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To quantify the excellence of multimedia quality, subjective evaluation experiments are conducted. In these experiments, the tradition of quantitative assessment is the most dominating, but it disregards the understanding of participants' interpretations, descriptions, and the evaluation criteria of quality. The goal of this paper is to present a new multimedia quality evaluation method called Open Profiling of Quality (OPQ) as a tool for building a deeper understanding on subjective quality. OPQ is a mixed method combining a conventional quantitative psychoperceptual evaluation and qualitative descriptive quality evaluation based on the individual's own vocabulary. OPQ is targeted for naïve participants applicable to experiments with heterogeneous and multimodal stimulus material. The paper presents the theoretical basis of the development of OPQ and overviews the methods for audiovisual quality research. We present three extensive quality evaluation studies where OPQ has been used with 120 participants. Finally, we conclude further recommendations of use of the method in quality evaluation research.

This paper focuses on the diagnostics and applications of the microhollow cathode discharge operated in Ar and He at high pressures. The gas temperature and electron number density in Ar and He are deduced from absorption and emission spectroscopy employing line profile analysis. Additionally, a collisional radiative model is used for the estimation of the electron number density in He. The gas temperature increases in Ar from 500 K at 100 mbar to 2000 K at 1000 mbar. The electron density also increases from 2 × 1015 to 9 × 1015 cm-3 in the same pressure range. In He, the gas temperature reaches values up to 800 K and the electron density does not exceed 5 × 1014 cm-3 at atmospheric pressure. The discharge was coupled with emission and mass spectrometry for analytical applications. The detection of organometallic compounds (ferrocene) reveals good detection limits of about 500 ppb for Fe. [ABSTRACT FROM AUTHOR]

The transfer of foreign genes into eukaryotic cells, in particular mammalian cells, has been essential to our understanding of the functional significance of genes and regulatory sequences as well as the development of gene therapy strategies. To this end, different mammalian expression vector systems have been designed. The choice of a particular expression system depends on the nature and purpose of the study and will involve selecting particular parameters of expression systems such as the type of promoter/enhancer sequences, the type of expression (transient versus stable) and the level of desired expression. In addition, the success of the study depends on efficient gene transfer. The purification of the expression vectors, as well as the transfer method, affects transfection efficiency. Numerous approaches have been developed to facilitate the transfer of genes into cells via physical, chemical or viral strategies. While these systems have all been effective in vitro they need to be optimized for individual cell types and, in particular, for in vivo transfection.

Purpose: Myocardial T 1ρ mapping techniques commonly acquire multiple images in one breathhold to calculate a single-slice T 1ρ map. Recently, non-selective adiabatic pulses have been used for robust spin-lock preparation (T 1ρ,adiab ). The objective of this study was to develop a fast multi-slice myocardial T 1ρ,adiab mapping approach., Methods: The proposed-sequence reduces the number of breathholds required for whole-heart 2D T 1ρ,adiab mapping by acquiring multiple interleaved slices in each breathhold using slice-selective T 1ρ,adiab preparation pulses. The proposed-sequence was implemented with two interleaved slices per breathhold scan and was quantitatively evaluated in phantom experiments and 10 healthy-volunteers against a single-slice T 1ρ,adiab mapping sequence. The sequence was demonstrated in two patients with myocardial scar., Results: The phantom experiments showed the proposed-sequence had slice-to-slice variation of 1.62% ± 1.05% and precision of 4.51 ± 0.68 ms. The healthy volunteer cohort subject-wise mean relaxation time was lower for the proposed-sequence than the single-slice sequence (137.7 ± 5.3 ms vs. 148.4 ± 8.3 ms, p < 0.001), and spatial-standard-deviation was better (18.7 ± 1.8 ms vs. 21.8 ± 3.4 ms, p < 0.018). The mean within-subject, coefficient of variation was 5.93% ± 1.57% for the proposed-sequence and 6.31% ± 1.92% for the single-slice sequence (p = 0.35) and the effect of slice variation (0.81 ± 4.87 ms) was not significantly different to zero (p = 0.61). In both patient examples increased T 1ρ,adiab (maximum American Heart Association-segment mean = 174 and 197 ms) was measured within the myocardial scar., Conclusion: The proposed sequence provides a twofold acceleration for myocardial T 1ρ,adiab mapping using a multi-slice approach. It has no significant difference in within-subject variability, and significantly better precision, compared to a 2D T 1ρ,adiab mapping sequence based on non-selective adiabatic spin-lock preparations., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Purpose: MRI-guidance of cardiac catheterization is currently performed using one or multiple 2D imaging planes, which may be suboptimal for catheter navigation, especially in patients with complex anatomies. The purpose of the work was to develop a robust real-time 3D catheter tracking method and 3D visualization strategy for improved MRI-guidance of cardiac catheterization procedures., Methods: A fast 3D tracking technique was developed using continuous acquisition of two orthogonal 2D-projection images. Each projection corresponds to a gradient echo stack of slices with only the central k-space lines being collected for each slice. To enhance catheter contrast, a saturation pulse is added ahead of the projection pair. An offline image processing algorithm was developed to identify the 2D coordinates of the balloon in each projection image and to estimate its corresponding 3D coordinates. Post-processing includes background signal suppression using an atlas of background 2D-projection images. 3D visualization of the catheter and anatomy is proposed using three live sagittal, coronal, and axial (MPR) views and 3D rendering. The technique was tested in a subset of a catheterization step in three patients undergoing MRI-guided cardiac catheterization using a passive balloon catheter., Results: The extraction of the catheter balloon 3D coordinates was successful in all patients and for the majority of time-points (accuracy >96%). This tracking method enabled a novel 3D visualization strategy for passive balloon catheter, providing enhanced anatomical context during catheter navigation., Conclusion: The proposed tracking strategy shows promise for robust tracking of passive balloon catheter and may enable enhanced visualization during MRI-guided cardiac catheterization., (© 2024 The Author(s). Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Background: Simultaneous multi-slice (SMS) bSSFP imaging enables stress myocardial perfusion imaging with high spatial resolution and increased spatial coverage. Standard parallel imaging techniques (e.g., TGRAPPA) can be used for image reconstruction but result in high noise level. Alternatively, iterative reconstruction techniques based on temporal regularization (ITER) improve image quality but are associated with reduced temporal signal fidelity and long computation time limiting their online use. The aim is to develop an image reconstruction technique for SMS-bSSFP myocardial perfusion imaging combining parallel imaging and image-based denoising using a novel noise map estimation network (NoiseMapNet), which preserves both sharpness and temporal signal profiles and that has low computational cost., Methods: The proposed reconstruction of SMS images consists of a standard temporal parallel imaging reconstruction (TGRAPPA) with motion correction (MOCO) followed by image denoising using NoiseMapNet. NoiseMapNet is a deep learning network based on a 2D Unet architecture and aims to predict a noise map from an input noisy image, which is then subtracted from the noisy image to generate the denoised image. This approach was evaluated in 17 patients who underwent stress perfusion imaging using a SMS-bSSFP sequence. Images were reconstructed with (a) TGRAPPA with MOCO (thereafter referred to as TGRAPPA), (b) iterative reconstruction with integrated motion compensation (ITER), and (c) proposed NoiseMapNet-based reconstruction. Normalized mean squared error (NMSE) with respect to TGRAPPA, myocardial sharpness, image quality, perceived SNR (pSNR), and number of diagnostic segments were evaluated., Results: NMSE of NoiseMapNet was lower than using ITER for both myocardium (0.045 ± 0.021 vs. 0.172 ± 0.041, p  < 0.001) and left ventricular blood pool (0.025 ± 0.014 vs. 0.069 ± 0.020, p  < 0.001). There were no significant differences between all methods for myocardial sharpness ( p  = 0.77) and number of diagnostic segments ( p  = 0.36). ITER led to higher image quality than NoiseMapNet/TGRAPPA (2.7 ± 0.4 vs. 1.8 ± 0.4/1.3 ± 0.6, p  < 0.001) and higher pSNR than NoiseMapNet/TGRAPPA (3.0 ± 0.0 vs. 2.0 ± 0.0/1.3 ± 0.6, p  < 0.001). Importantly, NoiseMapNet yielded higher pSNR ( p  < 0.001) and image quality ( p  < 0.008) than TGRAPPA. Computation time of NoiseMapNet was only 20s for one entire dataset., Conclusion: NoiseMapNet-based reconstruction enables fast SMS image reconstruction for stress myocardial perfusion imaging while preserving sharpness and temporal signal profiles., Competing Interests: SM, KK, PS, DS and RN were Siemens Healthcare employees at the time of the study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (© 2024 Adam, Kowalik, Tyler, Mooiweer, Neofytou, McElroy, Kunze, Speier, Stäb, Neji, Nazir, Razavi, Chiribiri and Roujol.)

Background: Myocardial quantitative susceptibility mapping (QSM) may offer better specificity to iron than conventional T 2 * imaging in the assessment of cardiac diseases, including intra-myocardial hemorrhage. However, the precision and repeatability of cardiac QSM have not yet been characterized. The aim of this study is to characterize these key metrics in a healthy volunteer cohort and show the feasibility of the method in patients., Methods: Free breathing respiratory-navigated multi-echo 3D gradient echo images were acquired, from which QSM maps were reconstructed using the Morphology Enhanced Dipole Inversion toolbox. This technique was first evaluated in a susceptibility phantom containing tubes with known concentrations of gadolinium. In vivo characterization of myocardial QSM was then performed in a cohort of 10 healthy volunteers where each subject was scanned twice. Mean segment susceptibility, precision (standard deviation of voxel magnetic susceptibilities within one segment), and repeatability (absolute difference in segment mean susceptibility between repeats) of QSM were calculated for each American Heart Association (AHA) myocardial segment. Finally, the feasibility of the method was shown in 10 patients, including four with hemorrhagic infarcts., Results: The phantom experiment showed a strong linear relationship between measured and predicted susceptibility shifts (R 2 > 0.99). For the healthy volunteer cohort, AHA segment analysis showed the mean segment susceptibility was 0.00 ± 0.02 ppm, the mean precision was 0.05 ± 0.04 ppm, and the mean repeatability was 0.02 ± 0.02 ppm. Cardiac QSM was successfully performed in all patients. Focal iron deposits were successfully visualized in the patients with hemorrhagic myocardial infarctions., Conclusion: The precision and repeatability of cardiac QSM were successfully characterized in phantom and in vivo experiments. The feasibility of the technique was also successfully demonstrated in patients. While challenges still remain, further clinical evaluation of the technique is now warranted., Trial Registration: This work does not report on a health care intervention., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: L.H. reports financial support was provided by Neoscan Solutions GmbH. P.G.M. reports a relationship with Perspectum Ltd. that includes consulting or advisory. L.H.: KCL employee at the time of the study and has since become an employee of Neoscan Solutions GmbH. K.K. and R.N.: Employees of Siemens Healthcare Limited. R.M.: Seconded to Siemens Healthcare Limited. P.G.M.: Consultant for Perspectum Diagnostics Limited. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Visualizing left atrial anatomy including the pulmonary veins (PVs) is important for planning the procedure of pulmonary vein isolation with ablation in patients with atrial fibrillation (AF). The aims of our study are to investigate the feasibility of the 3D whole-heart bright-blood and black-blood phase-sensitive (BOOST) inversion recovery sequence in patients with AF scheduled for ablation or electro-cardioversion, and to analyze the correlation between image quality and heart rate and rhythm of patients., Methods: BOOST was performed for assessing PVs both with T2 preparation pre-pulse (T2prep) and magnetization transfer preparation (MTC) in 45 patients with paroxysmal or permanent AF scheduled for ablation or electro-cardioversion. Image quality analyses were performed by two independent observers. Qualitative assessment was made using the Likert scale; for quantitative analysis, signal to noise ratios (SNR) and contrast to noise ratios (CNR) were calculated for each PV. Heart rate and rhythm were analyzed based on standard 12-lead ECGs., Results: All MTC-BOOST acquisitions achieved diagnostic quality in the PVs, while a significant proportion of T2prep-BOOST images were not suitable for assessing PVs. SNR and CNR values of the MTC-BOOST bright-blood images were higher if patients had sinus rhythm. We found a significant or nearly significant negative correlation between heart rate and the SNR and CNR values of MTC-BOOST bright-blood images., Conclusion: 3D whole-heart MTC-BOOST bright-blood imaging is suitable for visualizing the PVs in patients with AF, producing diagnostic image quality in 100% of cases. However, image quality was influenced by heart rate and rhythm., Clinical Relevance Statement: The novel 3D whole-heart BOOST CMR sequence needs no contrast administration and is performed during free-breathing; therefore, it is easy to use for a wide range of patients and is suitable for visualizing the PVs in patients with AF., Key Points: • The applicability of the novel 3D whole-heart bright-blood and black-blood phase-sensitive sequence to pulmonary vein imaging in clinical practice is unknown. • Magnetization transfer-bright-blood and black-blood phase-sensitive imaging is suitable for visualizing the pulmonary veins in patients with atrial fibrillation with excellent or good image quality. • Bright-blood and black-blood phase-sensitive cardiac magnetic resonance sequence is easy to use for a wide range of patients as it needs no contrast administration and is performed during free-breathing., (© 2023. The Author(s).)

Tixagevimab/cilgavimab (tix/cil) received emergency use authorization in December 2021 for pre-exposure prophylaxis against COVID-19 in moderately to severely immunocompromised patients. Our study aimed to describe the incidence of COVID-19 infection and assess the immunologic risks associated with tix/cil in kidney, pancreas, liver, and heart transplant recipients. Retrospective chart review was completed to provide descriptive analysis. Outcomes data included COVID-19 infection, severity of COVID-19 infection, graft function, and rejection. Safety outcomes included cardiovascular (CV) and hypersensitivity events post tix/cil administration. A total of 410 transplant patients were included in the analysis: 20 heart, 92 liver, 243 kidney, 25 simultaneous pancreas/kidney, 23 simultaneous liver/kidney, and seven simultaneous heart/kidney. Twenty-seven (6.5%) patients tested positive for COVID-19 via PCR or antigen test post tix/cil. No apparent difference was observed in patients testing positive for COVID-19 by type of organ transplant (p = .122). Twenty-five of the 27 patients testing positive for COVID-19 reported symptomatic infection, only nine of whom were hospitalized. No patients were mechanically ventilated and no deaths due to COVID-19 occurred. No significant changes in graft function were observed. Clinically significant rejection was diagnosed and treated in four patients. COVID-19 breakthrough infection rates remained low in immunocompromised solid organ transplant recipients who received tix/cil. No significant immunologic risks were observed., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Quantifying the intrinsic properties of 2D materials is of paramount importance for advancing their applications. Large-scale production of 2D materials merits the need for approaches that provide direct information about the role of growth substrate on 2D material properties. Transferring the 2D material from its growth substrates can modify the intrinsic properties of the asgrown 2D material. In this study, suspended chemical vapor deposition (CVD) graphene films are prepared directly on their growth substrates in a high-density grid array. The approach facilitates the quantification of intrinsic strain and doping in suspended CVD graphene films. To achieve this, transmission electron microscopy and large-area Raman mapping are employed. Remarkably, the analysis reveals consistent patterns of compressive strain (≈-0.2%) both in the diffraction patterns and Raman maps obtained from these suspended graphene films. By conducting investigations directly on the growth substrates, the potential influences introduced during the transfer process are circumvented effectively. Consequently, the methodology offers a robust and reliable means of studying the intrinsic properties of 2D materials in their authentic form, uninfluenced by the transfer-induced alterations that may skew the interpretation of their properties., (© 2023 The Authors. Advanced Science published by Wiley-VCH GmbH.)

An optical system for multichannel coupling of laser arrays to polymer waveguide array probes with a single biconvex lens is developed. The developed cylindrical module with 13 mm and 20 mm in diameter and length, respectively, enables coupling of eight individual optical channels using an aspheric lens. Specific coupling with crosstalk below -13 d B for each channel and quasi-uniform coupling over all channels is achieved for a waveguide array with 100 µm lateral facet pitch at the incoupling site. The polymer waveguide technology allows for tapering of the lateral waveguide pitch to 25 µm toward the tip of the flexible waveguide array. SU-8 and PMMA are used as the waveguide core and cladding, respectively. The optical coupling module is designed as a prototype for preclinical evaluation of optical neural stimulators.

Purpose: This study aims to evaluate the impact of birth weight (BW), gestational age (GA), retinopathy of prematurity (ROP), and perinatal brain injury (PBI) on optic nerve head (ONH) parameters and nerve fiber layer thickness (RNFLT) in preterm children., Methods: ONH parameters and RNFLT were examined prospectively in 5-15-year-old preterm and full-term children with RTVue-100 OCT (Optovue, USA). The parameters of the two groups were compared and possible influences of BW, GA, ROP, and PBI analyzed in preterm children., Results: In total, 51 full-term and 55 preterm children were included. The mean age was 9.98 ± 3.4 years in full-term and 10.0 ± 2.5 years in preterm children. The mean GA in preterm children was 29.6 ± 3.8 weeks with a BW of 1523 ± 732 g. RNFLT was significantly lower in preterm than in full-term children in all but temporal quadrants. Cup area, volume, cup/disc area ratio, and horizontal cup/disc ratio (CDR) were significantly larger and rim area significantly thinner in preterm children. GA was positively correlated with superior, nasal, and overall RNFLT and negatively correlated with cup area, volume, and horizontal CDR. ROP stage correlated negatively with superior and nasal RNFLT. PBI was the only significant predicting factor for RNFL thinning in all but temporal quadrant in multiple regression analysis. Preterm children with PBI had a significantly larger optic cup (CDR 0.70 ± 0.33 vs. 0.37 ± 0.27) and thinner optic rim., Conclusion: PBI correlated strongest with RNFL thinning, a thinner optic rim, and a larger optic cup in preterm children and should be evaluated in each patient to prevent incorrect diagnosis like glaucoma., (© 2023. The Author(s).)

Background: There is a paucity of evidence to inform the value of pharmacogenomic (PGx) results in patients after kidney transplant and how these results differ between Indigenous Americans and Whites. This study aims to identify the frequency of recommended medication changes based on PGx results and compare the pharmacogenomic (PGx) results and patients' perceptions of the findings between a cohort of Indigenous American and White kidney transplant recipients., Methods: Thirty-one Indigenous Americans and fifty White kidney transplant recipients were studied prospectively. Genetic variants were identified using the OneOme RightMed PGx test of 27 genes. PGx pharmacist generated a report of the genetic variation and recommended changes. Pre- and post-qualitative patient surveys were obtained., Results: White and Indigenous American subjects had a similar mean number of medications at the time of PGx testing (mean 13 (SD 4.5)). In the entire cohort, 53% received beta blockers, 30% received antidepressants, 16% anticoagulation, 47% pain medication, and 25% statin therapy. Drug-gene interactions that warranted a clinical action were present in 21.5% of patients. In 12.7%, monitoring was recommended. Compared to the Whites, the Indigenous American patients had more normal CYP2C19 ( p = 0.012) and CYP2D6 ( p = 0.012) activities. The Indigenous American patients had more normal CYP4F2 ( p = 0.004) and lower VKORC ( p = 0.041) activities, phenotypes for warfarin drug dosing, and efficacy compared to the Whites. SLC6A4, which affects antidepressant metabolism, showed statistical differences between the two cohorts ( p = 0.017); specifically, SLC6A4 had reduced expression in 45% of the Indigenous American patients compared to 20% of the White patients. There was no significant difference in patient perception before and after PGx., Conclusions: Kidney transplant recipients had several drug-gene interactions that were clinically actionable; over one-third of patients were likely to benefit from changes in medications or drug doses based on the PGx results. The Indigenous American patients differed in the expression of drug-metabolizing enzymes and drug transporters from the White patients.

Introduction: Left atrial appendage (LAA) thrombus is the most common source of embolization in atrial fibrillation (AF). Transesophageal echocardiography (TEE) is the gold standard method for LAA thrombus exclusion. Our pilot study aimed to compare the efficacy of a new non-contrast-enhanced cardiac magnetic resonance (CMR) sequence (BOOST) with TEE for the detection of LAA thrombus and to evaluate the usefulness of BOOST images for planning radiofrequency catheter ablation (RFCA) compared with left atrial (LA) contrast-enhanced computed tomography (CT). We also attempted to assess the patients' subjective experiences with TEE and CMR., Methods: Patients with AF undergoing either electrical cardioversion or RFCA were enrolled. Participants underwent pre-procedural TEE and CMR scans to evaluate LAA thrombus status and pulmonary vein anatomy. Patient experiences with TEE and CMR were assessed using a questionnaire developed by our team. Some patients scheduled for RFCA also had pre-procedural LA contrast-enhanced CT. In such cases, the operating physician was asked to subjectively define the quality of the CT and CMR scan on a scale of 1-10 (1 = worst, 10 = best) and comment on CMR's usefulness in RFCA planning., Results: Seventy-one patients were enrolled. In 94.4%, both TEE and CMR excluded, and in 1 patient, both modalities reported the presence of LAA thrombus. In 1 patient, TEE was inconclusive, but CMR excluded LAA thrombus. In 2 patients, CMR could not exclude the presence of thrombus, but in 1 of those cases, TEE was also indecisive. During TEE, 67%, during CMR, only 1.9% of patients reported pain ( p  < 0.0001), and 89% would prefer CMR in case of a repeat examination. The quality of the left atrial contrast-enhanced CT scans was better compared with the image quality of the CMR BOOST sequence [8 (7-9) vs. 6 (5-7), p  < 0.0001]. Still, the CMR images were useful for procedural planning in 91% of cases., Conclusion: The new CMR BOOST sequence provides appropriate image quality for ablation planning. The sequence might be useful for excluding larger LAA thrombi; however, its accuracy in detecting smaller thrombi is limited. Most patients preferred CMR over TEE in this indication., Competing Interests: KK, RN, and MK are employees of Siemens Healthineers. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Orbán, Dohy, Suhai, Nagy, Salló, Boga, Kiss, Kunze, Neji, Botnar, Prieto, Gellér, Merkely, Vágó and Szegedi.)

Abstract: The students at Mayo Clinic Alix School of Medicine (MCASOM) wrote a call to action to medical school leadership in June 2020. The students requested help in navigating socio-political barriers that affected one another and contributed to healthcare inequities and mistrust. Using the Association of American Medical Colleges (AAMC) tool to assess cultural competence training, our team evaluated the baseline 2017-2018 MCASOM curriculum. There were 254 learning objectives, of which 43 (17%) were related to inclusion, diversity, antiracism, and equity (I-DARE). Mirroring the concerns of the students, the findings identified minimal content about antiracism and inclusion. By applying DMAIC principles for quality and process improvement, we aimed to increase the number of taught learning objectives about I-DARE content for the first-year and second-year medical students by 100%, from 43 to 86 objectives, without adversely affecting student satisfaction and true attendance. To address the underlying causes, we launched a virtual, multisite I-DARE medical school course and doubled the number of I-DARE-taught learning objectives from 43 to 107 (149%), compared with the baseline. The program evaluation review revealed that the students were self-reflective and provided a spectrum of experiences regarding the I-DARE course., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 National Association for Healthcare Quality.)

Competing Interests: None disclosed.

Residual neuromuscular blockade (NMB) is an important and modifiable factor associated with prolonged mechanical ventilation after cardiac surgery. Studies evaluating the use of sugammadex for residual NMB reversal in the post-cardiac surgery ICU setting are lacking. We conducted a randomized trial to determine the efficacy of sugammadex in reducing time to extubation in patients admitted to the ICU after cardiac surgery., Design: Single-center, randomized, double-blind, placebo-controlled trial., Setting: University-based cardiothoracic ICU., Subjects: Patients ( n = 90) undergoing elective aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) surgery., Interventions: Participants were randomized to receive either sugammadex (2 mg/kg) or placebo after arrival to the ICU., Measurements and Main Results: The primary study endpoint was time from study drug administration to extubation. Of the 90 patients included in the study (45 in each group), a total of 68 patients underwent CABG, 13 AVR, and nine combined AVR and CABG. Baseline characteristics and intraoperative anesthetic medications were comparable between groups. Patients in sugammadex group had reduced time to extubation compared with the placebo group (median [interquartile range (IQR)]-sugammadex group: 126.0 min [84.0-274.0 min] vs placebo: 219.0 min [121.0-323.0 min]; difference in means [95% CI], 72.8 [1.5-144.1 min]; p = 0.01. There were no differences in negative inspiratory force (mean [sd]-sugammadex group: 33.79 cm H 2 O [8.39 cm H 2 O] vs placebo: -31.11 cm H 2 O [7.17 cm H 2 O]) and vital capacity (median [IQR]-sugammadex group: 1.1 L [0.9-1.3 L] vs placebo: 1.0 L [0.9-1.2 L]). There were no differences between groups in postoperative blood product requirement, dysrhythmias, length of ICU, or hospital stay. There were no serious adverse events in either group., Conclusions: This randomized trial showed that the administration of sugammadex after cardiac surgery decreased time to extubation by approximately 1 hour. Larger trials may be required to confirm these findings and determine the clinical implications., Competing Interests: The authors have disclosed that they do not have any potential conflicts of interest., (Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)

This study aimed to understand how genetics and environment influence organic winter naked barley composition and functionality, and to identify traits that might effectively categorize basic physicochemical functionality of food barley. Across three years, two locations, and 15 genotypes, genotype significantly influenced all 10 food-related traits and was the dominant influence for three. Location significantly influenced eight traits and was dominant for three. Year significantly influenced all traits but was dominant only for one. Of the interactions location * year was the most influential and was the dominant effect for two traits. For all interaction terms where genotype was a component, the effect sizes were either small or non-significant suggesting that even with low leverage traits there is the potential for genetic gain by observing trait rankings across environments. Principal component analysis identified six traits that could serve to categorize basic physicochemical functionality of food barley. These were grain protein content, beta-glucan content, flour-water batter flow, water solvent retention capacity, time to peak viscosity of cooked flour, and hardness of cooked intact grains.

Background: The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported., Objective: To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia., Design: Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505)., Setting: 46 U.S. and Canadian hospitals., Participants: Patients aged 50 years or older undergoing hip fracture surgery., Intervention: Spinal or general anesthesia., Measurements: Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care., Results: A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups., Limitation: Missing outcome data and multiple outcomes assessed., Conclusion: Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia., Primary Funding Source: Patient-Centered Outcomes Research Institute .

Ammonia solution etching was carried out on thermally-oxidised cuprous oxide (TO-Cu 2 O) in photocathode devices for water splitting. The etched devices showed increased photoelectrochemical (PEC) performance compared to the unetched ones as well as improved reproducibility. -8.6 mA cm -2 and -7 mA cm -2 photocurrent density were achieved at 0 V and 0.5 V versus the reversible hydrogen electrode (V RHE ), respectively, in the champion sample with an onset potential of 0.92 V RHE and a fill factor of 44%. An applied bias photon-to-current efficiency of 3.6% at 0.56 V RHE was obtained, which represents a new record for Cu 2 O-based photocathode systems. Capacitance-based profiling studies showed a strong pinning effect from interfacial traps in the as-grown device, and these traps were removed by ammonia solution etching. Moreover, the etching procedure gave rise to a diverse morphology of Cu 2 O crystals based on the different crystallographic orientations. The distribution of crystallographic orientations and the relationship between the crystal orientation and the morphology after etching were examined by electron backscatter diffraction (EBSD) and scanning electron microscopy (SEM). The high-index crystal group showed a statistically higher PEC performance than the low-index group. X-ray photoelectron spectroscopy (XPS) and transmission electron microscopy (TEM) revealed metallic copper at the Cu 2 O/Ga 2 O 3 interface, which we attribute as the dominant trap that limits the PEC performance. It is concluded that the metallic copper originates from the reduction of the CuO impurity layer on the as-grown Cu 2 O sample during the ALD process, while the reduction from Cu 2 O to Cu is not favourable., Competing Interests: W. N. received sponsored research funding from PERA Complexity for the work in this article. The methodology described above is part of a system with the potential for commercialization as technology to be led by PERA Complexity within its patent portfolio., (This journal is © The Royal Society of Chemistry.)

Introduction: The Orthopaedic Interview Spreadsheet (OIS) is an annual, open-source Google sheet used by prospective orthopaedic surgery applicants to share applicant statistics, interview data, and program information. The purpose of the current study was to determine whether self-reported applicant statistics within the OIS were representative of the official orthopaedic applicant pool, as reported by the National Resident Matching Program (NRMP)., Methods: A total of 243 self-reported applicants from the 2017-2018 (n=136) and 2019-20 (n=107) orthopaedic surgery residency application cycles who used the OIS were identified., Usmle: Step1 scores, Step2 scores, total research items reported on the Electronic Residency Application Service® (ERAS), and Alpha Omega Alpha (AOA) status were compared to NRMP weighted means from the 2018 and 2020 Charting Outcomes in the Match reports using one-sampled t-tests and one-sample binomial tests., Results: According to the 2017-2018 OIS data, the self-reported Step 1 score (n=126) (M:251.3 ±10.5, p<0.001), Step 2 score (n=113) (M:259.4 ±8.5, p<0.001), and total research items (n=129) (M:8.9 ±8.6, p=0.019) were all statistically different from their respective NRMP weighted means. The NRMP cohort of applicants with AOA membership (36.4%) was significantly different than the OIS cohort (53.7%), (p<0.001). Similarly, for 2019-2020, the OIS Step 1 score (n=105) (M: 248.8 ±0.7, p=0.016) and Step 2 score (n=93) (M:257.4 ±9.4, p<0.001) were statistically different from their respective NRMP weighted means. OIS total research items (n=102) (M: 15.0 ±15.2, p=0.656) was not statistically different from its NRMP weighted mean. The NRMP cohort of applicants with AOA membership (36.4%) was significantly different than the OIS cohort (53.7%), (p=0.040)., Conclusion: Prospective applicants should be cautious about using this document to solely gauge their competitiveness during the application process. The real value of the OIS is its non-quantifiable message board functions that provide peer-to-peer mentorship and the collaborative, uncensored community it fosters., Competing Interests: Conflict of interest None, (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Purpose: To develop and internally validate a machine-learning algorithm to reliably predict cost after anterior cruciate ligament reconstruction (ACLR)., Methods: A retrospective review of the New York State Ambulatory Surgery and Services database was performed to identify patients who underwent elective ACLR from 2015 to 2016. Features included in initial models consisted of patient characteristics (age, sex, insurance status, income, medical comorbidities as classified by the Clinical Classifications Software diagnosis code) as well as intraoperative variables (type of anesthesia and procedure-specific factors). Models were generated to predict total charges using 4 algorithms: random forest, extreme gradient boost, elastic net penalized regression, and support vector machines with radial kernels. Training was performed with 10-fold cross-validation followed by internal validation via 0.632 bootstrapping. Model discriminative performance was assessed by area under the receiver operating characteristic curve, calibration, and the Brier score. Decision curve analysis was performed to demonstrate the net benefit of using the final model in practice., Results: In total, 7,311 patients undergoing ambulatory ACLR were included. The random forest model demonstrated the best performance assessed via internal validation (area under the curve = 0.85), calibration, and the Brier score (0.208). Cost incurred was influenced by anesthesia type, operating room time, and number of chronic comorbidities. Decision curve analysis revealed a net benefit for use of the random forest model and the model was integrated into a web-based open-access application., Conclusions: The random forest model predicted cost after ambulatory ACLR using a large, statewide database with good performance. The top variables found to predict increased charges were general anesthesia, operating room time, meniscal repair, self-pay insurance, patient neighborhood characteristics, and number of chronic conditions., Level of Evidence: III, retrospective cohort study., (© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.)

Purpose: To develop and evaluate a novel and generalizable super-resolution (SR) deep-learning framework for motion-compensated isotropic 3D coronary MR angiography (CMRA), which allows free-breathing acquisitions in less than a minute., Methods: Undersampled motion-corrected reconstructions have enabled free-breathing isotropic 3D CMRA in ~5-10 min acquisition times. In this work, we propose a deep-learning-based SR framework, combined with non-rigid respiratory motion compensation, to shorten the acquisition time to less than 1 min. A generative adversarial network (GAN) is proposed consisting of two cascaded Enhanced Deep Residual Network generator, a trainable discriminator, and a perceptual loss network. A 16-fold increase in spatial resolution is achieved by reconstructing a high-resolution (HR) isotropic CMRA (0.9 mm 3 or 1.2 mm 3 ) from a low-resolution (LR) anisotropic CMRA (0.9 × 3.6 × 3.6 mm 3 or 1.2 × 4.8 × 4.8 mm 3 ). The impact and generalization of the proposed SRGAN approach to different input resolutions and operation on image and patch-level is investigated. SRGAN was evaluated on a retrospective downsampled cohort of 50 patients and on 16 prospective patients that were scanned with LR-CMRA in ~50 s under free-breathing. Vessel sharpness and length of the coronary arteries from the SR-CMRA is compared against the HR-CMRA., Results: SR-CMRA showed statistically significant (P < .001) improved vessel sharpness 34.1% ± 12.3% and length 41.5% ± 8.1% compared with LR-CMRA. Good generalization to input resolution and image/patch-level processing was found. SR-CMRA enabled recovery of coronary stenosis similar to HR-CMRA with comparable qualitative performance., Conclusion: The proposed SR-CMRA provides a 16-fold increase in spatial resolution with comparable image quality to HR-CMRA while reducing the predictable scan time to <1 min., (© 2021 The Authors. Magnetic Resonance in Medicine published by Wiley Periodicals LLC on behalf of International Society for Magnetic Resonance in Medicine.)

Introduction: To report the prevalence and outcomes of unselected pancreatic cancer (PC) patients with pathogenic/likely pathogenic germline variants (PGVs) detected using a universal testing approach., Methods: We undertook a prospective, multisite study of germline sequencing using a >80 gene next-generation sequencing platform among 250 patients with PC (not selected for age or family history of cancer) between April 1, 2018, and March 31, 2020. Demographic, tumor characteristics, and clinical outcomes were compared between PGV carriers and noncarriers., Results: Of 250 patients, the mean age was 65 years (SD 8.7), 56% was male, 83.6% was White, and 65.6% had advanced disease (stages III and IV). PGVs were found in 15.2% (N = 38) of patients, and 2 patients had more than 1 PGV. Variants of uncertain significance were found in 44.4% (N = 111). Family history of cancer (odds ratio: 2.36, 95% confidence interval: 1.14-5.19, P = 0.025) was associated with a higher risk of PGV. In a median follow-up of 16.5 months, the median overall survival was 16.8 months in PGV carriers compared with 16.5 months in noncarriers (hazard ratio: 0.51, 95% confidence interval: 0.25-1.01, P = 0.05). Higher levels of carbohydrate antigen 19-9 and advanced disease stages (III and IV) were associated with worse outcomes in both groups. Overall, 68% of PGV carriers had mutations in homologous recombination repair genes, including BRCA1, BRCA2, PALB2, ATM, CHEK2, NBN, and RAD51C., Discussion: Universal multigene panel testing in PC reveals that 1 in 6 patients are carriers of PGV. Multigene germline testing should be used to aid in treatment selection, prognostication, and familial cancer counseling., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Purpose: To develop an end-to-end deep learning technique for nonrigid motion-corrected (MoCo) reconstruction of ninefold undersampled free-breathing whole-heart coronary MRA (CMRA)., Methods: A novel deep learning framework was developed consisting of a diffeomorphic registration network and a motion-informed model-based deep learning (MoDL) reconstruction network. The registration network receives as input highly undersampled (~22×) respiratory-resolved images and outputs 3D nonrigid respiratory motion fields between the images. The motion-informed MoDL performs MoCo reconstruction from undersampled data using the predicted motion fields. The whole deep learning framework, termed as MoCo-MoDL, was trained end-to-end in a supervised manner for simultaneous 3D nonrigid motion estimation and MoCo reconstruction. MoCo-MoDL was compared with a state-of-the-art nonrigid MoCo CMRA reconstruction technique in 15 retrospectively undersampled datasets and 9 prospectively undersampled acquisitions., Results: The acquisition time for ninefold accelerated CMRA was ~2.5 min. The reconstruction time was ~22 s for the proposed MoCo-MoDL and ~35 min for the conventional approach. MoCo-MoDL achieved higher peak SNR (27.86 ± 3.00 vs. 26.71 ± 2.79; P < .05) and structural similarity (0.78 ± 0.06 vs. 0.75 ± 0.06; P < .05) than the conventional approach. Similar vessel length and visual image quality score were obtained with the 2 methods, whereas improved vessel sharpness was observed with MoCo-MoDL., Conclusion: An end-to-end deep learning approach was introduced for simultaneous nonrigid motion estimation and MoCo reconstruction of highly undersampled free-breathing whole-heart CMRA. The rapid free-breathing CMRA acquisition together with the fast reconstruction of the proposed approach promises easy integration into clinical workflow., (© 2021 International Society for Magnetic Resonance in Medicine.)

»: While the majority of patients with trigger finger obtain excellent outcomes from nonoperative treatment or release of the A1 pulley, a subset of patients with advanced trigger finger, defined as trigger finger with loss of active or passive range of motion, may have incomplete symptom relief and warrant specific attention., »: Advanced trigger finger is more refractory to complete symptom resolution from corticosteroid injection, and particular attention should be paid to incomplete improvement of flexion contractures., »: Unlike simple trigger finger, the pathology in advanced trigger finger involves not only the A1 pulley but also the flexor tendon, including thickening and degeneration., »: Progression toward surgical intervention should not be delayed when nonoperative measures fail, and specific attention should be paid to persistent inability to achieve full extension following A1 pulley release., »: Facing substantial residual flexion contracture, reduction flexor tenoplasty and partial or complete resection of the superficialis tendon followed by hand therapy and splinting may be needed to allow patients to regain reliable full range of motion., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A746)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: The widespread clinical application of coronary cardiovascular magnetic resonance (CMR) angiography (CMRA) for the assessment of coronary artery disease (CAD) remains limited due to low scan efficiency leading to prolonged and unpredictable acquisition times; low spatial-resolution; and residual respiratory motion artefacts resulting in limited image quality. To overcome these limitations, we have integrated highly undersampled acquisitions with image-based navigators and non-rigid motion correction to enable high resolution (sub-1 mm 3 ) free-breathing, contrast-free 3D whole-heart coronary CMRA with 100% respiratory scan efficiency in a clinically feasible and predictable acquisition time., Objectives: To evaluate the diagnostic performance of this coronary CMRA framework against coronary computed tomography angiography (CTA) in patients with suspected CAD., Methods: Consecutive patients (n = 50) with suspected CAD were examined on a 1.5T CMR scanner. We compared the diagnostic accuracy of coronary CMRA against coronary CTA for detecting a ≥ 50% reduction in luminal diameter., Results: The 50 recruited patients (55 ± 9 years, 33 male) completed coronary CMRA in 10.7 ± 1.4 min. Twelve (24%) had significant CAD on coronary CTA. Coronary CMRA obtained diagnostic image quality in 95% of all, 97% of proximal, 97% of middle and 90% of distal coronary segments. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were: per patient (100%, 74%, 55%, 100% and 80%), per vessel (81%, 88%, 46%, 97% and 88%) and per segment (76%, 95%, 44%, 99% and 94%) respectively., Conclusions: The high diagnostic image quality and diagnostic performance of coronary CMRA compared against coronary CTA demonstrates the potential of coronary CMRA as a robust and safe non-invasive alternative for excluding significant disease in patients at low-intermediate risk of CAD.

High-performance polymer composites are being increasingly favored for structural applications. For this purpose, efforts are being focused on exploring the potential of high-performance thermoplastics and thermosets. Cyanate ester (CE) resin is a special thermoset that can be used at up to 400 °C without any considerable degradation; however, its tribological properties are not at the adequate level. Hence, it is needed to use this polymer in composite form with the fibrous/particulate reinforcement to impart better tribological properties and mechanical strength via a strong fiber-matrix interface. Carbon fiber/fabrics are at the forefront as reinforcement for specialty polymers. The tribological and tensile properties of cyanate ester (CE) composites-filled graphite, polytetrafluoroethylene (PTFE), and MoS 2 micron-sized fillers reinforced with carbon fibers (CF) are investigated experimentally in a block-on-ring setup at 100 N, for 10 h, and with a sliding distance of approximately 10,000 m, against a hardened polished 100Cr6 steel shaft and diamond-like-coated (DLC) 100Cr6 steel shaft. The tribological properties of the composites including the coefficient of friction and specific wear rate are enhanced especially with the incorporation of graphite fillers. The friction coefficient and wear rate of the graphite-based composite was decreased significantly at 5 wt.% of graphite concentration. Further, at the same concentration, the graphite-based composite showed superior tensile properties as compared to the reference system owing to better dispersion and adhesion between the fibers and matrix. Tensile tests are performed to characterize the fiber-matrix interfacial adhesion and other strength properties.

Study Objective: To identify risk factors associated with postoperative urinary retention in patients undergoing outpatient minimally invasive hysterectomy., Design: A retrospective cohort study., Setting: An academic medical center., Patients: All patients undergoing outpatient minimally invasive hysterectomy between January 2013 and July 2018 were considered for inclusion in the study., Interventions: Outpatient laparoscopic, vaginal, or robotically assisted laparoscopic hysterectomy., Measurements and Main Results: Four hundred forty-four patients met the inclusion criteria. Postoperative urinary retention occurred in 94 patients, and 347 patients successfully passed their voiding trial in the postanesthesia care unit for a pass rate of 79%. Demographic characteristics were similar, except patients who experienced postoperative urinary retention were less likely to be menopausal (23.4% vs 34.7%, p = .038). Those with urinary retention received more perioperative opioids (morphine milligram equivalent of 14.4 mg vs11.2 mg, p = .012), had longer operative times (122.9 ± 55.6 vs 95.7 ± 42.3 minutes, p < .01), and experienced more blood loss (105.3 ± 134.4 vs 78.5 ± 86.8 mL, p = .025). The rate of urinary tract infections was similar. Logistic regression analysis showed that the route of hysterectomy and age were not associated with an increased risk for urinary retention, whereas a longer operative time and higher doses of perioperative opioid use were., Conclusion: In patients undergoing minimally invasive outpatient hysterectomy, a longer operative time and increased perioperative narcotic use increases the risk of postoperative urinary retention., (Copyright © 2019 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Cardiovascular magnetic resonance (CMR) T1ρ mapping can be used to detect ischemic or non-ischemic cardiomyopathy without the need of exogenous contrast agents. Current 2D myocardial T1ρ mapping requires multiple breath-holds and provides limited coverage. Respiratory gating by diaphragmatic navigation has recently been exploited to enable free-breathing 3D T1ρ mapping, which, however, has low acquisition efficiency and may result in unpredictable and long scan times. This study aims to develop a fast respiratory motion-compensated 3D whole-heart myocardial T1ρ mapping technique with high spatial resolution and predictable scan time., Methods: The proposed electrocardiogram (ECG)-triggered T1ρ mapping sequence is performed under free-breathing using an undersampled variable-density 3D Cartesian sampling with spiral-like order. Preparation pulses with different T1ρ spin-lock times are employed to acquire multiple T1ρ-weighted images. A saturation prepulse is played at the start of each heartbeat to reset the magnetization before T1ρ preparation. Image navigators are employed to enable beat-to-beat 2D translational respiratory motion correction of the heart for each T1ρ-weighted dataset, after which, 3D translational registration is performed to align all T1ρ-weighted volumes. Undersampled reconstruction is performed using a multi-contrast 3D patch-based low-rank algorithm. The accuracy of the proposed technique was tested in phantoms and in vivo in 11 healthy subjects in comparison with 2D T1ρ mapping. The feasibility of the proposed technique was further investigated in 3 patients with suspected cardiovascular disease. Breath-hold late-gadolinium enhanced (LGE) images were acquired in patients as reference for scar detection., Results: Phantoms results revealed that the proposed technique provided accurate T1ρ values over a wide range of simulated heart rates in comparison to a 2D T1ρ mapping reference. Homogeneous 3D T1ρ maps were obtained for healthy subjects, with septal T1ρ of 58.0 ± 4.1 ms which was comparable to 2D breath-hold measurements (57.6 ± 4.7 ms, P = 0.83). Myocardial scar was detected in 1 of the 3 patients, and increased T1ρ values (87.4 ± 5.7 ms) were observed in the infarcted region., Conclusions: An accelerated free-breathing 3D whole-heart T1ρ mapping technique was developed with high respiratory scan efficiency and near-isotropic spatial resolution (1.7 × 1.7 × 2 mm 3 ) in a clinically feasible scan time of ~ 6 mins. Preliminary patient results suggest that the proposed technique may find applications in non-contrast myocardial tissue characterization.

Context: Alcoholic liver cirrhosis is a significant risk factor for the development of hepatocellular carcinoma (HCC). The importance of tumour-associated cirrhosis in the development or progression of HCC is not understood. MiRNAs are important regulators for HCC development, but their role in HCC due to alcoholic liver cirrhosis is unclear. Objective: The aim of this study is the detection of miRNA expression in alcoholic liver cirrhosis, tumour-associated cirrhosis, and HCC. Materials and methods: We analysed the differences in the miRNA profiles of HCC, tumour-associated cirrhosis, and cirrhosis without HCC samples from 30 patients who underwent liver transplantation because of alcoholic liver disease. Results: Microarray analyses revealed 40 significantly differentially expressed miRNAs between HCC tissue and tumour-associated cirrhosis tissue. Furthermore, the microarray analysis discovered 56 differentially expressed miRNAs in tumour-associated cirrhosis and cirrhosis without HCC. Discussion: The differences of miRNA profile in alcoholic liver cirrhosis with and without HCC could improve understanding of HCC development, as well as lead to a new diagnostic tool in HCC screening. Conclusion: We were able to show for the first time, the differences of miRNA profile as promising biomarker in HCC, tumour-associated cirrhosis, and cirrhosis without HCC in context of alcoholic liver disease.

Study Objective: To determine the incidence of a successful in-office voiding trial after minimally invasive hysterectomy., Design: A retrospective cohort study., Setting: A tertiary care academic center., Patients: All patients undergoing minimally invasive hysterectomies (vaginal, laparoscopic, or robotic) from January 2013 to July 2018 who have an unsuccessful voiding trial in the postoperative unit., Interventions: A voiding trial., Measurements and Main Results: Of 558 outpatient hysterectomies (with same-day discharge) performed in the time period of interest, 174 patients were discharged home with a Foley catheter (31%). Of those patients, 37% presented for a repeat in-office voiding trial at less than 3 postoperative days, 31% presented at 3 postoperative days, and 31.6% presented at more than 3 postoperative days. Eighty-six percent of patients presenting for their first in-office voiding trial were successful at voiding. There were no differences noted in age, gravity, parity, the use of hormone replacement therapy, menopausal status, smoking, hypertension, or diabetes in patients who passed their first in-office voiding trial compared with those who did not. Vaginal hysterectomy was the most common route of hysterectomy and was performed in 57% of cases followed by robotic hysterectomy in 32%. There were no differences noted in the indication or route of hysterectomy between patients who pass or fail their first in-office voiding trial. At the time of hysterectomy, 47% of patients had concomitant female pelvic medicine and reconstructive surgery procedures performed (midurethral sling, periurethral injections, or colporrhaphy). The incidence of urinary tract infections in this patient cohort was 12%, but the incidence was significantly higher in patients who failed compared with those who passed their first in-office voiding trial (37.3% vs 7.3%, p <.001). After adjusting for age, hysterectomy route, and concomitant female pelvic medicine and reconstructive surgery procedures performed, the number of postoperative days at the time of the first in-office voiding trial does not predict success., Conclusion: The timing of the repeat in-office voiding trial in posthysterectomy patients who fail their initial voiding trial in the postanesthesia care unit was not related to success. The incidence of urinary tract infections is higher in patients who fail their repeat voiding trial because recatheterization and a longer duration of catherization are necessary., (Copyright © 2019. Published by Elsevier Inc.)

This study describes the course of renal recovery after dialysis in a specific population of chronically critically ill patients with a history of prolonged and complicated treatment in an intensive care unit. This study shows that, in a specialized center, patients can be successfully weaned from dialysis even months after acute kidney injury (AKI). Of the patients who could be recompensated (33%), approximately 20% achieved renal recovery more than 3 months after the start of dialysis. The duration of renal recovery after AKI did not differ between those patients with pre-existing chronic kidney disease (CKD) and those without. The reason for dialysis treatment such as sepsis, surgery, resuscitation, as well as the risk factors (e. g., diabetes mellitus, arterial hypertension, arteriosclerosis) did not reveal a difference in weaning in a hazard analysis. As a potential risk factor, only age significantly influenced weaning from dialysis in the multivariate hazard model.

In the current study the hypothesis should be proven that T1 weighted Fast Field Echo (FFE) sequence is a useful method to visualize intervertebral disc degeneration, respectively changes of the expected disc appearance. Medical records of 208 dogs were reviewed and images of 781 intervertebral discs were evaluated by two blinded examiners using a modified Pfirrmann classification system in two MRI sequences: FFE and Turbo-Spin-Echo T2-weighted sequence (T2W). The patients were allocated to three categories based on body conformation: (1) brachycephalic and chondrodystrophic breeds, (2) non-chondrodystrophic and non-brachycephalic breeds with a body weight of < 25 kg, and (3) non-chondrodystrophic and non-brachycephalic breeds with a body weight greater or equal 25 kg. In brachycephalic and chondrodystrophic dogs 340 intervertebral discs were evaluated, the majority of them presented a mild change of the normal disc structure, 53% in the FFE sequence and 41% in T2W images. High discrepancies were observed between mild and moderate degeneration: in the FFE-sequence 15% ( n = 50) of the discs had signs of mild degeneration, whereas in T2W the same discs were graded as moderately degenerated. In non-chondrodystrophic and non-brachycephalic breeds under 25 kg body weight 320 intervertebral discs were assessed. In the FFE-sequence 52% ( n = 166) of the intervertebral discs were judged as having a mild degeneration. In contrast, these same discs were graded as healthy discs (22%), mildly degenerated (33%), moderately degenerated (37%), and severely degenerated (8%) in T2W. In non-chondrodystrophic and non-brachycephalic breeds greater or equal 25 kg 121 intervertebral discs were assessed. The grading was equal in 43%, but differed in one grade (47%) and in two grades (10%) between the two sequences. In both sequences intervertebral disc herniations were equally well-diagnosed. The Kappa coefficient revealed a high discrepancy between the two MRI-sequences. In conclusion, FFE cannot replace the well-established T2W sequence for grading disc degeneration.

The coupled multicomponent diffusion of the species Ca 2 Si 2 O 6 , CaAl 2 SiO 6 and Mg 2 Si 2 O 6 was determined in diopside crystals in the diopside/anorthite (Di/An) system at temperatures ( T ) of 1110-1260 °C and oxygen fugacities ( fO 2 ) between 1.0 log unit below and above the fayalite-magnetite-quartz equilibrium (FMQ ± 1). Diffusion couples were prepared by the seed overgrowth technique. Element concentration profiles were measured perpendicular to the rim/core interface by step-scanning profiling with a field emission gun scanning electron microscope (FEG-SEM). The multicomponent diffusion matrix was solved by fitting its eigenvalues ( λ ) and eigenvectors ( v ) to the measured concentration profiles. The full diffusion matrix D can be recovered by using the formula D = P Λ P - 1 resulting in the following equation: D Di/An = 1.00 - 0.67 - 0.38 1.00 λ 1 T 0 0 λ 2 T 1.00 - 0.67 - 0.38 1.00 - 1 . The eigenvalues ( λ1 and λ2 ) represent upper limit values and are described by the following Arrhenius-type equations: λ 1 Di/An = 10 - 15.98 ± 1.17 × exp - 114.4 ± 32.8 kJ/mol RT , λ 2 Di/An = 10 - 16.23 ± 1.17 × exp - 114.4 ± 32.8 kJ/mol RT , where λ 1 and λ 2 are the first and second eigenvalue of the diffusion matrix in m 2  s -1 , R is the gas constant and T is the temperature in K . The dominant eigenvalue ( λ1 ) is one quarter order of magnitude larger than the second eigenvalue ( λ 2). The eigenvectors are constant for all experiments inferring that the entire D matrix can be described with the eigenvalues as the only T -dependent parameter. Additionally, the derived diffusion data and modeling approach were applied to constrain the duration of magmatic processes recorded in zoned clinopyroxene (cpx) phenocrysts from a basaltic, post-plutonic dyke of the Tertiary Adamello batholiths (N-Italy). The results reveal residence times of the overgrown cpx prior to final emplacement in the range of 0.25-1.7 years (lower limit values) testifying that the data and method can be applied to model cpx diffusion profiles in complex natural cpx.

Purpose: To investigate, through Heidelberg retina tomography II (HRT II) and RTVue-100 optical coherence tomography (OCT), normal parameters of the optic nerve head (ONH) in highly hyperopic children, and compare these with a group of children with low hyperopia and emmetropia, as fundus examination of highly hyperopic children often shows crowding of the optic disc, which may be difficult to distinguish from mild optic disc swelling., Patients and Methods: ONH of the higher hyperopic eye was examined with HRT II and the peripapillary nerve fiber layer (RNFL) with RTVue-100, in 6 to 15-year-old full-term children with normal visual acuity and spherical equivalent ≥ + 3.0 D (hyperopic group) and < + 3.0 to - 1.0 D (emmetropic group)., Results: Thirty highly hyperopic children and 33 emmetropic controls had a mean spherical equivalent of + 5.1 ± 1.5 D and a mean age of 8.4 ± 2.8 years, and + 1.0 ± 1.2 D and 9.6 ± 2.6 years, respectively. There was no significant difference in OCT-assessed RNFL thickness between the two groups. Compared to the emmetropic group, following HRT parameters were significantly smaller in the hyperopic group: Disc area (1.41 vs. 1.68 mm 2 , p = 0.023), cup area (0.19 vs. 0.37 mm 2 , p = 0.0001), cup volume (0.03 vs. 0.08 mm 3 , p = 0.02), cup/disc area (0.13 vs. 0.20, p = 0.006), linear cup/disc (0.33 vs. 0.42, p = 0.004), and mean cup depth (0.13 vs. 0.17 mm, p = 0.019)., Conclusion: In children, ONH of highly hyperopic eyes are smaller than those of emmetropic eyes. RNFL thickness and neural rim volume are similar to emmetropic eyes. They can therefore appear more crowded., Competing Interests: No conflicts of interest are declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: The specific influence of preoperative and postoperative radiographic measurements on patient-reported outcome measures after hip arthroscopy for femoroacetabular impingement (FAI) remains unclear., Purpose: To investigate the relationship between radiographic measurements and 2-year outcomes after hip arthroscopy for the treatment of FAI., Study Design: Case series; Level of evidence, 4., Methods: A clinical registry of patients undergoing primary hip arthroscopy for FAI between January 1, 2012, and December 31, 2014, was queried. Outcome measures included the Hip Outcome Score (HOS) Activities of Daily Living (ADL), HOS Sport-Specific Subscale (SSS), modified Harris Hip Score (mHHS), and visual analog scale (VAS) for pain and satisfaction. Preoperative and postoperative radiographic measurements were recorded. Univariate analysis was conducted to identify relationships between all radiographic and demographic variables and outcome scores. A multivariate regression analysis, controlling for demographic factors, was used to identify independent associations between radiographic measurements on plain radiographs and patient-reported outcomes., Results: The authors identified 707 patients who underwent primary hip arthroscopic management for FAI who were included for analysis. Two-year outcome surveys were completed for 78% to 84% of patients. The mean age of the patients was 33.2 ± 12.3 years, and 64.4% of the patients (n = 456) were female. The mean anteroposterior (AP) alpha angle decreased by 34.3° ( P < .0001), false profile alpha angle by 25.2° ( P < .0001), Dunn lateral alpha angle by 28.9° ( P < .0001), lateral center edge angle by 2.6° ( P < .0001), and anterior center edge angle by 3.4° ( P < .0001). The HOS-ADL score increased from 65.7 ± 18.7 preoperatively to 85.9 ± 16.7 postoperatively ( P < .0001), HOS-SSS increased from 43.4 ± 23.1 to 72.6 ± 27.2 ( P < .0001), and mHHS increased from 57.7 ± 14.0 to 79.1 ± 17.2 ( P < .0001). With multivariate analysis, independent predictors of the postoperative HOS-ADL score included the preoperative false profile alpha angle (beta = -0.16, P = .028). Independent predictors of HOS-SSS score were preoperative AP alpha angle (beta = -0.33, P = .032) and preoperative false profile alpha angle (beta = -0.28, P = .041). For the postoperative mHHS score, independent predictors included preoperative AP alpha angle (beta = -0.18, P = .046), preoperative false profile alpha angle (beta = -0.20, P = .014), and postoperative false profile alpha angle (beta = -0.48, P = .035). The preoperative AP alpha angle (beta = 0.28, P = .024) was a significant predictor for the postoperative VAS pain score. The preoperative false profile alpha angle (beta = -0.34, P = .040) was a significant predictor for the postoperative VAS satisfaction score., Conclusion: The authors observed that radiographic measurements, specifically the preoperative false profile alpha angle, AP alpha angle, and postoperative false profile alpha angle, are independent predictors of 2-year clinical outcomes. The femoral-side measurements were the strongest independent predictors of outcomes, especially measurements of the anterior and lateral-based CAM lesion.

Myelodysplastic syndromes are hematological neoplasias in which immunohistologic examination of bone marrow trephines is important for a definite diagnosis. Unequivocal distinction from reactive bone marrow changes is, however, sometimes difficult. Because neoplastic clones in myelodysplastic syndrome carry mutations in recurrent genes, mutation detection by targeted next-generation sequencing may be a useful support for differential diagnosis. To elucidate the accuracy of this approach in the clinical diagnostic setting, we analyzed single and consecutive bone marrow trephines processed for immunohistologic examination from 145 patients by targeted next-generation sequencing of 12 genes recurrently mutated in myelodysplastic syndromes. Of 110 patients with immunohistologic unequivocal diagnosis, 41 of 47 with myelodysplastic syndrome carried mutations. In 14 consecutive samples available from these patients, remissions were accompanied by loss of mutations and ongoing disease with persisting mutations. Of 35 samples with indefinite immunohistologic appearance, 22 developed clinical unequivocal myelodysplastic syndrome in the further course, and 19 carried mutations already in the initial biopsy, which persisted in consecutive samples available from 13 patients. No mutation was detected in any initial and consecutive sample of 13 patients with indefinite immunohistologic appearance without clinical unequivocal myelodysplastic syndrome in the further course. We conclude that targeted next-generation sequencing is an accurate tool for differential diagnosis of myelodysplastic syndrome in the clinical diagnostic setting., (Copyright © 2018 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.)

The POT1 protein binds and protects telomeres. Germline variants in the POT1 gene have recently been shown to be associated with risk of developing tumors in different tissues such as familial chronic lymphocytic leukemia, colorectal, glioma and melanoma tumors. Recently, we uncovered a variant in the POT1 gene (p.R117C) as causative of familial cardiac angiosarcomas (CAS) in Li-Fraumeni-like (LFL) syndrome families. Our in silico studies predicted that this protein had lost the ability to interact with TPP1 and single-stranded DNA. In vitro studies corroborated this prediction and showed that this lack of function leads to abnormally long telomeres. To better understand the POT1 gene and its role with tumorigenesis, we extended the study to LFL (with and without members affected with angiosarcomas (AS)) and sporadic AS and cardiac sarcomas. We found POT1 variants in the 20% of the families with members affected with AS and 10% of sporadic AS and sarcomas. In silico studies predicted that these new variants were damaging in the same manner as previously described for the POT1 p.R117C variants. The wide spectrum of variants in the POT1 gene leading to tumorigenesis in different tissues demonstrates its general importance. Study of the POT1 gene should be considered as routine diagnostic in these cancers.

After the successful introduction of PET/CT as a multimodality imaging technique, PET/MR has subsequently emerged as an attractive instrumentation for applications in neurology, oncology, and cardiology. Simultaneous data acquisition combining structural, functional, and molecular imaging provides a unique platform to link various aspects of cardiac performance for the non-invasive characterization of cardiovascular disease phenotypes. Specifically, tissue characterization by MR techniques with and without contrast agents allows for functional parameters such as LGE, myocardial perfusion, and T1 maps as well as an estimate of extracellular volume. PET tracers excel by their high sensitivity and specificity, thus supplementing the functional tissue characterization by MRI. Although the clinical applications are yet to be validated , the first experience with PET/MR suggests future applications in the area of vascular imaging (unstable plaque) as well as in the characterization of inflammatory processes involving the heart. Ischemic heart disease can be comprehensively assessed by integrating regional function, perfusion, and viability. Future technical improvements leading to less costly PET/MR instrumentation are necessary to support routine clinical application of this promising technique in cardiology.

We describe the design and commissioning of a novel aberration-corrected low energy electron microscope (AC-LEEM). A third magnetic prism array (MPA) is added to the standard AC-LEEM with two prism arrays, allowing the incorporation of an ultrafast spin-polarized electron source alongside the standard cold field emission electron source, without degrading spatial resolution. The high degree of symmetries of the AC-LEEM are utilized while we design the electron optics of the ultrafast spin-polarized electron source, so as to minimize the deleterious effect of time broadening, while maintaining full control of electron spin. A spatial resolution of 2nm and temporal resolution of 10ps (ps) are expected in the future time resolved aberration-corrected spin-polarized LEEM (TR-AC-SPLEEM). The commissioning of the three-prism AC-LEEM has been successfully finished with the cold field emission source, with a spatial resolution below 2nm., (Copyright © 2017 Elsevier B.V. All rights reserved.)