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Repeated intra-articular bleeding with subsequent development of chronic synovitis and cartilage changes, leading to haemophilic arthropathy, is one the most debilitating problems in haemophilic patients. Radiosynovectomy is a familiar therapeutic choice in management of chronic synovitis in haemophilia. We report the treatments results of synoviorthesis with 32P chromic phosphate with emphasis on clinical aspects. Between 2002 and 2006 we performed 66 procedures in 53 patients. Seven patients were excluded. The remaining 46 patients were followed for an average of 31 months. The mean age of patients at the time of injection was 15.9 years (range: 6–28). There were three repeat injections. According to Fernandez-pallazi and Cavilgia clinical classification ( Table 1 ) [ 23 ], nine joints were Stage II and 46 were Stage III. In latest follow-up, 77% of patients reported at least a 50% decrease in bleeding frequency after treatment ( P < 0.0001). The need for antihaemophilic factor consumption dropped by about 74% postradiosynovectomy ( P < 0.0001). In most of the injected joints, the range of motion remained stable or improved. A trend was found for the number of haemarthrosis to increase after a period of considerable improvement. Synoviorthesis using 32P effectively reduces the intra-articular bleeding rate and factor concentrate use. Durability of the response seems to be unpredictable, perhaps attributable to the late intervention. An early radiosynovectomy might be more helpful in terms of stability of response to treatment. [ABSTRACT FROM AUTHOR]

Introduction: The Mucopolysaccharidoses (MPS) are a group of inherited metabolic disorders caused by a deficiency or malfunctioning of lysosomal enzymes which are needed to break down complex carbohydrates known as mucopolysaccharides or glycosaminoglycans (GAGs). Accumulation of GAGs causes a cascade of events leading to the progressive damage of cells, tissue and organs. Morquio disease or Mucopolysaccharidosis Type IV (MPS IV) belongs to this group and has two sub-types, A and B. Type A is also known as Morquio A, GALNS deficiency, N-acetylgalactosamine-6-sulfate sulfatase deficiency or more simply MPS IVA. This lysosomal enzyme involved in the catabolism of keratan and chondroitin sulfate. Patients who inherit two mutated GALNS gene alleles have a decreased ability to degrade the glycosaminoglycans (GAGs) keratan sulfate and chondroitin 6-sulfate, thereby causing GAG accumulation within lysosomes and consequently pleiotropic disease. The objective was to report the results of clinical characteristics, enzyme activity determination and mutation analysis of GALNS gene in an Iranian patient with mucopolysaccharidosis (MPS) type IVA (Morquio A disease). Materials and Methods: The 10 years old Iranian boy with MPSIV was firstly diagnosed by urin GALNS determination who was charactraised by multiple skeletal abnormalities and dwarfism, kyphosis, hypermobility joints, difficultly in walking to 8 years old and now he can't walk. But his intelligence was normal. We investigated for all coding exons and adjacent intron regions of GALNS gene by PCR sequencing method. Results: We performed urin test (MS/MS) from patient. In this test total GAGS was high and MPS was likely. So lysosomal enzymes in dried blood were checked and MPS IVA was diagnosed. Two heterozygous missens mutation as c. 135 G>T (S>I) and c.510 C>A (P>H), and a homozygous mutation as c.181 A>G (y>C) in GALNS gene were detected in this patient. The mutation c. 181 (y>C) is a novel variant which is not reported yet.With the method of gene analysis of new variant, the mutation c. 181 (y>C) was considered to be a pathogenic mutation. Conclusion: The MPS IVA patient showed severe multiple skeletal deformities, normal intelligence, muscle weakness, short stature, who carries homozygous mutations c. 181 A>G (y>C). The bioinformatics analysis in POLYPHEN predicted this mutation as being probably pathogenic. [ABSTRACT FROM AUTHOR]

Background: Although several genetic biomarkers have been reported in the tocilizumab (TCZ) response in rheumatoid arthritis, no studies have addressed the pharmacogenomics effect of TCZ in COVID-19., Methods: In this prospective longitudinal study, 95 individuals with severe COVID-19 were selected between 2020-2022. The recovery process was measured at 24 h, 48 h, and 10 days before and after taking TCZ. All participants were genotyped using RFLP-PCR. Different genotypes of FCGR2A rs1801274 and IL-6R rs2228145 were compared in terms of the recovery process., Results: 43.2% of patients were male and 56.8% were female with an average age of 58.20(± 16.214) years. The GA genotype for FCGR2A rs1801274 increased the risk of death (OR = 2.83, P = 0.038) and ventilation (OR = 2.71, P = 0.047) in TCZ-treated individuals. However, there was no risk of death and ventilation with IL-6R rs2228145 (P > 0.05). Additionally, docking analysis showed that not only IL6R but also FCGR2A can be a ligand for TCZ., Conclusion: This study provides valuable insights into the impact of genetic variations on the response rate of TCZ in COVID-19 patients. The GA genotype for FCGR2A rs1801274 was associated with poor treatment outcomes., (© 2024. The Author(s).)

To improve embryo transfer success and increase the chances of live birth in assisted reproductive methods, there is a growing demand for the use of pre-implantation genetic testing (PGT). However, the invasive approaches used in PGT have led to in vitrofertilization failure and abortions, increasing anxiety levels for parents. To address this, non-invasive PGT methods have been introduced, such as the detection of DNA in blastocoel fluid of blastocysts and spent culture media (SCM). These methods have proven to be minimally invasive and effective in detecting aneuploidy in the chromosomes of human embryos. This review aims to explore the different approaches to pre-implantation diagnosis, including invasive and non-invasive methods, with a particular focus on non-invasive PGT (niPGT). The search strategy involved gathering data from scientific databases such as PubMed, Google Scholar, and Science Direct using relevant keywords. The search was conducted until January 2023. In total, 22 studies have successfully reported the detection and amplification of cell-free DNA in the embryonic SCM. It is important to note that niPGT has some limitations, which include differences in indicators such as cell-free DNA amplification rate, concordance, level of maternal DNA contamination, sensitivity, and specificity between SCM samples and biopsied cells. Therefore, more extensive and detailed research is needed to fully understand niPGT's potential for clinical applications., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2024 Karami et al.)

Purpose: This retrospective clinical study aimed to evaluate the implants placed in fresh sockets and investigate the effect of varied oral health conditions and treatment plan details on the clinical and radiographic outcomes., Materials and Methods: Fifty-nine participants (102 implants) were included in this study. Four variables, including mean probing depth (PD), mean marginal bone loss (MBL), pink esthetic score (PES), and patient satisfaction, were significant dependent variables, and the effects of independent variables on these four items were studied. The data were analyzed by the analysis of covariance (ANCOVA) using a statistical software., Results: The mean follow-up period was 4.75 ± 1.74 years, and the mean MBL was 1.21 ± 0.81 mm. The survival rate was 97 %. There were significant effects of the finish line site, keratinized gingival width, and attached gingival width on PD after adjusting the factors. Also, the implant brand, plaque index, and uncemented prosthesis affected MBL significantly. In addition, significant effects of the surgeon, implant brand, and proximal contact on PES were found., Conclusion: More PD was found around restorations with a finish line site > 1.5 mm subgingival. Sufficient attached gingiva was a more effective factor on PD than keratinized gingiva. Implants with more plaque scores showed more MBL., Competing Interests: 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., (© 2023 THE AUTHORS.)

Background: Psychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum., Methods: A cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions., Results: The prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (β = 1.776, P < 0.001), as well as its three subscales: somatization (β = 1.355, P = 0.019), anxiety symptoms (β = 2.249, P < 0.001), and depressive symptoms (β = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (β = 1.344, P = 0.038) and the somatization subscale (β = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (β = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (β = 1.998, P = 0.012) and depressive symptoms (β = 1.949, P = 0.020)., Conclusion: The high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits., (© 2023. The Author(s).)

In this work, to evaluate solute-solute, solute-solvent and phase separation in aqueous systems containing {betaine + poly ethylene glycol dimethyl ether with molar mass 250 g mol -1 (PEGDME 250 )}, {betaine + K 3 PO 4 } and {betaine + K 2 HPO 4 }, first water activity measurements were made at 298.15 K and atmospheric pressure using the isopiestic technique. The water iso-activity lines of these three systems were obtained which have positive deviations from the semi-ideal solutions. This suggests that betaine-polymer and betaine-K 3 PO 4 or betaine-K 2 HPO 4 interactions are unfavorable; and these mixtures may form aqueous two-phase systems (ATPSs) at certain concentrations. Indeed the formation of ATPSs was observed experimentally. Then, osmotic coefficient values were calculated using the obtained water activity data; and, using the polynomial method the solute activity coefficients were determined. Using these activity coefficients, the transfer Gibbs energy ([Formula: see text]) values were calculated for the transfer of betaine from aqueous binary to ternary systems consisting polymer (PEGDME250) or salts (K 3 PO 4 and K 2 HPO 4 ). The obtained positive [Formula: see text] values again indicated that there is unfavorable interaction between betaine and these solutes. Finally, the volumetric and ultrasonic studies were made on these systems to examine the evidence for the nature of interactions between betaine and the studied salts or polymer., (© 2023. Springer Nature Limited.)

Objective: Annular fissures are common findings on MR studies of the lumbar spine but have not been specifically examined in the thoracic spine. We sought to review the prevalence and stability of MRI imaging features of thoracic annular fissures and the association of thoracic AFs with intervertebral degenerative disk changes., Materials and Methods: We surveyed 10 years of MRI studies in which patients had one or more repeated examinations of the thoracic spine. For every annular fissure, we recorded its imaging features on all pulse sequences and the evolution of those imaging findings across all time periods., Results: We reviewed 210 patients and discovered that 66 (31.4%) had at least one thoracic annular fissure. The presence of annular fissures was positively correlated with older age and male gender. The initial annular fissure was always hyperintense on T2WI and annular fissures remained hyperintense on T2WI over time in all cases but showed less hyperintensity in 23.9% (n = 39/163) and more hyperintensity in 4.9% (n = 8/163). The rate of concomitant disk bulges was 85.8% (n = 140/163). Of the 71 annular fissures in which gadolinium-enhanced studies were performed, 20 (28.1%) showed enhancement and 14/20 (70%) annular fissures showed persistent enhancement over time (mean follow-up = 39.6 ± 44.1 months)., Conclusion: Thoracic annular fissures rarely resolve, remain hyperintense on T2WI, and, if they enhance, that enhancement generally persists., Competing Interests: Declaration of competing interest The authors declare no conflict of interest. Unrelated, Dr. David Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com, outside the submitted work., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Cervical annular fissures (AFs) have not been studied specifically as to their prevalence, imaging features, and persistence over time. We sought to determine the prevalence and natural history of cervical AFs. We hypothesized that these are static lesions that are not prevalent in the population., Methods: This was a cross-sectional retrospective study of cervical MRI examinations performed between 2011-2021. We retrospectively reviewed the studies of 115 consecutive patients (63 female, 52 male) who had 2 or more MRI studies of the cervical spine to identify (1) imaging features of cervical AFs on various pulse sequences, (2) the concurrence of disc bulges/herniations, (3) changes in those imaging findings over time (mean follow-up 39.3 months) and (4) rate at which cervical AFs were mentioned in radiology reports. 620 initial and follow-up studies were reviewed., Results: 50/115 (43.5%) patients had cervical AFs; 21 patients had a single AF and 29 patients had multi-level AFs (total 109 AFs). The most common levels affected were C4-C5 (28%, n = 31) and C5-C6 (27%, n = 30). All cervical AFs were hyperintense on T2WI and, over time, 95% (n = 104/109) of the AFs remained hyperintense; 22% (n = 25) showed less hyperintensity, 10% (n = 11) more hyperintensity, and 60% (n = 66) the same hyperintensity. 5 AFs (4%) resolved completely. Only 2 (8%) of 25 cervical AFs enhanced with gadolinium. The rate of concomitant disc bulges and herniations was 71% (n = 78) and 22% (n = 24) respectively. The presence of cervical AFs did not increase the risk of progression to bulges or herniations. None of the cervical AFs were mentioned in the radiology reports., Conclusions: Cervical AFs occurred in 43.5% of patients but were rarely reported. They usually remained bright on T2W but their brightness could vary over time. Cervical AFs were often associated with disc bulges/herniations and enhanced less frequently (8%) than lumbar disk AFs., Competing Interests: The authors declare no conflict of interest. Unrelated, Dr. Yousem reports royalties from Elsevier, personal fees from Medicolegal consultant, speaking and consulting fees from MRIOnline.com, outside the submitted work., (© 2023 The Author(s).)

Aims: Currently, diabetic nephropathy (DN) is considered the leading cause of the end-stage renal disease (ESRD). However, its specific molecular mechanism is still unclear, and there is still a lack of effective diagnostic and therapeutic methods., Method: A pathway was assumed after bioinformatics analysis of GEO datasets related to individuals with various levels of DN, LINC01410, MAFB, and FOSL1. Then, 46 patients with type 2 diabetes (T2DM) and different levels of albuminuria, and 12 individuals without diabetes, were selected. qPCR was performed to evaluate gene expression. One-way ANOVA followed by Tukey's -and linear trend tests were performed to analyze gene expression in different stages of the disease. Moreover, receiver operating characteristic (ROC) curves and the correlation between LINC01410, FOSL1, and MAFB were analyzed., Results: LINC01410, MAFB, and FOSL1 were selected based on bioinformatics analyses. The qPCR results showed that the expression of LINC01410 decreased, and FOSL1 and MAFB increased in micro-and macroalbuminuria groups compared to normoalbuminuria groups (P < 0.05). ROC curves demonstrated a significant diagnostic accuracy of LINC01410, MAFB, and FOSL1 between DN and participants with normoalbuminuria (P < 0.05). Pearson's correlation analysis revealed a positive association between the expressions of FOSL1 and MAFB (p = 0.01, r = 0.39). However, there was no correlation between LINC01410 with MAFB and FOSL1 (p = 0.23 and p = 0.21, respectively)., Conclusion: Dysregulation of LINC01410, MAFB, and FOSL1 is related to DN. These results may provide new insights into the role of LINC01410, MAFB, and FOSL1 as potential biomarkers in DN., 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., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Headache is a common presenting symptom in the ambulatory setting that often prompts imaging. The increased use and associated health care money spent in the setting of headache have raised questions about the cost-effectiveness of neuroimaging in this setting. Neuroimaging for headache in most cases is unlikely to reveal significant abnormality or impact patient management. In this article, reasons behind an observed increase in neuroimaging and its impact on health care expenditures are discussed. The typical imaging modalities available and various imaging guidelines for common clinical headache scenarios are presented, including recommendations from the American College of Radiology., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: The optimal quantification of PET in assessment of head and neck squamous cell carcinoma (HNSCC) is still under development. The effect of partial volume correction (PVC) on the evaluation of survival in the HNSCC patients has not been investigated yet., Methodology: Pretreatment 18F-FDG-PET/CT scans of a selected group of 57 patients with advanced stage HNSCC were collected. Conventional (SUVmean and SUVmax) and volumetric [total lesion glycolysis (TLG) and metabolic tumor volume (MTV)] PET metrics were calculated. The ROVER software (ABX GmbH, Radeberg, Germany) automatically applied PVC to the PET metrics. Cox proportional hazards regression model calculated hazard ratio (HR) for assessment of predictive parameters of progression-free survival (PFS)., Results: In multivariate Cox regression analysis, including age, gender, race, human papillomavirus status, and stage, the only significant predictors of PFS were the volumetric PET parameters (TLG: HR, 1.003; 95% CI, 1.001-1.005; P = 0.02), pvcTLG (HR, 1.002; 95% CI, 1.001-1.004; P = 0.01) and MTV (HR, 1.050; 95% CI, 1.024-1.077; P < 0.01). The partial volume-corrected values were significantly higher than the noncorrected values (Wilcoxon sign test; P < 0.05). However, there was not a statistically significant difference between the nonpartial volume corrected and partial volume-corrected PET metrics for assessment of PFS., Conclusion: Volumetric PET metrics were predictors of PFS in Cox regression analysis. Applying PVC could not significantly improve the accuracy of PET metrics for assessment of PFS., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Multiple ultrasound-based risk stratification systems (RSSs) for thyroid nodules are used worldwide. Variations in structure, performance, and recommendations are confusing for physicians and patients and complicate management decisions. The goal of this study was to determine the factors that are associated with choice of RSS and barriers to RSS use. These results are intended to inform development of a universal international thyroid ultrasound RSS. Methods: An online survey with questions about usage of RSSs, ultrasound practice and volumes, training, specialty, practice type, and geographic region was made available to members of five professional societies via email. Subgroup analysis was performed to identify the factors that governed use of one or more of five leading RSSs: American Association of Clinical Endocrinology (AACE), American College of Endocrinology (ACE), and Associazione Medici Endocrinologi (AME) Medical Guidelines, American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), American Thyroid Association (ATA) guidelines, European Thyroid Association TIRADS (EU-TIRADS), and Korean Society of Thyroid Radiology/Korean Thyroid Association TIRADS (K-TIRADS). Results: There were 875 respondents from 52 countries (response rate not estimated due to overlapping society membership). More than 7 specialties were represented, with most (538; 61.5%) in endocrinology. The choice of RSS was strongly associated with medical specialty and geographic region. Of 692 respondents who indicated that their practice used an RSS, 213 (30.8%) used more than one. The specialties that were more likely to use multiple RSSs were surgery and others (40%), followed by endocrinology (33.0%), and radiology or nuclear medicine (17%) ( p  < 0.001). Of 271 (31.0%) respondents who indicated that they do not personally use an RSS, the majority (168; 62%) preferred to describe the specific sonographic characteristics/features that they believe are most relevant in a nodule. Conclusions: Almost one third of respondents indicated use of more than one RSS in their practice, potentially leading to confusion, and a similar proportion reported not using an RSS for various reasons. A unified international system that addresses their concerns and simplifies risk classification of thyroid nodules may benefit practitioners and patients. This is particularly important as newer thyroid nodule management options gain acceptance.

Background: Isolated lateral compartment knee arthritis is less prevalent than medial. While the reported results of medial unicompartmental knee replacement (UKR) have been good and comparable to total knee replacement, the results of lateral UKR have been mixed. We present the short-term results and survivorship of a fixed-bearing UKR designed specifically for the lateral compartment., Methods: We report the result of 130 primary fixed-bearing lateral Oxford (FLO) UKRs (123 patients) performed between 2015 and 2019 with a minimum follow-up of 1 year. The indications for lateral UKR were: isolated lateral osteoarthritis (n = 122), post-trauma (n = 5) and osteonecrosis (n = 3). The mean age was 69.1 (± 11.6), mean BMI 28.4 (± 4.9), 66.9% female, 60% right-sided, and mean follow-up 3 (range 1-4.8 years, standard deviation ± 1) years. The primary outcome measure was the Oxford knee score (OKS). Survival analysis was performed with "revision for any reason", "reoperation", and "implant failure" as the endpoints., Results: Six patients died from unrelated reasons. None of the implants failed. One required the addition of a medial UKR for medial arthritis. There were no other reoperations. At 4 years, the survival for implant failure was 100% and for both revision and all reoperations was 99.5% (95% CI 96.7-99.9%). At the last review, at a mean of 3 years, the mean Oxford knee score was 41., Conclusion: The good survivorship and outcome scores suggest that UKR designed for the lateral compartment is an excellent alternative to total knee replacement in selected patients with isolated lateral tibiofemoral arthritis at short-term follow-up., (© 2022. The Author(s).)

Neurocysticercosis (NCC) is a parasitic infection caused by Cysticercus cellulosae , the metacestode of pork tapeworm ( Taenia solium ). NCC is one of the most common public health problems worldwide. We present a patient harboring a bilobed ring-enhancing lesion with a presumed diagnosis of brain metastasis, who returned to the USA after traveling to an endemic region. The diagnosis of NCC was established based on a characteristic resonance of succinate on proton magnetic resonance spectroscopy. Also, higher mean diffusivity and lower fractional anisotropy along with relative cerebral blood volume were observed from the lesion compared to contralateral normal brain regions. Multiparametric analysis may improve the differential diagnosis of ring-enhancing intracranial lesions such as NCC.

While not conventionally used as the first-line modality, [ 18 F]-2-fluoro-2-deoxy-D-glucose (FDG) - positron emission tomography/computed tomography (PET/CT) can identify infection and inflammation both earlier and with higher sensitivity than anatomic imaging modalities [including chest X-ray (CXR), computed tomography (CT), and magnetic resonance imaging (MRI)]. The extent of inflammation and, conversely, recovery within the lungs, can be roughly quantified on FDG-PET/CT using maximum standardized uptake value (SUVmax) values. The Coronavirus disease 2019 (COVID-19) pandemic has highlighted the value of FDG-PET/CT in diagnosis, elucidation of acute pulmonary and extrapulmonary manifestations, and long-term follow up. Similarly, many other pulmonary infections such as previously documented coronaviruses, aspergillosis, blastomycosis, candidiasis, coccidioidomycosis, cryptococcosis, histoplasmosis, mucormycosis, and typical/atypical mycobacterial infections have all been identified and characterized using FDG-PET/CT imaging. The goal of this review is to summarize the actual and potential benefits of FDG-PET/CT in the imaging of COVID-19 and other lung infections. Further research is necessary to determine the best indications and clinical applications of FDG-PET/CT, improve its specificity, and ultimately ascertain how this modality can best be utilized in the diagnostic work up of infectious pathologies., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burn-out, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization. These tenets are often created through an organic consensus of collegial workmates and then put to action by a leadership team. Reassessing the goals and virtues of the organization at appropriate intervals leads to ongoing loyalty and commitment to the team and a positive attitude. Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one's work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization's executive team should be dedicated to crafting an environment that leads to delighted, healthy employees., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Limited data exist regarding the long-term pulmonary sequelae of COVID-19. Identifying features utilizing multiple imaging modalities engenders a clearer picture of the illness's long-term consequences., Areas Covered: This review encompasses the common pulmonary findings associated with different imaging modalities during acute and late remission stages of COVID-19 pneumonia., Expert Opinion: Chest x-ray, a common preliminary diagnostic imaging technique, is not optimal for extended care due to limited tissue contrast resolution providing suboptimal assessment of pulmonary pathology and subtle interval changes. Ultrasound may be utilized on a case-by-case basis in certain patient populations, or in countries with limited resources. Chest CT's accessibility, high tissue contrast and spatial resolution make it the foremost modality for long-term COVID-19 follow-up. While MRI can viably monitor extrapulmonary disease due to its lack of radiation and high inherent soft-tissue contrast, it has limited pulmonary utility due to motion artifact and alveolar gas decreasing lung signal. Although 18F-FDG-PET/CT is costly and has limited specificity, it can provide molecular level data and inflammation quantification. Lung perfusion scintigraphy may also explain COVID-19 induced thromboembolic events and persistent dyspnea despite normal structural imaging and testing results. Correlating the long-term pulmonary findings of COVID-19 with each imaging modality is essential in elucidating the post-recovery course.

Atherosclerosis is the most common cause of peripheral artery disease (PAD). We compared the atherosclerotic burden in non-lower extremity arteries in patients with and without PAD using 18 F-sodium fluoride (NaF)-PET/CT. We identified five individuals (61.8±6.6 years, one male, four females) with PAD and matched to five individuals without PAD based on age and gender from the unfavorable cardiovascular risk profile group of the CAMONA trial (60±7.2 years, one male, four females). Individuals underwent PET/CT imaging 90 minutes after the injection of NaF (2.2 Mbq/Kg). CT imaging was conducted to account for attenuation correction and anatomic referencing. The NaF uptake was measured by manually defining regions of interest on each axial slice on the following arteries: coronary artery (CA), carotid artery (CR), ascending aorta (AS), arch of aorta (AR), descending aorta (DA), and abdominal aorta (AA). Average SUVmean (aSUVmean) was calculated for each segment. Wilcoxon's signed rank test was used for statistical analysis. The total aSUVmean was higher in the PAD group compared to the non-PAD group (6.54±0.9 vs. 5.03±0.45, P=0.043). Comparison revealed higher NaF uptake in CR, AS, AR, and DA in the PAD group compared to the non-PAD group (0.93±0.25 vs. 0.54±0.14, P=0.01; 1.28±0.20 vs. 0.86±1.19, P<0.01; 1.18±0.17 vs. 0.90±0.19, P=0.03; 1.32±0.24 vs. 0.91±0.15, P=0.01). The NaF uptake in CA and AA was similar between the two groups (0.77±0.04 vs. 0.71±0.05, P=0.11; 1.07±0.28 vs. 1.12±0.30, P=0.82). We found individuals with PAD had higher atherosclerotic burden in the carotid arteries and thoracic aorta compared to non-PAD subjects., Competing Interests: None., (AJNMMI Copyright © 2020.)

Background: In neuromyelitis optica spectrum disorder (NMOSD), clinical disability in NMOSD patients is relapse-related and progressive phase is rare. This observation raises the question whether there is any radiographic disease activity. The aim of present study was to determine the longitudinal changes in cerebral lesion number, lesion size, lesion-to-venule relationship, and morphological patterns of lesions in NMOSD using multiparametric 7T MR imaging. We also aimed to assess brain volume changes in NMOSD., Methods: A cohort of 22 patients with NMOSD underwent high-resolution 3D-susceptibility weighted imaging (SWI) and 2D-gradient-echo (GRE-T2*) weighted imaging on 7T MRI of brain at baseline and after ~2.8 years of follow-up. Morphologic imaging characteristics, and signal intensity patterns of lesions were recorded at both time points. Lesions were classified as "iron-laden" if they demonstrated hypointense signal on GRE-T2* images and/or SWI as well as hyperintense signal on quantitative susceptibility mapping (QSM). Lesions were considered "non-iron-laden" if they were hyperintense on GRE-T2*/SWI and isointense or hyperintense on QSM. Additionally, fractional brain parenchymal volume (fBPV) was computed at both time points., Results: A total of 169 lesions were observed at baseline. At follow-up, 6 new lesions were found in 5 patients. In one patient, a single lesion could not be detected on the follow-up scan. No appreciable change in lesion size and vessel-lesion relationship was observed at follow up. All lesions demonstrated hyperintense signal intensity on GRE-T2* weighted images and isointense signal on QSM at both time points. Therefore, these lesions were considered as non-associated with iron pathology. Additionally, no significant change in brain volume was observed: fBPV 0.78 ± 0.06 at baseline vs. 0.77 ± 0.05 at follow up, p>0.05., Conclusion: Cerebral lesions in NMOSD patients remain 'inert' and do not show any substantial variations in morphological characteristics during a 2-3-year follow-up period., Competing Interests: Declaration of Competing Interest We report no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: We used 18 F-sodium fluoride (NaF) to assess early atherosclerosis in the global heart in asymptomatic individuals with a coronary calcium score of zero and without a formal diagnosis of hypertension. We hypothesized that these individuals might present with subclinical atherosclerosis that correlates with systolic, diastolic and mean arterial pressure (SBP, DBP, and MAP)., Methods: We identified 20 asymptomatic individuals (41.6 ± 13.8 years, 8 females) from the CAMONA trial with C-reactive protein ≥3 mg/L, no smoking history, diabetes (fasting blood glucose <126 mg/dl) and dyslipidemia per the Adult Treatment Panel III Guidelines: untreated LDL <160 mg/dL, total cholesterol <240 mg/dL, HDL >40 mg/dL. All underwent PET/CT imaging 90 minutes after NaF injection (2.2 Mbq/Kg). The global cardiac average SUVmean (aSUVmean) was calculated for each individual. Correlation coefficients and linear regression models were employed for statistical analysis., Results: Significant positive correlation was revealed between global cardiac NaF uptake and all blood pressures: SBP (r=0.44, P=0.05), DBP (r=0.64, P=0.002), and MAP (r=0.59, P=0.007). After adjusting for age and gender, DBP and MAP were independent predictors of higher global cardiac NaF uptake., Conclusion: NaF-PET/CT for detecting and quantifying subclinical atherosclerosis in asymptomatic individuals revealed that cardiac NaF uptake correlated independently with DBP and MAP., Competing Interests: None., (AJCD Copyright © 2020.)

Background: Multi-drug resistant (MDR) Acinetobacter baumannii is one of the most important causes of nosocomial infections. The purpose of this study was to identify antibiotic resistance patterns, biofilm formation and the clonal relationship of clinical and environmental isolates of A. baumannii by Pulsed Field Gel Electrophoresis method. Forty-three clinical and 26 environmental isolates of the MDR A. baumannii were collected and recognized via API 20NE. Antibiotic resistance of the isolates was assessed by the disk diffusion method, and the biofilm formation test was done by the microtiter plate method. Pulsed Field Gel Electrophoresis (PFGE) was used to assess the genomic features of the bacterial isolates., Results: The resistance rate of clinical and environmental isolates against antibiotics were from 95 to 100%. The difference in antibiotic resistance rates between clinical and environmental isolates was not statistically significant (p > 0.05). Biofilm production capabilities revealed that 31 (44.9%), and 30 (43.5%) isolates had strong and moderate biofilm producer activity, respectively. PFGE typing exhibited eight different clusters (A, B, C, D, E, F, G, and H) with two significant clusters included A and G with 21 (30.4%) and 16 (23.2%) members respectively, which comprises up to 53.6% of all isolates. There was no relationship between biofilm formation and antibiotic resistance patterns with PFGE pulsotypes., Conclusions: The results show that there is a close relationship between environmental and clinical isolates of A. baumannii. Cross-contamination is also very important that occurs through daily clinical activities between environmental and clinical isolates. Therefore, in order to reduce the clonal contamination of MDR A. baumannii environmental and clinical isolates, it is necessary to use strict infection control strategies.

Introduction: Life-threatening hemorrhage associated with low-energy pelvic fracture has been described in single cases in the literature. However, there is limited evidence available on the bleeding risk associated with hemodynamically stable osteoporotic pelvic fractures. The objective of this study was to estimate the bleeding risk associated with low-energy osteoporotic pelvic fractures in the elderly population., Materials and Methods: A retrospective review of patients aged > 65 years old with pelvic fractures admitted between 2015 and 2018 was performed. Eighty-two patients were identified: 12 males and 70 females with a median age of 86 years. The median Charlson comorbidity index was 6 (interquartile range = 5-7). Eighty-one fractures were classified as lateral compression I or Tile A2, and 1 fracture was classified as lateral compression II or Tile B2. Forty patients were on concurrent anticoagulation treatment. In 4 patients on warfarin, this treatment was reversed on admission., Results: The mean hemoglobin (Hb) level on arrival was 12.36 g/dL (±1.67 g/dL). There were significant drops in Hb levels on day 1 (Hb = 11.22 ± 1.86 g/dL, P < .001) and day 4 (Hb = 10.97 ± 1.6 g/dL, P < .001). Nine percent of patients required a blood transfusion. The mean baseline Hb level pre-transfusion was 8.33 g/dL (±1.15). Preexisting anticoagulation treatment did not predispose patients to greater decreases in Hb levels on day 1 (mean difference = 0.16 g/dL, P = .62) or day 4 (mean difference = 0.29 g/dL, P = .48) post-admission., Discussion: An observed mean decrease in Hb level of up to 1.4 g/dL can occur in hemodynamically stable elderly patients with osteoporotic pelvic fractures, reflecting an approximate loss of 1.4 units of packed red blood cells., Conclusion: This degree of decrease in Hb may be clinically significant in geriatric patients with chronic anemia and a history of cardiovascular disease., Competing Interests: Declaration of Conflicting Interests: The author(s) declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Intramedullary nailing (IMN) is the treatment of choice in the surgical management of most tibia shaft fractures. The aim of the study was to evaluate the proximity of the common peroneal nerve (CPN) to the oblique proximal locking screw inserted from the anteromedial to the posterolateral direction. We identified all the patients who underwent the IMN of the tibia between 2008 and 2018. Patients who underwent post-operative computed tomography for any reason were identified. Patients were included if the CPN was visible on the axial slices, the proximal oblique locking screw was used, or the line of the drilling could be reconstructed. Twenty-nine patients met the inclusion criteria. The median length of the intramedullary nail was 345 mm. The median nail diameter was 10 mm. The median number of proximal interlocking screws was 2. All scans were reviewed by the musculoskeletal radiologist for verifying the visibility and marking of the CPN. The mean screw trajectory angle to the CPN was 9° (± 9°). Most of the drilling trajectories passed posterior to the CPN (79%). The depth of the intramedullary nail was on average - 8 mm (± 10 mm). A negative correlation was observed between the depth of the nail and the distance from the CPN (P < 0.001). During the insertion of the oblique proximal locking screw from the anteromedial to the posterolateral direction, the CPN is potentially at risk if the drill is allowed to plunge or an incorrectly long screw is used. Sinking the nail provides a better margin of safety.

Background: Several factors have been evaluated for their competency as applied bio-markers regarding dia-gnosis and therapy of ovarian cancer as one of the most cause of death due to the gynecologic malignancies. However, some Fox-factors have been shown to modulate cancer progression primarily by their impacts on the proliferation of the cells, the expression and potential function of FOXR2 (Forkhead Box R2), newly identified as a probable oncogene in a few human cancers, remains undecided in ovarian cancer. The aim of this study was to evaluate the FOXR2 and some epithelial-mesenchymal transition (EMT) -related gene expression profiles in epithelial ovarian cancer (EOC) tissues and their healthy samples as well as an ovarian cancer cell line (SKOV-3)., Methods: In this observational study, 20 epithelial ovarian adenocarcinoma and their marginal samples, obtained from 20 women with EOC, as well as SKOV-3, were investigated for the relative gene expression levels of FOXR2, CDH1 (encoding E-cadherin) and FN1 (encoding fibronectin-1) in 2 groups using qualitative real-time polymerase chain reaction technique (qRT-PCR)., Results: The findings demonstrated a significant up-regulation of FOXR2 and FN1 despite the CDH1 down-regulation in case samples compared to controls (P &lt; 0.05). There was a significant correlation between FOXR2 gene expression profile and EMT-related markers in high-grade tumors. Furthermore, the bio-marker index of 0.772 was obtained for FOXR2 gene expression levels., Conclusions: The findings indicated that the expression levels of FOXR2 have a significant association with ovarian cancer as far as it can be used as a dia-gnostic and therapeutic molecular bio-marker in ovarian cancer.

Background: The incidence of arterial injury associated with femoral fractures is approximately 1%. Lateral sub-muscular plate fixation is gaining popularity for the management of distal femoral fractures. The objective of this study was to assess the iatrogenic risk to the superficial femoral artery (SFA) during Less Invasive Stabilisation System (LISS) plate fixation of distal femoral fractures by analysing the range of distances and angles between LISS plate screws and the drilling line to the SFA., Materials and Methods: We identified all patients who underwent LISS plate fixation of distal femoral fractures between 2008 and 2018 in our level-1 trauma centre. Patients who underwent postoperative computed tomography for any reason were eligible for inclusion in the study. Twenty-five patients met the inclusion criteria. The sample comprised 10 male and 15 female patients with a mean age of 55 years. The most common fracture type was a supracondylar femur fracture (56%), followed by an intercondylar fracture (36%). A 13-hole LISS plate was the most common plate length used (44%). A consultant radiologist reviewed all scans to verify the visibility and marking of the SFA., Results: The median distance between the screw tip and the SFA was 21 mm (range, 8-65 mm). There was a negative correlation between the LISS plate hole number and the trajectory of drilling (Pearson coefficient: -0.87, p < 0.001). Using a linear regression model, the SFA was more likely to be in the line of drilling when the 6th to 10th holes in the LISS plate were used., Conclusion: Extra care is needed when drilling into the LISS plate holes from the lateral to the medial direction in order to reduce the risk of iatrogenic injury to the SFA, especially in the high-risk plate zone where the artery can be close to the drilling line., Competing Interests: Declaration of Competing Interest We, authors of the manuscript “Identification of the lateral femoral safe zone for drilling during LISS plate fixation of distal femur fractures” submitted to Injury Journal have no conflicts of interests or intent of financial gain regarding this research., (Copyright © 2019 Elsevier Ltd. All rights reserved.)