bluuebunny/crossref_metadata_2025 huggingface dataset:
Uterine tumors resembling ovarian sex cord tumors: A retrospective analysis of 7 cases from a single institution
Authors: Ma Zhe , Li Ying
Published: July 2024

To investigate the clinicopathological features, diagnosis, surgical treatment and prognosis of uterine tumors similar to ovarian sex cord tumors (UTROSCT). The clinical data, surgical approach, histopathological, and immunohistochemical features of 7 cases of UTROSCTs were retrospectively reviewed and followed up. All 4 patients were premenopausal women. The most common clinical presentation was menorrhagia (n = 4) followed by postmenopausal lower abdominal mass (n = 2) and postmenopausal bleeding (n = 1). Gynecological ultrasonography suggested uterine fibroids in 4 cases, adenomyosis with uterine fibroids in 2 cases, and an intrauterine mass in 1 case. Pelvic MRI was performed preoperatively in only 2 cases, and both indicated uterine fibroid degeneration, including 1 patient with suspected malignancy. Preoperative serum tumor markers were measured in 6 patients, and only 1 patient had elevated CA125 levels, up to 158 U/mL. Total hysterectomy with bilateral adnexectomy or salpingectomy was the most common treatment pattern (n = 6). The tumors were located within the myometrium (n = 4), submucosa (n = 1), and isthmus to external cervical os (n = 1), with a range of 2 to 12 (mean = 8) cm. Edema and degeneration were observed in 2 cases, and necrosis in 1 case. Postoperative follow-up ranged from 31 to 82 (mean = 43) months. Unfortunately, 1 patient died at 54 months of follow-up without undergoing hysterectomy. The remaining 6 cases showed no tumor recurrence or metastasis after surgery. Histological examination revealed a tumor composed of epithelioid tumor-like cells arranged in cords, trabeculae, and nests. All 7 tumors showed expression of 2 sex cord differentiation markers. Furthermore, all tumors expressed the smooth muscle marker, while epithelial marker CK (4/7). endometrial stromal marker CD10(0/7). The Ki-67 proliferation index was found to be <5% (5/7). The option of total hysterectomy may be considered for women who do not have any fertility requirements. However, for young women who desire to maintain their reproductive capacity, surgery to preserve the uterus may be an alternative, although it necessitates careful postoperative monitoring. In terms of follow-up monitoring, MRI is more suitable than ultrasound. The diagnosis of UTROSCT heavily relies on histopathological examination and immunohistochemical analysis.
The role of gut microbiota in prostate cancer progression: A Mendelian randomization study of immune mediation
Authors: Li Song , Liu Ruoxuan , Hao Xuexue , Liu Xiaoqiang
Published: July 2024

The potential relationship between the gut microbiota and prostate cancer, possibly influenced by immune cells, remains unclear. This study employed the mediation Mendelian randomization (MR) technique to investigate the causal link between the gut microbiota, immune cells, and prostate cancer. Data on immune cell activity were sourced from Valeria Orrù’s research, whereas the genome-wide association study outcome dataset was obtained from the Integrative Epidemiology Unit database. The bidirectional MR analysis utilized 5 different methods: inverse variance weighted (IVW), weighted median, MR-Egger regression, weighted mode, and simple mode. In addition, the mediating effect of immune cells on the gut microbiota and prostate cancer was explored using mediation analysis. Eighty-three single nucleotide polymorphisms associated with prostate cancer were screened as instrumental variables. In a positive MR analysis with gut microbiota as the exposure factor, IVW showed an association between 8 gut microbiota and prostate cancer. Additionally, 9 types of immune cells have been found to be associated with prostate cancer using methods such as IVW. MR analysis of the gut microbiota on immune cells (beta1) revealed a negative correlation between Bifidobacterium and CD39+ T regulatory cells (Tregs; odds ratio [OR] = 0.785, 95% confidence interval [CI] = 0.627–0.983, P = .03). Furthermore, MR analysis of immune cells in prostate cancer disease (beta2) showed that CD39+Tregs are a risk factor for prostate cancer (OR = 1.215, 95% CI = 1.027–1.354, P = .04). Moreover, MR analysis of gut microbiota in prostate cancer (total effect) indicated that Bifidobacterium is a protective factor for prostate cancer (OR = 0.905, 95% CI = 0.822–0.977, P = .04). The sensitivity analysis verified the robustness of the above results. Mediation analysis demonstrated that CD39+Tregs partially mediate the causal relationship between Bifidobacterium and prostate cancer. This study demonstrates that Bifidobacterium inhibits prostate cancer progression through CD39+Tregs as mediators, providing new ideas and approaches for the treatment and prevention of prostate cancer.
Association between lymphocyte-to-monocyte ratio and prostate cancer in men: A population-based study
Authors: Chen Pingzhou , Huang Zhijie , Wu Xiang
Published: July 2024

Using the novel inflammatory biomarker lymphocyte-to-monocyte ratio (LMR), this work aimed to look into any potential connections between LMR and prostate cancer (PCa). A cross-sectional research investigation was conducted on 7706 male participants involved in the National Health and Nutrition Examination Survey from 2001 to 2010. Multivariate logistic regression modeling investigated the relationship between LMR levels and PCa risk. Furthermore, threshold analysis, subgroup analysis, interaction testing, and smoothed curve fitting were carried out. A significant negative correlation was seen between LMR and PCa risk (OR = 0.79, 95% CI: 0.65–0.97, P = .0002), even after controlling for potential confounding factors. A significant nonlinear negative correlation with a threshold effect and a breakpoint of 4.86 was found by smooth curve fitting between LMR and PCa. Subgroup analysis revealed a significant interaction (P for interaction = 0.0448) between the negative correlation between PCa and LMR about hypertension. Moreover, additional stratified smoothed curve fitting demonstrated a statistically significant inverse relationship between PCa risk and LMR. According to our findings, there is a substantial inverse relationship between PCa risk and LMR level. The inflammatory response-related index is quick, easy to use, and offers some clinical references. However, more extensive prospective investigations are required to confirm the involvement of LMR levels in PCa.
Global trends and frontiers of research on Kümmell’s disease: A bibliometric analysis
Authors: Du Weifeng , Wu Zhoutong , Wu Huaiju , Li Yanlei , Jin Yebin
Published: July 2024

The prevalence of Kümmell’s disease (KD) has been increasing due to the aging population and the rise of osteoporotic vertebral compressibility fractures. As a result, there has been a growing concern about this condition. Despite the rapid advancements in its related research fields, the current research status and hotspot analysis of KD remain unclear. Therefore, our goal was to identify and analyze the global research trends on KD using bibliometric tools. All KD data were obtained from the Web of Science Core Collection. The information of research field was collected, including title, author, institutions, journals, countries, references, total citations, and years of publication for further analysis. From 1900 to 2022, a total of 195 articles and 1973 references have been published in this field, originating from 27 countries/regions and 90 journals, with China leading the contributions. The most significant institutional and author contributions come from Soochow University and Kim, HS, respectively. The journal with the highest number of published research and total citation frequency is Spine. The latest research focuses in this field include “risk factor,” “osteoporotic vertebral compression fracture,” “pedicle screw fixation,” “percutaneous vertebroplasty,” and “bone cement,” and should be closely monitored. Additionally, we have conducted a comprehensive analysis of the 50 most-cited articles in KD, providing a valuable list of articles to guide clinical decision-making and future research for clinicians and researchers. In recent years, there has been a significant increase in scientific research on KD. Future research in KD is likely to focus on surgical treatment, risk factors, and complications.
Scleral bridging technique for preventing PreserFlo microshunt exposure: A case report
Authors: Nakakura Shunsuke , Nagata Yuki , Fujisawa Yasuko , Kiuchi Yoshiaki
Published: July 2024

Introduction:

The use of the PreserFlo microshunt is gaining popularity owing to its ease of implantation and reduced need for postoperative intervention compared to conventional trabeculectomy.

Patient concerns:

However, microshunt exposure remains a severe complication of PreserFlo surgery, particularly in patients with a thin Tenon capsule and conjunctiva. However, the actual thickness and intensity of the Tenon capsule or conjunctiva can be confirmed only during surgery.

Diagnosis:

Exfoliation glaucoma with previous several glaucoma surgeries with thinner Tenon capsule or conjunctiva.

Interventions:

We performed PreserFlo implantation with a surgical technique to recover a thin Tenon capsule and conjunctiva by creating a half-thickness rectangular scleral flap under the shunt and covering it over the microshunt until the distal part, similar to the bridge.

Outcomes:

The patient had better intraocular pressure control with positive cosmetic appearance using this technique.

Conclusion:

This technique will be beneficial for both preventing exposure and holding down the top, in addition to improving cosmetic appearance.
Association between alcohol consumption and all-cause mortality, cardiovascular disease, and chronic kidney disease: A prospective cohort study
Authors: Shao Lan , Chen Yuchao , Zhao Zenghui , Luo Shengjun
Published: July 2024

In recent years, significant progress has been achieved in comprehending the impact of alcohol consumption on adverse health outcomes. However, the quality of evidence remains limited. Our objective was to conduct a prospective study examining the relationship between different types of alcoholic beverages and the risk of all-cause mortality, cardiovascular disease (CVD), and chronic kidney disease (CKD), and identifying the thresholds of safe dose stratified by sex using data from the UK Biobank. 502,490 participants were enrolled. These participants were initially registered between 2006 and 2010, and underwent reassessment between 2012 and 2013. All participants completed a detailed questionnaire on their alcohol consumption, including total alcohol consumption yesterday, weekly consumption of red wine, champagne plus white wine, beer, spirits, and fortified wine. All-cause mortality and the incidence of CVD and CKD were considered as the primary outcomes. 2852 participants reported CKD during a median follow-up period of 11.94 years, while 79,958 participants reported CVD over a median follow-up period of 11.35 years. Additionally, 18,923 participants died over a median follow-up period of 11.89 years. After adjusting for variables such as age, sex, education level, smoking status, diet score, and exercise score, total alcohol consumption showed a U-shaped relationship with the risk of CVD and all-cause mortality, but showed an inverse association with the risk of CKD. Upon further classification of alcoholic beverages, our analysis revealed that red wine, champagne plus white wine, beer, spirits, and fortified wine presented a U-shaped relationship with the risk of all-cause mortality and CKD. However, spirits were positively associated with the risk of CVD, only red wine, champagne plus white wine, beer, and fortified wine showed a U-shaped relationship with the risk of CVD. The safe doses of total alcohol consumption should be < 11 g/d for males and < 10 for females, red wine consumption should be < 7 glasses/week for males and < 6 for females, champagne plus white wine consumption should be < 5 glasses/week, and fortified wine consumption should be < 4 glasses/week. Red wine, champagne plus white wine, beer, and fortified wine below the corresponding thresholds of safe dose in our analysis were significantly associated with a lower risk of all-cause mortality, CVD, and CKD. And these alcoholic beverages under safe doses exhibited a protective effect against conditions like diabetes, depression, dementia, epilepsy, liver cirrhosis, and other digestive diseases, while didn’t increase the risk of cancer.
Identification of core genes shared by ischemic stroke and myocardial infarction using an integrated approach
Authors: Wang Min , Gao Yuan , Chen Huaqiu , Cheng Jianjie , Wang Guangming
Published: July 2024

Background:

Both ischemic stroke (IS) and myocardial infarction (MI) are caused by vascular occlusion that results in ischemia. While there may be similarities in their mechanisms, the potential relationship between these 2 diseases has not been comprehensively analyzed. Therefore, this study explored the commonalities in the pathogenesis of IS and MI.

Methods:

Datasets for IS (GSE58294, GSE16561) and MI (GSE60993, GSE61144) were downloaded from the Gene Expression Omnibus database. Transcriptome data from each of the 4 datasets were analyzed using bioinformatics, and the differentially expressed genes (DEGs) shared between IS and MI were identified and subsequently visualized using a Venn diagram. A protein–protein interaction (PPI) network was constructed using the Interacting Gene Retrieval Tool database, and identification of key core genes was performed using CytoHubba. Gene Ontology (GO) term annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the shared DEGs were conducted using prediction and network analysis methods, and the functions of the hub genes were determined using Metascape.

Results:

The analysis revealed 116 and 1321 DEGs in the IS and MI datasets, respectively. Of the 75 DEGs shared between IS and MI, 56 were upregulated and 19 were downregulated. Furthermore, 15 core genes – S100a12, Hp, Clec4d, Cd163, Mmp9, Ormdl3, Il2rb, Orm1, Irak3, Tlr5, Lrg1, Clec4e, Clec5a, Mcemp1, and Ly96 – were identified. GO enrichment analysis of the DEGs showed that they were mainly involved in the biological functions of neutrophil degranulation, neutrophil activation during immune response, and cytokine secretion. KEGG analysis showed enrichment in pathways pertaining to Salmonella infection, Legionellosis, and inflammatory bowel disease. Finally, the core gene–transcription factor, gene–microRNA, and small-molecule relationships were predicted.

Conclusion:

These core genes may provide a novel theoretical basis for the diagnosis and treatment of IS and MI.
Coronary artery event-free or resilient familial hypercholesterolemia: what's in a name?
Authors: Tamehri Zadeh Seyed Saeed , Chan Dick C. , Mata Pedro , Watts Gerald F.
Published: July 2024

Purpose of review

Familial hypercholesterolemia (FH) is an autosomal semi-dominant condition, characterized by excessive circulating low-density lipoprotein cholesterol (LDL-C) from birth that substantially accelerates the onset and progression of atherosclerotic cardiovascular disease (ASCVD), classically coronary artery disease (CAD). Elevated plasma LDL-C integrated over time is unequivocally the major determinant of ASCVD in heterozygous FH (HeFH); however, the wide variation in incidence and progression of ASCVD suggests a role for a wide spectrum of risk modifiers. We reviewed recent evidence describing the features of an ASCVD-free entity referred to as resilient FH among patients with HeFH.

Recent findings

Compared with nonresilient FH patients, resilient patients are more likely to be female, and have a lower prevalence of ASCVD comorbidities, higher levels of HDL-C and larger HDL particles, as well as a lower level of lipoprotein(a). A lower SAFEHEART risk score is also an independent predictor of resilient FH. Gene expression studies also demonstrate that resilient FH patients are associated with a less atherogenic gene expression profile in relation to HDL metabolism and immune responses, as reflected by higher expression of ABCA1 and ABCG1, and lower expression of STAT2 and STAT3, respectively.

A group of HeFH patients, referred as resilient FH, can survive to advance ages without experiencing any ASCVD events. Several key contributors to the event-fee CAD in HeFH patients have been identified. This could not only improve risk stratification and management for FH but also be of major importance for the general population in primary and secondary prevention. However, resilient FH remains an under-investigated area and requires further research.
Hospital-to-Home-Health Transition Quality (H3TQ) Index
Authors: Arbaje Alicia I. , Hsu Yea-Jen , Greyson Sylvan , Gurses Ayse P. , Marsteller Jill , Bowles Kathryn H. , McDonald Margaret V. , Vergez Sasha , Harbison Katie , Hohl Dawn , Carl Kimberly , Leff Bruce
Published: July 2024

Background:

We developed the Hospital-to-Home-Health Transition Quality (H3TQ) Index for skilled home healthcare (HH) agencies to identify threats to safe, high-quality care transitions in real time.

Objective:

Assess the validity of H3TQ in a large sample across diverse communities.

Research Design:

A survey of recently hospitalized older adults referred for skilled HH services and their HH provider at two large HH agencies in Baltimore, MD, and New York, NY.

Subjects:

There were five hundred eighty-seven participants (309 older adults, 141 informal caregivers, and 137 HH providers). Older adults, caregivers, and HH providers rated 747 unique transitions. Of these, 403 were rated by both the older adult/caregiver and their HH provider, whereas the remaining transitions were rated by either party.

Measures:

Construct, concurrent, and predictive validity were assessed via the overall H3TQ rating, correlation with the care transition measure (CTM), and the Medicare Outcome and Assessment Information Set (OASIS).

Results:

Proportion of transitions with quality issues as identified by HH providers and older adults/caregivers, respectively; Baltimore 55%, 35%; NYC 43%, 32%. Older adults/caregivers across sites rated their transitions as higher quality than did providers (P<0.05). H3TQ summed scores showed construct validity with the CTM-3 and concurrent validity with OASIS measures. Summed H3TQ scores were not significantly correlated with 30-day ED visits or rehospitalization.

Conclusions:

The H3TQ identifies care transition quality issues in real-time and demonstrated construct and concurrent validity, but not predictive validity. Findings demonstrate value in collecting multiple perspectives to evaluate care transition quality. Implementing the H3TQ could help identify transition-quality intervention opportunities for HH patients.
Incretin mimetics and acute pancreatitis: enemy or innocent bystander?
Authors: Pratley Richard , Saeed Zeb I. , Casu Anna
Published: July 2024

Purpose of review

The incretin enhancers and mimetics, including dipeptidyl peptidase-4 (DPP-4) inhibitors, GLP-1 receptor agonists (GLP-1RA) and GLP-1/GIP co-agonists, have become mainstays in the treatment of type 2 diabetes (T2D). Recently, the approval of certain GLP-1RA and GLP-1/GIP co-agonists for the treatment of obesity has broadened their popularity and use. In this review, we summarize the evidence for an association of these drugs with acute pancreatitis and other adverse events of special interest to gastroenterologists.

Recent findings

In addition to pancreatic islets, GLP-1 receptors are expressed in the exocrine cells of the pancreas. There is inconsistent evidence for an association of DPP-4 inhibitors, GLP-1RA and co-agonists with risk for acute pancreatitis in individual trials. Meta-analyses of long-term randomized controlled trials indicate a small risk of acute pancreatitis associated with DPP-4 inhibitors but not GLP-1RA or co-agonists. Cholecystitis and cholelithiasis may be more common among those treated with GLP-1RA and GLP-1/GIP co-agonists. There is no evidence that any of these drugs are associated with an increased risk of pancreatic cancer.

While drugs that leverage the incretin system are increasingly being used for patients with T2D and obesity, caution in warranted in those with a history of pancreatitis and gallbladder disease.
Onset of Acute Intermittent Porphyria After Etonogestrel Implant Insertion: A Case Report
Authors: Furcich Justin , Boucher Alexander A. , Grace James
Published: July 2024

A 17-year-old previously healthy female developed posterior reversible encephalopathy syndrome 1 week after etonogestrel implantation. She had a previous etonogestrel implant removed 4 months prior after unrelenting abdominal pain and hyponatremia with a negative workup for other etiologies, including hypercoagulable disorders and malignancy. This second insertion and resulting hospitalization allowed for the diagnosis of acute intermittent porphyria (AIP) to be confirmed. Progesterone can induce enzymatic activity upstream of porphobilinogen deaminase, the enzyme implicated in AIP, resulting in build-up of toxic metabolites. AIP requires high clinical suspicion for diagnosis but should be considered when hormonal triggers lead to unexplained neurovisceral symptoms.
Implementing a 4% EDTA Central Catheter Locking Solution as a Quality Improvement Project in a Large Canadian Hospital
Authors: Tremain Leanne , Collerman Ari , Harsha Prathiba , Ntow Kwadjo , Main Cheryl , Wohlgemut Janell , Brown Mark , Scott Ted , Dietrich Tim
Published: July 2024

Oncology and critical care patients often require central vascular access devices (CVADs), which can make them prone to central line-associated bloodstream infections (CLABSIs) and thrombotic occlusions. According to the literature, CLABSIs are rampant and increased by 63% during the COVID-19 pandemic, highlighting the need for innovative interventions. Four percent ethylenediaminetetraacetic acid (4% EDTA) is an antimicrobial locking solution that reduces CLABSIs, thrombotic occlusions, and biofilm. This retrospective pre-post quality improvement project determined if 4% EDTA could improve patient safety by decreasing CLABSIs and central catheter occlusions. This was implemented in all adult cancer and critical care units at a regional cancer hospital and center. Before implementing 4% EDTA, there were 36 CLABSI cases in 16 months (27 annualized). After implementation, there were 6 cases in 6 months (12 annualized), showing a statistically significant decrease of 59% in CLABSIs per 1000 catheter days. However, there was no significant difference in occlusions (alteplase use). Eighty-eight percent of patients had either a positive or neutral outlook, while most nurses reported needing 4% EDTA to be available in prefilled syringes. The pandemic and nursing shortages may have influenced the results; hence, randomized controlled trials are needed to establish a causal relationship between 4% EDTA and CLABSIs and occlusions.
Attenuated Angiogenesis and Macrophage Infiltration during Adipose Tissue Regeneration in Megavolume Human Fat Grafting
Authors: Bi Xin , Wu Weizi , Zou Jialiang , Zhao Jing , Lin Zhousheng , Li Ye , Lu Feng , Gao Jianhua , Li Bin , Dong Ziqing
Published: July 2024

Background:

Survival and regeneration mechanisms of large (>250 mL) fat grafts remain incompletely understood. In fat grafts from volunteers with megavolume fat transfer breast augmentation, neovascularization and inflammatory cell infiltration decreased within 7 days according to histologic analysis. The authors further investigated this phenomenon using a nude mouse model.

Methods:

To simulate clinical contexts, chambers containing 1 mL of human fat were implanted into nude mice. Chambers allowed selective transfer of tissue fluid from recipient nude mice into chambers, but not capillaries or macrophages. Seven days later, fat was removed from the chamber and reimplanted into a new nude mouse in the open-chambered fat group (OCFG) (n = 45). Adipose samples from volunteers and explanted grafts from OCFG were subjected to histologic analyses. Graft weight, vascularization, and immune response were also compared between the OCFG and conventional direct fat grafting (control group [CG]).

Results:

Percentage tissue integrity, percentage fibrosis, adipocyte viability, and neovascularization did not significantly differ between volunteer samples and OCFG grafts at day 7. On day 90, OCFG retention rate was decreased relative to the CG, and the fibrosis area was larger in the OCFG than in the CG. However, the macrophage and capillary counts were lower in the OCFG group relative to the CG at days 7 and 14 after transplantation.

Conclusions:

The present study provides histologic analyses of megavolume fat grafts sampled from clinical breast augmentation tissues and a xenograft nude mouse model. However, these preliminary results in a small clinical cohort should be further assessed in large allogeneic animal models.

Clinical Relevance Statement:

The results of this study will help surgeons understand the early regeneration of transplanted fat after large volume fat grafting for breast augmentation.
Performance of O-RADS MRI Score in Differentiating Benign From Malignant Ovarian Teratomas: MR Feature Analysis for Differentiating O-RADS 4 From O-RADS 2
Authors: Petrocelli Robert , Doshi Ankur , Slywotzky Chrystia , Savino Marissa , Melamud Kira , Tong Angela , Hindman Nicole
Published: July 2024

Objective

The aim of the study is to evaluate the performance of the ovarian-adnexal reporting and data system magnetic resonance imaging (O-RADS MRI) score and perform individual MRI feature analysis for differentiating between benign and malignant ovarian teratomas.

Methods

In this institutional review board–approved retrospective study, consecutive patients with a pathology-proven fat-containing ovarian mass imaged with contrast-enhanced MRI (1.5T or 3T) from 2013 to 2022 were included. Two blinded radiologists independently evaluated masses per the O-RADS MRI lexicon, including having a “characteristic” or “large” Rokitansky nodule (RN). Additional features analyzed included the following: nodule size/percentage volume relative to total teratoma volume, presence of bulk/intravoxel fat in the nodule, diffusion restriction in the nodule, angular interface, nodule extension through the teratoma border, presence/type of nodule enhancement pattern (solid versus peripheral), and evidence for metastatic disease. An overall O-RADS MRI score was assigned. Patient and lesion features associated with malignancy were evaluated and used to create a malignant teratoma score. χ2, Fisher's exact tests, receiver operating characteristic curve, and κ analysis was performed.

Results

One hundred thirty-seven women (median age 34, range 9–84 years) with 123 benign and 14 malignant lesions were included. Mean teratoma size was 7.3 cm (malignant: 14.4 cm, benign: 6.5 cm). 18/123 (14.6%) of benign teratomas were assigned an O-RADS 4 based on the presence of a “large” (11/18) or “noncharacteristic” (12/18) RN. 12/14 malignant nodules occupied >25% of the total teratoma volume (P = 0.09). Features associated with malignancy included the following: age <18 years, an enhancing noncharacteristic RN, teratoma size >12 cm, irregular cystic border, and extralesional extension; these were incorporated into a malignant teratoma score, with a score of 2 or more associated with area under the curve of 0.991 for reviewer 1 and 0.993 for reviewer 2. Peripheral enhancement in a RN was never seen with malignancy (64/123 benign, 0/14 malignant) and would have appropriated downgraded 9/18 overcalled O-RADS 4 benign teratomas.

Conclusions

O-RADS MRI overcalled 15% (18/123) benign teratomas as O-RADS 4 but correctly captured all malignant teratomas. We propose defining a “characteristic” RN as an intravoxel or bulk fat-containing nodule. Observation of a peripheral rim of enhancement in a noncharacteristic RN allowed more accurate prediction of benignity and should be added to the MRI lexicon for improved O-RADS performance.
Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical Practice
Authors: Lim Robert S. , Rosenberg Jarrett , Willemink Martin J. , Cheng Sarah N. , Guo Henry H. , Hollett Philip D. , Lin Margaret C. , Madani Mohammad H. , Martin Lynne , Pogatchnik Brian P. , Pohlen Michael , Shen Jody , Tsai Emily B. , Berry Gerald J. , Scott Gregory , Leung Ann N.
Published: July 2024

Objective

To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice.

Methods

This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6–15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2–7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models.

Results

Volumetric analysis improved sensitivity (P = 0.009) and allowed earlier recognition (P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules (P = 0.03) and recommendation of care escalation (P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group (P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38–0.66) and fair to moderate (0.33–0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 (P = 0.004) only on the second follow-up study.

Conclusions

Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.
68Ga-NODAGA–Exendin-4 PET/CT Findings in a Case of Metastatic Insulinoma With Refractory Hypoglycemia Controlled by 90Y Transarterial Radioembolization
Authors: Şahin Rahime , Rakıcı İbrahim Taşkın , Baloğlu Mehmet Can , Şahin Ömer Faruk , Çermik Tevfik Fikret
Published: July 2024

Metastatic insulinomas can cause recurrent hypoglycemia requiring continuous IV glucose infusion. Various medical and chemotherapeutic treatment options are used to reduce the patient’s risk of death due to hypoglycemia. Treatment-resistant hepatic metastatic insulinomas may benefit clinically from 90Y transarterial radioembolization therapy. In this case, we present a case of liver metastatic insulinoma that achieved clinical improvement after 2 cycles of 90Y microspheres transarterial radioembolization, and the presence of active metastases was demonstrated with 68Ga-NODAGA–exendin-4 PET/CT imaging.
177Lu-DOTATATE Uptake in the Lungs of a Patient With COVID-19 Pneumonia
Authors: Matsushita Tomoki , Otomi Yoichi , Okada Naoko , Kawanaka Takashi , Otsuka Hideki
Published: July 2024

A 76-year-old woman with liver and bone metastasis of a duodenal neuroendocrine tumor received peptide receptor radionuclide therapy with 177Lu-DOTATATE. Scintigraphy with SPECT/CT performed 4 days after the treatment demonstrated 177Lu-DOTATATE uptake as multifocal ground glass opacities in the bilateral lungs. This uptake was considered to be due to COVID-19 pneumonia because the patient was infected with the virus 7 days prior to the treatment. The lung opacities became smaller, showing a decreased uptake, 2 months later, after the second treatment. 177Lu-DOTATATE may be taken up during the active phase of COVID-19 pneumonia.
Temporal Changes in 18F-FDG PET/CT in Familial Neuronal Intranuclear Inclusion Disease, Based on the Clinical Course
Authors: Kim Ahro , Park Gyeong Min , Suh Jae Hee , Park Ji-Yun , Seo Minjung
Published: July 2024

We report temporal changes in 18F-FDG PET/CT in neuronal intranuclear inclusion disease (NIID). In a patient with encephalitis-like episodes, PET showed hypermetabolism correlating with EEG alterations. Affected sites later became hypometabolic and showed diffusion changes on MRI. In another patient, hypermetabolic regions correlated well with the EEG, whereas MRI showed changes after only 1 month. One chronic patient had diffuse hypometabolism, which correlated with atrophy on MRI and cerebral dysfunction on EEG. This is the first report of temporal changes in PET in NIID and suggests that it reflects the disease activity of NIID while correlating well with EEG.
Infectious Aortitis on 18F-FDG PET/CT
Authors: El Hoyek Nadine , Chen Wengen , Aktay Recai
Published: July 2024

Infectious aortitis is a challenging radiographic diagnosis due to overlapping features with the noninfectious category. We present a case of a 58-year-old woman who tested positive for SARS-CoV-2 and Streptococcus pneumoniae bacteremia. 18F-FDG PET/CT demonstrated large vessel vasculitis involving the thoracic, abdominal aorta, and the brachiocephalic branches of the aortic arch, and an incidental subcutaneous abscess in the right arm. Standard of care treatment was administered. Within a week, a drastic improvement of the wall thickening was noted, which can be, regardless of the biological markers, a surrogate marker of an infectious aortitis.
Thoracic SMARCA4-Deficient Undifferentiated Tumor Mimicking Malignant Pleural Mesothelioma on FDG PET/CT
Authors: Wu Haibo , Zhou Yinting , Dong Aisheng , Wang Yang , Han Yan
Published: July 2024

We describe contrast-enhanced CT and FDG PET/CT findings in a case of thoracic SMARCA4-deficient undifferentiated tumor with extensive pleural involvement and mediastinal lymph node metastases. Contrast-enhanced CT showed multiple enhancing right-sided pleural masses and soft tissue plaques and enlarged mediastinal lymph nodes. The pleural lesions and mediastinal lymph nodes showed intense FDG uptake mimicking malignant pleural mesothelioma with mediastinal lymph node metastases.
Prognostic Significance of 18F-FDG PET/CT Radiomics in Patients With Resectable Pancreatic Ductal Adenocarcinoma Undergoing Curative Surgery
Authors: Yoo Jang , Hyun Seung Hyup , Lee Jaeho , Cheon Miju , Lee Kwang Hyuck , Heo Jin Seok , Choi Joon Young
Published: July 2024

Purpose

This study aimed to investigate the prognostic significance of PET/CT radiomics to predict overall survival (OS) in patients with resectable pancreatic ductal adenocarcinoma (PDAC).

Methods

We enrolled 627 patients with resectable PDAC who underwent preoperative 18F-FDG PET/CT and subsequent curative surgery. Radiomics analysis of the PET/CT images for the primary tumor was performed using the Chang-Gung Image Texture Analysis toolbox. Radiomics features were subjected to least absolute shrinkage and selection operator (LASSO) regression to select the most valuable imaging features of OS. The prognostic significance was evaluated by Cox proportional hazards regression analysis. Conventional PET parameters and LASSO score were assessed as predictive factors for OS by time-dependent receiver operating characteristic curve analysis.

Results

During a mean follow-up of 28.8 months, 378 patients (60.3%) died. In the multivariable Cox regression analysis, tumor differentiation, resection margin status, tumor stage, and LASSO score were independent prognostic factors for OS (HR, 1.753, 1.669, 2.655, and 2.946; all P < 0.001, respectively). The time-dependent receiver operating characteristic curve analysis showed that the LASSO score had better predictive performance for OS than conventional PET parameters.

Conclusions

The LASSO score using the 18F-FDG PET/CT radiomics of the primary tumor was the independent prognostic factor for predicting OS in patients with resectable PDAC and may be helpful in determining therapeutic and follow-up plans for these patients.
AI in Neuro-Ophthalmology: Current Practice and Future Opportunities
Authors: Kenney Rachel C. , Requarth Tim W. , Jack Alani I. , Hyman Sara W. , Galetta Steven L. , Grossman Scott N.
Published: July 2024

Background:

Neuro-ophthalmology frequently requires a complex and multi-faceted clinical assessment supported by sophisticated imaging techniques in order to assess disease status. The current approach to diagnosis requires substantial expertise and time. The emergence of AI has brought forth innovative solutions to streamline and enhance this diagnostic process, which is especially valuable given the shortage of neuro-ophthalmologists. Machine learning algorithms, in particular, have demonstrated significant potential in interpreting imaging data, identifying subtle patterns, and aiding clinicians in making more accurate and timely diagnosis while also supplementing nonspecialist evaluations of neuro-ophthalmic disease.

Evidence Acquisition:

Electronic searches of published literature were conducted using PubMed and Google Scholar. A comprehensive search of the following terms was conducted within the Journal of Neuro-Ophthalmology: AI, artificial intelligence, machine learning, deep learning, natural language processing, computer vision, large language models, and generative AI.

Results:

This review aims to provide a comprehensive overview of the evolving landscape of AI applications in neuro-ophthalmology. It will delve into the diverse applications of AI, optical coherence tomography (OCT), and fundus photography to the development of predictive models for disease progression. Additionally, the review will explore the integration of generative AI into neuro-ophthalmic education and clinical practice.

Conclusions:

We review the current state of AI in neuro-ophthalmology and its potentially transformative impact. The inclusion of AI in neuro-ophthalmic practice and research not only holds promise for improving diagnostic accuracy but also opens avenues for novel therapeutic interventions. We emphasize its potential to improve access to scarce subspecialty resources while examining the current challenges associated with the integration of AI into clinical practice and research.
Reliable Change Indices and Minimum Detectable Change for the Montreal Cognitive Assessment in Electroconvulsive Therapy for Depression
Authors: Whooley Emma , Gusciute Gabriele , Kavanagh Keeva , McDonagh Kelly , McCaffrey Cathal , Doody Eimear , Jelovac Ana , McLoughlin Declan M.
Published: July 2024

Objective

The Montreal Cognitive Assessment (MoCA) is a commonly used brief cognitive screening tool for monitoring adverse cognitive effects of electroconvulsive therapy (ECT). The aim of this study was to examine three statistical methods for detecting reliable change in the MoCA following ECT.

Methods

In a prospective cohort study, 47 patients (mean age 55.2 [SD = 12.8], 59.6% female) with unipolar or bipolar depression treated with an acute course of brief-pulse ECT (72.3% right unilateral) and 47 depressed controls without ECT exposure were tested on the MoCA at baseline and retested at comparable time intervals. ECT patients' performance was also compared to published normative data from a community-based sample of older adults. We calculated proportions of ECT patients remaining stable, declining, and improving following ECT using practice-corrected reliable change index, standardized regression-based formulas, and minimum detectable change cutoff of ±4 MoCA points.

Results

Using the three methods, 72.3%–78.7% of ECT patients remained stable, 17.0%–23.4% declined, and 4.3% improved in MoCA performance following ECT compared to the two control groups.

Conclusions

All three methods yield consistent estimates of reliable change in MoCA scores from pre– to post–brief-pulse ECT. The minimum detectable change approach may be the most efficient and accessible method of detecting change due to simplicity of calculation.
Microbiological contamination of ready-to-eat sliced pineapple sold in commercial parts of Ibadan, Oyo State Nigeria.
Authors: Ajuwon Suzan Adetutu , Oluwatobi Joshua Oludare
Published: July 2024

This study evaluated the microbiological contamination of ready-to-eat sliced pineapple sold in Apete, Sango, and University of Ibadan markets. The anaerobic plate counts for all samples exceeded international standards. A total of eighteen bacterial species were identified, with Lactobacillus species being the most prevalent, accounting for 35% of the isolates. Six fungal species were also isolated, with Penicillium species being the most common, occurring at a frequency of 50%. Antibiotic sensitivity tests revealed that Ofloxacin, Gentamycin, and Ciprofloxacin demonstrated the greatest inhibitory properties against the isolates. The high levels of microbial contamination and the presence of potential pathogens pose significant risks to public health, underscoring the importance of enhanced hygiene practices and increased consumer awareness. These findings imply that Ofloxacin, Gentamycin, and Ciprofloxacin could be effective treatments for food borne infections resulting from the consumption of contaminated ready-to-eat sliced pineapple.
LazyAF, a pipeline for accessible medium-scale in silico prediction of protein-protein interactions
Authors: McLean Thomas C.
Published: July 2024

Artificial intelligence has revolutionized the field of protein structure prediction. However, with more powerful and complex software being developed, it is accessibility and ease of use rather than capability that is quickly becoming a limiting factor to end users. LazyAF is a Google Colaboratory-based pipeline which integrates the existing ColabFold BATCH software to streamline the process of medium-scale protein-protein interaction prediction. LazyAF was used to predict the interactome of the 76 proteins encoded on the broad-host-range multi-drug resistance plasmid RK2, demonstrating the ease and accessibility the pipeline provides.
On the cause and consequences of coinfection:A general mechanistic framework of within-host parasite competition
Authors: Ramesh Ashwini , Hall Spencer R
Published: July 2024

Coinfections pose serious threats to health and exacerbate parasite burden. If coinfection is detrimental, then what within-host factors facilitate it? Equally importantly, what hinders it, say via exclusion or priority effects? Such interactions ought to stem from their within-host environment (‘niche’), i.e., resources that parasites steal from hosts and immune cells that kill them. Yet, despite two decades of empirical focus on within-host infection dynamics, we lack a mechanistic framework to understand why coinfection arises and the diverse range of its’ consequences. Hence, we construct a trait-based niche framework, one that illustrates general principles that govern parasite competition for a resource and apparent competition for immune cells. We show that coinfection requires a competition-resistance tradeoff and that each parasite most impacts the niche factor to which it is most sensitive. These predictions then provide mechanistic interpretation for infection outcomes seen in a variety of extant experiments: Why does nutrient supplementation shift relative frequencies of coinfecting parasites? When and how does sequence of parasite invasion allow only early invading parasites to win? How does intrinsic variation in immune response shape coinfection burden? Together, this mechanistic framework of parasite competition offers new perspectives to better predict within-host infection dynamics and improve individual health.
Economic evaluation ofWolbachiadeployment in Colombia: A modeling study
Authors: Shepard Donald S. , Lee Samantha R. , Halasa-Rappel Yara A. , Rincon Perez Carlos Willian , Harker Roa Arturo
Published: July 2024

Background and Aims

Wolbachiaare bacteria that inhibit dengue virus replication within the mosquito. A cluster-randomized trial foundWolbachiareduced virologically-confirmed dengue cases by 77% and previous models predictedWolbachiato be highly cost-effective in Indonesia, Vietnam, and Brazil. in Colombia,Wolbachiawas introduced in the Aburrá Valley in 2015 and Cali in 2020. To inform decisions about future extensions, we performed economic evaluations of the potential expansion ofWolbachiadeployments to 11 target Colombian cities.

Methods

We assembled quantities and the distribution by severity of reported dengue cases from Colombia’s national disease surveillance system and the health service provision registry (RIPS). An epidemiological panel of three experts estimated the shares of non-medical cases and adjustments for under-reporting and misclassifications. We determined costs (in 2020 US dollars) of treating dengue illness from the benchmark insurance tariff, RIPS data on treatment services per symptomatic dengue case, and the national government database for establishing insurance premiums. A cluster randomized trial quantified the effectiveness ofWolbachiaagainst symptomatic dengue cases.

Results

Projecting impact over 10 years for Cali, we estimated a net health-sector savings of USD4.95 per person. We also estimated averting 369 disability-adjusted life years (DALYs) per 100,000 population. From a societal perspective, at 10 yearsWolbachiadeployment is expected to have highly favorable

Conclusions

Over 10 years,Wolbachiais highly beneficial on economic grounds, and almost universally cost saving. That is,Wolbachia’ssavings in health care costs alone would more than offset deployment costs nationally and in 9 target cities (those with adjusted annual dengue incidence at least 50/100,000 population). In these 9 target cities,Wolbachiawould generate at least USD3.00 in benefits per dollar invested, giving substantial confidence thatWolbachiadeployment would be cost-beneficial in Colombia.
Seropositivity to Dengue virus (DENV) in three neighborhoods in the periphery of a city with a recent history of outbreaks in Argentina: what can we learn from unreported cases?
Authors: Mendicino Diego Antonio , Ricardo Tamara , Cristaldi Maximiliano Ariel , Maglianese Mariana , Guzmán Gastón , Claussen Sebastián , Chiaraviglio Romina Guadalupe , Ávalos Christian Alberto , Previtali María Andrea
Published: July 2024

Background

Argentina has experienced several dengue outbreaks since its reemergence in 1998, but cases are underreported due to asymptomatic infections and inadequate access to the healthcare system, particularly in marginalized neighborhoods.

Methods

Between December 2019 and March 2020, we assessed seroprevalence of DENV in three neighborhoods in the periphery of the city of Santa Fe. Serum samples were obtained from one adult per household and analyzed by ELISA for DENV IgG antibodies. Multivariate logistic regression models were used to analyze seropositivity by demographic, socio-economic and environmental variables.

Results

From 184 participants,overall seroprevalence was 15.2% (95% CI: 10.7; 21.1%). Proximity to a vacant lot decreased the likelihood of seropositivity by 65% (OR: 0.35; 95% CI: 0.15; 0.80). This aligns with studies suggesting vegetation cover can reduce vector abundance and that DENV transmission is higher in densely populated urban areas. Surprisingly, knowledge of disease symptoms and transmission was not linked to lower seropositivity, echoing findings from other studies.

Conclusions

These findings contribute to building consensus on the factors that increase DENV infection and will be valuable in designing public health interventions in vulnerable neighborhoods during dengue outbreaks.