Evaluating the Compliance, Efficacy, and Cost of Formulated Vitamins Versus Separate Supplements in Post-bariatric Surgery Patients.

OBJECTIVE: Micronutrient deficiencies are common complications after bariatric surgery as alterations to the gastrointestinal tract change absorption. Patients are recommended to take supplements including multivitamins, B complex, calcium, vitamin D, and iron after bariatric surgery, and can take these as specifically formulated vitamins for post-bariatric patients or separate vitamin supplements. We investigated the compliance, efficacy, and cost of specifically formulated vitamins for post-bariatric patients in comparison to separate vitamin supplements. METHODS: We surveyed 126 post-bariatric adult patients between February 1, 2022, and August 31, 2022, who had undergone bariatric surgery between 2014 and 2021 to assess the type of supplements taken, compliance, and cost. Demographics, type of bariatric surgery, and serum micronutrient levels were evaluated for all patients. RESULTS: There were 51 patients taking formulated vitamins and 75 patients taking separate vitamins. The formulated vitamin group demonstrated greater adherence to optimal vitamin dosage (formulated vitamin group, 76.5% vs. separate supplement group, 30.7%; p < 0.001) and higher compliance (formulated vitamin group, 90.2% vs. separate supplement group, 66.7%; p = 0.002). The costs associated with both groups were comparable. No significant difference was observed in the incidence of micronutrient deficiency between the groups. CONCLUSIONS: Our study shows that formulated vitamins do not offer significant difference in micronutrient levels or cost compared to separate standard vitamin supplements. However, formulated bariatric vitamins have improved compliance compared to separate vitamin supplements.

Abbreviated Magnetic Resonance Imaging With Breath-Hold Three-Dimensional Magnetic Resonance Cholangiopancreatography: Assessment of Malignant Risk of Pancreatic Intraductal Papillary Mucinous Neoplasm.

BACKGROUND: For surveillance of pancreatic intraductal papillary mucinous neoplasms (IPMNs), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) is preferred over computed tomography, but the long acquisition time limits its use. PURPOSE: To investigate the diagnostic performance of abbreviated MRI with breath-hold (BH) three-dimensional MRCP (abbreviated MRI-BH) for malignant risk assessment of pancreatic IPMN. STUDY TYPE: Retrospective. POPULATION: Two hundred and thirty-five patients with IPMNs (M:F = 115:120; mean age ± SD, 66 ± 9 years; typical imaging features with ≥2-year stability [N = 172] and histopathologically confirmed [N = 63]). FIELD STRENGTH/SEQUENCE: 3.0 T/ abbreviated MRI-BH (single-shot fast spin-echo, T1W fat-suppressed gradient-echo sequence, and BH-3D-MRCP). ASSESSMENT: Abbreviated MRI-BH was reviewed by three reviewers, and its diagnostic performance was assessed using the predetermined scoring system. The diagnostic performance for the mural nodule detection was assessed. Additionally, diagnostic performance of abbreviated MRI was compared with that of full-sequence MRI. STATISTICAL TESTS: Area under the receiver operating characteristic curve (AUC) with z-test, and linear-weighted kappa values. RESULTS: Thirty-five patients had malignant IPMN. At a cut-off score ≥3, AUCs of abbreviated MRI-BH for detecting malignant IPMN were 0.959 for reviewer 1, 0.962 for reviewer 2, and 0.956 for reviewer 3. The sensitivity of reviewers 1, 2, and 3 was 97.1% for all, and the specificity was 85.5%, 86.0%, and 85.0%, respectively. Regarding mural nodule detection (N = 22), abbreviated MRI-BH demonstrated a sensitivity of 95.5% and a specificity of 88.3% for reviewer 1, a sensitivity of 86.4% and a specificity of 92.0% for reviewer 2, and a sensitivity of 86.4% and a specificity of 89.2% for reviewer 3. There were no significant differences between AUC of abbreviated MRI-BH and that of full-sequence MRI in the three reviewers (P > 0.05). DATA CONCLUSION: Abbreviated MRI-BH showed good diagnostic performance for detecting malignant IPMNs by using a predetermined scoring system. LEVEL OF EVIDENCE: 3 TECHNICAL EFFICACY STAGE: 2.

[Diagnosis and Severity Assessment of Alcohol-Related Liver Disease].

A diagnosis of alcohol-related liver disease (ALD) requires information on the history of excessive alcohol consumption (average intake of 40 g or more in men and 20 g or more in women a day). Furthermore, blood tests, such as GGT, AST, ALT, and mean corpuscular volume, and imaging studies, including abdominal ultrasound or transient elastography, are also useful. A liver biopsy can be useful for confirming the diagnosis and has prognostic value. ALD includes alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis, and in most cases, clinical manifestations can overlap. The prognostic scoring systems of ALD are limited mainly to alcoholic hepatitis, and the early mortality and treatment response can be predicted using various scoring systems. This review summarizes how to diagnose and evaluate the severity of ALD in clinical practice.

Quantitative Assessment of Liver Function by Using Gadoxetic Acid-enhanced MRI: Hepatocyte Uptake Ratio.

Purpose To determine whether hepatocyte uptake ratios derived at gadoxetic acid-enhanced MRI correlate with quantitative measures of liver function and can help to identify contraindication to major hepatectomy. Materials and Methods Between August 2016 and October 2016, 50 study participants with chronic liver disease or cirrhosis underwent liver MRI at 3.0 T including T1 mapping and elastography. Liver function was quantitatively assessed by using the indocyanine green retention test (ICG R15). T1 maps were obtained by using the Look-Locker sequence before and 10 minutes after gadoxetic acid administration (0.025 mmol/kg). The relationship between ICG R15 and the following MRI parameters was evaluated: pre- and postcontrast T1 values of the liver, hepatocyte uptake ratio representing the amount of contrast media solely taken into hepatocytes, liver volume, and degree of enhancement at the common bile duct. Diagnostic performance of the hepatocyte uptake ratio to identify patients with ICG R15 greater than 20% (ie, contraindication to hepatectomy) was compared with other parameters by using areas under the receiver operating characteristic curve. Results Hepatocyte uptake ratio showed a negative correlation with ICG R15 r of -0.78 (P < .001). In participants with chronic liver disease or Child-Pugh class A, those with ICG R15 of 20% or less showed higher hepatocyte uptake ratio than those with ICG R15 greater than 20% (P < .001). Hepatocyte uptake ratios demonstrated better performance for helping to detect ICG R15 greater than 20% than did liver volume (area under the curve, 0.96 vs 0.70; P = .01). Conclusion Hepatocyte uptake ratios are negatively correlated with liver function as measured by indocyanine green retention test and provide acceptable diagnostic performance for helping to identify participants who have contraindications to major hepatectomy. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Reeder in this issue.

Multiplex RT-PCR detection of H3N2 influenza A virus in dogs.

A multiplex RT-PCR (mRT-PCR) assay to detect H3N2 CIV genomic segments was developed as a rapid and cost-effective method. Its performance was evaluated with forty-six influenza A viruses from different hosts using three primer sets which amplify four segments of H3N2 CIV simultaneously. The mRT-PCR has been successful in detecting the viral segments, indicating that it can improve the speed of diagnosis for H3N2 CIV and its reassortants.

Design and testing of multiplex RT-PCR primers for the rapid detection of influenza A virus genomic segments: Application to equine influenza virus.

The avian influenza A virus causes respiratory infections in animal species. It can undergo genomic recombination with newly obtained genetic material through an interspecies transmission. However, the process is an unpredictable event, making it difficult to predict the emergence of a new pandemic virus and distinguish its origin, especially when the virus is the result of multiple infections. Therefore, identifying a novel influenza is entirely dependent on sequencing its whole genome. Occasionally, however, it can be time-consuming, costly, and labor-intensive when sequencing many influenza viruses. To compensate for the difficulty, we developed a rapid, cost-effective, and simple multiplex RT-PCR to identify the viral genomic segments. As an example to evaluate its performance, H3N8 equine influenza virus (EIV) was studied for the purpose. In developing this protocol to amplify the EIV eight-segments, a series of processes, including phylogenetic analysis based on different influenza hosts, in silico analyses to estimate primer specificity, coverage, and variation scores, and investigation of host-specific amino acids, were progressively conducted to reduce or eliminate the negative factors that might affect PCR amplification. Selectively, EIV specific primers were synthesized with dual priming oligonucleotides (DPO) system to increase primer specificity. As a result, 16 primer pairs were selected to screen the dominantly circulating H3N8 EIV 8 genome segments: PA (3), PB2 (1), PA (3), NP (3), NA8 (2), HA3 (1), NS (1), and M (2). The diagnostic performance of the primers was evaluated with eight sets composing of four segment combinations using viral samples from various influenza hosts. The PCR results suggest that the multiplex RT-PCR has a wide range of applications in detection and diagnosis of newly emerging EIVs. Further, the proposed procedures of designing multiplex primers are expected to be used for detecting other animal influenza A viruses.

Assessment of early response to concurrent chemoradiotherapy in cervical cancer: value of diffusion-weighted and dynamic contrast-enhanced MR imaging.

PURPOSE: To investigate diffusion-weighted (DWI) and dynamic contrast-enhanced MR imaging (DCE-MRI) as early response predictors in cervical cancer patients who received concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: Sixteen patients with cervical cancer underwent DWI and DCE-MRI before CCRT (preTx), at 1week (postT1) and 4weeks (postT2) after initiating treatment, and 1month after the end of treatment (postT3). At each point, apparent diffusion coefficient (ADC) and DCE-MRI parameters were measured in tumors and gluteus muscles (GM). Tumor response was correlated with imaging parameters or changes in imaging parameters at each point. RESULTS: At each point, ADC, K(trans) and Ve in tumors showed significant changes (P<0.05), as compared with those of GM (P>0.05). PostT1 tumor ADCs showed a significant correlation with tumor size response at postT2 (P=0.041), and changes in tumor ADCs at postT1 had a significant correlation with tumor size (P=0.04) and volume response (P=0.003) at postT2. In tumors, preTx K(trans) and Ve showed significant correlations with tumor size at postT3 (P=0.011) and tumor size response at postT2 (P=0.019), respectively. CONCLUSION: DWI and DCE-MRI, as early biomarkers, have the potential to evaluate therapeutic responses to CCRT in cervical cancers.

Predicting reductive debromination of polybrominated diphenyl ethers by nanoscale zerovalent iron and its implications for environmental risk assessment.

The reductive debromination of polybrominated diphenyl ethers (PBDEs) by nanoscale zerovalent iron (nZVI) has proven to be a successful remediation approach. This study simulates the congener profiles and overall ecotoxicological impact of PBDE debromination by nZVI. The relationship between the calculated redox potential values and PBDE debromination rates was sufficiently strong to generate a satisfactory predictive capacity, which was further used to develop a quantitative structure-activity relationship (QSAR) model for the determination of the PBDE debromination patterns and dominant pathways. The predicted results of deca-BDE debromination showed that it would completely disappear within 30 days, but its lower brominated products, particularly tri- to penta-homologues, could exist in the environment even after 5 years. Formation and accumulation of more toxic, low brominated congeners through deca-BDE debromination suggest that deca-BDE may pose prolonged environmental risks. Changes in the toxic equivalent (TEQ) values during deca-BDE debromination parallel the occurrence and transformation of specific low brominated congeners with dioxin-like potency.

Aquatic toxicity assessment of phosphate compounds.

OBJECTIVES: Tricalcium phosphate and calcium hydrogenorthophosphate are high production volume chemicals, mainly used as foodstuff additives, pharmaceuticals, lubricants, synthetic resin, and disinfectants. Phosphate has the potential to cause increased algal growth leading to eutrophication in the aquatic environment. However, there is no adequate information available on risk assessment or acute and chronic toxicity. The aim of this research is to evaluate the toxic potential of phosphate compounds in the aquatic environment. METHODS: An aquatic toxicity test of phosphate was conducted, and its physico-chemical properties were obtained from a database recommended in the Organization for Economic Cooperation and Development (OECD) guidance manual. An ecotoxicity test using fish, Daphnia, and algae was conducted by the good laboratory practice facility according to the OECD TG guidelines for testing of chemicals, to secure reliable data. RESULTS: THE RESULTS OF THE ECOTOXICITY TESTS OF TRICALCIUM PHOSPHATE AND CALCIUM HYDROGENORTHOPHOSPHATE ARE AS FOLLOWS: In an acute toxicity test with Oryzias latipes, 96 hr 50% lethal concentration (LC(50)) was >100 (measured:>2.14) mg/L and >100 (measured: >13.5) mg/L, respectively. In the Daphnia test, 48 hr 50% effective concentration (EC(50)) was >100 (measured: >5.35) mg/L and >100 (measured: >2.9) mg/L, respectively. In a growth inhibition test with Pseudokirchneriella subcapitata, 72 hr EC(50) was >100 (measured: >1.56) mg/L and >100 (measured: >4.4) mg/L, respectively. CONCLUSIONS: Based on the results of the ecotoxicity test of phosphate using fish, Daphnia, and algae, L(E)C(50) was above 100 mg/L (nominal), indicating no toxicity. In general, the total phosphorus concentration including phosphate in rivers and lakes reaches levels of several ppm, suggesting that phosphate has no toxic effects. However, excessive inflow of phosphate into aquatic ecosystems has the potential to cause eutrophication due to algal growth.

Assessment of renal lesions with blood oxygenation level-dependent MRI at 3 T: preliminary experience.

OBJECTIVE: The purpose of this article is to prospectively determine the feasibility of using blood oxygenation level-dependent (BOLD) MRI at 3 T in differentiating various renal lesions. SUBJECTS AND METHODS: Seventy-one patients (mean age, 53.8 years; range, 22-80 years) underwent kidney MRI, including BOLD MRI at 3 T. BOLD MRI was performed using a multiple fast-field echo (FFE) sequence to acquire 20 T2(*)-weighted images within a single breath-hold. The rate of spin dephasing (R2(*)) values of solid and benign cystic renal lesions were compared, and the results of four subgroups--simple cysts, renal cell carcinomas (RCCs), hemorrhagic cysts, and angiomyolipomas (AMLs)--were analyzed. The degree of overall imaging quality in BOLD MRI was also assessed. RESULTS: One hundred three renal lesions were detected in the 71 patients. The mean (± SD) R2(*) values of 45 solid lesions (30.6 ± 19.4 1/s) were significantly higher than those of 58 benign cystic lesions (4.5 ± 4.8 1/s; p < 0.001). The mean R2(*) values of simple cysts, RCCs, hemorrhagic cysts, and AMLs were 1.7 ± 1.7, 22.6 ± 12.6, 10.7 ± 3.7, and 48.0 ± 25.5 1/s, respectively (p < 0.001). The degree of overall imaging quality in all patients was satisfactory or better. CONCLUSION: Renal BOLD MRI at 3 T is a feasible technique and may be useful for differentiating various renal lesions.