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Abstract Background Lower extremity peripheral artery disease frequently presents with calcifications which reduces the accuracy of computed tomography (CT) angiography, especially below-the-knee. Photon-counting detector (PCD)-CT offers improved spatial resolution and less calcium blooming. We aimed to identify the optimal reconstruction parameters for PCD-CT angiography of the lower legs. Methods Tubes with different diameters (1–5 mm) were filled with different iodine concentrations and scanned in a water container. Images were reconstructed with 0.4 mm isotropic resolution using a quantitative kernel at all available sharpness levels (Qr36 to Qr76) and using different levels of quantum iterative reconstruction (QIR-2–4). Noise and image sharpness were determined for all reconstructions. Additionally, CT angiograms of 20 patients, reconstructed with a medium (Qr44), sharp (Qr60), and ultrasharp (Qr72) kernel at QIR-2-4, were evaluated by three readers assessing noise, delineation of plaques and vessel walls, and overall quality. Results In the phantom study, increased kernel sharpness led to higher image noise (e.g., 16, 38, 77 HU for Qr44, Qr60, Qr72, and QIR-3). Image sharpness increased with increasing kernel sharpness, reaching a plateau at the medium-high level 60. Higher QIR levels decreased image noise (e.g., 51, 38, 25 HU at QIR-2–4 and Qr60) without reducing vessel sharpness. The qualitative in vivo results confirmed these findings: the sharp kernel (Qr60) with the highest QIR yielded the best overall quality. Conclusion The combination of a sharpness level optimized reconstruction kernel (Qr60) and the highest QIR level yield the best image quality for PCD-CT angiography of the lower legs when reconstructed at 0.4-mm resolution. Relevance statement Using high-resolution PCD-CT angiography with optimized reconstruction parameters might improve diagnostic accuracy and confidence in peripheral artery disease of the lower legs. Key Points Effective exploitation of the potential of PCD-CT angiography requires optimized reconstruction parameters. Too soft or too sharp reconstruction kernels reduce image quality. The highest level of quantum iterative reconstruction provides the best image quality. Graphical Abstract

Abstract Preliminary work has shown that portal hypertension plays a key role for the prognosis in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Specifically, the presence of ascites appears to be a strong negative predictor for these patients. However, it remains unclear whether different ascites volumes influence prognosis. Therefore, the aim of this work was to investigate the influence of different ascites volumes on survival for patients with HCC undergoing TACE. A total of 327 treatment-naïve patients with HCC undergoing initial TACE at our tertiary care center between 2010 and 2020 were included. In patients with ascites, the fluid was segmented, and the volume quantified by slice-wise addition using contrast-enhanced CT imaging. Median overall survival (OS) was calculated and univariate and multivariate Cox regression analysis has been performed. Ascites was present in 102 (31.9%) patients. Ascites volume as continuous variable was significantly associated with an increased hazard ratio in univariate analysis (p

This study aimed to evaluate the safety and efficacy of a novel Poly-Ether-Ether-Ketone (PEEK) expandable vertebral body replacement (VBR) for anterior cervico-thoracic vertebral column reconstruction in patients with metastatic, traumatic, or degenerative diseases. Radiographic and clinical outcomes, as well as complication rates, were analyzed in a retrospective analysis of 28 patients (61 ± 13 years; 64% female) who underwent an anterior cervical corpectomy and fusion (ACCF) with the Expandable Corpectomy Device (ECD) from DePuy/Synthes (2011–2020). Correction of the bisegmental kyphotic angle (BKA) was chosen as the primary outcome. Bony fusion, loss of device height, and implant subsidence were evaluated additionally. Clinical outcome was assessed using Odom’s criteria, the numerical pain rating scale (NRS), the American Spinal Injury Association Impairment Scale (AIS), and the Karnofsky Performance Status Scale (KPSS). Our study found a significant improvement in the BKA (12.3° ± 9.6°; p = 0.0002) at the last follow-up with no statistically relevant loss of device height (p = 0.96) or implant subsidence (p = 0.99). Successful bony fusion was observed in all patients. The KPSS significantly improved in patients with a tumorous disease at the time of discharge (p = 0.0009), and the sensation of pain showed significant improvement at six months post-operatively and at the final follow-up (p = 0.004; p = 0.021). However, four patients needed further secondary posterior stabilization, and one ECD was explanted due to a severe surgical site infection after an accidental esophageal lesion. In conclusion, the ECD proofed the radiographic stability for the anterior column reconstruction of the cervico-thoracic spine with significantly improved clinical outcome.

Abstract Objectives Artificial intelligence (AI) has tremendous potential to help radiologists in daily clinical routine. However, a seamless, standardized, and time-efficient way of integrating AI into the radiology workflow is often lacking. This constrains the full potential of this technology. To address this, we developed a new reporting pipeline that enables automated pre-population of structured reports with results provided by AI tools. Methods Findings from a commercially available AI tool for chest X-ray pathology detection were sent to an IHE-MRRT-compliant structured reporting (SR) platform as DICOM SR elements and used to automatically pre-populate a chest X-ray SR template. Pre-populated AI results could be validated, altered, or deleted by radiologists accessing the SR template. We assessed the performance of this newly developed AI to SR pipeline by comparing reporting times and subjective report quality to reports created as free-text and conventional structured reports. Results Chest X-ray reports with the new pipeline could be created in significantly less time than free-text reports and conventional structured reports (mean reporting times: 66.8 s vs. 85.6 s and 85.8 s, respectively; both p

Abstract Purpose Kidney volume is important in the management of renal diseases. Unfortunately, the currently available, semi-automated kidney volume determination is time-consuming and prone to errors. Recent advances in its automation are promising but mostly require contrast-enhanced computed tomography (CT) scans. This study aimed at establishing an automated estimation of kidney volume in non-contrast, low-dose CT scans of patients with suspected urolithiasis. Methods The kidney segmentation process was automated with 2D Convolutional Neural Network (CNN) models trained on manually segmented 2D transverse images extracted from low-dose, unenhanced CT scans of 210 patients. The models’ segmentation accuracy was assessed using Dice Similarity Coefficient (DSC), for the overlap with manually-generated masks on a set of images not used in the training. Next, the models were applied to 22 previously unseen cases to segment kidney regions. The volume of each kidney was calculated from the product of voxel number and their volume in each segmented mask. Kidney volume results were then validated against results semi-automatically obtained by radiologists. Results The CNN-enabled kidney volume estimation took a mean of 32 s for both kidneys in a CT scan with an average of 1026 slices. The DSC was 0.91 and 0.86 and for left and right kidneys, respectively. Inter-rater variability had consistencies of ICC = 0.89 (right), 0.92 (left), and absolute agreements of ICC = 0.89 (right), 0.93 (left) between the CNN-enabled and semi-automated volume estimations. Conclusion In our work, we demonstrated that CNN-enabled kidney volume estimation is feasible and highly reproducible in low-dose, non-enhanced CT scans. Automatic segmentation can thereby quantitatively enhance radiological reports.

Abstract Background Photon-counting detector computed tomography (PCD-CT) may influence imaging characteristics for various clinical conditions due to higher signal and contrast-to-noise ratio in virtual monoenergetic images (VMI). Radiomics analysis relies on quantification of image characteristics. We evaluated the impact of different VMI reconstructions on radiomic features in in vitro and in vivo PCD-CT datasets. Methods An organic phantom consisting of twelve samples (four oranges, four onions, and four apples) was scanned five times. Twenty-three patients who had undergone coronary computed tomography angiography on a first generation PCD-CT system with the same image acquisitions were analyzed. VMIs were reconstructed at 6 keV levels (40, 55, 70, 90, 120, and 190 keV). The phantoms and the patients’ left ventricular myocardium (LVM) were segmented for all reconstructions. Ninety-three original radiomic features were extracted. Repeatability and reproducibility were evaluated through intraclass correlations coefficient (ICC) and post hoc paired samples ANOVA t test. Results There was excellent repeatability for radiomic features in phantom scans (all ICC = 1.00). Among all VMIs, 36/93 radiomic features (38.7%) in apples, 28/93 (30.1%) in oranges, and 33/93 (35.5%) in onions were not significantly different. For LVM, the percentage of stable features was high between VMIs ≥ 90 keV (90 versus 120 keV, 77.4%; 90 versus 190 keV, 83.9%; 120 versus 190 keV, 89.3%), while comparison to lower VMI levels led to fewer reproducible features (40 versus 55 keV, 8.6%). Conclusions VMI levels influence the stability of radiomic features in an organic phantom and patients’ LVM; stability decreases considerably below 90 keV. Relevance statement Spectral reconstructions significantly influence radiomic features in vitro and in vivo, necessitating standardization and careful attention to these reconstruction parameters before clinical implementation. Key points • Radiomic features have an excellent repeatability within the same PCD-CT acquisition and reconstruction. • Differences in VMI lead to decreased reproducibility for radiomic features. • VMI ≥ 90 keV increased the reproducibility of the radiomic features. Graphical Abstract

Abstract Background Excellent image quality is crucial for workup of hepatocellular carcinoma (HCC) in patients with liver cirrhosis because a signature tumor signal allows for non-invasive diagnosis without histologic proof. Photon-counting detector computed tomography (PCD-CT) can enhance abdominal image quality, especially in combination with a novel iterative reconstruction algorithm, quantum iterative reconstruction (QIR). The purpose of this study was to analyze the impact of different QIR levels on PCD-CT imaging of HCC in both phantom and patient scans. Methods Virtual monoenergetic images at 50 keV were reconstructed using filtered back projection and all available QIR levels (QIR 1–4). Objective image quality properties were investigated in phantom experiments. The study also included 44 patients with triple-phase liver PCD-CT scans of viable HCC lesions. Quantitative image analysis involved assessing the noise, contrast, and contrast-to-noise ratio of the lesions. Qualitative image analysis was performed by three raters evaluating noise, artifacts, lesion conspicuity, and overall image quality using a 5-point Likert scale. Results Noise power spectra in the phantom experiments showed increasing noise suppression with higher QIR levels without affecting the modulation transfer function. This pattern was confirmed in the in vivo scans, in which the lowest noise levels were found in QIR-4 reconstructions, with around a 50% reduction in median noise level compared with the filtered back projection images. As contrast does not change with QIR, QIR-4 also yielded the highest contrast-to-noise ratios. With increasing QIR levels, rater scores were significantly better for all qualitative image criteria (all p

Background: Human papilloma virus (HPV) infection is an important risk factor in oropharyngeal cancer. Several studies have analyzed the association of tumoral HPV status and different imaging parameters in FDG-PET/CT and magnetic resonance (MR) diffusion-weighted imaging (DWI), with contradictory findings. In this retrospective study, the influence of HPV-status on different parameters in FDG-imaging and MR DWI is investigated. Methods: In this retrospective, single-center study we analyzed patients diagnosed with oropharyngeal cancer between January 2018 and December 2020 at a tertiary center in Switzerland. HPV status was assessed via p16 immunohistochemistry and/or PCR. Standardized uptake value (SUV), total lesion glycolysis (TLG) and apparent diffusion coefficient (ADC) were measured in pretreatment imaging (FDG-PET/CT, FDG-PET/MR, DWI MR). Statistical analysis was performed using Mann-Whitney-U tests. All p values reported are two-sided, and p values

ABSTRACT: Background: Diagnosing myocarditis relies on multimodal data, including cardiovascular magnetic resonance (CMR), clinical symptoms, and blood values. The correct interpretation and integration of CMR findings require radiological expertise and knowledge. We aimed to investigate the performance of Generative Pre-trained Transformer 4 (GPT-4), a large language model, for report-based medical decision-making in the context of cardiac MRI for suspected myocarditis. Methods: This retrospective study includes CMR reports from 396 patients with suspected myocarditis and eight centers, respectively. CMR reports and patient data including blood values, age, and further clinical information were provided to GPT-4 and radiologists with 1 (resident 1), 2 (resident 2), and 4 years (resident 3) of experience in CMR and knowledge of the 2018 Lake Louise Criteria. The final impression of the report regarding the radiological assessment of whether myocarditis is present or not was not provided. The performance of Generative pre-trained transformer 4 (GPT-4) and the human readers were compared to a consensus reading (two board-certified radiologists with 8 and 10 years of experience in CMR). Sensitivity, specificity, and accuracy were calculated. Results: GPT-4 yielded an accuracy of 83%, sensitivity of 90%, and specificity of 78%, which was comparable to the physician with 1 year of experience (R1: 86%, 90%, 84%, p = 0.14) and lower than that of more experienced physicians (R2: 89%, 86%, 91%, p = 0.007 and R3: 91%, 85%, 96%, p

Introduction: Autism spectrum disorder (ASD) is characterized by deficits in social communication, repetitive behaviors, and can be accompanied by a spectrum of psychiatric symptoms, such as schizophrenia and catatonia. Rarely, these symptoms, if left untreated, can result in spinal deformities. Research question and case description: This case report details the treatment of a 16-year-old male ASD patient with catatonic schizophrenia and mutism, presenting with neck pain, left-rotated torticollis, and fever. MRI revealed atlantoaxial rotational instability and spinal cord compression from a dislocated dens axis. After inconclusive biopsies, empirical antibiotics, hard collar and halo fixation treatment, persistent instability necessitated C1/2 fusion. The ongoing catatonia was addressed with electroconvulsive therapy. Concurrently, he developed severe subaxial hyperkyphosis. The report examines the decision-making between conservative and surgical management for an adolescent with significant psychiatric comorbidity and progressive spinal symptoms against a backdrop of uncertain etiology. Materials and methods: A case report and review of the literature. Results: Posterior C1-C7 stabilization was successfully executed, effectively restoring cervical sagittal alignment, which was maintained throughout a two-year follow-up. Concurrently, the catatonia resolved. Discussion and conclusion: To our knowledge, this is the third reported case of severe cervical deformity associated with fixed posture in a psychiatric patient. This case report emphasizes the critical importance of multidisciplinary collaboration in managing the interplay between neuropsychiatric disorders and severe spinal deformities. It showcases the practicality and efficacy of surgical intervention for persistent cervical deformity in pediatric schizophrenia patients, highlighting the necessity for a comprehensive risk-benefit analysis.

Abstract Background MRI T2 mapping has been proven to be sensitive to the level of blood oxygenation. We hypothesized that impaired exercise capacity in chronic heart failure is associated with a greater difference between right (RV) to left ventricular (LV) blood pool T2 relaxation times due to a higher level of peripheral blood desaturation, compared to patients with preserved exercise capacity and to healthy controls. Methods Patients with chronic heart failure (n = 70) who had undergone both cardiac MRI (CMR) and a 6-min walk test (6MWT) were retrospectively identified. Propensity score matched healthy individuals (n = 35) served as control group. CMR analyses included cine acquisitions and T2 mapping to obtain blood pool T2 relaxation times of the RV and LV. Following common practice, age- and gender-adjusted nominal distances and respective percentiles were calculated for the 6MWT. The relationship between the RV/LV T2 blood pool ratio and the results from 6MWT were evaluated by Spearman’s correlation coefficients and regression analyses. Inter-group differences were assessed by independent t-tests and univariate analysis of variance. Results The RV/LV T2 ratio moderately correlated with the percentiles of nominal distances in the 6MWT (r = 0.66) while ejection fraction, end-diastolic and end-systolic volumes showed no correlation (r = 0.09, 0.07 and − 0.01, respectively). In addition, there were significant differences in the RV/LV T2 ratio between patients with and without significant post-exercise dyspnea (p = 0.001). Regression analyses showed that RV/LV T2 ratio was an independent predictor of the distance walked and the presence of post-exercise dyspnea (p

Abstract Background To evaluate the implementation process of structured reporting (SR) in a tertiary care institution over a period of 7 years. Methods We analysed the content of our image database from January 2016 to December 2022 and compared the numbers of structured reports and free-text reports. For the ten most common SR templates, usage proportions were calculated on a quarterly basis. Annual modality-specific SR usage was calculated for ultrasound, CT, and MRI. During the implementation process, we surveyed radiologists and clinical referring physicians concerning their views on reporting in radiology. Results As of December 2022, our reporting platform contained more than 22,000 structured reports. Use of the ten most common SR templates increased markedly since their implementation, leading to a mean SR usage of 77% in Q4 2022. The highest percentages of SR usage were shown for trauma CT, focussed assessment with ultrasound for trauma (FAST), and prostate MRI: 97%, 95%, and 92%, respectively, in 2022. Overall modality-specific SR usage was 17% for ultrasound, 13% for CT, and 6% for MRI in 2022. Both radiologists and referring physicians were more satisfied with structured reports and rated SR better than free-text reporting (FTR) on various attributes. Conclusions The increasing SR usage during the period under review and the positive attitude towards SR among both radiologists and clinical referrers show that SR can be successfully implemented. We therefore encourage others to take this step in order to benefit from the advantages of SR. Key points 1. Structured reporting usage increased markedly since its implementation at our institution in 2016. 2. Mean usage for the ten most popular structured reporting templates was 77% in 2022. 3. Both radiologists and referring physicians preferred structured reports over free-text reports. 4. Our data shows that structured reporting can be successfully implemented. 5. We strongly encourage others to implement structured reporting at their institutions.

Abstract Background Bone marrow mesenchymal stromal cells (BMSCs) are promising for therapeutic use in cartilage repair, because of their capacity to differentiate into chondrocytes. Often, in vitro differentiation protocols employ the use of high amount of glucose, which does not reflect cartilage physiology. For this reason, we investigated how different concentrations of glucose can affect the chondrogenic differentiation of BMSCs in cell culture pellets. Additionally, we investigated how fructose could influence the chondrogenic differentiation in vitro. Methods BMSC were isolated from six donors and cultured in DMEM containing glucose at either 25 mM (HG), 5.5 mM (LG) or 1 mM (LLG), and 1% non-essential amino acids, 1% ITS+, in the presence of 100 nM dexamethasone, 50 µg/ml ascorbic acid-2 phosphate and 10 ng/ml TGF-β1. To investigate the effect of different metabolic substrates, other groups were exposed to additional 25 mM fructose. The media were replaced every second day until day 21 when all the pellets were harvested for further analyses. Biochemical analysis for glycosaminoglycans into pellets and released in medium was performed using the DMMB method. Expression of GLUT3 and GLUT5 was assayed by qPCR and validated using FACS analysis and immunofluorescence in monolayer cultures. Chondrogenic differentiation was further confirmed by qPCR analysis of COL2A1, COL1A1, COL10A1, ACAN, RUNX2, SOX9, SP7, MMP13, and PPARG, normalized on RPLP0. Type 2 collagen expression was subsequently validated by immunofluorescence analysis. Results We show for the first time the presence of fructose transporter GLUT5 in BMSC and its regulation during chondrogenic commitment. Additionally, decreasing glucose concentration during chondrogenesis dramatically decreased the yield of differentiation. However, the use of fructose alone or together with low glucose concentrations does not limit cell differentiation, but on the contrary it might help in maintaining a stable chondrogenic phenotype comparable with the standard culture conditions (high glucose). Conclusion This study provides evidence that BMSC express GLUT5 and differentially regulate GLUT3 in the presence of glucose variation. This study gives a better comprehension of BMSCs sugar use during chondrogenesis.

Abstract Background We investigated whether features derived from texture analysis (TA) can distinguish breast density (BD) in spiral photon-counting breast computed tomography (PC-BCT). Methods In this retrospective single-centre study, we analysed 10,000 images from 400 PC-BCT examinations of 200 patients. Images were categorised into four-level density scale (a–d) using Breast Imaging Reporting and Data System (BI-RADS)-like criteria. After manual definition of representative regions of interest, 19 texture features (TFs) were calculated to analyse the voxel grey-level distribution in the included image area. ANOVA, cluster analysis, and multinomial logistic regression statistics were used. A human readout then was performed on a subset of 60 images to evaluate the reliability of the proposed feature set. Results Of the 19 TFs, 4 first-order features and 7 second-order features showed significant correlation with BD and were selected for further analysis. Multinomial logistic regression revealed an overall accuracy of 80% for BD assessment. The majority of TFs systematically increased or decreased with BD. Skewness (rho -0.81), as a first-order feature, and grey-level nonuniformity (GLN, -0.59), as a second-order feature, showed the strongest correlation with BD, independently of other TFs. Mean skewness and GLN decreased linearly from density a to d. Run-length nonuniformity (RLN), as a second-order feature, showed moderate correlation with BD, but resulted in redundant being correlated with GLN. All other TFs showed only weak correlation with BD (range -0.49 to 0.49, p < 0.001) and were neglected. Conclusion TA of PC-BCT images might be a useful approach to assess BD and may serve as an observer-independent tool.

Abstract Background Papillary muscle rupture due to infective endocarditis is a rare event and proper management of this condition has not been described in the literature. Our case aims to shed light on treatment strategies for these patients using the current guidelines. Case presentation This case presents a 58-year-old male with acute heart failure secondary to papillary muscle rupture. He underwent an en bloc resection of his mitral valve with a bioprosthetic valve replacement. Specimen pathology later showed necrotic papillary muscle due to infective endocarditis. The patient was further treated with antibiotic therapy. He recovered well post-operatively and continued to do well after discharge. Conclusion In patients who present with papillary muscle rupture secondary to infective endocarditis, clinical symptoms should drive the treatment strategy. Despite the etiology, early mitral valve surgery remains treatment of choice for patients who have papillary muscle rupture leading to acute heart failure. Culture-guided prolonged antibiotic treatment is vital in this category of patients, especially those who have a prosthetic valve implanted.

Objective. In the research presented here, quantum measurement is conceptualized as pragmatic information transfer when an intentional observer perceives motive-relevant quantum-based outcomes. Owing to the nature of pragmatic information as described in Lucadou’s Model of Pragmatic Information, this information transfer causes an observer-dependent intentional co-formation of reality and can only be scientifically documented under reduced objectivity conditions. The effects thus reflect a “sobjective” reality that occupies the space between subjectivity and objectivity. The present study was designed to find evidence for the existence of this sobjective reality. Method. A pre-registered micro-psychokinesis task involving a quantum random number generator assessed the impact of intentional observation on quantum-based stochastic outcomes under experimental variations of the applied measures’ objectivity. Results. As predicted, an intentionally congruent bias in quantum-based outcomes was observed using subjective memory data from the observations when additional objective computer-stored data were not inspected and finally erased (i.e., objectivity was reduced). Quantum randomness was confirmed in a maximum objective data collection context for both stored and memory data. Conclusion. The results indicate that pragmatic information was transferred during trial observation when scientific objectivity was reduced. The evidence for intentionally based reality formation or quantum-based random reality emergence was thus shown to be a function of the measurements’ objectivity levels. The data suggest the existence of a sobjective reality and that a physicalist/materialist or an intentional creation worldview depends on the presence of an intentional agent and the definition of the measurement process.

Abstract Introduction Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group. Method Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed. Results A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.

Abstract Study design This is a retrospective cohort study. Objectives This study aims to determine the proportional incidence, clinical characteristics, treatment patterns with complications and changes in treatment of vertebral fractures over 10 years at a Swiss university hospital. Methods A retrospective cohort study was performed. All patients with an acute vertebral fracture were included in this study. The extracted anonymized data from the medical records were manually assessed. Demographic data, exact location, etiology, type of treatment and complications related to the treatment were obtained. Results Of 330,225 treated patients, 4772 presented with at least one vertebral fracture. In total 8307 vertebral fractures were identified, leading to a proportional incidence of 25 vertebral fractures in 1000 patients. Fractures were equally distributed between genders. Male patients were significantly younger and more likely to sustain a traumatic fracture, while female patients more commonly presented with osteoporotic fractures. The thoracolumbar junction (Th11-L2) was the most frequent fracture site in all etiologies. More than two-thirds of vertebral fractures were treated surgically (68.6%). Out of 4622 performed surgeries, we found 290 complications (6.3%). The odds for surgical treatment in osteoporotic fractures were two times higher before 2010 compared to 2010 and after (odds ratio: 2.1, 95% CI 1.5–2.9, p

Mitigating the migration of mobile ions within perovskite solar cells is a crucial step on the way to improving their stability. In the past, transient capacitance measurements were applied to extract information about mobile ions, including their activation energy, diffusion coefficient, density, and polarity. However, in this work, we show that the interpretation of capacitance transients is more complex than originally proposed because of the intrinsic nature of the perovskite and the contributions of charge transport layers to the capacitance. Using drift-diffusion simulations and light-intensity-dependent capacitance transient measurements, we show that the direction of capacitance transients is not linked to the polarity of the migrating species. Instead, the direction of the transients is linked to the layer of the cell that dominates capacitance modulation. This work illustrates that transport layers can be crucial for the capacitance and impedance response of perovskite solar cells, and therefore, for characterizing mobile ions in perovskites.

Photon-counting detector computed tomography (PCD-CT) yields improved spatial resolution. The combined use of PCD-CT and a modern iterative reconstruction method, known as quantum iterative reconstruction (QIR), has the potential to significantly improve the quality of lung CT images. In this study, we aimed to analyze the impacts of different slice thicknesses and QIR levels on low-dose ultra-high-resolution (UHR) PCD-CT imaging of the lungs. Our study included 51 patients with different lung diseases who underwent unenhanced UHR-PCD-CT scans. Images were reconstructed using three different slice thicknesses (0.2, 0.4, and 1.0 mm) and three QIR levels (2–4). Noise levels were determined in all reconstructions. Three raters evaluated the delineation of anatomical structures and conspicuity of various pulmonary pathologies in the images compared to the clinical reference reconstruction (1.0 mm, QIR-3). The highest QIR level (QIR-4) yielded the best image quality. Reducing the slice thickness to 0.4 mm improved the delineation and conspicuity of pathologies. The 0.2 mm reconstructions exhibited lower image quality due to high image noise. In conclusion, the optimal reconstruction protocol for low-dose UHR-PCD-CT of the lungs includes a slice thickness of 0.4 mm, with the highest QIR level. This optimized protocol might improve the diagnostic accuracy and confidence of lung imaging.

Objective: To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments. Methods & Results: Five surgeons performed thirteen simulated surgical cases on three human cadavers. Procedures included (i) two abdominal aortic aneurysm (AAA) repairs, (ii) three carotid endarterectomies (CE), (iii) two femoropopliteal (fem-pop) bypasses, (iv) thoracic aortic aneurysm repair, (v) coronary artery bypass graft, (vi) aortic valve replacement, (vii) ascending aortic aneurysm repair, (viii) heart transplants, and (ix) mitral valve replacement. For each case an average of 139 surgical instruments were RFID-tagged and tracked intraoperatively. Data was captured and analyzed retrospectively. Of the 139 instruments tracked across each of the 13 cases, 55 instruments (39.5%) were actually used, demonstrating a high level of redundancy. For repeat cases (i.e. CE/AAA/fem-pop): (i) average instrument usage was 41 ± 3.6 (8.8% variation) for CE (n=3); (ii) average instrument usage was 69 ± 4.0 (5.8% variation) for AAA (n=2); and (iii) average instrument usage was 48 ± 2.5 (5.3% variation) for fem- pop (n=2). Results also showed a reduction in end-of-procedure instrument counting times of 58-87%. Conclusions: We report on a method for collecting intraoperative data analytics regarding instrument usage via RFID technology. This system will help refine instrument selection, quantitate instrument utilization and prevent inadvertent retention in a patient. This should help increase efficiency in packaging and sterilization and let surgeons make objective decisions in the composition of surgical trays. Clinical and Translational Impact Statement—Intraoperative analytics of surgical tools and associated equipment may ultimately lead to safer more efficient surgeries that increase patient outcomes while decreasing the cost of care.

Abstract Background The delayed percentage attenuation ratio (DPAR) was recently identified as a novel predictor of an early complete response in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). In this study, we aimed to validate the role of DPAR as a predictive biomarker for short-, mid-, and long-term outcomes after TACE. Methods We retrospectively reviewed laboratory and imaging data for 103 treatment-naïve patients undergoing initial TACE treatment at our tertiary care center between January 2016 and November 2020. DPAR and other washin and washout indices were quantified in the triphasic computed tomography performed before the initial TACE. The correlation of DPAR and radiologic response was investigated. Furthermore, the influence of DPAR on the 6-, 12-, 18-, and 24-month survival rates and the median overall survival (OS) was compared to other established washout indices and estimates of tumor burden and remnant liver function. Results The DPAR was significantly of the target lesions (TLs) with objective response to TACE after the initial TACE session was significantly higher compared to patients with stable disease (SD) or progressive disease (PD) (125 (IQR 118–134) vs 110 (IQR 103–116), p 120 was significantly higher in this group (n = 38 vs. n = 8; p = 0.03). However, no significant differences were observed in the 12-, 18-, and 24-month survival rates after the initial TACE. Regarding the median OS, no significant difference was observed for patients with a high DPAR compared to those with a low DPAR (18.7 months vs. 12.7 months, p = 0.260). Conclusions Our results confirm DPAR as the most relevant washout index for predicting the short-term outcome of patients with HCC undergoing TACE. However, DPAR and the other washout indices were not predictive of mid- and long-term outcomes.

PurposeTo compare coronary artery calcium volume and score (CACS) between photon-counting detector (PCD) and conventional energy integrating detector (EID) computed tomography (CT) in a phantom and prospective patient study.MethodsA commercially available CACS phantom was scanned with a standard CACS protocol (120 kVp, slice thickness/increment 3/1.5 mm, and a quantitative Qr36 kernel), with filtered back projection on the EID-CT, and with monoenergetic reconstruction at 70 keV and quantum iterative reconstruction off on the PCD-CT. The same settings were used to prospectively acquire data in patients (n = 23, 65 ± 12.1 years), who underwent PCD- and EID-CT scans with a median of 5.5 (3.0–12.5) days between the two scans in the period from August 2021 to March 2022. CACS was quantified using a commercially available software solution. A regression formula was obtained from the aforementioned comparison and applied to simulate risk reclassification in a pre-existing cohort of 514 patients who underwent a cardiac EID-CT between January and December 2021.ResultsBased on the phantom experiment, CACSPCD–CT showed a more accurate measurement of the reference CAC volumes (overestimation of physical volumes: PCD-CT 66.1 ± 1.6% vs. EID-CT: 77.2 ± 0.5%). CACSEID–CT and CACSPCD–CT were strongly correlated, however, the latter measured significantly lower values in the phantom (CACSPCD–CT: 60.5 (30.2–170.3) vs CACSEID–CT 74.7 (34.6–180.8), p = 0.0015, r = 0.99, mean bias –9.7, Limits of Agreement (LoA) –36.6/17.3) and in patients (non-significant) (CACSPCD–CT: 174.3 (11.1–872.7) vs CACSEID–CT 218.2 (18.5–876.4), p = 0.10, r = 0.94, mean bias –41.1, LoA –315.3/232.5). The systematic lower measurements of Agatston score on PCD-CT system led to reclassification of 5.25% of our simulated patient cohort to a lower classification class.ConclusionCACSPCD–CT is feasible and correlates strongly with CACSEID–CT, however, leads to lower CACS values. PCD-CT may provide results that are more accurate for CACS than EID-CT.

Quantum mechanics (QM) proposes that a quantum system measurement does not register a pre-existing reality but rather establishes reality from the superposition of potential states. Measurement reduces the quantum state according to a probability function, the Born rule, realizing one of the potential states. Consequently, a classical reality is observed. The strict randomness of the measurement outcome is well-documented (and theoretically predicted) and implies a strict indeterminacy in the physical world’s fundamental constituents. Wolfgang Pauli, with Carl Gustav Jung, extended the QM framework to measurement outcomes that are meaningfully related to human observers, providing a psychophysical theory of quantum state reductions. The Pauli-Jung model (PJM) proposes the existence of observer influences on quantum measurement outcomes rooted in the observer’s unconscious mind. The correlations between quantum state reductions and (un)conscious states of observers derived from the PJM and its mathematical reformulation within the model of pragmatic information (MPI) were empirically tested. In all studies, a subliminal priming paradigm was used to induce a biased likelihood for specific quantum measurement outcomes (i.e., a higher probability of positive picture presentations; Studies 1 and 2) or more pronounced oscillations of the evidence than expected by chance for such an effect (Studies 3 and 4). The replicability of these effects was also tested. Although Study 1 found strong initial evidence for such effects, later replications (Studies 2 to 4) showed no deviations from the Born rule. The results thus align with standard QM, arguing against the incompleteness of standard QM in psychophysical settings like those established in the studies. However, although no positive evidence exists for the PJM and the MPI, the data do not entirely falsify the model’s validity.

Abstract Background The economic burden of vertebral compression fractures (VCF) caused by osteoporosis was estimated at 37 billion euros in the European Union in 2010. In addition, the incidence is expected to increase by 25% in 2025. The recommendations for the therapy of VCFs (conservative treatment versus cement augmentation procedures) are controversial, what could be partly explained by the lack of standardized outcomes for measuring the success of both treatments. Consensus on outcome parameters may improve the relevance of a study and for further comparisons in meta-analyses. The aim of this study was to analyze outcome measures from frequently cited randomized controlled trials (RCTs) about VCF treatments in order to provide guidance for future studies. Material and methods We carried out a systematic search of all implemented databases from 1973 to 2019 using the Web of Science database. The terms “spine” and “random” were used for the search. We included: Level I RCTs, conservative treatment or cement augmentation of osteoporotic vertebral fractures, cited ≥50 times. The outcome parameters of each study were extracted and sorted according to the frequency of use. Results Nine studies met the inclusion criteria. In total, 23 different outcome parameters were used in the nine analyzed studies. Overall, the five most frequently used outcome parameters (≥ 4 times used) were the visual analogue scale (VAS) for pain (n = 9), European Quality of Life–5 Dimensions (EQ-5D; n = 4) and Roland–Morris Disability Questionnaire (RMDQ, n = 4). Conclusion With our study, we demonstrated that a large inconsistency exists between outcome measures in highly cited Level I studies of VCF treatment. Pain (VAS), followed by HrQoL (EQ-5D) and disability and function (RMDQ), opioid use, and radiological outcome (kyphotic angle, VBH, and new VCFs) were the most commonly used outcome parameters.

Persistent or recurrent cardiovascular symptoms have been identified as one of the hallmarks of long-COVID or post-acute sequelae of SARS-CoV-2 infection (PASC). The purpose of this study was to determine the prevalence and extent of cardiac abnormalities in patients referred for cardiac MRI due to clinical evidence of PASC. To investigate this, two tertiary care hospitals identified all patients who were referred for cardiac MRI under the suspicion of PASC in a 2-year period and retrospectively included them in this study. Patients with previously known cardiac diseases were excluded. This resulted in a total cohort of 129 patients (63, 51% female; age 41 ± 16 years). The majority of patients (57%) showed normal cardiac results. No patient had active myocarditis or an acute myocardial infarction. However, 30% of patients had evidence of non-ischemic myocardial fibrosis, which exceeds the prevalence in the normal adult population and suggests that a possible history of myocarditis might explain persistent symptoms in the PASC setting.