Carbon-Based Piezoresistive Polymer Nanocomposites by Extrusion Additive Manufacturing: Process, Material Design, and Current Progress.

Advancement in additive manufacturing (AM) allows the production of nanocomposites with complex and custom geometries not typically allowable with conventional manufacturing techniques. The benefits of AM have led to recent interest in producing multifunctional materials capable of being printed with current AM technologies. In this article, piezoresistive composites realized by AM and the matrices and fillers utilized to make such devices are introduced and discussed. Carbon-based nanoparticles (Carbon Nanotubes, Graphene/Graphite, and Carbon Black) are often the filler choice of most researchers and are heavily discussed throughout this review in combination with extrusion AM methods. Piezoresistive applications such as physiological and wearable sensors, structural health monitoring, and soft robotics are presented with an emphasis on material and AM selection to meet the demands of such applications.

Fracture or Not: An Easily Mistaken Benign Finding in a Tuberous Sclerosis Patient.

Tuberous sclerosis (TSC) is a rare autosomal dominant disorder that can affect multiple organ systems, including the brain, heart, lungs, and skin. Cutaneous manifestations are common, including ungual fibromas, however, these may be mistaken for other pathologies. Here, we present the case of a 14-year-old with TSC complaining of traumatic left little finger pain. Radiographic evaluation revealed cortical scalloping of the nailbed, concerning for a non-displaced fracture. Given the history of TSC, however, this defect may have also represented a periungual fibroma. The patient subsequently underwent conservative management and an eight-month radiographic follow-up showed no osseous remodeling, supporting the diagnosis of periungual fibroma. It is imperative for clinicians to understand the cutaneous manifestations of TSC to aid in proper diagnosis and avoidance of unnecessary treatment. In this case, interval follow-up confirmed the diagnosis and excluded fracture.

ACR Appropriateness Criteria® Soft Tissue Masses: 2022 Update.

Imaging should be performed in patients with a suspected soft tissue mass that cannot be clinically confirmed as benign. Imaging provides essential information necessary for diagnosis, local staging, and biopsy planning. Although the modalities available for imaging of musculoskeletal masses have undergone progressive technological advancements in recent years, their overall purpose in the setting of a soft tissue mass remains unchanged. This document identifies the most common clinical scenarios related to soft tissue masses and the most appropriate imaging for their assessment on the basis of the current literature. It also provides general guidance for those scenarios that are not specifically addressed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

ACR Appropriateness Criteria® Malignant or Aggressive Primary Musculoskeletal Tumor-Staging and Surveillance: 2022 Update.

Malignant or aggressive primary musculoskeletal tumors are rare and encompass a wide variety of bone and soft tissue tumors. Given the most common site for metastasis from these primary musculoskeletal tumors is to the lung, chest imaging is integral in both staging and surveillance. Extrapulmonary metastases are rarely encountered with only a few exceptions. Following primary tumor resection, surveillance of the primary tumor site is generally recommended. Local surveillance imaging recommendations differ between primary tumors of bone origin versus soft tissue origin. This document consolidates the current evidence and expert opinion for the imaging staging and surveillance of these tumors into five clinical scenarios. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

ACR Appropriateness Criteria® Suspected Osteomyelitis, Septic Arthritis, or Soft Tissue Infection (Excluding Spine and Diabetic Foot): 2022 Update.

Musculoskeletal infections involve bones, joints, and soft tissues. These infections are a common clinical scenario in both outpatient and emergent settings. Although radiography provides baseline findings, a multimodality approach is often implemented to provide more detailed information on the extent of infection involvement and complications. MRI with intravenous contrast is excellent for the evaluation of musculoskeletal infections and is the most sensitive for diagnosing osteomyelitis. MRI, CT, and ultrasound can be useful for joint and soft tissue infections. When MRI or CT is contraindicated, bone scans and the appropriate utilization of other nuclear medicine scans can be implemented for aiding in the diagnostic imaging of infection, especially with metal hardware and arthroplasty artifacts on MRI and CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

A dominant negative ADIPOQ mutation in a diabetic family with renal disease, hypoadiponectinemia, and hyperceramidemia.

Adiponectin, encoded by ADIPOQ, is an insulin-sensitizing, anti-inflammatory, and renoprotective adipokine that activates receptors with intrinsic ceramidase activity. We identified a family harboring a 10-nucleotide deletion mutation in ADIPOQ that cosegregates with diabetes and end-stage renal disease. This mutation introduces a frameshift in exon 3, resulting in a premature termination codon that disrupts translation of adiponectin's globular domain. Subjects with the mutation had dramatically reduced circulating adiponectin and increased long-chain ceramides levels. Functional studies suggest that the mutated protein acts as a dominant negative through its interaction with non-mutated adiponectin, decreasing circulating adiponectin levels, and correlating with metabolic disease.

Systematic review: investigating the added diagnostic value of gadolinium contrast agents for osteomyelitis in the appendicular skeleton.

OBJECTIVE: Osteomyelitis is an infection of the bone marrow. MRI with gadolinium-based contrast is frequently performed for cases of suspected osteomyelitis. The objective of this systematic review is to examine the diagnostic accuracy of contrast-enhanced vs non-contrast-enhanced MRI for osteomyelitis in the appendicular skeleton. MATERIALS AND METHODS: We conducted a systematic review of MRI in the diagnosis of osteomyelitis by searching MEDLINE and EMBASE from January 2000 to March 2020. There were 21 studies that met the inclusion criteria for the systematic review for a total of 1095 patients. Analytic methods were based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Evidence was evaluated using the STARD criteria for evaluation of completeness and transparency of reporting. RESULTS: For diagnosing osteomyelitis in the appendicular skeleton, MRI with gadolinium-based contrast has 89% sensitivity (95% CI, 86-92%), 79% specificity (95% CI, 75-83%), and 90% overall diagnostic accuracy ([SE] = 0.03). For diagnosing osteomyelitis in the appendicular skeleton, MRI without gadolinium-based contrast has a 92% sensitivity (95% CI, 87-96%), 89% specificity (95% CI, 84-93%), and 96% overall diagnostic accuracy ([SE] = 0.03). The median score of included studies was 85% utilizing the STARD criteria with excellent interobserver agreement of 83.4%. Limitations included small sample size of studies, with retrospective designs. CONCLUSION: No evidence was found to suggest an added diagnostic value of gadolinium contrast for the diagnosis of osteomyelitis in the appendicular skeleton. For routine cases of suspected non-spinal osteomyelitis, non-contrast MRI of the area of interest is the next most appropriate study after radiographs.

Inequality in mortality between Black and White Americans by age, place, and cause and in comparison to Europe, 1990 to 2018.

Although there is a large gap between Black and White American life expectancies, the gap fell 48.9% between 1990 and 2018, mainly due to mortality declines among Black Americans. We examine age-specific mortality trends and racial gaps in life expectancy in high- and low-income US areas and with reference to six European countries. Inequalities in life expectancy are starker in the United States than in Europe. In 1990, White Americans and Europeans in high-income areas had similar overall life expectancy, while life expectancy for White Americans in low-income areas was lower. However, since then, even high-income White Americans have lost ground relative to Europeans. Meanwhile, the gap in life expectancy between Black Americans and Europeans decreased by 8.3%. Black American life expectancy increased more than White American life expectancy in all US areas, but improvements in lower-income areas had the greatest impact on the racial life expectancy gap. The causes that contributed the most to Black Americans' mortality reductions included cancer, homicide, HIV, and causes originating in the fetal or infant period. Life expectancy for both Black and White Americans plateaued or slightly declined after 2012, but this stalling was most evident among Black Americans even prior to the COVID-19 pandemic. If improvements had continued at the 1990 to 2012 rate, the racial gap in life expectancy would have closed by 2036. European life expectancy also stalled after 2014. Still, the comparison with Europe suggests that mortality rates of both Black and White Americans could fall much further across all ages and in both high-income and low-income areas.

Virtual medical student radiology clerkships during the COVID-19 pandemic: Distancing is not a barrier.

BACKGROUND: Stress on medical education caused by COVID-19 has prompted medical schools to bar their students from onsite education at hospitals and clinics, limiting their educational experiences. Radiology is uniquely positioned to be a virtual rotation during this health crisis and beyond. PURPOSE: To implement virtual radiology clerkships and evaluate educational outcomes. METHODS: We developed virtual radiology clerkships using best practices from adult education theory; emphasizing self-directed and interactive learning through recommended reading materials, pre-recorded lectures, video conferencing, web-based learning modules from the ACR, as well as multimodality radiology resources to allow students flexibility in their individual approach to the subject matter. RESULTS: The mean performance on standardized exams for our cohorts was 75% (range 50-96%), matching the national average of 75%. Surveys of medical students after the clerkship showed positive subjective feedback on the content and structure of the course. CONCLUSIONS: Understanding of medical imaging is vital for student doctors to have a better understanding of applied anatomy, patient care strategies, appropriate use, and image interpretation. Radiology is uniquely positioned to be taught in a virtual format, or in a combination of online and in-person activities. Standardized examination performance for our institutional virtual radiology clerkships is comparable to performance on traditional courses. Virtual clerkships designed with adult learners in mind can help student doctors prepare for residency and future independent practice as they build knowledge and skills needed to provide high quality patient care.

Age specific trends in mortality disparities by socio-economic deprivation in small geographical areas of England, 2002-2018: A retrospective registry study.

BACKGROUND: Disparities in mortality rates according to socioeconomic position (SEP) have been rising in England. We describe the association between recent changes in socioeconomic inequality and trends in mortality disparities for different age and sex groups at small-area level in England. METHODS: Vital registration data from the Office for National Statistics on resident population size and number of deaths in each Lower Super Output Area (LSOA) in England from 2002 to 2018 were stratified by sex and 5-year age group. We grouped LSOA into ventiles of the Index of Multiple Deprivation (IMD), our indicator of SEP. We examined time trends in smoothed mortality rates, using 3 year moving averages for the period 2003-2017, by age across the IMD distribution. We measured mortality inequalities using the ratio of mortality rates between different deprivation groups. We calculated mortality rate ratios between the most and the least deprived 10% of areas (Total Inequality) and between the median and least deprived (Lower Inequality) 10% of areas by year, gender and age group, to examine where in the distribution of deprivation trends in mortality inequality arose. FINDINGS: Among <1 year olds, the inequality in mortality rates between the poorest 10% of LSOAs and the richest 10% of LSOAs fell between 2003 and 2017 by 22•7% for men and 22•8% for women. The largest inequalities were observed among 40 to 54 year olds. This inequality increased over the study period - from 3•2 times higher mortality rates for men in the most as opposed to the least deprived 10% of LSOAs in 2003 to 3•3 times in 2017. The rise was from 2•4 to 2•6 for women. Age groups ≥65 years, who experience the highest mortality risk, had low but rising inequality. Men and women aged 65 to 79 living in the most deprived LSOAs had a mortality rate 1•9 times higher than the least deprived in 2003 but this had increased to 2•2 times higher for women and 2•3 times higher for men by 2017. This was due to rising inequality in both halves of the distribution - between the top 10% of LSOA and the middle, and between the middle and the bottom 10% of LSOA. INTERPRETATION: Overall mortality inequality rose in England but there were substantial differences in the trends for specific age and sex groups. Infant and child mortality inequality fell. At older ages, mortality inequality rose across cohorts, although in different ways, as each cohort's exposure to life-course to labour market inequality has differed. Policy goals of reducing mortality inequality will be best met by a focus on the risk factors that are specific to particular age and deprivation groups. FUNDING: Economic and Social Research Council, through the ESRC Centre for the Microeconomic Analysis of Public Policy at the IFS. We gratefully acknowledge the support of the Nuffield Foundation, grant reference WEL/43603. The project has been funded by the Nuffield Foundation, but the views expressed are those of the authors and not necessarily the Foundation. Visit www.nuffieldfoundation.org. Research at UCL Great Ormond Street Institute of Child Health is supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre.

Superficial fibromatosis: MRI radiomics and T2 mapping correlate with treatment response.

BACKGROUND: Superficial fibromatosis exhibits variable MR signal intensity due to collagenous and fibroproliferative components. Quantifying this signal heterogeneity using image texture analysis and T2-mapping could have prognostic and therapeutic implications. METHODS: This IRB-approved retrospective study included 13 patients with superficial fibromatosis, managed by observation, electron beam radiotherapy (EBT), or pentoxifylline/vitamin E. Two-dimensional regions of interest (ROIs) were drawn on proton-density or T2-weighted MRI for radiomics feature analysis, and corresponding T2-maps. Comparisons were made between baseline and follow-up T2 relaxation times and radiomics features: Shannon's entropy, kurtosis, skewness, mean of positive pixels (MPP), and uniformity of distribution of positive gray-level pixel values (UPP). RESULTS: There were 19 nodules in 13 subjects. Mean patient age was 60 years; 62% (8/13) were female; mean follow-up was 9.7 months. Nodule diameter at baseline averaged 18.2 mm (std dev 16.2 mm) and decreased almost 10% to 16.6 mm (p = 0.1, paired t-test). Normalized T2 signal intensity decreased 23% from 0.71 to 0.55 (p = 0.03, paired t-test). T2 relaxation time decreased 16% from 46.5 to 39.1 ms (p < 0.001, paired t-test). Among radiomics features, skewness increased to 0.71 from 0.41 (p = 0.03, paired t-test), and entropy decreased from 8.37 to 8.03 (p = 0.05, paired t-test); differences in other radiomics features were not significant. CONCLUSIONS: Radiomics analysis and T2-mapping of superficial fibromatosis is feasible; robust decreases in absolute T2 relaxation time, and changes in image textural features (increased skewness and decreased entropy) offer novel imaging biomarkers of nodule collagenization and maturation.

International differences in interspousal health correlations.

Using objective measures of lung function, we document strong positive associations in health within couples in all European countries but large and significant differences in this correlation within broad European regions, with Southern Europe having by far stronger correlations than elsewhere. We analyze potential explanations for such differences, investigating the role of measures capturing current and past health behaviors, early life circumstances of each spouse, and measures capturing assortative mating in multiple dimensions. We show that marital sorting patterns by dimensions of early life health and socioeconomic position, as well as by geographical subregion within countries, are key to understanding the empirical patterns observed.

Inoperable Left Renal Vein Leiomyosarcoma Refractory to Chemotherapy Invades Inferior Vena Cava and Right Atrium: A Case Report.

Mesenchymal stem cells differentiate into a plethora of cell types. These differentiated cell types include osteoblasts, chondrocytes, myocytes, and adipocytes. Sarcomas occur secondary to malignant transformation of these mesenchymal, pluripotent stem cells. Involuntary smooth muscle is responsible for the make up of hollow organs and vasculature in our body and is regulated by our autonomic nervous system, hormones, as well as chemical and local mediators. Cancer involving smooth muscle cells is designated as leiomyosarcoma (LMS). LMS can arise from any location in the body where smooth muscle is present and is frequently reported in the abdomen and pelvis, as well as the trunk, extremities, and throughout the retroperitoneum.

Large renal leiomyoma: A multidisciplinary approach to diagnosis.

We report the case of a 45-year-old woman who presented with a large palpable abdominal mass. Initial sonographic and computed tomographic studies prompted a differential diagnosis of retroperitoneal or renal sarcoma, leiomyoma, and lipid-poor angiomyolipoma. A final diagnosis of renal leiomyoma was reached based on a consensus among radiology, surgery and pathology. In addition to reviewing the features of this entity, this case demonstrates the process of developing a working diagnosis, narrowing the differential as zadditional testing is performed and establishing a final diagnosis with interdepartmental coordination. Despite the rarity of this condition, the ability to recognize and apply imaging features to differentiate between abdominal masses of unknown origin is important for clinicians and researchers.

Radiology-pathology correlation for bone and soft tissue tumors or tumor-like masses: single institutional experience after implementation of a weekly conference.

OBJECTIVES: To determine the frequency of non-diagnostic and discordant results from bone and soft tissue biopsies performed at our institution over a 3-year period and to investigate whether implementation of a weekly musculoskeletal radiology-pathology correlation conference decreased the time to appropriate patient management in cases of discordance. METHODS: Consecutive image-guided core needle biopsy results obtained over a 12 month period of time were reviewed in a retrospective fashion. Following implementation of the correlation conference, subsequent consecutive image-guided core needle biopsy results obtained over a 26 month period of time were reviewed in a prospective fashion. For non-diagnostic and discordant cases, the time in days from date of availability of the biopsy result to date of documentation of a specific follow-up action plan was recorded. RESULTS: Diagnostic yield was 96.5% and 94.9% for the retrospective and prospective periods, respectively. There were four discordant results in the retrospective cohort (1.7%) and seven discordant results in the prospective cohort (2.1%). Following implementation of the weekly correlation conference, there was significant decrease (p < 0.05) in median time from a discordant biopsy result to follow-up action plan. There were no unnecessary surgeries, litigation, or other unfavorable consequences in either cohort. CONCLUSION: Image-guided core needle biopsies of bone and soft tissue provide high diagnostic yield, often with specific diagnoses. The statistically significant decrease in number of days to follow-up action plan for discordant results suggests radiology-pathology review has a positive impact on patient care. Subjective benefits from communication and educational standpoints are also noteworthy.

The Powerful Combination of Cross-country Comparisons and Life-History Data.

In this paper we discuss the value of international comparative empirical studies within the broad field of the economics of ageing. We argue the value is particularly great when such comparative research is based on long life-history data on participants, collected using large-scale autobiographical life-history methods. We identify particular aspects of such comparisons that create value relative to other empirical methods and also briefly survey recent key papers to illustrate each aspect. Finally we provide a short new application of this method, using data from SHARE and ELSA, to look at the question of how labour markets for older workers in Europe have been changing across cohorts and the extent to which this has been associated with changing retirement ages in public pension systems.

Mitochondrial pyruvate carrier is required for optimal brown fat thermogenesis.

Brown adipose tissue (BAT) is composed of thermogenic cells that convert chemical energy into heat to maintain a constant body temperature and counteract metabolic disease. The metabolic adaptations required for thermogenesis are not fully understood. Here, we explore how steady state levels of metabolic intermediates are altered in brown adipose tissue in response to cold exposure. Transcriptome and metabolome analysis revealed changes in pathways involved in amino acid, glucose, and TCA cycle metabolism. Using isotopic labeling experiments, we found that activated brown adipocytes increased labeling of pyruvate and TCA cycle intermediates from U13C-glucose. Although glucose oxidation has been implicated as being essential for thermogenesis, its requirement for efficient thermogenesis has not been directly tested. We show that mitochondrial pyruvate uptake is essential for optimal thermogenesis, as conditional deletion of Mpc1 in brown adipocytes leads to impaired cold adaptation. Isotopic labeling experiments using U13C-glucose showed that loss of MPC1 led to impaired labeling of TCA cycle intermediates. Loss of MPC1 in BAT increased 3-hydroxybutyrate levels in blood and BAT in response to the cold, suggesting that ketogenesis provides an alternative fuel source to compensate. Collectively, these studies highlight that complete glucose oxidation is essential for optimal brown fat thermogenesis.

Recessions and Health: The Long-Term Health Consequences of Responses to the Coronavirus.

The lockdown measures that were implemented in the spring of 2020 to stop the spread of COVID-19 are having a huge impact on economies in the UK and around the world. In addition to the direct impact of COVID-19 on health, the following recession will have an impact on people's health outcomes. This paper reviews economic literature on the longer-run health impacts of business-cycle fluctuations and recessions. Previous studies show that an economic downturn, which affects people through increased unemployment, lower incomes and increased uncertainty, will have significant consequences on people's health outcomes both in the short and longer term. The health effects caused by these adverse macroeconomic conditions will be complex and will differ across generations, regions and socio-economic groups. Groups that are vulnerable to poor health are likely to be hit hardest even if the crisis hit all individuals equally, and we already see that some groups such as young workers and women are worse hit by the recession than others. Government policies during and after the pandemic will play an important role in determining the eventual health consequences.