Lactation Performance and Rumen Fermentation in Dairy Cows Fed a Diet Supplemented with Monensin or Gum Arabic-Nano Montmorillonite Compost.

The exploration of natural alternatives to antibiotics for enhancing productivity and performance in dairy cows is a crucial objective in farm animal management. This is the first study aimed at developing and evaluating the physicochemical properties and effects of Arabic gum-nano montmorillonite (AGNM) compost compared to ionophore monensin as feed additives on rumen fermentation, blood metabolites, and milk production of Holstein dairy cows. In a replicated 4 × 4 Latin square design, four multiparous mid-lactation Holstein dairy cows with an average body weight of 520 ± 15 kg were enrolled. The dietary treatments included a control diet (basal diet without feed additives), monensin diet [a basal diet supplemented with 35 mg/kg dry matter (DM) monensin], and AGNM diets comprising basal diet supplemented with two levels: low (L-AGNM) at 1.5 g/kg DM, and high (H-AGNM) at 3 g/kg DM. AGNM as a feed additive demonstrated promising physiochemical parameters, including containing highly bioactive components (α-amyrin and lupeol), functional groups (OH and Si-O), and essential mineral contents (Mg2+). Supplementations with H-AGNM significantly improved ruminal (p = 0.031) concentrations of total volatile fatty acids (VFAs), acetic (p = 0.05) and butyric (p = 0.05), enhanced (p < 0.05) digestibility of fiber and organic matter, while decreased (p = 0.013) estimated methane production. However, an increase (p = 0.04) in blood high-density lipoprotein levels and decrease (p < 0.05) in concentrations of creatinine (CREA), bilirubin (BILT), cholesterol (CHOL), and sodium (Na) were observed with H-AGNM supplementation. Both monensin and H-AGNM improved (p = 0.008) feed efficiency compared to L-AGNM; however, neither AGNM nor monensin affected the milk composition or energy status indicators of the dairy cows. The findings of this study highlight the potential of AGNM as a natural candidate to replace monensin in enhancing ruminal VFA production, nutrient digestibility, feed efficiency, blood metabolites, and milk yield in dairy cows.

The Saudi Population's Knowledge and Attitude Towards Human Papillomavirus (HPV) Infection and Its Vaccination.

BACKGROUND: Human papillomavirus (HPV) infection is a major worldwide public health concern that can result in a range of clinical disorders, including cervical cancer. Saudi Arabia, similar to numerous other nations, has difficulties in facing HPV and its impact on society. The high incidence of cervical cancer in Saudi Arabia continues to be a cause for worry, highlighting the need for the adoption of efficient immunization programs. Nevertheless, public hesitation and inadequate knowledge can hinder the acceptance of vaccines. Evaluating public knowledge and attitudes concerning HPV and its vaccination is essential in order to create focused programs that enhance awareness and increase vaccine acceptance. METHODS: This study was cross-sectional in nature, using data from a sample of 516 Saudi participants 18 years and above. The participants completed online questionnaires that were distributed using Google Forms across social media platforms and ensured anonymity. RESULTS: A total of 516 participants made up the sample for this study, which had a predominance of females (83.5%, n=431); the majority aged 18-25 years (78.3%, n=404) and most of them (28.3%, n=146) were from the central region. The study results revealed that 43.7% (n=225) of the participants had a good knowledge level while 56.3% (n=291) of them had a poor level of knowledge about the HPV vaccine. A substantial proportion (35.9%, n=185) of the participants had good knowledge that HPV can be transmitted sexually from one person to another with only 30.2% (n=156) of them being aware that HPV is a common infection that causes cervical cancer (41.5%, n=214) and most of them (76.2%, n=393) knew that cervical cancer can be cured particularly when detected in early stages. The results established statistically significant associations between gender, education level, and occupation with p-values <0.005 (0.023, 0.003 and 0.001 respectively) and level of knowledge about the HPV vaccine. CONCLUSION: The study emphasizes the necessity of implementing focused health education and vaccination initiatives in Saudi Arabia to enhance understanding and attitudes regarding HPV infection and its vaccine. The results can provide guidance to healthcare professionals, legislators, and public health authorities in creating programs that increase knowledge and acceptance of the HPV vaccine, ultimately decreasing the prevalence of HPV-related diseases in the nation.

Cam-type hip morphology in asymptomatic patients.

BACKGROUND: The alpha angle has been widely used in the assessment of cam-type of impingement, but recent studies have shown that this angle may also be high in asymptomatic patients. The aim of this study is to report the prevalence of cam-type morphology in asymptomatic volunteers and explore its correlation with hip clinical and radiological parameters. METHODS: This single-centre prospective study included 48 asymptomatic male volunteers (96 hips). All candidates fulfilled the inclusion and exclusion criteria. Physical examination and 1.5 -T MRI imaging were done for bilateral hips on the same day. Alpha angle measurements were obtained from 4 different positions and cam-type morphology was considered positive using 2 different cut points >55° and >60°. Descriptive statistics were analysed and correlations were performed where appropriate and p-value < 0.05 was considered to be significant. RESULTS: The prevalence of cam-type morphology using alpha angle >55° was 68.8%, 87.5%, 50% and 34.4% in the 12, 1, 2 and 3 o'clock positions respectively. While it was 38.5%, 69.8%, 26% and 12.5% in the 12, 1, 2 and 3 o'clock positions of the studied hips respectively using alpha angle >60°. The maximum alpha angle was more frequently prevalent at the 1 o'clock position in 71 (74%). Labral tear was detected in 26 (27.1%) hips and impingement test was positive in 12 (12.5%) hips. There was no correlation between the presence of cam-type morphology and range of motion of the hip, presence of positive impingement test nor labral tears. CONCLUSIONS: Cam-type morphology prevalence is high among asymptomatic males, and mostly pronounced at the 1 o'clock position. A correlation between high alpha angle and positive impingement test or labral tear was not found in our cohort. Future studies are required to determine the natural history of asymptomatic cam-type morphology and risk of hip derangement.

Surface modification effect on contrast agent efficiency for X-ray based spectral photon-counting scanner/luminescence imaging: from fundamental study to in vivo proof of concept.

X-Ray imaging techniques are among the most widely used modalities in medical imaging and their constant evolution has led to the emergence of new technologies. The new generation of computed tomography (CT) systems - spectral photonic counting CT (SPCCT) and X-ray luminescence optical imaging - are examples of such powerful techniques. With these new technologies the rising demand for new contrast agents has led to extensive research in the field of nanoparticles and the possibility to merge the modalities appears to be highly attractive. In this work, we propose the design of lanthanide-based nanocrystals as a multimodal contrast agent with the two aforementioned technologies, allowing SPCCT and optical imaging at the same time. We present a systematic study on the effect of the Tb3+ doping level and surface modification on the generation of contrast with SPCCT and the luminescence properties of GdF3:Tb3+ nanocrystals (NCs), comparing different surface grafting with organic ligands and coatings with silica to make these NCs bio-compatible. A comparison of the luminescence properties of these NCs with UV revealed that the best results were obtained for the Gd0.9Tb0.1F3 composition. This property was confirmed under X-ray excitation in microCT and with SPCCT. Moreover, we could demonstrate that the intensity of the luminescence and the excited state lifetime are strongly affected by the surface modification. Furthermore, whatever the chemical nature of the ligand, the contrast with SPCCT did not change. Finally, the successful proof of concept of multimodal imaging was performed in vivo with nude mice in the SPCCT taking advantage of the so-called color K-edge imaging method.

Impact of ureteric access sheath use during flexible ureteroscopy: A comparative study on efficacy and safety.

OBJECTIVES: This study evaluates the impact of using an access sheath (AS) during flexible ureteroscopy (fURS) for urolithiasis treatment, focusing on outcomes such as stone-free rate, operation time, and complications. METHODS: This prospective, randomized study was carried out at Badr Hospital, Helwan University, and Ain Shams University hospitals from August 2021 to August 2022. Patients were systematically randomized into two groups (fURS with AS: 33 patients and without AS: 31 patients) and underwent preoperative and postoperative assessments, including lab tests and imaging. Possible procedure-associated risks, such as failed stone access, pain, bleeding, and sepsis, were monitored. RESULTS: The two groups were found to be comparable in terms of demographic characteristics or preoperative stone findings (p > 0.05 for all). However, operation duration was shorter in the No Sheath group (79.4 ±â€¯15.3 min vs. 90.4 ±â€¯16.7 min in the Sheath group, p = 0.008). Intraoperative complication rates, including failed access, operation termination, ureteric injury, and bleeding, were comparable in both groups (p > 0.05). Postoperative stone-free rates (78.8% vs. 71.0%, p = 0.305) and mean residual stone size (2.7 ±â€¯3.5 mm vs. 3.1 ±â€¯3.1 mm, p = 0.687) showed no significant differences. CONCLUSIONS: The present study suggests that fURS without an access sheath may offer an efficient and equally effective option for managing upper ureteric and renal stones. However, more studies with larger sample sizes and longer follow-up periods are required to validate these findings and to establish more precise indications for this approach.

Image quality improvement of a one-step spectral CT reconstruction on a prototype photon-counting scanner.

Objective. X-ray spectral computed tomography (CT) allows for material decomposition (MD). This study compared a one-step material decomposition MD algorithm with a two-step reconstruction MD algorithm using acquisitions of a prototype CT scanner with a photon-counting detector (PCD).Approach. MD and CT reconstruction may be done in two successive steps, i.e. decompose the data in material sinograms which are then reconstructed in material CT images, or jointly in a one-step algorithm. The one-step algorithm reconstructed material CT images by maximizing their Poisson log-likelihood in the projection domain with a spatial regularization in the image domain. The two-step algorithm maximized first the Poisson log-likelihood without regularization to decompose the data in material sinograms. These sinograms were then reconstructed into material CT images by least squares minimization, with the same spatial regularization as the one step algorithm. A phantom simulating the CT angiography clinical task was scanned and the data used to measure noise and spatial resolution properties. Low dose carotid CT angiographies of 4 patients were also reconstructed with both algorithms and analyzed by a radiologist. The image quality and diagnostic clinical task were evaluated with a clinical score.Main results. The phantom data processing demonstrated that the one-step algorithm had a better spatial resolution at the same noise level or a decreased noise value at matching spatial resolution. Regularization parameters leading to a fair comparison were selected for the patient data reconstruction. On the patient images, the one-step images received higher scores compared to the two-step algorithm for image quality and diagnostic.Significance. Both phantom and patient data demonstrated how a one-step algorithm improves spectral CT image quality over the implemented two-step algorithm but requires a longer computation time. At a low radiation dose, the one-step algorithm presented good to excellent clinical scores for all the spectral CT images.

Low-iodine 40-keV virtual monoenergetic CT angiography of the lower extremities.

Introduction: To evaluate a reduced iodine volume protocol for lower extremity CT angiography (CTA) using dual-energy CT (DECT). Methods: This retrospective study included consecutive patients who underwent lower extremity CTA from June to December 2022. A 10 ml 1:1 mixed test bolus was performed, followed by a 40 ml full bolus at a 2.5/s injection rate, using 400 mg/ml iodine contrast media. Conventional and 40 keV virtual monoenergetic images (VMI) were reconstructed. For both reconstructions, five main artery segments were assessed with a 3-point image quality score as well as quantitative attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measurements with diagnostic quality thresholds (respectively >150 HU and >3). Results: Forty patients were included in the study (mean age 68 ± 12 yo). 200 artery segments were assessed. Median qualitative image scores were 3 [IQR, 3, 3] for both reconstructions. 40 keV VMI upgraded qualitative scores for 51 (26%) of patients, including 9 (5%) from nondiagnostic to diagnostic quality. 40 keV VMI obtained attenuation and CNR diagnostic quality for respectively 100% and 100% of segments, compared with 96% and 98% for conventional images (p < 0.001). Distal artery segments showed the most differences between 40 keV VMI and conventional images. Conclusion: A low-iodine lower extremity CTA protocol is feasible, with 40 keV virtual monoenergetic spectral reconstruction enabling maintained diagnostic image quality at the distal artery segments.

Clinical Applications of Photon-counting CT: A Review of Pioneer Studies and a Glimpse into the Future.

CT systems equipped with photon-counting detectors (PCDs), referred to as photon-counting CT (PCCT), are beginning to change imaging in several subspecialties, such as cardiac, vascular, thoracic, and musculoskeletal radiology. Evidence has been building in the literature underpinning the many advantages of PCCT for different clinical applications. These benefits derive from the distinct features of PCDs, which are made of semiconductor materials capable of converting photons directly into electric signal. PCCT advancements include, among the most important, improved spatial resolution, noise reduction, and spectral properties. PCCT spatial resolution on the order of 0.25 mm allows for the improved visualization of small structures (eg, small vessels, arterial walls, distal bronchi, and bone trabeculations) and their pathologies, as well as the identification of previously undetectable anomalies. In addition, blooming artifacts from calcifications, stents, and other dense structures are reduced. The benefits of the spectral capabilities of PCCT are broad and include reducing radiation and contrast material dose for patients. In addition, multiple types of information can be extracted from a single data set (ie, multiparametric imaging), including quantitative data often regarded as surrogates of functional information (eg, lung perfusion). PCCT also allows for a novel type of CT imaging, K-edge imaging. This technique, combined with new contrast materials specifically designed for this modality, opens the door to new applications for imaging in the future.

High-intensity ultrasound improves color and oxidative stability of beef from grain-fed and pasture-fed Nellore cattle.

This research aimed to evaluate the influence of high-intensity ultrasound (HIU) levels (control: 0; high: 747.79; ultra-high: 1344.17 Wcm-2) on pH, instrumental color (redness, R630/580, hue angle and chroma) and oxidative stability (lipid and protein oxidation) of Psoas major (PM) muscle from Nellore cattle raised in two feeding systems: grain and pasture. Using a structural equation modeling (SEM) approach, the relations (P > 0.05) between exogenous (HIU levels) and endogenous (pH, color, lipid and protein oxidation) variables were observed. In beef from grain-fed animals the pH was directly and negatively related to lipid oxidation (γ = -0.321), hue angle (γ = -0.847) and chroma (γ = -0.442) and protein oxidation (γ = -0.752). In PM from pasture-fed HIU exhibited a negative relation with lipid (γ = -0.144) and protein (γ = -0.743) oxidation, suggesting a possible positive influence on the oxidative stability of meat and a positive relation with redness (γ = 0.197) and R630/580 (γ = 0.379). The HIU positively influenced the color and oxidative stability of beef from Bos indicus cattle, and a synergistic effect of HIU and feeding system on beef from pasture-fed animals.

Quality Attributes of Cold-Stored Khalal Barhi Dates Treated with Guava Leaf Extract and/or Lactic Acid as Natural Preservatives.

The use of natural ingredients to preserve the quality of fresh fruits is a promising approach to healthier products and a more sustainable industry. The present study was carried out to assess the effect of lactic acid (LA) and guava leaf extract (GLE) as natural preservatives on the quality parameters of Khalal Barhi dates. Physicochemical properties, antioxidant activity, color parameters, firmness, sensory properties, and yeast and mold counts of date fruits were evaluated during five weeks of storage at 4 ± 1 °C. The bioactive compounds in GLE were estimated by HPLC, which exhibited that GLE contains significant amounts of bioactive compounds, mainly, phenolics and flavonoids. With prolonged storage, the moisture content decreased, while the total soluble solids (TSS) increased in all samples. Similarly, a slight decrease in the pH with a concomitant increase in titratable acidity (TA) was observed throughout the storage. Generally, the samples treated with natural preservatives revealed lower changes in moisture content, TSS, pH, and TA than the control. The results exhibited decreased total phenolic content (TPC) and antioxidant activity for all samples with extended storage. The GLE and LA + GLE treatments significantly (p < 0.05) increased TPC and antioxidant activity on day 0 and preserved higher values of both during storage. Additionally, a decrease in the L* and b* values with an increase in the a* values of all samples was observed with advancement of storage. The LA + GLE treatment minimized the changes in color parameters and maintained higher firmness values during storage. Similarly, the sensory properties of all samples decreased with prolonged storage, but insignificant (p > 0.05) differences were found among the samples. Dipping treatments inhibited microbial growth over time, with the lowest yeast and mold counts achieved by the LA + GLE treatment. It can be concluded that the LA + GLE treatment has a protective effect on Khalal Barhi dates by minimizing post-harvest changes and decreasing the microbial load.

Yoga and massage are associated with small experimental placebo effects in chronic orofacial pain.

BACKGROUND: Complementary and Integrative Health Approaches (CIHA), including but not limited to, natural products and Mind and Body Practices (MBPs), are promising non-pharmacological adjuvants to the arsenal of pain management therapeutics. We aim to establish possible relationships between use of CIHA and the capacity of descending pain modulatory system in the form of occurrence and magnitude of placebo effects in a laboratory setting. METHODS: This cross-sectional study investigated the relationship between self-reported use of CIHA, pain disability, and experimentally induced placebo hypoalgesia in chronic pain participants suffering from Temporomandibular Disorders (TMD). In the 361 enrolled TMD participants, placebo hypoalgesia was measured using a well-established paradigm with verbal suggestions and conditioning cues paired with distinct heat painful stimulations. Pain disability was measured with the Graded Chronic Pain Scale, and use of CIHA were recorded with a checklist as part of the medical history. RESULTS: Use of physically oriented MBPs (e.g., yoga and massage) was associated with reduced placebo effects (F1,2110.44 = 23.15, p < 0.001, Cohen's d = 0.171). Further, linear regressions indicated that greater number of physically oriented MBPs predicted smaller placebo effects (ß = -0.17, p = 0.002), and less likelihood of being a placebo responder (OR = 0.70, p = 0.004). Use of psychologically oriented MBPs and natural product were not associated with placebo effects magnitude and responsiveness. CONCLUSIONS: Our findings suggest that use of physically oriented CIHA was associated with experimental placebo effects possibly through an optimized capability to recognize distinct somatosensorial stimulations. Future research is needed to understand the mechanisms underlying placebo-induced pain modulation in CIHA users. SIGNIFICANCE: Chronic pain participants who use physically oriented mind-body practices, such as yoga and massage, demonstrated attenuated experimentally induced placebo hypoalgesia in comparison with those who do not use them. This finding disentangled the relationship between use of complementary and integrative approaches and placebo effects, providing the potential therapeutic perspective of endogenous pain modulation in chronic pain management.

Effects of Pomegranate Peel Extract and/or Lactic Acid as Natural Preservatives on Physicochemical, Microbiological Properties, Antioxidant Activity, and Storage Stability of Khalal Barhi Date Fruits.

The use of natural preservatives in the storage of fresh fruits is a promising approach to healthier and more sustainable food processing. The current study was conducted to evaluate the effect of pomegranate peel extract (PPE) and lactic acid (LA) as natural preservatives on the shelf life of Khalal Barhi date fruits. Physicochemical properties, antioxidant activity, color parameters, texture profile, sensory characteristics, and microbiological quality of date fruits were evaluated during six weeks of cold storage (4 ± 1 °C). The bioactive compounds in PPE were determined by HPLC analysis, which showed that PPE is a rich source of bioactive compounds, particularly phenolics and flavonoids. The results exhibited decreased moisture content (from 68.36-68.43 to 62.13-63.11%) and an increased soluble solids content (from 27.16-27.24 to 31.45-33.91%) in all samples with prolonged storage. Likewise, a slight decrease in the pH (from 6.00-6.28 to 4.89-5.29) with an increase in acidity (from 0.12-0.14 to 0.23-0.27%) during storage was observed. Generally, treated samples showed lower changes in moisture content, soluble solids content, pH, and acidity than the control. A decrease in total phenolic content (TPC) (from 8.22-12.36 to 3.19-5.17 mg GAE/g) and antioxidant activity (from 44.11-68.26 to 23.84-38.52%) of all samples was observed with progressed storage, meanwhile, the treatment with PPE significantly (p < 0.05) increased TPC with a concomitant increase in antioxidant activity and maintained higher values of both throughout storage. The results exhibited a decrease in L* (from 54.87-55.92 to 41.68-45.68) and b* (from 36.25-37.09 to 23.59-25.42) values of all samples, while the a* value of all samples increased (from 1.29-1.40 to 2.22-2.43) with storage. Dipping treatment in PPE solution improved the color, exhibited the lowest change in color parameters, and maintained better texture properties during storage. Similarly, sensory properties decreased (from 8.21-8.66 to 6.71-7.21) during storage with insignificant (p > 0.05) differences among samples. Dipping treatments inhibited the growth of yeasts and molds over time, with the lowest microbial count recorded in the PPE-treated samples. It can be concluded that PPE was found to have protective effects on Khalal Barhi date fruit quality by controlling post-harvest changes and lowering the microbial load.

Virtual monochromatic images for coronary artery imaging with a spectral photon-counting CT in comparison to dual-layer CT systems: a phantom and a preliminary human study.

OBJECTIVES: To evaluate the quality of virtual monochromatic images (VMIs) from spectral photon-counting CT (SPCCT) and two energy-integrating detector dual-energy CT (EID-DECT) scanners from the same manufacturer, for the coronary lumen. METHODS: A 21-cm section of the Mercury v4.0 phantom was scanned using a cardiac CT protocol. VMIs from 40 to 90 keV were reconstructed using high-resolution (HR) parameters for EID-DECT and SPCCT (CB and HRB kernels at 0.67 mm slice thickness, respectively). Ultra-high-resolution (UHR) parameters were used in addition to SPCCT (detailed-2 kernel, 0.43 mm slice thickness). Noise-power-spectrum (NPS), task-based transfer function (TTF), and detectability index (d') were computed for 2-mm-diameter lumen detection. In consensus, two radiologists analyzed the quality of the images from 8 patients who underwent coronary CTA on both CT systems. RESULTS: For all keV images, fpeak, f50, and d' were higher with SPCCT. The fpeak and f50 were higher with UHR-SPCCT with greater noise and lower d' compared to those of the HR-SPCCT images. Noise magnitude was constant for all energy levels (keV) with both systems, and lower with HR images, and d' decreased as keV decreased. Subjective analysis showed greater lumen sharpness and overall quality for HR and UHR-SPCCT images using all keV, with a greater difference at low keV compared to HR-EID-DECT images. CONCLUSION: HR and UHR-SPCCT images gave greater detectability of the coronary lumen for 40 to 90 keV VMIs compared to two EID-DECT systems, with benefits of higher lumen sharpness and overall quality. KEY POINTS: • Compared with 2 dual-energy CT systems, spectral photon-counting CT (SPCCT) improved spatial resolution, noise texture, noise magnitude, and detectability of the coronary lumen. • Use of ultra-high-resolution parameters with SPCCT improved spatial resolution and noise texture and provided high detectability of the coronary lumen, despite an increase in noise magnitude. • In eight patients, radiologists found greater overall image quality with SPCCT for all virtual monochromatic images with a greater difference at low keV, compared with dual-energy CT systems.

Lung Dual-Energy CT Perfusion Blood Volume as a Marker of Severity in Chronic Thromboembolic Pulmonary Hypertension.

In chronic thromboembolic pulmonary hypertension (CTEPH), assessment of severity requires right heart catheterization (RHC) through cardiac index (CI). Previous studies have shown that dual-energy CT allows a quantitative assessment of the lung perfusion blood volume (PBV). Therefore, the objective was to evaluate the quantitative PBV as a marker of severity in CTEPH. In the present study, thirty-three patients with CTEPH (22 women, 68.2 ± 14.8 years) were included from May 2017 to September 2021. Mean quantitative PBV was 7.6% ± 3.1 and correlated with CI (r = 0.519, p = 0.002). Mean qualitative PBV was 41.1 ± 13.4 and did not correlate with CI. Quantitative PBV AUC values were 0.795 (95% CI: 0.637-0.953, p = 0.013) for a CI ≥ 2 L/min/m2 and 0.752 (95% CI: 0.575-0.929, p = 0.020) for a CI ≥ 2.5 L/min/m2. In conclusion, quantitative lung PBV outperformed qualitative PBV for its correlation with the cardiac index and may be used as a non-invasive marker of severity in CTPEH patients.

Extensive Arterial and Venous Thrombosis in a Female With a Known Untreated Polycystic Ovarian Syndrome: A Case Report.

Polycystic ovarian syndrome (PCOS) is a common heterogeneous endocrine disease associated with a twofold higher risk of stroke and venous thromboembolism (VTE). An 18-year-old female presented to the emergency department (ED) with a one-hour history of right-side body weakness, facial asymmetry, and altered mental status. The patient had poor mentation and was unable to protect her airway. She was intubated and admitted to the intensive care unit (ICU). She was diagnosed with polycystic ovarian syndrome three years ago; however, she was not on active treatment at the time of presentation. She received two doses of the BNT162b2 mRNA COVID-19 vaccine, and her last dose was six months before the current presentation. A workup showed that she had extensive arterial and venous thrombosis. Later during investigations, she was found to have a complex atrial septal defect (ASD) with a left-to-right shunt. This case reports a management approach for a young female with untreated polycystic ovarian syndrome that predisposed her to develop deep vein thrombosis (DVT), pulmonary embolism (PE), and ischemic stroke due to atrial septal defect with possible transient shunt reversal.

First Experience With a Whole-Body Spectral Photon-Counting CT Clinical Prototype.

ABSTRACT: Spectral photon-counting computed tomography (SPCCT) technology holds great promise for becoming the next generation of computed tomography (CT) systems. Its technical characteristics have many advantages over conventional CT imaging. For example, SPCCT provides better spatial resolution, greater dose efficiency for ultra-low-dose and low-dose protocols, and tissue contrast superior to that of conventional CT. In addition, SPCCT takes advantage of several known approaches in the field of spectral CT imaging, such as virtual monochromatic imaging and material decomposition imaging. In addition, SPCCT takes advantage of a new approach in this field, known as K-edge imaging, which allows specific and quantitative imaging of a heavy atom-based contrast agent. Hence, the high potential of SPCCT systems supports their ongoing investigation in clinical research settings. In this review, we propose an overview of our clinical research experience of a whole-body SPCCT clinical prototype, to give an insight into the potential benefits for clinical human imaging on image quality, diagnostic confidence, and new approaches in spectral CT imaging.