as it is available. Since we now know how fast boot is so beneficial, I would specifically highlight one to highlight one aspect of fast boot which helped with this demonstration very much. To do that, first let's see the before fast boot use case. Here if you see carefully, we are making two XHR calls namely articles and tags where the articles call is required to display the list that you can see on the left and the tags call is required to show some data at the bottom of the screen. This is normal, right? You make API calls and then render its response on the screen. This is a normal scenario. However, after fast boot, I'll show you something different. Here you can see, surprisingly, we are not making the articles call but you're still seeing the data on the screen. Just so you guys know, for the purposes of this demo, we have deliberately added this tags call as lazy loaded just to show that fast boot gives the developers a choice whether they want an API call to be made on the server side or they want to lazy load the network call just on the client side. So, okay, coming back to our example, like we can still see the articles list showing up without making the XHR call, what is making this happen or what's enabling this? That's where the concept of shoebox comes into the picture. So, let me walk you through how shoebox works and then I'll show you an illustration of how it looks like. So, when a user makes an HTTP request, fast boot receives the request, it runs the amber app on its side and then it begins the process of serving the request. In the meanwhile, if the app has any API calls needed to be made for serving the initial page, which is articles in our example, then fast boot will make that call to the data center and the data center will respond it back with the data and here is where the real magic happens. Now fast boot will also store this API response in something called as shoebox. So, now on the client side, when the app again loads and the time has come to make the API call for articles again, instead of making the XHR call, the client will query the shoebox instead and say, hey shoebox, do you have the matching response to this particular API request and if the shoebox has a matching request, then it's just going to return there and there itself. So, you can see the clear advantage here that instead of making an extra network call, we are eliminating that, not only that, we are also responding with the data as soon as possible like almost immediately, so the render time also improves. So, now let's see where do we store this information and how does the client get this information from? We basically embed the API response inside of the index.htm itself so that the client can later query. And this is stored inside of a script tag named shoebox, which you can find here on the screen. So, this was a little bit about what shoebox is and how it works in the nutshell and all of this is great, right? We saw all of the awesomeness that fast boot has to offer but now we come to the main question, how hard is it to adopt fast boot? Or how hard is it to adopt all of the concepts that I just showed you before? Do we need to make a lot of changes in that? Well, good for you, it's super simple. All you need to do is run this simple command Amber install Amber CLI fast boot and boom, your app is fast boot enabled. We also have an opt-in feature for smoother rehydration on the client side. So, what I mean is currently when you run this command, when server side responds with the HTML, Glimmer VM will re-render the whole DOM tree on the client side again. However, if you enable this experimental rehydration feature, which is experimental render mode serializes true, then Glimmer will only update the parts of the HTML that requires any correction that needs on the client side, which means things will be faster if you start using this experimental feature. Now to leverage shoebox, you can add a package called amber data storefront and extended in your applications adapter layer, which will do all the wiring required for your app to be shoebox ready. So, this is everything is awesome. And now let's see if the use cases or the requirements that the team had if we were able to match that and address those. So, let's do a quick recap. So, the first requirement was that they needed fasted content to the end user and by improving the LCP factor, we were able to achieve that. So, that's great. Next, by displaying the content sooner on the page, it showed better engagement from the users due to early rendering, which addresses the next requirement. And finally, since SEO is supported by fastboot inherently, the search indexing requirement was fulfilled as well. So, now everyone is happy. A few moments later... Surprise! The new requirements coming in after a few moments. So, this time, the good news is the company and the product is doing great and now we are going to build more features and more pages. But the problem for the team is since we will be building more pages and writing more code, that means we will have more code going into the JavaScript bundle, we will ultimately be delivered to every user's browser. So, the time to a fully booted up client-side Ember app will increase. So, the team is thinking about can we ship only the JavaScript needed for the initial page that the user is requesting? Therefore, when we are working on some new pages, we will negatively impact the performance of our homepage. And there is an answer from the Ember community that is to optimize the build of the Ember app. So, let's introduce in Boiler a modern build system for Ember JS applications. So, there are a lot of optimizations in Boiler provided to your Ember app. Let's talk about some of the features. The first thing I want to highlight is code splitting. So, traditionally Ember CLI build pipeline what it does is it will look at all the Ember code in your application and all your dependencies and Ember CLI will transpile those code and ultimately build into two separate JavaScript files. One is for your own applications and the other one is for all your dependencies combined together. What in Boiler does is it starts to take advantage of the non-adopted ES module syntax by the Ember community which is the important export syntax you have in your components and helpers all the files. What it does is it starts a static analysis for all those modules and figure out what are the exact code that you needed for a specific route. For example, for our homepage we have the application route, the index route and the services and the templates for it and for an article route which the user won't necessarily go into for the initial visit we can put it in a separate chunk and all the components that's only used by the article route will go together into that chunk. So this time when the user is visiting the initial homepage we won't be delivering all the code for the article route to the end user and you can also choose to include any route together with the initial bundle if that route is important and the user might go to it immediately. So the benefit of doing the route-based code spreading is we can deliver a smaller initial JavaScript asset to the end user and when we are working on another route we won't be concerned about impacting the performance for the homepage. The other thing I want to call out is trace-shaking so imagine you are using an Ember add-on which provides a lot of useful helpers or components for your Ember app but the problem is not everyone is going to use every functionality provided by the Ember add-on if you are only using two of the helpers provided the add-on traditionally the Ember cell-line will bundle all the helpers into a single JavaScript asset which you won't necessarily need it. What Inboarder does is it will analyze the import what exactly are the measures, the helpers or the components you are using and only package those into the final chunk and only deliver those to your end user. So this is great so now you may be wondering how would I use Inboarder so let's see how you can enable Inboarder to your Ember app the first thing you need to do is of course install the packages from Yon or NPN and then you can start leveraging Inboarder in your Ember cell-line build.js which is everything the build happens for your Ember app what Inboarder does is it starts a multi-stage build and the first two stages is to make sure all your Ember add-ons are compatible with a new build pipeline and it compiles out all the Ember specific code then you can really start leveraging all the benefits from a wider JavaScript community in this case we are using the webpack bundler to bundle all our JavaScript asset files you can use the options provided by Inboarder to progressively opt-in to all the optimizations Inboarder provide you you can turn on the static add-on and help your component options to tell Inboarder that you are not using the dynamic component syntax so Inboarder can safely perform the static analysis and build out all the chunks for your files and then you can start enjoying the route-based code splitting by using the Inboarder router what it does is it will read what are the routes you wanted to split away and then when the Ember router is running when it enters a new route it will fetch those routes from the server you can choose which route to split or which route to not split so you will have the full control and the benefit of enabling Inboarder also provides you the ability to use dynamic import so comparing to the static import which is all the import statements you write at the very top of the JavaScript file you can use import that returns a promise everywhere in your component or any other JavaScript code once the promise results you get access to the module you want to use so you may, during the runtime you have the full control of the exact timing you want to import that module fetch the module, the JavaScript file from your server and start using it later and now you might ask can I use it today for my Ember app anything so the question is yes you can start using it and we have been using it at LinkedIn for a while and we can share some of the benefits we are seeing when enabling Inboarder on a large LinkedIn application and we are really seeing Inboarder start to bring faster speed to our end user when Inboarder is enabled we are seeing a 35% reduction on the initial JavaScript size reduction and when the JavaScript is delivered to the end user's browser the final pasta size of all the code combined is almost half of the original size the reduced JavaScript bundle size translates to a faster page load time so what we are seeing is from the beginning to a fully booted up coincide Ember app there is a 6% reduction for the page load time which is roughly 200 milliseconds on a simulated slower network and most of the benefits are as expected from coming from a faster download and parsing time that's where the Inboarders, Cosplating and all the static analysis bring us all the metrics we are seeing are collected by Tracerbench which is a control performance benchmarking tool we use a lot at LinkedIn we use it to ensure we don't have any performance regression on the hood it runs the initial page visit multiple times and give us a statistically confident result in this case Tracerbench tell us it has more than 95% confidence that Inboarder is indeed making the app much faster and the benefit for the developers is also obvious for us after enabling Inboarder we are seeing the code build has dropped 58% of the original 100 seconds and the most impressive is the live reload has dropped from 3.5 seconds to less than 1 second so our development speed is also skyrocketing to recap after enabling Inboarder we are shipping less code to the end user which translates to a faster page load time and as a bonus our developer experience is also improving because of the faster build speed this is awesome I think I can see the team already celebrating they seem to be super happy with the fast boot and embroiderer adoption so Thomas let's talk about a little bit more of what's next in the world of fast boot sure there are a lot of things we can do to make fast boot and Inboarder experience much better so few things in my mind we have a fast boot app server which is a production ready out of box server side deployment option for people using fast boot and we want to add worker stress to it so we can further improve the server side throughput and we also want to support streaming back the initial HTML so people don't wait all the HTML get generated on the server side and start shipping it back to the browser which will bring us a better faster boot app we also want to make the faster and Inboarder combined experience a bit better right now if you load not the homepage but another page from the browser what Inboarder do is it will fetch the JavaScript file for a separate chunk after the Inboard app boots up what we want to do is we want to do this part in the fast boot world as well if you load the HTML it can in parallel fetch all the necessary JavaScript for the Inboard app to boot up awesome and just to give you guys more information we are also planning to stabilize the rehydration feature and enable it by default for all the users and also have a better testing infrastructure just to make it easier for the apps to test against fast boot and of course we want to continue the effort of improving the developer experience for example adding more instrumentation in place enhanced documentation etc cool and here are some more resources for folks to check out you can learn more about fast booting at its homepage and Inboarder at its GitHub repo there are a lot of instructions and more details about it and all the code we used for the demo app we showcased today you can access on GitHub to see it yourself and we really hope fast boot and Inboarder these modern toolings can provide better Ember developer experience and real value for our end user and we really hope you are excited as we are for the future of Ember oh wait but that's not all we have one more thing as a bonus we are hosting a virtual fast boot meetup where we will do a deep dive on fast boot and its various concepts and aspects please feel free to sign up for the meetup on emberfastboot.com and we can't wait to see you all there thank you very much everyone


Hello everyone, I am Dr. Naveen Kumar, working as Professor of Radio Diagnosis in Chalman Anandran Institute of Medical Sciences, and I am Chief Radiologist and Director of Mahalakshmi and Moran Diagnostics, Private Limited, located at Karygana, Telangana, India. I am very passionate about teaching, so I have started my own YouTube channel, that is RadVisionSNK, which is exclusive radiology channel, please do subscribe and share. And I have expertise in Neuro radiology for the past 10 years, as I have reported more than 150 MRIs. Please do support my upcoming Neuro radiology series in Indian Radiologist YouTube channel. Thank you all. Good evening all. I will be discussing intra-canalysis, both typical and atypical cases. So, coming to history 32 year mail with history of chronic headache, you can see there is a cystic lesion in the left temporal lobe, which is hyper intense on T1, hyper intense on T2, completely suppressed on flare, there is no restricted diffusion on DWA. So, this is a classical case of arachnoid cyst. So, remember arachnoid cyst, they will not show restricted diffusion on DWA. And remember, galactic classification, this falls under type 2 type of galactic classification.  And there will be no restricted diffusion on DWA in arachnoid cyst, whereas there is restricted diffusion on DWA in the epidermal cyst. So, this is other case 44 year mail with history of headache referred to MRI due to mild asymmetry of ventricular CT. You can see there is a intra-ventricular cystic lesion, which is hyper intense on T1, hyper intense on T2, there is no restricted diffusion on DWA, and no blooming on GRE. So, this is a case of intra-ventricular arachnoid cyst. Close differential can be ependymal cyst. Coming to the other case, 16 year mail with history of headache, diplopia, vomiting and unstable gait. You can see there is hydrocephalus, no restricted diffusion on DWA, hyper intense on T1. But here you can see a thin membrane, which is there, separating the rest of the ventricles from the cystic lesion. And on flare also, you can see the thin membrane clearly depicted, separating the cystic lesion from the rest of the ventricles. So, this is also a case of intra-ventricular arachnoid cyst, causing obstructive hydrocephalus. There is no blooming on GRE, v-patient is in situ. So, remember T2 weighted image and flare images are very crucial in differentiating the membrane of the membrane, which helps in differentiating normal hydrocephalus from intra-ventricular arachnoid cyst associated with hydrocephalus. So, this is an intra-ventricular arachnoid cyst associated with hydrocephalus. Next case, 17 year mail with history of chronic headache came with sudden onset of seizures vomiting following trauma. This is also case of arachnoid cyst. But what is the atypical feature in this arachnoid cyst is, there is no restricted diffusion on DWA. This is the cystic lesion in the left temporal lobe. But here you can see there is an extra-axial CSF signal antestatic collection noted against the left frontal temporal lobe convexities, which is not showing any restricted diffusion on DWA, not showing any blooming on GRE. But this extra-axial CSFs containing cystic collection is seen communicating with that of the cystic lesion in the left temporal lobe. So, here the wall of the arachnoid cyst is not well defined. There is breach in the wall of the arachnoid cyst with expulsion or ores of the contents of the arachnoid cyst into the subdural arachnoid space, subdural space. So, this is a case of arachnoid cyst with rupture with subdural hygroma. So, this is not an M-Pyema because there is no restricted diffusion on DWA, not an infected collection or M-Pyema because there is no restricted diffusion on DWA. And this is not hemorrhage because there is no blooming on GRE. So, this is a case of arachnoid cyst with rupture and concurrent subdural hygroma. Next case, 42 year male with history of headaches, scissors and ataxia. You can see there is a cystic lesion in the right CP angle, which is hyperintense on T1, hyperintense on T2, nearly suppressed on flare with few areas which are not suppressed in the periphery, restricted diffusion on DWA and no significant enhancement in the on-IV contrast. So, this is a case of epidermoid cyst.  So, this is a case of CP angle epidermoid cyst and it is a classical black epidermoid cyst which is hyperintense on T1, hyperintense on T2 and restricted diffusion on DWA. So, what is a typical white epidermoid? We will see in the subsequent case. This is 44 year female with history of chronic headaches, scissors and sudden onset of vomiting.   You can see heterogeneous hyperintense on T1, no restricted diffusion on DWA, even hyperintense on T2 and not completely suppressed on flare and showing blooming on GRE. So, this is a case of atypical or white epidermoid. So, this is fat containing lesion but there is on T1 these atypical or white epidermoid are hyperintense due to high triglyceride content, high lipid content and even high protein content. So, remember this is a case of white epidermoid. Next, 62 year female with history of chronic headaches and scissors. You can see there is a fat containing lesion with eccentric calcification in the left temporal lobe and even along the left cillian fissure. There is adjacent leiosis. The lesion is predominantly hyperintense on T1, suppressed on flare and showing heterogeneous hyperintense on T2 and showing blooming on GRE or SWA images there is blooming on GRE because fat can show blooming on SWA images and even on GRE. So, this is a case of fat containing lesion with eccentric calcification showing blooming on GRE. So, this is a classical case of intracranial dermoid cyst. So, the previous case there is no calcification and here there is a calcification. So, this calcification or any other tooth like structure or hair or other contents can differentiate dermoid cyst from epidermoid. So, remember this is the chart which helps in differentiation black epidermoid, white epidermoid and dermoid cyst. So, I have seen I have shown you three cases which will this is the case of classical black epidermoid this is the case of classical white epidermoid and this is the case of intracranial dermoid cyst. Next, 44 year male with history of chronic headache and sudden onset of scissors and vomiting. You can see here also there is a fat containing cystic lesion noted in the right temporal lobe with eccentric calcification and even tooth like structure noted within the wall of the lesion and here you can see there is a fat droplet noted in the sulci in the superior sections. So, these are the fat droplets noted in the sulci. So, this is a case of intracranial dermoid cyst with rupture leading to fat disseminating into the CSS spaces. So, this may these cases can present as chemical meningitis and thanks to Dr. Manish Jaishwalsar for contributing this case. So, this is intracranial dermoid cyst with rupture leading to dissemination of the fat into the CSS spaces. So, 35 year female with history of chronic headache and multiple cranial palaces you can see there is a cystic lesion in the cisternal spaces that is pre-ponten and pre-medular resistance which is not completely suppressed on flare and showing restricted diffusion on dW. So, this is a case of cisternal epidermoid cyst. So, sometimes the epidermoid cyst is seen in the cisternal spaces and even this is the cyst sequence where you can see this cystic lesion is causing displacement of the third cranial now bilateral cranial now is more on left side and even encasing the left fifth now this is the right fifth now and this is the left fifth now and also this is closely affecting the bilateral seventh now. So, that is why the patient presented with multiple cranial palaces. So, remember cisternal epidermoid cyst can cause multiple cranial now palaces. So, this is a classical case of cisternal epidermoid cyst. Next case this is also a typical epidermoid cyst case 50 to your mail with history of headache seizures and vomiting you can see there is a lesion cystic lesion which is hyper intense on T1 hyper intense on flare showing restricted diffusion on dWA no blooming on GRE showing patchy heterogeneous enhancement. So, this is a case of intraventricular epidermoid cyst with probable rupture because there is hyper intense contents also noted settling down in the ventricle and even associated vasculitis and infarcts. So, this is a case of intraventricular epidermoid cyst with rupture with secondary vasculitis and infarcts. So, sometimes also remember these epidermoid cyst can occur in the intraventricular location and they can also rupture leading to vasculitis and infarcts. So, this is a case of intraventricular epidermoid cyst with rupture leading to vasculitis and infarcts. Next this is a 12 year mail with history of chronic seizures preterm delivery of rare stones. You can see there are multiple cystic areas of gliosis noted scattered in bilateral paratoxpital lobes, there is mild volume loss, there is paucity of white matter and mild asymmetrical dilatation of atrial and occipital hearts of bilateral lateral ventricles and which is not showing restricted diffusion on dWA. So, this is a classical case of HE that is periventricular leukomalacia or cystic periventricular leukomalacia or HE is equivalent. And sometimes in the chronic stages of developing in HE which are nothing but called eulogyria. Next case, 8 year female history of lethargy caesars, delayed milestones, previous history of preterm delivery and delayed cry. You can see multiple cystic foci or cystic regions scattered in cerebral parenchyma which are hyper intense on T1, hyper intense on T2 there is associated mild carpus collageal agencies also and there are abnormal gravity matter differentiation. So, this is a case of classical multi cystic encephalomalacia. So, this cystic periventricular leukomalacia is one entity of HE and this is multi cystic encephalomalacia where you can see large cysts scattered in the cerebral parenchyma associated with abnormal gravity matter differentiation and they can be associated with other carpus collageal agencies. Next 7 year old baby was referred to MRI in view of finding an inter hemispheric cystic lesion in the brain during routine obstetrics scan. The baby cried immediately after birth. So, here you can see there is a cystic lesion between theеди lateral ventricles which is triangular in shape the TPP is pointing towards the foremen of Mbro, and the B is pointing towards the carpus collageal and this lesion is also causing elevation and posterior displacement of the carpus collageal And inferior displacement are inter circulable veins. So, whenever you see a cystic lesion be displaced between the bilateral lateral ventricles with TPP pointing towards the foremen of Mbro and the base pointing towards the carpus collageal connet with internal cerebral veins inferiorly, definitely think of KVM interpositum cyst, KVM vealum interpositum cyst. So, this is a classical case of KVM vealum interpositum cyst. Next 15 year mail with chronic history of caesars cognitive impairment and developmental delay. You can see there is a defect in the pharx. There is a cystic lesion noted along the pharx in the parafalsine location. There are classical tear drop configuration, suggestive of carpus callous allergences. There is wide widening or diverging frontal horns. And here you can see there are interdigitating are an abnormal gravid matter. So, and carpus callous is not clearly visualized in the sagittal sections. So, this is case of a carpus callous allergences with large inter hemispheric cyst. Next two year female with history of delayed milestones, hemiplegia, caesars and intermittent infantile spasms. You can see there is a CSR signal density lesion in the right temporal lobes. And this CSR signal density lesion is communicating with that of the lateral ventricle. So, this is a classical case of poransophilic cyst. And seven year mail with history of delayed milestones and chronic caesars. You can see there is a CSR density cystic lesion communicating directly with that of the lateral ventricle on right side. And there is a CSR abnormal CSR cleft which is seen partly communicating with that of the left frontal horn of the left lateral ventricle. So, this is a classical case of open rich caesars philly and closed lip caesars philly, both in a single case. So, caesars philly you can see there which is lined by abnormal gray matter, whereas poransophilic cyst which is lined by abnormal white matter. So, that is the differentiating point between the poransophilic cyst and the caesars philly. Next other case, ATR male with chronic history of trauma and caesars. You can see there is gliosis and there is a CSR density cystic lesion noted in the right parietal lobe which is causing erosions, remodelling of the bone and even expansion of the bone. And there are defects in the underlying parietal bone. So, this is a case of growing skull fracture or leptomeningal cyst. So, here you can see this is a depicted as growing skull fracture or the classical leptomeningal cyst. Thanks to Dr. Venkatesh for contributing this case. So, this is a classical case of leptomeningal cyst or also known as growing skull fracture. It is a four-year male with macrosophilae, delayed milestones, attack, sea and spasticity. You can see there is a retrosherbillar CSR-signature cystic lesion. There is no restricted diffusion on DWA, hyper intense on T1, hyper intense on T2. There is and completely suppressed on flare. So, a suggestion of CSR-signature cystic lesion in the retrosherbillar location associated with eplasia of the vermis or eplasia or hyperplasia of the vermis and directly the fourth Venkatesh seen communicating with it as the cystic lesion. So, this is a classical case of dandy walker malformation. Next, 35-year female with history of chronic headache and memory disturbances. You can see there is a cystic lesion which is hyper intense on T1, sitting in the foremen of Monroe, hyper intense on T2, no restricted diffusion on DWA, and flare there is peripheral hyper intense ring and central hyper intensity and not showing significant enhancement because it is already hyper intense on T1. So, this is a classical case of colloid cyst. So, location and the cystic lesion characteristics depict this as a colloid cyst. This is the other case which I am showing CT for a easy understanding. So, 20-year female with history of chronic headache and visual disturbances, you can see hyper dense cystic lesion in the foremen of Monroe. And the HE is approximately 55 to 60 HE, no significant enhancement on IV contrast. So, this is also a classical case of colloid cyst, but this is the CT of colloid cyst. Next, 17-year male with history of chronic headache and intermittent scissors. You can see a cystic lesion which is hyper intense on T2 in the left thalamus, no blooming on GRE, suppressed on flare, not completely suppressed on flare, which is hyper intense on T1. There is no restricted diffusion on DWA. So, this is a case of neuroglial cyst. So, this is a neuroglial cyst in a 17-year male. Next, 26-year female with history of headache, vomiting, salt and sensorium, scissors for 10 days, and even there is history of fever and weight loss since one month. Here you can see there is a cystic lesion which is hyper intense on T2, peripheral hyper intense in RIM, and showing adjacent perilligional vasogenic edema. And there is classical restricted diffusion on DWA noted in the central core of the cystic lesion. And on IV contrast, you can see multiple conglomerate ring enhancing lesions noted in the left temporary lobes with adjacent minimal dual thickening optic enhancement. So, this is a classical case of tuberculoma. So, this restricted diffusion in the central core of the tuberculoma is due to caseous necrosis. And these are conglomerate gram lobes which are commonly seen in tuberculomas than NCC. Next case, 12-year male with history of chronic recurrent scissors, you can see multiple cystic lesions noted scattered in cerebral parenchyma, and fewer showing perilligional vasogenic edema, and fewer not showing vasogenic edemia, and fewer showing peripheral RIM enhancement or ring enhancement. So, this is a classical appearance of starry sky appearance which is seen in NCC. So, there are these are various stages of cystic lesions. Some are non-cystic, some are cystic, some are active, and some are inactive, and few are calcified. So, this is a classical case of starry sky appearance seen in Neurocystic circumstances. Next, 35-year male with history of chronic headache came with certain loss of consciousness, scissors and vomiting. You can see there is a cystic lesion which is sitting in the left parietal, occipital lobe. There is peripheral RIM enhancement noted within the lesion and adjacent perilligional edema and even mass effect over the adjacent ventricle. You can see there are classical detached membranes noted within the cystic lesion. These are the detached membranes noted within the cystic lesion, and the peripheral RIM enhancement noted within the wall of the cystic lesion. So, this is a classical case of hydrated cystin brain which is rare nowadays. Next, 26-year female postpartum with sudden onset of severe headache, vomiting, hypertension and double vision. You can see there is a cystic lesion noted in the pituitary gland, replacing the pituitary gland in the cella. There is fluid fluid levels. This is hyper intense fluid in the top and iso-to-hypo intense fluid in the bottom which is showing blooming on GRE. And here also, you can see the fluid fluid levels. And there is peripheral RIM enhancement on IV contrast. So, this is a classical case of pituitary adenoma with cystic degeneration and hemorrhage. And because of this postpartum and these see hand syndromes can be suspected. So, other close differential can be Rathke's cleft cyst. Where in Rathke's cleft cyst, you can see cystic lesion with a nodule within it. So, whenever you see a cystic lesion in the pituitary with nodule in it, then suspect Rathke's cleft cyst. Next, this is an 80-year male with issue of chronic seizures, headache, vomiting and macrosaphalae. You can see there is a solid cystic lesion noted in the cella with supracellar extension. And the contents of the lesion are predominantly hyper intense on flare, heterogeneous to hyper intense on T2. There is no restricted diffusion on dW. So, whenever you see a child with solid cystic lesion in the cella with supracellar extension and even when you see high signal in the on T1 weighted sequencers or which is nothing but a classical case of adamantine omnitrous type of cranioferringioma, which is common in childs. And this classical T1 hyper intense appearance on T1 is due to high protein content, which is seen in the cystic lesion. So, also also classically described as motor oil appearance or motor oil consistency because of high viscosity. So, whenever you see a child with solid cystic lesion in the cella with supracellar extension and even calcification suspect cranioferringioma, which is adamantine omnitrous type and other type is papillary type, which can be seen in adults. Coming to 2 year mail with issue of macrosaphalae, motor delay, gradual onset of ataxia, spasticity and extracurricular symptoms, you can see there is a diffuse expansion of the white matter, which is predominantly hyper intense. So, this is classical spongiform degeneration of the white matter, which is causing expansion of the white matter, compression of the guyray and even causing the macrosaphalae. And here you can see there are C.S.S. signal intestine cystic lesions noted classically in the antero-middle temporal lobes or sitting in the antero-temperal lobes, which are hyper intense on T2 and completely suppressed on flare and no reshifted diffusion on D.W. in the white matter. So, whenever you see these type of cases where you can see diffuse expansion of the white matter, macrosaphalae and cystic lesions in the antero-temperal lobe or antero-middle temporal lobe, suspect megalencephalic leuconsollopathy with subcortical cysts or van der nap disease. So, this is a classical case of van der nap disease and the close differential can be vanishing white matter disease or Kana van's disease, where Kana van's disease will not find any classical cystic lesions in the antero-temporal lobes or antero-middle temporal lobes. So, this is van der nap disease, which is autosomal recessive disorder and close differentiation is Kana van's disease. 35 female with hitch of hearing loss, tinnitus, vertigo, headache and abnormal care. You can see there is a solid cystic lesion in the CP angle, which is heterogeneous to hyperintense on T2 and showing no enhancement in the cystic component with heterogeneous enhancement in the solid component. So, this is a classical case of CP angle acoustic schwannoma. Next 26 year male with history of chronic headache and intermittent seizures, you can see multiple cystic foci scattered in the left temporal lobe and even reaching up to the sylvan feature, which is causing mild mass effect on the frontal lobe. So, these are classical gaint VR spaces. So, this is a case of gaint VR spaces or tumor effective VR spaces. Sometimes they can even mimic a cystic neoplasm, but no restricted diffusion on WWE, no enhancement on IV contrast can differentiate gaint or tumor effective VR spaces from cystic neoplasms. Seven year male child with chronic history of headache, intermittent warnings, weight loss for six months, the sudden onset of back pain, attacks and urinary retention with weakness. So, here you can see there is a cystic lesion sitting in the floor of the fourth ventricle. There is no restricted diffusion on WWE, which is hyperintense on T2 with peripheral iso to hyperintense rim, no blooming on GRE. And here you can see this is the solid cystic lesion in the fourth ventricle, which is also extended into the CSS space of the upper saropnoid space with significant cord edema. On IV contrast, there is no enhancement in the cystic component, but there is minimal heterogeneous enhancement in the peripheral solid component. Here you can see this is the classical heterogeneous enhancement and the cystic lesion is also seen squeezing the postophosa into the CSS spaces of the upper spinal cord or saropnoid space. So, this is a classical case of ependymoma. So, ependymoma remember there is solid cystic lesion arising from the floor of the fourth ventricle, no restricted diffusion on WWE, and propensity to enter into the CSS spaces and plastic type of tumor, which is trying to squeezing out of the fourth ventricle into the CSS spaces is very pathognomonic of ependymoma. And here you can also see an enhancing nodule in the saropnoid space in the spinal cord. So, this is a case of ependymoma with drop metastasis. Here this is the drop metastasis. Ten year male child who came with history of chronic headache, vomiting, sweat loss since six months. You can see there is a solid cystic lesion in the postophosa and the cerebellum. This is the on IV contrast, you can see there is a solid enhancing or mural nodule. So, whenever you see a solid cystic lesion with enhancing mural nodule in the postophosa, suspect palesitic astrocytoma. And this is causing compression of the fourth ventricle with resultant dilatation of the supra-tentorial ventricular system. So, this is a classical case of palesitic astrocytoma. 26 year female came with chronic history of headache, vomiting, misdiagnosis, weakness in upper and lower limbs, intermittent abdominal pain since eight months. So, here you can see there is a cystic lesion with enhancing peripheral nodule or mural nodule in the cerebellum. And here you can see there is a enhancing nodule-like structure also noted in the spinal cord. So, this is a classical case of hemangioblastoma with drop metastasis. But what is the importance in this case? There are multiple cystic focades scattered in the pancreas and even in the kidneys. So, this is a case of one hippolinda disease with cerebellar hemangioblastoma and even drop metastasis. So, I want to show one mnemonic which has been framed by me to remember all the causes of drop metastasis. Already in the previous case, we have seen ependymoma. So, remember champagne. So, where C stands for corioplexus carcinoma, H for hemangioblastoma as we have seen in this case, A for anaplastic astrocytoma, M for medulloblastoma, P for pineositoma, P for pineoblastoma, P net, G for GVM or germinoma, E for ependymoma. Next, 6 to 10 year male with chronic history of smoking, cough, loss of weight, appetite, came with certain onset of unconscious and seizures. You can see there are multiple cystic focades scattered in volatile cerebellar parenchyma showing peripheral remanagement and showing significant choline peak with even lactate peak or inversion of lactate in the necrotic areas and choline peaks in the peripheral rim areas. So, considering the history of chronic smoking, elderly age with multiple cystic focades with raised choline, these are nothing but classical of cystic metastasis and primary could be in lung carcinoma because of the history. So, I think I have covered various cystic lesions in the brain both including typical and atypical presentations and I thank Dr. Sanjeev Manisar for giving me this opportunity to present in Indian radiologist. Thank you all.