bluuebunny/crossref_metadata_2025 huggingface dataset:
Major adverse limb events in patients with femoro-popliteal and below-the-knee peripheral arterial disease treated with either sirolimus-coated balloon or standard uncoated balloon angioplasty: a structured protocol summary of the “SirPAD” randomized controlled trial
Authors: Barco Stefano , Sebastian Tim , Voci Davide , Engelberger Rolf Peter , Grigorean Alexandru , Holy Erik , Leeger Claudia , Münger Mario , Périard Daniel , Probst Eliane , Spescha Rebecca , Held Ulrike , Kucher Nils
Published: April 2022

Background

Peripheral arterial disease is a progressive atherosclerotic disease with symptoms ranging from an intermittent claudication to acute critical limb ischemia and amputations. Drug-coated balloons and stents were developed to prevent neo-intimal proliferation and restenosis after percutaneous transluminal angioplasty. Randomized controlled trials showed that drug-coated, notably paclitaxel-coated, devices reduce restenosis, late lumen loss, and the need for target lesion re-vascularization compared with uncoated ones. However, the size of these trials was too small to prove superiority for “hard” clinical outcomes. Moreover, available studies were characterized by too restrictive eligibility criteria. Finally, it remains unclear whether paclitaxel-coated balloons may impair long-term survival. Alternative drug-coated balloons, the so-called limus-based analogs, have been approved for clinical use in patients with peripheral arterial disease. By encapsulating sirolimus in phospholipid drug nanocarriers, they optimize adhesion properties of sirolimus and provide better bioavailability.

Methods

In this investigator-initiated all-comer open-label phase III randomized controlled trial, we will evaluate whether sirolimus-coated balloon angioplasty is non-inferior and eventually superior, according to a predefined hierarchical analysis, to uncoated balloon angioplasty in adults with infra-inguinal peripheral arterial disease requiring endovascular angioplasty. Key exclusion criteria are pregnancy or breastfeeding, known intolerance or allergy to sirolimus, and participation in a clinical trial during the previous 3 months. The primary efficacy outcome is the composite of two clinically relevant non-subjective “hard” outcomes: unplanned major amputation of the target limb and endovascular or surgical target lesion re-vascularization for critical limb ischemia occurring within 1 year of randomization. The primary safety outcome includes death from all causes.

Discussion

By focusing on clinically relevant outcomes, this study will provide useful information on the efficacy and safety of sirolimus-coated balloon catheters for infra-inguinal peripheral arterial disease in a representative (“all-comer”) population of unselected patients. As regulatory agencies had raised safety concerns in patients exposed to paclitaxel-coated devices (versus uncoated ones), collect mortality data up to 5 years after randomization will be collected.

Trial registration

ClinicalTrials.govNCT04238546
Development of a PET/CT molecular radiomics-clinical model to predict thoracic lymph node metastasis of invasive lung adenocarcinoma ≤ 3 cm in diameter
Authors: Chang Cheng , Ruan Maomei , Lei Bei , Yu Hong , Zhao Wenlu , Ge Yaqiong , Duan Shaofeng , Teng Wenjing , Wu Qianfu , Qian Xiaohua , Wang Lihua , Yan Hui , Liu Ciyi , Liu Liu , Feng Jian , Xie Wenhui
Published: April 2022

Background

To investigate the value of 18F-FDG PET/CT molecular radiomics combined with a clinical model in predicting thoracic lymph node metastasis (LNM) in invasive lung adenocarcinoma (≤ 3 cm).

Methods

A total of 528 lung adenocarcinoma patients were enrolled in this retrospective study. Five models were developed for the prediction of thoracic LNM, including PET radiomics, CT radiomics, PET/CT radiomics, clinical and integrated PET/CT radiomics-clinical models. Ten PET/CT radiomics features and two clinical characteristics were selected for the construction of the integrated PET/CT radiomics-clinical model. The predictive performance of all models was examined by receiver operating characteristic (ROC) curve analysis, and clinical utility was validated by nomogram analysis and decision curve analysis (DCA).

Results

According to ROC curve analysis, the integrated PET/CT molecular radiomics-clinical model outperformed the clinical model and the three other radiomics models, and the area under the curve (AUC) values of the integrated model were 0.95 (95% CI: 0.93–0.97) in the training group and 0.94 (95% CI: 0.89–0.97) in the test group. The nomogram analysis and DCA confirmed the clinical application value of this integrated model in predicting thoracic LNM.

Conclusions

The integrated PET/CT molecular radiomics-clinical model proposed in this study can ensure a higher level of accuracy in predicting the thoracic LNM of clinical invasive lung adenocarcinoma (≤ 3 cm) compared with the radiomics model or clinical model alone.
High resolution detectors for whole-body PET scanners by using dual-ended readout
Authors: Liu Zheng , Niu Ming , Kuang Zhonghua , Ren Ning , Wu San , Cong Longhan , Wang Xiaohui , Sang Ziru , Williams Crispin , Yang Yongfeng
Published: April 2022

Background

Most current whole-body positron emission tomography (PET) scanners use detectors with high timing resolution to measure the time-of-flight of two 511 keV photons, improving the signal-to-noise ratio of PET images. However, almost all current whole-body PET scanners use detectors without depth-encoding capability; therefore, their spatial resolution can be affected by the parallax effect.

Methods

In this work, four depth-encoding detectors consisting of LYSO arrays with crystals of 2.98 × 2.98 × 20 mm3, 2.98 × 2.98 × 30 mm3, 1.95 × 1.95 × 20 mm3, and 1.95 × 1.95 × 30 mm3, respectively, were read at both ends, with 6 × 6 mm2 silicon photomultiplier (SiPM) pixels in a 4 × 4 array being used. The timing signals of the detectors were processed individually using an ultrafast NINO application-specific integrated circuit (ASIC) to obtain good timing resolution. The 16 energy signals of the SiPM array were read using a row and column summing circuit to obtain four position-encoding energy signals.

Results

The four PET detectors provided good flood histograms in which all crystals could be clearly resolved, the crystal energy resolutions measured being 10.2, 12.1, 11.4 and 11.7% full width at half maximum (FWHM), at an average crystal depth of interaction (DOI) resolution of 3.5, 3.9, 2.7, and 3.0 mm, respectively. The depth dependence of the timing of each SiPM was measured and corrected, the timing of the two SiPMs being used as the timing of the dual-ended readout detector. The four detectors provided coincidence time resolutions of 180, 214, 239, and 263 ps, respectively.

Conclusions

The timing resolution of the dual-ended readout PET detector was approximately 20% better than that of the single-ended readout detector using the same LYSO array, SiPM array, and readout electronics. The detectors developed in this work used long crystals with small cross-sections and provided good flood histograms, DOI, energy, and timing resolutions, suggesting that they could be used to develop whole-body PET scanners with high sensitivity, uniform high spatial resolution, and high timing resolution.
Consumer lending efficiency: commercial banks versus a fintech lender
Authors: Hughes Joseph P. , Jagtiani Julapa , Moon Choon-Geol
Published: April 2022

Fintechs are believed to help expand credit access to underserved consumers without taking on additional risk. We compare the performance efficiency of LendingClub’s unsecured personal loans with similar loans originated by banks. Using stochastic frontier estimation, we decompose the observed nonperforming loan (NPL) ratio into three components: the best-practice minimum NPL ratio, the excess NPL ratio, and a statistical noise, the former two of which reflect the lender’sinherent credit riskandlending inefficiency, respectively. As of 2013 and 2016, we find that the higher NPL ratios at the largest banks are driven by inherent credit risk, rather than lending inefficiency. Smaller banks are less efficient. In addition, as of 2013, LendingClub’s observed NPL ratio and lending efficiency were in line with banks with similar lending volume. However, its lending efficiency improved significantly from 2013 to 2016. As of 2016, LendingClub’s performance resembled the largest banks – consistent with an argument that its increased use of alternative data and AI/ML may have improved its credit risk assessment capacity above and beyond its peers using traditional approaches. Furthermore, we also investigate capital market incentives for lenders to take credit risk. Market value regression using the NPL ratio suggests that market discipline provides incentives to make less risky consumer loans. However, the regression using twodecomposed components(inherent credit risk and lending inefficiency) tells a deeper underlying story: market value is significantly positively related to inherent credit risk at most banks, whereas it is significantly negatively related to lending inefficiency at most banks.Market discipline appears to reward exposure to inherent credit risk and punish inefficient lending.
Findings of uncertain significance by optical coherence tomography (OCT) as prognostic factors in neovascular age-related macular degeneration (nAMD) treated with ranibizumab
Authors: Hayashi-Mercado Ricardo , Pérez-Montaño Carla , Reyes-Sánchez Jaime , Ramírez-Estudillo Abel
Published: April 2022

Background

Biomarkers hold great promise for personalized medicine as information gained from diagnostic or progression markers can be used to tailor treatment to the individual for highly effective intervention in the disease process.

Methods

The aim of this retrospective study was to evaluate the association between visual outcome and the presence of findings of uncertain significance by optical coherence tomography (OCT) pre and post loading dose in patients with neovascular age-related macular degeneration (nAMD) treated with ranibizumab.

Results

Univariate analysis revealed a higher letter gain in those with presence of onion sign (+ 5.6 ETDRS letters, p = 0.04) absence of prechoroidal cleft (+ 3.7 ETDRS letters, p = 0.04), intraretinal pseudocysts (+4.8 ETDRS letters, p = 0.002), subretinal pseudocysts (+ 4.6 ETDRS letters, p = 0.005) and choroidal caverns (+ 4.4 ETDRS, letters p = 0.0065).

Conclusions

The presence of prechoroidal cleft, intraretinal and subretinal pseudocysts and choroidal caverns were associated with lower visual gains. Moreover, we found that the onion sign is related as a biomarker of good prognostics.

Trial registration Registration number: 2021R13B2. Date of registration: 01/05/2020
Obstructive shock due to tracheal perforation following long-term placement of a tracheostomy tube in a pediatric patient: a case report
Authors: Sakai Wataru , Nawa Yuko , Junichi Oba
Published: April 2022

Background

Tracheal perforation, although rare, is a known late complication of tracheostomy tube placement.

Case presentation

We present a 7-year-old boy with severe physical and mental disabilities under tracheostomy and long-term mechanical ventilation and steroid therapy who suddenly developed obstructive shock secondary to pneumomediastinum and pneumothorax. Prior bronchoscopy had shown the tip of the tracheostomy tube contacting the posterior tracheal wall, causing ulceration and subsequent tracheal perforation. The perforation was bridged using a cuffed tracheostomy tube, but the patient subsequently died of additional comorbidities.

Conclusions

Our experience suggests that tracheal perforation should be considered when pediatric patients with tracheostomy tubes suddenly develop hypotension.
A review on One Health approach in Ethiopia
Authors: Erkyihun Gashaw Adane , Gari Fikru Regassa , Edao Bedaso Mammo , Kassa Gezahegne Mamo
Published: April 2022

The risk of spreading emerging and reemerging diseases has been increasing by the interactions of human – animal – ecosystems and increases account for more than one billion cases, a million deaths and caused hundreds of billions of US dollars of economic damage per year in the world. Countries in which their household income is dependent on livestock are characterized by a strong correlation between a high burden of zoonotic disease and poverty. The One Health approach is critical for solutions to prevent, prepare for, and respond to these complex threats. As part of the implementation of the Global Health Security Agenda, Ethiopia has embraced the One Health approach to respond to the existing and emerging threats. Several developments have been made to pioneer One Health schemes in Ethiopia which includes establishment of the National One Health Steering Committee and Technical Working Groups, prioritization of zoonotic diseases based on their impact on human and livestock, the development of prevention and control working documents for prioritized zoonotic diseases, joint disease surveillance and outbreak investigation, prioritization of zoonotic diseases, capacity building and other One Health promotions. Nevertheless, there are still so many challenges which need to be addressed. Poor integration among sectors in data sharing and communication, institutionalization of One Health, lack of continuous advocacy among the community, lack of financial funds from the government, limited research fund and activities on One Health, etc. are among many challenges. Hence, it is critical to continue raising awareness of One Health approach and foster leaders to work across disciplines and sectors. Therefore, continuous review on available global and national one health information and achievements to provide compiled information for more understanding is very important.
Determinants of consumers’ acceptance of indigenous leafy vegetables in Limpopo and Mpumalanga provinces of South Africa
Authors: Zulu Sinethemba Sibusisiwe , Ngidi Mjabuliseni , Ojo Temitope , Hlatshwayo Simphiwe Innocentia
Published: April 2022

Indigenous leafy vegetables (ILVs) do not only play a significant role in ensuring livelihoods for households in South Africa but can also contribute in enhancing the consumption of diversified foods for improved micronutrient intake. However, these plants are underutilized and their consumption is determined by ILVs' regional cuisines accepted in certain ethnic groups. This study was set out to assess the acceptance of indigenous leafy vegetables by consumers in Limpopo and Mpumalanga provinces. The study used secondary data that were collected by the South African Vulnerability Assessment Committee in 2016. A total of 1520 respondents were selected from the two provinces using a multistage stratified sampling method. The results of the descriptive statistics showed that blackjack was the least consumed leafy vegetable as compared to amaranth and cleome, which were, respectively, most consumed. Seemingly unrelated regression (SUR) model was employed to analyse the determinants of consumers’ acceptance of ILVs. The results of SUR showed that gender of the household head, marital status, HIV status, wages/salary, and grants were statistically significant in influencing the acceptance of ILVs by consumers. Education and marital status had a negative influence on the acceptance of all leafy vegetables being investigated in this study. Policy makers need to consider the inclusion of ILVs into the school curriculum and national food and nutrition security policy.
Are non-performing loans sensitive to macroeconomic determinants? an empirical evidence from banking sector of SAARC countries
Authors: Anita Saom Shawleen , Tasnova Nishat , Nawar Nousheen
Published: April 2022

The study empirically investigates selected macroeconomic determinants of non-performing loans (NPLs) for a panel of 8 South Asian Association for Regional Cooperation countries (Afghanistan, Bangladesh, Bhutan, India, Nepal, Maldives, Pakistan, and Sri Lanka), using annual data for the period 2008–2019. To examine the association, this study, primarily, conducted the OLS model, fixed effect estimates, and random effect estimates and, eventually, applied robust fixed effect estimates to resolve the problem of heteroscedasticity. The empirical findings confirmed the previous findings, indicating a significant positive association with the government budget balance and a significant inverse relationship with GDP, sovereign debt, inflation rate, and money supply. To reduce the aggregate NPLs in the South Asian Association for Regional Cooperation economy, the respective country’s government should identify the financial sector’s vulnerabilities and, thereby, emphasize boosting the economic growth, ensuring a moderate level of money supply along with inflation rate. The findings are useful for formulating macro-prudential along with fiscal policies to avoid the subsequent NPLs shock in South Asian Association for Regional Cooperation countries.
Similarity and Contact Frequency Promote Mentorship Quality among Hispanic Undergraduates in STEM
Authors: Pedersen Rachelle M. , Ferguson Carinna F. , Estrada Mica , Schultz P. Wesley , Woodcock Anna , Hernandez Paul R.
Published: April 2022

This study tests the process-oriented mentorship model (POMM) regarding how mentor–protégé similarities and the moderating role of contact frequency influence mentorship quality, coauthoring experiences, and STEM career persistence intentions among faculty-mentored Hispanic STEM majors in their senior year of college.
A dissemination and education programme to improve the clinical behaviours of psychiatrists in accordance with treatment guidelines for schizophrenia and major depressive disorders: the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project
Authors: Yamada Hisashi , Motoyama Mikuni , Hasegawa Naomi , Miura Kenichiro , Matsumoto Junya , Ohi Kazutaka , Yasui-Furukori Norio , Numata Shusuke , Takeshima Masahiro , Sugiyama Nobuhiro , Nagasawa Tatsuya , Kubota Chika , Atake Kiyokazu , Tsuboi Takashi , Ichihashi Kayo , Hashimoto Naoki , Inagaki Takahiko , Takaesu Yoshikazu , Iga Jun-ichi , Hori Hikaru , Onitsuka Toshiaki , Komatsu Hiroshi , Hishimoto Akitoyo , Fukumoto Kentaro , Fujimoto Michiko , Nakamura Toshinori , Nemoto Kiyotaka , Furihata Ryuji , Yamamura Satoshi , Yamagata Hirotaka , Ogasawara Kazuyoshi , Katsumoto Eiichi , Murata Atsunobu , Iida Hitoshi , Ochi Shinichiro , Makinodan Manabu , Kido Mikio , Kishimoto Taishiro , Yasuda Yuka , Usami Masahide , Suwa Taro , Inada Ken , Watanabe Koichiro , Hashimoto Ryota
Published: April 2022

Background

Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists.

Aims

The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes.

Method

A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme.

Results

All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending.

Conclusions

All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists.
Enumerating spanning trees of vertex-edge-growth graph
Authors: Ma Fei , Yao Bing
Published: April 2022

The problem of determining the number of spanning trees of graph having interesting structural properties such as the scale-free feature is attractive in science community. In this paper, we first present a class of outer-planar and self-similar graphs N(t) by using vertex-edge-growth operation. According to specific topological structure, we calculate the average degree, and show that the model N(t) is sparse. Then, we develop a series of iterative methods in order to obtain an exact solution of the total number of spanning trees of the model N(t), and also illustrate the corresponding spanning tree entropy. The calculation method used can be suitable for enumerating spanning trees of other graphs with similar properties.
Prediabetes in Young Adults and Its Association With Cardiovascular Health Metrics in the Progression to Diabetes
Authors: Suzuki Yuta , Kaneko Hidehiro , Okada Akira , Matsuoka Satoshi , Itoh Hidetaka , Fujiu Katsuhito , Michihata Nobuaki , Jo Taisuke , Takeda Norifumi , Morita Hiroyuki , Yamaguchi Satoko , Node Koichi , Yamauchi Toshimasa , Yasunaga Hideo , Komuro Issei
Published: April 2022

Context

The natural history of young adults with prediabetes and its association with cardiovascular health (CVH) metrics in progression to diabetes remain unknown.

Objective

We examined the association between CVH metrics and the annual incidence of diabetes in young adults with prediabetes.

Methods

This observational cohort study used the JMDC Claims Database. We analyzed 18 908 participants aged 18 to 44 years, with available fasting plasma glucose (FPG) data for 5 consecutive years, and who had prediabetes (FPG 100-125 mg/dL) at the initial health checkup. The ideal CVH metrics were as follows: nonsmoking, body mass index (BMI) less than 25 kg/m2, physical activity at goal, optimal dietary habits, blood pressure less than 120/80 mm Hg, and total cholesterol less than 200 mg/dL. We analyzed the association between CVH metrics and the annual incidence of diabetes. We also examined the relationship between 1-year changes in CVH metrics and the subsequent risk of diabetes.

Results

The incidence of diabetes was 3.3% at 1 year and 9.5% at 5 years after the initial health checkup. An increasing number of nonideal CVH metrics have been associated with an increased risk of diabetes. Nonideal BMI, smoking, blood pressure, and total cholesterol level were associated with an increased risk of diabetes. This association was observed both in men and women. A one-point increase in the number of nonideal CVH metric components was associated over 1 year with an increased risk of diabetes.

Conclusion

CVH metrics can stratify the risk of diabetes in young adults with prediabetes. Improving CVH metrics may reduce the risk of developing diabetes.
Extracellular Vesicles and Their Emerging Roles as Cellular Messengers in Endocrinology: An Endocrine Society Scientific Statement
Authors: Salomon Carlos , Das Saumya , Erdbrügger Uta , Kalluri Raghu , Kiang Lim Sai , Olefsky Jerrold M , Rice Gregory E , Sahoo Susmita , Andy Tao W , Vader Pieter , Wang Qun , Weaver Alissa M
Published: April 2022

During the last decade, there has been great interest in elucidating the biological role of extracellular vesicles (EVs), particularly, their hormone-like role in cell-to-cell communication. The field of endocrinology is uniquely placed to provide insight into the functions of EVs, which are secreted from all cells into biological fluids and carry endocrine signals to engage in paracellular and distal interactions. EVs are a heterogeneous population of membrane-bound vesicles of varying size, content, and bioactivity. EVs are specifically packaged with signaling molecules, including lipids, proteins, and nucleic acids, and are released via exocytosis into biofluid compartments. EVs regulate the activity of both proximal and distal target cells, including translational activity, metabolism, growth, and development. As such, EVs signaling represents an integral pathway mediating intercellular communication. Moreover, as the content of EVs is cell-type specific, it is a “fingerprint” of the releasing cell and its metabolic status. Recently, changes in the profile of EV and bioactivity have been described in several endocrine-related conditions including diabetes, obesity, cardiovascular diseases, and cancer. The goal of this statement is to highlight relevant aspects of EV research and their potential role in the field of endocrinology.
Passionate Work
Authors: Hong Renyi
Published: April 2022

In Passionate Work, Renyi Hong theorizes the notion of being “passionate about your work” as an affective project that encourages people to endure economically trying situations like unemployment, job change, repetitive and menial labor, and freelancing. Not simply a subject of aspiration, passion has been deployed as a means to build resilience and mend disappointments with our experiences of work. Tracking the rise of passion in nineteenth-century management to trends like gamification, coworking, and unemployment insurance, Hong demonstrates how passion can emerge in instances that would not typically be understood as passionate. Gamification numbs crippling boredom by keeping call center workers in an unthinking, suspensive state, pursuing even the most banal tasks in hope of career advancement. Coworking spaces marketed toward freelancers combat loneliness and disconnection at the precise moment when middle-class sureties are profoundly threatened. Ultimately, Hong argues, the ideal of passionate work sustains a condition of cruel optimism in which passion is offered as the solution for the injustices of contemporary capitalism.
GDF5+ chondroprogenitors derived from human pluripotent stem cells preferentially form permanent chondrocytes
Authors: Pothiawala Azim , Sahbazoglu Berke E. , Ang Bryan K. , Matthias Nadine , Pei Guangsheng , Yan Qing , Davis Brian R. , Huard Johnny , Zhao Zhongming , Nakayama Naoki
Published: April 2022

It has been established in the mouse model that during embryogenesis joint cartilage is generated from a specialized progenitor cell type, distinct from that responsible for the formation of growth plate cartilage. We recently found that mesodermal progeny of human pluripotent stem cells gave rise to two types of chondrogenic mesenchymal cells in culture: SOX9+ and GDF5+ cells. The fast-growing SOX9+ cells formed in vitro cartilage that expressed chondrocyte hypertrophy markers and readily underwent mineralization after ectopic transplantation. In contrast, the slowly growing GDF5+ cells derived from SOX9+ cells formed cartilage that tended to express low to undetectable levels of chondrocyte hypertrophy markers, but expressed PRG4, a marker of embryonic articular chondrocytes. The GDF5+-derived cartilage remained largely unmineralized in vivo. Interestingly, chondrocytes derived from the GDF5+ cells seemed to elicit these activities via non-cell-autonomous mechanisms. Genome-wide transcriptomic analyses suggested that GDF5+ cells might contain a teno/ligamento-genic potential, whereas SOX9+ cells resembled neural crest-like progeny-derived chondroprogenitors. Thus, human pluripotent stem cell-derived GDF5+ cells specified to generate permanent-like cartilage seem to emerge coincidentally with the commitment of the SOX9+ progeny to the tendon/ligament lineage.
Comparison between second-look ultrasound and second-look digital breast tomosynthesis in the detection of additional lesions with presurgical CESM
Authors: Bellini Chiara , Bicchierai Giulia , Amato Francesco , Savi Elena , De Benedetto Diego , Di Naro Federica , Boeri Cecilia , Vanzi Ermanno , Miele Vittorio , Nori Jacopo
Published: April 2022

Objectives:

To compare second-look ultrasound (SL-ultrasound) with second-look digital breast tomosynthesis (SL-DBT) in the detection of additional lesions (ALs) with presurgical contrast-enhanced spectral mammography (CESM).

Methods:

We retrospectively included 121 women with 128 ALs from patients who underwent CESM for presurgical staging at our centre from September 2016 to December 2018. These ALs underwent SL-ultrasound and a retrospective review of DBT (SL-DBT) performed 1–3 weeks prior to CESM to evaluate the performance of each technique individually and in combination. ALs in CESM images were evaluated according to enhancement type (focus, mass, or non-mass), size (<10 mm or >10 mm) and level of suspicion (BI-RADS 2, 3, 4 or 5). Our gold-standard was post-biopsy histology, post-surgical specimen or >24 month negative follow-up. McNemar’s test was used for the statistical analysis.

Results:

Out of the 128 ALs, an imaging correlate was found for 71 (55.5 %) with ultrasound, 79 (61.7%) with DBT, 53 (41.4 %) with DBT and ultrasound, and 97 (75.8%) with ultrasound and/or DBT. SL-DBT demonstrated a higher detection rate vs SL-ultrasound in non-mass enhancement (NME) pattern (p: 0.0325) and ductal carcinoma in situ histological type (p: 0.0081). Adding SL-DBT improved the performance vs SL-ultrasound alone in the overall sample (p: <0.0001) and in every subcategory identified; adding SL-ultrasound to SL-DBT improved the detectability of ALs in the overall sample and in every category except for NME (p: 0.0833), foci (p: 0.0833) and B3 lesions (p: 0.3173).

Conclusion:

Combined second-look imaging (SL-DBT+ SL-ultrasound) for CESM ALs is superior to SL-DBT alone and SL-ultrasound alone. In B3 lesions, NME, and foci, the analysis of a larger sample could determine whether adding SL-ultrasound to SL-DBT is necessary or not.

Advances in knowledge:

Thanks to its high sensitivity, CESM is a useful tool in presurgical staging to detect the extent of the disease burden and identify ALs not detected with conventional imaging. Since CESM-guided biopsy systems are still scarcely available in clinical practice, it is necessary to look for other approaches to histologically characterize ALs detected with CESM. In our study, combined second-look imaging (SL-DBT + SL-ultrasound) showed better performance in terms of detectability of ALs, than either SL-DBT or SL-ultrasound alone, and allowed us to identify 91.2% of ALs that turned out to be malignant at final histology; for the remaining 8.8% it was still necessary to perform MRI or MRI-guided biopsy. However, this issue could be solved once CESM-guided biopsies spread in clinical practice. SL-DBT demonstrated a higher detection rate than SL-ultrasound in NME and ductal carcinoma in situ histology.
Gastrointestinal bleeding: imaging and interventions in cancer patients
Authors: Wang Mindy X , Guccione Jeffrey , Korivi Brinda Rao , Abdelsalam Mohamed E , Klimkowski Sergio P , Soliman Moataz , Shalaby Ahmed S , Elsayes Khaled M
Published: April 2022

Gastrointestinal bleeding (GIB) among cancer patients is a major source of morbidity and mortality. Although a wide variety of etiologies contribute to GIB, special considerations should be made for cancer-related factors such as the type of malignancy, location and extent of disease, hemostatic parameters, and treatment effects. Key imaging modalities used to evaluate GIB include computed tomography angiography (CTA), radionuclide imaging, and catheter-based angiography. Understanding the cancer and treatment history and recognizing the associated imaging manifestations are important for identifying the source and potential causes of GIB in cancer patients. This article will review the common clinical presentations, causes, imaging manifestations, and angiographic management of GIB in cancer patients.
Overview of incidental breast lesions
Authors: Guirguis Mary S , Yang Wei T
Published: April 2022

Screening mammography identifies early-stage breast cancers and is associated with reduced breast cancer mortality. An unintended consequence of breast screening is the detection and diagnosis of multiple incidental benign and malignant breast lesions, including the heterogenous group of incidental benign (B3) lesions with uncertain biological outcomes and malignant potential, for which management remains controversial. Recent shifts toward more conservative management approaches, including the identification of patients who can undergo observation after vacuum-assisted excision, has gained interest. This commentary provides an overview of incidental B3 lesions and summarizes the current management paradigms for them.
Multidelay ASL of the pediatric brain
Authors: Golay Xavier , Ho Mai-Lan
Published: April 2022

Arterial spin labeling (ASL) is a powerful noncontrast MRI technique for evaluation of cerebral blood flow (CBF). A key parameter in single-delay ASL is the choice of postlabel delay (PLD), which refers to the timing between the labeling of arterial free water and measurement of flow into the brain. Multidelay ASL (MDASL) utilizes several PLDs to improve the accuracy of CBF calculations using arterial transit time (ATT) correction. This approach is particularly helpful in situations where ATT is unknown, including young subjects and slow-flow conditions. In this article, we discuss the technical considerations for MDASL, including labeling techniques, quantitative metrics, and technical artefacts. We then provide a practical summary of key clinical applications with real-life imaging examples in the pediatric brain, including stroke, vasculopathy, hypoxic-ischemic injury, epilepsy, migraine, tumor, infection, and metabolic disease.
Predictive scoring system for risk of complications in pediatric dengue infection
Authors: Bhaskar Monisha , Mahalingam Soundarya , M M Harish , Achappa Basavaprabhu
Published: April 2022

Background: Dengue infection has been a worrisome cause of mortality and morbidity in children. Though numerous scoring systems have been developed, they are in the adult population or are too complicated for use in children. Pediatric dengue infection has a wide spectrum from a mild illness to severe complications and an unpredictable course. Hence the need for a predictive scoring system where the possibility of complications can be identified which can contribute to reduction in mortality and morbidity of dengue by prompt referrals and anticipatory management.

Methods: Prospective case cohort study of children with confirmed dengue fever.

Results: 303 children were included and divided into two groups – the dengue fever group and the complicated dengue group based on the WHO clinical classification. The clinical and laboratory parameters were analysed individually, cut offs identified by ROC curves and compared for significance between the two groups. The parameters that emerged were hypotension, PCV ≥ 42%, platelet count ≤ 75000 cells/cumm, WBC ≥ 7000 cells/cumm, and ALT ≥ 70U/L.  Using the adjusted odd’s Ratio, and coefficient, individual predictive scores were tabulated ranging from 0 to 3, with a total score of 0 to 7. A cut-off score of 2 was then identified based upon the sensitivity (84.13%) and specificity (72.50%) as the ideal score to predict complicated dengue. Internal validation of the score was done where the area under the curve for predicting complicated dengue was 0.86 (95% CI 0.8-0.92) with a P value of <0.001. Conclusion: Our dengue predictive scoring system has been developed using five indicators, with a score of two and above, out of seven, suggesting increased risk of developing complications. This has been validated internally and can be used to predict complicated dengue among children.
Lower vitamin D level is associated with higher prevalence of pulmonary tuberculosis in under-five children actively living in tropical countries
Authors: Tamara Lianda , Bakhtiar Bakhtiar , Alam Anggraini , Kartasasmita Cissy B. , Gurnida Dida A.
Published: April 2022

Objective: Indonesia accounted for 845.000 tuberculosis (TB) cases, ranked as the second-highest TB incidence in the world. Various studies in childhood TB and vitamin D has overgrown in recent years, but there is no study for vitamin D status in under-five children with pulmonary tuberculosis in Indonesia as tropical country that has an abundant sun exposure. This study evaluates the vitamin D level in under-five children with pulmonary TB compared with healthy children control group.

Materials and Methods: This comparative study with a cross-sectional design was conducted in outpatient clinic from February 2019 – February 2020. We selected children ≤5 years old, diagnosed with pulmonary TB; the control group was the random siblings or neighbors who did not have tuberculosis. Differences in 25-hydroxyvitamin D levels in both groups were statistically analyzed with independent t-test. The vitamin D cutoff values were determined using receiver operating characteristic (ROC) curve analysis.

Results: A total of 70 patients aged ≤5 years old met the inclusion criteria, 35 childrens were assigned for each group. The 25-hydroxy vitamin D mean level in the TB group was 42.72 nmol/L and 97.74 nmol/L in control group. The TB group has significantly lower 25-hydroxy vitamin D levels than control group (p<0.001). With sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 97.1%, 97.2%, and 100%, respectively, the optimal cutoff point level for 25-hydroxy vitamin D was 80nmol/L.

Conclusion: Serum levels of 25-hydroxy vitamin D in children with pulmonary TB are significantly lower than in healthy children. Further study should be conducted to determine the efficacy of vitamin D supplementation in the treatment of children with tuberculosis.
Prevalence study of intermittent hormonal therapy of Prostate Cancer patients in Spain
Authors: Bonfill-Cosp Xavier , Auladell-Rispau Ariadna , Gich Ignasi , Zamora Javier , Saiz Luis Carlos , Pijoan Jose Ignacio , Urreta Iratxe , Cordero José Antonio
Published: April 2022

Background: Although intermittent androgen deprivation therapy was introduced many years ago to improve patients’ quality of life with the same carcinologic efficiency as continuous hormonal therapy, recent data suggest that intermittency could be underutilised. This study aims to estimate the prevalence of prostate cancer patients receiving intermittent androgen deprivation therapy in Spain.

Methods: A retrospective, longitudinal study was conducted using electronic drug dispensation data from four Spanish autonomous communities, which encompass 17.23 million inhabitants (36.22% of the total population in Spain). We estimated intermittent androgen therapy use (%IAD) and the prevalence of patients under intermittent androgen therapy in reference to the total number of PC patients using hormonal therapy (P IAD) and stratified by region. Other outcome variables included the pharmaceutical forms dispensed and the total direct annual expenditure on androgen deprivation therapy‐associated medications.

Results: A total of 863,005 dispensations corresponding to a total of 65,752 men were identified, treated with either luteinizing hormone-releasing hormone (LHRH) analogues (353,162) administered alone or in combination with anti‐androgens (509,843). Overall, the mean (±SD) age of the patients was 76.9 (±10.4) years. Results revealed that the mean annual P IAD along the study was 6.6% in the total population studied, and the overall %IAD during the five‐year study period was 5.6%. The mean cost of hormonal therapy per year was 25 million euros for LHRH analogues and 6.3 million euros for anti-androgens.

Conclusions:  Few prostate cancer patients in Spain use the intermittent androgen deprivation therapy suggesting underutilization of a perfectly valid option for a significant proportion of patients, missing the opportunity to improve their quality of life and to reduce costs for the National Health Service with comparable overall survival rates than continuous therapy.
Innovación docente en la enseñanza de la Geomorfología: La importancia de los recursos visuales
Authors: Roldán Muñoz María Esperanza
Published: April 2022

El presente trabajo recoge el diseño y los resultados de la aplicación de un Ciclo de Mejora en el Aula en la asignatura de Geomorfología e Hidrología. Su principal objetivo es el progresivo paso de un modelo metodológico puramente transmisivo hacia otro basado en la construcción del conocimiento por los propios alumnos, que pasan a ostentar un papel protagonista en el proceso de aprendi- zaje. Para su consecución se ha diseñado un modelo metodológico posible, adap- tado a las circunstancias de la asignatura, y una secuencia de actividades. Dentro de la misma se plantea la resolución en grupo de una serie de preguntas clave, apoyadas por recursos visuales, y una posterior puesta en común de los resulta- dos alcanzados por los alumnos, a partir de los cuales la docente introducirá ac- tividades de contraste y preguntas guía que orienten el proceso de aprendizaje. Finalmente, se ha planteado una evaluación de esta experiencia didáctica me - diante la elaboración de unos cuestionarios inicial y final por parte de los alum- nos y su plasmación en escaleras de aprendizaje. Palabras clave: Geomorfología e hidrología, grado en geografía y gestión del territorio, docencia universitaria, desarrollo profesional docente.
Paradigm Shift in Adaptive Cyber Defense for Securing the Web Data: The Future Ahead
Authors: Shandilya Shishir Kumar
Published: April 2022

Web Applications are becoming more sophisticated to cater the ever-growing demand of data processing and computing. Fast technological advancements in web engineering not only facilitate data intensive and high-performance computing, but also raise serious concerns on security. Cyber threats are also ramping up at the equal pace and attackers are now more organised and equipped with high-end servers. The Data over Web needs to be more authenticated and reliable. Data Provenance-aware methods are capable of identification of data breaches and manipulation through various attacks. They analyse underlying data for the potential threats to ensure protection against various attacks. Cyber Security Practitioners are witnessing severe issues in securing the Web Data and applications as the security risks are growing rapidly due to the sudden eruption in internet usage due to the pandemic in the last few years. People and organisations are relying more on Internet and web applications than ever before. The efforts for securing the web data on such a massive scale is premature to counter the ever-evolving attack attempts. Nature-inspired Cyber Security (NICS) facilitates the development and implementation of robust defensive mechanisms which are more adaptive and highly tolerant to online malicious programs. These methods are also capable of dealing with the common algorithmic issues like incompleteness and uncertainty of information and to provide a high-level security mechanism by effectively implementing the bio-inspired methodologies like deception, and camouflage etc. This article will attempt to explore the effectiveness of NICS in web data and application security to provide smart security methods.
Laryngeal solitary fibrous tumour: diagnostic challenge in a rare presentation
Authors: Kiakou M , Puvanendran M , Philpott J , Ali A , Paulucci B
Published: April 2022

Solitary fibrous tumours (SFT) are rare spindle cell mesenchymal neoplasms, most commonly appearing as well-circumscribed localised lesions arising from the abdominal or pelvic peritoneum. Their presence in the head and neck region is very rare; even more so in the post-cricoid region, with only one case described in the literature to date. The clinical behaviour of SFT may vary from benign to malignant, but only 10–15% of SFT demonstrate local recurrence or distant metastasis. The usual presenting symptoms of dysphagia and weight loss are very vague to give a definite diagnosis, and examination, even under general anaesthesia, combined with biopsies can sometimes be misleading, as in our case. Here, we describe a very challenging case of supraglottic SFT originating from the post-cricoid area. Our 73-year-old patient presented with dysphagia and upon examination a large supraglottic mass was revealed. Biopsies from the mass pointed to malignancy and the patient underwent total laryngectomy. The laryngeal specimen contradicted the biopsy and revealed a rare solitary fibrous tumour with benign features and thus adjuvant treatment was not necessary. Ever since the patient has been attending regular follow-up sessions and remains disease-free 18 months after surgery.
Vesicourachal diverticulum
Authors: Mohamed G , Ghani Z , Lynn N , Masilamani M , Rowlands J
Published: April 2022

We report a rare complication involving a healthy 45-year-old male patient who underwent an emergency laparoscopic appendicectomy for acute perforated gangrenous appendicitis. The patient was catheterised pre- procedure and the ports were inserted under vision. Upon completion of the procedure, a 15 Fr Robinson drain was left in the pelvis and was fed through the suprapubic port hole. Postoperatively the patient developed worsening, generalised abdominal pain and high output from the drain. The patient was re-catheterised but the computed tomography (CT) cystogram did not show any injury to the bladder. The drain fluid creatinine was noted to be raised (>4,000), indicating that urine was leaking into the drain. Conventional cystogram confirmed a contrast leak from the dome around the drain. Flexible cystoscopy confirmed that the drain had transversed the vesicourachal diverticula. The drain was pulled back and converted to a suprapubic catheter with the patient subsequently being discharged. Vesicourachal diverticula is a rare and often asymptomatic anomaly. When undertaking laparoscopic surgery, precautions should be taken to prevent port site injury such as catheterising the patient to ensure the bladder is empty and inserting the ports under direct vision. It is safer to visualise muscle rather than peritoneum during port insertion. In this case, the bladder diverticula was noticed extraperitoneally. Though the indirect CT cystogram reported no injury, this was unreliable as the bladder was not distended which led to the subtle injury being missed. Traditional cystogram should be considered in cases with a negative CT cystogram and a strong suspicion of bladder injury.
Unique collateralisation between the left internal thoracic artery and the coeliac artery
Authors: Patel S , McWilliams R , Neequaye S
Published: April 2022

Collateralisation around stenotic or occlusive arterial disease is a commonly observed adaptation for maintenance of arterial perfusion. It occurs through pathways of well-understood embryological origin. Examples include Winslow’s pathway (internal thoracic artery to iliac artery via the epigastric arteries) and the arc of Riolan (between superior and inferior mesenteric arteries).

In this article, we describe a pathway of collateralisation around stenotic disease of the coeliac and superior mesenteric arteries in a 76-year-old man with an abdominal aortic aneurysm. The collateral pathway was identified on computed tomography angiography between the left internal thoracic artery in the thorax and the coeliac artery in the abdomen via the left inferior phrenic artery. This has implications for routine cardiac surgery, such that left internal thoracic artery harvest during coronary artery bypass surgery would likely result in acute ischaemia of the abdominal viscera.