Per-patient Negative Predictive Value of the CT and MRI Liver Imaging Reporting and Data System Version 2018 Treatment Response Algorithm for Hepatocellular Carcinoma.

Background The Liver Imaging Reporting and Data System version 2018 (LI-RADS) treatment response algorithm (TRA) is a high-specificity, lower-sensitivity grading system to diagnose hepatocellular carcinoma (HCC) and recurrence after local-regional therapy. However, the emphasis on specificity can result in disease understaging, potentially leading to poorer posttransplant outcomes. Purpose To determine the negative predictive value (NPV) of pretransplant CT and MRI assessment for viable HCC on a per-patient basis using the LI-RADS TRA, considering explant pathology as the reference standard. Materials and Methods Patient records from 218 consecutive adult patients from a single institution with HCC who underwent liver transplant from January 2011 to November 2017 were retrospectively reviewed. Two readers blinded to the original report reviewed immediate (within 90 days) pretransplant imaging and characterized observations according to the LI-RADS TRA. Based on this, patients with LR-4, LR-5, or LR-TR (treatment response) viable tumors were designated as viable tumor; patients with solely LR-3 or LR-TR equivocal tumors were designated as equivocal; and patients with only LR-TR nonviable lesions were designated as no viable disease. Patients were designated as within or outside the Milan criteria. These per-patient designations were compared with the presence of viable disease at explant pathology. Fisher exact test was used to compare the differences between CT and MRI. Weighted κ values were used to calculate interreader reliability. Results Final study sample consisted of 206 patients (median age, 61 years [IQR, 57-65 years]; 157 male patients and 49 female patients). Per-patient LI-RADS TRA assessment of pretransplant imaging had an NPV of 32% (95% CI: 27, 38) and 26% (95% CI: 20, 33) (readers 1 and 2, respectively) for predicting viable disease. Seventy-five percent (reader 1) and 77% (reader 2) of patients deemed equivocal had residual tumors at explant pathology. Weighted interreader reliability was substantial (κ = 0.62). Conclusion Patient-based stratification of viable, equivocal, and nonviable disease at pretransplant CT or MRI, based on LI-RADS TRA, demonstrated low negative predictive value in excluding HCC at explant pathology. © RSNA, 2023 See also the editorial by Tamir and Tau in this issue.

Microwave NDT of Smart Composite Structures with Embedded Antennas.

The integration of antennas in composite structures is gaining popularity with advances in wireless communications and the ever-increasing demands for efficient smart structures. Efforts are ongoing to ensure that antenna-embedded composite structures are robust and resilient to inevitable impacts, loading and other external factors that threaten the structural integrity of these structures. Undoubtedly, the in situ inspection of such structures to identify anomalies and predict failures is required. In this paper, the microwave non-destructive testing (NDT) of antenna-embedded composite structures is introduced for the first time. The objective is accomplished using a planar resonator probe operating in the UHF frequency range (~525 MHz). High-resolution images of a C-band patch antenna fabricated on an aramid paper-based honeycomb substrate and covered with a glass fiber reinforced polymer (GFRP) sheet are presented. The imaging prowess of microwave NDT and its distinct advantages in inspecting such structures are highlighted. The qualitative as well as the quantitative evaluation of the images produced by the planar resonator probe and a conventional K-band rectangular aperture probe are included. Overall, the potential utility of microwave NDT for the inspection of smart structures is demonstrated.

Imaging in Gender Affirmation Surgery.

PURPOSE OF REVIEW: This review summarizes recent developments in gender affirmation surgery, imaging findings in patients undergoing these surgeries, focusing on common postoperative radiologic appearances, complications, and pitfalls in interpretation. RECENT FINDINGS: The imaging workup of masculinizing and feminizing genitourinary surgeries uses multiple modalities in presurgical planning and within the immediate and long-term postoperative period. CT and MRI can help identify immediate and remote postoperative complications. Fluoroscopic examinations can diagnose postoperative urethral complications after gender affirmation surgeries. Lastly, the patients can undergo imaging for unrelated acute and chronic pathology, and knowledge of these imaging findings can be very helpful. Imaging plays a significant role in the care of transgender patients and, particularly, in those pursuing gender affirmation surgery. As insurance coverage expands for these surgical procedures, radiologists should be prepared to encounter, understand, and interpret pre and postoperative findings.

Reductive Amination Reaction for the Functionalization of Cellulose Nanocrystals.

Cellulose nanocrystals (CNCs) represent intriguing biopolymeric nanocrystalline materials, that are biocompatible, sustainable and renewable, can be chemically functionalized and are endowed with exceptional mechanical properties. Recently, studies have been performed to prepare CNCs with extraordinary photophysical properties, also by means of their functionalization with organic light-emitting fluorophores. In this paper, we used the reductive amination reaction to chemically bind 4-(1-pyrenyl)butanamine selectively to the reducing termini of sulfated or neutral CNCs (S_CNC and N_CNC) obtained from sulfuric acid or hydrochloric acid hydrolysis. The functionalization reaction is simple and straightforward, and it induces the appearance of the typical pyrene emission profile in the functionalized materials. After a characterization of the new materials performed by ATR-FTIR and fluorescence spectroscopies, we demonstrate luminescence quenching of the decorated N_CNC by copper (II) sulfate, hypothesizing for these new functionalized materials an application in water purification technologies.

Do Demographic or Anthropometric Factors Affect Lateralization of the Tibial Tubercle in a Diverse Population? A Magnetic Resonance Imaging Analysis.

INTRODUCTION: The tibial tubercle-trochlear groove (TT-TG) distance is commonly used to evaluate and guide treatment for patellar instability. There is limited data available regarding TT-TG variability based on patient demographics and anthropometric factors. MATERIALS AND METHODS: TT-TG was measured on magnetic resonance imaging (MRI) for 384 consecutive adult patients. Demographic information for the corresponding was then gathered from the medical record and analyzed. Demographic variables analyzed included age, sex, race, height, weight, and body mass index (BMI). RESULTS: Mean TT-TG among the 384 patients was 12.68mm (standard deviation [SD]: 4.13mm, 95% confidence interval [CI] 12.26-13.10mm, range, 3.2-27.0mm), and there was a significant correlation with height (p=0.009), weight (p=0.017), and race (p<0.001). However, there was no significant correlation seen with sex (p=0.854), BMI (p=0.253), or age (p=0.096). Height and African American race were identified as independent predictors of increased TT-TG (p=0.007 and p<0.001, respectively); and females were found to have an increased TT-TG relative to height (p=0.015). CONCLUSION: Tibial tubercle-trochlear groove distance was significantly correlated with race and height in the 384 patients examined. These findings may help explain clinical differences in these patients and help establish "norms" for patients of various ethnic and anthropometric variability.

Deep Ensemble Learning Based Objective Grading of Macular Edema by Extracting Clinically Significant Findings from Fused Retinal Imaging Modalities.

Macular edema (ME) is a retinal condition in which central vision of a patient is affected. ME leads to accumulation of fluid in the surrounding macular region resulting in a swollen macula. Optical coherence tomography (OCT) and the fundus photography are the two widely used retinal examination techniques that can effectively detect ME. Many researchers have utilized retinal fundus and OCT imaging for detecting ME. However, to the best of our knowledge, no work is found in the literature that fuses the findings from both retinal imaging modalities for the effective and more reliable diagnosis of ME. In this paper, we proposed an automated framework for the classification of ME and healthy eyes using retinal fundus and OCT scans. The proposed framework is based on deep ensemble learning where the input fundus and OCT scans are recognized through the deep convolutional neural network (CNN) and are processed accordingly. The processed scans are further passed to the second layer of the deep CNN model, which extracts the required feature descriptors from both images. The extracted descriptors are then concatenated together and are passed to the supervised hybrid classifier made through the ensemble of the artificial neural networks, support vector machines and naïve Bayes. The proposed framework has been trained on 73,791 retinal scans and is validated on 5100 scans of publicly available Zhang dataset and Rabbani dataset. The proposed framework achieved the accuracy of 94.33% for diagnosing ME and healthy subjects and achieved the mean dice coefficient of 0.9019 ± 0.04 for accurately extracting the retinal fluids, 0.7069 ± 0.11 for accurately extracting hard exudates and 0.8203 ± 0.03 for accurately extracting retinal blood vessels against the clinical markings.

Synthetic Antenna Functioning As Light Harvester in the Whole Visible Region for Enhanced Hybrid Photosynthetic Reaction Centers.

The photosynthetic reaction center (RC) from the Rhodobacter sphaeroides bacterium has been covalently bioconjugated with a NIR-emitting fluorophore (AE800) whose synthesis was specifically tailored to act as artificial antenna harvesting light in the entire visible region. AE800 has a broad absorption spectrum with peaks centered in the absorption gaps of the RC and its emission overlaps the most intense RC absorption bands, ensuring a consistent increase of the protein optical cross section. The covalent hybrid AE800-RC is stable and fully functional. The energy collected by the artificial antenna is transferred to the protein via FRET mechanism, and the hybrid system outperforms by a noteworthy 30% the overall photochemical activity of the native protein under the entire range of visible light. This improvement in the optical characteristic of the photoenzyme demonstrates the effectiveness of the bioconjugation approach as a suitable route to new biohybrid materials for energy conversion, photocatalysis, and biosensing.

Organic Cation Transporter-Mediated Clearance of Cardiovascular Drugs: A Pharmacological Perspective.

There exist a number of mechanisms to clear xenobiotics from human circulation. For cationic drugs, clearance is performed by human organic cation transporters 1 and 2 (hOCT1 and hOCT2), which are expressed in the liver and kidney, respectively. Given the prevalence of patients taking cardiovascular drugs, the present review focuses on the elimination of circulating cardiovascular drugs by organic cation transporters (OCTs). A significant number of cardiovascular drugs compete for transport by OCT1 or OCT2, introducing the potential to alter the pharmacokinetic profile of other concomitantly administered medications. The OCT system thereby represents an important site of drug-drug interactions.

Perceived speed in peripheral vision can go up or down.

We measured the perceived speed and contrast of patterns in peripheral vision relative to foveal patterns for a range of eccentricities at both mesopic and photopic levels. The results indicate that perceived speed varies with eccentricity, speed, and luminance. At high (photopic) luminance, patterns appear slower when viewed peripherally rather than foveally, but at low (mesopic) luminance fast-moving patterns can appear faster when viewed peripherally. When perceived contrast is equated, perceived speed reduces as a function of eccentricity in a speed-independent manner. Peripheral stimuli appear faster or slower than foveal stimuli depending upon luminance-an image parameter known to influence the gain of magno and parvocellular cells. We conclude that speed encoding in the periphery is consistent with a ratio-type speed code that is weighted by ganglion cell density.

Assembly of a photosynthetic reaction center with ABA tri-block polymersomes: highlights on protein localization.

The reconstitution of the integral membrane protein photosynthetic reaction center (RC) in polymersomes, i.e. artificial closed vesicles, was achieved by the micelle-to-vesicle transition technique, a very mild protocol based on size exclusion chromatography often used to drive the incorporation of proteins contemporarily to liposome formation. An optimized protocol was used to successfully reconstitute the protein in a fully active state in polymersomes formed by the tri-block copolymers PMOXA22-PDMS61-PMOXA22. The RC is very sensitive to its solubilizing environment and was used to probe the positioning of the protein in the vesicles. According to charge-recombination experiments and to the enzymatic activity assay, the RC is found to accommodate in the PMOXA22 region of the polymersome, facing the water bulk solution, rather than in the PDMS61 transmembrane-like region. Furthermore, polymersomes were found to preserve protein integrity efficiently as the biomimetic lipid bilayers but show a much longer temporal stability than lipid based vesicles.

Perceptual biases are inconsistent with Bayesian encoding of speed in the human visual system.

The notion that Bayesian processes are fundamental to brain function and sensory processing has recently received much support, and a number of Bayesian accounts of how the brain encodes the speed of moving objects have been proposed that challenge earlier mechanistic models. We measured the perceived speed of low contrast patterns at both low (2.5 cd m(-2)) and high (25 cd m(-2)) luminance in order to assess these competing models of how the human visual system encodes speed. At both luminance levels low contrast stimuli are perceptually biased such that they appear slower at slow (< 8 Hz) speeds but faster at higher (16 Hz) speeds. However, we find that the reversal of the perceptual bias from under- to overestimation occurred at slower speeds at low luminance. We also found that the bias was greater at slow speeds at high luminance but greater at fast speeds at low luminance. Moreover, discrimination thresholds were found to be similar at high and low luminance. These findings can be predicted by models in which speed is encoded by the relative activity within two broadly tuned temporal channels but are inconsistent with Bayesian models of speed encoding. We conclude that Bayesian processes cannot adequately account for speed encoding in the human visual system.

Amiodarone-Induced Leukocytoclastic Vasculitis in a Decompensated Heart Failure Patient: A Case Report.

Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by inflammation and damage to the walls of small blood vessels. It typically presents with palpable purpura and can be associated with various systemic conditions. Although its etiology is diverse, LCV has been associated with systemic diseases, infections, medications, and autoimmune disorders. Here, we present a case of LCV in a patient with decompensated heart failure. A 58-year-old man presented with progressively deteriorating swelling in both his lower limbs and scrotum, a persistent dry cough associated with minor ulcerative lesions on his shins, and a patchy rash with pustules and flat reddish spots. He was hospitalized three days prior due to atrial fibrillation and rapid ventricular rate, for which he was commenced on amiodarone. This rash persisted for three days, yet he denied experiencing any discomfort or itchiness along with it. Based on his clinical picture, laboratory evaluations, and imaging findings, he was diagnosed with LCV induced by amiodarone.

Can evidence drive health equity in the COVID-19 pandemic and beyond?

Using scoping review methods, we systematically searched multiple online databases for publications in the first year of the pandemic that proposed pragmatic population or health system-level solutions to health inequities. We found 77 publications with proposed solutions to pandemic-related health inequities. Most were commentaries, letters, or editorials from the USA, offering untested solutions, and no robust evidence on effectiveness. Some of the proposed solutions could unintentionally exacerbate health inequities. We call on health policymakers to co-create, co-design, and co-produce equity-focussed, evidence-based interventions with communities, focussing on those most at risk to protect the population as a whole. Epidemiologists collaborating with people from other relevant disciplines may provide methodological expertise for these processes. As epidemiologists, we must interrogate our own methods to avoid propagating any unscientific biases we may hold. Epidemiology must be used to address, and never exacerbate, health inequities-in the pandemic and beyond.

Blood-stage malaria vaccine candidate RH5.1/Matrix-M in healthy Tanzanian adults and children; an open-label, non-randomised, first-in-human, single-centre, phase 1b trial.

BACKGROUND: A blood-stage Plasmodium falciparum malaria vaccine would provide a second line of defence to complement partially effective or waning immunity conferred by the approved pre-erythrocytic vaccines. RH5.1 is a soluble protein vaccine candidate for blood-stage P falciparum, formulated with Matrix-M adjuvant to assess safety and immunogenicity in a malaria-endemic adult and paediatric population for the first time. METHODS: We did a non-randomised, phase 1b, single-centre, dose-escalation, age de-escalation, first-in-human trial of RH5.1/Matrix-M in Bagamoyo, Tanzania. We recruited healthy adults (aged 18-45 years) and children (aged 5-17 months) to receive the RH5.1/Matrix-M vaccine candidate in the following three-dose regimens: 10 µg RH5.1 at 0, 1, and 2 months (Adults 10M), and the higher dose of 50 µg RH5.1 at 0 and 1 month and 10 µg RH5.1 at 6 months (delayed-fractional third dose regimen; Adults DFx). Children received either 10 µg RH5.1 at 0, 1, and 2 months (Children 10M) or 10 µg RH5.1 at 0, 1, and 6 months (delayed third dose regimen; Children 10D), and were recruited in parallel, followed by children who received the dose-escalation regimen (Children DFx) and children with higher malaria pre-exposure who also received the dose-escalation regimen (High Children DFx). All RH5.1 doses were formulated with 50 µg Matrix-M adjuvant. Primary outcomes for vaccine safety were solicited and unsolicited adverse events after each vaccination, along with any serious adverse events during the study period. The secondary outcome measures for immunogenicity were the concentration and avidity of anti-RH5.1 serum IgG antibodies and their percentage growth inhibition activity (GIA) in vitro, as well as cellular immunogenicity to RH5.1. All participants receiving at least one dose of vaccine were included in the primary analyses. This trial is registered at ClinicalTrials.gov, NCT04318002, and is now complete. FINDINGS: Between Jan 25, 2021, and April 15, 2021, we recruited 12 adults (six [50%] in the Adults 10M group and six [50%] in the Adults DFx group) and 48 children (12 each in the Children 10M, Children 10D, Children DFx, and High Children DFx groups). 57 (95%) of 60 participants completed the vaccination series and 55 (92%) completed 22 months of follow-up following the third vaccination. Vaccinations were well-tolerated across both age groups. There were five serious adverse events involving four child participants during the trial, none of which were deemed related to vaccination. RH5-specific T cell and serum IgG antibody responses were induced by vaccination and purified total IgG showed in vitro GIA against P falciparum. We found similar functional quality (ie, GIA per µg RH5-specific IgG) across all age groups and dosing regimens at 14 days after the final vaccination; the concentration of RH5.1-specific polyclonal IgG required to give 50% GIA was 14·3 µg/mL (95% CI 13·4-15·2). 11 children were vaccinated with the delayed third dose regimen and showed the highest median anti-RH5 serum IgG concentration 14 days following the third vaccination (723 µg/mL [IQR 511-1000]), resulting in all 11 who received the full series showing greater than 60% GIA following dilution of total IgG to 2·5 mg/mL (median 88% [IQR 81-94]). INTERPRETATION: The RH5.1/Matrix-M vaccine candidate shows an acceptable safety and reactogenicity profile in both adults and 5-17-month-old children residing in a malaria-endemic area, with all children in the delayed third dose regimen reaching a level of GIA previously associated with protective outcome against blood-stage P falciparum challenge in non-human primates. These data support onward efficacy assessment of this vaccine candidate against clinical malaria in young African children. FUNDING: The European and Developing Countries Clinical Trials Partnership; the UK Medical Research Council; the UK Department for International Development; the National Institute for Health and Care Research Oxford Biomedical Research Centre; the Division of Intramural Research, National Institute of Allergy and Infectious Diseases; the US Agency for International Development; and the Wellcome Trust.

Self-assembly of mono- and bidentate oligoarylene thiols onto polycrystalline Au.

Four thiolated oligoarylene molecules (i) 4-methoxy-terphenyl-4″-methanethiol (MTM), (ii) 4-methoxy-terphenyl-3″,5″-dimethanethiol (MTD), (iii) 4-nitro-terphenyl-4″-methanethiol (NTM), and (iv) 4-nitro-terphenyl-3″,5″-dimethanethiol (NTD) were synthesized and self-assembled as monolayers (SAMs) on polycrystalline Au electrodes of organic field-effect transistors (OFETs). SAMs were characterized by contact angle and AC/DC electrochemical measurements, whereas atomic force microscopy was used for imaging the pentacene films grown on the coated electrodes. The electrical properties of functionalized OFETs, the electrochemical SAMs features and the morphology of pentacene films were correlated to the molecular organization of the thiolated oligoarylenes on Au, as calculated by means of the density functional theory. This multi-methodological approach allows us to associate the systematic replacement of the SAM anchoring head group (viz. methanethiol and dimethanethiol) and/or terminal tail group (viz. nitro-, -NO2, and methoxy, -OCH3) with the change of the electrical features. The dimethanethiol head group endows SAMs with higher resistive features along with higher surface tensions compared with methanethiol. Furthermore, the different number of thiolated heads affects the kinetics of Au passivation as well as the pentacene morphology. On the other hand, the nitro group confers further distinctive properties, such as the positive shift of both threshold and critical voltages of OFETs with respect to the methoxy one. The latter experimental evidence arise from its electron-withdrawing capability, which has been verified by both DFT calculations and DC electrochemical measurements.

Assessment of antimicrobial activity of chitosan/silver nanoparticles hydrogel and cryogel microspheres.

This research investigates the synthesis and characterization of hydrogel and cryogel microspheres that are doped with green synthesised silver nanoparticles (CS-AgNPs). Also, the study assesses the antibacterial activity of hydrogel and cryogel microspheres by comparing them with commercial antibiotics. The porous structure of CS and the adequate dispersion of AgNPs were confirmed by SEM and EDX techniques, respectively. The disk diffusion method and the optical density measurement (OD600) confirm the outstanding antimicrobial activity of CS-AgNPs hydrogel and cryogel microspheres in comparison to antibiotics for both Gram-positive and Gram-negative bacteria. The CS-AgNPs microspheres demonstrate promising antimicrobial and biocompatible agents for medical field applications.

Autologous fat graft in cleft lip patients: a comprehensive systematic review of technique, outcomes, and complications.

Cleft lip is a common craniofacial anomaly and aesthetic obstacle. Different procedures, techniques, and steps are required for repair. These procedures may result in secondary abnormalities or volume deficiencies that can be managed by different methods such as autologous fat grafting. We aim through this study to identify the technique of autologous fat graft in cleft lip deformity and the patient characteristics for selecting this particular technique. This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The study systematically reviewed MEDLINE, Cochrane, and EMBASE databases without time-limitation. A total of 14 articles published in the period between 2004 and 2022 were included, then patients in each study who did not meet the inclusion criteria were excluded. A total of 519 patients who underwent autologous adipose tissue augmentation of cleft lip deformity were included and analyed. Autologous fat graft is found to be safe, effective in improving lip appearance as well as contour, and associated with high satisfaction rate among cleft lip patients. A selected patients with vermilion deficiency, whistle deformity, or overall lip volume deficiency is found to have a higher satisfaction rate. The most frequently reported complications were excess fullness, nodule formation, graft resorption, and nostril deformity.

A Rare Case of Chronic Photophobia Associated With Oral Vancomycin Therapy: Exploring the Relationship.

Vancomycin is a widely used tricyclic glycopeptide antibiotic for treating various Gram-positive infections, including Clostridium difficile colitis. Although considered generally safe, it has been associated with several side effects. In this case report, we highlight a rare adverse effect in which a patient experienced chronic photophobia following treatment with oral vancomycin. This sheds light upon a potential relationship between oral vancomycin therapy and photophobia, emphasizing the need for increased awareness in clinical practice and urging further investigation into this association.

Hyperthyroidism Masquerading as an Anxiety Disorder: A Report on a Misdiagnosed Case.

Hyperthyroidism is an endocrine disorder characterized by excess thyroid hormone production. Its classic symptoms include weight loss, palpitations, tremors, and anxiety. We present a case of a 33-year-old female who initially presented with anxiety-like symptoms, leading to a misdiagnosis of generalized anxiety disorder. Upon further evaluation, the patient was diagnosed with hyperthyroidism, highlighting the importance of evaluating endocrine causes in patients presenting with anxiety-like symptoms. This case report underscores the significance of a comprehensive medical evaluation in patients with anxiety to avoid misdiagnoses and ensure appropriate management.

Vitamin D and Cardiovascular Diseases: An Update.

Vitamin D is a vital nutrient that plays a significant part in several physiological processes within the human body, including calcium metabolism, bone health, immune function, and cell growth and differentiation. It is obtained mainly through exposure to sunlight but can be acquired from certain foods and supplements as well. Vitamin D deficiency (VDD) could be the risk factor for cardiovascular diseases (CVDs), such as heart disease and stroke. In blood vitamin D low levels have been linked with an enhanced risk of developing CVDs. However, it is unclear whether vitamin D levels are the leading cause or consequence of these conditions. While some studies highlight that taking vitamin D supplements could decrease the risk of CVD; however, more research is required to better understand the association between vitamin D and cardiovascular health. In this review, we aimed to summarize the currently available evidence supporting the association between vitamin D and CVDs and anesthesia considerations.