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A response by Wikstrom and others to a letter to the editor about their article "Random albumin/creatinine ratio for quantification of proteinuria in manifest pre-eclampsia" in the 2007 issue is presented.

Abstract: Two types of refractory bricks were used in reaction tests with slag from a production kiln for iron ore pellet production. Electron microscopy was used to characterize morphological changes at the slag/brick interface and active chemical reactions. Phases such as kalsilite, nepheline and potassium β-alumina form, in a layered structure, as a consequence of alkali metals migration in the brick. Larger hematite grains (50–100μm) in the slag remain at the original slag/brick interface, while smaller grains dissolve and move through the partly dissolved brick bulk, and forms micrometer sized needle-shaped crystals deeper in the lining material. Thermodynamic simulations predict the formation of a solid solution between hematite and corundum which is also observed in the reaction zone after extended time periods. [Copyright &y& Elsevier]

Abstract: There is increasing evidence showing that inflammation is involved in heart failure. However, heart failure may differ greatly due to different aetiologies. The role of inflammation in hypertensive heart failure, particularly in the early stage of cardiac dysfunction, has not been studied completely. This study aims at finding out whether inflammation is involved in the early stage of heart dysfunction due to hypertension. Methods: Ten spontaneously hypertensive rats (SHR) and ten age-matched Whistar rats were used. Cardiac morphology and function, as well as coronary flow reserve, were examined by echocardiography. mRNAs for cytokines and brain natriuretic peptide were determined by RT-PCR. Results: The results demonstrate cardiac hypertrophy with increased heart/body weight ratio in SHR. Echocardiographic examination has shown that SHR developed diastolic heart dysfunction as determined by tissue Doppler without decrease in systolic function. In heart biopsies, there were increased mRNA levels for interleukin-6 and brain natriuretic peptide whereas decreased mRNA for interleukin-2, beta adrenergic receptor, interferon and NFkb in SHR as compared to WKY group. Coronary flow remained unchanged in both groups. Conclusion: SHR developed cardiac hypertrophy complicated with diastolic heart dysfunction with increased expression of brain natriuretic peptide, down-regulation of beta adrenergic receptors and simultaneous up-regulation of IL-6, which indicates active proinflammatory process as, at least partly, underlying mechanism during the early stage when cardiac hypertrophy associated with diastolic dysfunction occurs. [Copyright &y& Elsevier]

Purpose: We evaluated in a clinical setting the INTERPRET decision-support system (DSS), a software generated to aid in MRS analysis to achieve a specific diagnosis for brain lesions.Methods: The material consisted of 100 examinations of focal intracranial lesions with confirmed diagnoses. MRS was obtained at 1.5 T using TE 20-30 ms. Data were processed with the LCModel for conventional analysis. The INTERPRET DSS 3.1. was used to obtain specific diagnoses. MRI and MRS were reviewed by one interpreter. DSS analysis was made by another interpreter, in 80 cases by two interpreters. The diagnoses were compared with the definitive diagnoses. For comparisons between DSS, conventional MRS analysis, and MRI, the diagnoses were categorised: high-grade tumour, low-grade tumour, non-neoplastic lesion.Results: Interobserver agreement in choosing the diagnosis from the INTERPRET database was 75%. The diagnosis was correct in 38/100 cases, incorrect in 57 cases. No good match was found in 5/100 cases. The diagnostic category was correct with DSS/conventional MRS/MRI in 67/58/52 cases, indeterminate in 5/8/20 cases, incorrect in 28/34/28 cases. Results with DSS were not significantly better than with conventional MRS analysis. All definitive diagnoses did not exist in the INTERPRET database. In the 61 adult patients with the diagnosis included in the database, DSS/conventional MRS/MRI yielded a correct diagnosis category in 48/32/29 cases (DSS vs conventional MRS: p = 0.002, DSS vs MRI: p = 0.0004).Conclusion: Use of the INTERPRET DSS did not improve MRS categorisation of the lesions in the unselected clinical cases. In adult patients with lesions existing in the INTERPRET database, DSS improved the results, which indicates the potential of this software with an extended database. [ABSTRACT FROM AUTHOR]

Objective: To evaluate in-vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function.Methods: A study population of 35 pregnant women, of whom 13 had pre-eclampsia (PE), were examined at 22-40 weeks' gestation. Within a 24-h period, each woman underwent an MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P  <  0.05) and therefore we included an interaction term between PE and covariates in the models.Results: The median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R(2)  = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms-like tyrosine kinase-1, estimated fetal weight and presence of PE.Conclusion: The placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 31-year-old primiparous woman with antenatal care at 12 weeks' gestation. She has undergone ultrasound examination and experienced symptoms interpreted as symphysiolysis at 23 weeks. The patient has an emergency Cesarean section at 28+3 weeks due to suspicion of placental abruption and her infant had an anemia, requiring a blood transfusion. The use of magnetic resonance imaging in the diagnosis of placental mesenchymal dysplasia is discussed.

Background: The aim of this study was to investigate the relationship between (i) carotid intima-media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (∆CIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA). Methods and results: In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ∆CIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306). Results: Carotid intima-media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ∆CIMT and TAS (P = 0·41). Conclusions: In the present study, CIMT, but not ∆CIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The principal aim of this study was to determine whether the amount of visceral adipose tissue (VAT) is more related than subcutaneous adipose tissue (SAT) to atherosclerosis assessed by whole-body MRA (WBMRA). A further objective was to investigate whether traditional risk factors, inflammation, or adipokines could explain the hypothesized relationship between VAT and atherosclerosis. Methods: Men and women aged 70 were recruited from the general population into the Prospective Investigation of The Vasculature in Uppsala Seniors (PIVUS) and 306 of them underwent WBMRA in a clinical 1.5-T scanner. The arterial tree was assessed for degree of stenosis or occlusion and a total atherosclerotic score (TAS) was established. Information on risk factors and BMI and on SAT and VAT, segmented on an axial MR scan was collected. Adiponectin, leptin, and high sensitive C-reactive protein (hsCRP) were measured in serum. HOMA index was used as a marker of insulin resistance. Results: VAT was related to TAS independently of gender, total obesity (BMI), amount of SAT, hsCRP and also to the traditional risk factors included in the Framingham risk score (FRS) in an elderly population. Adiponectin or the HOMA insulin resistance, but not leptin or VAT, together with FRS was significantly related to TAS in a multiple censored regression model. Conclusion: Adiponectin attenuated the relationship between VAT and TAS, suggesting that adiponectin and insulin resistance is an important link between visceral adiposity and atherosclerosis. [Copyright &y& Elsevier]

We have performed a two-stage study to analyse the association of polymorphism on chromosome 2q33 with multiple sclerosis (MS). In all, 17 markers were analysed in stage-1 in 134 Finnish MS families and the observed associations were tested in stage-2 in 186 MS families. We did not find previously reported allelic or haplotype associations with CTLA4. We obtained a weak signal of two distinct predisposing genes, one proximal the other distal of CTLA4. The putative proximal gene was associated with the marker rs3977 in families lacking HLA-DR2 (P=0.02 and 0.02) and the other distal gene was associated with D2S1271 in families from a high-risk region in western Finland (P=0.02 and 0.01). Based on the >3?cM distance and the lack of linkage disequilibrium between these loci, we conclude that the two association signals are independent. Our results provide preliminary evidence for two distinct MS susceptibility genes on 2q33 outside of CTLA4.Genes and Immunity (2004) 5, 142-146. doi:10.1038/sj.gene.6364049 Published online 15 January 2004 [ABSTRACT FROM AUTHOR]

A combined emotional Stroop and implicit memory (tachistoscopic identification) task with 3 types of words (panic-related, interpersonal threat, and neutral words) and 2 exposure conditions (subliminal, supraliminal) was administered to 35 patients with panic disorder and 35 age- and sex-matched controls. The patients showed Stroop interference for panic-related words both sub- and supraliminally and a similar but not equally robust effect on interpersonal threat words. On the tachistoscopic identification task, the patients identified more panic-related words than the controls did but showed no implicit memory bias effect. The patients' subliminal Stroop interference for panic-related words was found to correlate with trait anxiety and depression, although not with anxiety sensitivity. [ABSTRACT FROM AUTHOR]

In short terms, a society's available resources are finite and must be prioritised. The more resources that are spent on radiological protection, the lesser resources are available for other needs. The ALARA principle states that exposure of ionising radiation should be kept as low as reasonably achievable, taking into account economic and societal factors. In practice, one of several approaches to determine what is considered as reasonably achievable is cost-benefit analysis. A demanding part of cost-benefit analysis is to decide on an α value, which stipulates the value of radiological protection. There are different conversion methods on how to convert societal costs into an α value. However, with the assistance of recent developments within both health economics and radiological protection room for improvements was found. Therefore, the aims of the present study were to develop a new conversion method (on how to convert societal costs into an α value) and to provide recommendations of α values for each member country of The Organisation for Economic Co-operation and Development (OECD). With the help of systematic reviews of societal costs (the value of a statistical life, productivity losses and healthcare costs) and discount rates, as well as Monte Carlo simulations of the number of years between exposure and cancer diagnosis, a new conversion method and recommendations of α values could be presented. The new conversion method was expressed as a discounted nominal risk of exposure with a median (interquartile range) of 175 (136-222) per 10 000 persons per Sv for the public and 169 (134-207) per 10 000 persons per Sv for workers. For OECD in general, recommendations of α values were determined to be $56-170 per man.mSv for the public and $61-162 per man.mSv for workers (2023-USD)., (Creative Commons Attribution license.)

Purpose: We aimed to characterize the RYGB-induced changes in the dynamics of brain glucose uptake. We addressed heterogeneity between brain regions during experimental normo- and hypoglycemia and explored associations with anthropometric and metabolic outcomes of RYGB., Methods: Analyses of regional brain glucose uptake were performed on 9 individuals with obesity and no diabetes, investigated with combined brain 18 F-FDG-PET and fMRI during hyperinsulinemic normo- and hypoglycemic clamp, one month before and four months after RYGB. FDG clearance, reflecting glucose uptake rate, was assessed in 38 brain regions, covering all cortical areas and subcortical nuclei, during hyperinsulinemic normo- and hypoglycemia. Correlation analyses were performed to identify associations with other outcomes of RYGB., Results: FDG uptake rate during hypoglycemia was higher than during normoglycemia in all brain regions, both before and after RYGB. Moreover, in most regions and especially in cortical areas involved in inhibitory behavioral control, FDG uptake rate tended to be reduced after surgery during normoglycemia but elevated during hypoglycemia. However, these post-surgical changes in FDG uptake rate were opposite in the hypothalamus. Thus, the hypo-to-normoglycemia FDG clearance ratio tended to increase in all brain regions following RYGB, but not in the amygdala and the hypothalamus. Changes in regional FDG uptake rate after RYGB during normoglycemia were associated with weight loss and improved systemic insulin sensitivity., Conclusion: Using dynamic FDG-PET, we show region-specific patterns of changes in glucose utilization following RYGB. In the hypothalamus, glucose uptake during normoglycemia tended to rise after RYGB while it was reduced in cortical regions involved in behavioral control. Following RYGB, the hypothalamus and amygdala, in contrast to other regions, displayed trends of reduced glucose uptake during hypoglycemia. These pilot results highlight the brain effects of RYGB and suggest behavioral and neuroendocrine adaptations which contribute to its antidiabetic effects., Competing Interests: Compliance with ethical standards. Conflict of interest: The authors declare no competing interests. Ethics approval: All procedures were carried out in accordance with the Declaration of Helsinki and only upon verbal and written informed consent by the study participants. Consent to participate: The study was approved by the Regional Research Ethics Committee of Uppsala (DNR 2017/210)., (© 2024. The Author(s).)

Background: Eclampsia is a serious pregnancy complication and is associated with cerebral edema and infarctions. However, the underlying pathophysiology of eclampsia remains poorly explored., Objective: This study aimed to assess the pathophysiology of eclampsia using specialized magnetic resonance imaging to measure diffusion, perfusion, and vasospasm., Study Design: This was a cross-sectional study recruiting consecutive pregnant women between April 2018 and November 2021 at Tygerberg Hospital, Cape Town, South Africa. Women with eclampsia, preeclampsia, and normotensive pregnancies who underwent magnetic resonance imaging after birth were recruited. The main outcome measures were cerebral infarcts, edema, and perfusion using intravoxel incoherent motion imaging and vasospasm using magnetic resonance imaging angiography. The imaging protocol was established before inclusion., Results: Here, 49 women with eclampsia, 20 women with preeclampsia, and 10 normotensive women were included. Cerebral infarcts were identified in 34% of women with eclampsia and 5% of women with preeclampsia (risk difference, 0.29; 95% confidence interval, 0.06-0.52; P=.012). However, no cerebral infarct was identified in normotensive controls. Women with eclampsia were more likely to have vasogenic cerebral edema than women with preeclampsia (80% vs 20%, respectively; risk difference, 0.60; 95% confidence interval, 0.34-0.85; P<.001) and normotensive women (risk difference, 0.80; 95% confidence interval, 0.47-1.00; P<.001). Diffusion was increased in women with eclampsia in the parieto-occipital white matter (mean difference, 0.02 × 10 -3 mm 2 /s; 95% confidence interval, 0.00-0.05; P=.045) and caudate nucleus (mean difference, 0.02 × 10 -3 mm 2 /s; 95% confidence interval, 0.00-0.04; P=.033) compared with women with preeclampsia. In addition, diffusion was increased in women with eclampsia in the frontal white matter (mean difference, 0.07 × 10 -3 mm 2 /s; 95% confidence interval, 0.02-0.12; P=.012), parieto-occipital white matter (mean difference, 0.05 × 10 -3 mm 2 /s; 95% confidence interval, 0.02-0.07; P=.03), and caudate nucleus (mean difference, 0.04 × 10 -3 mm 2 /s; 95% confidence interval, 0.00-0.07; P=.028) compared with normotensive women. Perfusion was decreased in edematous regions. Hypoperfusion was present in the caudate nucleus in eclampsia (mean difference, -0.17 × 10 -3 mm 2 /s; 95% confidence interval, -0.27 to -0.06; P=.003) compared with preeclampsia. There was no sign of hyperperfusion. Vasospasm was present in 18% of women with eclampsia and 6% of women with preeclampsia. However, no vasospasm was present in the controls., Conclusion: Eclampsia was associated with cerebral infarcts, vasogenic cerebral edema, vasospasm, and decreased perfusion, which are not usually evident on standard clinical imaging. This finding may explain why some patients have cerebral symptoms and signs despite having normal conventional imaging., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Premenstrual dysphoric disorder (PMDD) is a depressive disorder triggered by fluctuations of progesterone and estradiol during the luteal phase of the menstrual cycle. Selective progesterone receptor modulation (SPRM), while exerting an antagonistic effect on progesterone and maintaining estradiol on moderate levels, has shown beneficial effects on the mental symptoms of PMDD. Progesterone is also known for its neuroprotective effects, while synthetic progestins have been suggested to promote myelination. However, the impact of SPRM treatment on white matter microstructure is unexplored., Methods: Diffusion tensor imaging was employed to collect data on white matter integrity in patients with PMDD, before and after treatment with ulipristal acetate (an SPRM) or placebo, as part of a double-blind randomized controlled-trial. Tract based spatial statistics were performed to investigate SPRM treatment vs. placebo longitudinal effects on fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD), on the whole white matter skeleton., Results: Voxel-wise analyses indicated no change over time in any white matter microstructure metrics in individuals treated with SPRM versus placebo. Improvement in PMDD symptoms did not correlate with changes in white matter microstructure. In secondary, exploratory, cross-sectional comparisons during treatment, the SPRM group displayed lower FA and higher MD, RD, and AD than the placebo group in several tracts., Conclusion: The main findings suggest that SPRM treatment did not impact white matter microstructure compared with placebo. However, secondary exploratory analyses yielded between-group differences after treatment, which call for further investigation on the tracts potentially impacted by progesterone antagonism., Clinical Trial Registration: EUDRA-CT 2016-001719-19; "Selective progesterone receptor modulators for treatment of premenstrual dysphoric disorder. A randomized, double-blind, placebo-controlled study."; https://www.clinicaltrialsregister.eu/ctr-search/trial/2016-001719-19/SE., Competing Interests: Declaration of competing interest EC receives funds from the Swedish Research Council (2015–00495), EU FP7-People-Cofund (INCA 600398) and SciLifeLab. The study drugs were provided by Gedeon Richter, but no further financial or design- related involvement was foreseen. R. Lanzenberger received investigator-initiated research funding from Siemens Healthcare regarding clinical research using PET/MR. He is a shareholder of the start-up company BM Health GmbH since 2019. The rest of the authors report no further financial interest or conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Sediments polluted with hydrophobic organic contaminants (HOCs) and metals can pose environmental risks, yet effective remediation remains a challenge. We investigated a new composite sorbent comprising granular activated carbon (GAC) and a calcium-silicate (Polonite®, PO) for thin-layer capping of polluted sediment, with the aim to sequester both HOCs and metals. Box cores were collected in polluted Oskarshamn harbor, Sweden, and the sediments were treated with GAC and/or Polonite in a 10-week mesocosm study to measure endpoints ranging from contaminant immobilization to ecological side effects on native fauna and biogeochemical processes. The GAC particle size was 300-500 μm to reduce negative effects on benthic fauna (by being non-ingestible) and of biogenic origin (coconut) to have a small carbon footprint compared with traditional fossil ACs. The calcium-silicate was a fine-grained industrial by-product used to target metals and as a carrier for GAC to improve the cap integrity. GAC decreased the uptake of dioxins (PCDD/Fs) in the bivalve Macoma balthica by 47 % and the in vitro bioavailability of PCB by 40 %. The composite cap of GAC + Polonite decreased sediment-to-water release of Pb < Cu < Ni < Zn < Cd by 42-98 % (lowest to highest decrease) and bioaccumulation of Cd < Zn < Cu in the worm Hediste diversicolor by 50-65 %. Additionally, in vitro bioavailability of Pb < Cu < Zn, measured using digestive fluid extraction, decreased by 43-83 %. GAC showed no adverse effects on benthic fauna while Polonite caused short-term adverse effects on fauna diversity and abundance, partly due to its cohesiveness, which, in turn, can improve the cap integrity in situ. Fauna later recovered and bioturbated the cap. Both sorbents influenced biogeochemical processes; GAC sorbed ammonium, Polonite decreased respiration, and both sorbents reduced denitrification. In conclusion, the side effects were relatively mild, and the cap decreased the release and bioavailability of both HOCs and metals effectively, thus offering a promising sustainable and cost-effective solution to remediating polluted sediments., Competing Interests: Declaration of competing interest We have no conflicts of interests to disclose. The funding sources did not have any participation in the research., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Sediments contaminated with hazardous metals pose risks to humans and wildlife, yet viable management options are scarce. In a series of laboratory experiments, we characterized Polonite® - an activated calcium-silicate - as a novel sorbent for thin-layer capping of metal-contaminated sediments. We tested a fine-grained by-product from the Polonite production as a cheap and sustainable sorbent. First, Polonite was reacted with solutions of Cu, Pb, and Zn, and the surface chemistry of the Polonite was examined using, e.g., scanning electron microscopy to investigate metal sorption mechanisms. Batch experiments were conducted by adding Polonite to industrially contaminated harbor sediment to determine sorption kinetics and isotherms. Importantly, we measured if the Polonite could reduce metal bioavailability to sediment fauna by performing digestive fluid extraction (DFE). Finally, a cap placement technique was studied by applying a Polonite slurry in sedimentation columns. The results showed rapid metal sorption to Polonite via several mechanisms, including hydroxide and carbonate precipitation, and complexation with metal oxides on the Polonite surface. Isotherm data revealed that the sediment uptake capacity (K f ) for Cu, Pb, and Zn increased by a factor of 25, 21, and 14, respectively, after addition of 5% Polonite. The bioavailability of Cu, Pb, and Zn was reduced by 70%, 65%, and 54%, respectively, after a 25% Polonite addition. In conclusion, we propose that sediment treatment with low doses of the Polonite by-product can be a cheap, sustainable, and effective remediation method compared to other more intrusive methods such as dredging or conventional isolation capping., Competing Interests: Declaration of competing interest We have no conflicts of interests to disclose. The funding sources did not have any participation in the research., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Impaired cognitive ability is one of the most frequently reported neuropsychiatric symptoms in the post-COVID phase among patients. It is unclear whether this condition is related to structural or functional brain changes., Purpose: In this study, we present a multimodal magnetic resonance imaging study of 36 post-COVID patients and 36 individually matched controls who had a mild form of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) infection from March 2020 to February 2022. This study aimed to investigate structural and functional brain alterations and their correlation with post-COVID symptoms and neurocognitive functions., Materials and Methods: The study protocol comprised an assessment of physical fatigue [Fatigue Severity Scale (FSS)], mental fatigue (Mental Fatigue Scale (MFS)], depression [Montgomery Asberg Depression Rating Scale (MADRS)], anxiety [Hospital Anxiety and Depression Scale (HAD)], post-COVID Symptoms Severity Score, and neurocognitive status [Repeatable Battery for the Assessment of Neuropsychological Status Update (RBANS)]. The magnetic resonance imaging protocol included morphological sequences, arterial spin labeling (ASL) and dynamic susceptibility contrast-enhanced (DSC) perfusion, diffusion tensor imaging (DTI), and resting-state functional magnetic resonance imaging (fMRI) sequences. Using these protocols, the assessments of macrostructural abnormalities, perfusion, gray matter density, white matter integrity, and brain connectivity were performed., Results: Post-COVID patients had higher levels of physical fatigue, mental fatigue, depression, and anxiety than controls and showed cognitive impairment in all the RBANS domains except in Visuospatial/Construction. The subjective mental fatigue correlated with objective impaired cognitive ability in the RBANS test, particularly in the Attention domain. There were no differences between patients and controls regarding macrostructural abnormalities, regional volumes, regional perfusion metrics, gray matter density, or DTI parameters. We observed a significant positive correlation between RBANS Total Scale Index score and gray matter volume in the right superior/middle-temporal gyrus ( p < 0.05) and a significant negative correlation between the white matter integrity and post-COVID symptoms ( p < 0.05) in the same area. The connectivity differences were observed between patients and controls in a few regions, including the right middle frontal gyrus, an important area of convergence of the dorsal and ventral attention networks. We also noted a positive correlation between post-COVID symptoms and increased connectivity in the right temporoparietal junction, which is part of the ventral attention system., Conclusion: In non-hospitalized subjects with post-COVID, we did not find any structural brain changes or changes in perfusion, compared to controls. However, we noted differences in connectivity within an important area for attention processes, which may be associated with post-COVID brain fog., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Fineschi, Fahlström, Fällmar, Haller and Wikström.)

Background: Hemodynamic changes are seen in the feeding arteries of arteriovenous malformations (AVMs). Phase-contrast MRI (PC-MRI) enables the acquisition of hemodynamic information from blood vessels. There is insufficient knowledge on which flow or velocity parameter best discriminates AVMs from healthy subjects., Purpose: To evaluate PC-MRI-measured flow and velocity in feeding arteries of AVMs before and, when possible, also after treatment and to compare these measurements to corresponding measurements in healthy controls., Materials and Methods: Highest flow (HF), lowest flow (LF), mean flow (MF), peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were measured in feeding arteries in patients with intracranial AVMs using 2D PC-MRI at 3 T. Measurements were compared to previously reported values in healthy individuals. Values in patients above the 95th percentile in the healthy cohort were categorized as pathological. Nidus volume was measured using 3D time-of-flight MR angiography., Results: Ten patients with diagnosed AVMs were examined with PC-MRI. Among these, three patients also underwent follow-up PC-MRI after treatment. Pathological velocities (PSV, EDV, and MV) were seen in all five subjects with a nidus larger or equal to 5.7 cm 3 , whereas pathological flow values were not seen in all, that is, pathologic HF in three, pathologic LF in two, and pathologic MF in two. After treatment, there was a decrease in flow and velocity (all measured parameters). After treatment, velocities (PSV, EDV, and MV) were no longer abnormal compared to healthy controls., Conclusion: Patients with a large AVM nidus show pathological velocities, but less consistent flow increases. Following treatment, velocities normalize., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Background/aim: Anterior resection is the gold standard surgery for high and middle rectal tumors. In cases where anterior resection is not feasible, the surgeon resorts to a non-restorative approach such as Hartmann's procedure or abdominoperineal resection. It is not well studied how Hartmann's procedure impacts quality of life. This cross-sectional cohort study compares the long-term quality of life after Hartmann's procedure with anterior resection and abdominoperineal resection., Patients and Methods: Patients operated for high- or middle rectal cancer in the southern healthcare region of Sweden between 2007 and 2017 were identified and data were extracted from the Swedish Colorectal Cancer Registry. Further clinical variables were retrieved from medical charts. Quality of life was evaluated by SF-12-, EQ-5D-5L- and EORTC QLQ - CR29 questionnaires., Results: Out of 521 patients included, 51 had undergone Hartmann's procedure, 381 anterior resection and 89 abdominoperineal resection. Hartmann patients were significantly older with more comorbidities. Median follow-up time was 104 months. There were no differences between groups in overall quality of life. Patients subjected to Hartmann's procedure reported inferior mobility, self-care, daily activities and reduced estimation of general health compared to those who had anterior resection. Abdominoperineal resection was associated with more impotence compared to Hartmann's procedure., Conclusion: Overall long-term QoL after Hartmann's procedure was comparable to anterior resection and abdominoperineal resection. In certain symptoms patients with Hartmann's procedure for rectal cancer scored worse compared to anterior resection, but patients were older and frailer making causal inference impossible., (Copyright © 2024, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: Paired cerebral blood flow (CBF) measurement is usually acquired before and after vasoactive stimulus to estimate cerebrovascular reserve (CVR). However, CVR may be confounded because of variations in time-to-maximum CBF response (t max ) following acetazolamide injection. With a mathematical model, CVR can be calculated insensitive to variations in t max , and a model offers the possibility to calculate additional model-derived parameters. A model that describes the temporal CBF response following a vasodilating acetazolamide injection is proposed and evaluated., Methods: A bi-exponential model was adopted and fitted to four CBF measurements acquired using arterial spin labelling before and initialised at 5, 15 and 25 min after acetazolamide injection in a total of fifteen patients with Moyamoya disease. Curve fitting was performed using a non-linear least squares method with a priori constraints based on simulations., Results: Goodness of fit (mean absolute error) varied between 0.30 and 0.62 ml·100 g -1 ·min -1 . Model-derived CVR was significantly higher compared to static CVR measures. Maximum CBF increase occurred earlier in healthy- compared to diseased vascular regions., Conclusions: The proposed mathematical model offers the possibility to calculate CVR insensitive to variations in time to maximum CBF response which gives a more detailed characterisation of CVR compared to static CVR measures. Although the mathematical model adapts generally well to this dataset of patients with MMD it should be considered as experimental; hence, further studies in healthy populations and other patient cohorts are warranted., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Children born very preterm often exhibit atypical gaze behaviors, affect recognition difficulties and are at risk for cerebral white matter damage. This study explored links between these sequalae. In 24 12-year-old children born very preterm, ventricle size using Evans and posterior ventricle indices, and corpus callosum area were used to measure white matter thickness. The findings revealed a correlation between less attention towards the eyes and larger ventricle size. Ventricle and posterior corpus callosum sizes were correlated to affect-recognition proficiency. Findings suggest a link between white matter damage, gaze behavior, and affect recognition accuracy, emphasizing a relation with social perception., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier Inc.)

Background: Fetal ultrasound has limitations, especially if the patient is obese or in cases with oligohydramnios. Magnetic resonance imaging (MRI) can then be used as a complement, but only few studies have focused on examinations in the second trimester., Purpose: To validate MRI as a complement to diagnose fetal anomalies in the second trimester., Material and Methods: This retrospective study retrieved data from January 2008 to July 2012 from the Fetal Medicine Unit and Department of Radiology at Uppsala University Hospital. Ultrasound and MRI findings were reviewed in 121 fetuses in relation to the final diagnosis, including postpartum follow-up and autopsy results., Results: Of the 121 fetuses, 51 (42%) had a CNS anomaly and 70 (58%) a non-CNS anomaly diagnosed or suspected. MRI provided additional information in 21% of all cases without changing the management and revealed information that changed the management of the pregnancy in 13%. When a CNS anomaly was detected or suspected, the MRI provided additional information in 22% and changed the management in 10%. The corresponding figures for non-CNS cases were 21% and 16%, respectively. The proportion of cases with additional information that changed the management was especially high in patients with a BMI >30 kg/m 2 (25%) and in patients with oligohydramnios (38%). In five cases in category III, false-positive ultrasound findings were identified., Conclusions: MRI in the second trimester complements ultrasound and improves diagnosis of fetal CNS- and non-CNS anomalies especially when oligohydramnios or maternal obesity is present., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Premenstrual dysphoric disorder (PMDD) is a mood disorder for which selective progesterone receptor modulator (SPRM) treatment has been demonstrated to be beneficial. The neural signatures of this treatment have been so far identified as greater fronto-cingulate reactivity during aggressive response to provocation, but no changes in terms of gray matter structure. White matter has recently been found to differ between patients with PMDD and healthy controls. The present study thus sought to investigate the relationship between white matter volume and SPRM treatment in patients with PMDD. A pharmaco-neuroimaging study was conducted on patients with PMDD participating in a randomized controlled trial. Participants underwent magnetic resonance imaging before and after treatment randomization to ulipristal acetate (an SPRM), or placebo, for three months. The interaction effect of treatment by time on white matter volume (WMV) was assessed. Voxel based morphometry analyses were performed on both a whole brain exploratory level and on regions of interest. No treatment effect was observed on WMV in any region, including the anterior thalamic radiations, cingulum, forceps minor, fornix, inferior fronto-occipital fasciculus, superior cerebellar peduncle, superior longitudinal fasciculus, and uncinate fasciculus. This is the first finding to indicate that no white matter volume alterations follow three-month progesterone antagonism, suggesting that white matter volume does not participate in symptom relief upon SPRM treatment for PMDD., Competing Interests: Declaration of Competing Interest The study drugs were provided by Gedeon Richter, but they had no further involvement in the study design, data collection, analysis, findings’ interpretation, or manuscript preparation. RL received travel grants and/or conference speaker honoraria within the last three years from Bruker BioSpin MR, Heel, and support from Siemens Healthcare regarding clinical research using PET/MR. He is a shareholder of the start-up company BM Health GmbH since 2019. ISP has served occasionally on advisory boards or acted as invited speaker at scientific meetings for Asarina Pharma, Bayer Health Care, Gedeon Richter, Peptonics, Shire/Takeda, Sandoz, and Lundbeck A/S. All other authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Radiological imaging to examine intracranial blood vessels is critical for preoperative planning and postoperative follow-up. Automated segmentation of cerebrovascular anatomy from Time-Of-Flight Magnetic Resonance Angiography (TOF-MRA) can provide radiologists with a more detailed and precise view of these vessels. This paper introduces a domain generalized artificial intelligence (AI) solution for volumetric monitoring of cerebrovascular structures from multi-center MRAs. Our approach utilizes a multi-task deep convolutional neural network (CNN) with a topology-aware loss function to learn voxel-wise segmentation of the cerebrovascular tree. We use Decorrelation Loss to achieve domain regularization for the encoder network and auxiliary tasks to provide additional regularization and enable the encoder to learn higher-level intermediate representations for improved performance. We compare our method to six state-of-the-art 3D vessel segmentation methods using retrospective TOF-MRA datasets from multiple private and public data sources scanned at six hospitals, with and without vascular pathologies. The proposed model achieved the best scores in all the qualitative performance measures. Furthermore, we have developed an AI-assisted Graphical User Interface (GUI) based on our research to assist radiologists in their daily work and establish a more efficient work process that saves time., (© 2024. The Author(s).)

Background: Phase-contrast magnetic resonance imaging (PC-MRI) quantifies blood flow and velocity noninvasively. Challenges arise in neurovascular disorders due to small vessels. We evaluated the impact of voxel size, number of signal averages (NSA), and velocity encoding (VENC) on PC-MRI measurement accuracy and precision in a small-lumen vessel phantom., Methods: We constructed an in vitro model with a constant flow rate using a 2.2-mm inner diameter plastic tube. A reservoir with a weight scale and timer was used as standard reference. Gradient-echo T1 weighted PC-MRI sequence was performed on a 3-T scanner with varying voxel size (2.5, 5.0, 7.5 mm 3 ), NSA (1, 2, 3), and VENC (200, 300, 400 cm/s). We repeated measurements nine times per setting, calculating mean flow rate, maximum velocity, and least detectable difference (LDD)., Results: PC-MRI flow measurements were higher than standard reference values (mean ranging from 7.3 to 9.5 mL/s compared with 6.6 mL/s). Decreased voxel size improved accuracy, reducing flow rate measurements from 9.5 to 7.3 mL/s. The LDD for flow rate and velocity varied between 1 and 5%. The LDD for flow rate decreased with increased voxel size and NSA (p = 0.033 and 0.042). The LDD for velocity decreased with increased voxel size (p < 10 -16 ). No change was observed when VENC varied., Conclusions: PC-MRI overestimated flow. However, it has high precision in a small-vessel phantom with constant flow rate. Improved accuracy was obtained with increasing spatial resolution (smaller voxels). Improved precision was obtained with increasing signal-to-noise ratio (larger voxels and/or higher NSA)., Relevance Statement: Phase-contrast MRI is clinically used in large vessels. To further investigate the possibility of using phase-contrast MRI for smaller intracranial vessels in neurovascular disorders, we need to understand how acquisition parameters affect phase-contrast MRI-measured flow rate and velocity in small vessels., Key Points: • PC-MRI measures flow and velocity in a small lumen phantom with high precision but overestimates flow rate. • The precision of PC-MRI measurements matches the precision of standard reference for flow rate measurements. • Optimizing PC-MRI settings can enhance accuracy and precision in flow rate and velocity measurements., (© 2024. The Author(s).)

Although most pituitary neuroendocrine tumors (PitNETs)/pituitary adenomas remain intrasellar, a significant proportion of tumors show parasellar invasive growth and 6% to 8% infiltrate the bone structures, thus affecting the prognosis. There is an unmet need to identify novel markers that can predict the parasellar growth of PitNETs. Furthermore, mechanisms that regulate bone invasiveness of PitNETs and factors related to tumor vascularization are largely unknown. We used genome-wide mRNA analysis in a cohort of 77 patients with PitNETs of different types to explore the differences in gene expression patterns between invasive and noninvasive tumors with respect to the parasellar growth and regarding the rare phenomenon of bone invasiveness. Additionally, we studied the genes correlated to the contrast enhancement quotient, a novel radiological parameter of tumor vascularization. Most of the genes differentially expressed related to the parasellar growth were genes involved in tumor invasiveness. Differentially expressed genes associated with bone invasiveness are involved in NF-κB pathway and antitumoral immune response. Lack of clear clustering regarding the parasellar and bone invasiveness may be explained by the influence of the cell lineage-related genes in this heterogeneous cohort of PitNETs. Our transcriptomics analysis revealed differences in the molecular fingerprints between invasive, including bone invasive, and noninvasive PitNETs, although without clear clustering. The contrast enhancement quotient emerged as a radiological parameter of tumor vascularization, correlating with several angiogenesis-related genes. Several of the top genes related to the PitNET invasiveness and vascularization have potential prognostic and therapeutic application requiring further research., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)

Purpose: This study aimed to investigate patient-related factors predicting the selection of rectal cancer patients to Hartmann's procedure as well as to investigate how often, and on what grounds, anterior resection is intraoperatively changed to Hartmann's procedure., Methods: Prospectively collected data from the Swedish Colorectal Cancer Registry regarding patients with rectal cancer operated upon from January 1 2007 to June 30 2017 in the county of Skåne were retrospectively reviewed. Data were expanded with further details from medical charts. A univariable analysis was performed to investigate variables associated with unplanned HP and significant variables included in a multivariable logistic regression analysis., Results: Altogether, 1141 patients who underwent Hartmann's procedure (275 patients, 24%), anterior resection (491 patients, 43%), or abdominoperineal resection (375 patients, 33%) were included. Patients undergoing Hartmann's procedure were significantly older and had more frequently comorbidity. The decision to perform Hartmann's procedure was made preoperatively in 209 (76%) patients, most commonly because of a comorbidity (27%) or oncological reasons (25%). Patient preference was noted in 8% of cases. In 64 cases (23%), the decision was made intraoperatively, most often due to anastomotic difficulties (60%) and oncological reasons (22%). Anastomotic difficulties were most often reported due to technical difficulties, a low tumor or neoadjuvant radiotherapy. Male gender was a significant risk factor for undergoing unplanned Hartmann's procedure., Conclusions: The decision to perform Hartmann's procedure was frequently made intraoperatively. Hartmann's procedure should be considered and discussed preoperatively in old and frail patients, especially in the presence of mid-rectal cancer and/or male gender, since these factors increase the risk of intraoperative anastomotic difficulties., (© 2024. The Author(s).)

Purpose: Very preterm birth increases risk for neonatal white matter injury, but there is limited data on to what extent this persists into adolescence and how this relates to ophthalmological outcomes. The aim of this study was to assess brain MRI findings in 12-year-old children born very preterm compared to controls and their association with concurrent ophthalmological outcomes., Methods: We included 47 children born very preterm and 22 full-term controls (gestational age <32 and >37 weeks, respectively). Brain MRI findings were studied in association with concurrent ophthalmological outcomes at 12-year follow-up., Results: Evans index (0.27 vs 0.25, p<0.001) and a proposed "posterior ventricle index" (0.47 vs 0.45, p=0.018) were increased in children born very preterm. Higher gestational age associated with larger corpus callosum area (β=10.7, 95%CI 0.59-20.8). Focal white matter lesions were observed in 15 (32%) of very preterm children and in 1 (5%) of full-term controls. Increased posterior ventricle index increased risk for visual acuity ≤1.0 (OR=1.07×10 11 , 95%CI=7.78-1.48×10 21 ) and contrast sensitivity <0.5 (OR=2.6×10 27 , 95%CI=1.9×10 8 -3.5×10 46 ). Decreased peritrigonal white matter thickness associated with impaired visual acuity (β=0.04, 95%CI 0.002-0.07)., Conclusion: More white matter lesions and evidence of lower white matter volume were found in children born very preterm compared with full-term controls at 12-year follow-up. The association between larger posterior ventricle index and reduced visual acuity and contrast sensitivity suggests disturbances of the posterior visual pathway due to diffuse white matter lesions., (© 2023. The Author(s).)

Denitrification in sediments is a key microbial process that removes excess fixed nitrogen, while dissimilatory nitrate reduction to ammonium (DNRA) converts nitrate to ammonium. Although microorganisms are responsible for essential nitrogen (N) cycling, it is not yet fully understood how these microbially mediated processes respond to toxic hydrophobic organic compounds (HOCs) and metals. In this study, we sampled long-term polluted sediment from the outer harbor of Oskarshamn (Baltic Sea), measured denitrification and DNRA rates, and analyzed taxonomic structure and N-cycling genes of microbial communities using metagenomics. Results showed that denitrification and DNRA rates were within the range of a national reference site and other unpolluted sites in the Baltic Sea, indicating that long-term pollution did not significantly affect these processes. Furthermore, our results indicate an adaptation to metal pollution by the N-cycling microbial community. These findings suggest that denitrification and DNRA rates are affected more by eutrophication and organic enrichment than by historic pollution of metals and organic contaminants., (© 2023. The Author(s).)

Objective: A small posterior fossa (PF) has been hypothesized to explain the increased incidence of trigeminal neuralgia (TN) in females and could make microvascular decompression (MVD) more challenging. The aim of this study was to investigate the association between the PF volume and dimensions in relation to biological sex, type of neurovascular conflict (NVC), and outcome after MVD in classic TN., Methods: In this observational study, 84 patients with TN operated on with MVD with a preoperative head computed tomography(CT) scan were included. Eighty-two adults without TN who had undergone head CT for other reasons were included as controls. PF volume and dimensions (x-axis, y-axis, and z-axis) were evaluated on the CT scans. For the patients with TN, Barrow Neurological Institute (BNI) grade was evaluated 6 months after MVD., Results: There was no difference in PF volume or dimensions between the patients with TN and controls. Women showed a smaller volume and narrower (x-axis) PF than men, but these differences did not manifest when comparing patients with TN and controls within each sex. Patients with an NVC involving the superior cerebellar artery had a narrower (x-axis) and shorter (y-axis) PF than did patients with an NVC resulting from other arteries. PF volume or dimensions were not associated with BNI grade after MVD., Conclusions: PF anatomy was related to the NVC type but did not differ between patients with TN and controls and was not related to the surgical outcome after MVD., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Many women are pregnant during several percent of their lives. Occasionally, there is a need for neuroradiological examinations during pregnancy or lactation. In our clinical work, we regularly see that female patients are being withheld relevant diagnostic scans during pregnancy, due to insufficient knowledge or an unbalanced comparison between benefits and risks. This article describes the current knowledge regarding conditions for performing CT and MRI scans in pregnant and lactating patients, including the use of contrast media. PET scans and reactions to contrast media are briefly mentioned, but interventional radiology is not discussed.