Deep learning-assisted radiomics facilitates multimodal prognostication for personalized treatment strategies in low-grade glioma.

Determining the optimal course of treatment for low grade glioma (LGG) patients is challenging and frequently reliant on subjective judgment and limited scientific evidence. Our objective was to develop a comprehensive deep learning assisted radiomics model for assessing not only overall survival in LGG, but also the likelihood of future malignancy and glioma growth velocity. Thus, we retrospectively included 349 LGG patients to develop a prediction model using clinical, anatomical, and preoperative MRI data. Before performing radiomics analysis, a U2-model for glioma segmentation was utilized to prevent bias, yielding a mean whole tumor Dice score of 0.837. Overall survival and time to malignancy were estimated using Cox proportional hazard models. In a postoperative model, we derived a C-index of 0.82 (CI 0.79-0.86) for the training cohort over 10 years and 0.74 (Cl 0.64-0.84) for the test cohort. Preoperative models showed a C-index of 0.77 (Cl 0.73-0.82) for training and 0.67 (Cl 0.57-0.80) test sets. Our findings suggest that we can reliably predict the survival of a heterogeneous population of glioma patients in both preoperative and postoperative scenarios. Further, we demonstrate the utility of radiomics in predicting biological tumor activity, such as the time to malignancy and the LGG growth rate.

Practical limitations of emergency donor panels as a risk mitigation in small-scale short-term training team operations.

Haemostatic resuscitation with blood products has become the expected standard of care for trauma casualties. As UK Defence increases its deployment of small-scale, short-term training teams (STTTs) in Defence Engagement and influence operations, ever greater reliance is being placed on emergency donor panels (EDP) as a source of whole blood. This paper outlines the practical limitations of using EDPs as a risk mitigation in conventional STTTs which must be considered prior to every deployment.

Specialist infantry and defence engagement.

In 2015, the UK government published the National Strategic Defence and Security Review (SDSR) 2015, which laid out their vision for the future roles and structure of the UK Armed Forces. SDSR 2015 envisaged making broader use of the Armed Forces to support missions other than warfighting. One element of this would be to increase the scale and scope of defence engagement (DE) activities that the UK conducts overseas. DE activities traditionally involve the use of personnel and assets to help prevent conflict, build stability and gain influence with partner nations as part of a short-term training teams. This paper aimed to give an overview of the Specialist Infantry Group and its role in UK DE. It will explore the reasons why the SDSR 2015 recommended their formation as well as an insight into future tasks.

Athletic altitude training protocols and their application in preparation for mountainous operations.

In recent years, small scale counter-insurgency and expeditionary operations have frequently taken place in mountainous, high-altitude areas. Preparation of soldiers for these environments has typically focussed on extended stays at altitude to ensure physiological acclimatisation. However, with the likelihood that future UK deployments may be unpredictable and thus with little time for preparation, is there a means by which the same acclimatisation may be achieved? The field of athletics has been researching such adaptations since the rise of the elite North African long-distance runners in the 1960s. These athletes all lived high above sea level and had become accustomed to performing in the relatively hypoxic environment found at high altitudes. The research has focussed on eliciting physiological acclimatisation in as short a time as possible, while maintaining the ability to train at the correct intensity. In the following review of altitude training we highlight areas for future investigation and assess whether protocols developed for athletes can be applied to military personnel.

Femoral acetabular impingement: the sex- and age-linked distribution of alpha angles in 146 patients of service age without pre-existing osteoarthritic or other hip pathology.

The use of the alpha angle to help the diagnosis of Femoral Acetabular Impingement (FAI) is common. However, there is currently no standard value available across an asymptomatic pre-arthritic population. We present the first large cohort of Computerised Tomography (CT) based alpha angles in patients with no history of hip pathology, including intra- and interobserver validation. We carried out a retrospective analysis of 73 consecutive individuals (146 hip joints) with ages ranging from 18 to 39 years. The age range 18-39 represents 82.4% of those currently serving in the UK Armed Forces. The cohort was drawn from those patients who had received a CT scan in the Lothian Region between 1 Jan 2011 and 31 Dec 2011 due to abdominal pathology. These patients had their electronic patient record checked to rule out any hip-related problems. The alpha angle of Nötzli was measured on the axial view bilaterally. The mean value for the 18-39 age range was found to be 51.89 degree for the left hip and 52.53 degree for the right. Femoral alpha angle is a reproducible measurement for assessing the femoral neck. However, there is wide variability in the alpha angle for patients, irrespective of the presence of symptoms. Our results would suggest that the alpha angle alone should not be used to diagnose FAI in service personnel, as even large angles may be normal.

Biphasic 24-hour variations in cyclic GMP accumulation in the rat pineal gland are due to corresponding changes in the activity of cytosolic and particulate guanylate cyclase.

Various parameters of the rat pineal gland display a 24-h rhythm. However, nothing is known about possible 24-h variations in cyclic GMP (cGMP) metabolism. In the present study, 24-h variations in pineal gland cGMP accumulation were investigated by determining the increase in cGMP level with and without inhibitors of phosphodiesterase at different time points over a light/dark cycle (12/12 h). Furthermore, the activity of guanylate cyclase (GC) was determined under substrate-saturated conditions regarding the cytosolic and particulate forms of the enzyme. It has been found that cGMP accumulation and GC activity display biphasic 24-h variations with two peaks--one approximately 7 h after lights "on" and the other approximately 7 h after lights "off." The activity of cytosolic GC remains unchanged in the presence of the nitric oxide (NO) synthesis inhibitor N-monomethyl-L-arginine, indicating that 24-h variations in the activity do not reflect changes in the synthesis of the GC stimulator NO.

Ca2+ control of electrolyte permeability in plasma membrane vesicles from cat pancreas.

The influence of Ca2+ and other cations on electrolyte permeability has been studied in isolated membrane vesicles from cat pancreas. Ca2+ in the micromolar to millimolar concentration range, as well as Mg2+, Sr2+, Mn2+ and La3+ at a tested concentration 10(-4) M, increased Na+ permeability when applied at the vesicle inside. When added to the vesicle outside, however, they decreased Na+ permeability. Ba2+ was effective from the outside but not from the vesicle inside. When Ca2+ was present at both sides of the membrane, Na+ efflux was not affected as compared to that in the absence of Ca2+. Monovalent cations such as Rb+, Cs+, K+, Tris+ and choline+ decreased Na+ permeability when present at the vesicle outside at a concentration range of 10 to 100 mM. Increasing Na+ concentrations from 10 to 100 mM at the vesicle inside increased Na+ permeability. The temperature dependence of Na+ efflux revealed that the activation energy increased in the lower temperature range (0 to 10 degrees C) when Ca2+ was present at the outside or at both sides, but not when present at the vesicle inside only or in the absence of Ca2+. The results suggest that the Ca2+ outside effect is due to binding of calcium to negatively charged phospholipids with a consequent reduction of both fluidity and Na+ permeability of the membrane. The Ca2+-inside effect most likely involves interaction with proteins with consequent increase in Na+ permeability. The data are consistent with current hypotheses on secretagogue-induced fluid secretion in acinar cells of the pancreas according to which secretagogues elicit NaCl and fluid secretion by liberating Ca2+ from cellular membranes and by stimulating Ca2+ influx into the cell. The increased intracellular Ca2+ concentration in turn increases the contraluminal Na+ permeability which leads to NaCl influx. The luminal sodium pump finally transports Na+ ions into the lumen.