Magnetic Resonance Imaging as a Diagnostic Tool for Ilio-Femoro-Caval Deep Venous Thrombosis.

This study aimed to test the accuracy of a magnetic resonance imaging (MRI)-based method to detect and characterise deep venous thrombosis (DVT) in the ilio-femoro-caval veins. Patients with verified DVT in the lower extremities with extension of the thrombi to the iliac veins, who were suitable for catheter-based venous thrombolysis, were included in this study. Before the intervention, magnetic resonance venography (MRV) was performed, and the ilio-femoro-caval veins were independently evaluated for normal appearance, stenosis, and occlusion by two single-blinded observers. The same procedure was used to evaluate digital subtraction phlebography (DSP), considered to be the gold standard, which made it possible to compare the results. A total of 123 patients were included for MRV and DSP, resulting in 246 image sets to be analysed. In total, 496 segments were analysed for occlusion, stenosis, or normal appearance. The highest sensitivity compared occlusion with either normal or stenosis (0.98) in MRV, while the lowest was found between stenosis and normal (0.84). Specificity varied from 0.59 (stenosis >< occlusion) to 0.94 (occlusion >< normal). The Kappa statistic was calculated as a measure of inter-observer agreement. The kappa value for MRV was 0.91 and for DSP, 0.80. In conclusion, MRV represents a sensitive method to analyse DVT in the pelvis veins with advantages such as no radiation and contrast and the possibility to investigate the anatomical relationship in the area.

An in silico modeling approach to understanding the dynamics of the post-burn immune response.

Introduction: Burns are characterized by a massive and prolonged acute inflammation, which persists for up to months after the initial trauma. Due to the complexity of the inflammatory process, Predicting the dynamics of wound healing process can be challenging for burn injuries. The aim of this study was to develop simulation models for the post-burn immune response based on (pre)clinical data. Methods: The simulation domain was separated into blood and tissue compartments. Each of these compartments contained solutes and cell agents. Solutes comprise pro-inflammatory cytokines, anti-inflammatory cytokines and inflammation triggering factors. The solutes diffuse around the domain based on their concentration profiles. The cells include mast cells, neutrophils, and macrophages, and were modeled as independent agents. The cells are motile and exhibit chemotaxis based on concentrations gradients of the solutes. In addition, the cells secrete various solutes that in turn alter the dynamics and responses of the burn wound system. Results: We developed an Glazier-Graner-Hogeweg method-based model (GGH) to capture the complexities associated with the dynamics of inflammation after burn injuries, including changes in cell counts and cytokine levels. Through simulations from day 0 - 4 post-burn, we successfully identified key factors influencing the acute inflammatory response, i.e., the initial number of endothelial cells, the chemotaxis threshold, and the level of chemoattractants. Conclusion: Our findings highlight the pivotal role of the initial endothelial cell count as a key parameter for intensity of inflammation and progression of acute inflammation, 0 - 4 days post-burn.

Biaxial compressive strain enhances calcium binding and mobility on two-dimensional Sc2C: a density functional theory investigation.

In this work, we investigated calcium binding and diffusion on pristine and biaxially strained 2D Sc2C via density functional theory calculations, for potential applications in calcium-ion batteries (CIBs). We found that 2D Sc2C is metallic under PBE, HSE06, and DFT+U approximation conditions, and thus can be potentially used as an electrode material for CIBs. Results showed that pristine 2D Sc2C adsorbs calcium modestly, with relatively low binding energy on the most stable site (0.38 eV). Interestingly, this value shoots up to -1.94 eV and -3.23 eV at 5% and 10% biaxial compressive strains, respectively. Furthermore, calcium's diffusion energy barrier, which is already low (80 meV) on pristine 2D Sc2C, goes down further (to 35 meV) upon application of median biaxial compressive strain (5%). As a result of the enhanced binding of calcium on strained 2D Sc2C, the maximum stable calcium concentration was also boosted. Consequently, the calculated theoretical specific energy capacity of 2D Sc2C with biaxial compressive strain is higher compared to that of the pristine case (878.29 mA h g-1vs. 1051.84 mA h g-1). The average open circuit voltages of the two cases are high and quite close at 9.3 V (pristine) and 9.0 V (with 5% biaxial compressive strain). Our results demonstrated that biaxial compressive strain could be tapped to improve the properties of 2D MXenes, such as Sc2C, thereby enhancing the battery performance indicators of these materials, such as theoretical specific energy capacity and open circuit voltage. Such findings are of great importance in the emerging new technology of CIBs.

The use of simulation in medical ultrasound: Current perspectives on applications and practical implementation (WFUMB state-of-the-art paper).

Simulation has been shown to improve clinical learning outcomes, speed up the learning process, and improve trainee confidence, while taking the pressure off initial face-to-face patient clinical areas. The second part of The World Federation for Ultrasound in Medicine and Biology state-of-the-art paper on the use of simulators provides a general approach on the practical implementation. The importance of needs assessment before developing a simulation-based training program is outlined. We describe the current practical implementation and critically analyze how simulators can be integrated into complex task scenarios to train small or large groups. A wide range of simulation equipment is available especially for those seeking interventional ultrasound training, ranging from animal tissue models, simple synthetic phantoms, to sophisticated high-fidelity simulation platforms using virtual reality. Virtual reality simulators provide feedback and thereby allow trainees to not only to practice their motor skills and hand eye coordination but also to interact with the simulator. Future developments will integrate more elements of automated assessment and artificial intelligence, thereby enabling enhanced realistic training experience and improving skill transfer into clinical practice.

Spermatocytic tumors in 2 patients aged 50 and 77 years: 2 case reports and brief review of the literature.

Testicular cancer is predominantly diagnosed in young men aged 15-35 years. However, there are some rare tumors such as spermatocytic tumors that are seen more often in the older male population. Spermatocytic tumors have previously been known as spermatocytic seminomas in the scientific literature. We report the cases of 2 patients aged 50 and 77 years both diagnosed with spermatocytic tumors. In this paper we will discuss the ultrasound and histopathology features of these tumors and review the literature of spermatocytic tumor cases.

The ultrasound use of simulators, current view, and perspectives: Requirements and technical aspects (WFUMB state of the art paper).

Simulation has been shown to improve clinical learning outcomes, speed up the learning process and improve learner confidence, whilst initially taking pressure off busy clinical lists. The World Federation for Ultrasound in Medicine and Biology (WFUMB) state of the art paper on the use of simulators in ultrasound education introduces ultrasound simulation, its advantages and challenges. It describes different simulator types, including low and high-fidelity simulators, the requirements and technical aspects of simulators, followed by the clinical applications of ultrasound simulation. The paper discusses the role of ultrasound simulation in ultrasound clinical training, referencing established literature. Requirements for successful ultrasound simulation acceptance into educational structures are explored. Despite being in its infancy, ultrasound simulation already offers a wide range of training opportunities and likely holds the key to a broader point of care ultrasound education for medical students, practicing doctors, and other health care professionals. Despite the drawbacks of simulation, there are also many advantages, which are expanding rapidly as the technology evolves.

Ultrasound and contrast enhanced CT imaging of a colon mesentery leiomyosarcoma.

Primary leiomyosarcoma of the colon mesentery is an extremely rare neoplasm, and only a small number of cases have been reported. We describe a case of leiomyosarcoma originating in the colonic mesentery, in a 68-year-old woman. Ultrasound showed a heterogeneous mass with varying vascularization in the left fossa. Central areas of the mass were hypoechoic, without detectable vascularization. Contrast enhanced computed tomography (CECT) of chest and abdomen showed a contrast enhanced tumour, with central non-enhanced areas. The tumour was radically resected and histopathology showed primary leiomyosarcoma. Two years after primary surgery, follow-up CECT revealed a local recurrence, which was re-resected. Subsequent follow-up CECT since have shown no sign of recurrence.

The Impact of Patient Characteristics and Tumor Biology on the Accuracy of Preoperative Staging of Colon Cancer in Denmark. A Nationwide Cohort Study.

BACKGROUND: Colon cancer is a common disease in western populations. The aim of this study was to assess the impact of mismatch repair (MMR) deficiency and other patient and tumor characteristics on the accuracy of preoperative staging by comparing histopathological T- and N-categories of the resected specimen with the preoperative clinical stage in a nationwide cohort of patients treated for colon cancer by elective bowel resection with curative intent. METHODS: A register study of a cohort extracted from the Danish Colorectal Cancer Group (DCCG) database, which holds prospective data on all new cases of colon and rectum cancer in Denmark. Patients diagnosed with colon cancer and treated with an elective bowel resection with curative intent in the years 2016-2019 were analyzed. RESULTS: A total of 6102 patients were included (n = 3161 (52%) men and n = 2941 (48%) women) with a median age of 72 years (range 23-97 years). MMR was deficient in 24% of the patients and proficient in 76%. MMR deficiency, tumor sidedness and histopathological type were significant predictors of the accuracy of preoperative staging of colon cancer in univariate and multivariate analysis. MMR status in particular showed a strong impact on the risk of overstaging. CONCLUSIONS: MMR deficiency, but also tumor sidedness and to some degree histopathological type, impacted the accuracy of preoperative staging of colon cancer. MMR status should be taken into consideration in everyday clinical staging.

Influence of potassium-solubilizing bacteria on the growth and radiocesium phyto-transfer of Brassica rapa L. var. perviridis grown in contaminated Fukushima soils.

The supply of K, being the chemical analog of Cs, affects the phytotransfer of radiocesium such as 137Cs from contaminated soils and its accumulation in plant tissues. Since K and Cs have high affinity to the same clay particle surfaces, the presence of potassium-solubilizing bacteria (KSB) could increase the availability of not only K+ in the rhizosphere but also of radiocesium. In this study, we obtained five KSB isolates with the highest solubilization capacities from soybean rhizosphere on modified Aleksandrov medium containing sericite as K source. Based on biochemical and 16S rRNA gene sequence analysis, we identified the bacteria as Bacillus aryabhattai MG774424, Pseudomonas umsongensis MG774425, P. frederiksbergensis MG774426, Burkholderia sabiae MG774427, and P. mandelii MG774428. We evaluated the KSB isolates based on plant growth promotion and 137Cs accumulation in komatsuna (Brassica rapa L. var. Perviridis) grown in three soils collected from Miyanoiri, Takanishi, and Ota contaminated by 137Cs from the Fukushima accident. Inoculation with KSB showed beneficial effects on plant growth and increased the overall plant biomass production (~40%). On the average, KSB inoculation resulted in the removal of 0.07 ± 0.04% of 137Cs from the soil, more than twice the control. But similar to the effect of KSB inoculation on komatsuna biomass production, different KSBs performed variably and exhibited site-specific responses independent of their K-solubilizing capacities, with higher 137Cs phyto-transfer in roots than in shoots. In terms of root transfer factor (TF), values were highest in komatsuna plants grown in Miyanoiri and Ota soils inoculated with P. frederiksbergensis and Burkholderia sabiae, while they were highest in Takanishi soils inoculated with Bacillus aryabhattai and P. umsongensis. These TF values were also much higher than previously reported values for komatsuna grown in 137Cs-contaminated Fukushima soils inoculated with other rhizobacteria. Thus, KSB inoculation significantly enhance not only the growth of komatsuna but 137Cs uptake.

Spontaneous dissolution of a cyst located within the septum pellucidum in a patient with sarcoidosis: a case report.

Sarcoidosis is a granulomatous multisystem disease of unknown etiology. Typically, the disease affects the lungs, causing enlargement of the mediastinal lymph nodes, but other organs can be affected. Neurosarcoidosis is reported in 5-10% of the patients. This case represents a 39-year-old male patient diagnosed with lung sarcoidosis. Due to neurological symptoms, a contrast-enhanced cerebral magnetic resonance imaging was performed. Neurosarcoidosis was presented with meningeal enhancement adjacent to a cyst located within the cavum septum pellucidum. The cyst dissolved spontaneously within six months. The finding of a cyst located within the septum pellucidum is rare.

Long-term ultrasound follow-up in patients with small gallbladder polyps.

INTRODUCTION: Gallbladder polyps often have a benign appearance by ultrasonography. Even so, the current guideline recommends follow-up in gallbladder polyps lesser-than 6 mm. The aim of this study was to investigate long-term follow-up growth of polyps in patients with a polyp size lesser-than 6 mm in a ten-year cohort. METHODS: Abdominal ultrasonography reports from 2007 to 2009 were reviewed, including reports on patients diagnosed with a gallbladder polyp (polyp size lesser-than 6 mm) during the 2007-2009 period. The patients were invited to a final follow-up ultrasonography of the gallbladder conducted during October 2019 to February 2020. A total of 154 patients were included (100 women and 54 men). RESULTS: In 53 patients (34.4%), the polyp was not visible at the ultrasonography follow-up. Gallbladder polyps were confirmed in 101 (65.6%) patients. A total of 49 patients had a single polyp (31.8%) and 52 (33.8%) patients had multiple polyps. The median size of the gallbladder polyp was 4 mm (range: 2.0-5.9 mm) at baseline compared with 4 mm (range: 1.7-15.0 mm) at the follow-up. A total of 15 patients experienced polyp growth of 2 mm or more. None developed gallbladder cancer. CONCLUSIONS: Our study showed that gallbladder polyps lesser-than 6 mm has a low probability of increasing in size. None of the patients with small polyps developed gallbladder cancer. FUNDING: none. TRIAL REGISTRATION: not relevant.

Reporting colon cancer staging using a template.

PURPOSE: The purpose of this study was to evaluate the effect of completeness of the radiological reports in primary local staging colon cancer when using a template. METHODS: The study used primary staging reports retrieved from the departments RIS/PACS. Five key tumour descriptors were evaluated within each report: tumour morphology (polypoid or annular), information on tumour breach of the colon wall (≥ T3), tumour out-growth in mm, nodal status and TNM in conclusion. The failure to provide a description of the presence or absence of a feature in a report counted as 'not reported'. To allow comparisons between reporting styles, the template or free-text style of reporting was also recorded. RESULTS: During a two year period, a total of 666 patients CT reports were evaluated at the colorectal center multidisciplinary team (MDT) conference. In 200 of these reports a template was used. Information on tumour morphology (polypoid or annular) was present in 81% of the template reports vs 9% in free-text style. The figures in percentage for information on tumour breach of the colon wall (≥ T3) were 93% vs 48 %, tumour out-growth in mm: 51% vs 17%, nodal status: 99% vs 86% and TNM in conclusion: 98% vs 51%. P < 0.0001. CONCLUSION: The present study provides additional support for the routine use of template reports to improve imaging reporting standards in colonic cancer.

Isolation and Screening of Indigenous Plant Growth-promoting Rhizobacteria from Different Rice Cultivars in Afghanistan Soils.

To develop biofertilizers for rice in Afghanistan, 98 plant growth-promoting rhizobacteria were isolated from rice plants and their morphological and physiological characteristics, such as indole-3-acetic acid production, acetylene reduction, phosphate and potassium solubilization, and siderophore production, were evaluated. The genetic diversity of these bacteria was also analyzed based on 16S rRNA gene sequences. Of 98 bacteria, 89.7% produced IAA, 54.0% exhibited nitrogenase activity, and 40% showed phosphate solubilization and siderophore production. Some isolates assigned to Pseudomonas (brassicacearum, chengduensis, plecoglossicida, resinovorans, and straminea) formed a relationship with rice, and P. resinovorans and P. straminea showed nitrogen fixation. Rhizobium borbori and R. rosettiformans showed a relationship with rice plants and nitrogen fixation. Among the isolates examined, AF134 and AF137 belonging to Enterobacter ludwigii and P. putida produced large amounts of IAA (92.3 µg mL-1) and exhibited high nitrogenase activity (647.4 nmol C2H4 h-1), respectively. In the plant growth test, more than 70% of the inoculated isolates showed significantly increased root and shoot dry weights. Highly diverse bacterial isolates showing promising rice growth-promoting traits were obtained from Afghanistan alkaline soils.

Towards integrated management of a shallow tropical lake: assessment of water quality, sediment geochemistry, and phytoplankton diversity in Lake Palakpakin, Philippines.

The limited carrying capacities of shallow tropical lakes render them more vulnerable to ecological problems like eutrophication. Unregulated human activities such as unsustainable aquaculture and urbanization can alter ecosystem dynamics rapidly, and this warrants more comprehensive researches than what has been previously conducted. Here, we presented an integrated assessment of the nutrient dynamics, phytoplankton diversity, and sediment geochemistry in Lake Palakpakin, a shallow tropical lake of volcanic origin, to understand its deteriorating ecological state. Water, phytoplankton, and sediment samples were collected, and in situ water quality measurements were done during wet and dry seasons in four critical areas in the lake, namely, the inlet, center, sanctuary, and outlet. Results revealed that high light extinction coefficient (1.13 m-1), high turbidity (28 NTU), high phosphate concentration (> 2.0.5 mg/L), and the abundance of Microcystis aeruginosa, Anabaena helicoidea, and Lyngbya sp. indicate that from a relatively healthy lake in 2008, Lake Palakpakin has become a eutrophic to hypereutrophic freshwater body. High concentrations of available nutrients such as N and P were detected in the center and sanctuary sediments, which drive the internal nutrient loading in the lake. We recommend that management efforts be directed towards a whole-ecosystem approach in addressing the problem of eutrophication, especially in shallow tropical lakes.

Voice quality outcomes of idiopathic Parkinson's disease medical treatment: A systematic review.

INTRODUCTION: To investigate voice quality (VQ) impairments in idiopathic Parkinson's disease (IPD) and to explore the impact of medical treatments and L-Dopa challenge testing on voice. METHODS: Relevant studies published between January 1980 and June 2017 describing VQ evaluations in IPD were retrieved using PubMed, Scopus, Biological Abstracts, BioMed Central and Cochrane databases. Issues of clinical relevance, including IPD treatment efficiency and voice quality outcomes, were evaluated for each study. The grade of recommendation for each publication was determined according to the Oxford Centre for Evidence-Based Medicine evidence levels. RESULTS: The database research yielded 106 relevant publications, of which 33 studies met the inclusion criteria, for a total of 964 patients with IPD. Data were extracted by 3 independent physicians who identified 21, 11 and 1 trials with IIIb, IIb and IIa evidence levels, respectively. The main VQ assessment tools used were acoustic testing (N = 27), aerodynamic testing (N = 10), subjective measurements (N = 8) and videolaryngostroboscopy (N = 3). The majority of trials (N = 32/33) identified subjective or objective VQ improvements after medical treatment (N = 10) or better VQ evaluations in healthy subjects compared to patients with IPD (N = 22). Especially, our analysis supports that VQ overall improves during the L-Dopa challenge testing, making the VQ evaluation an additional tool for the IPD diagnosis. The methodology used to assess subjective and objective VQ substantially varied from 1 study to another. All of the included studies took into consideration the patient's clinical profile in the VQ analysis. CONCLUSION: The majority of studies supported that VQ assessments remain useful as outcome measures of the effectiveness of medical treatment and could be helpful for the IPD diagnosis based on L-Dopa challenge testing. Further controlled studies using standardised and transparent methodology for measuring acoustic parameters are necessary to confirm the place of each tool in both IPD diagnosis and treatment evaluation.

Detecting Breast Cancer with a Dual-Modality Device.

Although mammography has been the gold standard for the early detection of breast cancer, if a woman has dense breast tissue, a false negative diagnosis may occur. Breast ultrasound, whether hand-held or automated, is a useful adjunct to mammography but adds extra time and cost. The primary aim was to demonstrate that our second-generation Aceso system, which combines full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in a single platform, is able to produce improved quality images that provide clinically meaningful results. Aceso was first tested using two industry standards: a Contrast Detail Mammography (CDMAM) phantom to assess the FFDM images, and the CIRS 054GS phantom to evaluate the ABUS images. In addition, 25 women participated in a clinical trial: 14 were healthy volunteers, while 11 were patients referred by the breast clinic at Groote Schuur Hospital. The CDMAM phantom results showed the FFDM results were better than the European Reference (EUREF) standard of "acceptable" and were approaching "achievable". The ABUS results showed a lateral and axial spatial resolution of 0.5 mm and an adequate depth penetration of 80 mm. Our second-generation Aceso system, with its improved quality of clinical FFDM and ABUS images, has demonstrated its potential for the early detection of breast cancer in a busy clinic.

Testing a dual-modality system that combines full-field digital mammography and automated breast ultrasound.

PURPOSE: The aim of this study was to test a novel dual-modality imaging system that combines full-field digital mammography (FFDM) and automated breast ultrasound (ABUS) in a single platform. Our Aceso system, named after the Greek goddess of healing, was specifically designed for the early detection of cancer in women with dense breast tissue. MATERIALS AND METHODS: Aceso was first tested using two industry standards: a Contrast Detail Mammography (CDMAM) phantom as endorsed by European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services was used to assess the FFDM images; and the CIRS 040GSE ultrasound phantom was imaged to evaluate the quality of the ABUS images. In addition, 58 women participated in a clinical trial: 51 were healthy volunteers aged between 40 and 65, while 7 were patients referred by the breast clinic, 6 of whom had biopsy-proven breast cancer. RESULTS: The CDMAM tests showed that the FFDM results were "acceptable" but fell short of "achievable" which was attributed to the low dose used. The ABUS images had good depth penetration (80 mm) and adequate axial resolution (0.5 mm), but the lateral resolution of 2 mm was judged to be too coarse. In a 42-year-old volunteer with extremely dense breast tissue, the ABUS modality detected a lesion (a benign cyst) that was mammographically occult in the FFDM image. For a 73-year-old patient with fatty breasts, a malignant lesion was successfully detected and co-registered in the FFDM and ABUS images. On average, each woman spent less than 11 min in the acquisition room. CONCLUSIONS: While there is room for improvement in the quality of both the FFDM and ABUS images, Aceso has demonstrated its ability to acquire clinically meaningful images for a range of women with varying breast densities and, therefore, has potential as a screening device.

Ultrasound follow-up for gallbladder polyps less than 6 mm may not be necessary.

INTRODUCTION: The management of ultrasound (US) detected gallbladder (GB) polyps remains a dilemma. The aim of this study was to assess the size distribution and the outcome of US follow-up of GB polyps. MATERIAL AND METHODS: The study was approved by the Danish Data Protection Agency. US reports from patients examined with abdominal US in our department from January 2008 to the end of December 2009 were reviewed with a view to including all patients with GB polyps. Patients with GB polyps are routinely recommended a 2-year follow-up with US every six months. The GB polyp size was recorded at baseline and at subsequent US reports. Pathology reports were finally reviewed for all patients with GB polyps to check who underwent cholecystectomy and to register the histological diagnosis. RESULTS: A total of 203 patients (median age 54 years; range 19-95 years) with GB polyps were included; 89 (44%) men and 114 (56%) women. The mean polyp size was 5 mm (range 2-40 mm). In 143 patients (70%) the GB polyp diameter was less than 6 mm. The first US follow-up was performed in 120 patients (59%), and only 31 (15%) completed the full 2-year US follow-up programme. Polyp size was stable in 100 patients, decreased in five patients, increased in eight and resolved in 15 patients. A total of 13 patients (6%) underwent cholecystectomy. Of the 203 patients, none showed neoplastic or malignant GB polyps. CONCLUSION: We recommend that follow-up US of patients with GB polyps < 6 mm is avoided. Alternatively, the intervals between US follow-up of GB polyps < 6 mm may be extended. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.