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Throughout metazoa, germ cells assemble RNA-protein organelles (germ granules). In Drosophila ovaries, perinuclear nuage forms in the nurse cells, while compositionally similar polar granules form in the oocyte. A similar system appears to exist in the distantly related (â¼350 million years) wasp Nasonia, with some surprising divergences. Nuage is similarly formed in Nasonia, except that anterior nurse cells accumulate significantly more nuage, in association with high levels of DNA double-strand breaks, suggesting that increased transposon activity in anterior is silenced by high nuage levels. In the oocyte, the germ plasm forms a single granule that is 40 times larger than a homologous Drosophila polar granule. While conserved germ granule proteins are recruited to the oosome, they show unusual localization: Tudor protein forms a shell encapsulating the embryonic oosome, while small Oskar/Vasa/Aubergine granules coalesce interiorly. Wasp Vasa itself is unusual since it has an alternative splice form that includes a novel nucleoporin-like phenylalanine-glycine repeat domain. Our work is consistent with the high degree of evolutionary plasticity of membraneless organelles and describes new experimental model and resources to study biomolecular condensates.
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The generation and interpretation of positional information are key processes in developmental systems. In this issue, Chen et al. report discoveries made in the Drosophila embryo that give new insights into how positional information can be produced by patterning gradients.
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Gene body methylation (GBM) is an ancestral mode of DNA methylation whose role in development has been obscured by the more prominent roles of promoter and CpG island methylation. The wasp Nasonia vitripennis has little promoter and CpG island methylation, yet retains strong GBM, making it an excellent model for elucidating the roles of GBM. Here we show that N. vitripennis DNA methyltransferase 1a (Nv-Dnmt1a) knockdown leads to failures in cellularization and gastrulation of the embryo. Both of these disrupted events are hallmarks of the maternal-zygotic transition (MZT) in insects. Analysis of the embryonic transcriptome and methylome revealed strong reduction of GBM and widespread disruption of gene expression during embryogenesis after Nv-Dnmt1a knockdown. Strikingly, there was a strong correlation between loss of GBM and reduced gene expression in thousands of methylated loci, consistent with the hypothesis that GBM directly facilitates high levels of transcription. We propose that lower expression levels of methylated genes due to reduced GBM is the crucial direct effect of Nv-Dnmt1 knockdown. Subsequently, the disruption of methylated genes leads to downstream dysregulation of the MZT, culminating in developmental failure at gastrulation.
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Vespas , Animais , Ilhas de CpG/genética , Metilação de DNA/genética , Genoma , Vespas/genética , Zigoto/metabolismoRESUMO
Convolutional neural networks (CNN) can accurately predict chronological age in healthy individuals from structural MRI brain scans. Potentially, these models could be applied during routine clinical examinations to detect deviations from healthy ageing, including early-stage neurodegeneration. This could have important implications for patient care, drug development, and optimising MRI data collection. However, existing brain-age models are typically optimised for scans which are not part of routine examinations (e.g., volumetric T1-weighted scans), generalise poorly (e.g., to data from different scanner vendors and hospitals etc.), or rely on computationally expensive pre-processing steps which limit real-time clinical utility. Here, we sought to develop a brain-age framework suitable for use during routine clinical head MRI examinations. Using a deep learning-based neuroradiology report classifier, we generated a dataset of 23,302 'radiologically normal for age' head MRI examinations from two large UK hospitals for model training and testing (age range = 18-95 years), and demonstrate fast (< 5 s), accurate (mean absolute error [MAE] < 4 years) age prediction from clinical-grade, minimally processed axial T2-weighted and axial diffusion-weighted scans, with generalisability between hospitals and scanner vendors (Δ MAE < 1 year). The clinical relevance of these brain-age predictions was tested using 228 patients whose MRIs were reported independently by neuroradiologists as showing atrophy 'excessive for age'. These patients had systematically higher brain-predicted age than chronological age (mean predicted age difference = +5.89 years, 'radiologically normal for age' mean predicted age difference = +0.05 years, p < 0.0001). Our brain-age framework demonstrates feasibility for use as a screening tool during routine hospital examinations to automatically detect older-appearing brains in real-time, with relevance for clinical decision-making and optimising patient pathways.
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Envelhecimento , Encéfalo/diagnóstico por imagem , Desenvolvimento Humano , Imageamento por Ressonância Magnética , Neuroimagem , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/patologia , Envelhecimento/fisiologia , Aprendizado Profundo , Desenvolvimento Humano/fisiologia , Humanos , Imageamento por Ressonância Magnética/métodos , Imageamento por Ressonância Magnética/normas , Pessoa de Meia-Idade , Neuroimagem/métodos , Neuroimagem/normas , Adulto JovemRESUMO
OBJECTIVES: The purpose of this study was to build a deep learning model to derive labels from neuroradiology reports and assign these to the corresponding examinations, overcoming a bottleneck to computer vision model development. METHODS: Reference-standard labels were generated by a team of neuroradiologists for model training and evaluation. Three thousand examinations were labelled for the presence or absence of any abnormality by manually scrutinising the corresponding radiology reports ('reference-standard report labels'); a subset of these examinations (n = 250) were assigned 'reference-standard image labels' by interrogating the actual images. Separately, 2000 reports were labelled for the presence or absence of 7 specialised categories of abnormality (acute stroke, mass, atrophy, vascular abnormality, small vessel disease, white matter inflammation, encephalomalacia), with a subset of these examinations (n = 700) also assigned reference-standard image labels. A deep learning model was trained using labelled reports and validated in two ways: comparing predicted labels to (i) reference-standard report labels and (ii) reference-standard image labels. The area under the receiver operating characteristic curve (AUC-ROC) was used to quantify model performance. Accuracy, sensitivity, specificity, and F1 score were also calculated. RESULTS: Accurate classification (AUC-ROC > 0.95) was achieved for all categories when tested against reference-standard report labels. A drop in performance (ΔAUC-ROC > 0.02) was seen for three categories (atrophy, encephalomalacia, vascular) when tested against reference-standard image labels, highlighting discrepancies in the original reports. Once trained, the model assigned labels to 121,556 examinations in under 30 min. CONCLUSIONS: Our model accurately classifies head MRI examinations, enabling automated dataset labelling for downstream computer vision applications. KEY POINTS: ⢠Deep learning is poised to revolutionise image recognition tasks in radiology; however, a barrier to clinical adoption is the difficulty of obtaining large labelled datasets for model training. ⢠We demonstrate a deep learning model which can derive labels from neuroradiology reports and assign these to the corresponding examinations at scale, facilitating the development of downstream computer vision models. ⢠We rigorously tested our model by comparing labels predicted on the basis of neuroradiology reports with two sets of reference-standard labels: (1) labels derived by manually scrutinising each radiology report and (2) labels derived by interrogating the actual images.
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Aprendizado Profundo , Área Sob a Curva , Humanos , Imageamento por Ressonância Magnética , Radiografia , RadiologistasRESUMO
BACKGROUND: The oosome is the germline determinant in the wasp Nasonia vitripennis and is homologous to the polar granules of Drosophila. Despite a common evolutionary origin and developmental role, the oosome is morphologically quite distinct from polar granules. It is a solid sphere that migrates within the cytoplasm before budding out and forming pole cells. RESULTS: To gain an understanding of both the molecular basis of oosome development and the conserved essential features of germ plasm, we quantified and compared transcript levels between embryo fragments that contained the oosome and those that did not. The identity of the differentially localized transcripts indicated that Nasonia uses a distinct set of molecules to carry out conserved germ plasm functions. In addition, functional testing of a sample of localized transcripts revealed potentially novel mechanisms of ribonucleoprotein assembly and pole cell cellularization in the wasp. CONCLUSIONS: Our results demonstrate that the composition of germ plasm varies significantly within Holometabola, as very few mRNAs share localization to the oosome and polar granules. Some of this variability appears to be related to the unique properties of the oosome relative to the polar granules in Drosophila, and some may be related to differences in pole formation between species. This work will serve as the basis for further investigation into the patterns of germline determinant evolution among insects, the molecular basis of the unique properties of the oosome, and the incorporation of novel components into developmental networks.
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Embrião não Mamífero/metabolismo , Células Germinativas/metabolismo , Vespas/embriologia , Vespas/genética , Animais , RNA Mensageiro/metabolismo , TranscriptomaRESUMO
The anatomy of the brainstem is complex. It contains numerous cranial nerve nuclei and is traversed by multiple tracts between the brain and spinal cord. Improved MRI resolution now allows the radiologist to identify a higher level of anatomic detail, but an understanding of functional anatomy is crucial for correct interpretation of disease. Brainstem syndromes are most commonly due to occlusion of the posterior circulation or mass effect from intrinsic space-occupying lesions. These syndromes can have subtle imaging findings that may be missed by a radiologist unfamiliar with the anatomy or typical manifesting features. This article presents the developmental anatomy of the brainstem and discusses associated pathologic syndromes. Congenital and acquired syndromes are described and correlated with anatomic locations at imaging, with diagrams to provide a reference to aid in radiologic interpretation. ©RSNA, 2019.
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Imageamento por Ressonância Magnética/métodos , Bulbo/diagnóstico por imagem , Mesencéfalo/diagnóstico por imagem , Neuroimagem/métodos , Ponte/diagnóstico por imagem , Encefalopatias/diagnóstico por imagem , Infarto Encefálico/diagnóstico por imagem , Anormalidades Craniofaciais/diagnóstico por imagem , Humanos , Bulbo/anatomia & histologia , Bulbo/patologia , Mesencéfalo/anatomia & histologia , Mesencéfalo/patologia , Ponte/anatomia & histologia , Ponte/patologia , SíndromeRESUMO
The gene regulatory network (GRN) underpinning dorsal-ventral (DV) patterning of the Drosophila embryo is among the most thoroughly understood GRNs, making it an ideal system for comparative studies seeking to understand the evolution of development. With the emergence of widely applicable techniques for testing gene function, species with sequenced genomes, and multiple tractable species with diverse developmental modes, a phylogenetically broad and molecularly deep understanding of the evolution of DV axis formation in insects is feasible. Here, we review recent progress made in this field, compare our emerging molecular understanding to classical embryological experiments, and suggest future directions of inquiry.
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Evolução Biológica , Padronização Corporal/fisiologia , Insetos/embriologia , Animais , Drosophila melanogaster/classificação , Drosophila melanogaster/embriologia , Desenvolvimento Embrionário/fisiologia , Insetos/classificação , Oogênese/fisiologiaRESUMO
The nucleocytoplasmic (N/C) ratio plays a prominent role in the maternal-to-zygotic transition (MZT) in many animals. The effect of the N/C ratio on cell-cycle lengthening and zygotic genome activation (ZGA) has been studied extensively in Drosophila, where haploid embryos experience an additional division prior to completing cellularization and triploid embryos cellularize precociously by one division. In this study, we set out to understand how the obligate difference in ploidy in the haplodiploid wasp, Nasonia, affects the MZT and which aspects of the Drosophila MZT are conserved. While subtle differences in early embryonic development were observed in comparisons among haploid, diploid, and triploid embryos, in all cases embryos cellularize at cell cycle 12. When ZGA was inhibited, both diploid female, and haploid male, embryos went through 12 syncytial divisions and failed to cellularize before dying without further divisions. We also found that key players of the Drosophila MZT are conserved in Nasonia but have novel expression patterns. Our results suggest that zygotically expressed genes have a reduced role in determining the timing of cellularization in Nasonia relative to Drosophila, and that a stronger reliance on a maternal timer is more compatible with species where variations in embryonic ploidy are obligatory.
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Desenvolvimento Embrionário/genética , Ploidias , Vespas/genética , Animais , Divisão Celular , Feminino , Proteínas de Insetos/genética , Proteínas de Insetos/metabolismo , Masculino , Vespas/embriologia , Zigoto/metabolismoRESUMO
The animal head is a complex structure where numerous sensory, structural and alimentary structures are concentrated and integrated, and its ontogeny requires precise and delicate interactions among genes, cells, and tissues. Thus, it is perhaps unsurprising that craniofacial abnormalities are among the most common birth defects in people, or that these defects have a complex genetic basis involving interactions among multiple loci. Developmental processes that depend on such epistatic interactions become exponentially more difficult to study in diploid organisms as the number of genes involved increases. Here, we present hybrid haploid males of the wasp species pair Nasonia vitripennis and Nasonia giraulti, which have distinct male head morphologies, as a genetic model of craniofacial development that possesses the genetic advantages of haploidy, along with many powerful genomic tools. Viable, fertile hybrids can be made between the species, and quantitative trail loci related to shape differences have been identified. In addition, a subset of hybrid males show head abnormalities, including clefting at the midline and asymmetries. Crucially, epistatic interactions among multiple loci underlie several developmental differences and defects observed in the F2 hybrid males. Furthermore, we demonstrate an introgression of a chromosomal region from N. giraulti into N. vitripennis that shows an abnormality in relative eye size, which maps to a region containing a major QTL for this trait. Therefore, the genetic sources of head morphology can, in principle, be identified by positional cloning. Thus, Nasonia is well positioned to be a uniquely powerful model invertebrate system with which to probe both development and complex genetics of craniofacial patterning and defects.
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Anormalidades Craniofaciais , Modelos Animais de Doenças , Epistasia Genética , Genes de Insetos , Cabeça/anatomia & histologia , Vespas/genética , Animais , Biometria , Padronização Corporal/genética , Mapeamento Cromossômico , Cromossomos de Insetos/genética , Feminino , Haploidia , Cabeça/anormalidades , Hibridização Genética , Masculino , Locos de Características Quantitativas , Caracteres Sexuais , Especificidade da Espécie , Vespas/anatomia & histologiaRESUMO
BACKGROUND: Measuring the evolutionary rate of reproductive isolation is essential to understanding how new species form. Tempo calculations typically rely on fossil records, geological events, and molecular evolution analyses. The speed at which genetically-based hybrid mortality arises, or the "incompatibility clock", is estimated to be millions of years in various diploid organisms and is poorly understood in general. Owing to these extended timeframes, seldom do biologists observe the evolution of hybrid mortality in real time. RESULTS: Here we report the very recent spread and fixation of complete asymmetric F1 hybrid mortality within eight years of laboratory maintenance in the insect model Nasonia. The asymmetric interspecific hybrid mortality evolved in an isogenic stock line of N. longicornis and occurs in crosses to N. vitripennis males. The resulting diploid hybrids exhibit complete failure in dorsal closure during embryogenesis. CONCLUSION: These results comprise a unique case whereby a strong asymmetrical isolation barrier evolved in real time. The spread of this reproductive isolation barrier notably occurred in a small laboratory stock subject to recurrent bottlenecks.
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Hibridização Genética , Isolamento Reprodutivo , Vespas/genética , Animais , Evolução Biológica , Feminino , MasculinoRESUMO
BACKGROUND: Gene regulatory networks (GRNs) underlie developmental patterning and morphogenetic processes, and changes in the interactions within the underlying GRNs are a major driver of evolutionary processes. In order to make meaningful comparisons that can provide significant insights into the evolution of regulatory networks, homologous networks from multiple taxa must be deeply characterized. One of the most thoroughly characterized GRNs is the dorsoventral (DV) patterning system of the Drosophila melanogaster embryo. We have developed the wasp Nasonia as a comparative DV patterning model because it has shown the convergent evolution of a mode of early embryonic patterning very similar to that of the fly, and it is of interest to know whether the similarity at the gross level also extends to the molecular level. RESULTS: We used RNAi to dorsalize and ventralize Nasonia embryos, RNAseq to quantify transcriptome-wide expression levels, and differential expression analysis to identify genes whose expression levels change in either RNAi case. This led to the identification of >100 genes differentially expressed and regulated along the DV axis. Only a handful of these genes are shared DV components in both fly and wasp. Many of those unique to Nasonia are cytoskeletal and adhesion molecules, which may be related to the divergent cell and tissue behavior observed at gastrulation. In addition, many transcription factors and signaling components are only DV regulated in Nasonia, likely reflecting the divergent upstream patterning mechanisms involved in producing the conserved pattern of cell fates observed at gastrulation. Finally, several genes that lack Drosophila orthologs show robust and distinct expression patterns. These include genes with vertebrate homologs that have been lost in the fly lineage, genes that are found only among Hymenoptera, and several genes that entered the Nasonia genome through lateral transfer from endosymbiotic bacteria. CONCLUSIONS: Altogether, our results provide insights into how GRNs respond to new functional demands and how they can incorporate novel components.
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Padronização Corporal/genética , Redes Reguladoras de Genes , Vespas/embriologia , Vespas/genética , Animais , Besouros/genética , Drosophila melanogaster/embriologia , Drosophila melanogaster/genética , Ectoderma/embriologia , Ectoderma/metabolismo , Desenvolvimento Embrionário/genética , Perfilação da Expressão Gênica , Regulação da Expressão Gênica no Desenvolvimento , Genes de Insetos , Mesoderma/embriologia , Mesoderma/metabolismo , Interferência de RNA , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Análise de Sequência de RNA , Zigoto/metabolismoRESUMO
BACKGROUND: Advancement of knowledge requires presentation and publication of high-quality scientific research. Studies submitted for presentation undergo initial peer review before acceptance and the rate of subsequent publication may be taken as an indicator of access to publication for pediatric radiology studies. OBJECTIVES: Evaluate the proportion of abstracts also published in journals for pediatric radiology conferences and identify factors associated with publication success. MATERIALS AND METHODS: All Medline articles that originated from oral presentations at the European Society for Paediatric Radiology (ESPR), the Society for Pediatric Radiology (SPR) or the International Pediatric Radiology (IPR) conferences between 2010 - 2012 were evaluated. Descriptive statistics to evaluate published and unpublished groups were calculated overall and split by characteristics of the abstracts such as number of authors. RESULTS: Overall number of abstracts published was 300/715 (41.9%), with most articles published in radiology specific journals (181/300; 60.3%), with median impact factor 2.31 (interquartile range [IQR]: 1.65-3.14, range: 0-18.03). Those published after the conference (262/300, 87.6%) had a median time to publication of 18 months and for those published before, the median time was -11 months. Median sample size in published articles was 52 (IQR: 33-105, range: 1-6,351). CONCLUSION: Of pediatric radiology oral abstracts, 41.9% achieve publication after a period of at least 3 years from presentation. Studies originating from certain countries and on certain subspecialty topics were more likely to get published.
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Congressos como Assunto/estatística & dados numéricos , Pediatria , Editoração/estatística & dados numéricos , Radiologia , Indexação e Redação de Resumos/estatística & dados numéricos , Bibliometria , Humanos , Fator de Impacto de Revistas , MEDLINE , Manuscritos Médicos como Assunto , Sociedades MédicasRESUMO
BACKGROUND: With the widespread ownership of smartphones, many health care professionals question the degree to which medically related smartphone applications are reliable. OBJECTIVES: To assess the variety of smartphone applications relating to paediatric radiology and the presence of health care professional involvement in their development. As a secondary objective, we explore whether there are gaps within the paediatric radiology app market. MATERIALS AND METHODS: The most popular smartphone marketplaces (Apple iTunes App Store, Blackberry Mobile Market, Google Play Android Market, Nokia Ovi, Samsung and Microsoft Windows Marketplace) were searched for terms relating to paediatric radiology. Cost, review ratings, number of downloads, health care involvement and target audience were recorded. RESULTS: Nine paediatric radiology applications were found in the Apple iTunes App Store and nine in the Google Play Android Market. The target audiences for all applications were health care professionals. None were available for patients or their caregivers. All applications were reported to have medical expertise in their development. CONCLUSION: All paediatric radiology applications were developed with the aid of a health care professional. Due to the small number available online, there is a potential gap in the marketplace for further applications in this field, possibly aimed at patients and their families.
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Informação de Saúde ao Consumidor/estatística & dados numéricos , Internet/estatística & dados numéricos , Aplicativos Móveis/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Radiologia/estatística & dados numéricos , Smartphone/estatística & dados numéricos , Informação de Saúde ao Consumidor/economia , Mineração de Dados/estatística & dados numéricos , Diagnóstico por Imagem/estatística & dados numéricos , Aplicativos Móveis/economia , Pediatria/economia , Radiologia/economia , Smartphone/economia , Estados UnidosRESUMO
Regulatory networks composed of interacting genes are responsible for pattern formation and cell type specification in a wide variety of developmental contexts. Evolution must act on these regulatory networks in order to change the proportions, distribution, and characteristics of specified cells. Thus, understanding how these networks operate in homologous systems across multiple levels of phylogenetic divergence is critical for understanding the evolution of developmental systems. Among the most thoroughly characterized regulatory networks is the dorsal-ventral patterning system of the fly Drosophila melanogaster. Due to the thorough understanding of this system, it is an ideal starting point for comparative analyses. Here we report an analysis of the DV patterning system of the wasp, Nasonia vitripennis. This wasp undergoes a mode of long germ embryogenesis that is superficially nearly identical to that of Drosophila, but one that was likely independently derived. We have found that while the expression of genes just prior to the onset of gastrulation is almost identical in Nasonia and Drosophila, both the upstream network responsible for generating this pattern, and the downstream morphogenetic movements that it sets in motion, are significantly diverged. From this we conclude that many network structures are available to evolution to achieve particular developmental ends.
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Padronização Corporal/genética , Regulação da Expressão Gênica no Desenvolvimento , Vespas/genética , Vespas/fisiologia , Animais , Linhagem da Célula , Drosophila melanogaster , Feminino , Gastrulação , Perfilação da Expressão Gênica , Mesoderma/metabolismo , Filogenia , Transdução de Sinais , Especificidade da Espécie , TriboliumRESUMO
The transforming growth factor beta (TGF)-ß signaling pathway and its modulators are involved in many aspects of cellular growth and differentiation in all metazoa. Although most of the core components of the pathway are highly conserved, many lineage-specific adaptations have been observed including changes regarding paralog number, presence and absence of modulators, and functional relevance for particular processes. In the parasitic jewel wasp Nasonia vitripennis, the bone morphogenetic proteins (BMPs), one of the major subgroups of the TGF-ß superfamily, play a more fundamental role in dorsoventral (DV) patterning than in all other insects studied so far. However, Nasonia lacks the BMP antagonist Short gastrulation (Sog)/chordin, which is essential for polarizing the BMP gradient along the DV axis in most bilaterian animals. Here, we present a broad survey of TGF-ß signaling in Nasonia with the aim to detect other lineage-specific peculiarities and to identify potential mechanisms, which explain how BMP-dependent DV pattering occurs in the early Nasonia embryo in the absence of Sog.
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Proteínas de Insetos/genética , Proteínas de Insetos/metabolismo , Transdução de Sinais , Fator de Crescimento Transformador beta/metabolismo , Vespas/genética , Vespas/metabolismo , Animais , Padronização Corporal , Proteínas Morfogenéticas Ósseas/genética , Proteínas Morfogenéticas Ósseas/metabolismo , Filogenia , Proteínas Smad/genética , Proteínas Smad/metabolismo , Fator de Crescimento Transformador beta/genética , Vespas/crescimento & desenvolvimentoRESUMO
The establishment of the germline is a critical, yet surprisingly evolutionarily labile, event in the development of sexually reproducing animals. In the fly Drosophila, germ cells acquire their fate early during development through the inheritance of the germ plasm, a specialized maternal cytoplasm localized at the posterior pole of the oocyte. The gene oskar (osk) is both necessary and sufficient for assembling this substance. Both maternal germ plasm and oskar are evolutionary novelties within the insects, as the germline is specified by zygotic induction in basally branching insects, and osk has until now only been detected in dipterans. In order to understand the origin of these evolutionary novelties, we used comparative genomics, parental RNAi, and gene expression analyses in multiple insect species. We have found that the origin of osk and its role in specifying the germline coincided with the innovation of maternal germ plasm and pole cells at the base of the holometabolous insects and that losses of osk are correlated with changes in germline determination strategies within the Holometabola. Our results indicate that the invention of the novel gene osk was a key innovation that allowed the transition from the ancestral late zygotic mode of germline induction to a maternally controlled establishment of the germline found in many holometabolous insect species. We propose that the ancestral role of osk was to connect an upstream network ancestrally involved in mRNA localization and translational control to a downstream regulatory network ancestrally involved in executing the germ cell program.
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Proteínas de Drosophila/genética , Drosophila/genética , Células Germinativas/crescimento & desenvolvimento , Insetos/genética , Sequência de Aminoácidos , Animais , Clonagem Molecular , Citoplasma/genética , Drosophila/crescimento & desenvolvimento , Proteínas de Drosophila/metabolismo , Desenvolvimento Embrionário , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Dados de Sequência Molecular , Oogênese , Filogenia , Interferência de RNA , Análise de Sequência de ProteínaRESUMO
BACKGROUND: Flow diversion has evolved as a minimally invasive treatment for intracranial aneurysms. The Silk Vista Baby (SVB) can be navigated into small cerebral vessels because it can be deployed through a low-profile microcatheter. METHODS: We report on treating a patient in his 70s with an unruptured fusiform right superior cerebellar artery aneurysm using an SVB. RESULTS: Significant foreshortening of the device was noted during the initial procedure; however, the position was satisfactory with good apposition and clearance of the aneurysm neck. A stable position of the SVB on 1-day and 2-month postprocedural computed tomography angiography was also demonstrated. Subsequently, a 6-month follow-up computed tomography angiography detected delayed foreshortening and prolapse of the SVB into the aneurysm, for which an additional SVB was placed in a second procedure. There were no complications and the patient remained clinically well. CONCLUSIONS: Although the intraoperative foreshortening was not unexpected, the delayed postprocedural behavior of proximal foreshortening and subsequent prolapse of the SVB into the aneurysm have not been previously described. We would like to share this for awareness in this technical note.
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Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano , Humanos , Artéria Basilar , Angiografia Cerebral , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Prolapso , Stents , Resultado do TratamentoRESUMO
PURPOSE: AI-image interpretation, through convolutional neural networks, shows increasing capability within radiology. These models have achieved impressive performance in specific tasks within controlled settings, but possess inherent limitations, such as the inability to consider clinical context. We assess the ability of large language models (LLMs) within the context of radiology specialty exams to determine whether they can evaluate relevant clinical information. METHODS: A database of questions was created with official sample, author written, and textbook questions based on the Royal College of Radiology (United Kingdom) FRCR 2A and American Board of Radiology (ABR) Certifying examinations. The questions were input into the Generative Pretrained Transformer (GPT) versions 3 and 4, with prompting to answer the questions. RESULTS: One thousand seventy-two questions were evaluated by GPT-3 and GPT-4. 495 (46.2%) were for the FRCR 2A and 577 (53.8%) were for the ABR exam. There were 890 single best answers (SBA), and 182 true/false questions. GPT-4 was correct in 629/890 (70.7%) SBA and 151/182 (83.0%) true/false questions. There was no degradation on author written questions. GPT-4 performed significantly better than GPT-3 which selected the correct answer in 282/890 (31.7%) SBA and 111/182 (61.0%) true/false questions. Performance of GPT-4 was similar across both examinations for all categories of question. CONCLUSION: The newest generation of LLMs, GPT-4, demonstrates high capability in answering radiology exam questions. It shows marked improvement from GPT-3, suggesting further improvements in accuracy are possible. Further research is needed to explore the clinical applicability of these AI models in real-world settings.
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Inteligência Artificial , Radiologia , Humanos , Redes Neurais de Computação , Bases de Dados FactuaisRESUMO
OBJECTIVE: Carotid artery webs are an underappreciated cause of recurrent ischemic stroke, and may represent a significant portion of cryptogenic stroke. Evidence-based guidelines for the management of symptomatic carotid webs do not exist. The goal of this study is to audit our local experience for patients with symptomatic carotid artery webs undergoing carotid stenting as a treatment option, along with describing the hypothesized dynamic physiology of carotid webs. METHODS: All patients undergoing stenting for symptomatic carotid artery web at two comprehensive regional stroke centers with high endovascular thrombectomy volume from January 1, 2012 to March 1, 2021 were included. The modified Rankin Scale (mRS) score was used to define functional outcome at 3 months after stenting. RESULTS: Fourteen consecutive patients with symptomatic carotid artery webs underwent stenting. Twelve patients were female (86%), with a median age of 54 (IQR, 48-64) years across all patients. Stroke was the qualifying event in 12 (86%) patients and TIA in 2. Eleven patients (11/14, 79%) achieved a mRS score of 0-2 at 90 days, 2 (14%) were mRS 3-5, and one patient was lost to follow-up. The median follow-up was 12 months (IQR, 10-12). There was no recurrent stroke or TIA like symptoms in any patients. CONCLUSIONS: Carotid stenting appears to be safe at preventing recurrent stroke/TIA with a median follow-up of 12 months in this retrospective multicenter observational study.