Ultrasound of the bowel with a focus on IBD: the new best practice.

Inflammatory Bowel Disease (IBD) is a lifelong chronic disease affecting any part of the gastrointestinal tract with a predilection for the terminal ileum. IBD patients require repeat imaging throughout the course of their disease, necessitating a safe, noninvasive, available, and repeatable method. Imaging is required at diagnosis, routine surveillance, and acute exacerbation of disease. Ultrasound imaging meets these demands with a high degree of accuracy and wide patient acceptance. Ultrasound provides high-resolution imaging and is excellent for detailed evaluation of the bowel wall and surrounding soft tissues. Regular greyscale bowel evaluation and color Doppler imaging now have accepted standards for evaluating disease activity based on wall thickness, perienteric inflammatory fat, and blood flow, which is invaluable in staging and grading disease. High-resolution dynamic real-time imaging on ultrasound has the ability to show functional as well as morphologic detail, including dysfunctional peristalsis associated with bowel stricture and incomplete mechanical bowel obstruction. Fibrostenotic and penetrating complications of IBD may be associated with an acute or chronic presentation that is easily assessed using ultrasound. Newer software technologies for ultrasound, including Contrast-Enhanced ultrasound and Shear wave elastography, have transformed ultrasound from a basic preliminary imaging technique into a highly sophisticated modality that is now competitive with CT and MR enterography for managing IBD patients. Our long experience with ultrasound of the bowel suggests that the new best practice would include ultrasound as the first test for evaluation of the bowel at any stage of the disease.

Data visualization and decision making in adults with acquired and developmental language disabilities: A scoping review.

BACKGROUND: Accessibility of data visualization has been explored for users with visual disabilities but the needs of users with language disabilities have seldom been considered. AIM: This scoping review synthesised what is known about data visualization for adults with language disabilities, specifically the acquired language disability, aphasia and Developmental Language Disorder. It sought to extract key findings and identify what practices support effective visualization for decision making for people with language disabilities. METHOD: Papers were included if they investigated visualization of data, and the consumers of the data visualization were people with aphasia or developmental language disability. Seven databases were searched: CINAHL, Academic Search, Medline, PsychINFO, Ovid, ACM Digital Library and IEEE Xplore. Included studies were charted to extract title, author(s), year, country, paper type, scientific field, participant number(s), participant group(s), main topic, subtopic, method, task description, task category, data visualization, summary, key findings relevant to the review question, and guidelines or recommendations. Narrative synthesis was used to describe how people with language disability have interacted with data visualization from a range of literature. MAIN CONTRIBUTION: Six studies (seven publications) were included in the review. One study came from the field of health, one from a disability rights collaboration and four studies from computer science. No studies satisfying the review criteria explored data visualization for Developmental Language Disorder; however, five studies explored participants with cognitive disabilities that included impairments of language, so these were included. A range of visualization designs were found. Studies predominantly explored understanding of visualization (4/6). One study explored how to express data visually, and one explored the use of the visualization that is, for an action, choice, or decision. Cognitively accessible data visualization practices were described in four papers and synthesized. Supportive practices reported were reducing the cognitive load associated with processing a visualization and increasing personal relevance of data visualization. CONCLUSION: Accessible data visualization for adults with aphasia and Developmental Language Disorder has only minimally been explored. Practices to specifically support users with language disability are not yet apparent. As data use in making everyday decisions is widespread, future research should explore how people with language disabilities make use of data visualization. WHAT THIS PAPER ADDS: What is already known on this subject Visual resources are used widely to support people with language disabilities in understanding of language. That is, icons, maps timelines and so forth, are used to support auditory processing. However, data visualization is used routinely by people without a language disability to support everyday decisions for example, visualization of live traffic data is used to provide users with the best route to their destination. It is unclear whether any work has explored data visualization for people with language disabilities.  What this paper adds to existing knowledge This paper brings together research on the use of data visualization by adults with either Developmental Language Disorder or aphasia, collectively people with language disabilities. It highlights a gap in the design of inclusive data visualization for language disabilities and the minimal research exploring the use of data visualization for decision making in these populations. What are the clinical implications of this work? Access to data can be empowering. It has potential to enable agency in decisions and increase social participation. The existing gap in knowledge about how to design inclusive data visualization for people with language disabilities thus poses a risk of exclusion and threats to informed decision making. Highlighting the current field of literature may drive research and clinical activity.

Fine-scale Dietary Polyphenol Intake is Associated with Systemic and Gastrointestinal Inflammation in Healthy Adults.

BACKGROUND: Polyphenols are dietary bioactive compounds, many of which have anti-inflammatory properties. However, information on the intake of dietary polyphenols at the class and compound level and their associations with gastrointestinal (GI) and systemic inflammation is lacking. OBJECTIVE: Estimate dietary polyphenol intake in healthy adults and examine its relationship with GI and systemic inflammation markers. METHODS: Healthy adults (n = 350) completed the USDA Nutritional Phenotyping Study, an observational, cross-sectional study balanced for age, sex, and body mass index. Dietary intake, assessed via multiple 24-hour recalls, was ingredientized and mapped to FooDB, a comprehensive food composition database. Dietary polyphenol intake (total, class, compound) was estimated and examined for its relationship to GI and systemic inflammation markers using linear models and random forest regressions. RESULTS: Mean total polyphenol intake was approximately 914 mg/1000 kcal per day with flavonoids as the greatest class contributor (495 mg/1000 kcal per day). Tea, coffee, and fruits were among the largest food contributors to polyphenol intake. Total polyphenol intake negatively associated with the GI inflammation marker, fecal calprotectin (ß=-0.004, p=0.04). At the class level, polyphenols categorized as prenol lipids (ß=-0.94, p<0.01) and phenylpropanoic acids (ß=-0.92, p<0.01) negatively associated with plasma lipopolysaccharide-binding protein, a proxy for GI permeability. Food sources of these two classes included mainly olive products. We further detected a positive association between C-Reactive protein and polyphenols in the "cinnamic acids and derivatives" class using hierarchical feature engineering and random forest modeling. CONCLUSION: Even in healthy adults, dietary polyphenol intake was negatively associated with GI inflammation and intake of prenol lipids and phenylpropanoic acids were negatively associated with GI permeability. Relationships between polyphenol intake and inflammatory outcomes varied with the resolution - total, class, compound - of polyphenol intake, suggesting a nuanced impact of polyphenols on GI and systemic inflammation. CLINICAL TRIAL REGISTRY: NCT02367287, ClinicalTrials.gov.

Exploring the influence of washing activities on the transfer and persistence of fibres in forensic science.

In forensic science, a robust and sound interpretation and evaluation of transferred fibre evidence requires an understanding of the principles and mechanisms that underpin fibre transfer, yet existing research lacks consistency and repeatability. This study investigates the impact of washing activities on both the release of fibres into wastewater and the transfer of constituent fibres from donor garments to receiver swatches. Using a low-cost friction tester and automated data collection through photography and ImageJ image processing software, controlled conditions were maintained for repeated experiments. Results indicated significant fibre release during wash cycles, with load size and donor garment history playing crucial roles. The donor garments subjected to repetitive washes exhibit a progressive decrease in the number of fibres transferred, independently of the load size. This study underscores the importance of considering a garment's washing history in forensic science contexts, but also for consistency in the way that data are collected.

Mental Health, Drug Use, and Programming: Applying a Needs Assessment Framework in Arkansas' Largest Jail.

Jail programming is rarely informed by site-specific health needs, diagnostic-specific screening tools that are validated, or the input of incarcerated individuals. Using the community needs assessment (CNA) framework, we aimed to fill these gaps among people incarcerated in the Pulaski County Regional Detention Facility (PCRDF), Arkansas' largest jail. Participants were 179 adults at the PCRDF who completed surveys and open-ended questions focused on (a) their mental and behavioral health and (b) programming needs at the facility. Using a concurrent transformative mixed-methods design, we descriptively analyzed surveys and conducted content analysis of the open-ended questions. Over half of participants reported clinically significant anxiety (62.6%), post-traumatic stress disorder (53.1%), and/or depression (50.3%) symptoms; positive substance use disorder screening was especially common (91.7%). Nearly all (97%) individuals queried desired more programming, with the most desired being mental health and substance use programs. Other desired programs included physical health, education, community reintegration, family support, recreation, nutrition, religious/spiritual services, and meditation. Our CNA ensured the input of those directly impacted during program-focused decision making and identified strategies to effectively implement and sustain jail-based programs. Such assessments can be a potential mechanism for addressing the burden of mental and behavioral health problems in jail populations.

Liver Imaging Reporting and Data System Contrast-Enhanced US Nonradiation Treatment Response Assessment Version 2024.

The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) standardizes the imaging technique, reporting lexicon, disease categorization, and management for patients with or at risk for hepatocellular carcinoma (HCC). LI-RADS encompasses HCC surveillance with US; HCC diagnosis with CT, MRI, or contrast-enhanced US (CEUS); and treatment response assessment (TRA) with CT or MRI. LI-RADS was recently expanded to include CEUS TRA after nonradiation locoregional therapy or surgical resection. This report provides an overview of LI-RADS CEUS Nonradiation TRA v2024, including a lexicon of imaging findings, techniques, and imaging criteria for posttreatment tumor viability assessment. LI-RADS CEUS Nonradiation TRA v2024 takes into consideration differences in the CEUS appearance of viable tumor and posttreatment changes within and in close proximity to a treated lesion. Due to the high sensitivity of CEUS to vascular flow, posttreatment reactive changes commonly manifest as areas of abnormal perilesional enhancement without washout, especially in the first 3 months after treatment. To improve the accuracy of CEUS for nonradiation TRA, different diagnostic criteria are used to evaluate tumor viability within and outside of the treated lesion margin. Broader criteria for intralesional enhancement increase sensitivity for tumor viability detection. Stricter criteria for perilesional enhancement limit miscategorization of posttreatment reactive changes as viable tumor. Finally, the TRA algorithm reconciles intralesional and perilesional tumor viability assessment and assigns a single LI-RADS treatment response (LR-TR) category: LR-TR nonviable, LR-TR equivocal, or LR-TR viable.

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict.

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study.

BACKGROUND: Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. METHODS: Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. RESULTS: Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). CONCLUSION: There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. IMPLICATIONS: The results will be important to consider for a future intervention, although further consultation will be needed for app development. PATIENT OR PUBLIC CONTRIBUTION: Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.

Psychoneuroimmunology in multiple myeloma and autologous hematopoietic stem cell transplant: Opportunities for research among patients and caregivers.

Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.

Lower Diet Quality Associated with Subclinical Gastrointestinal Inflammation in Healthy United States Adults.

BACKGROUND: Higher diet quality has been associated with lower risk of developing inflammatory bowel disease, but associations between diet and gastrointestinal (GI) inflammation in healthy adults prior to disease onset are understudied. OBJECTIVES: The purpose of this project was to examine associations between reported dietary intake and markers of GI inflammation in a healthy adult human cohort. METHODS: In a cross-sectional observational trial of 358 healthy adults, participants completed ≤3 unannounced 24-h dietary recalls using the Automated Self-Administered Dietary Assessment Tool and a Block 2014 Food Frequency Questionnaire to assess recent and habitual intake, respectively. Those who provided a stool sample were included in this analysis. Inflammation markers from stool, including calprotectin, neopterin, and myeloperoxidase, were measured by ELISA along with LPS-binding protein from plasma. RESULTS: Recent and habitual fiber intake was negatively correlated with fecal calprotectin concentrations (n = 295, P = 0.011, 0.009). Habitual soluble fiber intake was also negatively correlated with calprotectin (P = 0.01). Recent and habitual legume and vegetable intake was negatively correlated with calprotectin (P = 0.013, 0.026, 0.01, 0.009). We observed an inverse correlation between recent Healthy Eating Index (HEI) scores and calprotectin concentrations (n = 295, P = 0.026). Dietary Inflammatory Index scores were calculated and positively correlated with neopterin for recent intake (n = 289, P = 0.015). When participants with clinically elevated calprotectin were excluded, recent and habitual fiber, legume, vegetable, and fruit intake were negatively correlated with calprotectin (n = 253, P = 0.00001, 0.0002, 0.045, 0.001, 0.009, 0.001, 0.004, 0.014). Recent total HEI score was inversely correlated with subclinical calprotectin (P = 0.003). CONCLUSIONS: Higher diet quality may be protective against GI inflammation even in healthy adults. This trial was registered at clinicaltrials.gov as NCT02367287.

Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound.

BACKGROUND: Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed. AIMS: To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition. METHODS: We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2. RESULTS: There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation. CONCLUSIONS: This systematic review is the first step for a structured program to develop a stricture IUS index for CD.

Twelve Weeks of Daily Lentil Consumption Improves Fasting Cholesterol and Postprandial Glucose and Inflammatory Responses-A Randomized Clinical Trial.

Lentils have potential to improve metabolic health but there are limited randomized clinical trials evaluating their comprehensive impact on metabolism. The aim of this study was to assess the impact of lentil-based vs. meat-based meals on fasting and postprandial measures of glucose and lipid metabolism and inflammation. Thirty-eight adults with an increased waist circumference (male ≥ 40 inches and female ≥ 35 inches) participated in a 12-week dietary intervention that included seven prepared midday meals totaling either 980 g (LEN) or 0 g (CON) of cooked green lentils per week. Linear models were used to assess changes in fasting and postprandial markers from pre- to post-intervention by meal group. Gastrointestinal (GI) symptoms were assessed through a survey randomly delivered once per week during the intervention. We found that regular consumption of lentils lowered fasting LDL (F = 5.53, p = 0.02) and total cholesterol levels (F = 8.64, p < 0.01) as well as postprandial glucose (ß = -0.99, p = 0.01), IL-17 (ß = -0.68, p = 0.04), and IL-1ß (ß = -0.70, p = 0.03) responses. GI symptoms were not different by meal group and all symptoms were reported as "none" or "mild" for the duration of the intervention. Our results suggest that daily lentil consumption may be helpful in lowering cholesterol and postprandial glycemic and inflammatory responses without causing GI stress. This information further informs the development of pulse-based dietary strategies to lower disease risk and to slow or reverse metabolic disease progression in at-risk populations.

LI-RADS CT and MRI Ancillary Feature Association with Hepatocellular Carcinoma and Malignancy: An Individual Participant Data Meta-Analysis.

Background The independent contribution of each Liver Imaging Reporting and Data System (LI-RADS) CT or MRI ancillary feature (AF) has not been established. Purpose To evaluate the association of LI-RADS AFs with hepatocellular carcinoma (HCC) and malignancy while adjusting for LI-RADS major features through an individual participant data (IPD) meta-analysis. Materials and Methods Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from January 2014 to January 2022 for studies evaluating the diagnostic accuracy of CT and MRI for HCC using LI-RADS version 2014, 2017, or 2018. Using a one-step approach, IPD across studies were pooled. Adjusted odds ratios (ORs) and 95% CIs were derived from multivariable logistic regression models of each AF combined with major features except threshold growth (excluded because of infrequent reporting). Liver observation clustering was addressed at the study and participant levels through random intercepts. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2. Results Twenty studies comprising 3091 observations (2456 adult participants; mean age, 59 years ± 11 [SD]; 1849 [75.3%] men) were included. In total, 89% (eight of nine) of AFs favoring malignancy were associated with malignancy and/or HCC, 80% (four of five) of AFs favoring HCC were associated with HCC, and 57% (four of seven) of AFs favoring benignity were negatively associated with HCC and/or malignancy. Nonenhancing capsule (OR = 3.50 [95% CI: 1.53, 8.01]) had the strongest association with HCC. Diffusion restriction (OR = 14.45 [95% CI: 9.82, 21.27]) and mild-moderate T2 hyperintensity (OR = 10.18 [95% CI: 7.17, 14.44]) had the strongest association with malignancy. The strongest negative associations with HCC were parallels blood pool enhancement (OR = 0.07 [95% CI: 0.01, 0.49]) and marked T2 hyperintensity (OR = 0.18 [95% CI: 0.07, 0.45]). Seventeen studies (85%) had a high risk of bias. Conclusion Most LI-RADS AFs were independently associated with HCC, malignancy, or benignity as intended when adjusting for major features. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Crivellaro in this issue.

Unique portal venous phase imaging discordance between CEUS and MRI: a valuable predictor of intrahepatic cholangiocarcinoma?

PURPOSE: We have long noted unique portal venous phase (PVP) imaging discordance of focal liver masses between CEUS, showing rapid marked washout, and MRI, showing progressive or sustained enhancement. We postulate association of this unique discordance with intrahepatic cholangiocarcinoma (ICC) and causal relationship to different contrast agent behavior. We investigate this unique discordance, propose its clinical significance for ICC diagnosis, and confirm further histologic associations. METHODS: Cases were collected within our CEUS department and from pathology records over a ten-year interval. This retrospective review includes 99 patients, 73 with confirmed ICC and 26 other diagnoses, showing unique PVP discordance. The CEUS and MRI enhancement characteristics were compared for all patients. RESULTS: Unique discordance is identified in 67/73 (92%) ICC and difference between the PVP appearance on MRI and CEUS is statistically significant (p <  0.0001). Arterial phase enhancement did not show statistically significant difference between CEUS and MRI, p >  0.05. Other diagnoses showing unique discordance include especially lymphoma (n = 7), sclerosed hemangioma (n = 6), HCC (n = 4), metastases (n = 2), and other rare entities. CONCLUSION: ICC shows this discrepant intermodality enhancement pattern in a statistically significant number of cases and should be considered along with other LR-M features in at-risk patients. Discordance is also rarely seen in a number of other liver lesions.

Contrast-enhanced ultrasound liver imaging reporting and data system: clinical validation in a prospective multinational study in North America and Europe.

BACKGROUND AND AIMS: The objective of this study is to determine the diagnostic accuracy of the American College of Radiology Contrast-Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System LR-5 characterization for HCC diagnosis in North American or European patients. APPROACH AND RESULTS: A prospective multinational cohort study was performed from January 2018 through November 2022 at 11 academic and nonacademic centers in North America and Europe. Patients at risk for HCC with at least 1 liver observation not previously treated, identified on ultrasound (US), or multiphase CT or MRI performed as a part of standard clinical care were eligible for the study. All participants were examined with CEUS of the liver within 4 weeks of CT/MRI or tissue diagnosis to characterize up to 2 liver nodules per participant using ACR CEUS Liver Imaging Reporting and Data System. Definite HCC diagnosis on the initial CT/MRI, imaging follow-up, or histology for CT/MRI-indeterminate nodules were used as reference standards. A total of 545 nodules had confirmed reference standards in 480 patients, 73.8% were HCC, 5.5% were other malignancies, and 20.7% were nonmalignant. The specificity of CEUS LR-5 for HCC was 95.1% (95% CI 90.1%-97.7%), sensitivity 62.9% (95% CI 57.9%-67.7%), positive predictive value 97.3% (95% CI 94.5%-98.7%), and negative predictive value 47.7% (95% CI 41.7%-53.8%). In addition, benign CEUS characterization (LR-1 or LR-2) had 100% specificity and 100% positive predictive value for nonmalignant liver nodules. CONCLUSIONS: CEUS Liver Imaging Reporting and Data System provides an accurate categorization of liver nodules in participants at risk for HCC.

Synoptic Reporting of Focal Liver Masses in at Risk Patients: Algorithmic Diagnosis and CEUS LI-RADS.

OBJECTIVES: Reporting contrast-enhanced ultrasound (CEUS) for focal liver masses in at risk patients is a challenging task. Traditionally used prose reporting (PR) is inconsistent and lacks standardization. We propose synoptic reporting (SR), encompassing algorithmic interpretation and liver imaging and reporting data system (LI-RADS) categorization. METHODS: A software worksheet from Kailo Medical (Melbourne, AU), incorporates the CEUS algorithm for liver interpretation and CEUS LI-RADS categorization. Part 1. Feasibility of SR: twenty participants of varying experience were presented a brief lecture on SR, algorithmic approach to liver mass interpretation, and CEUS LI-RADS categorization. Ten representative liver masses were shown as unknown cases. Participants inputted data into SR worksheets. Results and LI-RADS category were generated solely by SR. Data were categorized as "correct" or "incorrect." Part 2. Prospective Analysis: Ninety-one patients for SR and 56 for PR, all were tested for completeness, efficiency, and user satisfaction. RESULTS: Part 1: Junior participants, pass rate 81.6%, and senior participants, pass rate 83.3% showed no difference in performance. Part 2: Completeness: SR 98.4% and PR 87.0%. Efficiency: Average total time to completion: SR 11 minutes and PR 20 minutes. User satisfaction: Ultrasound technologists, all referring physicians, and six out of seven radiologists preferred SR over PR. Major benefits cited were total time saved, consistency and accuracy in documentation, and report completeness. CONCLUSIONS: SR is a reliable and useful tool in clinical practice to report liver masses on ultrasound and assign an appropriate LI-RADS categorization and management pathway. This ultimately improves communication with referring clinicians and leads to better patient outcomes.

Gut Microbiota Richness and Diversity Track With T Cell Aging in Healthy Adults.

BACKGROUND: This study examined how gut microbiota diversity and richness relate to T cell aging among 96 healthy adults of all ages. It also explored whether these links differed throughout the lifespan. METHODS: Peripheral blood was obtained from 96 study participants (N = 96, aged 21-72) to assess mRNA markers of T cell aging (p16ink4a, p14ARF, B3gat1, Klrg1) and DNA methylation. T cell aging mRNA markers were combined into an aging index, and the Horvath epigenetic clock algorithm was used to calculate epigenetic age based on DNA methylation status of over 500 loci. Participants also collected a stool sample from which the V4 region of the 16S rRNA gene was sequenced to derive the Shannon and Simpson diversity indices, and the total count of observed operational taxonomic units (richness). Models controlled for BMI, comorbidities, sex, dietary quality, smoking status, physical activity, and sleep quality. RESULTS: Lower microbiota richness was associated with higher T cell age based on mRNA markers, but when probing the region of significance, this relationship was only significant among adults 45 years and older (p = .03). Lower Shannon diversity (p = .05) and richness (p = .07) marginally correlated with higher epigenetic age (ie, greater T cell DNA methylation). CONCLUSIONS: Gut microbiota complexity may correspond with the rate of T cell aging, especially in mid-to-late life. These results suggest an interplay between the gut microbiome and immunological aging that warrants further experimental work.

Depression, Inflammation, and the Moderating Role of Metformin: Results from the Midlife in the United States (MIDUS) Study and Sacramento Area Latino Study on Aging (SALSA).

OBJECTIVE: Depression can promote inflammation and accelerate aging. Metformin, a widely prescribed antidiabetic, has shown promising preclinical evidence of aging-related health benefits, including decreased inflammation. The current study examined whether metformin usage buffers the association between depressive symptoms and inflammatory markers in two large samples of middle-aged and older, primarily white adults, and older Latino adults. METHODS: Data from the Midlife in the United States Study (MIDUS; N = 1255) and the Sacramento Area Latino Study on Aging (SALSA; N = 1786) included information on medication use, depressive symptoms, and inflammatory markers, namely IL-6, TNF-α, and CRP. These data were merged into a harmonized sample, and the sample group variable was included in a three-way interaction for analysis. RESULTS: Specifically, in the MIDUS sample, metformin buffered the association between depressive symptoms and CRP (b = -0.029, SE = 0.013, p = .007) and IL-6 (b = 0.21, SE = 0.010, p = .046), while no significant association was found with TNF-α. Metformin non-users displayed higher depressive symptoms associated with elevated CRP (b = 0.01, SE = 0.003, p < .001) and IL-6 (b = 0.011, SE = 0.003, p < .001), whereas this association was not present among metformin users (ps > .068). Conversely, in the SALSA sample, metformin use did not show a significant protective link. CONCLUSION: Results from mostly white, highly educated adults supported a mitigating role of metformin in ties between depression, a well-known behavioral risk factor, and inflammation, a key source of biological aging. However, the benefits did not extend to a large sample of older Mexican Americans. The findings reveal a hidden potential benefit of this therapeutic agent and raise important questions around its health equity.Trial Registration: The study was pre-registered on OSF (https://osf.io/c92vw/).

Understanding the health effects of caregiving stress: New directions in molecular aging.

Dementia caregiving has been linked to multiple health risks, including infectious illness, depression, anxiety, immune dysregulation, weakened vaccine responses, slow wound healing, hypertension, cardiovascular disease, metabolic syndrome, diabetes, frailty, cognitive decline, and reduced structural and functional integrity of the brain. The sustained overproduction of proinflammatory cytokines is a key pathway behind many of these risks. However, contrasting findings suggest that some forms of caregiving may have beneficial effects, such as maintaining caregivers' health and providing a sense of meaning and purpose which, in turn, may contribute to lower rates of functional decline and mortality. The current review synthesizes these disparate literatures, identifies methodological sources of discrepancy, and integrates caregiver research with work on aging biomarkers to propose a research agenda that traces the mechanistic pathways of caregivers' health trajectories with a focus on the unique stressors facing spousal caregivers as compared to other informal caregivers. Combined with a focus on psychosocial moderators and mechanisms, studies using state-of-the-art molecular aging biomarkers such as telomere length, p16INK4a, and epigenetic age could help to reconcile mixed literature on caregiving's sequelae by determining whether and under what conditions caregiving-related experiences contribute to faster aging, in part through inflammatory biology. The biomarkers predict morbidity and mortality, and each contributes non-redundant information about age-related molecular changes -together painting a more complete picture of biological aging. Indeed, assessing changes in these biopsychosocial mechanisms over time would help to clarify the dynamic relationships between caregiving experiences, psychological states, immune function, and aging.

Older Adults' Social Profiles and Links to Functional and Biological Aging in the United States and Mexico.

OBJECTIVE: Social stress-loneliness, isolation, and low relationship quality-increase risks for aging-related diseases. However, the ways in which they intersect to undermine healthy aging remain poorly understood. We utilized latent class analysis to identify groups of older adults based on their social stress in both the United States and Mexico. Thereafter, we examined their cross-sectional associations with markers of functional and biological aging. METHOD: Participants in the Health and Retirement Study (HRS, N = 8,316) and Mexican Health and Aging Study (MHAS, N = 15,001) reported their loneliness, isolation (i.e., living alone), and relationship quality with spouse, children, and friends. Outcomes included C-reactive protein (CRP), functional limitations, self-rated health, comorbidities, gait speed, and grip strength. Models controlled for demographics, health behaviors, and body mass index (BMI). RESULTS: In both countries, five classes emerged, a Supported group and four with elevated social stress: (1) Strained, (2) Isolated, (3) Spousal Ambivalence, and (4) Unhappily Married. Compared to the others, Strained participants in both samples had greater functional limitations, poorer self-rated health, and more comorbidities, as well as slower gait in HRS and weaker grip in MHAS. Generally, Supported participants fared better than the other groups. In HRS, CRP levels differed between the Strained group and others, but these associations were explained by health behaviors and BMI. CONCLUSIONS: Older adults in both countries with strained relationships fared worst in their aging-related outcomes, revealing new insights about the links between toxic social stress and unhealthy aging.