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The nonlocal boundary value problem 𝑑2𝑢(𝑡)/𝑑𝑡2+𝐴𝑢(𝑡)=𝑓(𝑡)(0≤𝑡≤1), 𝑖(𝑑𝑢(𝑡)/𝑑𝑡)+𝐴𝑢(𝑡)=𝑔(𝑡)(−1≤𝑡≤0), 𝑢(0+)=𝑢(0−), 𝑢𝑡(0+)=𝑢𝑡(0−), 𝐴𝑢(−1)=𝛼𝑢(𝜇)+𝜑, 0

The liver has long been identified as a target organ of arsenic exposure. Arsenic is a potent environmental toxicant and its accumulation in the liver causes hepatotoxicity. In our study, the investigation of effects of melatonin on arsenic-induced liver damage in rats was planned. In our study, 27 male rats were divided into three groups: control (saline, 5 ml/kg/day, intragastrically), arsenic (sodium arsenite, 5 mg/kg/day, intragastrically), and arsenic+melatonin (sodium arsenite, 5 mg/kg/day, intragastrically and melatonin, 25 mg/kg/day, intraperitoneally) group. At the end of 15 days, the rats were weighed and sacrificed then liver tissues were collected. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidise (GSH-Px) activities as well as malondialdehyde (MDA) levels were determined by spectrophotometry. The amount of arsenic in liver tissue was analyzed by Inductively Coupled Plasma/Optical Emission Spectrometer (ICP-OES). There were no significant differences in respect to weights of rats among the groups. Arsenic significantly decreased the enzyme activities of SOD, CAT, and GSH-Px as well as increased the levels of MDA in liver tissues. Melatonin treatments significantly increased of reduced SOD, CAT, and GSH-Px enzyme activities and decreased the elevated tissue MDA levels in liver tissues. The amount of arsenic in liver tissues significantly increased in arsenic group. There were no significant differences in respect to the amount of arsenic in liver tissues between the arsenic group and melatonin group. These data suggested that melatonin has beneficial effects against arsenic-induced liver damage by decreasing oxidative stress and lipid peroxidation. [ABSTRACT FROM AUTHOR]

Dural arteriovenous fistulas (DAVF) are rare and constitute 10% to 15% of all intracranial arteriovenous malformations. Only few cases of DAVFs are reported in children. Here is the first case report describing CT angiographic findings in a 14 year old child having multiple DAVFs involving spinal canal, both cavernous and cerebral sinuses. [ABSTRACT FROM AUTHOR]

Hydatid disease involving the vertebral body and paravertebral soft tissues is rare even in rural areas where echinococcosis is endemic. We report a case with hydatid disease in the T11-L1 vertebral bodies and involvement in bilateral psoas muscles. [ABSTRACT FROM AUTHOR]

We report the structural, magnetic, and magnetocaloric properties Ni 50 Mn 35− x B x In 15 (x = 1,1.5) Heusler alloys by using room-temperature X-ray diffraction (XRD), differential scanning calorimetry (DSC), and magnetization measurements. The substitution of B instead of Mn decreases the transition temperatures. Moreover, we observe a large magnetization difference between austenite and martensite phases with a thermal hysteresis around the martensitic transition. Magnetic field dependent measurements reveal that the application of a magnetic field stabilizes the austenite phase, which has higher magnetization. We calculate magnetic entropy change by two methods, namely, Maxwell relation and fraction method. We computed a maximum magnetic entropy change of 15 J kg−1K−1 and 8 J kg−1K−1 around magnetostructural phase transition for a magnetic field change of 5 T, respectively, for Ni 50 Mn 34 B 1 In 15 and Ni 50 Mn 33.5 B 1.5 In 15 samples. • Boron substitution is an effective way to tune martensitic transitions temperatures. • Both alloys have moderate ΔM and thermal hysteresis across martensitic transformation. • Transition entropy, magnetocaloric effect decreased meanwhile thermal hysteresis increased with B substitution. • Moderate magnetocaloric effect is obtained and validated by two different methods. [ABSTRACT FROM AUTHOR]

Purpose: The increased consumption of high-fructose corn syrup (HFCS) may contribute to the worldwide epidemic of fatty liver. In this study, we have investigated whether HFCS intake (20 % beverages) influences lipid synthesis and accumulation in conjunction with insulin receptor substrate-1/2 (IRS-1; IRS-2), endothelial nitric oxide synthase (eNOS), sirtuin 1 (SIRT1) and inducible NOS (iNOS) expressions in liver of rats. Resveratrol was tested for its potential efficacy on changes induced by HFCS. Methods: Animals were randomly divided into four groups as control, resveratrol, HFCS and resveratrol plus HFCS (resveratrol + HFCS). HFCS was given as 20 % solutions in drinking water. Feeding of all rats was maintained by a standard diet that enriched with or without resveratrol for 12 weeks. Results: Dietary HFCS increased triglyceride content and caused mild microvesicular steatosis in association with up-regulation of fatty acid synthase and sterol regulatory element binding protein (SREBP)-1c in liver of rats. Moreover, HFCS feeding impaired hepatic expression levels of IRS-1, eNOS and SIRT1 mRNA/proteins, but did not change iNOS level. Resveratrol promoted IRS, eNOS and SIRT1, whereas suppressed SREBP-1c expression in rats fed with HFCS. Conclusions: Resveratrol supplementation considerably restored hepatic changes induced by HFCS. The improvement of hepatic insulin signaling and activation of SIRT1 by resveratrol may be associated with decreased triglyceride content and expression levels of the lipogenic genes of the liver. [ABSTRACT FROM AUTHOR]

Ion irradiation induced modifications of the thermomagnetic properties of equiatomic FeRh thin films have been investigated. The application of 20 keV Ne + ions at different fluencies leads to broadening of the antiferromagnetic to ferromagnetic phase transition as well as a shift of the transition temperature towards lower temperatures with increasing ion fluence. Moreover, the ferromagnetic background at low temperatures generated by the ion irradiation leads to pronounced saturation magnetisation at 5 K. Complete erasure of the transition, i.e. ferromagnetic ordering through the whole temperature regime was achieved at a Ne + fluence of 3 × 10 14 ions/cm 2 . It does not coincide with the complete randomization of the chemical ordering of the crystal lattice. [ABSTRACT FROM AUTHOR]

Two series of epitaxial Ni–Mn–Sn thin films of different thickness are investigated for the thickness and composition dependence of the martensitic transformation. Thin films ranging in thickness from 20 to 200 nm (series A) and 10 to 100 nm (series B) were prepared by magnetron co-sputtering and deposited on heated MgO(0 0 1) substrates. The structural characterization was done by temperature-dependent X-ray diffraction measurements. Magnetization and resistivity measurements were performed to investigate the transformation characteristics. We find a strong influence of the film thickness on the relative amount of material undergoing the martensitic transformation, the temperature range of the transformation, and the transformation temperatures. The main contribution originates from the rigid substrate which delays the transformation of the Ni–Mn–Sn near the interface and even leads to a layer of residual austenite at low temperatures. Another issue are size effects which presumably broaden the martensitic transformation and decrease the transformation temperatures. By variation of the thin film composition we find changes of the substrate influence due to a different mismatch between the lattice of MgO and austenite. A better phase compatibility between martensite and austenite, denoted by λ 2 , not only results in a smaller hysteresis but is also beneficial for the transformation of material close to the substrate. [ABSTRACT FROM AUTHOR]

We report recent experimental results on the magnetic, magnetotransport, and magneto-optical properties of Co- and V-doped TiO magnetic oxides at the doping level around 1 at. %. The samples were prepared using rf magnetron sputtering in identical conditions that allows to compare the mechanisms of above-room-temperature ferromagnetism observed in both cases of doping. In spite of the comparable values of magnetic moment around 1 ÷ 2.5 µ per 3 d impurity derived from macroscopic magnetic measurements for both systems, the magneto-optical response of TiO:V was at least 2 orders of magnitude weaker. The anomalous Hall effect was absent in V-doped TiO, and no appreciable magnetic moment on V impurities was found by X-ray magnetic circular dichroism (XMCD) technique in contrast to Co-doped TiO. The obtained experimental data indicate dissimilar origin of intrinsic ferromagnetism in TiO:Co and TiO:V. [ABSTRACT FROM AUTHOR]

In our multicenter, prospective study; we aimed to investigate the impact of testosterone deficiency on cognitive functions in prostate cancer patients receiving hormone therapy. Conclusions Androgene deprivation therapy in patients with prostate cancer does not affect patients' cognitive functions. [Extracted from the article]

Circumcision is a common ritual defined both in Muslim and Jewish faith, which predates both religions. There were 3 previous studies which studied the relationship between PE and the timing of the pre-adult circumcision, which had conflicting results. We are planning to do further studies when the study is completed and do higher statistical analysis with the perceived trauma of the circumcision and how well does the subjects their experience of circumcision. [Extracted from the article]

Background: The prognosis for patients with central nervous system (CNS) retinoblastoma (RB) (trilateral or stage 4b metastatic RB) treated with high-dose chemotherapy and autologous stem cell transplant (HDC-ASCT) remains poor. The impact of irradiation when administered as part of upfront therapy post HDC-ASCT on treatment outcomes and survival is unknown., Methods: We performed a retrospective review of all patients with CNS RB (seven stage 4b, eight trilateral, one pineal lesion belonging to methylation group RB) who underwent induction chemotherapy with an intent to proceed to HDC-ASCT at two institutions., Results: Twelve of 16 patients (n = 75%) achieved an objective response to induction chemotherapy, while four patients had progressive/refractory disease; two patients responded to subsequent therapy and proceeded to ASCT, and two patients did not. Seven of 14 patients who underwent HDC-ASCT, received radiotherapy as part of upfront therapy post HDC-ASCT in the form of craniospinal irradiation (CSI) (n = 3), intraventricular radioimmunotherapy (n = 3), or both CSI and intraventricular radioimmunotherapy (n = 1). The Kaplan-Meier estimate of overall survival for these patients was 62.5% at 5 years; no patients developed second malignant neoplasms within the radiation fields. For the seven patients who did not receive radiotherapy, the overall survival was 28.6% at 5 years., Conclusions: CSI (23.4 Gy) alone or in conjunction with intraventricular RIT may have clinical utility in eliminating persistent MRD post HDC-ASCT, contributing to improved disease-free survival in patients with CNS RB. This treatment strategy merits evaluation in a prospective, multicenter clinical trial for patients with CNS metastatic RB., (© 2024 Wiley Periodicals LLC.)

Objectives: Breast cancer is a type of cancer caused by the uncontrolled growth of cells in the breast tissue. In a few cases, erroneous diagnosis of breast cancer by specialists and unnecessary biopsies can lead to various negative consequences. In some cases, radiologic examinations or clinical findings may raise the suspicion of breast cancer, but subsequent detailed evaluations may not confirm cancer. In addition to causing unnecessary anxiety and stress to patients, such diagnosis can also lead to unnecessary biopsy procedures, which are painful, expensive, and prone to misdiagnosis. Therefore, there is a need for the development of more accurate and reliable methods for breast cancer diagnosis., Methods: In this study, we proposed an artificial intelligence (AI)-based method for automatically classifying breast solid mass lesions as benign vs malignant. In this study, a new breast cancer dataset (Breast-XD) was created with 791 solid mass lesions belonging to 752 different patients aged 18 to 85 years, which were examined by experienced radiologists between 2017 and 2022., Results: Six classifiers, support vector machine (SVM), K-nearest neighbor (K-NN), random forest (RF), decision tree (DT), logistic regression (LR), and XGBoost, were trained on the training samples of the Breast-XD dataset. Then, each classifier made predictions on 159 test data that it had not seen before. The highest classification result was obtained using the explainable XGBoost model (X 2 GAI) with an accuracy of 94.34%. An explainable structure is also implemented to build the reliability of the developed model., Conclusions: The results obtained by radiologists and the X 2 GAI model were compared according to the diagnosis obtained from the biopsy. It was observed that our developed model performed well in cases where experienced radiologists gave false positive results., (© 2024 The Author(s). Journal of Ultrasound in Medicine published by Wiley Periodicals LLC on behalf of American Institute of Ultrasound in Medicine.)

Conventional MRI is currently the preferred imaging technique for detection and evaluation of malignant spinal lesions. However, this technique is limited in its ability to assess tumor viability. Unlike conventional MRI, dynamic contrast-enhanced (DCE) MRI provides insight into the physiologic and hemodynamic characteristics of malignant spinal tumors and has been utilized in different types of spinal diseases. DCE has been shown to be especially useful in the cancer setting; specifically, DCE can discriminate between malignant and benign vertebral compression fractures as well as between atypical hemangiomas and metastases. DCE has also been shown to differentiate between different types of metastases. Furthermore, DCE can be useful in the assessment of radiation therapy for spinal metastases, including the prediction of tumor recurrence. This review considers data analysis methods utilized in prior studies of DCE-MRI data acquisition and clinical implications., (© 2025 by American Journal of Neuroradiology.)

Objectives: To develop an efficient and easy-to-use nomogram which can predict testicular sperm extraction(TESE) success in men with non-obstructive azoospermia(NOA) by using pre-operative parameters., Materials and Metods: Data of 3093 men who underwent TESE for NOA were included in this study. Demographic data, testis volumes, presence of varicocele, length of infertility, history of previous surgeries, history of genitourinary infections, smoking status, chromosome abnormalities, presence of Y-chromosome microdeletion, family history of infertility, testis biopsy, surgical data, sperm retrieval rate, final pathology obtained at testicular sperm extraction, follicle stimulating hormone, luteinizing hormone, testosterone levels were recorded. The primary outcome was to develop an efficient nomogram which can predict the TESE success in men with NOA. The secondary outcomes were identifying the significant pre-operative parameters which are associated with success in TESE., Results: Sperm retrieval rate was 50.2%(1553/3093). Testis volume, history of varicocelectomy, chromosome abnormalities, presence of Y-chromosome microdeletion were shown to affect sperm retrieval rate significantly(p<0.05). Sperm retrieval success was higher in men with older age, higher testis volume(>10mL), lower follicle stimulating hormone level(≤ 12.92mIU/mL), lower luteinizing hormone level, and higher testosterone level(p<0.05). Only testis volume and patient's age were associated with succesful sperm retrieval in multivariate logistic regression analysis., Conclusion: In men with NOA, high testis volume, old age, low follicle stimulating hormone level, low luteinizing hormone level, and high testosterone level are advantageous for successful sperm retrieval in TESE. Herein we present a nomogram which can predict the outcome of TESE in men with NOA with adequate success., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Disclosure Statement Authors have no conflict of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Aortic valve stenosis (AS) is a common valvular heart disease, especially in the elderly, and is associated with a high prevalence of atrial fibrillation. Although the risk of atrial fibrillation is expected to decrease after the intervention, atrial fibrillation develops in many patients undergoing surgical or percutaneous transaortic valve implantation. We aimed to evaluate atrial refractoriness since it may play a key role in the occurrence of atrial fibrillation after transaortic valve implantation., Methods: Seventy-nine consecutive patients who underwent TAVI between October 2021 and May 2023 were enrolled in this trial. Sixty-seven patients underwent electrophysiology study before and after TAVI. We evaluated the changes in PA and AH intervals, as well as atrial effective refractory periods., Results: Besides the hemodynamic changes, atrial effective refractory periods increased, and atrial effective refractory period dispersion (39.8±21.6 vs. 31.1±18.0) decreased significantly after TAVI. The change in atrial effective refractory period dispersion after TAVI was correlated only with the changes in left ventricular end-diastolic pressure (r=0.77, P=0.001) and the changes in aortic gradient (r=0.4, P=0.001). The independent variables affecting the changes in atrial effective refractory period dispersion were basal pro-BNP levels, besides the changes in left ventricular end-diastolic pressure and aortic gradient after transaortic valve implantation., Conclusions: Our results show an acute improvement in atrial refractoriness after TAVI, though high atrial fibrillation rates are reported in the literature. The timing of aortic valve replacement is important, as irreversible maladaptive changes might have already developed by the time of intervention.

Purpose: We aimed to compare the success rate of spermatozoa retrieval through microscopic testicular sperm extraction (mTESE) in non-obstructive azoospermic (NOA) men with a solitary testis with that of mTESE in NOA men with bilateral testes and the parameters affecting these rates., Methods: A retrospective cross-sectional study of factors contributing to infertility in NOA patients with a solitary testis and men with bilateral testes was carried out. In this multicenter study, 74 patients with NOA with a solitary testis were matched with 74 patients with bilateral testes in terms of age, duration of infertility, and volume of the solitary testis from 2770 patients with NOA with bilateral testes. Hormonal parameters, presence of varicocele, history of varicocelectomy, history of undescended testis and karyotype analysis results were compared., Results: Spermatozoa were obtained from 40 (54.1%) patients with a solitary testis and 42 (56.76%) patients with bilateral testes. No differences were found regarding age, duration of infertility, or mean testicular volume between patients with a solitary testis and patients with bilateral testes. When serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels were compared regardless of sperm retrieval status, it was observed that both levels were greater in the group of patients with a solitary testis (p < 0.01). Patients with solitary and bilateral testes from whom spermatozoa were obtained had larger testes than those from whom spermatozoa could not be obtained (p < 0.05). Similarly, the serum levels of FSH and LH were significantly greater in patients with a solitary testis than in those with bilateral testes (p < 0.05)., Conclusions: To the best of our knowledge, this is the first study in the literature to evaluate the parameters that influence mTESE outcome in NOA patients with a solitary testis and NOA patients with bilateral testes. Greater testicular volume was found to positively affect spermatozoa retrieval for patients with a solitary testis. The higher levels of FSH and LH in patients with a solitary testis than in patients with bilateral testes of similar testicular volume may be due to a compensatory mechanism developed by the hypothalamic-pituitary-gonadal axis. The fact that these hormones are higher in patients with a solitary testis does not mean that the number of spermatozoa obtained through mTESE will be decreased., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Gram-negative bacteria pose a major challenge in antibiotic drug discovery because their cell envelope presents a permeability barrier that affords high intrinsic resistance to small-molecule drugs. The identification of correlations between chemical structure and Gram-negative permeability would thus enable development of predictive tools to facilitate antibiotic discovery. Toward this end, have advanced a library design paradigm in which various chemical scaffolds are functionalized at different regioisomeric positions using a uniform reagent set. This design enables decoupling of scaffold, regiochemistry, and substituent effects upon Gram-negative permeability of these molecules. Building upon our recent synthesis of a library of C2-substituted sulfamidoadenosines, we have now developed an efficient synthetic route to an analogous library of regioisomeric C8-substituted congeners. The C8 library samples a region of antibiotic-relevant chemical space that is similar to that addressed by the C2 library, but distinct from that sampled by a library of analogously substituted oxazolidinones. Selected molecules were tested for accumulation in Escherichia coli in a pilot analysis, setting the stage for full comparative evaluation of these libraries in the future., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: B.S.S. is a former employee of Merck Sharpe & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. D.S.T. has received in-kind research support from Merck Sharpe & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA as a collaborating institution on this project and, in the last 3 years, has held equity interests in Merck & Co., Inc., Rahway, NJ, USA., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: To evaluate by using 3D renal volumetric assessment and compare renal parenchymal preservation between patient who underwent open partial nephrectomy (OPN) and robot assisted laparoscopic partial nephrectomy (RALPN). Methods: We retrospectively reviewed the records of the patients to evaluate the effect of OPN (23 patients) or RALPN (19 patients) partial nephrectomy on renal parenchymal preservation. The CT or MRI were examined using 3D-Slicer image processing software. The tumor volume and preoperative and postoperative non-tumor bearing parenchymal volumes were evaluated with the segmentation. The preoperative and postoperative parenchymal volumes, serum creatinine levels, and estimated glomerular filtration rates (eGFRs) were compared between the surgical techniques. Results: The data of 42 patients were included in the final analysis. The patient and tumor characteristics were similar between the two groups. Postoperative renal parenchymal volumetric changes were seen similar between groups. Although the serum creatinine levels and eGFRs did not change postoperatively in the RALPN group ( P = .145 and P = .085, respectively), creatinine increased while eGFR decreased in the OPN group ( P = .003 and P = .002, respectively). Conclusions: Our analysis showed that RALPN could be considered similar to OPN in terms of parenchymal volume preservation, but the rate of parenchymal volume preservation was not associated with the change in functional parameters. These results should be supported by further research.

Purpose: To evaluate the diagnostic performance of diffusion-weighted imaging (DWI) in the 6-month interval post chemoradiation therapy (CRT) in determining persistent disease and whether persistent diffusion restriction on DWI at 6 months is associated with overall survival; and secondarily, to investigate the accuracy of pelvic lymph node assessment on T2-weighted imaging and DWI in the 6-month interval post CRT, in patients with squamous cell carcinoma of the anus., Methods and Materials: This retrospective study included patients with squamous cell carcinoma of the anus who underwent CRT followed by restaging rectal MRI from January 2010 to April 2020, with ≥1 year of follow-up after CRT. DW images were qualitatively evaluated by 2 junior and 2 senior abdominal radiologists to determine anal persistent disease. The reference standard for anal persistent disease was digital rectal examination/endoscopy and histopathology. Diagnostic performance was estimated using sensitivity, specificity, negative predictive value, and positive predictive value. Survival outcomes were evaluated via Kaplan-Meier analysis, and associations between survival outcomes and DWI status were tested for significance using the log-rank test. Additionally, DW and T2-weighted images were evaluated to determine lymph node status., Results: Among 84 patients (mean age, 63 ± 10.2 years; 64/84 [76%] female), 14 of 84 (17%) had confirmed persistent disease. Interreader agreement on DWI between all 4 radiologists was moderate (Light's κ = 0.553). Overall, DWI had a sensitivity of 71.4%, specificity of 72.1%, positive predictive value of 34.5%, and negative predictive value of 92.5%. Patients with a negative DWI showed better survival than patients with a positive DWI (3-year overall survival of 92% vs 79% and 5-year overall survival of 87% vs 74%), although the difference did not reach statistical significance (P = .063). All patients with suspicious lymph nodes (14/14, 100%) showed negative pathology or decreased size during follow-up., Conclusions: At 6 months post CRT, DWI showed value in excluding anal persistent disease. Persistent diffusion restriction on DWI was not significantly associated with overall survival. Pelvic nodal assessment on DWI and T2-weighted imaging was limited in predicting persistent nodal metastases., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Pancreatic leaks occur when a disruption in the pancreatic ductal system results in the leakage of pancreatic enzymes such as amylase, lipase, and proteases into the abdominal cavity. While often associated with pancreatic surgical procedures, trauma and necrotizing pancreatitis are also common culprits. Cross-sectional imaging, particularly computed tomography, plays a crucial role in assessing postoperative conditions and identifying both early and late complications, including pancreatic leaks. The presence of fluid accumulation or hemorrhage near an anastomotic site strongly indicates a pancreatic fistula, particularly if the fluid is connected to the pancreatic duct or anastomotic suture line. Pancreatic fistulas are a type of pancreatic leak that carries a high morbidity rate. Early diagnosis and assessment of pancreatic leaks require vigilance and an understanding of its imaging hallmarks to facilitate prompt treatment and improve patient outcomes. Radiologists must maintain vigilance and understand the imaging patterns of pancreatic leaks to enhance diagnostic accuracy. Ongoing improvements in surgical techniques and diagnostic approaches are promising for minimizing the prevalence and adverse effects of pancreatic fistulas. In this pictorial review, our aim is to facilitate for radiologists the comprehension of pancreatic leaks and their essential imaging patterns., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Triage refers to classifying and prioritizing patients based on the severity of their injuries or illnesses in the health care setting. The increasing number of elderly patients seeking care in emergency departments (EDs) highlights the need for special attention to the unique needs of this patient population., Aim: We aimed to compare the qSOFA, Emergency Severity Index (ESI), National Early Warning Score (NEWS), and Manchester Triage System (MTS) scores to assist ED physicians in assessing the severity of elderly patients' clinical conditions and triaging them appropriately., Methods: This cross-sectional study included 1066 patients aged 65 and over who presented to our ED as outpatients or by ambulance between September 1, 2022, and August 30, 2023. Scoring systems at the time of admission to the ED were recorded separately for outpatients and arriving by ambulance., Results: According to the qSOFA, patients with a score of 0 were 0.976 times less likely to arrive by ambulance compared to those scoring 1 and above (OR = 0.976, p = .934). According to the NEWS, patients in the moderate-risk category were 0.447 times less likely to arrive by ambulance (OR = 0.447, p = .054). According to the ESI score, patients requiring high resource use with normal vital signs were 146.758 times more likely to arrive by ambulance (OR = 146.758, p = .001)., Conclusion: Significant differences in patients' methods of presentation to the ED were observed based on the MTS, qSOFA, NEWS, and ESI scores., (© 2024. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Background and Purpose: The aim of this study was to determine the diagnostic value of fractional plasma volume derived from dynamic contrast-enhanced perfusion MR imaging versus ADC, obtained from DWI in differentiating between grade 2 (low-grade) and grade 3 (high-grade) intracranial ependymomas., Materials and Methods: A hospital database was created for the period from January 2013 through June 2022, including patients with histologically-proved ependymoma diagnosis with available dynamic contrast-enhanced MR imaging. Both dynamic contrast-enhanced perfusion and DWI were performed on each patient using 1.5T and 3T scanners. Fractional plasma volume maps and ADC maps were calculated. ROIs were defined by a senior neuroradiologist manually by including the enhancing tumor on every section and conforming a VOI to obtain the maximum value of fractional plasma volume (Vp max ) and the minimum value of ADC (ADC min ). A Mann-Whitney U test at a significance level of corrected P  = .01 was used to evaluate the differences. Additionally, receiver operating characteristic curve analysis was applied to assess the sensitivity and specificity of Vp max and ADC min values., Results: A total of 20 patients with ependymomas (10 grade 2 tumors and 10 grade 3 tumors) were included. Vp max values for grade 3 ependymomas were significantly higher ( P  < .002) than those for grade 2. ADC min values were overall lower in high-grade lesions. However, no statistically significant differences were found ( P  = .12114)., Conclusions: As a dynamic contrast-enhanced perfusion MR imaging metric, fractional plasma volume can be used as an indicator to differentiate grade 2 and grade 3 ependymomas. Dynamic contrast-enhanced perfusion MR imaging plays an important role with high diagnostic value in differentiating low- and high-grade ependymoma., (© 2024 by American Journal of Neuroradiology.)

Background: β-Lactams are the most widely used antibiotic family in the world. Nevertheless, they also stand out as the primary culprits for inducing drug hypersensitivity reactions (HSR). Methods: Between May 2018 and March 2023, patients with suspected HSRs to β-lactams, who underwent skin tests (ST), were retrospectively screened. The determinants of allergenic penicillin (DAP) tests, which include penicillin minor and major determinants, clavulanic acid, and amoxicillin, along with ampicillin, sulbactam, the identified culprit drugs, and alternative cephalosporins, which include cefuroxime, ceftriaxone prick and/or intradermal tests, were administered. The analysis focused on identifying positive ST results and determining the true HSRs rates in this patient cohort. Results: Of the 147 patients, 78.9% (n = 116) were women and the median (minimum-maximum) age was 41 years (18-71 years). Mild HSRs (grades 1-2) were observed in 72.78% (n = 107), whereas 24.4% (n = 36) had severe reactions (grades 3-4) and 2.7% (n = 4) had an unknown grade. Of the patients, 64% (n = 94) experienced HSRs within the first hour after the last dose of the identified culprit drug. The overall positivity rate for all STs was 26.5% (n = 39). ST positivity rates were notably higher in individuals who had experienced HSRs within the past 6 months (p = 0.02) and those with severe anaphylaxis (p < 0.001). Conclusion: β-Lactam ST positivity is higher, especially in those with grades 3-4 reactions and consulted a physician within the first 6 months after their HSRs.

Background: In mucinous rectal cancer, it can be difficult to differentiate between cellular and acellular mucin. The purpose of this study was to evaluate, in patients with mucinous rectal cancer, the value of static enhancement (enh) and pharmacokinetic parameters of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in predicting pathologic complete response., Methods: This retrospective cross-sectional study performed at Memorial Sloan Kettering Cancer Center included 43 patients (24 males and 19 females; mean age, 57 years) with mucinous rectal cancer who underwent MRI at baseline as well as after neoadjuvant chemoradiotherapy but before surgical resection between 2008 and 2019. Two radiologists independently segmented tumors on contrast-enhanced axial 3D T1-weighted images and sagittal DCE magnetic resonance images. On contrast-enhanced axial T1-weighted images, the static parameters enh and relative enhancement (renh) were estimated. On DCE images, the pharmacokinetic parameters K trans , k ep , relative K trans (rK trans ), and relative k ep (rk ep ) were estimated. Associations between all parameters with pathologic complete response were tested using Wilcoxon signed-rank tests. Receiver operating characteristic (ROC) analysis was performed to assess the area under the curve (AUC) for each parameter., Results: Of the 43 patients who were included in the study, 42/43 (98%) had evaluable contrast-enhanced axial T1-weighted images and 35/43 (81%) had evaluable DCE images. Of the patients with evaluable contrast-enhanced axial T1-weighted images, 9/42 (21%) had pathologic complete response and 33/42 (79%) did not have pathologic complete response. For reader 1, enh(pre-neoadjuvant chemotherapy), enh(post-neoadjuvant chemotherapy), and renh were significant predictors of pathologic complete response [P=0.045 (AUC =0.73), 0.039 (AUC =0.74), and 0.0042, respectively]. For reader 2, enh(pre-neoadjuvant chemotherapy) and renh were significant predictors [P=0.021 (AUC =0.77) and 0.002, respectively]. For renh, the AUC was 0.83 for reader 1, and 0.82 for reader 2. Meanwhile, of those patients with evaluable DCE images, 9/35 (26%) had pathologic complete response and 26/35 (74%) did not have pathologic complete response. K trans (pre-neoadjuvant chemotherapy), k ep (pre-neoadjuvant chemotherapy), and rk ep were significant predictors [P=0.016 (AUC =0.73), 0.00057 (AUC =0.81), and 0.0096 (AUC =0.74), respectively]., Conclusions: Static and pharmacokinetic parameters of contrast-enhanced MRI show promise to predict neoadjuvant treatment response. Static enh parameters, which are simpler to assess, showed the strongest prediction., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-23-1463/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

The pseudo-natural product (pseudo-NP) concept aims to combine NP fragments in arrangements that are not accessible through known biosynthetic pathways. The resulting compounds retain the biological relevance of NPs but are not yet linked to bioactivities and may therefore be best evaluated by unbiased screening methods resulting in the identification of unexpected or unprecedented bioactivities. Herein, various NP fragments are combined with a tricyclic core connectivity via interrupted Fischer indole and indole dearomatization reactions to provide a collection of highly three-dimensional pseudo-NPs. Target hypothesis generation by morphological profiling via the cell painting assay guides the identification of an unprecedented chemotype for Aurora kinase inhibition with both its relatively highly 3D structure and its physicochemical properties being very different from known inhibitors. Biochemical and cell biological characterization indicate that the phenotype identified by the cell painting assay corresponds to the inhibition of Aurora kinase B., (© 2024 The Authors. Advanced Science published by Wiley‐VCH GmbH.)

Background: Early diagnosis of hypertension (HT) is crucial for preventing end-organ damage. This study aims to identify the risk factors for future HT in young individuals through the application of machine learning (ML) models., Methods: The study included individuals aged 18-40 years who had not been diagnosed with HT through ambulatory blood pressure monitoring (ABPM). These participants were monitored for hypertension diagnosis from the date of ABPM application until the date of data collection. Hypertension prediction was carried out using three distinct ML methods: Support Vector Machine, Random Forest, and Least Absolute Shrinkage and Selection Operator. The identification of variables significant for future HT was based on the outcomes of these models., Results: This study comprised 516 patients, with a mean follow-up duration of 793.4±58.6 days. Following the integration of demographic data, laboratory results, and ABPM findings into the ML models, age, high-density lipoprotein cholesterol, triglycerides, and the standard deviation of systolic blood pressure (SDsis) were identified as predictors for future HT. A logistic regression with the selected variables (age, diabetes mellitus history, HDL, triglycerides, white blood cell count, and SDsis) using the full data set gave the following log odds 0.0737 (P<0.001), 0.7146 (P<0.001), -0.0160 (P=0.071), 0.0026 (P=0.002), 0.0857 (P=0.069), and 0.0850 (P=0.005), respectively. The corresponding probability values of age, diabetes mellitus history, HDL, triglycerides, white blood cell count, and SDsis were 0.5184, 0.6714, 0.4960, 0.5006, 0.5214, and 0.5212, respectively. This indicates a unit increase in all factors, except diabetes mellitus history, increases the probability of future HT by 50%. A history of diabetes, however, increases the probability of future HT by more than two thirds. The history of diabetes mellitus emerged as the most crucial predictor of future HT across all applied methods., Conclusions: ML methods appear to be valuable tools for predicting future HT. The widespread adoption of these methods and the refinement of more comprehensive models will lay the groundwork for future studies.

Background and Purpose: Distinguishing treatment-induced imaging changes from progressive disease has important implications for avoiding inappropriate discontinuation of a treatment. Our goal in this study is to evaluate the utility of dynamic contrast-enhanced (DCE) perfusion MRI as a biomarker for the early detection of progression. We hypothesize that DCE-MRI may have the potential as an early predictor for the progression of disease in GBM patients when compared to the current standard of conventional MRI. Methods: We identified 26 patients from 2011 to 2023 with newly diagnosed primary glioblastoma by histopathology and gross or subtotal resection of the tumor. Then, we classified them into two groups: patients with progression of disease (POD) confirmed by pathology or change in chemotherapy and patients with stable disease without evidence of progression or need for therapy change. Finally, at least three DCE-MRI scans were performed prior to POD for the progression cohort, and three consecutive DCE-MRI scans were performed for those with stable disease. The volume of interest (VOI) was delineated by a neuroradiologist to measure the maximum values for Ktrans and plasma volume (Vp). A Friedman test was conducted to evaluate the statistical significance of the parameter changes between scans. Results: The mean interval between subsequent scans was 57.94 days, with POD-1 representing the first scan prior to POD and POD-3 representing the third scan. The normalized maximum Vp values for POD-3, POD-2, and POD-1 are 1.40, 1.86, and 3.24, respectively (FS = 18.00, p = 0.0001). It demonstrates that Vp max values are progressively increasing in the three scans prior to POD when measured by routine MRI scans. The normalized maximum Ktrans values for POD-1, POD-2, and POD-3 are 0.51, 0.09, and 0.51, respectively (FS = 1.13, p < 0.57). Conclusions: Our analysis of the longitudinal scans leading up to POD significantly correlated with increasing plasma volume (Vp). A longitudinal study for tumor perfusion change demonstrated that DCE perfusion could be utilized as an early predictor of tumor progression.

Significant advancements in cancer treatment have led to improved survival rates for patients, particularly in the context of spinal metastases. However, early detection and monitoring of treatment response remain crucial for optimizing patient outcomes. Although conventional imaging methods such as bone scan, PET, MR imaging, and computed tomography are commonly used for diagnosing and monitoring treatment, they present challenges in differential diagnoses and treatment response monitoring. This review article provides a comprehensive overview of the principles, applications, and practical uses of dynamic contrast-enhanced MR imaging and diffusion-weighted imaging in the assessment and monitoring of marrow-replacing disorders of the spine., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Malaria poses an enormous threat to human health. With ever increasing resistance to currently deployed drugs, breakthrough compounds with novel mechanisms of action are urgently needed. Here, we explore pyrimidine-based sulfonamides as a new low molecular weight inhibitor class with drug-like physical parameters and a synthetically accessible scaffold. We show that the exemplar, OSM-S-106, has potent activity against parasite cultures, low mammalian cell toxicity and low propensity for resistance development. In vitro evolution of resistance using a slow ramp-up approach pointed to the Plasmodium falciparum cytoplasmic asparaginyl-tRNA synthetase (PfAsnRS) as the target, consistent with our finding that OSM-S-106 inhibits protein translation and activates the amino acid starvation response. Targeted mass spectrometry confirms that OSM-S-106 is a pro-inhibitor and that inhibition of PfAsnRS occurs via enzyme-mediated production of an Asn-OSM-S-106 adduct. Human AsnRS is much less susceptible to this reaction hijacking mechanism. X-ray crystallographic studies of human AsnRS in complex with inhibitor adducts and docking of pro-inhibitors into a model of Asn-tRNA-bound PfAsnRS provide insights into the structure-activity relationship and the selectivity mechanism., (© 2024. The Author(s).)

The study was carried out to investigate the effect of the artery with different pulse values and stenosis rates on the pressure drop, the peristaltic pump outlet pressure, fractional flow reserve (FFR) and most importantly the amount of power consumed by the peristaltic pump. For this purpose, images taken from the clinical environment were produced as models (10 mm inlet diameter) with 0% and 70% percent areal stenosis rates (PSR) on a three-dimensional (3D) printer. In the experimental system, pure water was used as the fluid at 54, 84, 114, 132, and 168 bpm pulse values. In addition, computational fluid dynamics (CFD) analyzes of the test region were performed using experimental boundary conditions with the help of ANSYS-Fluent software. The findings showed that as PSR increases in the arteries, the pressure drop in the stenosis region increases and this amount increases dramatically with increasing effort. An increase of approximately 40% was observed in the pump outlet pressure value from 54 bpm to 168 bpm in the PSR 0% model and 51% increase in the PSR 70% model. It has been observed that the pump does more work to overcome the increased pressure difference due to increased pulse rate and PSR. With the effect of contraction, the power consumption of the pump increased from 9.2% for 54 bpm to 13.8% for 168 bpm. In both models, the Wall Shear Stress (WSS) increased significantly. WSS increased abruptly in the stenosis and arcuate regions, while sudden decreases were observed in the flow separation region., (© 2023 John Wiley & Sons Ltd.)

Competing Interests: Declaration of Competing Interest The authors have no conflict of interest to declare.

Background and Purpose: Current imaging techniques have difficulty differentiating treatment success and failure in spinal metastases undergoing radiation therapy. This study investigated the correlation between changes in dynamic contrast-enhanced MR imaging perfusion parameters and clinical outcomes following radiation therapy for spinal metastases. We hypothesized that perfusion parameters will outperform traditional size measurements in discriminating treatment success and failure., Materials and Methods: This retrospective study included 49 patients (mean age, 63 [SD, 13] years; 29 men) with metastatic lesions treated with radiation therapy who underwent dynamic contrast-enhanced MR imaging. The median time between radiation therapy and follow-up dynamic contrast-enhanced MR imaging was 62 days. We divided patients into 2 groups: clinical success ( n = 38) and failure ( n = 11). Failure was defined as PET recurrence ( n = 5), biopsy-proved ( n = 1) recurrence, or an increase in tumor size ( n = 7), while their absence defined clinical success. A Mann-Whitney U test was performed to assess differences between groups., Results: The reduction in plasma volume was greater in the success group than in the failure group (-57.3% versus +88.2%, respectively; P < .001). When we assessed the success of treatment, the sensitivity of plasma volume was 91% (10 of 11; 95% CI, 82%-97%) and the specificity was 87% (33 of 38; 95% CI, 73%-94%). The sensitivity of size measurements was 82% (9 of 11; 95% CI, 67%-90%) and the specificity was 47% (18 of 38; 95% CI, 37%-67%)., Conclusions: The specificity of plasma volume was higher than that of conventional size measurements, suggesting that dynamic contrast-enhanced MR imaging is a powerful tool to discriminate between treatment success and failure., (© 2023 by American Journal of Neuroradiology.)

Extraosseous Ewing sarcoma is a rare and aggressive malignancy belonging to the Ewing sarcoma family of tumors, primarily affecting soft tissues such as the pelvis, retroperitoneum, and chest wall. Although it predominantly involves these soft tissues, extraosseous Ewing sarcoma can also occur in solid organs, including the pancreas. Here, we present a rare case of a 4-year-old girl diagnosed with primary extraosseous Ewing sarcoma of the pancreas.