bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidentally found parotid gland lesion in 18F-FDG PET/CT for staging evaluation of patients with hepatocellular carcinoma: remote possibility of metastatic tumor or second primary salivary gland malignancy
Authors: Jung Jin Hyung , Lee Yoon Se , Jung Young Ho , Choi Seung-Ho , Nam Soon Yuhl , Cho Hyo Jung , Kwon Minsu
Published: April 2024

Objectives

We primarily aimed to evaluate whether parotid incidental lesion (PIL) in 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging evaluation of patients with hepatocellular carcinoma (HCC) would represent a possibility of extrahepatic metastasis or second primary malignancy (SPM). Additionally, we explored the incidence of PIL in HCC patients and examined any associated risk factors.

Methods

We retrospectively analyzed patients with HCC who underwent 18F-FDG PET/CT at our institution from 2010 to 2022. The pathological findings of PILs in HCC patients were investigated for confirmatory identification of the risk of HCC metastasis or SPM in parotid gland. Healthy controls received 18F-FDG PET/CT for health screening were also enrolled to compare the incidence of PILs with HCC patients. Various parameters associated with patient demographics and characteristics of HCC were analyzed to find the related factors of PILs.

Results

A total of 17,674 patients with HCC and 2,090 healthy individuals who had undergone 18F-FDG PET/CT scans were enrolled in the analyses. Among the 54 HCC patients who underwent pathological confirmation for PILs, benign primary parotid tumor was most commonly observed (n = 43 [79.6%]); however, no malignant lesions were detected, including HCC metastasis. The incidence of PILs was higher in patients diagnosed with HCC compared with the control group (485 [2.7%] vs. 23 [1.1%], p = 0.002). Analysis for the risk factors for PILs revealed that patient age, sex, and positive viral markers were significantly associated with the incidence of PILs in patients with HCC (all p < 0.001).

Conclusions

Our study demonstrates that PILs are more frequently identified in patients with HCC on 18F-FDG PET/CT. However, no malignant PIL, including extrahepatic metastasis of HCC, was identified. Therefore, the presence of PIL should not impede or delay the treatment process for patients with HCC. Additionally, we suggested that for future swift and straightforward differential diagnoses of PIL, the development of additional protocols within the PET/CT imaging could be beneficial.
PD-L1 expression in tumor and inflammatory cells is associated with favorable tumor features and favorable prognosis in muscle-invasive urothelial carcinoma of the bladder not treated by immune checkpoint inhibitors
Authors: Plage Henning , Furlano Kira , Hofbauer Sebastian , Weinberger Sarah , Ralla Bernhard , Franz Antonia , Fendler Annika , de Martino Michela , Roßner Florian , Elezkurtaj Sefer , Kluth Martina , Lennartz Maximilian , Blessin Niclas C. , Marx Andreas H. , Samtleben Henrik , Fisch Margit , Rink Michael , Slojewski Marcin , Kaczmarek Krystian , Ecke Thorsten , Hallmann Steffen , Koch Stefan , Adamini Nico , Zecha Henrik , Minner Sarah , Simon Ronald , Sauter Guido , Weischenfeldt Joachim , Klatte Tobias , Schlomm Thorsten , Horst David , Schallenberg Simon
Published: April 2024

Background

A high level of PD-L1 expression is the most relevant predictive parameter for response to immune checkpoint inhibitor (CPI) therapy in urinary bladder cancer. Existing data on the relationship between PD-L1 expression and the natural course of disease are controversial and sparse.

Methods

To expand our understanding of the relationship between PD-L1 expression and parameters of cancer aggressiveness, PD-L1 was analyzed on tissue microarrays containing 2710 urothelial bladder carcinomas including 512 patients with follow-up data who underwent radical cystectomy and follow-up therapies in the pre-immune checkpoint inhibitor therapy era.

Results

Tumor cell positivity in ≥10% of cells were seen in 513 (20%) and an immune cell positivity occurred in 872 (34%) of 2566 interpretable cancers. PD-L1 positivity in tumor cells increased from pTaG2 low grade (0.9% positive) to pTaG3 high grade (4.1%; p = 0.0255) and was even higher in muscle-invasive (pT2–4) carcinomas (29.3%; p < 0.0001). However, within pT2–4 carcinomas, PD-L1 positivity was linked to low pT stage (p = 0.0028), pN0 (p < 0.0001), L0 status (p = 0.0005), and a better prognosis within 512 patients with cystectomy who never received CPIs (p = 0.0073 for tumor cells and p = 0.0086 for inflammatory cells). PD-L1 staining in inflammatory cells was significantly linked to PD-L1 staining in tumor cells (p < 0.0001) and both were linked to a positive p53 immunostaining (p < 0.0001).

Conclusion

It cannot be fully excluded that the strong statistical link between PD-L1 status and favorable histological tumor features as well as better prognosis could influence the outcome of studies evaluating CPIs in muscle-invasive urothelial carcinoma.
Rice yellow mottle virus is a suitable amplicon vector for an efficient production of an anti-leishmianiasis vaccine in Nicotiana benthamiana leaves
Authors: Bamogo PKA , Tiendrébéogo F , Brugidou C , Sérémé D , Djigma FW , Simporé J , Lacombe S
Published: April 2024

Background

Since the 2000’s, plants have been used as bioreactors for the transient production of molecules of interest such as vaccines. To improve protein yield, “amplicon” vectors based on plant viruses are used. These viral constructs, engineered to carry the gene of interest replicate strongly once introduced into the plant cell, allowing significant accumulation of the protein. Here, we evaluated the suitability of the monocot-infecting RNA virus Rice yellow mottle virus (RYMV) as an amplicon vector. The promastigote surface antigen (PSA) of the protozoan Leishmania was considered as a protein of interest due to its vaccine properties against canine leishmaniasis.

Results

Since P1 (ORF1) and CP (ORF3) proteins are not strictly necessary for viral replication, ORF1 was deleted and the PSA gene was substituted to ORF3 in the RYMV-based vector. We evaluated its expression in the best described plant bioreactor system, Nicotiana benthamiana which, unlike rice, allows transient transformation by Agrobacterium. Despite not being its natural host, we demonstrated a low level of RYMV-based vector replication in N. benthamiana leaves. Under optimized ratio, we showed that the P19 silencing suppressor in combination with the missing viral CP ORF significantly enhanced RYMV amplicon replication in N. benthamiana. Under these optimized CP/P19 conditions, we showed that the RYMV amplicon replicated autonomously in the infiltrated N. benthamiana cells, but was unable to move out of the infiltrated zones. Finally, we showed that when the RYMV amplicon was expressed under the optimized conditions we set up, it allowed enhanced PSA protein accumulation in N. benthamiana compared to the PSA coding sequence driven by the 35S promoter without amplicon background.

Conclusion

This work demonstrates that a non-dicot-infecting virus can be used as an amplicon vector for the efficient production of proteins of interest such as PSA in N. benthamiana leaves.
Multilingual education: medical interns perceptions regarding the usefulness of non-mother tongue communications skills taught during the undergraduate curriculum
Authors: van Rooyen Ian , Claassen Joel , Moodaley Natasha , Doyle Gregory , Skade Thuli , Nash Rae , Gxilishe Sandile , Hellenberg Derek Adriaan
Published: April 2024

Background

This paper investigates the perceptions of medical interns regarding the usefulness of non-mother tongue communication skills taught during the undergraduate curriculum at the University of Cape Town in South Africa. In 2003, the university decided to incorporate Afrikaans and IsiXhosa communication skills into the new MBChB curriculum in order to meet the Faculty of Health Sciences goals to promote quality and equity in healthcare, and to prepare graduating health practitioners for multilingual communities where they would be serving. Despite annual internal evaluations and reviews of the languages courses, the usefulness, if any, of the additional languages in the working clinical environment had not been determined.

Methods

Data were collected during the second year of medical internship across a five-year period through survey questionnaires, as well as focus group interviews conducted in the Western Cape, South Africa. Surveys were conducted from 2009 to 2013.

Results

The study shows that the usefulness of each of the probed categories was not consistent across both languages. The interns expressed a need for an overall improvement of the isiXhosa course offering, while the outcomes for the Afrikaans language were more positive across all categories except for cultural understanding.

Conclusion

The study indicates a positive trend amongst the interns towards developing usefulness in communication skills in Afrikaans and isiXhosa to communicate with their patients.
The effect of resilience training with mHealth application based on micro-learning method on the stress and anxiety of nurses working in intensive care units: a randomized controlled trial
Authors: Abbasalizadeh Maryam , Farsi Zahra , Sajadi Seyedeh Azam , Atashi Afsaneh , Fournier Andrew
Published: April 2024

Introduction

Nurses in intensive care units (ICUs) face high stress and anxiety, impacting their well-being and productivity. Addressing this, this study evaluated the impact of resilience training via a mHealth application based on micro-learning on ICU nurses’ stress and anxiety levels.

Materials and methods

This study, a single-blind randomized controlled trial conducted in 2022-23, involved sixty ICU nurses from two Tehran hospitals. Nurses were chosen through purposive sampling and divided into intervention and control groups by simple randomization. The intervention group was taught resilience via an educational mHealth application based on micro-learning, with data collected using the anxiety and stress subscales of DASS-21.

Results

Before the intervention, there were no significant differences in stress and anxiety scores between the intervention and control groups (P > 0.05). Upon utilizing the mHealth application, the intervention group exhibited significant reductions in stress, from 10.77 ± 3.33 to 9.00 ± 1.66 (P = 0.001), and in anxiety, from 9.43 ± 3.35 to 7.93 ± 0.98 (P < 0.001). In contrast, the control group experienced a slight increase in stress levels, from 10.10 ± 2.19 to 10.73 ± 2.15 (P = 0.002), and in anxiety levels, from 9.10 ± 1.63 to 10.23 ± 1.65 (P < 0.0001).

Conclusions

The micro-learning-based mHealth application for resilience training significantly reduced ICU nurses’ stress and anxiety, recommending its adoption as an innovative educational method.

Trial registration

The study has been registered in the Iranian Registry of Clinical Trials (No. IRCT20221225056916N1, Date: 04/29/2023).
Feasibility of a quality-improvement program based on routinely collected health outcomes in Dutch primary care physical therapist practice: a mixed-methods study
Authors: Smeekens LSF , Verburg AC , Maas MJM , van Heerde R , van Kerkhof A , van der Wees PJ
Published: April 2024

Background

This study evaluates the feasibility of a nine-month advanced quality-improvement program aimed at enhancing the quality of care provided by primary care physical therapists in the Netherlands. The evaluation is based on routinely collected health outcomes of patients with nonspecific low back pain, assessing three feasibility domains: (1) appropriateness, feasibility, and acceptability for quality-improvement purposes; (2) impact on clinical performance; and (3) impact on learning and behavioral change.

Methods

A mixed-methods quality-improvement study using a concurrent triangulation design was conducted in primary care physical therapist practice. Feedback reports on the processes and outcomes of care, peer assessment, and self-assessment were used in a Plan-Do-Study-Act cycle based on self-selected goals. The program’s appropriateness, feasibility, and acceptability, as well as the impact on clinical performance, were evaluated using the Intervention Appropriate Measure, Feasibility Intervention Measure, Acceptability Intervention Measure (for these three measure, possible scores range from 4 to 20), and with a self-assessment of clinical performance (scored 0–10), respectively. The impact on learning and behavioral change was evaluated qualitatively with a directed content analysis.

Results

Ten physical therapists from two practices participated in this study. They rated the program with a mean of 16.5 (SD 1.9) for appropriateness, 17.1 (SD 2.2) for feasibility, and 16.4 (SD 1.5) for acceptability. Participants gave their development in clinical performance a mean score of 6.7 (SD 1.8). Participants became aware of the potential value of using outcome data and gained insight into their own routines and motivations. They changed their data collection routines, implemented data in their routine practice, and explored the impact on their clinical behavior.

Conclusions

This explorative study demonstrated that a quality-improvement program, using health outcomes from a national registry, is judged to be feasible.

Impact statement

This study provides preliminary evidence on how physical therapists may use health outcomes to improve their quality, which can be further used in initiatives to improve outcome-based care in primary physical therapy.
The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China
Authors: Li Haoye , Lin Fanyu , Wang Rui , Zhu Chenxuan , Cao Keyao , Chen Yu , Fang Gang , Li Jiaming , Ding Jinxi , Li Wei
Published: April 2024

Purpose

Under the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization.

Method

A pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated.

Results

After policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs.

Conclusion

The NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.
How does atmospheric pressure cold helium plasma affect the biomechanical behaviour on alkali-lesioned corneas?
Authors: Neri Simona , Mascolini Maria Vittoria , Peruffo Antonella , Todros Silvia , Zuin Matteo , Cordaro Luigi , Martines Emilio , Contiero Barbara , Carniel Emanuele Luigi , Iacopetti Ilaria , Patruno Marco , Fontanella Chiara Giulia , Perazzi Anna
Published: April 2024

Background

Melting corneal ulcers are a serious condition that affects a great number of animals and people around the world and it is characterised by a progressive weakening of the tissue leading to possible severe ophthalmic complications, such as visual impairment or blindness. This disease is routinely treated with medical therapy and keratoplasty, and recently also with alternative regenerative therapies, such as cross-linking, amniotic membrane transplant, and laser. Plasma medicine is another recent example of regenerative treatment that showed promising results in reducing the microbial load of corneal tissue together with maintaining its cellular vitality. Since the effect of helium plasma application on corneal mechanical viscoelasticity has not yet been investigated, the aim of this study is first to evaluate it on ex vivo porcine corneas for different exposition times and then to compare the results with previous data on cross-linking treatment.

Results

94 ex vivo porcine corneas divided into 16 populations (healthy or injured, fresh or cultured and treated or not with plasma or cross-linking) were analysed. For each population, a biomechanical analysis was performed by uniaxial stress-relaxation tests, and a statistical analysis was carried out considering the characteristic mechanical parameters. In terms of equilibrium normalised stress, no statistically significant difference resulted when the healthy corneas were compared with lesioned plasma-treated ones, independently of treatment time, contrary to what was obtained about the cross-linking treated corneas which exhibited more intense relaxation phenomena.

Conclusions

In this study, the influence of the Helium plasma treatment was observed on the viscoelasticity of porcine corneas ex vivo, by restoring in lesioned tissue a degree of relaxation similar to the one of the native tissue, even after only 2 min of application. Therefore, the obtained results suggest that plasma treatment is a promising new regenerative ophthalmic therapy for melting corneal ulcers, laying the groundwork for further studies to correlate the mechanical findings with corneal histology and ultrastructural anatomy after plasma treatment.
Barriers to clinical remission in severe asthma
Authors: Farinha Inês , Heaney Liam G
Published: April 2024

Severe asthma is associated with an increased risk for exacerbations, reduced lung function, fixed airflow obstruction, and substantial morbidity and mortality. The concept of remission in severe asthma as a new treatment goal has recently gained attention due to the growing use of monoclonal antibody therapies, which target specific pathologic pathways of inflammation. This review evaluates the current definitions of asthma remission and unveils some of the barriers for achieving this state in the severe asthma population. Although there is no unified definition, the concept of clinical remission in asthma should be based on a sustained period of symptom control, elimination of oral corticosteroid exposure and exacerbations, and stabilization of pulmonary function. The conjugation of these criteria seems a realistic treatment target in a minority of asthmatic patients. Some unmet needs in severe asthma may affect the achievement of clinical remission. Late intervention with targeted therapies in the severe asthma population may increase the risk of corticosteroid exposure and the development of irreversible structural airway changes. Moreover, airway infection is an important component in persistent exacerbations in patients on biologic therapies. Phenotyping exacerbations may be useful to guide therapy decisions and to avoid the liberal use of oral corticosteroids. Another challenge associated with the aim of clinical remission in severe asthma is the multifaceted interaction between the disease and its associated comorbidities. Behavioural factors should be evaluated in case of persistent symptoms despite optimised treatment, and assessing biomarkers and targeting treatable traits may allow for a more objective way of reaching remission. The concept of clinical remission will benefit from an international consensus to establish unifying criteria for its assessment, and it should be addressed in the future management guidelines.
Systolic blood pressure status modifies the associations between the triglyceride-glucose index and incident cardiovascular disease: a national cohort study in China
Authors: Qiu Weida , Cai Anping , Li Liwen , Feng Yingqing
Published: April 2024

Background

The triglyceride-glucose (TyG) index and blood pressure (BP) are correlated and serve as risk factors for cardiovascular disease (CVD). The potential impact of BP status on the association between the TyG index and CVD risk remains uncertain. This study aims to investigate the relationships between the TyG index and incident CVD in Chinese middle-aged and elderly adults, considering variations in BP status among participants.

Methods

6558 participants (mean age: 58.3 (± 8.7) years; 46.0% were men) without prevalent CVD were recruited from the China Health and Retirement Longitudinal Study. Participants were divided into three groups according to their systolic blood pressure (SBP) levels (< 120mmHg, 120 ∼ 129mmHg, ≥ 130mmHg). The TyG index was computed as ln[triglyceride (mg/dl) * fasting blood glucose (mg/dl)/2]. The primary outcome was CVD (heart disease and stroke), and the secondary outcomes were individual CVD components. Cox regression models and restricted cubic splines were performed to investigate the associations between continuous and categorical TyG with CVD.

Results

1599 cases of CVD were captured during 58,333 person-years of follow-up. Per 1-SD higher TyG index was associated with a 19% (HR: 1.19; 95% CI: 1.12, 1.27) higher risk for incident CVD, and the participants with the highest quartile of TyG index had a 54% (HR: 1.54; 95% CI: 1.29, 1.84) higher risk of CVD compared to those in the lowest quartile. SBP significantly modifies the association between the TyG index and CVD, with higher HRs for CVD observed in those with optimal and normal SBP. SBP partially mediated the associations between the TyG index with CVD. The results were generally consistent among participants with varying pulse pressure statuses rather than diastolic BP statuses.

Conclusions

The associations between the TyG index and CVD were modified by BP status, with greater HRs for CVD observed among those who had SBP < 130mmHg. SBP can partially mediate the association between the TyG index with CVD, highlighting the importance of early screening for the TyG index to identify at risk of hypertension and CVD.
Therapeutic bacteria and viruses to combat cancer: double-edged sword in cancer therapy: new insights for future
Authors: Yarahmadi Aref , Zare Mitra , Aghayari Masoomeh , Afkhami Hamed , Jafari Gholam Ali
Published: April 2024

Cancer, ranked as the second leading cause of mortality worldwide, leads to the death of approximately seven million people annually, establishing itself as one of the most significant health challenges globally. The discovery and identification of new anti-cancer drugs that kill or inactivate cancer cells without harming normal and healthy cells and reduce adverse effects on the immune system is a potential challenge in medicine and a fundamental goal in Many studies. Therapeutic bacteria and viruses have become a dual-faceted instrument in cancer therapy. They provide a promising avenue for cancer treatment, but at the same time, they also create significant obstacles and complications that contribute to cancer growth and development. This review article explores the role of bacteria and viruses in cancer treatment, examining their potential benefits and drawbacks. By amalgamating established knowledge and perspectives, this review offers an in-depth examination of the present research landscape within this domain and identifies avenues for future investigation.

Graphical Abstract

The double-edged sword role of bacteria and viruses in cancer therapy.
Opening the black box: explainable deep-learning classification of wood microscopic image of endangered tree species
Authors: Zheng Chang , Liu Shoujia , Wang Jiajun , Lu Yang , Ma Lingyu , Jiao Lichao , Guo Juan , Yin Yafang , He Tuo
Published: April 2024

Background

Traditional method of wood species identification involves the use of hand lens by wood anatomists, which is a time-consuming method that usually identifies only at the genetic level. Computer vision method can achieve "species" level identification but cannot provide an explanation on what features are used for the identification. Thus, in this study, we used computer vision methods coupled with deep learning to reveal interspecific differences between closely related tree species.

Result

A total of 850 images were collected from the cross and tangential sections of 15 wood species. These images were used to construct a deep-learning model to discriminate wood species, and a classification accuracy of 99.3% was obtained. The key features between species in machine identification were targeted by feature visualization methods, mainly the axial parenchyma arrangements and vessel in cross section and the wood ray in tangential section. Moreover, the degree of importance of the vessels of different tree species in the cross-section images was determined by the manual feature labeling method. The results showed that vessels play an important role in the identification of Dalbergia, Pterocarpus, Swartzia, Carapa, and Cedrela, but exhibited limited resolutions on discriminating Swietenia species.

Conclusion

The research results provide a computer-assisted tool for identifying endangered tree species in laboratory scenarios, which can be used to combat illegal logging and related trade and contribute to the implementation of CITES convention and the conservation of global biodiversity.
The integration of ortho-plastic limb salvage teams in the humanitarian response to violence-related open tibial fractures: evaluating outcomes in the Gaza Strip
Authors: Farhat Theresa , Moussally Krystel , Nahouli Hasan , Hamad Shahd Abu , Qaraya Khulood Abul , Abdul-Sater Zahi , El Sheikh Walaa G. , Jawad Nadine , Al Sedawi Khouloud , Obaid Mohammed , AbuKhoussa Hafez , Nyaruhirira Innocent , Tamim Hani , Hettiaratchy Shehan , Bull Anthony M. J. , Abu-Sittah Ghassan
Published: April 2024

Background

Limb salvage by ortho-plastic teams is the standard protocol for treating open tibial fractures in high-income countries, but there’s limited research on this in conflict settings like the Gaza Strip. This study assessed the clinical impact of gunshot-related open tibial fractures, compared patient management by orthopedic and ortho-plastic teams, and identified the risk factors for bone non-union in this context.

Methods

A retrospective review of medical records was conducted on Gaza Strip patients with gunshot-induced-open tibial fractures from March 2018 to October 2020. Data included patient demographics, treatments, and outcomes, with at least one year of follow-up. Primary outcomes were union, non-union, infection, and amputation.

Results

The study included 244 injured individuals, predominantly young adult males (99.2%) with nearly half (48.9%) having Gustilo-Anderson type IIIB fractures and more than half (66.8%) with over 1 cm of bone loss. Most patients required surgery, including rotational flaps and bone grafts with a median of 3 admissions and 9 surgeries. Ortho-plastic teams managed more severe muscle and skin injuries, cases with bone loss > 1 cm, and performed less debridement compared to other groups, though these differences were not statistically significant. Non-union occurred in 53% of the cases, with the ortho-plastic team having the highest rate at 63.6%. Infection rates were high (92.5%), but no significant differences in bone or infection outcomes were observed among the different groups. Logistic regression analysis identified bone loss > 1 cm, vascular injury, and the use of a definitive fixator at the first application as predictors of non-union.

Conclusions

This study highlights the severity and complexity of such injuries, emphasizing their significant impact on patients and the healthcare system. Ortho-plastic teams appeared to play a crucial role in managing severe cases. However, further research is still needed to enhance our understanding of how to effectively manage these injuries.
Real-time ultrasound-guided sacral plexus block combined with mild sedation for hemorrhoidectomy and hemorrhoidal artery ligation in a patient with amyotrophic lateral sclerosis: a case report
Authors: Li Yan , Hu Qianhui , Wang Qian , Liu Taotao , Gao Min
Published: April 2024

Background

Patients with amyotrophic lateral sclerosis present perioperative challenges for clinical anesthesiologists for anesthesia-associated complications.

Case presentation

A 54-year-old Han woman with a 2-year history of amyotrophic lateral sclerosis was scheduled for hemorrhoidectomy and hemorrhoidal artery ligation. We performed real-time ultrasound-guided sacral plexus block with dexmedetomidine under standard monitoring. The anesthesia method met the surgical demands and avoided respiratory complications during the procedures. There was no neurological deterioration after the surgery and 3 months after, the patient was discharged.

Conclusions

Real-time ultrasound-guided sacral plexus block combined with mild sedation may be an effective and safe technique in patients with amyotrophic lateral sclerosis undergoing hemorrhoidectomy and hemorrhoidal artery ligation.
Psilocybin therapy and anorexia nervosa: a narrative review of safety considerations for researchers and clinicians
Authors: Downey Amanda E. , Chaphekar Anita V. , Woolley Joshua , Raymond-Flesch Marissa
Published: April 2024

Background

Clinical trials using psilocybin therapy to treat anorexia nervosa (AN) are currently underway. The safety and tolerability of psilocybin is of utmost importance in individuals with AN who may present unique medical vulnerabilities. The purpose of this review is to describe how the common physiologic adverse effects of psilocybin may impact medical complications experienced by individuals with AN in clinical trials of psilocybin therapy.

Main body

The physiologic underpinnings of common adverse effects following psilocybin administration are described, including tachycardia, hypertension, electrocardiogram changes, nausea, headache, and lightheadedness. These anticipated physiologic changes are described in relation to the common medical correlates seen in individuals with AN. Risk mitigation strategies for each adverse effect are proposed.

Conclusion

Early evidence suggests that psilocybin therapy is well-tolerated in individuals with AN. Understanding the unique medical complications of AN, and how they may be impacted by common physiologic adverse effects of psilocybin administration, leads to tailored risk mitigation strategies to enhance safety and tolerability of this novel intervention.
Quantification of biochemical PSA dynamics after radioligand therapy with [177Lu]Lu-PSMA-I&T using a population pharmacokinetic/pharmacodynamic model
Authors: Siebinga Hinke , de Wit-van der Veen Berlinda J. , de Vries-Huizing Daphne M. V. , Vogel Wouter V. , Hendrikx Jeroen J. M. A. , Huitema Alwin D. R.
Published: April 2024

Background

There is an unmet need for prediction of treatment outcome or patient selection for [177Lu]Lu-PSMA therapy in patients with metastatic castration-resistant prostate cancer (mCRPC). Quantification of the tumor exposure–response relationship is pivotal for further treatment optimization. Therefore, a population pharmacokinetic (PK) model was developed for [177Lu]Lu-PSMA-I&T using SPECT/CT data and, subsequently, related to prostate-specific antigen (PSA) dynamics after therapy in patients with mCRPC using a pharmacokinetic/pharmacodynamic (PKPD) modelling approach.

Methods

A population PK model was developed using quantitative SPECT/CT data (406 scans) of 76 patients who received multiple cycles [177Lu]Lu-PSMA-I&T (± 7.4 GBq with either two- or six-week interval). The PK model consisted of five compartments; central, salivary glands, kidneys, tumors and combined remaining tissues. Covariates (tumor volume, renal function and cycle number) were tested to explain inter-individual variability on uptake into organs and tumors. The final PK model was expanded with a PD compartment (sequential fitting approach) representing PSA dynamics during and after treatment. To explore the presence of a exposure–response relationship, individually estimated [177Lu]Lu-PSMA-I&T tumor concentrations were related to PSA changes over time.

Results

The population PK model adequately described observed data in all compartments (based on visual inspection of goodness-of-fit plots) with adequate precision of parameters estimates (< 36.1% relative standard error (RSE)). A significant declining uptake in tumors (k14) during later cycles was identified (uptake decreased to 73%, 50% and 44% in cycle 2, 3 and 4–7, respectively, compared to cycle 1). Tumor growth (defined by PSA increase) was described with an exponential growth rate (0.000408 h−1 (14.2% RSE)). Therapy-induced PSA decrease was related to estimated tumor concentrations (MBq/L) using both a direct and delayed drug effect. The final model adequately captured individual PSA concentrations after treatment (based on goodness-of-fit plots). Simulation based on the final PKPD model showed no evident differences in response for the two different dosing regimens currently used.

Conclusions

Our population PK model accurately described observed [177Lu]Lu-PSMA-I&T uptake in salivary glands, kidneys and tumors and revealed a clear declining tumor uptake over treatment cycles. The PKPD model adequately captured individual PSA observations and identified population response rates for the two dosing regimens. Hence, a PKPD modelling approach can guide prediction of treatment response and thus identify patients in whom radioligand therapy is likely to fail.
Proteus syndrome: clinical and radiological findings through a new case report
Authors: Hager Barakizou , Azza Khelifi , Maryem Ferjani , Tahar Gargah
Published: April 2024

Background

Proteus syndrome (PS) is a complex and uncommon disorder with as its main feature a patchy or mosaic postnatal overgrowth. A high clinical and radiological variability characterizes it.

Case presentation

We report the case of a 2-year-old boy presenting with lipomas and diagnosed as PS in front of general criteria (sporadic occurrence, progressive course, and mosaic distribution of lesions) and specific criteria (linear epidermal nevus in the chest and asymmetric and overgrowth in the upper limbs) of Biesecker. The course of the disease was marked by a huge overgrowth of arms despite several surgeries. By the age of 10 years, a painful swelling of the right forearm revealed a venous thrombosis on a venous malformation.

Conclusions

This case report highlights the variability of clinical findings in PS. It also emphasizes the contribution of routine imaging tools for the diagnosis and the follow-up of this rare disease.
Patient and Caregiver Perceptions of an Interface Design to Communicate Artificial Intelligence–Based Prognosis for Patients With Advanced Solid Tumors
Authors: Sloss Elizabeth A. , McPherson Jordan P. , Beck Anna C. , Guo Jia-Wen , Scheese Carolyn H. , Flake Naomi R. , Chalkidis George , Staes Catherine J.
Published: April 2024

PURPOSE

Use of artificial intelligence (AI) in cancer care is increasing. What remains unclear is how best to design patient-facing systems that communicate AI output. With oncologist input, we designed an interface that presents patient-specific, machine learning–based 6-month survival prognosis information designed to aid oncology providers in preparing for and discussing prognosis with patients with advanced solid tumors and their caregivers. The primary purpose of this study was to assess patient and caregiver perceptions and identify enhancements of the interface for communicating 6-month survival and other prognosis information when making treatment decisions concerning anticancer and supportive therapy.

METHODS

This qualitative study included interviews and focus groups conducted between November and December 2022. Purposive sampling was used to recruit former patients with cancer and/or former caregivers of patients with cancer who had participated in cancer treatment decisions from Utah or elsewhere in the United States. Categories and themes related to perceptions of the interface were identified.

RESULTS

We received feedback from 20 participants during eight individual interviews and two focus groups, including four cancer survivors, 13 caregivers, and three representing both. Overall, most participants expressed positive perceptions about the tool and identified its value for supporting decision making, feeling less alone, and supporting communication among oncologists, patients, and their caregivers. Participants identified areas for improvement and implementation considerations, particularly that oncologists should share the tool and guide discussions about prognosis with patients who want to receive the information.

CONCLUSION

This study revealed important patient and caregiver perceptions of and enhancements for the proposed interface. Originally designed with input from oncology providers, patient and caregiver participants identified additional interface design recommendations and implementation considerations to support communication about prognosis.
A Large Benign Adrenocortical Adenoma Cosecreting Testosterone and Cortisol
Authors: Dillon Martha , Shteyman Sara , Rabiehashemi Samaneh , Madhavan Parvathy , Luthra Pooja
Published: April 2024

Most adrenal incidentalomas are benign neoplasms of the adrenal cortex. While the majority are nonfunctional, many secrete cortisol. Androgen- or estrogen-secreting adenomas are rare. A 44-year-old female, with history of hypertension and prediabetes, presented with worsening acne, hirsutism, secondary amenorrhea for 2 years, and a 40-pound weight gain. Laboratory evaluation showed high 24-hour urine free cortisol, suppressed adrenocorticotropic hormone (ACTH) level, indicative of ACTH independent Cushing syndrome, and elevated testosterone and androstenedione. Abdominal computed tomography (CT) revealed a 6.3 × 5.2 × 5.6 cm left adrenal mass. Patient underwent left open adrenalectomy. Pathology revealed benign adrenocortical adenoma. Postoperatively there was a significant improvement in her blood pressure and blood sugar levels, resumption of menses, and complete resolution of hyperandrogenism and hypercortisolism. We describe a patient with an adrenal adenoma cosecreting cortisol and androgen, leading to Cushing syndrome and significant virilization. Adrenal masses secreting androgens are less common and concerning for adrenocortical carcinoma (ACC). Patients with adrenal masses cosecreting multiple hormones should undergo workup expediently since ACC confers poor outcomes.
Persistent Gynecomastia due to Short-term Low-dose Finasteride for Androgenetic Alopecia
Authors: Farkas Hal Steven , Jee Youn Hee , Szymczuk Vivian , Leschek Ellen Werber
Published: April 2024

We report a case of persistent gynecomastia in a healthy 20-year-old man after 1 month of low-dose finasteride. Finasteride was discontinued after 2 months, and gynecomastia was unchanged 5 months after drug withdrawal. The gynecomastia regressed but did not resolve after 6 months of treatment with raloxifene, a selective estrogen receptor modulator. One year later, bilateral mammoplasty was performed to remove the remaining breast tissue. Finasteride, a 5-alpha-reductase inhibitor, is widely used for the treatment of androgenetic alopecia. Gynecomastia is an expected side effect of this therapy given its mechanism of action. However, only 8 cases of gynecomastia have been reported with low-dose (1 mg daily) finasteride treatment since its approval for androgenetic alopecia in 1997. This raises the concern that gynecomastia resulting from low-dose finasteride is significantly underreported, causing inadequately informed patients. Further, because of the risk of gynecomastia, it is important for prescribing physicians to counsel patients regarding this complication and to consider early intervention when finasteride-induced gynecomastia first arises to prevent fibrosis and thus irreversible gynecomastia.
Αναπτυξιακές τράπεζες και πως επηρεάζουν την ανταγωνιστικότητα των κρατών
Authors: Ρεμπούτσικα Γεωργία
Published: April 2024

Ολοένα και συχνότερα συναντάμε τον όρο αναπτυξιακή τράπεζα, ως ένα από τα πλέον επίκαιρα χρηματοδοτικά εργαλεία, που καλούνται να εκπληρώσουν αναπτυξιακούς εθνικούς στόχους, τους οποίους η εκάστοτε κυβέρνηση εντάσσει στο πρόγραμμά διακυβέρνησής της. Ενώ ο όρος αυτός συνδέεται απόλυτα με την παγκόσμια οικονομική ιστορία, λίγοι είναι σε θέση να κατανοήσουν σε βάθος τι πραγματικά περιλαμβάνει και τους τρόπους που μπορεί να επιτευχθεί σύνδεση μεταξύ αναπτυξιακών τραπεζών και αναπτυξιακής πορείας ενός κράτους. Η προσπάθεια σύνδεσης των αναπτυξιακών τραπεζών, οι οποίες επηρεάζονται σε πολύ μεγάλο βαθμό από τις πολιτικές των κρατών με τον παράγοντα ανταγωνιστικότητα, και κατά συνέπεια το ρυθμό ανάπτυξης, θα μας οδηγήσει στο βαθμό επιρροής αυτών των ιδρυμάτων στην αναπτυξιακή πορεία των κρατών μελών της Ευρωπαϊκής Ένωσης. Άλλωστε, αυτό είναι και το βασικό ερευνητικό ερώτημα, το οποίο δημιουργεί κατά συνέπεια και άλλα επιμέρους ερωτήματα, τα οποία βρίσκουν απάντηση σε παραδείγματα περιπτώσεων αλλά και μέσα από την ίδια τη βιβλιογραφία. Οι τελευταίες κρίσεις που βίωσε η ανθρωπότητά μας έθεσε νέους κανόνες, αναφορικά με το ρόλο που καλούνται να διαδραματίσουν τα κράτη, τόσο από χρηματοοικονομική πλευρά αλλά και από μια κοινωνική οπτική γωνία. Η παρέμβαση του κρατικού μηχανισμού και ο βαθμός απόκρισης αυτής, τόσο για ζητήματα υγείας όσο και οικονομικής ενίσχυσης, αξιολογήθηκε και κρίθηκε απαραίτητη από τους πολίτες. Σημαντική παράμετρος στη μελέτη θα αποτελέσει και η αποτίμηση της ενίσχυσης αυτών των ιδρυμάτων στην περίοδο κρίσης που βίωσε ο πλανήτης το 2020, με την έξαρση της πανδημίας Covid-19 να επιδρά ανασταλτικά στις περισσότερες παραγωγικές δομές των κρατών. Στην περίοδο αυτή, αλλά και σε περιόδους κρίσεων γενικότερα, οι αναπτυξιακές τράπεζες κλήθηκαν να υπενθυμίσουν το νευραλγικό τους ρόλο μέσα σε ένα διαρκώς εναλλασσόμενο οικονομικό περιβάλλον. Η εποχή της βιώσιμης ανάπτυξης, που δε δικαιολογεί αποκλεισμούς, ευνοεί τη λειτουργία των τραπεζών που ενισχύουν την ανάπτυξη χωρίς αποκλεισμούς, τη βιώσιμη χρήση πόρων, την αξία που προσδίδει το περιβάλλον αλλά και την απασχόληση. Η εκπλήρωση των στόχων που προαναφέρθηκαν προϋποθέτει και μακροπρόθεσμες επενδύσεις για να επιτύχουμε βιώσιμα αποτελέσματα.Ο ρόλος των αναπτυξιακών τραπεζών θα εξετασθεί σε συνάρτηση με τους αναπτυξιακούς στόχους που θέτει το κάθε κράτος αλλά και το ποσοστό επίτευξης αυτών μέσα από τα χρηματοδοτικά εργαλεία που προσφέρουν στα ενδιαφερόμενα μέρη.
Mapping efficient convolutional neural networks to resource-limited system-on-chip field-programmable gate arrays for mobile deep learning application acceleration
Authors: Μουσουλιώτης Παναγιώτης
Published: April 2024

Η παρούσα διατριβή μελετά και παρουσιάζει την επιτάχυνση σύγχρονων αλγορίθμων νευρωνικών δικτύων σε σύστημα-σε-τσιπ (System-on-a-Chip (SoC)) το οποίο περιλαμβάνει μέσα στο ίδιο τσιπ έναν επεξεργαστή γενικού σκοπού καθώς και μία συστοιχία επιτόπια προγραμματιζόμενων πυλών. Αυτού του είδους τα τσιπ αναφέρονται και ως SoC FPGAs. Για την υλοποίηση φορητών εφαρμογών χαμηλού κόστους έχουν επιλεγεί SoC FPGAs χαμηλού κόστους και σχετικά χαμηλών δυνατοτήτων που παρουσιάζουν κατανάλωση ισχύος μικρότερη των 5 Watts. Επιπρόσθετα, για τη μείωση του χρόνου ανάπτυξης του επιταχυντή σε SoC FPGA, έχει επιλεγεί η ανάπτυξη με τη χρήση εργαλείων υψηλού-επιπέδου σύνθεσης (High-Level Synthesis (HLS)). Με τη χρήση HLS εργαλείων, ο σχεδιαστής μπορεί να περιγράψει τον επιταχυντή σε μια γλώσσα υψηλού επιπέδου όπως C/C++ και αυτή η περιγραφή θα μεταφραστεί τελικά από το HLS εργαλείο σε γλώσσα περιγραφής υλικού (Hardware Description Language (HDL)). Τελικά ο επιταχυντής υλοποιείται στο FPGA τμήμα του SoC FPGA, ενώ στον επεξεργαστή του SoC εκτελείται η εφαρμογή συμπερασμού του νευρωνικού δικτύου (inference) που επικοινωνεί με τον επιταχυντή που υλοποιείται στο FPGA μέσω κλήσεων λογισμικού. Οι κλήσεις λογισμικού ελέγχουν την λειτουργία του επιταχυντή και είναι υπεύθυνες για τη μεταφορά δεδομένων από και προς τον επιταχυντή από το σύστημα μνήμης του επεξεργαστή του SoC μέσω γρήγορων διαύλων επικοινωνίας. Όσον αφορά τους σύγχρονους αλγόριθμους νευρωνικών δικτύων, έχουν επιλεγεί σύγχρονοι και αποδοτικοί αλγόριθμοι συνελικτικών νευρωνικών δικτύων (Convolutional Neural Networks (CNNs)), οι οποίοι χρησιμοποιούνται για την επίλυση του προβλήματος της αναγνώρισης αντικειμένου (object recognition) σε εικόνα και την κατάταξή του σε κλάση (classification). Για το σκοπό αυτό, χρησιμοποιείται το σύνολο δεδομένων του ImageNet, το οποίο περιλαμβάνει πάνω από 1.2 εκατομμύρια εικόνες που ανήκουν σε 1000 κλάσεις.
Detection and analysis through communication channels of the physical characteristics of metals by using of ultrasonic sensors
Authors: Δασκαλάκη Διονυσία
Published: April 2024

Η διατριβή πραγματεύεται πτυχές που σχετίζονται με τη μέτρηση των δυνάμεων κατά τη δοκιμή των φορτίων εξαρτημάτων, κατασκευών, μονάδων και πλήρους εξοπλισμού, τα οποία είναι κατασκευασμένα από μέταλλο σε διάφορους τομείς της επιχείρησης και της βιομηχανίας. Έχει εισαχθεί η έννοια της τεχνητής νοημοσύνης σε προσεγγίσεις για ποιοτική και ποσοτική ανάλυση των δεδομένων μέτρησης που αποκτήθηκαν από τη συμπερίληψη λειτουργικών μετατροπέων μέτρησης παραμόρφωσης σε κλασικά κυκλώματα γεφυρών για την παρακολούθηση και τον έλεγχο των φορτίων ισχύος. Μία από τις πιο σημαντικές πτυχές στις σύγχρονες επικοινωνίες σχετίζεται με τον εντοπισμό και την αξιολόγηση υπερτιθέμενων ανεπιθύμητων τυχαίων θορύβων στα κανάλια επικοινωνίας για επικοινωνία στη μετάδοση εξειδικευμένων δεδομένων ξανά με βάση τεχνητά νευρωνικά δίκτυα. Μια ουσιαστική πτυχή, η οποία αποτελεί και αντικείμενο ανάλυσης στη διπλωματική εργασία με ενσωμάτωση τεχνητής νοημοσύνης, αφορά τη δυνατότητα πρόβλεψης της ποσοτικής μετρήσιμης ικανότητας του όγκου των δεδομένων πακέτων που εξυπηρετούνται. Αυτό θα εξασφαλίσει ποιοτικό έλεγχο και βελτιστοποίηση της εξυπηρετούμενης κίνησης όσον αφορά την κανονική λειτουργία ενός συγκεκριμένου συστήματος μέτρησης πληροφοριών και επικοινωνιών για την παρακολούθηση των επιπτώσεων ισχύος, χωρίς αποκλίσεις στις διαδικασίες εξυπηρέτησης πελατών.