Management of suspected and known eosinophilic esophagitis-a nationwide survey in Austria.

INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus with increasing incidence and dysphagia as the main symptom. The management of suspected or known EoE by Austrian endoscopists has not been investigated yet. METHODS: A web-based survey with 13 questions about the management of EoE was sent to endoscopists via the Austrian Society of Gastroenterology and Hepatology (ÖGGH). RESULTS: A total of 222 endoscopists (74% gastroenterologists, 23% surgeons, and 2% pediatricians; 68% working in a hospital) from all 9 states participated. In patients with dysphagia but a normal appearing esophagus, 85% of respondents reported always taking biopsies; however, surgeons were less likely to obtain biopsies compared to gastroenterologists ("always" 69% vs. 90%, "sometimes" 29% vs. 10%, "never" 2% vs. 0%, p < 0.001). The approved budesonide orodispersible tablet is the preferred first-line drug used in EoE, ahead of proton pump inhibitors (PPI). Only 65% of participants monitor the patients by endoscopy and histology after 12 weeks of induction therapy, 26% do not continue maintenance therapy, and 22% monitor patients only when symptomatic. CONCLUSION: The vast majority of Austrian endoscopists adhere to the European and US guidelines in cases of suspected EoE. In contrast, despite the chronic disease course, a significant percentage of providers indicate not to use maintenance therapy and monitor the patients routinely.

Replicative manufacturing of metal moulds for low surface roughness polymer replication.

Tool based manufacturing processes like injection moulding allow fast and high-quality mass-market production, but for optical polymer components the production of the necessary tools is time-consuming and expensive. In this paper a process to fabricate metal-inserts for tool based manufacturing with smooth surfaces via a casting and replication process from fused silica templates is presented. Bronze, brass and cobalt-chromium could be successfully replicated from shaped fused silica replications achieving a surface roughnesses of Rq 8 nm and microstructures in the range of 5 µm. Injection moulding was successfully performed, using a commercially available injection moulding system, with thousands of replicas generated from the same tool. In addition, three-dimensional bodies in metal could be realised with 3D-Printing of fused silica casting moulds. This work thus represents an approach to high-quality moulding tools via a scalable facile and cost-effective route surpassing the currently employed cost-, labour- and equipment-intensive machining techniques.

AI Denoising Improves Image Quality and Radiological Workflows in Pediatric Ultra-Low-Dose Thorax Computed Tomography Scans.

(1) This study evaluates the impact of an AI denoising algorithm on image quality, diagnostic accuracy, and radiological workflows in pediatric chest ultra-low-dose CT (ULDCT). (2) Methods: 100 consecutive pediatric thorax ULDCT were included and reconstructed using weighted filtered back projection (wFBP), iterative reconstruction (ADMIRE 2), and AI denoising (PixelShine). Place-consistent noise measurements were used to compare objective image quality. Eight blinded readers independently rated the subjective image quality on a Likert scale (1 = worst to 5 = best). Each reader wrote a semiquantitative report to evaluate disease severity using a severity score with six common pathologies. The time to diagnosis was measured for each reader to compare the possible workflow benefits. Properly corrected mixed-effects analysis with post-hoc subgroup tests were used. Spearman's correlation coefficient measured inter-reader agreement for the subjective image quality analysis and the severity score sheets. (3) Results: The highest noise was measured for wFBP, followed by ADMIRE 2, and PixelShine (76.9 ± 9.62 vs. 43.4 ± 4.45 vs. 34.8 ± 3.27 HU; each p < 0.001). The highest subjective image quality was measured for PixelShine, followed by ADMIRE 2, and wFBP (4 (4−5) vs. 3 (4−5) vs. 3 (2−4), each p < 0.001) with good inter-rater agreement (r ≥ 0.790; p ≤ 0.001). In diagnostic accuracy analysis, there was a good inter-rater agreement between the severity scores (r ≥ 0.764; p < 0.001) without significant differences between severity score items per reconstruction mode (F (5.71; 566) = 0.792; p = 0.570). The shortest time to diagnosis was measured for the PixelShine datasets, followed by ADMIRE 2, and wFBP (2.28 ± 1.56 vs. 2.45 ± 1.90 vs. 2.66 ± 2.31 min; F (1.000; 99.00) = 268.1; p < 0.001). (4) Conclusions: AI denoising significantly improves image quality in pediatric thorax ULDCT without compromising the diagnostic confidence and reduces the time to diagnosis substantially.

Injection Molding of Magnesium Aluminate Spinel Nanocomposites for High-Throughput Manufacturing of Transparent Ceramics.

Transparent ceramics like magnesium aluminate spinel (MAS) are considered the next step in material evolution showing unmatched mechanical, chemical and physical resistance combined with high optical transparency. Unfortunately, transparent ceramics are notoriously difficult to shape, especially on the microscale. Therefore, a thermoplastic MAS nanocomposite is developed that can be shaped by polymer injection molding at high speed and precision. The nanocomposite is converted to dense MAS by debinding, pre-sintering, and hot isostatic pressing yielding transparent ceramics with high optical transmission up to 84 % and high mechanical strength. A transparent macroscopic MAS components with wall thicknesses up to 4 mm as well as microstructured components with single micrometer resolution are shown. This work makes transparent MAS ceramics accessible to modern high-throughput polymer processing techniques for fast and cost-efficient manufacturing of macroscopic and microstructured components enabling a plethora of potential applications from optics and photonics, medicine to scratch and break-resistant transparent windows for consumer electronics.

Melt-Extrusion-Based Additive Manufacturing of Transparent Fused Silica Glass.

In recent years, additive manufacturing (AM) of glass has attracted great interest in academia and industry, yet it is still mostly limited to liquid nanocomposite-based approaches for stereolithography, two-photon polymerization, or direct ink writing. Melt-extrusion-based processes, such as fused deposition modeling (FDM), which will allow facile manufacturing of large thin-walled components or simple multimaterial printing processes, are so far inaccessible for AM of transparent fused silica glass. Here, melt-extrusion-based AM of transparent fused silica is introduced by FDM and fused feedstock deposition (FFD) using thermoplastic silica nanocomposites that are converted to transparent glass using debinding and sintering. This will enable printing of previously inaccessible glass structures like high-aspect-ratio (>480) vessels with wall thicknesses down to 250 µm, delicate parts including overhanging features using polymer support structures, as well as dual extrusion for multicolored glasses.

AI Lung Segmentation and Perfusion Analysis of Dual-Energy CT Can Help to Distinguish COVID-19 Infiltrates from Visually Similar Immunotherapy-Related Pneumonitis Findings and Can Optimize Radiological Workflows.

(1) To explore the potential impact of an AI dual-energy CT (DECT) prototype on decision making and workflows by investigating its capabilities to differentiate COVID-19 from immunotherapy-related pneumonitis. (2) Methods: From 3 April 2020 to 12 February 2021, DECT from biometrically matching patients with COVID-19, pneumonitis, and inconspicuous findings were selected from our clinical routine. Three blinded readers independently scored each pulmonary lobe analogous to CO-RADS. Inter-rater agreement was determined with an intraclass correlation coefficient (ICC). Averaged perfusion metrics per lobe (iodine uptake in mg, volume without vessels in ml, iodine concentration in mg/mL) were extracted using manual segmentation and an AI DECT prototype. A generalized linear mixed model was used to investigate metric validity and potential distinctions at equal CO-RADS scores. Multinomial regression measured the contribution "Reader", "CO-RADS score", and "perfusion metrics" to diagnosis. The time to diagnosis was measured for manual vs. AI segmentation. (3) Results: We included 105 patients (62 ± 13 years, mean BMI 27 ± 2). There were no significant differences between manually and AI-extracted perfusion metrics (p = 0.999). Regardless of the CO-RADS score, iodine uptake and concentration per lobe were significantly higher in COVID-19 than in pneumonitis (p < 0.001). In regression, iodine uptake had a greater contribution to diagnosis than CO-RADS scoring (Odds Ratio (OR) = 1.82 [95%CI 1.10-2.99] vs. OR = 0.20 [95%CI 0.14-0.29]). The AI prototype extracted the relevant perfusion metrics significantly faster than radiologists (10 ± 1 vs. 15 ± 2 min, p < 0.001). (4) Conclusions: The investigated AI prototype positively impacts decision making and workflows by extracting perfusion metrics that differentiate COVID-19 from visually similar pneumonitis significantly faster than radiologists.

High Resolution Patterning of an Organic-Inorganic Photoresin for the Fabrication of Platinum Microstructures.

Platinum (Pt) is an interesting material for many applications due to its high chemical resilience, outstanding catalytic activity, high electrical conductivity, and high melting point. However, microstructuring and especially 3D microstructuring of platinum is a complex process, based on expensive and specialized equipment often suffering from very slow processing speeds. In this work, organic-inorganic photoresins, which can be structured using direct optical lithography as well as two-photon lithography (TPL) with submicrometer resolution and high-throughput is presented. The printed structures are subsequently converted to high-purity platinum using thermal debinding of the binder and reduction of the salt. With this technique, complex 3D structures with a 3D resolution of 300 nm were fabricated. At a layer thickness of 35 nm, the patterns reach a high conductivity of 67% compared to bulk platinum. Microheaters, thermocouple sensors as well as a Lab-on-a-Chip system are presented as exemplary applications. This technology will enable a broad range of application from electronics, sensing and heating elements to 3D photonics and metamaterials.

Fused Deposition Modeling of Microfluidic Chips in Transparent Polystyrene.

Polystyrene (PS) is one of the most commonly used thermoplastic materials worldwide and plays a ubiquitous role in today's biomedical and life science industry and research. The main advantage of PS lies in its facile processability, its excellent optical and mechanical properties, as well as its biocompatibility. However, PS is only rarely used in microfluidic prototyping, since the structuring of PS is mainly performed using industrial-scale replication processes. So far, microfluidic chips in PS have not been accessible to rapid prototyping via 3D printing. In this work, we present, for the first time, 3D printing of transparent PS using fused deposition modeling (FDM). We present FDM printing of transparent PS microfluidic channels with dimensions as small as 300 µm and a high transparency in the region of interest. Furthermore, we demonstrate the fabrication of functional chips such as Tesla-mixer and mixer cascades. Cell culture experiments showed a high cell viability during seven days of culturing, as well as enabling cell adhesion and proliferation. With the aid of this new PS prototyping method, the development of future biomedical microfluidic chips will be significantly accelerated, as it enables using PS from the early academic prototyping all the way to industrial-scale mass replication.

High-throughput injection molding of transparent fused silica glass.

Glass is one of the most relevant high-performance materials that has the benefit of a favorable environmental footprint compared with that of other commodity materials. Despite the advantageous properties of glasses, polymers are often favored because they can be processed using scalable industrial replication techniques like injection molding (IM). Glasses are generally processed through melting, which is both energy intensive and technologically challenging. We present a process for glassworks using high-throughput IM of an amorphous silicon dioxide nanocomposite that combines established process technologies and low-energy sintering. We produce highly transparent glass using classical IM and sintering, allowing for a potentially substantial reduction in energy consumption. Our strategy merges polymer and glass processing, with substantial implications for glass utilization.

Fused Deposition Modeling of Microfluidic Chips in Polymethylmethacrylate.

Polymethylmethacrylate (PMMA) is one of the most important thermoplastic materials and is a widely used material in microfluidics. However, PMMA is usually structured using industrial scale replication processes, such as hot embossing or injection molding, not compatible with rapid prototyping. In this work, we demonstrate that microfluidic chips made from PMMA can be 3D printed using fused deposition modeling (FDM). We demonstrate that using FDM microfluidic chips with a minimum channel cross-section of ~300 µm can be printed and a variety of different channel geometries and mixer structures are shown. The optical transparency of the chips is shown to be significantly enhanced by printing onto commercial PMMA substrates. The use of such commercial PMMA substrates also enables the integration of PMMA microstructures into the printed chips, by first generating a microstructure on the PMMA substrates, and subsequently printing the PMMA chip around the microstructure. We further demonstrate that protein patterns can be generated within previously printed microfluidic chips by employing a method of photobleaching. The FDM printing of microfluidic chips in PMMA allows the use of one of microfluidics' most used industrial materials on the laboratory scale and thus significantly simplifies the transfer from results gained in the lab to an industrial product.

Genetic characterization of toggenburg orbivirus, a new bluetongue virus, from goats, Switzerland.

A novel bluetongue virus (BTV) termed Toggenburg orbivirus (TOV) was detected in goats from Switzerland by using real-time reverse transcription-PCR. cDNA corresponding to the complete sequence of 7 of 10 double-stranded RNA segments of the viral genome was amplified by PCR and cloned into a plasmid vector. Five clones for each genome segment were sequenced to determine a consensus sequence. BLAST analysis and dendrogram construction showed that TOV is closely related to BTV, although some genome segments are distinct from the 24 known BTV serotypes. Maximal sequence identity to any BTV ranged from 63% (segment 2) to 79% (segments 7 and 10). Because the gene encoding outer capsid protein 2 (VP2), which determines the serotype of BTV, is placed within the BTV serogroup, we propose that TOV represents an unknown 25th serotype of BTV.

Genetic stability of Schmallenberg virus in vivo during an epidemic, and in vitro, when passaged in the highly susceptible porcine SK-6 cell line.

Schmallenberg virus (SBV), an arthropod-borne orthobunyavirus was first detected in 2011 in cattle suffering from diarrhea and fever. The most severe impact of an SBV infection is the induction of malformations in newborns and abortions. Between 2011 and 2013 SBV spread throughout Europe in an unprecedented epidemic wave. SBV contains a tripartite genome consisting of the three negative-sense RNA segments L, M, and S. The virus is usually isolated from clinical samples by inoculation of KC (insect) or BHK-21 (mammalian) cells. Several virus passages are required to allow adaptation of SBV to cells in vitro. In the present study, the porcine SK-6 cell line was used for isolation and passaging of SBV. SK-6 cells proved to be more sensitive to SBV infection and allowed to produce higher titers more rapidly as in BHK-21 cells after just one passage. No adaptation was required. In order to determine the in vivo genetic stability of SBV during an epidemic spread of the virus the nucleotide sequence of the genome from seven SBV field isolates collected in summer 2012 in Switzerland was determined and compared to other SBV sequences available in GenBank. A total of 101 mutations, mostly transitions randomly dispersed along the L and M segment were found when the Swiss isolates were compared to the first SBV isolated late 2011 in Germany. However, when these mutations were studied in detail, a previously described hypervariable region in the M segment was identified. The S segment was completely conserved among all sequenced SBV isolates. To assess the in vitro genetic stability of SBV, three isolates were passage 10 times in SK-6 cells and sequenced before and after passaging. Between two and five nt exchanges per genome were found. This low in vitro mutation rate further demonstrates the suitability of SK-6 cells for SBV propagation.

Detection of Toggenburg Orbivirus by a segment 2-specific quantitative RT-PCR.

Toggenburg Orbivirus (TOV) has been detected recently in healthy goats in Switzerland. The virus is related closely to bluetongue virus (BTV) and is considered tentatively as a 25th serotype of BTV. Upon detection of additional TOV-positive goats in Switzerland, Germany, and Italy, these TOV isolates were characterized genetically by partial sequencing of the viral genome segment 2 which encodes VP2, the major outer capsid protein of orbiviruses. A TOV-specific RT-qPCR was developed, targeting conserved areas within segment 2. Since TOV cannot be propagated up to now outside its natural host, a synthetic positive control for the RT-qPCR was constructed by cloning the entire coding region of segment 2 and subsequent in vitro transcription of RNA from both ends to obtain double-stranded RNA. The TOV-specific RT-qPCR was able to detect as few as 30 dsRNA copies and proved to be equally sensitive as a pan BTV assay that was shown previously to have a detection limit of 0.001 TCID(50).