An Investigative Analysis of Therapeutic Strategies in Hepatocellular Carcinoma: A Raetrospective Examination of 23 Biopsy-Confirmed Cases Emphasizing the Significance of Histopathological Insights.

BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) combines standardized terminology with a classification system for imaging findings in patients with HCC, therefore rendering diagnostic biopsy unnecessary in many cases. This retrospective study included 23 patients with a biopsy diagnosis of HCC, performed either before or after local interventional procedures, in order to evaluate the histopathologic changes induced by previous procedures and their potential influence on the response to immune therapy. MATERIAL AND METHODS: The study encompassed a cohort of patients diagnosed with Hepatocellular Carcinoma (HCC). Diagnosis was established via contrast-enhanced computer tomography or magnetic resonance imaging that identified LI-RADS-5 nodules in conjunction with historical liver disease and elevated alpha-fetoprotein (AFP) levels or via histological examination confirming positivity for glypican3, heat shock protein 70, and glutamine synthetase. The study detailed the liver disease etiology, LI-RADS scores, characteristics and dimensions of HCC nodules, serum AFP concentrations, Edmondson-Steiner grading, and the expression of programmed cell death ligand 1 (PD-L1) in the tumor cells. RESULTS: Among the study's cohort of Hepatocellular Carcinoma (HCC) patients, a portion had not received any prior treatments, while the remainder experienced local HCC recurrence following trans-arterial chemoembolization or radiofrequency ablation. Observations indicated elevated alpha-fetoprotein (AFP) levels in those who had not undergone any previous interventions, showing statistical significance. The Edmondson-Steiner classification predominantly identified grade III differentiation across patients, irrespective of their treatment history. Furthermore, an increase in intra-tumoral programmed cell death ligand 1 (PD-L1) expression was noted in patients who had not been subjected to previous therapies. CONCLUSION: Liver biopsy offers valuable insights for patients with Hepatocellular Carcinoma (HCC), assisting in the tailoring of immune therapy strategies, particularly in cases of recurrence following prior local interventions.

Pancreatic Adenocarcinoma: Imaging Modalities and the Role of Artificial Intelligence in Analyzing CT and MRI Images.

Pancreatic ductal adenocarcinoma (PDAC) stands out as the predominant malignant neoplasm affecting the pancreas, characterized by a poor prognosis, in most cases patients being diagnosed in a nonresectable stage. Image-based artificial intelligence (AI) models implemented in tumor detection, segmentation, and classification could improve diagnosis with better treatment options and increased survival. This review included papers published in the last five years and describes the current trends in AI algorithms used in PDAC. We analyzed the applications of AI in the detection of PDAC, segmentation of the lesion, and classification algorithms used in differential diagnosis, prognosis, and histopathological and genomic prediction. The results show a lack of multi-institutional collaboration and stresses the need for bigger datasets in order for AI models to be implemented in a clinically relevant manner.

A "Mix and Match" in Hemochromatosis-A Case Report and Literature Focus on the Liver.

Hemochromatosis is a genetic disorder characterized by increased iron storage in various organs with progressive multisystemic damage. Despite the reports dating back to 1865, the diagnosis of hemochromatosis poses a challenge to clinicians due to its non-specific symptoms and indolent course causing significant delay in disease recognition. The key organ that is affected by iron overload is the liver, suffering from fibrosis, cirrhosis or hepatocellular carcinoma, complications that can be prevented via early diagnosis and treatment. This review aims to draw attention to the pitfalls in diagnosing hemochromatosis. We present a case with multiorgan complaints, abnormal iron markers and a consistent genetic result. We then examine the relevant literature and discuss hemochromatosis subtypes and liver involvement, including transplant outcome and treatment options. In summary, hemochromatosis remains difficult to diagnose due to its symptom heterogeneity and rarity; thus, further education for practitioners of all disciplines is useful in facilitating its early recognition and management.

Liver Transplant in Patients with Hepatocarcinoma: Imaging Guidelines and Future Perspectives Using Artificial Intelligence.

Hepatocellular carcinoma is the most common primary malignant hepatic tumor and occurs most often in the setting of chronic liver disease. Liver transplantation is a curative treatment option and is an ideal solution because it solves the chronic underlying liver disorder while removing the malignant lesion. However, due to organ shortages, this treatment can only be applied to carefully selected patients according to clinical guidelines. Artificial intelligence is an emerging technology with multiple applications in medicine with a predilection for domains that work with medical imaging, like radiology. With the help of these technologies, laborious tasks can be automated, and new lesion imaging criteria can be developed based on pixel-level analysis. Our objectives are to review the developing AI applications that could be implemented to better stratify liver transplant candidates. The papers analysed applied AI for liver segmentation, evaluation of steatosis, sarcopenia assessment, lesion detection, segmentation, and characterization. A liver transplant is an optimal treatment for patients with hepatocellular carcinoma in the setting of chronic liver disease. Furthermore, AI could provide solutions for improving the management of liver transplant candidates to improve survival.

Preparation and Characterization of Microalgae Styrene-Butadiene Composites Using Chlorella vulgaris and Arthrospira platensis Biomass.

The food industry is a high consumer of polymer packing materials, sealing materials, and engineering components used in production equipment. Biobased polymer composites used in the food industry are obtained by incorporating different biogenic materials into the structure of a base polymer matrix. Renewable resources such as microalgae, bacteria, and plants may be used as biogenic materials for this purpose. Photoautotrophic microalgae are valuable microorganisms that are able to harvest sunlight energy and capture CO2 into biomass. They are characterized by their metabolic adaptability to environmental conditions, higher photosynthetic efficiency than terrestrial plants, and natural macromolecules and pigments. The flexibility of microalgae to grow in either low-nutrient or nutrient-rich environments (including wastewater) has led to the attention for their use in various biotechnological applications. Carbohydrates, proteins, and lipids are the main three classes of macromolecular compounds contained in microalgal biomass. The content in each of these components depends on their growth conditions. In general, proteins represent 40-70% of microalgae dry biomass, followed by carbohydrates (10-30%) and lipids (5-20%). A distinctive feature of microalgae cells is the presence of light-harvesting compounds such as photosynthetic pigments carotenoids, chlorophylls, and phycobilins, which are also receiving growing interest for applications in various industrial fields. The study comparatively reports on polymer composites obtained with biomass made of two species of green microalgae: Chlorella vulgaris and filamentous, gram-negative cyanobacterium Arthrospira. Experiments were conducted to reach an incorporation ratio of the biogenic material into the matrix in the 5-30% range, and the resulting materials were characterized by their mechanical and physicochemical properties.

Outcomes of simultaneous vs. sequential pars plana vitrectomy and cataract surgery.

The coexistence of cataract and vitreoretinal diseases is common in clinical practice. The technological achievements of the last decade in both types of surgeries, allow simultaneous interventions on lens and retina. This retrospective study assessed the morphofunctional results obtained after performing simultaneous surgeries in a series of 87 patients presenting with both pathologies. The cases were retrospectively reviewed from their clinical records from 2017 to 2019. The patients were divided into two groups: group 1 comprising 41 cases underwent the combined procedure and group 2 comprising 46 patients underwent vitrectomy, followed by cataract surgery after 3-10 months. The functional and anatomical outcomes and the complications were assessed pre- and post-operatively. The statistical analysis was carried out by MaxStat software. The final best corrected visual acuity (BCVA), in group 1 was <0.1 in 4.88% of the cases, 0.1 to 0.3 in 17.07%, 0.3 to 0.5 in 51.22% and >0.5 in 26.83% eyes. In group 2, the final BCVA, after both surgeries were completed was <0.1 in 8.7% cases, 0.1 to 0.3 in 30.43%, 41.3% were 0.3 to 0.5 and 19.57% were >0.5. During the cataract surgery, the most common intraoperative complication was miosis, followed by posterior capsule rupture. Postoperative, 12.2% cases from group 1 developed an immediate inflammatory reaction in the anterior chamber, and 17.07% presented with posterior capsular opacification (PCO). Simultaneous surgery is safe and effective in obtaining a good morphological and functional result and offers the advantage of a clear eye media that allows a safer vitrectomy and thus a quicker rehabilitation of the patient. The analysis of the risks and benefits of each procedure should be taken into account and the cases selected individually for either simultaneous or sequential surgery in order to obtain the best outcomes.

Lumbar artery aneurysm: A rare manifestation of vasculopathy in a patient with neurofibromatosis type 1.

Lumbar artery aneurysms are rare but important to diagnose, since rupture can have serious consequences due to life-threatening hemorrhage. A 49-year-old male with Neurofibromatosis type 1 (NF-1) was admitted to the emergency room with abrupt onset of severe abdominal pain. Ultrasound examination was normal, noncontrast CT revealed a tapered retroperitoneal mass adjacent to the right psoas muscle. A multiphased contrast-enhanced CT scan raised suspicion of an arterial lumbar aneurysm and was confirmed by selective catheter based angiography. The patient underwent successful treatment with endovascular coiling and the patient was discharged within a few days after an uneventful course.

Malignant (necrotizing) externa otitis: the experience of a single hyperbaric centre.

INTRODUCTION: Malignant otitis externa (MOE) is a potentially life-threatening infection of the soft tissues of the external ear, quickly spreading to involve the periosteum and bone of the skull base. Treatment includes antibiotics and eventually surgery. Hyperbaric oxygen treatment (HBOT) has been proposed as an adjunctive therapy. However, in the tenth consensus conference, this disease was considered as a non-indication for HBOT. The aim of this study was to evaluate the effectiveness of HBOT in MOE treatment. METHODS: Retrospective and observational study was conducted of patients with MOE treated in our centre. Staging of the disease was made according to the clinicopathological classification system. RESULTS: From March 1998 to November 2016, 16 patients were referred. 6% patients were on stage 1 of the disease at the time they were referred, 20% in stage 2, 7% in stage 3a, 13% in stage 3b and 53% in stage 4. Seven (43.75%) patients had VII nerve palsy and three (18.75%) patients had multiple nerve palsy. Average length of symptoms of disease was 5 months (maximum 11 months). Average number of sessions was 33 and the length of hospitalization prior to HBOT (median 90 days) was significantly longer than the time between beginning HBOT and cure (p = 0.028, Wilcoxon signed rank test). There were no fatalities due to MOE and all patients were considered free of disease after HBOT. CONCLUSION: HBOT was well tolerated and revealed to be a helpful adjuvant treatment in MOE. According to our data, HBOT should be considered for patients who failed conventional treatments and in severe cases.

Cardiac computed tomography previous to atrial fibrillation ablation - effects of technological improvements and protocol optimization. / Tomografia computorizada cardíaca prévia a ablação de fibrilhação auricular ­ efeitos da evolução tecnológica e otimização de protocolos.

BACKGROUND: Cardiac computed tomography (CT) can provide a precise tridimentional anatomic map and exclude intra-cardiac thrombus. We aimed to access the impact of CT protocol optimization and technological evolution on the contrast and radiation dose as well as on image quality previous to atrial fibrillation (AF) ablation. METHODS: From a prospective registry of consecutive patients who underwent cardiac CT in a single center, we selected 270 patients in whom the CT was done for evaluation prior to AF ablation and they were distributed in 3 groups: Group1: the first 150 patients included; Group2: the last 60 patients performed with the same CT scanner; Group3: the first 60 exams performed with the new CT scanner. Quality of the protocol was access based on radiation dose, contrast volume used, the use of a second (delayed) acquisition, and on quantitative image quality analisis (signal to noise and contrast to noise ratios; density homogeneity racio between LA and LAA). RESULTS: We found a significant radiation dose as well as contrast dose reduction between the first and last subgroups (G1: 5,6mSv and 100ml; G2: 1,3mSv and 90ml; G3: 0,6mSv and 65ml). Even though group 3 had less radiation and contrast used it still had better quantitative image quality (signal/noise of 13,5; contrast/noise 14,8; density homogeneity racio of 0,92). CONCLUSION: Protocol optimization and technology both contributed to significant lower radiation dose and contrast volume used on cardiac CTs prior to AF ablation, without compromising image quality.

Overview of the radiographers' practice in 65 healthcare centers using digital mammography systems in Portugal.

PURPOSE: To assess current practices in digital mammography (DM) in Portuguese healthcare providers using digital systems. To investigate compliance with European standards regarding mean glandular dose and quality control practice and to identify optimisation needs. METHODS: Two questionnaires, targeted at breast radiographers and chief radiographers, were designed and applied in 65 imaging departments offering DM. Questions fielded were focused on the staff profile and technical/clinical practice. RESULTS: Prior to starting their activity in DM, 70% (82 out of 118) of the respondents received training in DM. The practice in 29 out of 59 providers was established by the manufacturers' recommendations for image acquisition. Variations were observed between radiographers who belong to the same provider namely the selection of exposure parameters such as the target-filter combination and automatic mode. The use of the manual exposure mode was reported for imaging breast implants (44%) and surgical specimens (22%). The main causes of repeat examinations were skin folding (21%) and absence of pectoral muscle (PM) (20%). CONCLUSIONS: The study revealed opportunities to optimise radiographers' practice in DM regarding the selection of exposure parameters. A robust and consistent training programme in DM and established local protocols can help to reduce the variations observed and improve clinical practice. MAIN MESSAGES: • Radiographers adopted different practices selecting AEC modes and T/F combinations. • Radiographer practice is more consistent using DR than using CR systems. • The main causes for rejecting images were the visibility of skin folding and PM absence. • Radiographers were partly unaware of the dose indicator. • Radiographers' training needs: QC, interventional procedures and breast dose optimisation.