Search

Purpose: To validate the diagnostic performance of adrenal washout CT in patients without known malignancy in a Western Australian population. Methods: A radiology information system (RIS) search for CT reports containing "adrenal" and "washout" across six networked metropolitan public hospitals between January 2005 and November 2021. Homogenous nodules ≥ 1 cm, ≥ 10 HU without a suspected functional component in patients without a history of malignancy were included. Reported absolute and relative washout percentages were recorded and re-measured from unenhanced, 60-s portal venous and 15-min delayed phase imaging and compared to either histopathological or CT follow up for growth (≥ 12 months) reference standards. Results: 2653 studies were screened with 191 meeting inclusion criteria. 105 nodules underwent washout CT and then had either histopathological (12 patients) or CT follow up (93 patients) reference standards available. Reported absolute washout (aWO) estimated sensitivity and specificity for malignant/indeterminate nodules was low at 33% (95% CI 25–43%) and 77% (95% CI 68–84%) respectively. Reported relative washout (rWO) sensitivity and specificity were 56% (95% CI 46–65%) and 69% (95% CI 60–77%) respectively. Negative predictive values for both aWO and rWO were reassuring at 92% (95% CI 86–96%) and 94% (95%CI 88–97%). Conclusion: Our study validates a recent report suggesting that adrenal washout has poor sensitivity for and consequent limited utility to exclude malignancy in patients with no cancer history. However, patients with incidental adrenal nodules < 4 cm in size with benign washout can be reassured by the high negative predictive value and worked up to exclude functional adenoma and re-imaged in a year to confirm no growth. [ABSTRACT FROM AUTHOR]

Background: The Liver Imaging Reporting and Data System (LI-RADS) Treatment Response Algorithm (TRA) (LI-RADS TRA) is used for assessing response of HCC to locoregional therapy (LRT), however, the value of ancillary features (AFs) for TACE-treated HCCs has not been extensively investigated on extracellular agent MRI (ECA-MRI). Purpose: To evaluate the diagnostic performance of LI-RADS v2018 TRA on ECA-MRI for HCC treated with transarterial chemoembolization (TACE) and the value of ancillary features. Methods: This retrospective study included patients who underwent TACE for HCC and then followed by hepatic surgery between January 2019 and June 2023 with both pre- and post-TACE contrast-enhanced MRI available. Two radiologists independently evaluated the post-treated lesions on MRI using LI-RADS treatment response (TR) (LR-TR) algorithm and modified LR-TR (mLR-TR) algorithm in which ancillary features (restricted diffusion and intermediate T2-weighted hyperintensity) were added, respectively. Lesions were categorized as complete pathologic necrosis (100%, CPN) and non-complete pathologic necrosis (< 100%, non-CPN) on the basis of surgical pathology. The diagnostic performance in predicting viable and non-viable tumors based on LR-TR and mLR-TR algorithms was compared using the McNemar test. Interreader agreement was calculated by using Cohen's weighted and unweighted κ. Results: A total of 61 patients [mean age 59 years ± 10 (standard deviation); 47 men] with 79 lesions (57 pathologically viable) were included. For non-CPN prediction, the sensitivity, specificity of LR-TR viable and mLR-TR viable category were 75% (43 of 57), 82% (18 of 22) and 88% (50 of 57), 77% (17 of 22), respectively, the sensitivity of mLR-TR was significantly higher than that of LR-TR (P = 0.016) without difference in specificity (P = 1.000). Interreader agreement for LR-TR and mLR-TR category was moderate (k = 0.50, 95% confidence interval 0.33, 0.67, k = 0.42, 95% confidence interval 0.20, 0.63). The sensitivity of both LR-TR and mLR-TR algorithms in predicting viable tumors between conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE) did not have significant difference (cTACE: 76%, 89% vs. DEB-TACE: 73%, 82%). Conclusions: On ECA-MRI, applying ancillary features to LI-RADS v2018 TRA can improve the sensitivity in predicting pathologic tumor viability in patients treated with TACE for hepatocellular carcinoma with no significant difference in specificity. [ABSTRACT FROM AUTHOR]

An approach was developed for high sensitivity characterization of the washout effect in display applications. The proposed measurement method and quantitative metric of washout are practical tools for the development of antiglare (AG) cover plates for display applications. [ABSTRACT FROM AUTHOR]

Abstract Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results.

Cervical lymph node (LN) metastasis is common in differentiated thyroid cancer (DTC). This study evaluated the utility of the washout CYFRA 21-1 level, combined with the thyroglobulin (Tg) concentration, in terms of diagnosis of LN metastasis. We prospectively enrolled 53 patients who underwent thyroid surgery to treat DTC with lateral cervical LN metastases. Preoperative ultrasound guided needle localization was used to surgical sampling of specific LNs during the operation. The intraoperative washout Tg and CYFRA 21-1 levels were measured in such LNs. The Tg and CYFRA 21-1 levels differed significantly between metastatic and benign LNs. The cutoff values were 2.63 ng/mL for washout CYFRA 21-1 and 22.62 ng/mL for Tg. Combined use of the washout Tg and CYFRA 21-1 levels afforded the highest diagnostic accuracy (92.5%), better than that of individual markers. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) were 94.6%, 90.0%, 91.4%, 93.8%, respectively. The conjunction of the washout CYFRA21-1 and Tg levels enhances the diagnostic accuracy of LN metastasis in DTC patients. The washout CYFRA 21-1 level may be useful when malignancy is suspected, especially in cases where the cytology and washout Tg findings do not provide definitive results. [ABSTRACT FROM AUTHOR]

AbstractIntroducing pulsatility in LVADs is known to reduce complications such as stagnation and thrombosis, but it is an ongoing topic of research on what the optimal form is. We present a framework consisting of parametrized full-order simulations, reduced-order models, and sensitivity analysis to systematically quantify the effects of parametrized pulsatility on washout. As a sample problem, we study the washout in an idealized 2D left ventricle and a parametrized sinusoidal LVAD flow rate. The framework yields speed-ups proportional to the number of samples required in the sensitivity analysis. In our setting, we find that short, intense pulses wash out the left ventricle best, while the time between consecutive pulses does not play a significant role. [ABSTRACT FROM AUTHOR]

The aim of the work described here was to evaluate the impact of hepatocellular carcinoma (HCC) tumor size on Sonazoid contrast-enhanced ultrasound (CEUS) enhancement features, especially in tumors with diameters ≤30 mm and <10 mm. In this retrospective study, we included patients with histopathologically confirmed HCC lesions and divided them into three groups on the basis of tumor size. All patients underwent Sonazoid-enhanced CEUS examinations before surgery. B-mode ultrasound (BMUS) features and CEUS enhancement patterns were evaluated according to current World Federation for Ultrasound in Medicine and Biology Guidelines criteria. The χ2- and Student t -tests were used to compare differences between groups. We included 132 patients with histopathologically confirmed HCC lesions from November 2020 to September 2022. On the basis of tumor size, patients were divided into group 1 (<10 mm, n = 5), group 2 (10–30 mm, n = 54) and group 3 (>30 mm, n = 73). On BMUS, most HCCs appeared heterogeneous but predominantly hypo-echoic (61.4%, 81/132) with ill-defined margins and irregular shapes. Meanwhile, iso-echoic features were more common in small HCCs ≤30 mm (15.3%, 9/59), but a mixed hyper- and hypo-echoic appearance was more common in HCCs >30 mm (17.8%, 13/73) (p = 0.003). On Sonazoid-enhanced CEUS, all HCCs presented arterial phase hyperenhancement (APHE) (100.0%, 132/132). Most HCCs >30 mm exhibited heterogeneous hyperenhancement (86.3%, 63/73), whereas nearly one-third of small HCCs ≤30 mm exhibited homogeneous hyperenhancement (35.6%, 21/59) (p = 0.003). In the portal venous phase, there was a significantly higher proportion of washout in HCCs >30 mm (84.9%, 62/73) than in small HCCs ≤30 mm (64.4%, 38/59) (p = 0.006). During the Kupffer phase, 11 additional hypo-enhanced lesions (mean size: 14.1 ± 4.1 mm, iso-echoic on BMUS), which were also suspected to be HCC lesions, were detected in 5 patients with small HCCs ≤30 mm and 4 patients with HCCs >30 mm. All 5 cases of HCCs <10 mm exhibited APHE and late washout (>60 s). The majority (3/5, 60%) exhibited washout in the portal venous phase (70, 74 and 75 s), one case did so in the late phase (125 s) and another in the Kupffer phase (420 s). Tumor size had a significant impact on the washout features of HCC lesions on Sonazoid-enhanced CEUS. Small HCC lesions ≤30 mm had a higher proportion of relatively late washout in comparison to larger lesions. Sonazoid-enhanced CEUS might be helpful in the detection and characterization of HCC lesions <10 mm. [ABSTRACT FROM AUTHOR]

IntroductionPrompt reperfusion of coronary artery after acute myocardial infarction (AMI) is crucial for minimizing heart injury. The myocardium, however, may experience additional injury due to the flow restoration itself (reperfusion injury, RI). The purpose of this study was to demonstrate that short preconditioning (10 min) with selective autoretroperfusion (SARP) ameliorates RI, based on a washout hypothesis.MethodsAMI was induced in 23 pigs (3 groups) by occluding the left anterior descending (LAD) artery. In SARP-b (SARP balloon inflated) and SARP-nb (SARP balloon deflated) groups, arterial blood was retroperfused for 10 min via the great cardiac vein before releasing the arterial occlusion. A mathematical model of coronary circulation was used to simulate the SARP process and evaluate the potential washout effect.ResultsSARP restored left ventricular function during LAD occlusion. Ejection fraction in the SARP-b group returned to baseline levels, compared to SARP-nb and control groups. Infarct area was significantly larger in the control group than in the SARP-b and SARP-nb groups. End-systolic wall thickness was preserved in the SARP-b compared to the SARP-nb and control groups. Analyte values (pH, lactate, glucose, and others), measured every 2 min during retroperfusion, suggest a “washout” effect as one important mechanism of action of SARP in reducing infarct size. With SARP, the values progressively approached baseline levels. The mathematical model also confirmed a possible washout effect of tracers.DiscussionRI can be ameliorated by delaying restoration of arterial flow for a brief period of time while pretreating the infarction with SARP to restore homeostasis via a washout mechanism.

Hot rolling is a highly efficient steel processing method involving the heating and subsequent rolling of semi-finished cast products within mills; however, heating results in the formation of an undesirable, inhomogeneous oxide layer on the surface. Removal of this layer, known as scales, prior to rolling is essential to prevent scales from being rolled into the surface. The scales are removed in the descaler. Most descalers use multiple high-pressure hydraulic descaling nozzles with overlapping sprays. This setting can cause excessive cooling in the overlap area, uneven descaling of the surface, and the presence of residual scales. It can also result in uneven cooling at the finishing line. This study illustrates a typical nozzle configuration commonly used in industrial plants in the hydraulic descaling process and compares its results with a new configuration. The research focuses on examining the overlap area and the washout area of the sprays. The goal is to address the inhomogeneous descaling problem and propose procedures to prevent residual scales. It was shown that one of the problematic areas is the washout area, where the average thickness of the remaining scales was more than four times higher than other descaling areas. Reducing the offset angle has proven to be a good way to eliminate the washout area and achieve a homogeneous descaling process. [ABSTRACT FROM AUTHOR]

The mainstay of evidence development in medicine is the parallel-group randomized controlled trial (RCT), which generates estimates of treatment efficacy or effectiveness for the average person in the trial. In contrast, personalized trials (sometimes referred to as 'single-person trials' or 'N-of-1 trials') assess the comparative effectiveness of two or more treatments in a single individual. These single-subject, randomized crossover trials have been used in a scattershot fashion in medicine for over 40 years but have not been widely adopted. An important barrier is the paucity of strong evidence that personalized trials improve outcomes. However, the principal impediment may have less to do with proof of efficacy than with practical aspects of design and implementation. These include decisions about treatment regimen flexibility, blinding, and washout periods as well as organizational, clinician, and patient-level challenges. After reviewing the essential elements of personalized trials, this article addresses these speed bumps and fundamentally asks, 'Why have personalized trials not been more widely adopted, and how can they be made more readily deployable and useful?' The article concludes by suggesting ways in which emerging technologies and approaches promise to overcome existing barriers and open promising vistas for the next generation of personalized-trial researchers and practitioners.

Purpose: To determine the effect of discontinuing chronic topical immune modulating (IM) treatment on Schirmer tear test (STT) values in dogs with dry eye disease (DED). Methods: Serial measurements of STTs from 14 dogs (16 eyes) previously diagnosed with DED were obtained before and after discontinuation of topical IM agents. Dogs with moderate to severe DED that had been well controlled with a topical IM treatment were included. After initial assessment topical IM treatment was discontinued, but topical lubricant was continued, and STT values were obtained sequentially. A mixed-effects regression model was used to evaluate the effects of age, gender, breed, clinical score, frequency of treatment, baseline STT value, and drug type on final STT values after IM withdrawal. P

Unipolar brush cells (UBCs) in the cerebellum and dorsal cochlear nucleus (DCN) perform temporal transformations by converting brief mossy fiber bursts into long-lasting responses. In the cerebellar UBC population, mixing inhibition with graded mGluR1-dependent excitation leads to a continuum of temporal responses. In the DCN, it has been thought that mGluR1 contributes little to mossy fiber responses and that there are distinct excitatory and inhibitory UBC subtypes. Here, we investigate UBC response properties using noninvasive cell-attached recordings in the DCN of mice of either sex. We find a continuum of responses to mossy fiber bursts ranging from 100 ms excitation to initial inhibition followed by several seconds of excitation to inhibition lasting for hundreds of milliseconds. Pharmacological interrogation reveals excitatory responses are primarily mediated by mGluR1. Thus, UBCs in both the DCN and cerebellum rely on mGluR1 and have a continuum of response durations. The continuum of responses in the DCN may allow more flexible and efficient temporal processing than can be achieved with distinct excitatory and inhibitory populations. [ABSTRACT FROM AUTHOR]

Coastal barrier systems are low‐lying environments that bear the brunt of storm impacts, with cumulative and complex consequences for barrier evolution. Most studies of barrier responses to storms examine what happens when water and sediment get driven landward across a barrier from its ocean side. Sherwood et al. (2023, https://doi.org/10.1029/2022jf006934) investigate the effects of overland flow and sediment transport forced across a barrier in the opposite direction—from its sheltered side, seaward. Using high‐resolution imagery of a barrier island observed before and after a hurricane, Sherwood et al. (2023, https://doi.org/10.1029/2022jf006934) show that "outwash" flow across the barrier shifted several times more sediment by volume than is typically reported for beach and dune erosion from onshore forcing. Their findings are remarkable because they are not exceptional: a related survey of barriers along the Atlantic and Gulf Coasts of the USA observed patterns of outwash morphology essentially everywhere. Insights into outwash morphology open exciting questions regarding the overlooked role of storm‐driven seaward sediment transport in barrier dynamics, with important implications for post‐storm barrier recovery and barrier evolution over decades to centuries. Plain Language Summary: Coastal barrier systems—beaches backed by dunes, marshes, and often a lagoon or sound—offer natural protection to coastal floodplains by absorbing some of the physical impacts of storms, including hurricanes. Most studies of storm impacts on coastal barriers investigate changes that occur when a storm drives water and sediment landward, over a barrier from its ocean‐facing side. But storms also drive sediment‐laden flows in the opposite direction: over the back of a barrier from its more sheltered side, toward the ocean. Here, I highlight work by Sherwood et al. (2023, https://doi.org/10.1029/2022jf006934) that details extensive patterns of erosion and accretion from "outwash" flow seaward over a barrier during a hurricane. Added up over time, sediment shifting landward and seaward across a barrier shapes the barrier landscape and affects how the barrier may respond to future storm impacts. Sherwood et al. (2023, https://doi.org/10.1029/2022jf006934) offer findings with important implications for understanding how coastal barriers evolve in space and time, and address a question that is fundamental to many geomorphic systems: when a large volume of sediment moves during an extreme weather event, where does it all go? Key Points: Sediment transport seaward during storms remains largely overlooked in coastal researchSeaward outwash may shift more sediment by volume than onshore‐forcing processes of beach and dune erosionThe complex relationship between storm‐driven seaward transport and barrier recovery opens exciting questions regarding barrier evolution [ABSTRACT FROM AUTHOR]

The purpose of the study was to assess the clinical, biochemical, and sonographic factors influencing the performance of parathormone washout measurement (PTHw) vs. MIBI in the preoperative localization of parathyroid adenoma (PA). The studied group consisted of 39 patients with primary or tertiary hyperparathyroidism. The measurement of PTH concentrations was performed using an electro-chemiluminescence immunoassay. Scintigraphic localization of PA was carried out using dual-tracer planar neck scintigraphy, using 74 MBq 99mTc-pertechnetate and 740 MBq of 99mTc-MIBI. MIBI was unambiguously positive in 74% of patients. Among patients with negative or inconclusive MIBI, 90% had a positive PTHw result. Among patients with negative PTHw, two out of three had a positive MIBI result. The PTHw of lesions <10 mm in their largest diameter yielded positive results in 95%, compared to 75% for MIBI. For lesions ≥10 mm in largest diameter, 88% were visualised using MIBI. In conclusion, PTHw is a highly effective, easy, quick, safe, and relatively cheap procedure which might be considered for PA localisation, especially in patients with lesions presenting typical ultrasound features and a size below 10 mm. MIBI remains a useful procedure in specialized centres, particularly for patients in whom PTHw failed, larger lesions, and in cases of the ectopic location of PA. [ABSTRACT FROM AUTHOR]

Magnetic fluid seals have long been thought to be a successful sealing form while sealing liquids are always a challenge. The instability of the liquid–liquid interface under the washout has become the key technical problem that hinders the realization of sealing liquid. This work mainly presents an experimental study about the influence of high viscosity and magnetoviscous effects on washout resistance. Three engine oil-based magnetic fluids of different viscosities were prepared with two kinds of surfactants. The magnetoviscous effects of the prepared magnetic fluids under different working conditions were found through rheological experiments. The viscosity of the three samples decreased at most by about 100 times with the shear rate increasing. An experimental platform was designed and built for the washout tests. The entire process of magnetic fluids being washed away was obtained experimentally. The magnetic fluid of higher viscosity can remain stationary with lower magnetic force. The quantitative results show that the viscosity of the magnetic fluid has a significant influence on washout resistance under a magnetic field. [ABSTRACT FROM AUTHOR]

The structural-aggregate composition of leached chernozems (Voronic Chernozems Pachic according to WRB-2014), the distribution of organic compounds Corg and labile humic substances (LHS) in the structural-aggregate fractions of carbon in the conditions of a slope type of terrain during the development of erosion were studied. The work was carried out in the northern part of the Voronezh region on the catena, which included a section of the watershed, smoothly turning into a southwestern slope about 1500 m long and 5˚ steep. The soils of the following sections of the catena were studied: 1) the watershed part; 2) the upper part of the slope; 3) the middle part of the slope. It was shown that degradation of the structural-aggregate state occurs in eroded chernozems, accompanied by a deterioration in microstructurality, a decrease in the number of mesoaggregates and a structural coefficient, as well as a loss of a water-resistant structure. According to the results, LHS play a very important role in maintaining the water-stable structure of chernozems. The most significant contribution to the content of Corg contribute mesoaggregates 5-1 mm in size, which are actively lost during the development of erosion.

Bone void fillers are used to fill in the empty space within bone defect. The use of fillers is aiming to reduce the time required for healing the defect. The filler should show the resistance to washout and the ability of adsorption within human body. In the present study, a microstructure design approach is employed to evaluate the performance of bone void filler. The microstructure features, such as the contacts between particles, the size of pores, and their interconnectivity, are considered. The pellets composing of these microstructure features are prepared for in vitro and in vivo evaluations. The type of contacts between resorbable particles plays a key role on washout resistance. The interconnectivity of pores affects significantly on the absorption rate in vivo. Through the control of these microstructure characteristics, the resorbable behavior of bone void filler can be tailored. [ABSTRACT FROM AUTHOR]

Wound complications are a prevalent concern for neuromodulation procedures. While removal of the device was recommended, attempts to salvage expensive hardware have become commonplace. We examine our management in wound issues to aid in providing guidance for these situations. We identified 40 patients over an 8-year period in a large neuromodulation practice, who underwent washout or partial salvage of hardware. We examined the efficacy of washout and partial explants on the ability to salvage the implants. Covariates including age, sex, body mass index, smoking status, anticoagulation, and device type were considered. There were 29 washouts and 10 partial hardware removal cases. Washouts were successful in 15/29 cases (51.7%), partial hardware removal was successful in 2/10 cases (20%), and removal with replacement was not successful (0 of 1). Washouts tended to be more successful than partial removal procedures (P = 0.08). In cases of successful washout, the average duration between infectious symptoms and washout was 7.27 ± 2.19 days. None of the demographic variables were associated with increased likelihood of washout failure. Our results demonstrate a higher rate of washout failure in those who underwent partial device removal and in the presence of purulence at the surgical site. Further investigation must be conducted to determine the instances in which hardware removal is indicated to prevent failure or removal due to infection. Identification of these parameters will optimize therapeutic benefit and long-term financial impact. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the residual effect of narasin on intake and ruminal fermentation parameters in Nellore cattle fed a forage-based diet. Thirty rumen-cannulated Nellore steers [initial body weight (BW) = 281 ± 21 kg] were allocated to individual pens in a randomized complete block design, with 10 blocks and 3 treatments, defined according to the fasting BW at the beginning of the experiment. The animals were fed a forage-based diet containing 99% Tifton-85 haylage and 1% concentrate. Within blocks, animals were randomly assigned to one of three treatments: (1) forage-based diet without addition of narasin (CON; n = 10), (2) CON diet plus 13 mg of narasin/kg DM (N13 ; n = 10), or (3) CON diet plus 20 mg of narasin/kg DM (N20 ; n =10). The experiment lasted 156 d and was divided into two periods. The first period lasted 140 d and consisted of the daily supply of narasin. In the second period (last 16 d), the animals were not supplemented with narasin when the residual effect of the additive was evaluated. The treatments were evaluated by linear and quadratic orthogonal contrasts. The results were reported as least square means and the effect was considered significant when P ≤ 0.05. No treatment × day interaction was identified for dry matter intake (P = 0.27). There was a treatment × day (P ≤ 0.03) interaction after narasin removal for the molar proportion of acetate, propionate, ac:prop ratio, and ammonia nitrogen. The inclusion of narasin decreased linearly (P < 0.01) the molar proportion of acetate (P < 0.01), and this effect persisted until day 5 after narasin withdrawal (P < 0.01). Narasin inclusion linearly increased the molar proportion of propionate (P < 0.04), and linearly decreased (P < 0.01) ac:prop ratio up to 5 d after removing narasin from the diets. No treatment effects were observed (P > 0.45) on days 8 and 16 after the withdrawal. Narasin linearly decreased ammonia nitrogen up to 1 day after withdrawal (P < 0.01). In conclusion, the use of narasin for a prolonged period (140 d) resulted in a residual effect on rumen fermentation parameters after the removal of the additive from the diets. [ABSTRACT FROM AUTHOR]

Hot rolling is a highly efficient steel processing method involving the heating and subsequent rolling of semi-finished cast products within mills; however, heating results in the formation of an undesirable, inhomogeneous oxide layer on the surface. Removal of this layer, known as scales, prior to rolling is essential to prevent scales from being rolled into the surface. The scales are removed in the descaler. Most descalers use multiple high-pressure hydraulic descaling nozzles with overlapping sprays. This setting can cause excessive cooling in the overlap area, uneven descaling of the surface, and the presence of residual scales. It can also result in uneven cooling at the finishing line. This study illustrates a typical nozzle configuration commonly used in industrial plants in the hydraulic descaling process and compares its results with a new configuration. The research focuses on examining the overlap area and the washout area of the sprays. The goal is to address the inhomogeneous descaling problem and propose procedures to prevent residual scales. It was shown that one of the problematic areas is the washout area, where the average thickness of the remaining scales was more than four times higher than other descaling areas. Reducing the offset angle has proven to be a good way to eliminate the washout area and achieve a homogeneous descaling process.

Retention tests conducted after sensorimotor adaptation frequently exhibit a rapid return to baseline performance once the altered sensory feedback is removed. This so-called washout of learning stands in contrast with other demonstrations of retention, such as savings on re-learning and anterograde interference effects of initial learning on new learning. In the present study, we tested the hypothesis that washout occurs when there is a detectable discrepancy in retention tests between visual information on the target position and somatosensory information on the position of the limb. Participants were tested following adaptation to gradually rotated visual feedback (15° or 30°). Two different types of targets were used for retention testing, a point target in which a perceptual mismatch is possible, and an arc-target that eliminated the mismatch. It was found that, except when point targets were used, retention test movements were stable throughout aftereffect trials, indicating little loss of information. Substantial washout was only observed in tests with a single point target, following adaptation to a large amplitude 30° rotation. In control studies designed to minimize the use of explicit strategies during learning, we observed similar patterns of decay when participants moved to point targets that suggests that the effects observed here relate primarily to implicit learning. The results suggest that washout in aftereffect trials following visuomotor adaptation is due to a detectable mismatch between vision and somatosensation. When the mismatch is removed experimentally, there is little evidence of loss of information. [ABSTRACT FROM AUTHOR]

Purpose: To verify the hypothesis that extracellular volume fraction (ECV) and precontrast CT density are the main determinants of washout of hepatocellular carcinoma (HCC) at the equilibrium phase CT. Materials and methods: Between 2018 and 2020, patients with surgically resected HCC were recruited who had undergone preoperative 4-phase CT. Those larger than 6 cm were excluded to minimize the possibility of intratumoral hemorrhage or degeneration. Two radiologists reviewed the whole images in consensus and divided cases into washout positive and negative groups. Washout positive group at the equilibrium phase was defined as "HCC showing relatively low density as compared to the surrounding background liver (BGL), irrespective of the presence of early enhancement or fibrous capsule". Several clinico-pathological and radiological features, including ECV and precontrast CT density, were correlated to the presence of washout, using uni- and multi-variable analyses. Results: 27 HCC in 24 patients met the inclusion criteria. 22 (82%) and five HCC belonged to washout positive and negative groups, respectively. Univariable analysis revealed ECV of HCC and BGL, ECV difference between HCC and BGL, and presence of fibrous capsule on the equilibrium phase CT were the significant factors. Multivariable analysis showed ECV of HCC and BGL, and precontrast CT density of BGL, were the independently significant factors related to washout, suggesting washout is more likely observed with lower HCC ECV, higher BGL ECV, and higher BGL precontrast CT density. Conclusion: Major determinants of washout of HCC may be ECV of HCC and BGL, and precontrast CT density of BGL. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the Sonazoid-enhanced contrast-enhanced ultrasound (CEUS) features of hepatocellular carcinoma (HCC) in a non-cirrhosis liver background, in comparison to those in liver cirrhosis. Methods: In this retrospective study, 19 patients with surgery and histopathologically proven HCC lesions in non-cirrhosis liver background were included regarding Sonazoid-enhanced CEUS characteristics. Two radiologists evaluated the CEUS features of HCC lesions according to the WFUMB (World Federation of Societies for Ultrasound in Medicine and Biology) guidelines criteria. Thirty-six patients with HCC lesions in liver cirrhosis were included as a control group. Final diagnoses were confirmed by surgery and histopathological results. Results: Liver background of the non-cirrhosis group including normal liver (n = 7), liver fibrosis (n = 11), and alcoholic liver disease (n = 1). The mean size of non-cirrhosis HCC lesions was 60.8 ± 46.8 mm (ranging from 25 to 219 mm). During the arterial phase of Sonazoid-enhanced CEUS, most HCCs in non-cirrhotic liver (94.7%, 18/19) and in cirrhotic liver (83.3%, 30/36) presented non-rim hyperenhancement. During the portal venous phase, HCC lesions in the non-cirrhosis liver group showed relatively early washout (68.4%, 13/19) (p = 0.090). Meanwhile, HCC lesions in liver cirrhosis background showed isoenhancement (55.6%, 20/36). All lesions in the non-cirrhotic liver group showed hypoenhancement in the late phase and the Kupffer phase (100%, 19/19). Five cases of HCC lesions in liver cirrhosis showed isoenhancement during the late phase and hypoenhancement during the Kupffer phase (13.9%, 5/36). The rest of the cirrhotic HCC lesions showed hypoenhancement during the late phase and the Kupffer phase (86.1%, 31/36). Additional hypoenhanced lesions were detected in three patients in the non-cirrhosis liver group and eight patients in the liver cirrhosis group (mean size: 13.0 ± 5.6 mm), which were also suspected to be HCC lesions. Conclusions: Heterogeneous hyperenhancement during the arterial phase as well as relatively early washout are characteristic features of HCC in the non-cirrhotic liver on Sonazoid-enhanced CEUS. [ABSTRACT FROM AUTHOR]

In this prospective study, we postulate that there is a difference between clearance of [99mTc]Tc- ethyl cysteinate dimer (ECD) in the seizure onset zone (SOZ) and other brain areas and thus SOZ localization by clearance patterns might become a potential novel method for SOZ localization in epilepsy. The parametric images of brain ECD clearance were generated by linear regression model analysis from serial brain SPECT scans from 30 to 240 min after ECD injection (7-times point) in 7 patients with drug-resistant epilepsy and 3 normal volunteers. Clearance patterns of the SOZ confirmed by good surgical outcome or consensus with other investigations were analyzed quantitatively and semi-quantitatively by visual grading (slower or faster washout than contralateral brain regions). The average [99mTc]Tc-ECD clearance rates of SOZs were + 1.08% ± 2.57%/hr (wash in), -7.02% ± 2.56%/hr (washout), and -5.37% ± 1.71%/hr (washout) in ictal, aura and interictal states, respectively. Paired t-tests between the SOZ and contralateral regions showed statistically significant difference (p = 0.039 in interictal state). Clearance patterns that can define the SOZs were 1) wash in and slow washout on ictal slope, 2) fast washout on aura slope and interictal slope with 100% (6/6), 100% (2/2) and 75% (6/8) localization using ictal, aura, and interictal slope maps, respectively. Our study provided the evidence that clearance pattern methods are potential additive diagnostic tools for SOZ localization when routine one-time point SPECT are unable to define the SOZ. [ABSTRACT FROM AUTHOR]

Simple Summary: Milk is the most consumed dairy product in the world and for humans is one of the major sources of beneficial biocomponents. Lipids from oilseeds can be transferred to milk from cows or converted to other biomolecules with nutraceutical effects, resulting in healthier milk. However, there is a great uncertainty with regard to the effect of some variables related to the animal, the seed, the level of inclusion and the characteristics of the diet. The objective of this review was to show the effect of the inclusion of oilseeds in the diet of dairy cows on milk yield, milk components and the fatty acid profile in milk. A systematized search was carried out of published articles with high scientific rigor where the feeding strategy in dairy cows was the inclusion of oilseeds in the diet. Milk from oilseed-fed cows contained a higher amount of unsaturated 18-carbon fatty acids, including omega-3 series, rumenic and vaccenic fatty acids. Overall, supplementation with oilseeds in the cow's diets increases the concentration of biomolecules in milk with potential positive effects on human health. Oilseed supplementation is a strategy to improve milk production and milk composition in dairy cows; however, the response to this approach is inconsistent. Thus, the aim of this study was to evaluate the effect of oilseed supplementation on milk production and milk composition in dairy cows via a meta-analysis and meta-regression. A comprehensive and structured search was performed using the following electronic databases: Google Scholar, Primo-UAEH and PubMed. The response variables were: milk yield (MY), atherogenic index (AI), Σ omega-3 PUFA, Σ omega-6 PUFA, fat, protein, lactose, linoleic acid (LA), linolenic acid (LNA), oleic acid (OA), vaccenic acid (VA), conjugated linoleic acid (CLA), unsaturated fatty acid (UFA) and saturated fatty acid (SFA) contents. The explanatory variables were breed, lactation stage (first, second, and third), oilseed type (linseed, soybean, rapeseed, cottonseed, and sunflower), way (whole, extruded, ground, and roasted), dietary inclusion level, difference of the LA, LNA, OA, forage and NDF of supplemented and control rations, washout period and experimental design. A meta-analysis was performed with the "meta" package of the statistical program R. A meta-regression analysis was applied to explore the sources of heretogeneity. The inclusion of oilseeds in dairy cow rations had a positive effect on CLA (+0.27 g 100 g−1 fatty acids (FA); p < 0.0001), VA (+1.03 g 100 g−1 FA; p < 0.0001), OA (+3.44 g 100 g−1 FA; p < 0.0001), LNA (+0.28 g 100 g−1 FA; p < 0.0001) and UFA (+8.32 g 100 g−1 FA; p < 0.0001), and negative effects on AI (−1.01; p < 0.0001), SFA (−6.51; p < 0.0001), fat milk (−0.11%; p < 0.001) and protein milk (−0.04%; p < 0.007). Fat content was affected by animal breed, lactation stage, type and processing of oilseed and dietary NDF and LA contents. CLA, LA, OA and UFA, desirable FA milk components, were affected by type, processing, and the intake of oilseed; additionally, the concentrations of CLA and VA are affected by washout and design. Oilseed supplementation in dairy cow rations has a positive effect on desirable milk components for human consumption. However, animal response to oilseed supplementation depends on explanatory variables related to experimental design, animal characteristics and the type of oilseed. [ABSTRACT FROM AUTHOR]

Objective: To compare diagnostic accuracy of washout (WO)-CT to chemical shift (CS)-MRI + T2W adrenal MRI Calculator (T2W-Calculator) to diagnose adrenal adenoma in indeterminate adrenal masses. Methods: This retrospective, cross-sectional, non-inferiority study evaluated 40 consecutive indeterminate adrenal masses; each with WO-CT and MRI. Two blinded radiologists independently evaluated in mixed order: pre-contrast attenuation (Hounsfield Units, HU) and absolute WO ([Peak.HU-Delay.HU]/[Peak.HU-Pre.HU] × 100%), Chemical Shift Signal Intensity (CS-SI) Index, T2W SI ratio, and Entropy (which were imputed into the T2W-Calculator). Diagnostic accuracy for adrenal adenoma was tabulated using 2 × 2 tables. True -positive diagnoses of adenoma were CT = Pre-HU < 10 or absolute WO ≥ 60%, MRI = SI index ≥ 16.5% or T2W-Calculator < 0.631. Results: There were 73% (29/40) adenomas and 27% (11/40) other masses (5 pheochromocytoma, 3 solitary fibrous tumor, 1 metastasis, 1 cavernous hemangioma, and 1 adrenocortical carcinoma). Sensitivity, specificity, and accuracy for diagnosis of adenoma using CT-WO were 78% (95% confidence intervals [CI] 56–93%), 35% (14–62%), and 57% (42–71%) Reader 1 and 72% (53–87%), 46% (17–77%), and 59% (41–76%) Reader 2. Sensitivity, specificity, and accuracy for diagnosis of adenoma using MRI were 100% (88–100%), 64% (34–90%), and 82% (67–97%) Reader 1 and 86% (68–96%), 73% (39–94%), and 80% (64–95%) Reader 2. MRI had higher overall accuracy (p = 0.02 Reader 1, 0.05 Reader 2) compared to CT-WO. Conclusion: Chemical shift MRI combined with the T2W adrenal MRI calculator is not inferior to CT Washout for diagnosis of adrenal adenoma among indeterminate adrenal masses. [ABSTRACT FROM AUTHOR]

Giant intracerebral aneurysms (GIA) comprise up to 5 % of all intracranial aneurysms. The indirect surgical strategy, which leaves the GIA untouched but reverses the blood flow by performing a bypass in combination with proximal parent artery occlusion is a useful method to achieve spontaneous aneurysm occlusion. The goal of this study was to assess the utility of computational fluid dynamics (CFD) in preoperative GIA treatment planning. We hypothesise that CFD simulations will predict treatment results. A fluid-structure interaction (FSI) CFD investigation was performed for the entire arterial brain circulation. The analyses were performed in three patient-specific CT angiogram models. The first served as the reference geometry with a C6 internal carotid artery (ICA) GIA, the second a proximal parent artery occlusion (PAO) and virtual bypass to the frontal M2 branch of the middle cerebral artery (MCA), and the third a proximal PAO in combination with a temporal M2 branch bypass. The volume of "old blood", flow residence time (FRT), dynamic viscosity and haemodynamic changes were also analysed. The "old blood" within the aneurysm in the bypass models reached 41 % after 20 cardiac cycles while in the reference model it was fully washed out. In Bypass 2 "old blood" was also observed in the main trunk of the MCA after 20 cardiac cycles. Extrapolation of the results yielded a duration of 4 years required to replace the "old blood" inside the aneurysm after bypass revascularization. In both bypass models a 7-fold increase in mean blood viscosity in the aneurysm region was noted. Bypass revascularization combined with proximal PAO favours thrombosis. Areas prone to thrombus formation, and subsequently the treatment outcomes, were accurately identified in the preoperative model. Virtual surgical operations can give a remarkable insight into haemodynamics that could support operative decision-making., 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 © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Adrenal incidentalomas (AI) are predominantly nonfunctional and benign, and their detection and differential diagnosis are aided by computed tomography (CT). A nonfunctioning adrenal incidentaloma (NFAI) usually requires regular follow-up; however, adrenalectomy may be necessary in certain patients. This study aimed to evaluate prognostic predictors to guide the treatment approach for AIs., Methods: This retrospective, single-center study involved patients diagnosed with NFAI from January 2000 to December 2020. Patients were divided into surgery and observation groups. A subgroup analysis compared malignant and benign adenoma within the surgery group., Results: A total of 307 patients were included, with 127 in the surgery group and 180 in the observation group. The surgery group displayed distinct morphological and malignant potential features in CT scans more frequently than the observational group did. The malignant subgroup exhibited more irregular borders on CT, and a higher number of patients with absolute washout under 60 % and relative washout under 40 % compared with the benign adenoma subgroup. Interestingly, within the surgery group, the mean tumor size was <4 cm for the both malignant and benign adenoma subgroups., Conclusions: Characterizing NFAI is important for appropriate treatment, as not all AIs have a favorable prognosis. CT findings associated with malignant potential, such as Hounsfield unit and washout values, were useful in determining the need for surgical treatment. However, the conventional criterion of a 4-cm size threshold for surgery was not a reliable malignancy predictor. Surgical resection should be considered for specific patient groups to ensure proper treatment over mere observation., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objective: Dorsal root ganglion stimulation (DRG-S) is a novel therapy to treat chronic pain. It has shown efficacy when delivered intermittently, suggesting a delayed washout effect exists. To measure the washout period, and to determine whether there are differences in washout times among different types of treated pain, we measured the time for pain to return at the end of the patients' one-week DRG stimulation trials., Materials and Methods: Patients who completed a successful DRG-S trial were included. The times until 25% (t25) and 90% (t90) of baseline pain level returned were recorded. The patients were divided into neuropathic, nociceptive, and mixed pain groups for subgroup comparison. t25 and t90 were plotted in the entire cohort and subgroups using reverse Kaplan-Meier plots (failure curves) and compared using a log-rank test., Results: In total, 29 consecutive patients were included. Median t25 and t90 times were 7.1 and 19.5 hours, respectively. Median (interquartile range) times were longest for the nociceptive pain group (n = 17) and shortest for the neuropathic pain group (n = 6), with the mixed-pain group (n = 6) in between (t25: 7.1 [1.7-19.4], 3.40 [1.4-8.4], and 5.7 [0.8-17.6]; t90, 22.0 [10.7-71.0], 7.6 [3.6-19.8], and 20.9 [14.2-31.2], respectively). t90 times differed significantly by pain type (p = 0.040)., Conclusions: This study showed a prolonged washout period after cessation of DRG-S therapy. Washout times vary according to pain type. The observed effects are possibly due to long-term depression of pain signaling and could allow the implementation of alternative stimulation strategies with DRG-S. Further investigations evaluating DRG-S washout times are warranted., Competing Interests: Conflict of Interest Kenneth B. Chapman reports a relationship with Abbott that includes funding grants. The remaining authors reported no conflict of interest., (Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Abstract Background Metastasis to the breast is rare. We herein report a patient with metastatic medullary thyroid carcinoma to the breast for whom measuring the calcitonin level was an important clue to the correct diagnosis. Case presentation A 54-year-old woman visited our hospital for the treatment of recurrent metastatic medullary thyroid carcinoma due to multiple endocrine neoplasia 2A and breast cancer. Positron emission tomography performed before the operation for metastatic medullary thyroid carcinoma recurrence in the neck showed the accumulation of 18F-fluorodeoxyglucose in the bilateral breast at sites other than the disease in the neck. Ultrasonography revealed multiple tumors in both breasts. A core needle biopsy of three breast tumors was performed. Microscopically, the tumor cells showed solid growth and did not show a tubular structure. She was diagnosed with triple-negative invasive ductal carcinoma. Post-operative positron emission tomography was performed as the serum calcitonin level increased after the operation. The accumulation of 18F-fluorodeoxyglucose in the bilateral breast tumors and lymph nodes in the neck was noted. The possibility of the breast tumors being metastasis of metastatic medullary thyroid carcinoma was considered. Needle aspiration was performed for three breast tumors. The calcitonin level of the washout fluid was measured and found to be ≥ 17,500 pg/mL. Immunohistochemistry showed that the tumor cells were calcitonin-positive and gross cystic disease fluid protein-15-negative. Vandetanib was started as recurrent metastatic medullary thyroid carcinoma with breast metastasis was finally diagnosed. The serum calcitonin level decreased after 1 month. Conclusion Although breast metastasis of medullary thyroid carcinoma is rare, a correct diagnosis is indispensable for appropriate treatment. When a breast tumor shows atypical morphological features for breast cancer according to the histopathology in a patient with a history of cancer, metastasis to the breast should be considered. Calcitonin measurement of the needle washout fluid was useful for confirming metastatic medullary thyroid carcinoma.

The purpose of the study was to assess the clinical, biochemical, and sonographic factors influencing the performance of parathormone washout measurement (PTHw) vs. MIBI in the preoperative localization of parathyroid adenoma (PA). The studied group consisted of 39 patients with primary or tertiary hyperparathyroidism. The measurement of PTH concentrations was performed using an electro-chemiluminescence immunoassay. Scintigraphic localization of PA was carried out using dual-tracer planar neck scintigraphy, using 74 MBq 99mTc-pertechnetate and 740 MBq of 99mTc-MIBI. MIBI was unambiguously positive in 74% of patients. Among patients with negative or inconclusive MIBI, 90% had a positive PTHw result. Among patients with negative PTHw, two out of three had a positive MIBI result. The PTHw of lesions

Magnetic fluid seals have long been thought to be a successful sealing form while sealing liquids are always a challenge. The instability of the liquid–liquid interface under the washout has become the key technical problem that hinders the realization of sealing liquid. This work mainly presents an experimental study about the influence of high viscosity and magnetoviscous effects on washout resistance. Three engine oil-based magnetic fluids of different viscosities were prepared with two kinds of surfactants. The magnetoviscous effects of the prepared magnetic fluids under different working conditions were found through rheological experiments. The viscosity of the three samples decreased at most by about 100 times with the shear rate increasing. An experimental platform was designed and built for the washout tests. The entire process of magnetic fluids being washed away was obtained experimentally. The magnetic fluid of higher viscosity can remain stationary with lower magnetic force. The quantitative results show that the viscosity of the magnetic fluid has a significant influence on washout resistance under a magnetic field.

Introduction: Hepatocellular Carcinoma (HCC) is the sixth most diagnosed cancer and the fourth leading cause of cancerrelated death globally. The male: female ratio for HCC in India is 4:1 with age of presentation ranging from 40 to 70 years. There is limited clinical information on the course of Subcentimeter- Sized Nodules (SCSNs) detected during surveillance for HCC. Aim: To evaluate the serial outcome of subcentimeter arterially enhancing nodules evolving into HCC and henceforth, to identify specific radiological features which can prognosticate and, if possible, predict which SCSNs will turn into HCC. Materials and Methods: A prospective cohort study was conducted in a tertiary care center in Delhi NCR, in the Department of Radiodiagnosis between 1st May 2018 and 30th April 2019. Total of 72 lesions in 59 patients were evaluated during the study period of one year, which included images spanning over a mean duration of three years (range 2-6.5 years). Dynamic contrast enhanced imaging was done as per Liver Imaging Reporting and Data System version 2018 (LI-RADS version 2018) using either Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The gold standard for HCC diagnosis was LR 5 lesion. Size cut-off, rate of growth, enhancement features were studied and calculated. Student's t-test was used for comparison of quantitative outcome parameters. Results: A total of 59 patients were analysed with mean age 53±12 years, of which 85% were males. The cumulative HCC development rate was 47.5%. A 60.9% of the SCSNs which turned into HCCs showed an increase in size, 31.6% of the non HCC-SCSN lesions also showed an increase in size. Upon baseline comparison, the growth difference was more in the HCC group (8.2±12.24 mm) than in the non HCC group (3.37±7.39 mm). The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increased significantly was 8.5 mm on CT and 10.5 mm on MRI. Conclusion: Around 47.5% of arterially enhancing SCSN converted into HCC; this percentage is much higher than quoted literature. A six monthly follow-up may be considered as 52.2 percent of lesions turned into HCC in a span of 1 year. The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increases can be taken as 8.55 mm on CT and 10.5 mm on MRI. Among the lesions showing washout, 80.8 % on CT and 91.3% nodules on MRI changed into HCC. [ABSTRACT FROM AUTHOR]

This paper considers a stochastic chemostat model with degenerate diffusion. Firstly, the Markov semigroup theory is used to establish sufficient criteria for the existence of a unique stable stationary distribution. The authors show that the densities of the distributions of the solutions can converge in L1 to an invariant density. Then, conditions are obtained to guarantee the washout of the microorganism. Furthermore, through solving the corresponding Fokker-Planck equation, the authors give the exact expression of density function around the positive equilibrium of deterministic system. Finally, numerical simulations are performed to illustrate the theoretical results. [ABSTRACT FROM AUTHOR]

Objective: Both myocardial perfusion scintigraphy and 18F-fluorodeoxyglucose positron emission tomography (FDG PET) are useful for the diagnosis of cardiac sarcoidosis (CS). However, the association between the washout of 99mTc-labeled tracer and FDG PET has not been established. This study aimed to evaluate the association between the washout of 99mTc-labeled tracer and FDG PET findings in patients with CS. Methods: We retrospectively analyzed 64 patients (65.0 ± 11.2 years, 53% male) with suspected CS who underwent myocardial single-photon emission computed tomography (SPECT) with 99mTc-labeled tracer and FDG PET. The SPECT images were acquired at 15 min (early images) and 3 h (delayed images) after injection and scored visually using a 17-segment model with a 5-point scoring system. The washout score was defined as the difference between the early and delayed total defect scores. FDG positivity was considered as focal or focal on diffuse patterns on visual assessment, and FDG uptake was quantified by measuring the standardized uptake value (SUV) of each of the 17 segments. Results: The washout score was significantly higher for the CS group than for the non-CS group (3.0 [−1.0–5.0] vs. 0.0 [−0.5–1.0], p = 0.010). Receiver operating characteristic analysis showed that a washout score of ≥ 2 had the best accuracy for detecting CS (88% sensitivity and 56% specificity) and FDG positivity (71% sensitivity and 89% specificity). In the segment-based analysis of 833 segments from 49 patients, excluding 15 patients with diffuse FDG uptake, the median SUVs for FDG uptake for the washout scores of ≤ 0, 1, and 2 were 2.3 (1.8–3.6), 4.2 (2.9–7.8), and 8.3 (6.5–9.4), respectively (p < 0.001). Conclusions: The washout of 99mTc-labeled tracer can be a useful marker for the evaluation of FDG PET findings in patients with CS. [ABSTRACT FROM AUTHOR]

Background: Increasingly, people with relapsing-remitting multiple sclerosis (RRMS) are switched to highly effective disease-modifying therapies (DMTs) such as ocrelizumab. Objective: To determine predictors of relapse and disability progression when switching from another DMT to ocrelizumab. Methods: Patients with RRMS who switched to ocrelizumab were identified from the MSBase Registry and grouped by prior disease-modifying therapy (pDMT; interferon-β/glatiramer acetate, dimethyl fumarate, teriflunomide, fingolimod or natalizumab) and washout duration (<1 month, 1–2 months or 2–6 months). Survival analyses including multivariable Cox proportional hazard regression models were used to identify predictors of on-ocrelizumab relapse within 1 year, and 6-month confirmed disability progression (CDP). Results: After adjustment, relapse hazard when switching from fingolimod was greater than other pDMTs, but only in the first 3 months of ocrelizumab therapy (hazard ratio (HR) = 3.98, 95% confidence interval (CI) = 1.57–11.11, p = 0.004). The adjusted hazard for CDP was significantly higher with longer washout (2–6 m compared to <1 m: HR = 9.57, 95% CI = 1.92–47.64, p = 0.006). Conclusion: The risk of disability worsening during switch to ocrelizumab is reduced by short treatment gaps. Patients who cease fingolimod are at heightened relapse risk in the first 3 months on ocrelizumab. Prospective evaluation of strategies such as washout reduction may help optimise this switch. [ABSTRACT FROM AUTHOR]

Background: 99mTc-sestamibi myocardial perfusion imaging (MIBI) washout is associated wit hmyocardial mitochondrial damage in patients with a successful percutaneous coronary intervention (PCI) following acute myocardial infarction (AMI) and may predict the functional improvement of the left ventricle in follow-ups. Objectives: This study aimed to investigate the clinical efficacy of 99mTc-MIBI washout in patients with AMI by measuring the mean defect area based on 99mTc-MIBI myocardial perfusion-single photon emission computed tomography (MP-SPECT) rest imaging in early and delayed phases and comparing it with the defect area based on 99mTc-MIBI MP-SPECT adenosine stress imaging based on a two-day rest/stress protocol. Patients and Methods: This study was conducted on 29 consecutive patients with AMI (23 males and 6 females; mean age, 71± 8.4 years), who underwent MP-SPECT using a standard two-day rest/stress protocol. The rest 99mTc-MIBI MP-SPECT images were acquired in the early phase at one hour after the injection of 99mTc-MIBI and in the delayed phase at three hours after the early phase. The total perfusion deficit (TPD) score for SPECT was measured to compare the defect area between the rest-early phase, rest-delayed phase, and post-stress imaging conditions. Results: Based on the results, the post-stress TPD score was significantly lower than the rest-delayed phase score (TPD: 22.2% ± 14.3% vs. 27.8% ± 14.0%; P < 0.001). Also, the rest-early phase score was significantly lower than the rest-delayed phase score (TPD: 21.5% ± 14.9% vs. 27.8% ± 14.0%; P < 0.001). However, no significant difference was observed between the post-stress score and the rest-early phase score. Conclusion: The combination of rest-early phase, delayed phase, and post-stress 99mTc-MIBI imaging using a two-day protocol after AMI reperfusion was a clinically useful method, which could identify residual ischemia and predict the left ventricular function improvement in the chronic phase of disease while reducing the exposure dose. [ABSTRACT FROM AUTHOR]

A comprehensive research study was conducted to evaluate the compressive strength of a new underwater concrete (UWC) type, commonly referred to as self-protected underwater concrete (SPUC). As the compressive strength is generally considered an essential characteristic of the performances of hydraulic and marine structures, especially because it is affected by the washout rate, the compressive strengths of SPUC were determined using the same concrete mixtures as those used for the SPUC washout loss tests. The concept of SPUC is different from that of the conventional UWC because it depends on the alteration of water characteristics in conjunction with the use of an underwater protective agent (UPA), such that the water medium can be readily available to receive fresh self-compacted concrete without mass loss. In addition to the air specimen, a strength test was conducted with freshwater and seawater specimens. The test results showed that the relative compressive strengths reached values equal to 90% and 88.48% for seawater and freshwater, respectively. These findings are compatible with the washout measurement outcomes. In addition, it is notable that the optimum slump flow for the compressive strength of the SPUC should not exceed 650 mm. Furthermore, the 28-day strength can be inferred from the 7-day strengths of freshwater and seawater.

Introduction: Hepatocellular Carcinoma (HCC) is the sixth most diagnosed cancer and the fourth leading cause of cancer-related death globally. The male:female ratio for HCC in India is 4:1 with age of presentation ranging from 40-70 years. There is limited clinical information on the course of Subcentimeter-Sized Nodules (SCSNs) detected during surveillance for HCC. Aim: To evaluate the serial outcome of subcentimeter arterially enhancing nodules evolving into HCC and henceforth, to identify specific radiological features which can prognosticate and, if possible, predict which SCSNs will turn into HCC. Materials and Methods: A prospective cohort study was conducted in a tertiary care centre in Delhi, India, in the Department of Radiodiagnosis between 1st May 2018 and 30th April 2019. Total of 72 lesions in 59 patients were evaluated during the study period of one year, which included images spanning over a mean duration of three years (range 2-6.5 years). Dynamic contrast enhanced imaging was done as per Liver Imaging Reporting and Data System version 2018 (LI-RADS version 2018) using either Magnetic Resonance Imaging (MRI) or Computed Tomography (CT). The gold standard for HCC diagnosis was LR 5 lesion. Size cut-off, rate of growth, enhancement features were studied and calculated. Student’s t-test was used for comparison of quantitative outcome parameters. Results: A total of 59 patients were analysed with mean age 53±12 years, of which 85% were males. The cumulative HCC development rate was 47.5%. A 60.9% of the SCSNs which turned into HCCs showed an increase in size, 31.6% of the non HCC-SCSN lesions also showed an increase in size. Upon baseline comparison, the growth difference was more in the HCC group (8.2±12.24 mm) than in the non HCC group (3.37±7.39 mm). The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increased significantly was 8.5 mm on CT and 10.5 mm on MRI. Conclusion: Around 47.5% of arterially enhancing SCSN converted into HCC; this percentage is much higher than quoted literature. A six monthly follow-up may be considered as 52.2 percent of lesions turned into HCC in a span of 1 year. The optimal cut-off points after which the likelihood of an arterially enhancing lesion turning into HCC increases can be taken as 8.55 mm on CT and 10.5 mm on MRI. Among the lesions showing washout, 80.8% on CT and 91.3% nodules on MRI changed into HCC.

Abstract Background To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Although RW is considered a safe practice, data on the complication risk are scarce. Our aim was to examine the association between RW and 30-day postoperative complications after AR for rectal cancer. Methods Patients from the Swedish Colorectal Cancer Registry who underwent AR between 2007 and 2013 were analysed using multivariable methods. Results A total of 4821 patients were included (4317 RW, 504 no RW). The RW group had lower rates of overall complications (1578/4317 (37%) vs. 208/504 (41%), p = 0.039), surgical complications (879/4317 (20%) vs. 140/504 (28%), p < 0.001) and 30-day mortality (50/4317 (1.2%) vs. 12/504 (2.4%), p = 0.020). In multivariable analysis, RW was a risk factor neither for overall complications (OR 0.73, 95% CI 0.60–0.90, p = 0.002) nor for surgical complications (OR 0.62, 95% CI 0.50–0.78, p < 0.001). Conclusions RW is a safe technique that does not increase the 30-day postoperative complication risk after AR with TME technique for rectal cancer.

Intraluminally shed viable tumor cells might contribute to anastomotic recurrence in cancer of the esophagus and the cardia. The study aimed to establish a method of esophageal washout and, hence, to reduce intraluminal cancer cells before esophageal anastomosis. Forty-eight consecutive patients with esophago-gastric resection for histologically proven cancer of the esophagus or the cardia were included in a prospective, interventional study. Before transection, the esophagus was clamped proximally to the tumor and rinsed with 1:10 diluted povidone–iodine-solution (10 × 30 ml) applied by a transorally inserted 24F-Foley catheter. The first, fifth and tenth portion of the lavage fluid were sent to cytological examination. Intraoperative frozen sections confirmed clear proximal resection margins of the esophagus. The cytological examination of the fluid recovered from the esophageal washout revealed malignant cells in 13/48 patients (27%). The presence of malignant cells was significantly less likely in patients with neoadjuvant treatment than in patients without neoadjuvant treatment: 2/23 (9%) vs. 11/25 (44%) (p = 0.009). Repetitive washout reduced the probability of detectable malignant cells from 13 to 8 (62%) patients after 5, and further to 4 patients (30%) after 10 washout maneuvers. Free malignant cells may be present in the esophageal lumen following intraoperative manipulation of cancers of the esophagus or cardia. Transoral washout of the esophagus is novel, feasible and enables reduction or even elimination of these tumor cells. The reliability of this procedure raises with increasing washout volume. Esophageal washout might be especially worthwhile in patients who do not receive neoadjuvant therapy. [ABSTRACT FROM AUTHOR]

Aim: Intraoperative rectal washout is performed to eliminate exfoliated intraluminal cancer cells and thereby decrease the risk of local recurrence. Rectal washout in abdominoperineal resection has not been studied. The aim of this study was to assess the oncological outcome after rectal washout in abdominoperineal resection for rectal cancer and to find evidence as to whether rectal washout should be performed or not. Method: Data for all patients registered in the Swedish Colorectal Cancer Registry who underwent elective surgery with abdominoperineal resection for rectal cancer (TNM Stages I–III) between 2007 and 2013 were analysed using multivariable analysis. Results: No significant differences were shown between the rectal washout group and the no rectal washout group for local recurrence [10/265 (3.8%) vs. 87/2160 (4.0%), p = 0.84], distant metastasis [51/265 (19.2%) vs. 476/2160 (22.0%), p = 0.29] or overall recurrence [53/265 (20.0%) vs. 505/2160 (23.4%), p = 0.21]. In multivariable analysis, rectal washout did not significantly affect the oncological outcome in terms of local recurrence, distant metastasis, overall recurrence or 5‐year overall or relative survival. Conclusion: Our results do not support routine rectal washout during abdominoperineal resection in order to improve the oncological outcome. [ABSTRACT FROM AUTHOR]

Purpose: To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection. Methods: A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery. Results: After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51–0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms. Conclusion: It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications. [ABSTRACT FROM AUTHOR]

Purpose: The sensitivity of cytology after fine needle aspiration (FNA-cytology) in detecting medullary thyroid carcinoma (MTC) is low. To overcome this problem, measuring calcitonin (CT) in washout fluid of FNA (FNA-CT) has been largely diffused and showed good performance. However, no evidence-based study exists comparing systematically the sensitivity of FNA-cytology and FNA-CT. This study aimed to systematically review the literature and collect data allowing a head-to-head comparison meta-analysis between FNA-cytology and FNA-CT in detecting MTC lesions. Methods: The online databases of PubMed/MEDLINE and Scopus were searched until June 2021. Original articles reporting the use of both FNA-cytology and FNA-CT in the same series of histologically proven MTC lesions were included They were extracted general features of each study, number of MTC lesions (nodule and neck lymph nodes), and true positive and false negatives of both FNA-cytology and FNA-CT. Results: Six studies were included. The sensitivity of FNA-cytology varied from 20% to 86% with a pooled value of 54% (95% CI 35–73%) and significant heterogeneity. The sensitivity of FNA-CT was higher than 95% in almost all studies with a pooled value of 98% (95% CI 96–100%) without heterogeneity. The sensitivity of FNA-CT was significantly higher than that of FNA-cytology. Conclusions: FNA-CT is significantly more sensitive than FNA-cytology in detecting MTC. Accordingly, FNA-CT represents the standard method to use in patients with suspicious MTC lesions, combined with cytology. [ABSTRACT FROM AUTHOR]

Hydraulic drilling jar (HDJ) was twisted off (fractured) at the end of the female-threaded box connection with upper lock housing during drilling operation in Egyptian oil company. The failed HDJ was used in drilling in two section holes 16″ and 12 ¼″. The jar was rotated under compression cyclic bending and fatigue stresses. The failure investigation included visual examination, chemical analysis and microstructure characterization performed by light microscopy, micro-hardness testing, scanning electron microscopy and energy-dispersive spectroscopy analysis. The experienced failure was identified as multiple fatigue cracking, washout and twisting off. The root cause of failure is the exposure of the jar to severe combined stresses caused by axial and lateral vibrations and rotation bending during drilling through the 16″ hole followed by the 12 ¼″ hole sections employing the same jar along string high deflections. Corrosion appears to be a contributing factor in both the initiation and propagation of fatigue cracks. The fatigue cracks are propagated and connected under the exerted severe loads reaching the housing outer wall and forming perforations. The pressurized mud flushes out and enlarges the perforations leading to wash out condition with sudden drop of mud pressure. Eventual jar twist-off occurrs when drilling is further continued. [ABSTRACT FROM AUTHOR]

While earlier studies reported no relevant effect of the HeartMate 3 (HM3) artificial pulse (AP) on bulk pump washout, its effect on regions with prolonged residence times remains unexplored. Using numerical simulations, we compared pump washout in the HM3 with and without AP with a focus on the clearance of the last 5% of the pump volume. Results were examined in terms of flush-volume (Vf, number of times the pump was flushed with new blood) to probe the effect of the AP independent of changing flow rate. Irrespective of the flow condition, the HM3 washout scaled linearly with flush volume up to 70% washout and slowed down for the last 30%. Flush volumes needed to washout 95% of the pump were comparable with and without the AP (1.3–1.4 Vf), while 99% washout required 2.1–2.2 Vf with the AP vs. 2.5 Vf without the AP. The AP enhanced washout of the bend relief and near-wall regions. It also transiently shifted or eliminated stagnation regions and led to rapid wall shear stress fluctuations below the rotor and in the secondary flow path. Our results suggest potential benefits of the AP for clearance of fluid regions that might elicit in-pump thrombosis and provide possible mechanistic rationale behind clinical data showing very low rate of in-pump thrombosis with the HM3. Further optimization of the AP sequence is warranted to balance washout efficacy while limiting blood damage.

ObjectiveTo compare the conspicuity of hepatocellular carcinoma (HCC) on hepatobiliary phase of gadoxetate disodium-enhanced vs. delayed phase of gadodiamide-enhanced MR images, relative to liver function.Methods and materialsWe retrospectively identified 86 patients with newly diagnosed HCC between 2010 and 2013 and recorded the severity of liver disease by Child-Pugh class (CPC). 38 patients had gadodiamide-enhanced 5-min delayed and 48 had gadoxetate disodium-enhanced 20-min delayed hepatobiliary MR images. The conspicuity of 86 HCCs (mean size, 2.7 cm) was graded visually on a 3-point scale and quantified by liver-to-tumor contrast ratios (LTC). The relative liver parenchymal enhancement (RPE) was measured. For different CPCs, we compared the conspicuity of HCC and RPE between gadodiamide and gadoxetate.ResultsIn patients with CPC A, the visual conspicuity and LTC of the 27 HCCs imaged with gadodiamide were significantly lower than those of the 38 HCCs with gadoxetate (P