CASCADE: Context-Aware Data-Driven AI for Streamlined Multidisciplinary Tumor Board Recommendations in Oncology.

This study addresses the potential of machine learning in predicting treatment recommendations for patients with hepatocellular carcinoma (HCC). Using an IRB-approved retrospective study of patients discussed at a multidisciplinary tumor board, clinical and imaging variables were extracted and used in a gradient-boosting machine learning algorithm, XGBoost. The algorithm's performance was assessed using confusion matrix metrics and the area under the Receiver Operating Characteristics (ROC) curve. The study included 140 patients (mean age 67.7 ± 8.9 years), and the algorithm was found to be predictive of all eight treatment recommendations made by the board. The model's predictions were more accurate than those based on published therapeutic guidelines by ESMO and NCCN. The study concludes that a machine learning model incorporating clinical and imaging variables can predict treatment recommendations made by an expert multidisciplinary tumor board, potentially aiding clinical decision-making in settings lacking subspecialty expertise.

Development of a sample preparation approach for the analysis of fining agents in wines by liquid chromatography with tandem mass spectrometry.

During winemaking a wide variety of processing aids such as albumin, caseinates and lysozyme are often used. These proteins are considered allergenic and could become a human health risk in susceptible individuals. In our knowledge, there are no methods published for the analysis of these three proteins simultaneously by liquid chromatography with tandem mass spectrometry, with electrospray ionization. Therefore, in this work, a sample preparation approach for the analysis of α-casein, ß-casein, albumin and lysozyme, in a single run, was performed and compared with published data. Through a pH adjustment, combining the use of cellulose ester membranes, a precipitation with organic solvents and a final concentration/clean-up, we achieved recovery values from 90.7 to 108.6%. The method was validated, showing determination coefficients R2 ≥ 0.99. This method was able to quantify proteins even at lower levels (limits of quantification from 0.01 to 0.25 mg/L) than the current legal limits.

Effect of sinapic acid ester derivatives on the oxidative stability of omega-3 fatty acids rich oil-in-water emulsions.

Oil-in-water (O/W) emulsions are important delivery systems of omega-3 fatty acids (n-3 FA). We investigated the effect of sinapic acid esters concentration and chain length, the electrical charge of the emulsifier and emulsion pH on the oxidative stability of n-3 FA rich O/W emulsions. Echium oil was applied as n-3 FA source. A 24 factorial design was used to simultaneously evaluate these factors. Peroxide value, malondialdehyde, 2,4-heptadienal and 2,4-decadienal were measured in the emulsions. pH and the electrical charge of the emulsifier modulated the antioxidant effectiveness of sinapic acid esters, while concentration was not relevant. The combination of positively charged emulsifier with neutral pH provided the best oxidative stability for echium oil emulsions. Our results also suggested that the increase of length chain of sinapic acid, from C4 to C12, reduced the secondary products of oxidation, when echium oil emulsions were prepared using negatively charged emulsifier under acidic conditions.

Chemical typicality of South American red wines classified according to their volatile and phenolic compounds using multivariate analysis.

In this study, 83 wines representating four commercial categories: "Argentinean Malbec", "Brazilian Merlot", "Uruguayan Tannat" and "Chilean Carménère" were analyzed according to their phenolic and volatile compounds. The objective was to identify the chemical compounds that would typify each category. From approximately about 600 peaks obtained by chromatographic techniques, 169 were identified and 53 of them were selected for multivariate statistical analysis. Chilean Carménère was the best discriminated group by the methods applied in our study, followed by Argentinean Malbec. Brazilian Merlot mixed mainly with some Carménère, whileTannat mixed with all wines categories, especially Malbec. In general, Chilean Carménère wines can be characterized by a bluish color, higher amounts of sulphur dioxide, higher content of octanoic acid, isobutanol, ethyl isoamyl succinate and catechin and a smaller amount of quercetin. These data can contribute for further process of authenticity or typification of South American red wines.

Endovascular Treatment of Bilateral Pulmonary Artery Stenoses and Superior Vena Cava Syndrome in a Patient with Advanced Mediastinal Fibrosis.

Vascular stenosis is a relatively uncommon and often fatal sequela of mediastinal fibrosis. There are very few reports in the medical literature of endovascular treatment for concomitant bilateral pulmonary artery stenoses and superior vena cava syndrome. We report the endovascular treatment of these conditions in a 54-year-old man, and the long-term outcome.

Hepatoblastoma Associated with Trisomy 18.

Very few reports exist in the literature regarding a possible association between trisomy 18 patients and the incidence of hepatoblastoma. Fewer reports exist on patients with multifocal hepatoblastoma. We reviewed our institutional database for the past 10 years and found three cases with this possible association to the tumor.

CT Dose Reduction Workshop: An Active Educational Experience.

PURPOSE: Improving patient safety by minimizing CT radiation dose, while maintaining diagnostic image quality, has become an important skill in diagnostic radiology. The aim of this study was to examine the value of an educational workshop for optimizing CT protocols in an academic department, and to assess its impact on resident education. METHODS: The CT Dose Reduction Workshop met monthly for 1 year, to teach and implement dose reduction strategies. Changes were made to CT protocols through group consensus while participants kept up to date with current literature. A survey was sent to 48 radiology residents and 32 attending radiologists in the department, including both participants and nonparticipants, after completion of the workshop, to assess its utility. The survey used a 5-point Likert-type scale. Average doses for a specific CT protocol before and after the workshop were compared. RESULTS: About 80% of respondents agreed or strongly agreed that the workshop was essential. Workshop participants expressed greater confidence in their knowledge of dose reduction techniques, with a mean score of 3.74 (95% confidence interval, 3.35-4.13), compared with nonparticipants, who had a mean score of 3.00 (95% confidence interval, 2.64-3.36) (P < .01). Dose reductions were established across numerous CT protocols. For instance, the average total dose-length product in renal mass protocol CT examinations decreased by 54% (P < .0001). CONCLUSIONS: A CT dose reduction workshop increases participants' confidence in knowledge of dose reduction techniques, fosters a culture of safety and quality improvement in the department, and reduces radiation dose to patients.

Tuberculosis IRIS: a mediastinal problem.

We present a case of a 39 year old male patient with Acquired Immune Deficiency Syndrome (AIDS) who developed Mycobacterium tuberculosis related Immune Reconstitution Inflammatory Syndrome (IRIS) after initiation of Highly Active Antiretroviral Therapy (HAART) treatment. The inflammatory response resulted in mediastinal necrotic lymphadenopathy and subsequent perforation of the esophageal wall.

Chemical characterization of South American red wines / Caracterização química de vinhos tintos sul americanos

In this study, 83 wines considered by experts as representatives of the following commercial categories: "Argentinean Malbec (AM)", "Brazilian Merlot (BM)", "Uruguayan Tannat (UT)" and "Chilean Carménère (CC)" were analyzed according to their composition of phenolic, volatiles and semi-volatiles compounds. The objective was to identify the chemical compounds profile that characterized each commercial category. From about 600 peaks obtained by chromatographic techniques, 169 were identified and 53 of them were selected for multivariate statistical analysis. Four clusters, designated as "Chemical Categories" were obtained. Chemical Category 2 and Chemical Category 4 were composed by 90% of CC and 68% of AM respectively, Chemical Category 3 grouped mostly CC (50%) and BM (36%), while Chemical Category 1 showed predominance of AM (37%) and UT (30%). Based on the chemical classification, CC wines were characterized by higher content of Isopentyl lactate, Isobutyl alcohol, Ionone, malvidin and gallic acid and lower content of rutin, quercetin and resveratrol. On the other side, AM wines showed higher concentration of myricetin. UT wines had the highest antioxidant activity, higher content of quercetin, epicatechin, rutin and also the highest amount of all semi-volatiles detected in the negative mode, while BM wines only showed the highest concentration of catechin, petunidin and all semi-volatiles detected in the positive mode. Considering that phenolic and volatile compounds are strictly associated to the wines sensory characteristics, these data can contribute to establish criteria for further wines authentication and typification

Neste estudo, 83 vinhos considerados por especialistas como representantes das seguintes categorias comerciais: "Malbec Argentino (AM)", "Merlot Brasileiro (BM)", "Tannat Uruguaio (UT)" e "Carménere Chileno (CC)" foram analisados de acordo com a sua composição de compostos fenólicos, voláteis e semi-voláteis. O objetivo foi identificar a combinação dos compostos químicos que caracteriza cada categoria comercial. De cerca de 600 picos obtidos por técnicas cromatográficas, 169 foram identificados e 53 deles foram selecionados para análise estatística multivariada. Quatro clusters, designados como "Categorias Químicas" foram obtidos. A Categoria Química 2 e a Categoria Química 4 foram compostas por 90% de CC e 68% de AM respectivamente, a Categoria Química 3 agrupou principalmente CC (50%) e BM (36%), enquanto a Categoria Química 1 mostrou predominância de AM (37%) e UT (30%). Com base na classificação química, os vinhos CC foram caracterizados por apresentarem maior teor de lactato isopentílico, álcool isobutílico, ionona, malvidina e ácido gálico e menor teor de rutina, quercetina e resveratrol. Por outro lado, os vinhos AM apresentaram maior concentração de miricetina. Os vinhos UT apresentaram a maior atividade antioxidante, maior teor de quercetina, epicatequina, rutina e também a maior quantidade de todos os semi-voláteis detectados no modo negativo, enquanto os vinhos BM apresentaram a maior concentração de catequina, petunidina e todos os semi-voláteis detectados no modo positivo. Considerando que compostos fenólicos e voláteis estão estritamente associados às características sensoriais dos vinhos, esses dados podem contribuir para o estabelecimento de critérios para posterior autenticação e tipificação de vinhos sul americanos

Thyroid nodules in children

Se revisó la experiencia en el manejo quirúrgico de pacientes menores de 18 años de edad con nódulos solitarios del tiroides. Durante el período de 15 años evaluado, un total de 49 pacientes pediátricos fueron operados de masas dominantes del tiroides. Las evaluación patológica post-operatoria de éstos nódulos tiroideos demostró que 80% eran lesiones benignas y 20% eran malignas. El diagnóstico benigno más frecuente fue adenoma folicular (53%). Entre las lesiones malignas, el diagnóstico más común fue adenocarcinoma papilar. En nuestra serie se notó una predominancia femenina en una razón de 4:1, pero los varones tuvieron una incidencia de malignidad más alta (33%) que las hembras (18%). Las pruebas diagnósticas disponibles para tratar de diferenciar entre lesiones benignas y malignas pre-operatoriamente, no ayudó significativamente en nuestros pacientes. Las naturaleza inexacta de la información obtenida del historial y pruebas de laboratorio sugiere que la cirugía aún tiene un papel importante en el manejo de niños con nódulos solitarios tiroideos

Congenital cystic adenomatoid malformation of the lung

La malformación adenomatoide quística congénita es una anomalía poco común, la cual debe considerarse entre las posibilidades ante el diagnóstico diferencial de la dificuldad respiratoria del neonato y de las lesiones quísticas pulmonares que se descubran en el mismo. Una vez que se establece el diagnóstico de la malformación adenomatoide, el tratamiento definitivo es quirúrgico. Se presenta el caso de una recién nacida con la malformación adenomatoide quística en el pulmón izquierdo. Tomando en consideración la posibilidad de hipoplasia del pulmón derecho, se practicó la lobectomía del lóbulo inferior izquierdo y cistectomía en el lóbulo superior izquierdo. La recuperación fue incompleta por motivo de la enfermedad residual del lóbulo superior izquierdo. Se practicó la resección del mismo y la paciente recuperó totalmente. Hemos llegado a la conclusión de que, después de valorar la función del pulmón contralateral, todo el pulmón afectado por la malformación debe ser resecado, aun cuando durante la operación un lóbulo parezca estar afectado en forma mínima