Creating the freedom to thrive: Honoring the legacy of RSNA gold medalist, Deborah Levine, MD.

Awarded the Radiological Society of North America (RSNA) Gold Medal in 2018, Dr. Deborah Levine's research, journalism, and mentorship have left an indelible mark on the radiology field. Her work in ultrasound led to its use as the standard for monitoring benign adnexal cysts. She helped popularize obstetric magnetic resonance imaging (MRI) through her research on its use in placental accreta and fetal abnormalities, which led to the development of the 'Compendium of Fetal MRI' website. This work in research led naturally to a career in journalism, where she eventually became Senior Deputy Editor of Radiology and founded Radiology Select. Concurrently with her personal achievements, Dr. Levine has dedicated herself to the mentorship of her female trainees. She sought various leadership positions to learn more about and advocate for the promotion and support of female leadership in radiology departments. In many ways, Dr. Levine's career and work have transformed radiology as we know it today for both patients and physicians.

The proteomic and particle composition of human platelet lysate for cell therapy products.

Following health agencies warning, the use of animal origin supplements should be avoided in biological products proposed as therapy in humans. Platelet lysate and several other growth factors sources are alternatives to replace fetal calf serum, the current gold standard in clinical-grade cell culture. However, the platelet supplement's content lacks data due to different production methods. The principle behind these products relays on the lysis of platelets that release several proteins, some of which are contained in heterogeneous granules and coordinate biological functions. This study aims to analyze the composition and reproducibility of a platelet lysate produced with a standardized method, by describing several batches' protein and particle content using proteomics and dynamic light scattering. Proteomics data revealed a diversified protein content, with some related to essential cellular processes such as proliferation, morphogenesis, differentiation, biosynthesis, adhesion, and metabolism. It also detected proteins responsible for activation and binding of transforming growth factor beta, hepatocyte growth factor, and insulin-like growth factor. Total protein, biochemical, and growth factors quantitative data showed consistent and reproducible values across batches. Novel data on two major particle populations is presented, with high dispersion level at 231 ± 96 d.nm and at 30 ± 8 d.nm, possibly being an important way of protein trafficking through the cellular microenvironment. This experimental and descriptive analysis aims to support the content definition and quality criteria of a cell supplement for clinical applications.

Age-dependent white matter disruptions after military traumatic brain injury: Multivariate analysis results from ENIGMA brain injury.

Mild Traumatic brain injury (mTBI) is a signature wound in military personnel, and repetitive mTBI has been linked to age-related neurogenerative disorders that affect white matter (WM) in the brain. However, findings of injury to specific WM tracts have been variable and inconsistent. This may be due to the heterogeneity of mechanisms, etiology, and comorbid disorders related to mTBI. Non-negative matrix factorization (NMF) is a data-driven approach that detects covarying patterns (components) within high-dimensional data. We applied NMF to diffusion imaging data from military Veterans with and without a self-reported TBI history. NMF identified 12 independent components derived from fractional anisotropy (FA) in a large dataset (n = 1,475) gathered through the ENIGMA (Enhancing Neuroimaging Genetics through Meta-Analysis) Military Brain Injury working group. Regressions were used to examine TBI- and mTBI-related associations in NMF-derived components while adjusting for age, sex, post-traumatic stress disorder, depression, and data acquisition site/scanner. We found significantly stronger age-dependent effects of lower FA in Veterans with TBI than Veterans without in four components (q < 0.05), which are spatially unconstrained by traditionally defined WM tracts. One component, occupying the most peripheral location, exhibited significantly stronger age-dependent differences in Veterans with mTBI. We found NMF to be powerful and effective in detecting covarying patterns of FA associated with mTBI by applying standard parametric regression modeling. Our results highlight patterns of WM alteration that are differentially affected by TBI and mTBI in younger compared to older military Veterans.

Bone Marrow Mesenchymal Stem Cells in Acute-on-Chronic Liver Failure Grades 2 and 3: A Phase I-II Randomized Clinical Trial.

Introduction: Acute-on-chronic liver failure (ACLF) is an acute liver decompensation in cirrhotic patients, which leads to organ failures and high short-term mortality. The treatment is based on the management of complications and, in severe cases, liver transplantation. Since specific treatment is unavailable, we aimed to evaluate the safety and initial efficacy of bone marrow mesenchymal stem cells (BM-MSC) in patients with ACLF Grades 2 and 3, a population excluded from previous clinical trials. Methods: This is a randomized placebo-controlled phase I-II single center study, which enrolled 9 cirrhotic patients from 2018 to 2020, regardless of the etiology. The control group (n = 5) was treated with standard medical therapy (SMT) and placebo infusion of saline. The intervention group (n = 4) received SMT plus 5 infusions of 1 × 106 cells/kg of BM-MSC for 3 weeks. Both groups were monitored for 90 days. A Chi-square test was used for qualitative variables, and the t-test and Mann-Whitney U test for quantitative variables. The Kaplan-Meier estimator was used to build survival curves. In this study, we followed the intention-to-treat analysis, with a significance of 5%. Results: Nine patients with a mean Child-Pugh (CP) of 12.3, MELD of 38.4, and CLIF-C score of 50.7 were recruited. Hepatitis C and alcohol were the main etiologies. The average infusion per patient was 2.9 and only 3 patients (2 in control and 1 in the BM-MSC group) received all the protocol infusions. There were no infusion-related side effects, although one patient in the intervention group presented hypernatremia and a gastric ulcer, after the third and fifth infusions, respectively. The survival rate after 90 days was 20% (1/5) for placebo versus 25% (1/4) for the BM-MSC. The patient who completed the entire MSC protocol showed a significant improvement in CP (C-14 to B-9), MELD (32 to 22), and ACLF (grade 3 to 0). Conclusion: BM-MSC infusion is safe and feasible in patients with ACLF Grades 2 and 3.

Prevalência de lesões bucais em tecidos mole e duro diagnosticadas em idosos em um serviço histopatológico de referência / Prevalence of oral lesions in soft and hard tissue in elderly patients in a single histopathological service / Prevalencia de lesiones bucales en tejido blando y duro enancianos diagnosticadas en un servicio de referencia histopatológico

O envelhecimento populacional é um fenômeno mundial, sendo percebido também no estado do Amazonas. Com a alta expectativa de vida, o enfoque na saúde geral e bucal impactam diretamente a qualidade de vida da pessoa. Desta forma, os levantamentos acerca da população geriátrica não devem ser restritos às alterações fisiológicas da idade, devendo abordar também as manifestações patológicas, retratando assim quais são as lesões bucais mais recorrentes. O trabalho em questão visa levantar o número de lesões bucais prevalentes em tecido mole e duro em idosos. Sendo feito a partir de um levantamento das lesões bucais prevalentes em tecido mole e duro que acometeram os idosos registrados nos laudos do Serviço de Patologia Oral e Maxilofacial da Universidade do Estado do Amazonas, SEPAT-UEA, entre os anos de 2012 a 2018. Segundo os dados coletados, a categoria de neoplasias de tecido mole (28,94%) teve o maior número de casos, em que a lesão mais prevalente, sendo esta do mesmo grupo, foi a hiperplasia fibrosa inflamatória (14,04%). Teve maior acometimento em mulheres (54,91%), pessoas com 60-69 anos (74,77%), usuários de próteses removíveis (15,56%) e a mandíbula (17,28%) foi a localização mais comum. Com as informações adquiridas, a partir de um serviço de referência do estado do Amazonas, é possível ter um melhor direcionamento dos recursos para a população geriátrica tendo um maior enfoque para as lesões mais prevalentes visando assim uma melhor saúde bucal e consequentemente uma melhor qualidade de vida(AU)

Population aging is a worldwide phenomenon, and is also noticed in the state of Amazonas. According to the high life expectancy, the focus on general health and the oral impact directly on the person's quality of life. Thus, surveys about thegeriatric population should not be restricted as physiological changes in age, but should also be addressed as pathological manifestations, thus portraying which are the most recurrent oral lesions. The aim of the study is to raise the frequency of the most prevalent of oral lesions in soft and hard tissue in the elderly. Being made from a survey of oral lesions in soft and hard tissue that affected the elderly registered in the reports of the Oral and Maxillofacial Pathology Service of the Amazonas State University, SEPAT-UEA, between the years 2012 to 2018. According to collected data, the category of soft tissue neoplasms (28.94%) had the highest number of cases, in which the most prevalent lesion, being the same group, for an inflammatory fibrous hyperplasia (14.04%). It was more recurrent in women (54.91%), elderly in 60-69 years (74.77%), users of removable prosthesis (15.56%) and the mandible (17.28%) was the most common location. With the information acquired, from a reference service in the state of Amazonas, it is possible to have a better targeting of resources for the geriatric population, with agreater focus on the most prevalent injuries, thus better oral health and consequently a better quality of life care(AU)

El envejecimiento de la población es un fenómeno mundial, se percibe también en el estado de Amazonas. Con la alta expectativa de vida, el enfoque en la salud general y bucal impactan directamente la calidad de vida de la persona. De esta forma, las encuestas sobre la población geriátrica no deben restringir a los cambios fisiológicos de la edad, sino que deben abordar también las manifestaciones patológicas, describiendo así cuáles son las lesiones bucales más recurrentes. El trabajo en cuestión tiene por objeto levantar el número de lesiones bucales prevalentes en tejido blando y duro en ancianos. Se realiza a partir de um estudio de las lesiones bucales prevalentes que han afectado a los ancianos registrados en los informes del Servicio de Patología Oral y Maxilofacial de la Universidad del Estado de Amazonas, SEPAT-UEA, entre los años 2012 a 2018. Según los datos recogidos, la categoría de neoplasias de tejidos blandos (28,94%) presentó el mayor número de casos, en la que la lesión más prevalente fue la hiperplasia fibrosa inflamatoria (14,04%). Fue más afectado por mujeres (54,91%), personas de 60 a 69 años (74,77%), usuarios de prótesis removibles (15,56%) y la mandíbula (17,28%) fue la localización más común. Con la información adquirida, de un servicio de referencia en el estado de Amazonas, es posible tener una mejor focalización de recursos para la población geriátrica, con un mayor enfoque en las lesiones más prevalentes, apuntando así a una mejor salud bucal y consecuentemente una mejor calidad de vida(AU)

Emotional Awareness in Schizophrenia Is Associated With Gray Matter Volume of Right Precuneus.

Objectives: We assessed the relationship between emotional awareness (e.g., the ability to identify and differentiate our own feelings and feelings of others) and regional brain volumes in healthy and in schizophrenia groups. Methods: Magnetic resonance images of 29 subjects with schizophrenia and 33 matched healthy controls were acquired. Brain gray matter was parcellated using FreeSurfer and 28 regions of interest associated with emotional awareness were analyzed. All participants were assessed using the Levels of Emotional Awareness Scale (LEAS) of Self and of Other. LEAS scores were correlated with gray matter volume for each hemisphere on the 14 brain regions of the emotional awareness network. Results: Individuals with schizophrenia showed decreased emotional awareness on both LEAS Self and LEAS Other compared to healthy controls. There were no statistically significant between-group differences in gray matter volumes of the emotional awareness network. The performance on LEAS Other correlated negatively with right precuneus gray matter volume only in the schizophrenia group. Conclusion: Our findings suggest a relationship between gray matter volume of the right precuneus and deficits in understanding of emotional states of others in schizophrenia.

Patients with psychogenic nonepileptic seizures report more severe migraine than patients with epilepsy.

PURPOSE: Clinical observations suggest that psychogenic non-epileptic seizure (PNES) patients often have severe migraine, more severe than epilepsy patients. Investigations into migraine characteristics in patients with PNES are lacking. In this study we tested the hypothesis that, compared to epilepsy patients, PNES patients have more severe migraine, with more frequent and longer duration attacks that cause greater disability. METHOD: In this observational study, 633 patients with video-EEG proven epilepsy or PNES were identified from the Mayo Clinic Epilepsy Monitoring Unit database. Contacted patients were screened for migraine via a validated questionnaire, and when present, data regarding migraine characteristics were collected. Two-sample t-tests, chi square analyses, and Mann-Whitney U tests were used to compare migraine characteristics in PNES patients to those of epilepsy patients. RESULTS: Data from 43 PNES patients with migraine and 29 epilepsy patients with migraine were available. Compared to epilepsy patients, PNES patients reported having more frequent headaches (mean 15.1 ± 9.8 vs. 8.1 ± 6.6 headache days/month, p<.001), more frequent migraine attacks (mean 6.5 ± 6.3 vs. 3.8. ± 4.1 migraines/month, p=.028), longer duration migraines (mean 39.5 ± 28.3 vs. 27.3 ± 20.1h, p=.035), and more frequently had non-visual migraine auras (78.6% vs. 46.7% of patients with migraine auras, p=.033). Migraine-related disability scores were not different between PNES and epilepsy patients (median 39, interquartile range 89 vs. 25, interquartile range 60.6, p=.15). CONCLUSION: Compared to epilepsy patients with migraine, PNES patients with migraine report having a more severe form of migraine with more frequent and longer duration attacks that are more commonly associated with non-visual migraine auras.

Magnetic resonance elastography: evaluation of new inversion algorithm and quantitative analysis method.

PURPOSE: To assess mean shear hepatic stiffness calculations using various region of interest (ROI) techniques, a new inversion algorithm, and a confidence threshold mask. METHODS: Seventy-three patients (49 with abnormal liver function tests/known chronic liver disease and 24 healthy liver transplant donors) underwent liver biopsy and magnetic resonance elastography (MRE). MRE data processed with the current inversion algorithm [multiscale direct inversion (MSDI)] was assessed using 2 ROI methods (single vs. triple). The data were then reprocessed using the new inversion algorithm (multimodel direct inversion [MMDI]) Hepatic stiffness calculations were performed using a single (70%) ROI method, with/without a 95% confidence threshold mask, and compared with MSDI. RESULTS: For MSDI, average stiffness difference between single and triple ROI methods was not statistically significant by the 2-sample t test [0.15 kilopascals (kPa); P = .77]. For the 2 algorithms, there was little difference in average stiffness measurements of MSDI and MMDI (mean, 0.32 kPa; 9%) using a confidence mask with good agreement [intraclass correlation coefficient (ICC), 0.986 (95% CI 0.975-0.994)]. Use of the confidence mask showed excellent consistency and less variance [ICC, 0.995 (95% CI 0.993-0.998)] compared to either the inter-observer or intra-observer freehand technique. CONCLUSION: MRE analysis showed no significant difference between the 2 freehand ROI techniques. With a 9% average kPa variance, stiffness measurements for MSDI and MMDI were also not significantly different. The use of the confidence mask reduces calculated stiffness variability, which impacts the use of MRE for assessing therapy response and initial/longitudinal assessment of chronic liver disease.

Magnetic resonance elastography can discriminate normal vs. abnormal liver biopsy in candidates for live liver donation.

PURPOSE: The aim of this study was to define liver shear stiffness by magnetic resonance elastography (MRE) that distinguishes normal from abnormal liver biopsy, especially when steatosis ≥20%, among potential live liver donors. METHODS: Baseline clinical, laboratory, imaging, MRE, and liver biopsy results were recorded. Using MRE, hepatic shear stiffness in kilopascals (kPa) was measured and compared to liver biopsy. Comparison between groups was done using χ(2) or Fisher's exact test for categorical variables and Wilcoxon test for continuous variables. Receiver operating characteristic (ROC) curve was calculated to assess diagnostic accuracy. Statistical significance was set at p < 0.05. RESULTS: 38 healthy adults were included. Liver biopsy was normal in 27 and abnormal in 11. ROC curve for MRE defined optimal cutoff at 2.6 kPa (sensitivity 0.72, specificity 0.85, AUC 0.81) to distinguish these 2 groups. Hepatic steatosis ≥20% on biopsy is a contraindication for liver donation in our center. We evaluated the ability of MRE to distinguish this degree of steatosis: 8 persons had steatosis ≥20% and were excluded from donation. ROC curve for MRE defined optimal cutoff at 2.82 kPa (sensitivity 0.88, specificity 1, AUC 0.98) to identify this group. CONCLUSIONS: Liver stiffness measured by MRE, even in the absence of liver fibrosis, can be useful in differentiating normal from abnormal liver histology, and most importantly in patients under evaluation for live liver donation, can very accurately distinguish those with complicated hepatic steatosis ≥20%, our cutoff for donation. In the future, MRE might provide supplementary information to make liver biopsy unnecessary in the donor evaluation process.

Magnetic resonance elastography (MRE) in assessing hepatic fibrosis: performance in a cohort of patients with histological data.

PURPOSE: The purpose of this study was to compare fibrosis seen on liver biopsy to MR elastography (MRE) stiffness measurements in normal controls and patients with abnormal transaminases and chronic liver disease. METHODS: The control group consisted of 22 healthy liver transplant donors who by definition had normal transaminases. The patient group (32 patients) was recruited from the Mayo Clinic Arizona hepatobiliary clinic over a 3-year span. All subjects underwent a liver biopsy as part of their evaluation and agreed to MRE within 35 days of biopsy. Non-parametric tests were used to compare the MRE-predicted liver fibrosis to the fibrosis noted on liver biopsy. RESULTS: Analysis included 54 subjects (32 patients with chronic liver disease and 22 healthy liver donor candidates). MRE median liver stiffness measurements increased per histologic liver fibrosis stage (one-way ANOVA p = 0.001), with significant correlation between increasing fibrosis stage and stiffness values. Median MRE for control group (2.13 kPa; mean = 2.3 ± 0.6 kPa) was significantly lower than for patient group (3.7 kPa; mean = 4.1 ± 2.1 kPa) (p = 0.003). Significantly, lower median stiffness was seen in zero-to-moderate (F0-2, n = 22) vs. severe fibrosis stages (F3-4, n = 10) 2.80 vs. 5.9 kPa, respectively (p < 0.05). Using a 3.7-kPa cut-off value, the predicted sensitivity and specificity for detecting F0-2 from F3-4 were 91% and 80%, respectively. CONCLUSIONS: Our analysis supports previous findings that MRE is a non-invasive and effective method for detection and assessment of liver fibrosis, particularly for discrimination between F0-2 stages and F3-4 stages. MRE may represent a valuable tool to finely discern hepatic fibrosis non-invasively.

Early Outcome of Prostate Intensity Modulated Radiation Therapy (IMRT) Incorporating a Simultaneous Intra-Prostatic MRI Directed Boost.

This study assessed the feasibility and outcomes of treating prostate cancer with intensity modulated radiotherapy (IMRT) incorporating a Magnetic Resonance Imaging (MRI) directed boost. Seventy-eight men received IMRT for localized prostate cancer. The entire prostate received 77.4Gy in 43 fractions and simultaneous intra-prostatic boosts (SIB) of 83Gy were administered to increase the dose to the MRI identified malignancy. In 16 (21%) patients, the MRI didn't detect a neoplasm and these patients received an SIB of 81Gy to the posterior prostate. Androgen Deprivation Therapy (ADT) was also administered to 32 (41%) patients. The 3-year rates of biochemical control, local control, distant control, and survival were 92%, 98%, 95%, and 95% respectively. While grade 1-2 toxicities were common, there were only 2 patients who suffered grade 3 toxicity. These patients developed strictures which were dilated resulting in improvement in symptoms such that both had grade 1-2 toxicity at last follow up examination. The results of this program of IMRT incorporating a MRI directed intra-prostatic boost suggest this technique is feasible and well tolerated. This technique appears to shift the therapeutic index favorably by boosting the malignancy to the highest dose without increasing the doses administered to the bladder and rectum.

Reducing radiation dose in CT enterography.

Computed tomographic (CT) enterography is a diagnostic examination that is increasingly being used to evaluate disorders of the small bowel. An undesirable consequence of CT, however, is patient exposure to ionizing radiation. This is of particular concern with CT enterography because patients tend to be young and require numerous follow-up examinations. There are multiple strategies to reduce radiation dose at CT enterography, including adjusting acquisition parameters, reducing scan length, and reducing tube voltage or tube current. The drawback to dose reduction strategies is degradation of image quality due to increased image noise. However, image noise can be reduced with commercial iterative reconstruction and denoising techniques. With a combination of low-dose techniques and noise-control strategies, one can markedly reduce radiation dose at CT enterography while maintaining diagnostic accuracy.

Células-tronco mesenquimais: caracterização, cultivo, propriedades imunológicas e aplicações clínicas / Mesenchymal stem cells: characterization, cultivation, immunological properties and clinical applications

As células-tronco mesenquimais (CTM) são consideradas células multipotentes não hematopoéticas com propriedades de autorrenovação e capacidade de diferenciação em tecidos mesenquimais e, possivelmente, em não mesenquimais. Vários estudos recentes têm reforçado o caráter multipotente destas células pela capacidade de diferenciarem-se em células derivadas da mesoderma embrionário: osteócitos, condroblastos e adipócitos. Devido ao fácil isolamento e cultivo, potencial de diferenciação e produção de fatores de crescimento e citocinas, as CTMs têm se tornado as candidatas ideais para os protocolos da medicina regenerativa. Este artigo revisa as principais características dessa célula, forma de obtenção e cultivo, propriedades imunológicas e aplicações clínicas.

Mesenchymal stem cells (MSC) are nonhematopoietic multipotent cells with selfrenewal properties and the ability to differentiate into mesenchymal tissues and possibly nonmesenchymal cells. Several lines of evidence in the past few years have confirmed the ability of these cells to differentiate into cells derived from embryonic mesoderm, such as osteocytes, adipocytes and chondroblasts. Because they are easy to isolate and culture and due to their differentiation potential and production of growth factors and cytokines, MSC have become ideal candidates for regenerative medicine protocols. This study reviews the main characteristics of MSC, how to isolate and culture them, and their immunological properties and clinical applications.