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Induction of remission in biologic-experienced individuals with moderate to severe Crohn’s disease (CD) can be a challenge. We hereby present a case of CD with secondary non-response to infliximab. Adding methotrexate and switching to ustekinumab plus methotrexate did not stop the inflammatory process. Therefore, combination therapy with two classes of biologics consisting of ustekinumab and adalimumab plus methotrexate was initiated. He achieved clinical remission in 4 weeks and remained on triple therapy for 6 months which was subsequently tailored to adalimumab/methotrexate combination therapy due to insurance restriction on ustekinumab. He remained in remission for the duration of follow-up, 14 months after initiation of triple therapy and 8 months after switching to methotrexate/adalimumab biologic monotherapy. Triple therapy with anti-TNF, IL-12/23 inhibitor and methotrexate could potentially be an option for induction of remission in biologic-experienced individuals with good initial clinical response to anti-TNF agents.

Examples of Fe complexes with long-lived (≥1 ns) charge-transfer states are limited to pseudo-octahedral geometries with strong -donor chelates. Alternative strategies based on varying both coordination motifs and ligand donicity are highly desirable. Reported herein is an air-stable, tetragonal FeII complex, Fe(HMTI)(CN)2 (HMTI = 5,5,7,12,12,14-hexamethyl-1,4,8,11-tetraazacyclotetradeca-1,3,8,10-tetraene) with a 1.25 ns metal-to-ligand charge transfer (MLCT) lifetime. The structure has been determined, and the photophysical properties examined in a variety of solvents. The HMTI ligand is highly pi-acidic due to low lying pi*(C=N), which enhances DeltaFe via stabilizing t2g orbitals. The inflexible geometry of the macrocy-cle results in short Fe-N bonds, and density functional theory calculations show that this rigidity results in an unusual set of nested potential energy surfaces. Moreover, the lifetime and energy of the MLCT state depends strongly on the solvent environment. This dependence is caused by modulation of the axial ligand-field strength by Lewis acid-base interactions between the solvent and the cyano ligands. This work represents the first example of a long-lived charge transfer state in an Fe(II) macrocyclic species.

To determine preferences of clinicians and surgeons regarding radiology reporting of liver observations in patients at risk for hepatocellular carcinoma (HCC). Members of the American College of Radiology Liver Imaging and Data Reporting System (LI-RADS) Outreach & Education Group (30 members) as well as Society of Abdominal Radiology Disease-Focused Panel on HCC diagnosis (27 members) created and distributed an 18-question survey to clinicians and surgeons, with focus on preferences regarding radiology reporting of liver observations in patients. The survey questions were directed to physician demographics, current use of LI-RADS by their local radiologists, their opinions about current LI-RADS and potential improvements. A total of 152 physicians responded, 66.4% (101/152) from North America, including 42 surgeons, 81 physicians and 29 interventional radiologists. Participants were predominantly from academic centers 83% (126/152), while 13.8% (21/152) worked in private/community centers and 3.2% (5/152) worked in a hybrid practice. Almost 90% (136/152) of participants preferred the use of LI-RADS (compared to nothing or other standardized reporting systems; OPTN and AASLD) to communicate liver-related observations. However, only 28.5% (43/152) of participants input was sought at the time of implementing LI-RADS in their institutions. Fifty-eight percent (88/152) of all participants found standardized LI-RADS management recommendations in radiology reports to be clinically helpful. However, a subgroup analysis of surgeons in academic centers showed that 61.8% (21/34) prefer not to receive standardized LI-RADS recommendations. Most participants preferred the use LI-RADS in reporting CT and MRI examination. When considering inclusion of management recommendations, radiologists should consult with their referring physicians, as preference may differ.

Fe(II) coordination complexes are promising alternatives to Ru(II) and Ir(III) chromophores for photoredox chemistry and solar energy conversion, but rapid deactivation of the initial metal-to-ligand charge transfer (MLCT) state to low-lying (d,d) states limits their performance. Relaxation to a long-lived quintet state is postulated to occur via a metal-centered triplet state, but this mechanism remains controversial. We use femtosecond extreme ultraviolet (XUV) transient absorption spectroscopy to measure the excited-state relaxation of Fe(phen)32+ and conclusively identify a 3T intermediate that forms in 170 fs and decays to a vibrationally hot 5T2g state in 39 fs. A coherent vibrational wavepacket with a period of 249 fs and damping time of 0.63 ps is observed on the 5T2g surface, and the spectrum of this oscillation serves as a fingerprint for the Fe–N symmetric stretch. The results show that the shape of the M2,3-edge X-ray absorption near-edge structure (XANES) spectrum is sensitive to the electron...

Incorporation of new treatment modalities has significantly increased the complexity of the treatment and management of rectal cancer, including perioperative therapy for local advanced disease and organ preservation for those with response to the preoperative treatment. This review may help practitioners better understand the rationale and selection.

To quantify how often the LI-RADS v2018 category changed when utilizing major features only, when utilizing major and ancillary features, and when utilizing major and ancillary features excluding gadoxetate-specific ancillary features. Retrospective analysis of 100 patients age 18 and older at high risk for hepatocellular carcinoma who had an MRI abdomen performed with intravenous contrast gadoxetate between 1/1/2017 and 3/23/2018. Each examination was reviewed by a body fellowship-trained radiologist. LI-RADS category was assigned to the liver observation after review of major features only. Ancillary features were then reviewed and LI-RADS category assigned both including and excluding ancillary features specific to gadoxetate. Utilizing all MRI ancillary features, including those specific to gadoxetate, changed the final LI-RADS category in 56.4% of liver observations, the majority an increase or decrease from LR-3. When not including the ancillary features specific to gadoxetate, the final LI-RADS category changed in 30.9% of observations, the majority increasing from LR-3 to LR-4. Utilizing LI-RADS v2018 ancillary features can significantly alter the final LI-RADS category, especially when using gadoxetate-specific ancillary features. Understanding the correct application of ancillary features for the final LI-RADS category helps implement a more consistent category assessment amongst users.

The goal of this study was to determine the best method for localizing peripherally inserted central catheters (PICCs) in postplacement portable chest radiographs. A retrospective analysis showed no significant difference in visualization of the PICC tip between different chest radiograph projections. Modifications were made to an institutional PICC protocol to obtain anteroposterior chest views with the guidewire present only. Repeat analysis demonstrated statistically significant increases in the frequency of anteroposterior radiographs performed, the number of chest radiographs with guidewire, and the localization of the catheter. By standardizing the acquisition of PICC placement chest radiographs, fewer variant projection radiographs were performed and the catheter tip was confidently localized in more examinations.

Our purpose in this study was to compare delivered radiation exposure via computed tomography dose index volume (CTDIvol) and dose length production (DLP) measurements from computed tomography (CT) examinations performed on scanners with and without image-quality enhancing iterative reconstruction (IR) software. A retrospective analysis was conducted on randomly selected chest, abdomen, and/or pelvis CT examinations from three different scanners from 1 January 2013 to 31 December 2013. CTDIvol and DLP measurements were obtained from two CT scanners with and one CT scanner without IR software. To evaluate inter-scanner variability, we compared measurements from the same model CT scanners, one with and one without IR software. To evaluate intra-scanner variability, we compared measurements between two scanners with IR software from different manufacturers. CT scanners with IR software aided in the overall reduction in radiation exposure, measured as CTDIvol by 30% and DLP by 39% when compared to a scanner without IR. There was no significant difference in CTDlvol or DLP measurements across different manufacturers with IR software. As a result, IR software significantly decreased the radiation exposure to patients, but there were no differences in radiation measurements across CT manufacturers with IR software.

Cobalt complexes that undergo charge-transfer induced spin-transitions (CTIST) or valence tautomerism (VT) from low spin (LS) Co(III) to high spin (HS) Co(II) are potential candidates for magneto-optical switches. We use M-edge XANES spectroscopy with 40 fs time resolution to measure the excited-state dynamics of Co(III)(Cat-N-SQ)(Cat-N-BQ), where Cat-N-BQ and Cat-N-SQ are the singly and doubly reduced forms of the 2-(2-hydroxy-3,5-di-tert-butylphenyl-imino)-4,6-di-tert-butylcyclohexa-3,5-dienone ligand. The extreme ultraviolet probe pulses, produced using a tabletop high-harmonic generation light source, measure 3p3d transitions and are sensitive to the spin and oxidation state of the Co center. Photoexcitation at 525 nm produces a low-spin Co(II) ligand-to-metal charge transfer state which undergoes intersystem crossing to high-spin Co(II) in 67 fs. Vibrational cooling from this hot HS Co(II) state competes on the hundreds-of-fs timescale with back-intersystem crossing to the ground state, with 60% of the population trapped in a cold HS Co(II) state for 24 ps. Ligand field multiplet simulations accurately reproduce the ground-state spectra and support the excited-state assignments. This work demonstrates the ability of M-edge XANES to measure ultrafast photophysics of molecular Co complexes.

Cobalt complexes that undergo charge-transfer induced spin-transitions (CTIST) or valence tautomerism (VT) from low spin (LS) Co(III) to high spin (HS) Co(II) are potential candidates for magneto-optical switches. We use M-edge XANES spectroscopy with 40 fs time resolution to measure the excited-state dynamics of Co(III)(Cat-N-SQ)(Cat-N-BQ), where Cat-N-BQ and Cat-N-SQ are the singly and doubly reduced forms of the 2-(2-hydroxy-3,5-di-tert-butylphenyl-imino)-4,6-di-tert-butylcyclohexa-3,5-dienone ligand. The extreme ultraviolet probe pulses, produced using a tabletop high-harmonic generation light source, measure 3p3d transitions and are sensitive to the spin and oxidation state of the Co center. Photoexcitation at 525 nm produces a low-spin Co(II) ligand-to-metal charge transfer state which undergoes intersystem crossing to high-spin Co(II) in 67 fs. Vibrational cooling from this hot HS Co(II) state competes on the hundreds-of-fs timescale with back-intersystem crossing to the ground state, with 60% of the population trapped in a cold HS Co(II) state for 24 ps. Ligand field multiplet simulations accurately reproduce the ground-state spectra and support the excited-state assignments. This work demonstrates the ability of M-edge XANES to measure ultrafast photophysics of molecular Co complexes.

Fe(II) coordination complexes are promising alternatives to Ru(II) and Ir(III) chromophores for photoredox chemistry and solar energy conversion, but rapid deactivation of the initial metal-to-ligand charge transfer (MLCT) state to low-lying (d,d) states limits their performance. Relaxation to a 5T2g state is postulated to occur via a metal-centered triplet state, but this mechanism remains controversial. We use femtosecond extreme ultraviolet (XUV) transient absorption spectroscopy to measure the excited-state relaxation of Fe(phen)32+ and conclusively identify a 3T intermediate that forms in 170 fs and decays to a vibrationally hot 5T2g state in 40 fs. A coherent vibrational wavepacket with a period of 250 fs and damping time of 0.66 ps is observed on the 5T2g surface, and the spectrum of this oscillation serves as a fingerprint for the Fe-N symmetric stretch. The results show that the shape of the M2,3-edge X-ray absorption near edge structure (XANES) spectrum is sensitive to the electronic structure of the metal center, and the high spin sensitivity, fast time resolution, and tabletop convenience of XUV transient absorption make it a powerful tool for studying the complex photophysics of transition metal complexes.

© 2018, Springer Science+Business Media, LLC, part of Springer Nature. The Liver Imaging and Reporting Data System (LI-RADS) is a comprehensive system for standardizing the terminology, technique, interpretation, reporting, and data collection of liver imaging with the overarching goal of improving communication, clinical care, education, and research relating to patients at risk for or diagnosed with hepatocellular carcinoma (HCC). In 2018, the American Association for the Study of Liver Diseases (AASLD) integrated LI-RADS into its clinical practice guidance for the imaging-based diagnosis of HCC. The harmonization between the AASLD and LI-RADS diagnostic imaging criteria required minor modifications to the recently released LI-RADS v2017 guidelines, necessitating a LI-RADS v2018 update. This article provides an overview of the key changes included in LI-RADS v2018 as well as a look at the LI-RADS v2018 diagnostic algorithm and criteria, technical recommendations, and management suggestions. Substantive changes in LI-RADS v2018 are the removal of the requirement for visibility on antecedent surveillance ultrasound for LI-RADS 5 (LR-5) categorization of 10-19 mm observations with nonrim arterial phase hyper-enhancement and nonperipheral “washout”, and adoption of the Organ Procurement and Transplantation Network definition of threshold growth (≥ 50% size increase of a mass in ≤ 6 months). Nomenclatural changes in LI-RADS v2018 are the removal of -us and -g as LR-5 qualifiers.

Prior studies have shown that dose-escalated radiation therapy for prostate cancer improves clinical outcomes. However, this is associated with increased rectal toxicity. Hydrogel spacer for prostate cancer therapy is an effective way of decreasing rectal toxicity in the late post-therapeutic stages. In some occasions, the gel spacer may not be placed symmetrically between the rectum and prostate. There are several forms of a malpositioned spacer, including lateral displacement, rectal wall infiltration, and prostate capsule infiltration. This manuscript is aimed at evaluating appropriately positioned and malpositioned gel spacers, primarily via magnetic resonance imaging. There are limited educational imaging guides that address what radiologists should evaluate on post-spacer placement imaging. This pictorial review will specifically evaluate post-injection pitfalls such as asymmetry, rectal wall infiltration, and subcapsular injection.

A uterine artery pseudoaneurysm in a pregnancy is a potentially life-threatening condition. A haemorrhage from a uterine artery pseudoaneurysm complicating a pregnancy is described in this review. ...

Medical training institutions utilize a variety of approaches to present specialty educational material such as radiology. Typically, this material is introduced during the latter years of medical school and includes interactive modules, individual contexts, and case-based learning. This is a quasi-experimental study designed to evaluate the effectiveness of case-based radiology education presented to first-year medical students. Pre- and post-surveys were administered to measure changes in knowledge, perceptions of, and career interest in radiology. The results suggest that the use of case-based learning may improve medical students’ perceived knowledge of radiology and perceived importance of radiologists in the patient care process.

BackgroundPatients with decompensated hepatitis C virus (HCV) cirrhosis experience various outcomes after sustained virological response (SVR), ranging from clinical recovery to further deterioration. We hypothesised that the genetic risk for steatosis, namely the polymorphisms rs738409 of Patatin-like Phospholipase Domain-Containing 3 (PNPLA3), rs58542926 of Transmembrane-6-Superfamily-2 (TM6SF2), and rs641738 of Membrane-bound O-acyltransferase Domain-Containing 7 (MBOAT7), is predictive of recovery.MethodsWe prospectively enrolled 56 patients with Child-Pugh (CPT) B/C cirrhosis who underwent antiviral therapy. The primary outcome was change in CPT score at 12, 24, and 48 weeks after SVR. We used a linear mixed-effects model for analysis.ResultsForty-five patients (PNPLA3: 21 CC, 19 CG, 5 GG) survived to the first endpoint without liver transplantation. The mean change in CPT score at 12, 24, and 48 weeks was −1.57 (SE=0.30), –1.76 (SE=0.32), and −2.0 (SE=0.36), respectively, among the patients with thePNPLA3CC genotype and −0.50 (SE=0.20), –0.41 (SE=0.25), and −0.24 (SE=0.27), respectively, among the other 24 patients. After adjustment for baseline characteristics, thePNPLA3CG/GG genotypes were associated with a 1.29 (SE=0.30, pConclusionThePNPLA3CG/GG genotypes could identify a subgroup of patients with decompensated HCV cirrhosis that had suboptimal clinical recovery despite SVR. An understanding of the genetic factors that influence clinical outcomes will help target patients for liver transplant based on individual genetic risk factors and provide insight leading to new therapeutic approaches.