Perioperative Tracking of Intravenous Iron in Patients Undergoing On-Pump Cardiac Surgery: A Prospective, Single-Center Pilot Trial.

BACKGROUND: Preoperative intravenous iron administration is a frequently used patient blood management procedure. If the timeframe of intravenous iron administration before surgery is short, (1) the concentration of the intravenous iron compound might still be high in patients' plasma when undergoing surgery and (2) this iron in patients' plasma is at risk to be lost due to blood loss. The aim of the current study was, therefore, to track the iron compound ferric carboxymaltose (FCM) before, during, and after cardiac surgery requiring cardiopulmonary bypass, with an emphasis on intraoperative iron losses in shed blood and potential recovery through autologous cell salvage. METHODS: Concentrations of FCM were analyzed in patients' blood using a hyphenation of liquid chromatography and inductively coupled plasma-mass spectrometry to distinguish between pharmaceutical compound FCM and serum iron. In this prospective, single-center pilot trial, 13 anemic and 10 control patients were included. Anemic patients with hemoglobin levels ≤12/13 g/dL in women and men were treated with 500 milligrams (mg) intravenous FCM 12 to 96 hours before elective on-pump cardiac surgery. Patients' blood samples were collected before surgery and at days 0, 1, 3, and 7 after surgery. One sample each was taken of the cardiopulmonary bypass, the autologous red blood cell concentrate generated by cell salvage, and the cell salvage disposal bag. RESULTS: Patients who had received FCM <48 hours before surgery had higher FCM serum levels (median [Q1-Q3], 52.9 [13.0-91.6]) compared to ≥48 hours (2.1 [0.7-5.1] µg/mL, P = .008). Of 500-mg FCM administered <48 hours, 327.37 (257.96-402.48) mg were incorporated compared to administration ≥48 hours with 493.60 (487.78-496.70) mg. After surgery, patients' plasma FCM concentration in the FCM <48 hours group was decreased (-27.1 [-30 to -5.9] µg/mL). Little FCM was found in the cell salvage disposal bag (<48 hours, 4.2 [3.0-25.8] µg/mL, equivalent to 29.0 [19.0-40.7] mg total; equivalent to 5.8% or 1/17th of the 500 mg FCM initially administered), almost none in the autologous red blood cell concentrate (<48 hours, 0.1 [0.0-0.43] µg/mL). CONCLUSIONS: The data generate the hypotheses that nearly all FCM is incorporated into iron stores with administration ≥48 hours before surgery. When FCM is given <48 hours of surgery, the majority is incorporated into iron stores by the time of surgery, although a small amount may be lost during surgical bleeding with limited recovery by cell salvage.

Automatic Segmentation of Parkinson Disease Therapeutic Targets Using Nonlinear Registration and Clinical MR Imaging: Comparison of Methodology, Presence of Disease, and Quality Control.

INTRODUCTION: Accurate and precise delineation of the globus pallidus pars interna (GPi) and subthalamic nucleus (STN) is critical for the clinical treatment and research of Parkinson's disease (PD). Automated segmentation is a developing technology which addresses limitations of visualizing deep nuclei on MR imaging and standardizing their definition in research applications. We sought to compare manual segmentation with three workflows for template-to-patient nonlinear registration providing atlas-based automatic segmentation of deep nuclei. METHODS: Bilateral GPi, STN, and red nucleus (RN) were segmented for 20 PD and 20 healthy control (HC) subjects using 3T MRIs acquired for clinical purposes. The automated workflows used were an option available in clinical practice and two common research protocols. Quality control (QC) was performed on registered templates via visual inspection of readily discernible brain structures. Manual segmentation using T1, proton density, and T2 sequences was used as "ground truth" data for comparison. Dice similarity coefficient (DSC) was used to assess agreement between segmented nuclei. Further analysis was done to compare the influences of disease state and QC classifications on DSC. RESULTS: Automated segmentation workflows (CIT-S, CRV-AB, and DIST-S) had the highest DSC for the RN and lowest for the STN. Manual segmentations outperformed automated segmentation for all workflows and nuclei; however, for 3/9 workflows (CIT-S STN, CRV-AB STN, and CRV-AB GPi) the differences were not statically significant. HC and PD only showed significant differences in 1/9 comparisons (DIST-S GPi). QC classification only demonstrated significantly higher DSC in 2/9 comparisons (CRV-AB RN and GPi). CONCLUSION: Manual segmentations generally performed better than automated segmentations. Disease state does not appear to have a significant effect on the quality of automated segmentations via nonlinear template-to-patient registration. Notably, visual inspection of template registration is a poor indicator of the accuracy of deep nuclei segmentation. As automatic segmentation methods continue to evolve, efficient and reliable QC methods will be necessary to support safe and effective integration into clinical workflows.

Analysis of real-world visual ergonomics at the visual display unit.

INTRODUCTION: In this interventional study, the ergonomic workplace set-up and the impact of character size on subjectively estimated working productivity and computer vision syndrome (CVS) were evaluated in the field. METHODS: The number of displays and their size, resolution, surface structure, position in the room and relation to the eye were evaluated for 152 units. CVS was assessed using the CVS-Questionnaire. Habitually used character size for an uppercase E was recorded and compared to the ISO 9241-303:2011, national standards (e.g., ANSI/HFES 100-2007) and national guidelines (e.g., German DGUV Information 215-410). In case of failure to comply with these standards, character size was increased to 22 angular minutes to reach the recommended ranges. Reasons for returning to former or smaller character sizes were recorded, and subjectively perceived changes in productivity were estimated by the participants using a visual analogue scale before and 2 weeks after the intervention using a questionnaire. RESULTS: The average visual display unit consisted of two non-glare (matt) 24″ widescreen monitors that were located approximately 73 cm (primary) and 76 cm (secondary) from the eyes. The mean (SD) habitually set character size was 14.29 angular minutes (3.53) and therefore both statistically and clinically significantly too small compared with ISO 9241-303:2011 (p < 0.001). Increasing the character size to 22 angular minutes produced a 26% reduction in subjectively rated productivity (p < 0.001). No significant correlation between character size and symptoms of CVS was demonstrated. CONCLUSIONS: In the workplaces investigated, recommendations for character size were not adhered to. This resulted in a reduction in productivity and was not compatible with some of the work requirements, for example, obtaining a broad overview of a spreadsheet.

Sun-safe behavior and perceptions during winter sports: an Austrian study based on the Theory of Planned Behavior.

As a preventable disease, skin cancer is a public health issue in Austria. Most sun-safety studies focus on people's activities in summer, but little is known about sun-protective behavior in winter. Based on the Theory of Planned Behavior (TPB), this study examines psychological perceptions among people who engage in winter sports in Austria. Following a TPB-based belief elicitation study, a consequent survey was conducted among 114 participants (51.8% female; Mage = 29.54 years) in South Austria. Intention, attitude, subjective norm, perceived behavioral control, and risk perception showed strong and significant associations with sun-safe behavior among people who engage in winter sports. The TPB framework explained a large portion of variance in sun-safe behavior (75%) and intention (73%). Gender differences have been identified in TPB-variables as well as several beliefs. Based on the utility of the TPB, our findings suggest guidelines for sun-safety in winter sports settings. Gender differences are in line with previous research, highlighting the vulnerability of men to sun damage during winter sports.

An Unprecedented Tolerance to Deletion of the Periplasmic Chaperones SurA, Skp, and DegP in the Nosocomial Pathogen Acinetobacter baumannii.

The outer membrane (OM) of Gram-negative bacteria efficiently protects from harmful environmental stresses such as antibiotics, disinfectants, or dryness. The main constituents of the OM are integral OM ß-barrel proteins (OMPs). In Gram-negative bacteria such as Escherichia coli, Yersinia enterocolitica, and Pseudomonas aeruginosa, the insertion of OMPs depends on a sophisticated biogenesis pathway. This comprises the SecYEG translocon, which enables inner membrane (IM) passage; the chaperones SurA, Skp, and DegP, which facilitate the passage of ß-barrel OMPs through the periplasm; and the ß-barrel assembly machinery (BAM), which facilitates insertion into the OM. In E. coli, Y. enterocolitica, and P. aeruginosa, the deletion of SurA is particularly detrimental and leads to a loss of OM integrity, sensitization to antibiotic treatment, and reduced virulence. In search of targets that could be exploited to develop compounds that interfere with OM integrity in Acinetobacter baumannii, we employed the multidrug-resistant strain AB5075 to generate single gene knockout strains lacking individual periplasmic chaperones. In contrast to E. coli, Y. enterocolitica, and P. aeruginosa, AB5075 tolerates the lack of SurA, Skp, or DegP with only weak mutant phenotypes. While the double knockout strains ΔsurAΔskp and ΔsurAΔdegP are conditionally lethal in E. coli, all double deletions were well tolerated by AB5075. Strikingly, even a triple-knockout strain of AB5075, lacking surA, skp, and degP, was viable. IMPORTANCE Acinetobacter baumannii is a major threat to human health due to its ability to persist in the hospital environment, resistance to antibiotic treatment, and ability to deploy multiple and redundant virulence factors. In a rising number of cases, infections with multidrug-resistant A. baumannii end up fatally, because all antibiotic treatment options fail. Thus, novel targets have to be identified and alternative therapeutics have to be developed. The knockout of periplasmic chaperones has previously proven to significantly reduce virulence and even break antibiotic resistance in other Gram-negative pathogens. Our study in A. baumannii demonstrates how variable the importance of the periplasmic chaperones SurA, Skp, and DegP can be and suggests the existence of mechanisms allowing A. baumannii to cope with the lack of the three periplasmic chaperones.

Structure, Function and Pharmacology of SLC7 Family Members and Homologues.

Amino acids are essential components of all living cells serving as building blocks of proteins, as energy source, and as precursors of metabolites and signaling molecules. Amino acid transporters are membrane proteins that mediate the transfer of amino acids across the plasma membrane, and between compartments in cells, different cells and organs. The absence, overexpression or malfunction of specific amino acid transporters have been associated with human disease. One of the projects within the Swiss National Centre of Competence in Research (NCCR) TransCure was directed at SLC7 family amino acid transporters, with a particular focus on the heteromeric amino acid transporters 4F2hc-LAT1 (SLC3A2-SLC7A5) and 4F2hc-LAT2 (SLC3A2-SLC7A8), and the bacterial homologue AdiC. The project addressed questions of basic research (function and structure), pharmacology (identification of potent inhibitors and activators), and pre-clinical medicine (e.g., physiological role in the placenta) and disease models (e.g., tumor progression) of specific SLC7 family amino acid transporters. This review presents, summarizes and discusses selected main results obtained in this NCCR TransCure project.

Regulatory, Legal, and Market Aspects of Smart Wearables for Cardiac Monitoring.

In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access are often evolving slowly, sometimes creating market barriers. This article gives a brief overview of the existing clinical studies regarding the use of smart wearables in cardiac monitoring and provides insight into the main regulatory and legal aspects that need to be considered when such products are intended to be used in a health care setting. Based on this brief overview, the article elaborates on the specific requirements in the main areas of authorization/certification and reimbursement/compensation, as well as data protection and data security. Three case studies are presented as examples of specific market access procedures: the USA, Germany, and Belgium. This article concludes that, despite the differences in specific requirements, market access pathways in most countries are characterized by a number of similarities, which should be considered early on in product development. The article also elaborates on how regulatory and legal requirements are currently being adapted for digitally driven wearables and proposes an ongoing evolution of these requirements to facilitate market access for beneficial medical technology in the future.

Small molecule inhibitors provide insights into the relevance of LAT1 and LAT2 in materno-foetal amino acid transport.

The placenta supplies the foetus with critical nutrients such as essential amino acids (AA, eg leucine) for development and growth. It also represents a cellular barrier which is formed by a polarized, differentiated syncytiotrophoblast (STB) monolayer. Active Na+ -independent leucine transport across the placenta is mainly attributed to the System L transporters LAT1/SLC7A5 and LAT2/SLC7A8. This study explored the influence of trophoblast differentiation on the activity of LAT1/LAT2 and the relevance of LAT1/LAT2 in leucine uptake and transfer in trophoblasts by applying specific small molecule inhibitors (JPH203/JG336/JX009). L-leucine uptake (total dose = 167 µmol/L) was sensitive to LAT1-specific inhibition by JPH203 (EC50  = 2.55 µmol/L). The inhibition efficiency of JPH203 was increased by an additional methoxy group in the JPH203-derivate JG336 (EC50  = 1.99 µmol/L). Interestingly, JX009 showed efficient System L inhibition (EC50  = 2.35 µmol/L) and was the most potent inhibitor of leucine uptake in trophoblasts. The application of JPH203 and JX009 in Transwell® -based leucine transfer revealed LAT1 as the major accumulative transporter at the apical membrane, but other System L transporters such as LAT2 as rate-limiting for leucine efflux across the basal membrane. Therefore, differential specificity of the applied inhibitors allowed for estimation of the contribution of LAT1 and LAT2 in materno-foetal AA transfer and their potential impact in pregnancy diseases associated with impaired foetal growth.

Nanoscale organization and dynamics of the siglec CD22 cooperate with the cytoskeleton in restraining BCR signalling.

Receptor organization and dynamics at the cell membrane are important factors of signal transduction regulation. Using super-resolution microscopy and single-particle tracking, we show how the negative coreceptor CD22 works with the cortical cytoskeleton in restraining BCR signalling. In naïve B cells, we found endogenous CD22 to be highly mobile and organized into nanodomains. The landscape of CD22 and its lateral diffusion were perturbed either in the absence of CD45 or when the CD22 lectin domain was mutated. To understand how a relatively low number of CD22 molecules can keep BCR signalling in check, we generated Brownian dynamic simulations and supported them with ex vivo experiments. This combined approach suggests that the inhibitory function of CD22 is influenced by its nanoscale organization and is ensured by its fast diffusion enabling a "global BCR surveillance" at the plasma membrane.

Long noncoding RNAs in B-cell development and activation.

Long noncoding RNAs (lncRNAs) are potentially important regulators of cell differentiation and development, but little is known about their roles in B lymphocytes. Using RNA-seq and de novo transcript assembly, we identified 4516 lncRNAs expressed in 11 stages of B-cell development and activation. Most of these lncRNAs have not been previously detected, even in the closely related T-cell lineage. Comparison with lncRNAs previously described in human B cells identified 185 mouse lncRNAs that have human orthologs. Using chromatin immunoprecipitation-seq, we classified 20% of the lncRNAs as either enhancer-associated (eRNA) or promoter-associated RNAs. We identified 126 eRNAs whose expression closely correlated with the nearest coding gene, thereby indicating the likely location of numerous enhancers active in the B-cell lineage. Furthermore, using this catalog of newly discovered lncRNAs, we show that PAX5, a transcription factor required to specify the B-cell lineage, bound to and regulated the expression of 109 lncRNAs in pro-B and mature B cells and 184 lncRNAs in acute lymphoblastic leukemia.

Siglec-G Deficiency Leads to Autoimmunity in Aging C57BL/6 Mice.

Siglec-G, a member of the sialic acid-binding Ig-like lectin (Siglec) family, is expressed on B cell and dendritic cell surfaces. It acts as an inhibitory coreceptor and modulates B cell activation, especially on B1 cells, as Siglec-G-deficient mice show mainly a B1 cell-restricted phenotype resulting in increased B1 cell numbers. Although higher B1 cell numbers are discussed to be associated with autoimmunity, loss of Siglec-G does not result in autoimmune disease in BALB/c mice. However, there is evidence from Siglec-G × CD22 double-deficient mice and Siglec-G(-/-) mice on an autoimmune-prone MRL/lpr background that Siglec-G is important to maintain tolerance in B cells. In this study, we analyzed the role of Siglec-G in induction and maintenance of B cell tolerance on C57BL/6 background and in the FcγRIIb-deficient background. We find that aging Siglec-G-deficient and Siglec-G × FcγRIIb double-deficient mice develop an autoimmune phenotype with elevated autoantibody levels and mild glomerulonephritis. Aging Siglec-G-deficient mice have elevated numbers of plasma cells and germinal center B cells, as well as a higher number of activated CD4 T cells, which likely all contribute to autoantibody production. Additional loss of the inhibitory receptor FcγRIIb in Siglec-G(-/-) mice does not result in exacerbation of disease. These results indicate that Siglec-G is important to maintain tolerance in B cells and prevent autoimmunity.

A balance between B cell receptor and inhibitory receptor signaling controls plasma cell differentiation by maintaining optimal Ets1 levels.

Signaling through the BCR can drive B cell activation and contribute to B cell differentiation into Ab-secreting plasma cells. The positive BCR signal is counterbalanced by a number of membrane-localized inhibitory receptors that limit B cell activation and plasma cell differentiation. Deficiencies in these negative signaling pathways may cause autoantibody generation and autoimmune disease in both animal models and human patients. We have previously shown that the transcription factor Ets1 can restrain B cell differentiation into plasma cells. In this study, we tested the roles of the BCR and inhibitory receptors in controlling the expression of Ets1 in mouse B cells. We found that Ets1 is downregulated in B cells by BCR or TLR signaling through a pathway dependent on PI3K, Btk, IKK2, and JNK. Deficiencies in inhibitory pathways, such as a loss of the tyrosine kinase Lyn, the phosphatase Src homology region 2 domain-containing phosphatase 1 (SHP1) or membrane receptors CD22 and/or Siglec-G, result in enhanced BCR signaling and decreased Ets1 expression. Restoring Ets1 expression in Lyn- or SHP1-deficient B cells inhibits their enhanced plasma cell differentiation. Our findings indicate that downregulation of Ets1 occurs in response to B cell activation via either BCR or TLR signaling, thereby allowing B cell differentiation and that the maintenance of Ets1 expression is an important function of the inhibitory Lyn → CD22/SiglecG → SHP1 pathway in B cells.

CD22 ligand-binding and signaling domains reciprocally regulate B-cell Ca2+ signaling.

A high proportion of human B cells carry B-cell receptors (BCRs) that are autoreactive. Inhibitory receptors such as CD22 can downmodulate autoreactive BCR responses. With its extracellular domain, CD22 binds to sialic acids in α2,6 linkages in cis, on the surface of the same B cell or in trans, on other cells. Sialic acids are self ligands, as they are abundant in vertebrates, but are usually not expressed by pathogens. We show that cis-ligand binding of CD22 is crucial for the regulation of B-cell Ca(2+) signaling by controlling the CD22 association to the BCR. Mice with a mutated CD22 ligand-binding domain of CD22 showed strongly reduced Ca(2+) signaling. In contrast, mice with mutated CD22 immunoreceptor tyrosine-based inhibition motifs have increased B-cell Ca(2+) responses, increased B-cell turnover, and impaired survival of the B cells. Thus, the CD22 ligand-binding domain has a crucial function in regulating BCR signaling, which is relevant for controlling autoimmunity.

Repositioning the Cobb human archive: the merger of a skeletal collection and its texts.

The W. Montague Cobb skeletal collection, mainly comprised of African Americans living in Washington, DC, before 1969, is an important collection for human biological studies of the African Diaspora. This article outlines the process of constructing an improved study sample for biocultural analysis by merging skeletal remains from the collection with their associated texts. The merging allows for the inclusion of individuals from the original series for whom we no longer have skeletons. We argue that this step is necessary to construct a data set that reflects the demographic breadth (age, ethnicity, social class) of the original collection, taking into account a substantial number of skeletons lost during storage and disuse. The mechanics of this process were informed by a critical and humanistic orientation toward human biological study built upon the following premises: (1) scientific investigation is not an objective or passive practice, nor must it be; and, (2) relevant, publically accessible human biological research requires competence with social justice issues, as well as previous and current scholarship focused on addressing those issues. This approach to sample construction engages skeletal remains as biological and social products, and enhances the social and translational implications of our research practices.

BLASTphylo: An Interactive Web Tool for Taxonomic and Phylogenetic Analysis of Prokaryotic Genes.

Identifying a protein's function is crucial to reveal its role in the cellular complex. Computationally, the most common approach is to search for homologous proteins in a large database of proteins of known function using BLAST. One goal of such an analysis is the identification and visualization of the protein in the taxonomy of interest. Another goal is the reconstruction of the phylogenetic history of the protein. However, the BLAST result provides information about the occurrence of the protein in the taxonomy and its putative function mainly in a tabular format. This requires manual interventions and makes the taxonomic identification laborious. Although various tools exist to visualize and annotate large-scale trees, none of them intuitively and interactively visualizes the protein's occurrence in the taxonomy for different taxonomic ranks. To target this gap, we developed BLASTphylo, a web tool that combines BLAST with automatic taxonomic mapping and phylogenetic analysis and provides the results in interactive visualizations. We demonstrate the functionalities of BLASTphylo in two case studies.

Second-Trimester Dilation and Evacuation: A Simulation-Based Team Training Curriculum.

Introduction: Despite the need for providers skilled in second-trimester dilation and evacuation (D&E) procedures, there are few second-trimester abortion training opportunities for OB/GYN residents and other health care trainees. Barriers to such training include restrictive state laws and institutional policies, lack of trained faculty, and limited procedural volume. Simulation-based D&E training is, therefore, a critical tool for OB/GYN residents and other medical professionals to achieve clinical competency. Methods: This simulation for OB/GYN residents centers on a 29-year-old woman at 18 weeks gestation with intrauterine fetal demise, requiring learners to perform a second-trimester D&E and manage an unexpected postprocedural hemorrhage. We designed the simulation to be used with a high-fidelity mannequin. Personnel roles required for the simulation included an anesthesiologist, medical assistant, OR nurse, and two OB/GYN faculty. Learner performance was assessed using a pre- and postsimulation learner evaluation, a critical action checklist, and a focus group with simulation facilitators. Results: Forty-nine residents participated over an 8-year period. Learners demonstrated improved competency performing a second-trimester D&E and increased confidence managing postprocedural hemorrhage after participating in this simulation. In addition, focus group participants reported that a majority of learners demonstrated confidence and effective communication with team members while performing in a decision-making role. Discussion: In addition to improving learners' clinical competency and surgical confidence for second-trimester D&E procedures, this simulation serves as a valuable instrument for the standardized assessment of learners' performance, as well as an opportunity for all participants to practice teamwork and communication in a high-acuity setting.

Evaluation of eight registration algorithms applied to the insula and insular gyri.

BACKGROUND AND PURPOSE: Spatial registration is crucial in establishing correspondence between anatomic brain regions for research and clinical purposes. The insular cortex (IC) and gyri (IG) are implicated in various functions and pathologies including epilepsy. Optimizing registration of the insula to a common atlas can improve the accuracy of group-level analyses. Here, we compared six nonlinear, one linear, and one semiautomated registration algorithms (RAs) for registering the IC and IG to the Montreal Neurologic Institute standard space (MNI152). METHODS: 3T images acquired from 20 controls and 20 temporal lobe epilepsy patients with mesial temporal sclerosis underwent automated segmentation of the insula. This was followed by manual segmentation of the entire IC and six individual IGs. Consensus segmentations were created at 75% agreement for IC and IG before undergoing registration to MNI152 space with eight RAs. Dice similarity coefficients (DSCs) were calculated between segmentations after registration and the IC and IG in MNI152 space. Statistical analysis involved the Kruskal-Wallace test with Dunn's test for IC and two-way analysis of variance with Tukey's honest significant difference test for IG. RESULTS: DSCs were significantly different between RAs. Based on multiple pairwise comparisons, we report that certain RAs performed better than others across population groups. Additionally, registration performance differed according to specific IG. CONCLUSION: We compared different methods for registering the IC and IG to MNI152 space. We found differences in performance between RAs, which suggests that algorithm choice is important factor in analyses involving the insula.

[The transformative effect of artificial intelligence in hospitals : The focus is on the individual]. / Die transformative Wirkung von künstlicher Intelligenz im Krankenhaus : Der Mensch steht im Mittelpunkt.

Rapid advances in digital technology and the promising potential of artificial intelligence (AI) are changing our everyday lives and have already impacted on hospital procedures. The use of AI applications, in particular, enables a wide range of possible uses and has considerable potential for improving medical and nursing care. In radiological diagnostics, for example, there are already many well-researched applications for AI-based image evaluation. In this article further AI developments are presented, which can help to relieve medical staff in order to create more time for direct patient care. In addition, essential aspects regarding the development and transfer of AI-based applications are highlighted. It is crucial that the integration of AI into medical practice is carried out with the utmost care and prudence. Data protection and ethical aspects need to be considered and respected at all times. Ensuring the reliability and integrity of AI systems is essential to earn the trust of both patients and healthcare professionals. A comprehensive inspection for possible bias within the underlying data and algorithms is indispensable. In this field of tension between promising possibilities and ethical challenges, the digital transformation in medicine and care can be designed to increase patient safety and to relieve staff.

Machine learning-based classification of chronic traumatic brain injury using hybrid diffusion imaging.

Background and purpose: Traumatic brain injury (TBI) can cause progressive neuropathology that leads to chronic impairments, creating a need for biomarkers to detect and monitor this condition to improve outcomes. This study aimed to analyze the ability of data-driven analysis of diffusion tensor imaging (DTI) and neurite orientation dispersion imaging (NODDI) to develop biomarkers to infer symptom severity and determine whether they outperform conventional T1-weighted imaging. Materials and methods: A machine learning-based model was developed using a dataset of hybrid diffusion imaging of patients with chronic traumatic brain injury. We first extracted the useful features from the hybrid diffusion imaging (HYDI) data and then used supervised learning algorithms to classify the outcome of TBI. We developed three models based on DTI, NODDI, and T1-weighted imaging, and we compared the accuracy results across different models. Results: Compared with the conventional T1-weighted imaging-based classification with an accuracy of 51.7-56.8%, our machine learning-based models achieved significantly better results with DTI-based models at 58.7-73.0% accuracy and NODDI with an accuracy of 64.0-72.3%. Conclusion: The machine learning-based feature selection and classification algorithm based on hybrid diffusion features significantly outperform conventional T1-weighted imaging. The results suggest that advanced algorithms can be developed for inferring symptoms of chronic brain injury using feature selection and diffusion-weighted imaging.

The Evaluation of l-Tryptophan Derivatives as Inhibitors of the l-Type Amino Acid Transporter LAT1 (SLC7A5).

A series of derivatives of the substrate amino acid l-tryptophan have been investigated for inhibition of the L-type amino acid transporter LAT1 (SLC7A5), which is an emerging target in anticancer drug discovery. Of the four isomeric 4-, 5-, 6-, or 7-benzyloxy-l-tryptophans, the 5-substituted derivative was the most potent, with an IC50 of 19 µM for inhibition of [3 H]-l-leucine uptake into HT-29 human colon carcinoma cells. The replacement of the carboxy group in 5-benzyloxy-l-tryptophan by a bioisosteric tetrazole moiety led to a complete loss in potency. Likewise, the corresponding tetrazolide derived from l-tryptophan itself was found to be neither a substrate nor an inhibitor of the transporter. Increasing the steric bulk at the 5-position, while reasonably well tolerated in some cases, did not result in an improvement in potency. At the same time, none of these derivatives was found to be a substrate for LAT1-mediated transport.