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Patients with systemic mastocytosis (SM) are at increased risk of hypersensitivity reactions (HRs). Although Hymenoptera venoms are the predominant triggers, cases of contrast media-induced HR (CMIHR) have also been reported and prophylactic premedication is often performed. However, data from larger series are limited and differences between indolent and advanced SM have not yet been investigated.To determine the incidence and severity of CMIHR in all subtypes of SM.We analyzed 162 adult patients with SM (indolent systemic mastocytosis [ISM], n = 65; advanced systemic mastocytosis [advSM], n = 97). First, the cumulative incidence of CMIHR was retrospectively assessed in the patient's history. Second, at our institution, patients underwent 332 contrast media (CM)-enhanced imaging including 80 computed tomography (CT) scans with iodine-based contrast agent and 252 magnetic resonance imaging (MRI) with a gadolinium-based contrast agent, and tolerance was assessed.Previous CMIHRs to CT (vomiting, n = 1, erythema, n = 1, cardiovascular shock, n = 1), and MRI (dyspnea, n = 1, cardiovascular shock, n = 1) had been reported by 4 out of 162 (2.5%) patients (ISM, n = 3; advSM, n = 1). In contrast, during or after 332 CM-enhanced CT or MRI examinations at our institution, no CMIHRs were reported. Premedication was solely given to 3 patients before CT scans, including 1 with previous CMIHR, who tolerated the imaging well.We conclude that: (1) there is a substantial discrepancy between the perception and prevalence of HRs to CM in SM; (2) reactions are scarce in ISM and even rarer in advSM; and (3) in SM patients without previous history of CM hypersensitivity, prophylactic premedication before CM-enhanced CT or MRI is dispensable.

Background Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT). Methods CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome. Results GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p Conclusion LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.

Objectives The purpose of this study was to evaluate the diagnostic accuracy of a fast, needle-free test for myocardial ischemia using fast Strain-ENCoded (fSENC) cardiovascular MR (CMR) after a hyperventilation/breath-hold maneuver (HVBH). Background Myocardial stress testing is one of the most frequent diagnostic tests performed. Recent data indicate that CMR first-pass perfusion outperforms other modalities. Its use, however, is limited by the need for both, a vasodilatory stress and the intravenous application of gadolinium. Both are associated with added cost, safety concerns, and patient inconvenience. The combination of 2 novel CMR approaches, fSENC, an ultrafast technique to visualize myocardial strain, and HVBH, a physiological vasodilator, may overcome these limitations. Methods Patients referred for CMR stress testing underwent an extended protocol to evaluate 3 different tests: 1) adenosine-perfusion; 2) adenosine-strain; and 3) HVBH-strain. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. Results A total of 122 patients (age 66 ± 11years; 80% men) suspected of obstructive coronary artery disease were enrolled. All participants completed the protocol without significant adverse events. Adenosine-strain and HVBH-strain provided significantly better diagnostic accuracy than adenosine-perfusion, both on a patient level (adenosine-strain: sensitivity 82%, specificity 83%; HVBH-strain: sensitivity 81%, specificity 86% vs. adenosine-perfusion: sensitivity 67%, specificity 92%; p Conclusions HVBH-strain has a high diagnostic accuracy in detecting significant coronary artery stenosis. It is not only significantly faster than any other method but also neither requires contrast agents nor pharmacological stressors.

The purpose of the present work was to compare the quality of low-dose projections from a photon-counting with a flat-panel system, and to evaluate a novel image processing method. Images were acquired of phantoms in both systems at average glandular doses ranging from ~ 0.15 to 1.4 mGy. Automated detection of low-contrast features and modulation transfer functions were evaluated in phantom images. The novel image processing method was compared with standard processing in a series of clinical cases. At low-doses (~0.15) the photon-counting system out-performed the flat-panel system with a much higher detectability of low-contrast features. The novel algorithm was superior to both manufacturers’ processing in terms of conspicuity of soft-tissue lesions (p > 0.05), whereas it was not significantly different in calcification conspicuity. Photon-counting should allow more low-dose projections to be acquired at the same total dose. The novel image enhancer can help to further increase the image quality.

ZusammenfassungBeim Screening und in der kurativen Therapie des Mammakarzinoms ist die Mammografie die Bildgebung der Wahl. Der Brustultraschall ist jedoch ein weiterer Baustein in der Brustbildgebung und wesentlich, um z. B. Befunde aus der digitalen Mammografie oder der dynamischen MRT zu bewerten, eine Läsion als gut- oder bösartig zu klassifizieren oder verdächtige Läsionen zu biopsieren.

The aim of this paper is to present a novel concept for control of hybrid photovoltaic-thermal systems: a Maximum Exergy Point Tracker. It operates by evaluation of the exergetic and energetic performance of a solar photovoltaic-thermal (PV/T) system, to find the maximum cell temperature that produces at least the same exergy as the system without cogeneration. This maximum working temperature is a very important issue for proper design of cogeneration plants and their operation. The operation with concentration showed better results for energetic and exergetic efficiencies, in addition to an increase in the maximum operating temperature of the photovoltaic cell, compared to operation without concentration. The results allow selecting a suitable photovoltaic cell for a given application, depending on its reference efficiency and temperature coefficient.

Zusammenfassung Einleitung Die Behandlung des Reizdarmsyndroms (RDS) ist in der Praxis oft eine Herausforderung. Als Therapieoption gewinnt die Modulation des Darmmikrobioms dabei immer mehr an Bedeutung. Die Wirksamkeit des Bakterienstamms Lactobacillus plantarum 299v (LP299V) wurde bei Reizdarmpatienten bereits in mehreren placebokontrollierten Studien über 4 Wochen gezeigt. Ziel der im Folgenden beschriebenen nichtinterventionellen Studie war es, die Verträglichkeit und Wirksamkeit von LP299V unter Praxisbedingungen zu untersuchen und neue Erkenntnisse über einen längeren Einnahmezeitraum zu gewinnen. Methodik In 25 Zentren wurden prospektiv Daten von 221 RDS-Patienten zur Verträglichkeit und Wirksamkeit von LP299V (1 Kapsel/Tag; 1 × 1010 KBE) über eine maximale Beobachtungsdauer von 12 Wochen erhoben. Die Erhebung erfolgte mittels Reizdarmtagebüchern und ärztlicher Dokumentation bei den Studienvisiten. Die Veränderung von Häufigkeit und Schweregrad der Beschwerden gegenüber der Baseline wurde als primärer Endpunkt festgelegt. Ergebnisse Im Verlauf der 12-wöchigen Behandlung kam es zu einer signifikanten und kontinuierlichen Reduktion der Gesamtsymptomatik (p Diskussion LP299V konnte die Gesamtbeschwerden von RDS-Patienten unter deutschen Alltagsbedingungen signifikant bessern. Um einen größeren Effekt zu erzielen, ist eine längerfristige Einnahme von LP299V (hier 12 Wochen) sinnvoll; die Verträglichkeit ist in diesem Zeitraum gut.

Purpose: Low-dose computer tomography (NCCT) is the standard imaging modality for patients with acute flank pain with a suspicion of urolithiasis. The stone size is usually measured 2D by a radiologist. We compared 3D stone measurement using different windows to the 2D measurement and evaluated the clinical impact on ureterorenoscopic stone removal (URS). Methods: One hundred sixty-four patients (201 stones) with a preoperative NCCT, following a URS within 4 weeks, were included in this study. Stone location, number and size of stones, operating time, and laser lithotripsy were documented. Stones were measured in 3D using bone and soft tissue window. The maximum diameter was compared to the radiological report. The U test, Kruskal-Wallis, and regression were used for statistical analyses. Results: Almost two-thirds (64.68%; 130 stones) of stone measurements in 3D with the bone window were lower than the radiologist reports in 2D. One-third (34.83%; 70 stones) of stone measurements were higher and 0.5% (1 stone) reported the same size. Using the 3D soft tissue window, 81.09% (163 stones), 17.91% (37 stones), and 1% (2 stones) of stones were measured bigger, smaller, or had the same measurement results, respectively. In the clinical setting, we could calculate a cutoff for laser lithotripsy at a maximum stone diameter of 5.70 mm (p < 0.01) with the 3D and 6.01 mm with the 2D measurements, respectively, and found a significant correlation between maximum stone diameter and operating time (p < 0.01) and number of stones and operating time (p < 0.01 with and p = 0.02 without laser). Conclusion: 3D stone measurement with bone window seems to be more accurate than 2D measurement, but 2D is sufficient for planning stone treatment.

Zur dreidimensionalen Erfassung von akuten Kniebinnenverletzungen ist die bisherige SPACE-Sequenz aufgrund ihrer langen Untersuchungszeit und geometrischen Unscharfe fur die Routineuntersuchung ungeeignet. Im Vergleich zu den konventionellen MRT-Standardsequenzen sollte uberpruft werden, ob eine Nichtunterlegenheit der 3‑D-SPACE-Sequenz mit Compressed-sensing-Technologie im Vergleich mit den etablierten 2‑D-Sequenzen bei verkurzter Untersuchungszeit vorliegt. Insgesamt 109 Patienten im Alter von 18 bis 50 Jahren mit Kniebinnenverletzung wurden von April 2017 bis Mai 2018 mittels MRT untersucht. Die Inter- und Intraobserver-Konkordanz von zwei geblindeten Readern wurde bestimmt. Bei Befundabweichung erfolgte ein Konsensus. Die deskriptive Analyse von absoluten und relativen Haufigkeiten und die Verteilung wurden mit exaktem Fisher-Test auf Unterschiede getestet. Die Interobserver-Konkordanz (IK) bei den konventionellen Sequenzen betrug vor/nach dem Konsensus am Innenmeniskus (IM) 58,8/68,1 %, am Ausenmeniskus (AM) 68,8/88,7 %, am vorderen Kreuzband (VKB) 88,9/97,2 %, am hinteren Kreuzband (HKB) 99/100 %, an den Kollateralbandern (KB) 88,9/97,2 % und fur Knorpelschaden (KS) 1–2: 64,2 %, KS 3: 77 % und KS 4: 76 %. Die IK betrug bei der CS-SPACE vor/nach dem Konsensus am IM 50,4/77 %, AM 68,8/88 %, VKB 89,9/94,5 %, HKB 97,2/99,0 %, KB 92,6/96,3 %. Die IK bei KS erfolgte ohne Konsensus und belief sich bei KS 1–2 auf 65,1 %, KS 3 auf 66 % und KS 4 auf 81,6 %. Bei Verletzungen des VKB, HKB und KB besteht eine hohe IK zwischen den 3‑D- und 2‑D-Sequenzen. In den Standardsequenzen ergibt sich bei KS 3 und 4 eine hohe IK, in der CS-SPACE nur bei KS 4. Unsere Befunde sprechen dafur, dass die CS-SPACE bei akuten Kniegelenktraumen gut geeignet ist.

O artigo relata algumas ações executadas pelo projeto de extensão universitária Atelier Solidário, vinculado ao curso de Design de Moda da Univali - SC, no decorrer do ano de 2017. Este projeto busca realizar atividades que contribuam para a melhoria de vida das comunidades com vulnerabilidade social existentes no entorno dos campi da Universidade, seguindo premissas sustentáveis e de inclusão social, tratando-se de um estudo qualitativo baseado em pesquisa-ação. Por meio de parcerias estabelecidas com duas entidades, o Grupo Musical “Morro do Boi”, localizado em Balneário Camboriú - SC e a Fundação Municipal de Cultural de Bombinhas - SC, foram elaborados figurinos para apresentações musicais e de dança, utilizando materiais oriundos do descarte têxtil de empresas da região. Assim sendo, o projeto de extensão atendeu a uma determinada demanda social, ao mesmo tempo em que promoveu o reaproveitamento do descarte fabril. Além disso, o projeto de extensão contribuiu para a formação dos acadêmicos do curso de Design de Moda, uma valiosa experiência prática na área do desenvolvimento de produtos, necessária para a qualificação profissional dos estudantes.

Individuals with mental illnesses are often stigmatized by healthcare professionals and students, shaping the quality of care that such clients receive. This study examines the knowledge, attitudes, and behavioural responses of healthcare professionals and students toward individuals with mental illnesses. The seven-phase meta-ethnography was utilized to complete this study: getting started, deciding relevance, reading the studies, determining how the studies are related, translating the studies into one another, synthesizing translations, and expressing the synthesis. The meta-synthesis yielded five core themes. Two themes described insight into positive and negative perceptions and behaviours of healthcare professionals and students toward individuals with mental illnesses. Three themes addressed the factors, including insufficiencies in the healthcare system, contact experiences, and other biological and social influences, that impact the perceptions and behaviours. Understanding these humiliating perceptions and behaviours and the factors that shape them is the first step toward diminishing mental health stigma in the healthcare system.

Background The combination of motion-insensitive, high-temporal, and spatial resolution imaging with evaluation of quantitative perfusion has the potential to increase the diagnostic capabilities of magnetic resonance imaging (MRI) in the female pelvis. Purpose To compare a free-breathing compressed-sensing VIBE (fbVIBE) with flexible temporal resolution (range = 4.6–13.8 s) with breath-hold VIBE (bhVIBE) and to evaluate the potential value of quantifying uterine perfusion. Material and Methods A total of 70 datasets from 60 patients (bhVIBE: n = 30; fbVIBE: n = 40) were evaluated by two radiologists. Only temporally resolved reconstruction (fbVIBE) was performed on 30 of the fbVIBE datasets. For a subset (n = 10) of the fbVIBE acquisitions, a time- and motion-resolved reconstruction (mrVIBE) was evaluated. Image quality (IQ), artifacts, diagnostic confidence (DC), and delineation of uterine structures (DoS) were graded on Likert scales (IQ/DC/DoS: 1 (non-diagnostic) to 5 (perfect); artifacts: 1 (no artifacts) to 5 (severe artifacts)). A Tofts model was applied for perfusion analysis. Ktrans was obtained in the myometrium (Mm), junctional zone (Jz), and cervix (Cx). Results The median IQ/DoS/DC scores of fbVIBE (4/5/5 κ >0.7–0.9) and bhVIBE (4/4/4; κ = 0.5–0.7; P > 0.05) were high, but Artifacts were graded low (fbVIBE/bhVIBE: 2/2; κ = 0.6/0.5; P > 0.05). Artifacts were only slightly improved by the additional motion-resolved reconstruction (fbVIBE/mrVIBE: 2/1.5; P = 0.08); fbVIBE was preferred in most cases (7/10). Significant differences of Ktrans values were found between Cx, Jz, and Mm (0.12/0.21/0.19; P Conclusion The fbVIBE sequence allows functional and morphological assessment of the uterus at comparable IQ to bhVIBE.

Background Catheter ablation of right ventricular outflow tract ventricular arrhythmias from above the pulmonary valve is being increasingly reported. Objective The purpose of this study was to systematically analyze the spatial relationship between the pulmonary trunk and the left coronaries. Methods Contrast-enhanced computed tomographic scans from 58 patients were analyzed. After segmentation of the pulmonary trunk and the proximal left coronaries, 3-dimensional geometries were generated. Minimal distance between the pulmonary trunk and the coronaries was automatically determined using a newly developed mathematical algorithm. Results The minimal distance between the pulmonary trunk and the coronaries was 1.4 ± 0.11 mm. Closest relationship was detected 13.8 ± 0.87 mm above the pulmonary valve annulus. Considering a safety margin of 5 mm to render coronary damage unlikely, 84% of patients were found to be at potential risk within the bottom 10 mm of the left sinus cusp. In contrast, positions within or above the right and anterior cusps were less likely to exhibit a close relationship. We identified the anterior aspect of the left cusp as the most critical region. Positions 10–20 mm above the left cusp were found to be critical in 97% of patients. Clinical parameters such as gender, age, height, weight, and body mass index were not predictive of a close spatial relationship. Conclusion Our data provide evidence for a close spatial relationship between the pulmonary trunk and coronary arteries. These results should be considered when performing catheter ablation from above the pulmonary valve.

We report a rare case of concomitant hypertrophic cardiomyopathy and cardiac myxoma without LEOPARD syndrome. Additionally, 6 similar cases were systemically reviewed, and the characteristics of this first-ever studied patient group were summarized. (Level of Difficulty: Beginner.), Graphical abstract, This article reports a rare case of concomitant hypertrophic cardiomyopathy and cardiac myxoma without LEOPARD syndrome. Six similar cases were reviewed…

Purpose Systemic mastocytosis (SM) is characterized by the expansion of clonal mast cells that infiltrate various organ systems. The extent of organ infiltration and subsequent organ damage distinguishes between indolent SM (ISM) defined by a nearly normal life expectancy and advanced SM (AdvSM) defined by poor prognosis. In ISM, measurement of the bone mineral density (BMD) frequently reveals osteoporosis. In contrast, the clinical implication of an increased BMD and osteosclerosis remains unclear. Methods BMD was evaluated in 61 patients with mastocytosis (ISM, n = 29, 48%; AdvSM, n = 32, 52%). We correlated the prevalence of osteoporosis, increased BMD and osteosclerosis with clinical parameters, disease variant and prognosis. Results Osteoporosis was detected in 11/29 (38%) patients with ISM but only in 2/32 (6%) patients with AdvSM (p = 0.004). An increased BMD was detected in 1/29 (3%) patients with ISM and 24/32 (75%) patients with AdvSM (p p p = 0.031). Conclusions Osteoporosis is a common feature in ISM but not in AdvSM. An increased BMD is frequently present in AdvSM but not in ISM and is associated with more advanced disease and inferior outcome.

This article presents the development of an active thermography algorithm capable of detecting defects in materials, based on the techniques of Thermographic Signal Reconstruction (TSR), Thermal Contrast (TC) and the physical principles of heat transfer. The results obtained from this algorithm are compared to the TSR technique and the raw thermogram obtained by stepped thermography inspection. Experimentally, a short thermal pulse is used and the surface temperature of the sample is monitored over time with an infrared camera. Due to the volume of data, the first step is data compression. Newton's law of cooling was used to store the normalized temperature data pixel-by-pixel over time and a compression ratio of 99% was obtained. The main contributions of the developed algorithm are: only four parameters for data compression and the concept of change in the direction of the heat flow to delimit the edges of the defects, where the borders are identified with a remarkable accuracy. Some well known image processing technique are also integrated to improve the thermal analysis: edge detection/interface between the sample and the image background; consolidation in a single image by aggregating the indicators referring to the concept of cooling/heating time constant, maximum thermal amplitude and contrast.

Background: Cardiac magnetic resonance (CMR) pharmacological stress-testing is a well-established technique for detecting myocardial ischemia. Although stressors and contrast agents seem relatively safe, contraindications and side effects must be considered. Substantial costs are further limiting its applicability. Dynamic handgrip exercise (DHE) may have the potential to address these shortcomings as a physiological stressor. We therefore evaluated the feasibility and physiologic stress response of DHE in relation to pharmacological dobutamine-stimulation within the context of CMR examinations.Methods: Two groups were prospectively enrolled: (I) volunteers without relevant disease and (II) patients with known CAD referred for stress-testing. A both-handed, metronome-guided DHE was performed over 2 min continuously with 80 contractions/minute by all participants, whereas dobutamine stress-testing was only performed in group (II). Short axis strain by fast-Strain-ENCoded imaging was acquired at rest, immediately after DHE and during dobutamine infusion.Results: Eighty middle-aged individuals (age 56 ± 17 years, 48 men) were enrolled. DHE triggered significant positive chronotropic (HRrest: 68 ± 10 bpm, HRDHE: 91 ± 13 bpm, p < 0.001) and inotropic stress response (GLSrest: −19.4 ± 1.9%, GLSDHE: −20.6 ± 2.1%, p < 0.001). Exercise-induced increase of longitudinal strain was present in healthy volunteers and patients with CAD to the same extent, but in general more pronounced in the midventricular and apical layers (p < 0.01). DHE was aborted by a minor portion (7%) due to peripheral fatigue. The inotropic effect of DHE appears to be non-inferior to intermediate dobutamine-stimulation (GLSDHE= −19.5 ± 2.3%, GLSDob= −19.1 ± 3.1%, p = n.s.), whereas its chronotropic effect was superior (HRDHE= 89 ± 14 bpm, HRDob= 78 ± 15 bpm, p < 0.001).Conclusions: DHE causes positive ino- and chronotropic effects superior to intermediate dobutamine-stimulation, suggesting a relevant increase of myocardial oxygen demand. DHE appears to be safe and timesaving with broad applicability. The data encourages further studies to determine its potential to detect obstructive CAD.

To compare in patients with known peripheral artery occlusive disease (PAOD), image quality of a combined CTA to a combined MRA protocol, including both static and dynamic acquisitions. Twenty-two patients with PAOD were examined with a combined CTA and MRA protocol consisting of static acquisitions (s-CTA, s-MRA) of the entire runoff and dynamic acquisitions (d-CTA, d-MRA) of the calves. Two radiologists compared image quality of the s-MRA versus s-CTA as well as d-MRA versus d-CTA. Image quality was assessed on a segmental basis using a 4-point Likert scale. For s-CTA, 76% of segments were rated as excellent or good. For s-MRA, 50% of segments were rated as excellent or good (p

Purpose To report the recent rate of acute postoperative endophthalmitis following cataract surgery at the University of Kansas Medical Center (KUMC) where postoperative topical antibiotics were excluded. Methods This was a retrospective chart review of patients who underwent phacoemulsification with or without intraocular lens insertion as standalone surgery from February 2018 through August 2020. Those undergoing combination surgeries were excluded. All patients received intracameral moxifloxacin at the conclusion of cataract surgery but were not prescribed postoperative topical antibiotics. Acute postoperative endophthalmitis was defined as occurring within six weeks after surgery. Results There were 2,218 standalone cataract surgeries performed on 1,418 patients. Zero cases of acute postoperative endophthalmitis were identified (0%). There were no systemic adverse reactions to intracameral moxifloxacin administration in the 41 patients with a preexisting fluoroquinolone allergy. Conclusion The recent rate of acute postoperative endophthalmitis following cataract surgery at KUMC using intracameral moxifloxacin without postoperative topical antibiotics is 0%.

Cardiac sarcoidosis is a chronic inflammatory disease with a large spectrum of symptoms that can mimic diseases such as dilated, hypertrophic, or arrhythmogenic cardiomyopathies. It can be asymptomatic but can also present with ventricular arrhythmias, conduction disease, and heart failure (HF) or even sudden cardiac death (SCD). We present here the case of a patient transplanted due to end‐stage arrhythmogenic right ventricular cardiomyopathy (ARVC), fulfilling the task force criteria. A few years after successful heart transplantation (HTX), the patient developed similar symptoms and morphofunctional changes of the heart, which led to critical re‐evaluation of his primary diagnosis.

A long-standing hypothesis in radiotherapy is that intensity-modulated radiotherapy (IMRT) increases the risk of second cancer due to low-dose exposure of large volumes of normal tissue. Therefore, young patients are still treated with conventional techniques rather than with modern IMRT. We challenged this hypothesis in first-of-its-kind experiments using an animal model. Cancer-prone Tp53+/C273X knockout rats received mediastinal irradiation with 3 × 5 or 3 × 8 Gy using volumetric-modulated arc therapy (VMAT, an advanced IMRT) or conventional anterior-posterior/posterior-anterior (AP/PA) beams using non-irradiated rats as controls (n = 15/group, ntotal = 90). Tumors were assigned to volumes receiving 90–107%, 50–90%, 5–50%, and n = 26) rather than 5–50% (n = 7) of the target dose. Latency was significantly shortened only after 3 × 8 Gy vs. controls (p p = 0.29) and latency (218 vs. 189 days; p = 0.17) of radiation-associated tumors were similar after VMAT vs. AP/PA. LOH was strongly associated with sarcoma but not with treatment. The results do not support the hypothesis that IMRT increases the risk of second cancer. Thus the current practice of withholding dose-sparing IMRT from young patients may need to be re-evaluated.

The methods used to protect agricultural products currently undergo drastic changes. Artificial Intelligence is a prime candidate to overcome two challenges faced by farmers around the world: The increasing cost and decreasing availability of human labor for weed control, and the growing global restriction of herbicides. Deep Learning is one of the most prominent approaches for applying AI to all kinds of use cases in industrial applications, entertainment, and security. Its latest field of application is plant classification that enables automated weed control and precise spot spraying of herbicides. While cheap, powerful platforms for deploying classification mechanisms are widely available, this comes at the cost of expensive and effort rich classifier training. This effectively makes Deep Learning-based approaches unavailable for the majority of the agricultural sector. Deepfield Robotics presents a systematic approach for deploying AI onto fields at large, including the learnings that led to their self-contained AI driven plant classification modules that relieve individuals from having to deploy their own AI solution. The same technology acts as enabler for more agricultural domains, such as targeted fertilization, nano irrigation, and automated phenotyping. This article documents Deepfield Robotics’ findings and vision on how AI can be the workhorse for agricultural weeding labor.

Introduction To evaluate long-term outcomes following stand-alone implantation of two second-generation trabecular micro-bypass stents (iStent inject®, Glaukos Corp., San Clemente, CA, USA) in eyes with predominantly primary open-angle glaucoma (POAG) and considerable preoperative disease burden. Methods Eyes with POAG, pseudoexfoliative glaucoma (PXG), appositional narrow-angle glaucoma (NAG, with open-angle configuration in the area of implantation), or secondary glaucoma were included in this prospective, non-randomized, consecutive case series. All eyes underwent ab interno iStent inject implantation as a sole procedure. Assessments through 36 months included IOP, medications, corrected distance visual acuity (CDVA), secondary glaucoma surgeries, and complications and adverse events. Results Two iStent inject stents were implanted in 44 consecutive eyes (POAG = 38, PXG = 4, appositional NAG = 1, secondary neovascular glaucoma = 1) of 31 patients, and 33 eyes had 36-month follow-up data. Preoperative mean IOP was 25.3 ± 6.0 mmHg on a mean of 2.98 ± 0.88 medications, with 75% of eyes on 3–5 medications, no eyes medication-free, and 50% of eyes with history of prior glaucoma surgery. At 36 months postoperatively, mean IOP reduced by 42% to 14.6 ± 2.0 mmHg (p

The use of metal wires, called Kirschner wires, is a simple and effective fixation method for the correction of shoulder fractures and of dislocations in orthopedic surgery. Wire migration during the postoperative follow-up is a possible complication of the procedure. The authors present the case of a 48-year-old male patient, a business administrator, who suffered a fall from his own height during a soccer match resulting in right shoulder trauma. The patient was treated at a specialized orthopedics and trauma hospital and was diagnosed with a grade V acromioclavicular dislocation. Four days after the trauma, the acromioclavicular dislocation was surgically treated using ligatures with anchor wires, coracoacromial ligament transfer, and fixation with Kirshner wires from the acromion to the clavicle. At the follow-up, 12 days after the surgical procedure, migration of the Kirschner wire to the acromion edge was identified. The patient was oriented to undergo another surgery to remove the Kirshner wire, due to the possibility of further migration; nonetheless, he refused the surgery. Nine months after the surgical treatment, the patient complained of pain on the left shoulder (contralateral side), difficulty to mobilize the shoulder, ecchymosis, and protrusion. Bilateral radiographs demonstrated that the Kirschner wire, originally from the right shoulder, was on the left side. The patient then underwent a successful surgery to remove the implant.

Purpose: CMR pharmacological stress-testing is well-established to detect myocardial ischemia. Despite stressor and contrast agents appear rather save, contraindications and side effects have to be considered. Substantial costs are further limiting its applicability. Dynamic handgrip exercise(DHE) may have the potential to address these shortcomings as a physiological stressor. We therefore evaluated the feasibility and physiologic stress response of DHE in relation to pharmacological dobutamine-stimulation by cardiac magnetic resonance(CMR).Methods: Two subgroups were prospectively enrolled: (i)volunteers without relevant disease and (ii)patients with known CAD referred for stress-testing. A both-handed, metronome-guided DHE was performed over 2 minutes continuously with 80 contractions/minute by all participants, whereas dobutamine stress-testing was only performed in group(ii). Short axis strain by fast-Strain-ENCoded imaging was acquired at rest, immediately after DHE and during dobutamine infusion. Results: Eighty middle-aged individuals(age 56±17years, 48males) were enrolled. DHE triggered significant positive chronotropic(HRrest:68±10bpm, HRDHE:91±13bpm, prest:-19.4±1.9%, GLSDHE:-20.6±2.1%, pDHE=-19.5±2.3%, GLSDob=-19.1±3.1%, p=n.s.), whereas its chronotropic effect was superior (HRDHE=89±14bpm, HRDOB=78±15bpm, pConclusions: DHE causes positive ino- and chronotropic effects superior to intermediate dobutamine-stimulation, suggesting a relevant increase of myocardial oxygen demand. DHE appears safe and timesaving with broad applicability. The data encourages further studies to determine its potential to detect obstructive CAD.

Background Systemic effects of altered serum copper processing in Wilson Disease (WD) might induce myocardial copper deposition and consequently myocardial dysfunction and structural remodeling. This study sought to investigate the prevalence, manifestation and predictors of myocardial tissue abnormalities in WD patients. Methods We prospectively enrolled WD patients and an age-matched group of healthy individuals. We applied cardiovascular magnetic resonance (CMR) to analyze myocardial function, strain, and tissue characteristics. A subgroup analysis of WD patients with predominant neurological (WD-neuro+) or hepatic manifestation only (WD-neuro−) was performed. Results Seventy-six patients (37 years (27–49), 47% women) with known WD and 76 age-matched healthy control subjects were studied. The prevalence of atrial fibrillation in WD patients was 5% and the prevalence of symptomatic heart failure was 2.6%. Compared to healthy controls, patients with WD had a reduced left ventricular global circumferential strain (LV-GCS), and also showed abnormalities consistent with global and regional myocardial fibrosis. WD-neuro+ patients presented with more severe structural remodeling and functional impairment when compared to WD-neuro− patients. Conclusions In a large cohort, WD was not linked to a distinct cardiac phenotype except CMR indexes of myocardial fibrosis. More research is warranted to assess the prognostic implications of these findings. Trial registration: This trial is registered at the local institutional ethics committee (S-188/2018).

Simple Summary Immune checkpoint inhibitors are revolutionizing cancer treatment, but lead to the occurrence of immune related adverse events including ICI-associated myocarditis (ICIM). To date, transcriptional alterations of this rare phenomenon with a high mortality rate are not characterized. 19 ICIM patients at the University Hospitals Heidelberg and Kiel showed diverse clinical presentations. Comparative transcriptomics was able to distinguish ICIM patients from patients with dilated cardiomyopathy or virus-induced myocarditis in the upregulation of 3784 genes. The RNA-based analyses and immunohistology revealed a potential role of an inflammasome-regulating protein, GBP5, as a potential pathomechanism in cardiomyocytes. These alterations may help to diagnose ICIM and potentially enable to identify patients at risk in an early stage. Abstract Immune checkpoint inhibitors (ICIs) are revolutionizing cancer treatment. Nevertheless, their increasing use leads to an increase of immune-related adverse events (irAEs). Among them, ICI-associated myocarditis (ICIM) is a rare irAE with a high mortality rate. We aimed to characterize the transcriptional changes of ICIM myocardial biopsies and their possible implications. Patients suspected for ICIM were assessed in the cardio-oncology units of University Hospitals Heidelberg and Kiel. Via RNA sequencing of myocardial biopsies, we compared transcriptional changes of ICIM (n = 9) with samples from dilated cardiomyopathy (DCM, n = 11), virus-induced myocarditis (VIM, n = 5), and with samples of patients receiving ICIs without any evidence of myocarditis (n = 4). Patients with ICIM (n = 19) showed an inconsistent clinical presentation, e.g., asymptomatic elevation of cardiac biomarkers (hs-cTnT, NT-proBNP, CK), a drop in left ventricular ejection fraction, or late gadolinium enhancement in cMRI. We found 3784 upregulated genes in ICIM (FDR < 0.05). In the overrepresented pathway ‘response to interferon-gamma’, we found guanylate binding protein 5 and 6 (compared with VIM: GBP5 (log2 fc 3.21), GBP6 (log2 fc 5.37)) to be significantly increased in ICIM on RNA- and protein-level. We conclude that interferon-gamma and inflammasome-regulating proteins, such as GBP5, may be of unrecognized significance in the pathophysiology of ICIM.

Background One main challenge in pediatric imaging is to reduce motion artifacts by calming young patients. To that end, the Radiological Society of North America (RSNA) as early as 1997 stated the necessity of adults accompanying their child during the child’s examination. Nonetheless, current research lacks data regarding radiation dose to these chaperones. Objective The aim of this study was to measure the radiation dose of accompanying adults during state-of-the-art pediatric CT protocols. Materials and methods In addition to a 100-kV non-contrast-enhanced chest CT (Protocol 1), we performed a 70-kV contrast-enhanced chest protocol (Protocol 2) using a third-generation dual-source CT. We acquired data on the radiation dose around the scanner using digital dosimetry placed right at the gantry, 1 m away, as well as beside the gantry. We acquired the CT-surrounding radiation dose during scanning of a pediatric phantom as well as 12 pediatric patients. Results After conducting 10 consecutive phantom scans using Protocol 1, we found the location with the highest cumulative dose acquired was right next to the gantry opening, at 3 μSv. Protocol 2 showed highest cumulative dose of 2 μSv at the same location. For Protocol 1, the location with the highest radiation doses during pediatric scans was right next to the gantry opening, with doses of 0.75±0.70 μSv. For Protocol 2, the highest radiation was measured 1 m away at 0.50±0.60 μSv. No radiation dose was measured at any time beside the gantry. Conclusion Our results provide proof that chaperones receive low radiation doses during state-of-the-art CT examinations. Given knowledge of these values as well as the optimal spots with the lowest radiation doses, parents as well as patients might be more relaxed during the examination.

Funding Acknowledgements Type of funding sources: None. Background Safety concerns for gadolinium-containing contrast agents and pharmacological stressors, together with tremendous costs and inconsistent reimbursement modalities are still limiting a widespread application of CMR stress testing despite proven benefits. Like the effect of adenosine, hyperventilation-breath-hold-maneuver (HVBH) has demonstrated to induce myocardial vasodilation and might serve as a stressor to induce coronary steal with consecutive hypokinesia. Purpose To evaluate the diagnostic accuracy of a needle-free, ultrafast stress test to detect myocardial ischemia by strain-encoded CMR (fSENC) after HVBH. Methods Patients referred for CMR stress testing underwent an extended protocol in order to evaluate three different stress forms: (1) Adenosine first-pass perfusion (Ad-FPP), (2) Adenosine-fSENC (Ad-fSENC) and (3) HVBH-fSENC. Diagnostic accuracy was assessed using quantitative coronary angiography as reference. Results One-hundred-twenty-two predominantly male patients (age 66 ± 11years; 80% men) suspected for obstructive CAD were enrolled. Ad-fSENC and HVBH-fSENC provided significantly better diagnostic accuracy than Ad-FPP, both on a patient-level (Ad-fSENC: sensitivity 82%[65-93], specificity 83%[73-90], p Conclusions Stress testing by HVBH-fSENC provides promising diagnostic accuracy to detect myocardial ischemia and is faster than established methods without the necessity to apply contrast agent or pharmacological stressors.

Introduction: Immune checkpoint inhibitors (ICIs) are revolutionizing cancer treatment. Nevertheless, their increasing clinical use leads to higher rates of adverse immune related events (irAEs). One of those irAEs is the ICI-induced myocarditis (ICIM) - a rare phenomenon with an estimated mortality rate of up to 50%. We aimed to characterize the molecular changes of ICIM which are not yet understood completely. Methods: Patients suspected for ICIM were assessed in the cardio-oncology units of University Hospitals Heidelberg and Kiel. Via RNA sequencing of myocardial biopsies, we compared transcriptional changes of ICIM (n=9) with samples from dilatative cardiomyopathy (DCM, n=11) and virus-induced myocarditis (VIM, n=5). Results: Clinical analysis of 19 patients with ICIM showed an inconsistent presentation, e.g. an elevation of cardiac biomarkers (hsTnT, NT-proBNP, CK), a drop in leftventricular ejection fraction or late gadolinium enhancement in cMRI. We found 3784 (FDR Conclusion: Taken together, we were able to identify CD8 and CD8-associated genes as specifically regulated transcripts in ICIM. Moreover, based on the variable clinical phenotype, we propose that analysis of CD8 and CD8-dependent genes will be important to identify ICIM patients and to potentially sub-differentiate different phenotypes.

Background Cardiomyopathies (CMP) may cause impairment of cardiac function and structure. Cardiac Magnetic Resonance Imaging (CMR) is used for analysis and risk stratification of CMP by Late Gadolinium Enhancement (LGE). However, T1 mapping (T1) and fast strain encoded (f-SENC) sequences allow contrast-free and faster exams. The aim of this study was to characterize CMP by T1 and f-SENC to develop a faster and safer CMR protocol (fast-CMR). Methods CMP scans from our CMR database were retrospectively analyzed. All patients were scanned at 1.5T/3T scanner. Study groups were divided as follows: Patients with normal findings, dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and cardiac amyloidosis. Global T1 times, longitudinal (GLS) and circumferential (GCS) strain using f-SENC of study groups were compared to healthy individuals (controls). Scan time and amount of gadolinium-based contrast agent (CA) in CMR-protocol with LGE were compared to fast-CMR. Results 174 patients and 31 controls were recruited. T1 times, GLS and GCS were similar between controls and normal individuals. T1 times were significantly increased (p Conclusion Normal findings could be identified by fast-CMR without contrast agent. Fast CMR might also be a useful tool to identify different forms of CMP. Funding Acknowledgement Type of funding source: None

Cardiovascular magnetic resonance (CMR) is the reference standard for the quantitative assessment of cardiac morphology and function. The aim of the study was to determine age- and gender-related reference values for cardiac morphology and function according to current recommendations. 454 healthy volunteers (235 men, median age 52.0 (44.0–59.0) years) underwent a standard CMR scan and were divided into six groups of nearly equal size with regard to sex (male, female) and age (21–47 years, 48–57 years, 58–84 years). Left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes and LV mass (LV-M) were measured at end-diastole and end-systole in steady-state free precession series with including papillary muscles and trabecular tissue in the LV-M. Absolute and indexed volumetric parameters were significantly different between gender groups with higher values in men compared to women (all p

Background To differentiate effects of ventricular asynchrony from an underlying hypocontractile cardiomyopathy this study aimed to enhance the understanding of functional impairment and structural remodeling in idiopathic left bundle-branch block (LBBB). We hypothesize, that functional asynchrony with septal flash volume effects alone might not entirely explain the degree of functional impairment. Hence, we suggest the presence of a superimposed contractile cardiomyopathy. Methods In this retrospective study, 53 patients with idiopathic LBBB were identified and matched to controls with and without cardiovascular risk factors. Cardiovascular magnetic resonance (CMR) was used to evaluate cardiac function, volumes and myocardial fibrosis using native T1 mapping and late gadolinium enhancement (LGE). Septal flash volume was assessed by CMR volumetric measurements and allowed to stratify patients with systolic dysfunction solely due to isolated ventricular asynchrony or superimposed contractile impairment. Results Reduced systolic LV-function, increased LV-volumes and septal myocardial fibrosis were found in patients with idiopathic LBBB compared to healthy controls. LV-volumes increased and systolic LV-function declined with prolonged QRS duration. Fibrosis was typically located at the right ventricular insertion points. Subgroups with superimposed contractile impairment appeared with pronounced LV dilation and increased fibrotic remodeling compared to individuals with isolated ventricular asynchrony. Conclusions The presence of superimposed contractile impairment in idiopathic LBBB is crucial to identify patients with enhanced structural remodeling. This finding suggests an underlying cardiomyopathy. Future studies are needed to assess a possible prognostic impact of this entity and the development of heart failure. Trial registration: This study was retrospectively registered.

Augmented reality improves planning and execution of surgical procedures. The aim of this study was to evaluate the feasibility of a 3D augmented reality hologram in live parotic surgery. Another goal was to develop an accuracy measuring instrument and to determine the accuracy of the system. We created a software to build and manually align 2D and 3D augmented reality models generated from MRI data onto the patient during surgery using the HoloLens® 1 (Microsoft Corporation, Redmond, USA). To assess the accuracy of the system, we developed a specific measuring tool applying a standard electromagnetic navigation device (Fiagon GmbH, Hennigsdorf, Germany). The accuracy of our system was measured during real surgical procedures. Training of the experimenters and the use of fiducial markers significantly reduced the accuracy of holographic system (p = 0.0166 and p = 0.0132). Precision of the developed measuring system was very high with a mean error of the basic system of 1.3 mm. Feedback evaluation demonstrated 86% of participants agreed or strongly agreed that the HoloLens will play a role in surgical education. Furthermore, 80% of participants agreed or strongly agreed that the HoloLens is feasible to be introduced in clinical routine and will play a role within surgery in the future. The use of fiducial markers and repeated training reduces the positional error between the hologram and the real structures. The developed measuring device under the use of the Fiagon navigation system is suitable to measure accuracies of holographic augmented reality images of the HoloLens.

Background/aim Lung diseases are common in patients with abdominal aortic aneurysms (AAA). This study evaluates the prevalence of lung cancer (LC) in high-risk patients screened for AAA. Patients and methods Six hundred and one male patients (≥65 years of age, cardiovascular high-risk profile) were enrolled and followed prospectively over a median of 16.5 months. Results In 29 patients (4.8%) LC and in another 50 patients (8.3%) AAA were found. The prevalence of LC among patients with AAA was even higher (9 of 50, 18.0%). Twenty-one patients had an initial diagnosis of LC, with an incidence of 12.0% (6 of 50) in patients with AAA. During follow-up, 14 of 70 patients with AAA and/ or LC (20.0%) deceased. The highest mortality was found in patients with LC only (8 of 20, 40.0%), followed by patients with both AAA and LC (3 of 9, 33.3%), while patients with AAA only had the lowest mortality rate (3 of 41, 7.3%). Conclusion In patients with a high cardiovascular risk profile, a high prevalence of both AAA and LC were found, whereby the prognosis is largely determined by the LC. Therefore, LC is of particular importance in the setting of screening and surveillance of AAA.

Introduction: To compare RENAL, preoperative aspects and dimensions used for an anatomical (PADUA) classification, and Mayo Adhesive Probability (MAP) scores with the respective intraoperative findings and surgeon’s assessment in predicting surgical outcome of patients undergoing partial nephrectomy. Methods: Data of 150 eligible patients treated at the University Medical Center Mannheim between 2016 and 2018 were analyzed. Tumors were radiologically and intraoperatively assessed by PADUA, RENAL, and MAP scores and surgeon’s assessment. Correlations and regression models were created to predict ischemia time (IT), major complications, and Trifecta (negative surgical margin, IT < 25 min, and absence of major complications). Results: There were strong correlations between radiological and intraoperative RENAL (r = 0.68; p < 0.001) and PADUA scores (r = 0.72; p < 0.001). Radiological RENAL, PADUA, and MAP scores and surgeon’s assessment were independent predictors of Trifecta (OR = 0.71, p = 0.015; OR = 0.77, p = 0.035; OR = 0.65, p = 0.012; OR = 0.40, p = 0.005, respectively). IT showed significant associations with radiological RENAL, PADUA, and surgeon’s assessment (OR = 1.41, p = 0.033; OR = 1.34, p = 0.044; OR = 3.04, p = 0.003, respectively). MAP score proved as only independent predictor of major complications (OR = 2.12, p = 0.002). Conclusion: Radiologically and intraoperatively assessed scores correlated well with each other. Intraoperative nephrometry did not outperform radiological scores in predicting outcome confirming the value of the existing systems. MAP score correlates well with surgeon’s assessment of perirenal fat and major complications underlining the importance of perirenal fat characteristics.

PURPOSE The aim of this study was to compare respiratory-triggered diffusion-weighted imaging with simultaneous-multislice acceleration (SMS-RT-DWI) to a standard free-breathing echoplanar DWI (s-DWI) for 3 T renal imaging with respect to image quality and artifacts. MATERIALS AND METHODS A total of 40 patients who had undergone renal magnetic resonance imaging were included in this retrospective analysis of a prospectively planned cohort study. All examinations were performed on a 3 T whole-body magnetic resonance system. Both s-DWI and SMS-RT-DWI were obtained and images were independently reviewed by 2 radiologists on a 5-point Likert scale with respect to overall preference and image quality, renal edge and parenchymal sharpness, cortico-medullary differentiation, and sequence-related artifacts. Furthermore, discernibility of renal lesions was assessed. The signal-to-noise ratio (SNR) was measured from SNR maps. The derived mean apparent diffusion coefficients were also compared. Qualitative parameters were assessed with the Wilcoxon rank-sum test, and quantitative parameters, with the Student t test. RESULTS Overall image quality, renal edge, and parenchymal sharpness of SMS-RT-DWI were rated as superior to s-DWI by the readers, with fewer sequence-related artifacts (P < 0.01 for all). Lesion discernibility was significantly improved for SMS-RT-DWI (P < 0.01). Both readers preferred SMS-RT-DWI to s-DWI in all cases (40/40). The acquisition time for SMS-RT-DWI was 30% shorter than for s-DWI. Mean SNR heterogeneity of SMS-RT-DWI at b = 800 s/mm was statistically significantly lower than s-DWI, whereas mean SNR was significantly higher for SMS-RT-DWI. Mean apparent diffusion coefficient values from both sequences were comparably homogeneous throughout the kidneys. CONCLUSION Simultaneous multislice DWI of the kidney at 3 T with respiratory triggering yields substantially improved image quality and lesion discernibility compared with standard single-shot echoplanar DWI with a 30% reduction in scan acquisition time.

Objective: To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. Method: Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. Results: 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. Conclusion: Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth. RESUMEN Objetivo: Describir y analizar las prácticas sugeridas en las redes sociales como Blogs/Sitios, no recomendadas por la OMS, sobre la planificación de los partos. Método: Se trata de un estudio cualitativo, exploratorio y descriptivo, de análisis temático. Entre marzo y julio de 2016, se seleccionaron 41 direcciones electrónicas de 200 identificadas con antelación. Tres estaban situadas en Portugal y las demás, en Brasil. Resultados: Se identificaron 48 prácticas no citadas entre las recomendaciones de la Organización Mundial de la Salud (OMS). Conclusión: Los Blogs/Sitios, al ser vehículos de transmisión, circulación y producción de conocimientos, permiten la expresión de valores de manera horizontal, instigando a las mujeres a planificar eventos considerados importantes para sus partos y a transferir las decisiones de las prácticas del parto para sí, lo que ha generado controversia en el discurso de la humanización del trabajo de parto. RESUMO Objetivo: Descrever e analisar práticas sugeridas nas mídias sociais para elaboração de Planos de Partos disponíveis em Blogs/Sites e que não constam nas recomendações da OMS. Método: Estudo qualitativo, exploratório, descritivo, de análise temática. Foram selecionados para análise 41 endereços eletrônicos dos 200 previamente identificados, entre março e julho de 2016. Três endereços eletrônicos estavam sitiados em Portugal e os demais no Brasil. Resultados: Foram identificadas 48 práticas não citadas entre as recomendações da Organização Mundial da Saúde (OMS). Conclusões: Os Blogs/Sites, por serem ferramentas de transmissão, circulação e produção de conhecimentos, possibilitam a expressão de valores de forma horizontal, instigando mulheres ao planejamento dos eventos considerados importantes para seus partos e deslocando as decisões das práticas de parto para si, o que tem provocado polêmica no discurso da humanização do parto.

18F-MK-6240 (18F-labeled 6-(fluoro)-3-(1H-pyrrolo[2,3-c]pyridin-1-yl)isoquinolin-5-amine) is a highly selective, subnanomolar-affinity PET tracer for imaging neurofibrillary tangles (NFTs). Plasma kinetics, brain uptake, and preliminary quantitative analysis of 18F-MK-6240 in healthy elderly (HE) subjects, subjects with clinically probable Alzheimer disease (AD), and subjects with amnestic mild cognitive impairment were characterized in a study that is, to our knowledge, the first to be performed on humans. Methods: Dynamic PET scans of up to 150 min were performed on 4 cognitively normal HE subjects, 4 AD subjects, and 2 amnestic mild cognitive impairment subjects after a bolus injection of 152–169 MBq of 18F-MK-6240 to evaluate tracer kinetics and distribution in brain. Regional SUV ratio (SUVR) and distribution volume ratio were determined using the cerebellar cortex as a reference region. Total distribution volume was assessed by compartmental modeling using radiometabolite-corrected input function in a subgroup of 6 subjects. Results:18F-MK-6240 had rapid brain uptake with a peak SUV of 3–5, followed by a uniformly quick washout from all brain regions in HE subjects; slower clearance was observed in regions commonly associated with NFT deposition in AD subjects. In AD subjects, SUVR between 60 and 90 min after injection was high (approximately 2–4) in regions associated with NFT deposition, whereas in HE subjects, SUVR was approximately 1 across all brain regions, suggesting high tracer selectivity for binding NFTs in vivo. 18F-MK-6240 total distribution volume was approximately 2- to 3-fold higher in neocortical and medial temporal brain regions of AD subjects than in HE subjects and stabilized by 60 min in both groups. Distribution volume ratio estimated by the Logan reference tissue model or compartmental modeling correlated well (R2 > 0.9) to SUVR from 60 to 90 min for AD subjects. Conclusion:18F-MK-6240 exhibited favorable kinetics and high binding levels to brain regions with a plausible pattern for NFT deposition in AD subjects. In comparison, negligible tracer binding was observed in HE subjects. This pilot study suggests that simplified ratio methods such as SUVR can be used to quantify NFT binding. These results support further clinical development of 18F-MK-6240 for potential application in longitudinal studies.

Background Relapsed and refractory multiple myeloma (RRMM) remains a major challenge. With each relapse, patients (pts) experience decreased response duration leading to shortened survival. Pts with triple-class refractory disease (refractory to one class of the following: immunomodulatory agents (IMiDs), proteasome inhibitors (PI) and anti-CD38 monoclonal antibody) have a poor prognosis. Belantamab mafodotin is a first-in class B-cell maturation antigen (BCMA) antibody-drug conjugate. The aim of this study was to analyze the clinical outcomes of belantamab/dexamethasone (Bd) in triple-class RRMM. Patients & Methods Twenty-eight pts with triple-class RRMM receiving Bd were identified at University of Kansas Health System between October 2019 and June 2021 and reviewed retrospectively. These pts received belantamab 2.5 mg/kg IV every 3 weeks and dexamethasone (20-40) mg PO weekly. Descriptive analyses were performed on available data for patient characteristics. Survival curves were generated using the Kaplan-Maier method. Responses were evaluated using the International Myeloma Working Group (IMWG) criteria. Results The median age was 67 yrs (42-85). Eleven pts (39%) had IgG isotype, 14 pts (50%) had R-ISS stage III disease, 20 pts (71%) had high-risk cytogenetics, and 13 pts (46%) had extramedullary disease (EMD). Patients characteristics are summarized in Table 1. Median number of Bd cycles received was 3 (2-18). The median number of previous lines of therapy was 5 (3-15). All pts were triple-class refractory, whereas 15 pts (54%) were penta-refractory. Twenty-one pts (75%) received autologous stem cell transplant, and 8 pts (29%) had previously received BCMA-targeted therapy. The response rate for all pts was 46% with 18% achieving very good partial response and better. Median follow-up was 7.4 months. Median progression-free survival (PFS) was 4.9 months, while median overall survival (OS) was 7.4 months. The response rates are summarized in Table 2. Keratopathy was one of the most common adverse events (AEs), occurring in 23 (82%) pts, 13 (56%) pts had grade 3 or 4 keratopathy. Nineteen patients (68%) required dose reduction or delay due to keratopathy. Other common AEs included: anemia (83%), thrombocytopenia (70%), neutropenia (30%), and elevated liver function tests (53%). Eighteen patients (64%) discontinued due to progression of disease or death. No treatment-related mortality was noted in this review. Conclusion Our analysis demonstrates a reasonable efficacy of Bd in those who are heavily treated triple-class RRMM patients in the real world. Keratopathy remains a challenging AE and the main cause of dose reduction and delay. Figure 1 Figure 1. Disclosures Atrash: AMGEN: Research Funding; Jansen: Research Funding, Speakers Bureau; GSK: Research Funding. Mahmoudjafari: GSK: Membership on an entity's Board of Directors or advisory committees; Omeros: Membership on an entity's Board of Directors or advisory committees; Incyte: Membership on an entity's Board of Directors or advisory committees. McGuirk: Magenta Therapeutics: Consultancy, Honoraria, Research Funding; Allovir: Consultancy, Honoraria, Research Funding; Kite/ Gilead: Consultancy, Honoraria, Other: travel accommodations, expense, Kite a Gilead company, Research Funding, Speakers Bureau; Gamida Cell: Research Funding; Novartis: Research Funding; EcoR1 Capital: Consultancy; Juno Therapeutics: Consultancy, Honoraria, Research Funding; Novartis: Research Funding; Fresenius Biotech: Research Funding; Astelllas Pharma: Research Funding; Bellicum Pharmaceuticals: Research Funding; Pluristem Therapeutics: Research Funding.

Postinfarct cardiac hypertrophy is an independent risk factor for heart failure and sudden death. Regression of cardiac hypertrophy has emerged as a promising strategy in the treatment of myocardial infarction (MI). Here we hypothesized that frizzled1 (FZD1), a receptor of the canonical Wnt signaling pathway, is a novel mediator of ischemia-associated cardiac hypertrophy. MI was induced in mice by left anterior descending (LAD) coronary occlusion. One week after MI, the expression of FZD1 was found to be notably increased in the left ventricles (LVs) of the MI-mice compared to shams. Mouse recombinant FZD1 protein (RFP) was subcutaneously injected in the mice to provoke autoimmunization response. Anti-FZD1 antibody titer was significantly increased in the plasma of RFP-treated mice. RFP significantly mitigated the MI-induced cardiac hypertrophy and improved cardiac function in the MI mouse hearts. Moreover, increased heart and LV weights, myocardial size and the expression of β-myosin heavy chain in the MI-mice were also found to be attenuated by RFP. FZD1 was found to be significantly up-regulated in hypoxia-treated neonatal rat cardiomyocytes (NRCMs). Silencing FZD1 by siRNA transfection notably repressed the hypoxia-induced myocardial hypertrophy in NRCMs. Mechanistically, activation of canonical Wnt signaling induced by MI, e.g., β-catenin and glycogen synthase kinase-3β, was restrained in the LVs of the MI-mice treated by RFP, these inhibition on canonical Wnt signaling was further confirmed in hypoxic NRCMs transfected with FZD1 siRNA. In conclusion, immunization of RFP attenuated cardiac hypertrophy and improved cardiac function in the MI mice via blocking the canonical Wnt signaling pathway.

To evaluate the accuracy of a T2-weighted (T2w) - and a parallel transmit zoomed b = 2000 s/mm2 (b2000) - diffusion-weighted imaging sequence among three readers with different degrees of experience for prostate cancer (Pca) detection.Ninety-three patients with suspected Pca were enrolled. For b2000 a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory was applied, and the field of view (FOV) was reduced to one-third. All three readers (Reader A: 7, B 4 and C1 years of experience in prostate MRI) independently evaluated b2000 with regard to the presence of suspicious lesions that displayed increased signal. The results were compared to histopathology obtained by real-time MR/ultrasound fusion and systematic biopsy.In 62 patients Pca was confirmed. One significant Pca (Gleason score (GS) 7b) was missed by Reader C. Overall, sensitivity/specificity/positive predictive value/negative predictive value were 90/71/86/79% for Reader A, 87/84/92/76% for Reader B and 85/74/87/72% for Reader C, respectively. Detection rates for significant Pca (GS7a) were 100/100/94% for Readers A/B/C, respectively. Inter-reader agreement was generally good (Kappa A/B: 0.8; A/C: 0.82; B/C: 0.74).B2000 in combination with a T2w could be useful to detect clinically significant Pca.• Significant prostate cancer using zoomed ultra-high b-value DWI was detected. • Diagnostic performance among readers with different degrees of experience was good. • mp- MRI of the prostate using a comprehensive non-contrast protocol is clinically feasible.

Background Hepatocyte-specific gadolinium based contrast agents (HSCA) provide substantial information for the classification of liver lesions in magnetic resonance imaging (MRI). However, breathing artifacts which reduce image quality and diagnostic confidence of hepatobiliary phase acquisitions are regularly observed in clinical routine. The aim of this study was to evaluate two approaches to reduce breathing artifacts for hepatobiliary phase imaging. Methods Twenty minutes after administration of a HSCA (gadoxetic acid), a T1-weighted VIBE sequence with radial k-space sampling (radialVIBE, 180 s acquisition time in free breathing) and a highly accelerated Cartesian VIBE with Dixon fat separation (CD-VIBE, CAIPIRINHA acceleration with r = 2 × 2, breath-hold 8–10 s) were acquired in 35 patients (12 female, 57 ± 13 years), who showed breath-holding difficulties in early phases of the examinations. Image quality (image sharpness, noise, artifacts, homogeneity of fat saturation, bile duct delineation and overall image quality) as well as conspicuity and liver-to-lesion signal intensity (SI) ratios of focal liver lesions were assessed for both radial- and CD-VIBE. Results Overall image quality was rated good to excellent for both sequences, while CD-VIBE was preferred in most cases. Though radialVIBE received better results regarding image noise and artifacts, both sequences were rated equally regarding bile duct delineation and sharpness. Focal liver lesion (n = 42) conspicuity was rated significantly better and SI-ratios were significantly higher on CD-VIBE (2.45 ± 1.44 vs. 1.61 ± 0.70 in radialVIBE, p = 0.0001). In three patients, CD-VIBE was rated non-diagnostic due to severe breathing artifacts, while radialVIBE was diagnostic in those patients. Conclusion Both highly accelerated Cartesian as well as radial acquisition techniques provide good to excellent image quality in hepatobiliary phase MRI. In comparison, CD-VIBE offered better overall image quality and liver lesion conspicuity. However, radialVIBE was a valuable alternative in patients unable to sustain even short breath-hold intervals. Further studies including lager patient cohorts are desirable to allow a transfer of these results to a general patient population.

Detektion und Charakterisierung fokaler Leberlasionen. Die MRT ist aufgrund des exzellenten Weichteilkontrasts, der Verfugbarkeit leberspezifischer Kontrastmittel und der Moglichkeit funktioneller Bildgebung die Methode der Wahl zur Abklarung fokaler Leberlasionen. Die diffusionsgewichtete Bildgebung („diffusion-weighted imaging“, DWI) ermoglicht es, neben den rein morphologischen auch funktionelle Informationen uber die Mikrostruktur eines Gewebes zu generieren. Bei der Detektion fokaler Leberlasionen zeigt die DWI eine bessere Detektionsrate im Vergleich zu T2w-Sequenzen und eine etwas schlechtere Detektionsrate im Vergleich zu dynamischen T1w-Sequenzen. Prinzipiell ist es mit der DWI moglich, maligne Leberlasionen von benignen zu unterscheiden sowie ein Therapieansprechen fruhzeitig zu detektieren. Sowohl fur die Detektion als auch fur die Charakterisierung fokaler Leberlasionen stellt die DWI eine vielversprechende Alternative zu den morphologischen Sequenzen dar. Insbesondere fur die Charakterisierung solider benigner Lasionen sollte jedoch deren nahere Charakterisierung unter Zuhilfenahme weiterer Sequenzen erfolgen. Fur die Beurteilung und die Prognose eines Therapieansprechens bietet die DWI Vorteile im Vergleich zu den rein morphologischen Sequenzen. Zur reinen Detektion fokaler Leberlasionen ist die DWI prinzipiell ausreichend. Nach visueller Detektion einer soliden Leberlasion sollte deren nahere Charakterisierung unter Zuhilfenahme weiterer Sequenzen (insbesondere dynamischer T1w-Sequenzen) erfolgen. Fur die Beurteilung und die Prognose eines Therapieansprechens sollte die DWI herangezogen werden.