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Traditionally, the performance of firms is evaluated based on financial criteria; however, the present study aims to propose a new qualitative comprehensive framework that incorporates ethical criteria into the portfolio models and is widely matched with the preferences of socially responsible investors. The increasing trend of corporate deceptions has made investors or fund managers consider the ethical assessments in their investment management. Therefore, it is essential to develop models capable of capturing the ethical and financial criteria in investment processes. In this study, a multi-stage methodology was proposed and linguistic Z-numbers were applied to represent the evaluation information. In addition, Muirhead Mean (MM) aggregation operators were employed to fuse the input data into the linguistic Z-number environment. To accomplish the objectives of this study, first, four linguistic Z-number MM operators were developed. Then, through the max-score rule and score-accuracy trade-off rule, three qualitative portfolio models were proposed. These models were established to maximize the financial performance of portfolio as their main objective, and they were distinguished by the ethical goal the investor follows. The obtained results of numerical example validated the capability of the models in constructing more diversified portfolio based on a trade-off between financial and ethical criteria according to the investors' preferences. [ABSTRACT FROM AUTHOR]

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Obviously, improving the road safety and the efficient allocation of limited resources to the provinces according to their ranking should be done. This paper presents a hybrid method of multivariate statistical analysis-decision making to evaluate Iran road traffic safety. In order to solve the problems of road traffic safety, a macroscopic evaluation and traffic safety level classification in Iran was carried out. An index system which consists of 14 relative indexes for road traffic safety evaluation was established. The principal component analysis method was used to reduce the dimensions of the multi-index data. Based on this, 2 components were extracted. The Index of Road Traffic Safety (IRTS) was calculated to rank the provinces of the country. A K-means method was applied to classify the provinces. A TOPSIS technique was used to examine the status of each cluster in terms of safety levels. Results showed that there are 4 safety levels entitled good, average, weak and very weak. The levels are approximately similar to result of the rankings. [ABSTRACT FROM AUTHOR]

Purpose: Tumor-infiltrating lymphocytes (TILs) have prognostic significance in several cancers, including breast cancer. Despite interest in combining radiation therapy with immunotherapy, little is known about the effect of radiation therapy itself on the tumor-immune microenvironment, including TILs. Here, we interrogated longitudinal dynamics of TILs and systemic lymphocytes in patient samples taken before, during, and after neoadjuvant radiation therapy (NART) from PRADA and Neo-RT breast clinical trials., Methods and Materials: We manually scored stromal TILs (sTILs) from longitudinal tumor samples using standardized guidelines as well as deep learning-based scores at cell-level (cTIL) and cell- and tissue-level combination analyses (SuperTIL). In parallel, we interrogated absolute lymphocyte counts from routine blood tests at corresponding time points during treatment. Exploratory analyses studied the relationship between TILs and pathologic complete response (pCR) and long-term outcomes., Results: Patients receiving NART experienced a significant and uniform decrease in sTILs that did not recover at the time of surgery (P < .0001). This lymphodepletive effect was also mirrored in peripheral blood. Our SuperTIL deep learning score showed good concordance with manual sTILs and importantly performed comparably to manual scores in predicting pCR from diagnostic biopsies. The analysis suggested an association between baseline sTILs and pCR, as well as sTILs at surgery and relapse, in patients receiving NART., Conclusions: This study provides novel insights into TIL dynamics in the context of NART in breast cancer and demonstrates the potential for artificial intelligence to assist routine pathology. We have identified trends that warrant further interrogation and have a bearing on future radioimmunotherapy trials., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Maxillary morphology has long been a subject of interest due to its possible impact on palatally and labially displaced canines. This study aims to conduct a comparison of the palate morphology between individuals with palatal and labially displaced canines and control subjects using statistical shape analysis on a coronal cross-sectional of CBCT images., Materials and Methods: Patients aged between 12 and 43 years with palatally or labially displaced canines referred to Hamadan School of Dentistry between 2014 and 2019 were recruited for this retrospective study. The sample included 29 palatally displaced canines (PDC), 20 labially displaced canines (LDC), and 20 control groups (CG). Initially, the maxillary palate coronal section was acquired and landmarked in the region between the right and the left first molar. Procrustes and principal component analyses were used to identify the primary patterns of palatal shape variation. Statistical tests were then performed to examine both shape and size differences., Results: According to the results of Hotelling's T2 test, there is a significant difference between the mean shape of palate in PDC and CG (P = 0.009), while the difference between the PDC-LDC and LDC-CG groups is not significant. The longest full Procrustes distance was observed between PDC and CG (distance = 0.043), and the shortest full Procrustes distance was observed between LDC and CG (distance = 0.029). The first two principal components accounted for 84.47% of the total variance. The predictive accuracy of the discriminant analysis model showed that 72.46% of cases were correctly classified into the three study groups., Conclusions: In terms of centroid size, there was no significant difference in the sectional area between the three groups, but the difference between the mean shape of palate in the PDC and CG groups was significant. The PDC group showed more prominent mid-palatal area in the molar region., (© 2023. The Author(s).)

When there is an extensive number of inputs and outputs compared to the number of DMUs, one of the drawbacks of Data Envelopment Analysis appears, which incorrectly classifies inefficient DMUs, as efficient ones. Accordingly, the DEA ranking power becomes further moderated. To improve the ranking power, this paper renders the details of an algorithm that presents a model combining the Principal Component Analysis and the Slacks-Based Measure (PCA-SBM) which reduces the number of the incorrectly determined efficient DMUs. Also to complete ranking of DMUs, the algorithm presents a Super-Efficiency model integrated with PCA (PCA-Super SBM) which can rank the efficient DMUs (extreme and non-extreme). Whereas the most important previous models for ranking efficient units cannot rank non-extreme ones. Additionally, in most previous studies, DEA models combined with PCA fail to handle negative data, while, the presented models can cover this data. Two case studies (pharmaceutical companies listed on the Iranian stock market and bank branches) are manipulated to demonstrate the applicability and performance of the algorithm. To show the superiority of the presented models, the SBM model without PCA and the Super SBM model without PCA have been implemented on the data of both cases. In comparing the two methods (PCA-SBM and SBM), the PCA-SBM model has higher ranking power (five efficient DMUs versus nineteen in the case of pharmaceutical companies and four efficient DMUs versus twenty-nine in the case of bank branches). Also in comparing the PCA-Super SBM and Super SBM, the PCA-Super SBM model works more powerfully in complete ranking. As the Super SBM model cannot rank non-extreme units unlike the PCA-Super SBM. Consequently, the presented algorithm works successfully in ranking the DMUs completely (inefficient, extreme, and non-extreme efficient) with low complexity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Yazdi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Efficient biomarker discovery and clinical translation depend on the fast and accurate analytical output from crucial technologies such as multiplex imaging. However, reliable cell classification often requires extensive annotations. Label-efficient strategies are urgently needed to reveal diverse cell distribution and spatial interactions in large-scale multiplex datasets., Methods: This study proposed Self-supervised Learning for Antigen Detection (SANDI) for accurate cell phenotyping while mitigating the annotation burden. The model first learns intrinsic pairwise similarities in unlabelled cell images, followed by a classification step to map learnt features to cell labels using a small set of annotated references. We acquired four multiplex immunohistochemistry datasets and one imaging mass cytometry dataset, comprising 2825 to 15,258 single-cell images to train and test the model., Findings: With 1% annotations (18-114 cells), SANDI achieved weighted F1-scores ranging from 0.82 to 0.98 across the five datasets, which was comparable to the fully supervised classifier trained on 1828-11,459 annotated cells (-0.002 to -0.053 of averaged weighted F1-score, Wilcoxon rank-sum test, P = 0.31). Leveraging the immune checkpoint markers stained in ovarian cancer slides, SANDI-based cell identification reveals spatial expulsion between PD1-expressing T helper cells and T regulatory cells, suggesting an interplay between PD1 expression and T regulatory cell-mediated immunosuppression., Interpretation: By striking a fine balance between minimal expert guidance and the power of deep learning to learn similarity within abundant data, SANDI presents new opportunities for efficient, large-scale learning for histology multiplex imaging data., Funding: This study was funded by the Royal Marsden/ICR National Institute of Health Research Biomedical Research Centre., Competing Interests: Declaration of interests The authors declare the following competing financial interests: a patent has been filed for the methodology reported in the paper (applicant, the Institute of Cancer Research; inventors, H.Z and Y.Y; application number, UK patent GB 2106397.9 and PCT/EP2022/061941). Other authors have no conflict of interest to disclose., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Hypoxia promotes aggressive tumor phenotypes and mediates the recruitment of suppressive T cells in invasive breast carcinomas. We investigated the role of hypoxia in relation to T-cell regulation in ductal carcinoma in situ (DCIS). We designed a deep learning system tailored for the tissue architecture complexity of DCIS, and compared pure DCIS cases with the synchronous DCIS and invasive components within invasive ductal carcinoma cases. Single-cell classification was applied in tandem with a new method for DCIS ductal segmentation in dual-stained CA9 and FOXP3, whole-tumor section digital pathology images. Pure DCIS typically has an intermediate level of colocalization of FOXP3+ and CA9+ cells, but in invasive carcinoma cases, the FOXP3+ (T-regulatory) cells may have relocated from the DCIS and into the invasive parts of the tumor, leading to high levels of colocalization in the invasive parts but low levels in the synchronous DCIS component. This may be due to invasive, hypoxic tumors evolving to recruit T-regulatory cells in order to evade immune predation. Our data support the notion that hypoxia promotes immune tolerance through recruitment of T-regulatory cells, and furthermore indicate a spatial pattern of relocalization of T-regulatory cells from DCIS to hypoxic tumor cells. Spatial colocalization of hypoxic and T-regulatory cells may be a key event and useful marker of DCIS progression., (© 2022. The Author(s).)

Purpose: Sex determination can be done by morphological analysis of different parts of the body. The mastoid region, with its anatomical location at the skull base, is ideal for sex identification. Statistical shape analysis provides a simultaneous comparison of geometric information on different shapes in terms of size and shape features. This study aimed to investigate the geometric morphometry of the inter-mastoid triangle as a tool for sex determination in the Iranian population., Materials and Methods: The coordinates of 5 landmarks on the mastoid process on the 80 cone-beam computed tomographic images (from individuals aged 17-70 years, 52.5% female) were registered and digitalized. The Cartesian x-y coordinates were acquired for all landmarks, and the shape information was extracted from the principal component scores of generalized Procrustes fit. The t-test was used to compare centroid size. Cross-validated discriminant analysis was used for sex determination. The significance level for all tests was set at 0.05., Results: There was a significant difference in the mastoid size and shape between males and females ( P <0.05). The first 2 components of the Procrustes shape coordinates explained 91.3% of the shape variation between the sexes. The accuracy of the discriminant model for sex determination was 88.8%., Conclusion: The application of morphometric geometric techniques will significantly impact forensic studies by providing a comprehensive analysis of differences in biological forms. The results demonstrated that statistical shape analysis can be used as a powerful tool for sex determination based on a morphometric analysis of the inter-mastoid triangle., Competing Interests: Conflicts of Interest: None, (Copyright © 2021 by Korean Academy of Oral and Maxillofacial Radiology.)

Objectives: While telestroke 'hub-and-spoke' systems are a well-established model for improving acute stroke care at spoke facilities, utility beyond the hyperacute phase is unknown. In patients receiving intravenous thrombolysis via telemedicine, care at spoke facilities has been shown to be associated with longer length of stay and worse outcomes. We sought to explore the impact of ongoing stroke care by a vascular neurologist via telemedicine compared to care provided by local neurologists., Methods: A network spoke facility protocol was revised to pilot telestroke consultation with a hub vascular neurologist for all patients presenting to the emergency department with ischemic stroke or transient ischemic attack regardless of time since onset or severity. Subsequent telestroke rounds were performed for patients who received initial telestroke consultation. Key outcome measures were length of stay, 30-day readmission and mortality and 90-day mRS. Results during the pilot (post-cohort) were compared to the same hospital's previous outcomes (pre-cohort)., Results: Of 257 enrolled patients, 67% were in the post-cohort. Forty percent (69) of the post-cohort received an initial telestroke consult. In spoke-retained patients followed by telestroke rounds (55), median length of stay decreased by 0.8 days (P = 0.01). Readmission and mortality rates did not differ significantly between groups (19.5 vs. 9.1%, P = 0.14 and 3.9 vs. 3.6%, P = 1, respectively). The favorable functional outcome rate was similar between groups (47.3% vs 65.9%, P = 0.50)., Conclusions: Longitudinal stroke care via telestroke may be economically viable through length of stay reduction. Randomized prospective studies are needed to confirm our findings and further investigate this model's potential benefits., 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. The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Jovin reports other from Anaconda, Route92, VizAi, Cerenovus, FreeOx, Stryker Neurovascular, Corindus, Methinks, and Contego Medical outside the submitted work. The other authors report no competing interest ., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The field of immuno-oncology has expanded rapidly over the past decade, but key questions remain. How does tumour-immune interaction regulate disease progression? How can we prospectively identify patients who will benefit from immunotherapy? Identifying measurable features of the tumour immune-microenvironment which have prognostic or predictive value will be key to making meaningful gains in these areas. Recent developments in deep learning enable big-data analysis of pathological samples. Digital approaches allow data to be acquired, integrated and analysed far beyond what is possible with conventional techniques, and to do so efficiently and at scale. This has the potential to reshape what can be achieved in terms of volume, precision and reliability of output, enabling data for large cohorts to be summarised and compared. This review examines applications of artificial intelligence (AI) to important questions in immuno-oncology (IO). We discuss general considerations that need to be taken into account before AI can be applied in any clinical setting. We describe AI methods that have been applied to the field of IO to date and present several examples of their use., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

The control charts with the Principal Component Analysis (PCA) approach and its extension are among the data-driven methods for process monitoring and the detection of faults. Industrial processing data involves complexities such as high dimensionality, auto-correlation, and non-stationary which may occur simultaneously. An efficient fault detection technique is an approach that is robust against data training, sensitive to all the feasible faults of the process, and agile to the detection of the faults. To date, approaches such as the recursive PCA (RPCA) model and the moving-window PCA (MWPCA) model have been proposed when data is high-dimensional and non-stationary or dynamic PCA (DPCA) model and its extension have been suggested for autocorrelation data. But, using the techniques listed without considering all aspects of the process data increases fault detection indicators such as false alarm rate (FAR), delay time detection (DTD), and confuses the operator or causes adverse consequences. A new PCA monitoring method is proposed in this study, which can simultaneously reduce the impact of high-dimensionality, non-stationary, and autocorrelation properties. This technique utilizes DPCA property to decrease the effect of autocorrelation and adaptive behavior of MWPCA to control non-stationary characteristics. The proposed approach has been tested on the Tennessee Eastman Process (TEP). The findings suggest that the proposed approach is capable of detecting various forms of faults and comparing attempts to improve the detection of fault indicators with other approaches. The empirical application of the proposed approach has been implemented on a turbine exit temperature (TET). The results demonstrate that the proposed approach has detected a real fault successfully., Competing Interests: The authors have declared that no competing interests exist.

Introduction: People living in many parts of the world have limited access to diagnostic studies and therapies for rheumatologic, musculoskeletal, and connective tissue diseases. The challenge has been particularly poignant for rural areas of low- and middle-income countries. Objectives: We report on the implementation of a telemedicine program in Iran for the evaluation and treatment of patients with rheumatologic and musculoskeletal diseases. More than 4,800 patients were seen remotely over a span of 5 years by a rheumatologist in the United States. The remote rheumatologist was aided by a general physician and a nurse at a local charity hospital in northeastern Iran that has a catchment area that includes rural regions extending to the border of Afghanistan. Seventy to 90 patients were evaluated online by the remote rheumatologist 3 days a week. A subset of patients was evaluated by the rheumatologist in person every 4 months. Materials and Methods: The population of rheumatology patients was evaluated using descriptive statistics. Information collected included demographic information consisting of age, gender, and primary rheumatologic diagnosis. Results: The average age of patients who were seen was 52 years and 89% of patients were women. Approximately 50% of patients were Afghan refugees. The most common disorders included osteoarthritis (1,149, 23.6%), rheumatoid arthritis (653, 13.4%), axial spondyloarthropathies (647, 13.3%), lumbar spinal stenosis (427, 8.8%), meniscal tear of the knee (326, 6.7%), and psoriatic arthritis (217, 4.5%). Certain conditions were lower than expected such as lupus (19, 0.4%) and fibromyalgia (169, 3.5%). Diagnostic tests included serologic tests (1,328, 27.3%), plain radiographs (946, 19.5%), magnetic resonance imaging (899, 18.5%), bone densitometry (147, 3.0%), and electromyography and nerve conduction study (132, 2.7%). The most common medications prescribed were non-steroidal anti-inflammatory drugs (791, 16.3%), methotrexate (764, 15.7%), pregabalin (234, 4.8%), duloxetine (230, 4.7%), sulfasalazine (177, 3.6%), etanercept (97, 2.0%), tofacitinib (64, 1.3%), adalimumab (18, 0.4%), and infliximab (9, 0.2%). Conclusions: Telemedicine is becoming more prevalent. We report the successful use of this service in evaluation and management of rheumatic diseases in a region with limited access to rheumatologic care. We have shown that patients can be seen, evaluated, and successfully treated with a variety of medications, including biologic agents.

Z-numbers can generate a more flexible structure to model the real information because of capturing expert's reliability. Moreover, various semantics can flexibly be reflected by linguistic terms under various circumstances. Thus, this study aims to model the portfolio selection problems based on aggregation operators under linguistic Z-number environment. Therefore, a multi-stage methodology is proposed and linguistic Z-numbers are applied to describe the assessment information. Moreover, the weighted averaging (WA) aggregation operator, the ordered weighted averaging (OWA) aggregation operator and the hybrid weighted averaging (HWA) aggregation operator are developed to fuse the input arguments under the linguistic Z-number environment. Then, using the max-score rule and the score-accuracy trade-off rule, three qualitative portfolio models are presented to allocate the optimal assets. These models are suitable for general investors and risky investors. Finally, to illustrate the validity of the proposed qualitative approach, a real case including 20 corporations of Tehran stock exchange market in Iran is provided and the obtained results are analyzed. The results show that combining linguistic Z-numbers with portfolio selection processes can increase the tendencies and capabilities of investors in the capital market and it helps them manage their portfolios efficiently., Competing Interests: The authors have declared that no competing interests exist.

Background: This study aimed to investigate the sufficient (≥ 16) lymph node assessment in 449 patients with gastric adenocarcinoma and literature review., Methods: Four hundred and forty-nine patients with pathologically confirmed locoregional invasive gastric adenocarcinoma from 2004 to 2013 were included. A standard surgical resection was performed for all the patients with (n = 16) or without (n = 433) neoadjuvant treatment., Results: In this study, 301 men and 148 women with a median age of 58 (range 21-88) years were included. The median total numbers of examined lymph nodes were 9 (range 0-55). Ninety-five patients (21.2%) had adequate (≥ 16) lymph node examination, and 70 patients (15.6%) had no examined lymph nodes. In univariate analysis, total or near total gastrectomy (P <  0.001), advanced node stage (P < 0.001), primary tumor size > 6 cm (P < 0.001), and the presence of perineural invasion (P = 0.039) were associated with more average number of examined lymph nodes. On multivariate analysis, node stage (P < 0.001) and type of surgery (P = 0.008) were independent predictive factors., Conclusion: In this study, approximately one in five patients with gastric adenocarcinoma had sufficient lymph node assessment. More studies are suggested for identifying a true inadequate lymph node dissection from insufficient lymph node assessment.

Immune checkpoint inhibitor (ICPI) therapy unleashes the body's natural immune system to fight cancer. ICPIs improve overall cancer survival, however, the unbridling of the immune system may induce a variety of immune-related adverse events. Neuromuscular immune complications are rare but they can be severe. Myasthenia gravis and inflammatory neuropathy are the most common neuromuscular adverse events but a variety of others including inflammatory myopathy are reported. The pathophysiologic mechanism of these autoimmune disorders may differ from that of non-ICPI-related immune diseases. Accordingly, while the optimal treatment for ICPI-related neuromuscular disorders generally follows a traditional paradigm, there are important novel considerations in selecting appropriate immunosuppressive therapy. This review presents 2 new cases, a summary of neuromuscular ICPI complications, and an approach to the diagnosis and treatment of these disorders. Muscle Nerve, 2018., (© 2018 Wiley Periodicals, Inc.)

Introduction: Numerous adverse effects of antidepressants as well as the attitudes of breastfeeding mothers, who prefer to consume herbal medicine rather than chemical drugs, encouraged us to assess the effects of saffron (Crocus sativus L.) on mothers suffering from mild-to-moderate postpartum depressive disorder., Methods: A double-blind, randomized, and placebo-controlled trial was conducted on 60 new mothers who had a maximum score of 29 on the Beck Depression Inventory-Second Edition (BDI-II). They were randomly assigned to the saffron (15 mg/Bid) or placebo group. The primary outcome was a change in the BDI-II scores 8 weeks after treatment compared to the baseline. The response and remission rates were considered to be secondary outcome measures., Results: Saffron had a more significant impact on the BDI-II scores than the placebo. The mean BDI-II scores decreased from 20.3 ± 5.7 to 8.4 ± 3.7 for the saffron group (p < .0001) and from 19.8 ± 3.2 to 15.1 ± 5.4 for the placebo group (p < .01). In the final assessment, 96% of the saffron group were in remission compared to 43% of the placebo group (p < .01). The complete response rates were 6% for the placebo group and 66% for the saffron group., Conclusion: When administered to treat minor PPD in breastfeeding mothers, saffron had a more significant impact on the BDI-II than the placebo., (Copyright © 2017 Elsevier GmbH. All rights reserved.)

Objective: To evaluate the value of anatomic and volumetric functional magnetic resonance imaging (MRI) in early assessment of response to trans-arterial chemoembolization (TACE) in hypovascular liver metastases., Methods: This retrospective study included 52 metastatic lesions (42 targeted and 10 non-targeted) in 17 patients who underwent MRI before and early after TACE. Two reviewers reported response by anatomic criteria (Response Evaluation Criteria in Solid Tumor [RECIST], modified RECIST [mRECIST], and European Association for the Study of Liver Disease [EASL]) and functional criteria (volumetric apparent diffusion coefficient and contrast enhancement). Treatment endpoint was RECIST at 6 months. A 2-sample paired t test was used to compare the mean changes after intra-arterial therapy. P < .05 was considered statistically significant., Results: Reduction in mRECIST and EASL at 1 month was significant in the whole cohort as well as in responders by RECIST at 6 months, and the changes fulfilled partial response criteria for both metrics in responders. Responders also had significant changes in volumetric apparent diffusion coefficient (P = .01 and P = .03) and contrast enhancement (P < .0001 and P < .0001) at 1 month for both readers, respectively., Conclusion: At 1 month post treatment, responders did not fulfill RECIST criteria but fulfilled mRECIST and EASL criteria. In addition, volumetric contrast-enhanced and diffusion-weighted MRI may be helpful in evaluating early treatment response after TACE in hypovascular liver metastases in patients who have failed to respond to initial chemotherapy., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the value of quantitative volumetric functional MR imaging in early assessment of response to yttrium-90-labeled ((90)Y) transarterial radioembolization (TARE) in patients with hypo-vascular liver metastases., Materials and Methods: Seventy four metastatic lesions in 14 patients with hypo-vascular liver metastases after TARE were included in this retrospective study. Diffusion and contrast-enhanced MR imaging was performed before and early after treatment. All MR images were analyzed by two experienced radiologists. Response by anatomic metrics (RECIST, mRECIST, EASL) and functional metrics (ADC and arterial and venous enhancement) were reported in targeted and non-targeted lesions. A two-sample paired t test was used to compare the changes after TARE. A p value of <0.05 was considered statistically significant., Results: The anatomic metrics did not show any significant changes in both targeted and non-targeted groups. Targeted lesions demonstrated an increase in mean volumetric ADC (23.4%; p = 0.01), a decrease in arterial and venous enhancement (-22.9% and -6.7%, respectively; p < 0.001 and p = 0.002, respectively) 1 month after treatment. Twenty one responding lesions (42%) by RECIST at 6 months demonstrated a significant increase in volumetric ADC (37.2%; p = 0.01), decrease in arterial and venous enhancement (-58.5% and -23.9%, respectively; p < 0.001) at 1 month post-treatment. Responding lesions did not change significantly by anatomic metrics., Conclusions: RECIST, mRECIST, and EASL criteria failed to stratify lesions into responders and non-responders early after TARE in hypo-vascular liver metastasis. Quantitative volumetric functional MR imaging could be a promising tool as a biomarker for predicting early response and can potentially be utilized in clinical trials.

Background: Obese patients may present with metabolic abnormalities that impact liver regeneration. We sought to assess the impact of body mass index (BMI) on liver volume regeneration index (RI) and kinetic growth rate (KGR) among patients undergoing liver resection., Methods: The study included 102 patients undergoing major hepatectomy (≥3 segments) between July 2004 and April 2015 and stratified the patients by preoperative BMI, number of segments resected, and postoperative remnant liver volume (RLVp) to total liver volume ratio. Resected volume at operation was subtracted from total liver volume to calculate postoperative RLVp. RI was defined as the relative increase in RLV within 2 months [(RLV2m-RLVp)/RLVp] and 7 months [(RLV7m-RLVp)/RLVp] postoperatively; KGR was calculated as RI divided by time postoperatively (weeks)., Results: Median patient age was 59.6 years (interquartile range 48.1-68.7 years), and most patients were men (52.0%). Liver failure was associated with the KGR at 2 months (KGR2m) and was greater among patients with KGR2m <2.5% per week (KGR <2.5%, 18.5% vs KGR ≥ 2.5%, 4.6%; P = .04). Although RI and KGR within 2 and 7 months postoperatively were similar among all patients, after excluding patients with fibrosis, obese (0.42% per week) and overweight patients (0.29% per week) had lesser KGR2-7m compared with patients of normal BMI (0.82% per week; P < .05). Additionally, risk of a major complication was greatest among obese patients (normal weight, 8.1% vs overweight, 12.9% vs obese, 29.4%; P = .04)., Conclusion: BMI did not impact liver regeneration during the first 2 months. In contrast, KGR per week between 2 and 7 months postoperatively was less among overweight and obese patients., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Introduction: The impact of phosphorus as well as glycemic alterations on liver regeneration has not been directly examined. We sought to determine the impact of phosphorus and glucose on liver regeneration after major hepatectomy., Methods: Early and late liver regeneration index was defined as the relative increase of liver volume (RLV) within 2[(RLV2m-RLVp)/RLVp] and 7 months[(RLV7m-RLVp)/RLVp] following surgery. The association of perioperative metabolic factors, liver regeneration, and outcomes was assessed., Results: On postoperative day 2, 50 (52.6 %) patients had a low phosphorus level (≤2.4 mg/dl), while 45 (47.4 %) had a normal/high phosphorus level (>2.4 mg/dl). Despite comparable clinicopathologic characteristics (all P > 0.05) and RLV/TLV at surgery (P = 0.84), regeneration index within 2 months was lower in the normal/high phosphorus group (P = 0.01) with these patients having increased risk for postoperative liver failure (P = 0.01). The inhibition of liver regeneration persisted at 7 months (P = 0.007) and was associated with a worse survival (P = 0.02). Preoperative hypoglycemia was associated only with a lower early regeneration index (P = 0.02)., Conclusions: Normal/high phosphorus was associated with inhibition of early and late liver regeneration, as well as with an increased risk of liver failure and worse long-term outcomes. Immediate preoperative hypoglycemia was associated with a lower early volumetric gain. Metabolic factors may represent early indicators of liver failure that could identify patients at increased risk for worse outcomes.

Objective: The aim of the study was to evaluate the value of volumetric contrast-enhanced magnetic resonance imaging (MRI) using gadoxetate disodium in early assessment of treatment response after intra-arterial therapy (IAT)., Materials and Methods: This prospective study included 21 patients (32 malignant lesions) who underwent MRI using gadoxetate disodium before and early after IAT. Two reviewers reported response by anatomic criteria including Response Evaluation Criteria in Solid Tumor (RECIST), Modified RECIST (mRECIST), and European Association for the Study of Liver Disease and functional criteria including volumetric enhancement in hepatic arterial phase and portal venous phase. Treatment end point was RECIST at 6 months. A 2-sample paired t test was used to compare the mean changes after IAT. A P value of less than 0.05 was considered statistically significant., Results: Responders by RECIST at 6 months did not fulfill partial response by conventional criteria at 1 month, except for mRECIST by reader 2. The mRECIST and European Association for the Study of Liver Disease could not be assessed in a total of 4 and 3 lesions for readers 1 and 2, respectively. However, volumetric measurements were obtained in all lesions and the changes were statistically significant at 1 month for hepatic arterial phase (P = 0.02 and P = 0.008) and portal venous phase (P < 0.0001 and P < 0.0001), as assessed by both readers, respectively., Conclusions: Volumetric contrast-enhanced MRI using gadoxetate disodium may be a helpful tool to evaluate early treatment response after IAT in malignant liver tumors.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer. One of the most important risk factors of HCC is cirrhosis. The optimal treatment of HCC is liver transplantation, since it treats both the underlying cirrhosis and the cancer. Patients that have risk factors should be included in surveillance programs since HCC can be cured only during the early stages. Surveillance can be performed by ultrasonography (US), which is an inexpensive, non-invasive, and widely available technique, but it is considered to have a low sensitivity. If a suspicious lesion is detected on US exam, computerized tomography (CT) or magnetic resonance imaging (MRI) can be used to further evaluate this lesion. MRI is considered to be superior to CT because it has greater contrast resolution and tissue characterization. In this article, we present a review of MRI for HCC in liver transplantation (LT) with a focus on characteristic MR features of this tumor and current guidelines.

Background: The aim of this study was to evaluate the protective effect of melatonin on ischemia-reperfusion syndrome., Methods: Thirty-three adult male Wistar albino rats were randomized into three experimental groups of 11: Group C --control group with no ischemia or reperfusion. Groups I/R and I/R + M had 2.5 hours of ischemia and of two hours of reperfusion by means of clamping of the common femoral artery. All the animals received maintenance fluid with intraperitoneal (i.p) normal saline following general anesthesia. The animals of Group I/R + M were treated with i.p Melatonin (10 mg/kg) five minutes before reperfusion. At the end of reperfusion, samples were taken for histological evaluation and biochemical analysis. Parameters studied were biopsies of the soleus muscle, level of lactate, creatine phosphokinase (CPK), lactate dehydrogenase (LDH), sodium, potassium (K), calcium (Ca) and arterial blood gasometry., Results: In I/R group, the levels of K, CPK increased dramatically contrast with groups C and IR+M (P < 0.05). A significant decrease in HCO3 was found in I/R Group in comparison with Group IR+M and Group C (P < 0.001). In Group IR+M, lactate level decreased dramatically compared to other groups (P < 0.001). Histological injury in I/R + M was found to be less than in I/R group (P < 0.05). There was no significant difference in PO2, pH, carbon dioxide, partial pressure of oxygen, Na, LDH, Ca and P in three groups (P > 0.05). Histological change in the group C and group M didn't differ significantly, but the difference in group I/R was significant compared to group C and IR+M (P < 0.05)., Conclusion: We suggest that melatonin has protective effect against I/R syndrome in blood and skeletal muscle and may reduce the morbidity following revascularization surgery in vascular trauma.

Background: Human T-cell lymphoma/leukemia virus type 1 (HTLV-1) infection is relatively common in northeast Iran. It is important to understand which factors play a role in the pathogenesis of this virus. Blood group antigens may act as a receptor for various infectious agents. This study was performed to detect any association between Rh blood group antigens and HTLV-1 infection in northeast Iran., Methods: In this case and control study, Rhesus blood group antigens (D, C, c, E and e) were determined within 24 hours of blood collection by commercial antibodies in 100 HTLV-I infected individuals and 332 healthy blood donors at the Khorasan Blood Transfusion Center, Mashhad, Iran, in 2011. The results of HTLV-I positive subjects and the control group were compared using SPSS software., Results: The frequencies of Rh blood group antigens in the case group were D in 88%, C in 72%, c in 68%, E in 27%, and e in 94%. In the control group the frequencies were D in 91%, C in 75.5%, c in 72.9%, E in 28.6% and e in 98.2%. Chi-square test showed a significant difference between the two groups for the frequency of e antigen (p = 0.03)., Conclusions: Our study showed that e antigen expression is associated with a decreased risk of HTLV-I infection in northeast Iran.