Role of 18F-FDG PET/CT for providing a targeted approach for etiology of PUO.

AIM: This study aimed to evaluate the potential role of 18F-fluorodeoxyglucose PET/computed tomography (18F-FDG PET/CT) in providing a targeted approach for diagnosing the etiology of Pyrexia of Unknown Origin (PUO). METHODS: A total of 573 PUO patients were included in this ambispective study, with a mean age of 39.40 ±â€…4.6 years. Patients underwent FDG PET/CT scans using dedicated hybrid scanners. PET/CT data were interpreted by experienced nuclear medicine physicians. The study analyzed the guidance provided by FDG PET/CT for appropriate biopsy sites and assessed concordance between PET/CT findings and histopathological examination. RESULTS: Out of the 573 patients, a final diagnosis was reached for 219 patients, including malignancy, infectious causes, noninfectious inflammatory causes (NIID), and precancerous conditions. FDG PET/CT played a crucial role in guiding clinicians to appropriate biopsy sites, contributing to a higher diagnostic yield. Concordance between PET/CT findings and histopathological examination emphasized the noninvasive diagnostic potential of PET/CT in identifying underlying causes of PUO. Overall, FDG PET/CT contributed to guiding the appropriate site of biopsy or concordance of the first differential diagnosis with the final diagnosis in 50.05% of cases. CONCLUSION: This study highlights the valuable role of FDG PET/CT in providing a targeted approach for diagnosing PUO, showcasing its potential in guiding clinicians towards appropriate biopsy sites and improving the diagnostic yield. The findings underscore the importance of integrating FDG PET/CT into the diagnostic pathway for PUO, ultimately enhancing patient management and outcomes. Further prospective studies are necessary to validate these results and refine the integration of FDG PET/CT in the diagnosis of PUO.

Strongly correlated multielectron bunches from interaction with quantum light.

Strongly correlated electron systems are a cornerstone of modern physics, being responsible for groundbreaking phenomena from superconducting magnets to quantum computing. In most cases, correlations in electrons arise exclusively because of Coulomb interactions. In this work, we reveal that free electrons interacting simultaneously with a light field can become highly correlated via mechanisms beyond Coulomb interactions. In the case of two electrons, the resulting Pearson correlation coefficient for the joint probability distribution of the output electron energies is enhanced by more than 13 orders of magnitude compared to that of electrons interacting with the light field in succession (one after another). These highly correlated electrons are the result of momentum and energy exchange between the participating electrons via the external quantum light field. Our findings pave the way to the creation and control of highly correlated free electrons for applications including quantum information and ultrafast imaging.

Vaccine for Targeted Therapy of Lung Cancer: Advances and Developments.

Considering that lung cancer is a leading global perpetrator, novel treatment approaches must be investigated. Due to the broad spectrum of lung cancer, conventional therapies including chemotherapy, radiotherapy, and surgeries, are not always effective and can have adverse consequences. The present study's overarching objective was to enhance the development of a personalized vaccine for targeted lung cancer therapy. Vaccination functions by eliciting a strong and targeted immune response defense by taking advantage of the specific antigens that are expressed by lung cancer cells. Crucial antigens associated with tumor cells have been identified with the recognition of the genetic and immunological circumstances of lung cancer in this review. The vaccine includes these antigens to prime the immune system, directing it toward recognizing and attacking cancerous cells. In this review, we have addressed the possible benefits of a targeted vaccine strategy, which include a reduction in off-target effects and an improvement in health outcomes for patients. These studies highlight the promise of a tailored vaccine in a novel way for the treatment of lung cancer. The integration of molecular profiling and immunological insights offers a rationale for the design and implementation of personalized vaccines. While challenges exist, the promise of improved treatment outcomes and reduced side effects positions targeted vaccine therapy as a compelling avenue for advancing lung cancer treatment.

FDG PET/CT in the Diagnosis and After Sunitinib Follow-up of Synchronous Base of Tongue and Thyroid Metastases From Renal Cell Carcinoma.

ABSTRACT: Renal cell carcinoma (RCC) is a leading cause of mortality among genitourinary malignancies with limited therapeutic options. The hematogenous route, lymphatic spread, and direct invasion have been documented in RCC. Usually, metastases are regional lymph nodes, lungs, bone, liver, adrenal glands, contralateral kidney, and brain. Metastases to the rare sites such as skin, breast, head and neck were documented in the literature. In the present case, we describe the synchronous metastases to the base of the tongue and thyroid gland in RCC and the response to sunitinib therapy on 18F-FDG PET/CT.

Free-electron crystals for enhanced X-ray radiation.

Bremsstrahlung-the spontaneous emission of broadband radiation from free electrons that are deflected by atomic nuclei-contributes to the majority of X-rays emitted from X-ray tubes and used in applications ranging from medical imaging to semiconductor chip inspection. Here, we show that the bremsstrahlung intensity can be enhanced significantly-by more than three orders of magnitude-through shaping the electron wavefunction to periodically overlap with atoms in crystalline materials. Furthermore, we show how to shape the bremsstrahlung X-ray emission pattern into arbitrary angular emission profiles for purposes such as unidirectionality and multi-directionality. Importantly, we find that these enhancements and shaped emission profiles cannot be attributed solely to the spatial overlap between the electron probability distribution and the atomic centers, as predicted by the paraxial and non-recoil theory for free electron light emission. Our work highlights an unprecedented regime of free electron light emission where electron waveshaping provides multi-dimensional control over practical radiation processes like bremsstrahlung. Our results pave the way towards greater versatility in table-top X-ray sources and improved fundamental understanding of quantum electron-light interactions.

Symmetrical peripheral gangrene and Roth spots in a patient with infective endocarditis.

We present a case of a young man with symmetrical peripheral gangrene (SPG) resulting from Streptococcus viridans-related infective endocarditis, an association which has not previously been reported. SPG is associated with up to 40% mortality and may necessitate amputation; early identification and treatment of the precipitating factors is very important.

Excellent Response to Full-Dose 177 Lu-PSMA-617 RLT in Metastatic Castration-Resistant Prostate Cancer With Transplant Kidney : A Step Ahead.

ABSTRACT: 177 Lu-PSMA radioligand therapy (RLT) has shown very encouraging results in metastatic castrate-resistant prostate cancer (mCRPC) patients with acceptable adverse events. The adverse events of RLT are mainly limited to salivary glands and kidneys. However, there is dearth of available data of RLT in transplanted kidney patients with mCRPC. Here is a case of 68-year-old mCRPC patient with history of renal transplant who underwent 4 cycles of 177 Lu-PSMA-617 RLT (~7.4 GBq/cycle). Posttherapy serum creatinine and glomerular filtration rate remained stable along with excellent response and symptomatic improvement, thus demonstrating the safety of full dose of 177 Lu-PSMA in renal transplant patients.

Dedifferentiation and Proliferation of Artery Endothelial Cells Drive Coronary Collateral Development in Mice.

BACKGROUND: Collateral arteries act as natural bypasses which reroute blood flow to ischemic regions and facilitate tissue regeneration. In an injured heart, neonatal artery endothelial cells orchestrate a systematic series of cellular events, which includes their outward migration, proliferation, and coalescence into fully functional collateral arteries. This process, called artery reassembly, aids complete cardiac regeneration in neonatal hearts but is absent in adults. The reason for this age-dependent disparity in artery cell response is completely unknown. In this study, we investigated if regenerative potential of coronary arteries is dictated by their ability to dedifferentiate. METHODS: Single-cell RNA sequencing of coronary endothelial cells was performed to identify differences in molecular profiles of neonatal and adult endothelial cells in mice. Findings from this in silico analyses were confirmed with in vivo experiments using genetic lineage tracing, whole organ immunostaining, confocal imaging, and cardiac functional assays in mice. RESULTS: Upon coronary occlusion, neonates showed a significant increase in actively cycling artery cells and expressed prominent dedifferentiation markers. Data from in silico pathway analyses and in vivo experiments suggested that upon myocardial infarction, cell cycle reentry of preexisting neonatal artery cells, the subsequent collateral artery formation, and recovery of cardiac function are dependent on arterial VegfR2 (vascular endothelial growth factor receptor-2). This subpopulation of dedifferentiated and proliferating artery cells was absent in nonregenerative postnatal day 7 or adult hearts. CONCLUSIONS: These data indicate that adult artery endothelial cells fail to drive collateral artery development due to their limited ability to dedifferentiate and proliferate.

Comparative evaluation of visual analogue scale and pupillary diameter for post-operative pain: An observational study.

Background and Aims: An objective understanding of pain guides the effectiveness of various postoperative pain management strategies. The measurement of pain by the visual analogue scale (VAS) is dependent on the individual's cognitive and emotional ability. Pupillary dilatation has been successfully used to measure pain in quantitative terms. The present study was conducted to study the correlation between VAS and pupillary diameter in the evaluation of postoperative pain. Methods: This observational study was carried out on 85 patients 18-65 years of age, scheduled for lower abdominal surgical procedures under general anaesthesia. Postoperative pain assessment was done using the VAS at 6 h, 12 h, 18 h and 24 h. In addition, the pupillary diameter of both eyes was measured simultaneously. Paired t-test and analysis of variance (ANOVA) were used to compare the data, and Pearson's correlation coefficient was calculated to assess the bivariate correlation between VAS score and pupillary diameter. Results: Mean ± standard deviation (SD) of VAS scores at baseline, 6 h, 12 h, 18 h and 24 h postoperatively were 0, 4.88 ± 0.88, 3.39 ± 0.86, 2.19 ± 0.66 and 1.40 ± 0.49, respectively. Mean change was significant at all time intervals (P < 0.001). The mean ± SD change in average pupillary diameter was 0.59 ± 0.64, 0.44 ± 0.54, 0.22 ± 0.34 and 0.07 ± 0.22 mm, respectively, showing a significant change from baseline (P < 0.05). On overall evaluation, mean pupillary diameter showed a significant incremental trend with an increasing VAS score (P < 0.001). Conclusion: Change in pupillary diameter correlated well with the pain scores (VAS) and thus pupillary diameter can be chosen as an objective measurement of postoperative pain severity.

Anteromedial thalamus gates the selection and stabilization of long-term memories.

Memories initially formed in hippocampus gradually stabilize to cortex over weeks-to-months for long-term storage. The mechanistic details of this brain re-organization remain poorly understood. We recorded bulk neural activity in circuits that link hippocampus and cortex as mice performed a memory-guided virtual-reality task over weeks. We identified a prominent and sustained neural correlate of memory in anterior thalamus, whose inhibition substantially disrupted memory consolidation. More strikingly, gain amplification enhanced consolidation of otherwise unconsolidated memories. To gain mechanistic insights, we developed a technology for simultaneous cellular-resolution imaging of hippocampus, thalamus, and cortex throughout consolidation. We found that whereas hippocampus equally encodes multiple memories, the anteromedial thalamus preferentially encodes salient memories, and gradually increases correlations with cortex to facilitate tuning and synchronization of cortical ensembles. We thus identify a thalamo-cortical circuit that gates memory consolidation and propose a mechanism suitable for the selection and stabilization of hippocampal memories into longer-term cortical storage.

Lower Permian Gondwana sequence of Rajhara (Daltonganj Coalfield), Damodar Basin, India: floristic and geochemical records and their implications on marine ingressions and depositional environment.

Early Permian floral diversity and palaeodepositional environment of the Lower Permian Rajhara sequence of Damodar Basin have been studied based on mega-, microfossil and geochemical proxies. Even though Gondwana sediments are generally considered as fluvio-lacustrine deposits, recent studies indicate marine inundations with patchy records. Here in the present study, an attempt has been made to address the changeover from fluviatile to shallow marine conditions and also to address the palaeodepositional aspects. Luxuriant vegetation during deposition of the Lower Barakar Formation generated thick coal seams. The macroplant fossil assemblage shows Glossopteridales, Cordaitales and Equisetales comprising one palynoassemblage with the dominance of bisaccate pollen grains having glossopterid affinities. However, Lycopsids are absent in the megafloral record and are represented in megaspore assemblage. The present floral assemblage led to envisage the presence of dense forest with swampy conditions and prevalence of warm and humid climate during the deposition of Barakar sediments. Correlation with the coeval Indian assemblages and those from other Gondwanan continents also supports an Artinskian age and reveals a stronger affinity with flora of Africa than that of South America. Biomarker analysis reveals low pristane/phytane values (0.30-0.84), noticeable absence of hopanoid triterpenoids and long-chain n-alkanes that is attributed to the obliteration of organic compounds and subsequent alteration of composition due to thermal effect. The high chemical index of alteration, A-CN-K plot and PIA also suggest severe denudation under a warm/humid climate. The V/Al2O3 and P2O5/Al2O3 indicated freshwater-near-shore conditions. However, signature of possible marine influence is identified from Th/U and Sr/Ba ratios resulted from the eustatic fluctuations during Permian.

Anteromedial Thalamus Gates the Selection & Stabilization of Long-Term Memories.

Memories initially formed in hippocampus gradually stabilize to cortex, over weeks-to-months, for long-term storage. The mechanistic details of this brain re-organization process remain poorly understood. In this study, we developed a virtual-reality based behavioral task and observed neural activity patterns associated with memory reorganization and stabilization over weeks-long timescales. Initial photometry recordings in circuits that link hippocampus and cortex revealed a unique and prominent neural correlate of memory in anterior thalamus that emerged in training and persisted for several weeks. Inhibition of the anteromedial thalamus-to-anterior cingulate cortex projections during training resulted in substantial memory consolidation deficits, and gain amplification more strikingly, was sufficient to enhance consolidation of otherwise unconsolidated memories. To provide mechanistic insights, we developed a new behavioral task where mice form two memories, of which only the more salient memory is consolidated, and also a technology for simultaneous and longitudinal cellular resolution imaging of hippocampus, thalamus, and cortex throughout the consolidation window. We found that whereas hippocampus equally encodes multiple memories, the anteromedial thalamus forms preferential tuning to salient memories, and establishes inter-regional correlations with cortex, that are critical for synchronizing and stabilizing cortical representations at remote time. Indeed, inhibition of this thalamo-cortical circuit while imaging in cortex reveals loss of contextual tuning and ensemble synchrony in anterior cingulate, together with behavioral deficits in remote memory retrieval. We thus identify a thalamo-cortical circuit that gates memory consolidation and propose a mechanism suitable for the selection and stabilization of hippocampal memories into longer term cortical storage.

Quantum Interference between Fundamentally Different Processes Is Enabled by Shaped Input Wavefunctions.

This work presents a general framework for quantum interference between processes that can involve different fundamental particles or quasi-particles. This framework shows that shaping input wavefunctions is a versatile and powerful tool for producing and controlling quantum interference between distinguishable pathways, beyond previously explored quantum interference between indistinguishable pathways. Two examples of quantum interference enabled by shaping in interactions between free electrons, bound electrons, and photons are presented: i) the vanishing of the zero-loss peak by destructive quantum interference when a shaped electron wavepacket couples to light, under conditions where the electron's zero-loss peak otherwise dominates; ii) quantum interference between free electron and atomic (bound electron) spontaneous emission processes, which can be significant even when the free electron and atom are far apart, breaking the common notion that a free electron and an atom must be close by to significantly affect each other's processes. Conclusions show that emerging quantum wave-shaping techniques unlock the door to greater versatility in light-matter interactions and other quantum processes in general.

Semiquantitative evaluation of 68Ga-DOTANOC uptake in the normal myocardium: establishment of reference values.

BACKGROUND: To ascertain presence of physiological uptake and derive standardized uptake values (SUV) of 68Ga-DOTANOC in normal myocardium and establish reference values. METHODS AND RESULTS: Dedicated cardiac 68Ga-DOTANOC PET/CT studies of patients referred for evaluation of cardiac sarcoidosis (CS) or myocarditis and found to be normal on visual assessment and on cardiac MRI were analyzed semiquantitatively. The studies were acquired 45-60 minutes after intravenous injection of 111-185 MBq of 68Ga-DOTANOC. Myocardial SUVmax normalized to lean body mass (SUVmax_lbm) values for septum, anterior wall, proximal lateral wall, distal lateral wall, inferior wall, and apical region were 1.12 ± .39, 1.09 ± .42, 1.26 ± .49, 1.16 ± .40, 1.23 ± .39, and 1.05 ± .40, respectively. Myocardial SUVmax_lbm-to-blood pool SUVmean_lbm ratios were calculated for each region and 95th percentile values of these ratios were considered the upper limit of normal. 95th percentile values of myocardial SUVmax_lbm-to-blood pool SUVmean_lbm ratio for the corresponding regions were 1.70, 1.70, 2.00 1.95, 2.05, and 1.70, respectively. CONCLUSION: There can be physiological uptake of 68Ga-DOTANOC in normal myocardium and the reference values of semiquantitative parameters established in this study may be employed as a corroborative tool for visual assessment in patients undergoing 68Ga-DOTANOC PET/CT for suspected CS or myocarditis.

Development of a Nonlinear Model Predictive Control-Based Nonlinear Three-Mode Controller for a Nonlinear System.

This paper presents the novelty on a nonlinear proportional integral derivative (NPID) controller developed from the gain values obtained using the Lyapunov-based nonlinear model predictive controller (LyNMPC). The tuning parameters of the proposed controller are taken from the dynamics of the nonlinear system, and these parmeters are dynamic with their value varying according to the error in the system. In this article, the authors have considered two highly nonlinear systems, namely, batch polymerization reactor and quadrotor unmanned aerial vehicle systems. The nonlinear mathematical modeling of the batch reactor as well as the quadrotor system considered from the past literature of authors. The acrylamide polymerization reaction under consideration is an exothermic reaction, thereby making the temperature profile tracking and control a challenging task. The primary aim of this article is to develop the NPID controller based on the LyNMPC algorithm and to validate the NPID on a batch reactor bench-scale plant and on an hardware-in-the-loop platform for the quadrotor hardware. A comparative study of trajectory tracking and control capabilities of LyNMPC on derived non-linear models of the batch reactor and quadrotor system is presented. The system mathematical models are obtained with the help of the first-principle energy balance equation for the batch reactor and with the nonlinear dynamics of the quadrotor which is derived based on Newton-Euler formulations. With LyNMPC, the stability of the nonlinear systems can be improved because the error sensitivity is considered in the cost function.

Hierarchical self-assembling and helical structure in focal conic domains in meniscus of ferroelectric liquid crystal.

We investigate experimentally the formation of focal conic domains of the ferroelectric phase of a liquid crystal, chiral smectic C (SmC^{*}), in the meniscus geometry. The meniscus geometry is formed in the gap between two glass plates which are placed on a common substrate. This gap is called here a physical cavity. Focal conic domains (FCDs) in the physical cavity with dimensions of micrometer scale are investigated under an optical polarizing microscope which enables us to extract the information on the helical structure formation in the constraint and gradient topological meniscus interface. The helical pitch in the FCD is observed to be shorter than in planar confined geometry. A crucial phenomenon of unwrapping and wrapping of helical structure from one FCD to another is also observed. In-plane application of an electric field on a FCD revealed the asymmetric helical unwinding process whereas an increase in temperature has shown symmetrical unwinding. The helical structure based observation is significant for understanding the ferroelectric phase in focal conic domains and their application in microlenses and optical components.

Deep Learning Capabilities for the Categorization of Microcalcification.

Breast cancer is the most common cancer in women worldwide. It is the most frequently diagnosed cancer among women in 140 countries out of 184 reporting countries. Lesions of breast cancer are abnormal areas in the breast tissues. Various types of breast cancer lesions include (1) microcalcifications, (2) masses, (3) architectural distortion, and (4) bilateral asymmetry. Microcalcification can be classified as benign, malignant, and benign without a callback. In the present manuscript, we propose an automatic pipeline for the detection of various categories of microcalcification. We performed deep learning using convolution neural networks (CNNs) for the automatic detection and classification of all three categories of microcalcification. CNN was applied using four different optimizers (ADAM, ADAGrad, ADADelta, and RMSProp). The input images of a size of 299 × 299 × 3, with fully connected RELU and SoftMax output activation functions, were utilized in this study. The feature map was obtained using the pretrained InceptionResNetV2 model. The performance evaluation of our classification scheme was tested on a curated breast imaging subset of the DDSM mammogram dataset (CBIS-DDSM), and the results were expressed in terms of sensitivity, specificity, accuracy, and area under the curve (AUC). Our proposed classification scheme outperforms the ability of previously used deep learning approaches and classical machine learning schemes.

Optical coherence tomography characterization of spontaneous recanalized coronary thrombus - Single center experience.

Introduction: Recanalized thrombus is an under diagnosed clinical entity. Aim was to investigate the utility of optical coherence tomography (OCT) in identifying spontaneously recanalized thrombi (SRCT) for management in clinical practice. Methods: This was a retrospective study analyzing 2678 coronary angiograms over a 4-year period which included intravascular imaging guidance in 75.8% of the percutaneous coronary interventions (PCI). Angiographic suspicion of SRCT has hazy appearance seen in 34 patients. Results: Eight patients (7 males and 1 female) were confirmed with SRCT on OCT and two underwent intravascular ultrasound (IVUS). Median age was 52 years (range 33-67 years). Based on clinical symptoms, diagnosis was STEMI-2, NSTEMI-1, unstable angina-3 and chronic stable angina-2. Angiographic patterns were veiled/hazy appearances in 3; braided in 2; pseudo dissection in 2; and near occlusion in 1 patient. OCT findings displayed multiple small cavities, signal-rich with high backscattering and thin septa with smooth inner borders dividing the lumen and intercommunications. Presence of multiple holes conferred typical "Swiss cheese" or 'lotus root' like appearance, characteristic of recanalized thrombi. SRCT lesion length was (median interquartile ranges [IQR], 16.5[12.07-21.5] mm) and minimal luminal area (median [IQR], 1.77 [0.93-3.26] mm2) with significant stenosis (median [IQR], 74.0[67.0-81.0] %). Minimum/maximum number of channels were (median [IQR], 2.0[2.0-2.0]) and (median [IQR], 4.50[4.0-6.75]) respectively. Lipid rich plaque was predominant. IVUS demonstrated echo-lucent channels with small cavities. All but one patient underwent PCI. Conclusion: Intravascular imaging by OCT delineates the characteristics of recanalized thrombi and distinguishes ambiguous lesions. Majority of the lesions involving SRCT were significant both symptomatic and stenosis severity wise on OCT requiring PCI.