Acute aortic dissection:utilizing imaging modalities to improve detection

Acute aortic dissection is a serious condition in elderly patients and may become fatal rapidly if left undiagnosed and untreated. As pointed out by Welch et al1chest radiography is a screening test for this condition by detecting these signs such as widening mediastinum,blurring of the aortic knob, left apical cap, etc.

215 CASES OF OBESITY TREATED WITH TCM MODALITIES

Cases of obesity are increasing in recentyears,especially in the cities.The mecha-nism ot obesity is the excessive accumulationof fat chiefly in the subcutaneous tissue dueto unnecessary intake of food calories thattransform into fat.The author adopted va-rious modalities for the treatment of 215cases of obesity with good results as re-ported in the following.

Clinical-Pathological Features and Treatment Modalities of Primary Brain Tumors in Tanzania—4 Years of Institutional Experience

Background: The profile of primary brain tumors and treatment modalities employed in Tanzania remains largely unknown. The study aimed to describe the baseline clinical-pathological profile and treatment modalities for primary brain tumors in adults treated at the Ocean Road Cancer Institute (ORCI) from 2017 to 2020. Materials and Methods: This was a retrospective study conducted at ORCI by reviewing 61 medical records of patients with primary brain tumors over the age of 15 from January 2017 to December 2020. A structured questionnaire was used to retrieve information on sociodemographic, clinical-pathological characteristics, and treatment modalities. The 2007 WHO classification system and the International Classification of Cancer Diseases (ICD-0-3) were used for classification and diagnosis. The X2 test and Fisher’s exact test were used to compare the proportions and an independent t-test was used to compare the means. A P-value less than 0.05 was deemed statistically significant. The Results: The mean age of the females was 41.8 years and the mean age of males was 42.9 years. Overall M: F ratio was 1:1.2. Meningioma was the only tumor that was more commonly found in women with M:F of 1:2.1. The most prevalent symptom was headache (57.4%). Glioblastoma (GBM) was the most common tumor among adults (38%), followed by astrocytomas (23%) and meningioma (18%). Approximately 91.8% of all tumors occurred in the supratentorial region. The Frontal lobe was the most common site (29.5%). Approximately 81.9% of patients received surgery. The gross tumor resection (GTR) rate was 26.2%, and the subtotal tumor resection (STR) rate was 55.7%. Roughly 18% of the tumors were inoperable. An estimated 80.3% of respondents received radiation therapy. The radiotherapy technique was 3DCRT in two-thirds of the patients and the rest received conventional 2D radiotherapy. The mean equivalent dose in the 2 Gy fractions (EQD2) was 43.9 Gy. Respondents with low-grade intracranial tumors were treated with a mean EQD2 of 47.3 Gy, while those with high-grade intracranial tumors were treated with a mean EQD2 of 44.3 Gy and the difference was statistically significant. Only half of the patients who received adjuvant radiotherapy received it concurrently with chemotherapy. Temozolomide was the most widely used cytotoxic medication. Conclusion: Mean age of the patients was 41 years old. Most tumors were in the supratentorial area and GBM was the most common tumor. Only meningioma was a bit more common amongst females. Overall, radiotherapy doses and the gross tumor resection rates were low. Concurrent chemotherapy with radiotherapy was given to a few patients.

Impact of treatment modalities on patients with recurrent hepatocellular carcinoma after liver transplantation:Preliminary experience

Background:Post-liver transplantation(LT)hepatocellular carcinoma(HCC)recurrence still occurs in approximately 20%of patients and drastically affects their survival.This study aimed to evaluate the efficacy of various treatments for recurrent HCC after LT in a Chinese population.Methods:A total of 64 HCC patients with tumor recurrence after LT were enrolled in this study.Univariate and multivariate analyses were performed to identify factors affecting post-recurrence survival.Results:Of the 64 patients with recurrent HCC after LT,those who received radical resection followed by nonsurgical therapy had a median overall survival(OS)of 20.9 months after HCC recurrence,significantly superior to patients who received only nonsurgical therapy(9.4 months)or best supportive care(2.4 months).The one-and two-year OS following recurrence was favorable for patients receiving radical resection followed by nonsurgical therapy(93.8%,52.6%),poor for patients receiving only nonsurgical therapy(30.8%,10.8%),and dismal for patients receiving best supportive care(0%,0%;overall P<0.001).Median OS in sorafenib-tolerant patients treated with lenvatinib was 19.5 months,far surpassing the patients that discontinued sorafenib or were treated with regorafenib after sorafenib failure(12 months,P<0.001).Compared with tacrolimus-based immunosuppressive therapy,OS was significantly increased with sirolimus-based therapy at one and two years after HCC recurrence(P=0.035).Multivariate analysis showed radical resection combined with nonsurgical therapy for recurrent HCC and sorafenib-lenvatinib sequential therapy were independent favorable factors for post-recurrence survival.Conclusions:Aggressive surgical intervention in well-selected patients significantly improves OS after recurrence.A multidisciplinary treatment approach is required to slow down disease progression for patients with unresectable recurrent HCC.

Coronary atherosclerosis is already ongoing in pre-diabetic status: Insight from intravascular imaging modalities

Diabetes mellitus is a powerful risk factor of coronary artery disease(CAD), leading to death and disability. In recent years, given the accumulating evidence that prediabetes is also related to increasing risk of CAD including cardiovascular events, a new guideline has been proposed for the treatment of blood cholesterolfor primary prevention of cardiovascular events. This guideline recommends aggressive lipid-lowering statin therapy for primary prevention in diabetes and other patients. The ultimate goal of patient management is to inhibit progression of systemic atherosclerosis and prevent fatal cardiovascular events such as acute coronary syndrome(ACS). Because disruption of atherosclerotic coronary plaques is a trigger of ACS, the high-risk atheroma is called a vulnerable plaque. Several types of novel diagnostic imaging technologies have been developed for identifying the characteristics of coronary atherosclerosis before the onset of ACS, especially vulnerable plaques. According to coronary angioscopic evaluation, atherosclerosis severity and plaque vulnerability were more advanced in prediabetic than in nondiabetic patients and comparable to that in diabetic patients. In addition, pharmacological intervention by statin therapy changed plaque color and complexity, and the dynamic changes in plaque features are considered plaque stabilization. In this article, we review the findings of atherosclerosis in prediabetes, detected by intravascular imaging modalities, and the therapeutic implications.

WHAT ARE THE ACUPUNCTURE MODALITIES FOR TREATMENT OF EPIGASTRIC PAIN

Epigastric pain is a common symptomusually induced by improper diet(disharmonious temperature effects dam-aging the Spleen and Stomach),emotionalfrustration that stirs up perverted flow ofLiver-qi to disrupt the Stomach,or defi-ciency and stagnation of cold in the Spleenand Stomach.Therefore,epigastric pain in-volves the Stomach,the Spleen,and the Liv-er.For treatment,the individual patientsshould be discriminated with respect to thespecific nature of the pain and accom-panying symptoms,and whether the case isone of exuberance or deficiency.

Unexpected Dramatic Response of Pretreated Invasive Thymic Malignancies on Pemetrexed-Case Report and Review of Current Treatment Modalities

Thymomas are rare and usually slowly growing tumors, originating from the epithelial layer of the thymus. Prognosis depends on the extent of invasion of adjacent tissues whereby multimodality treatment including surgery with or without adjuvant chemoradiotherapy is the preferred approach for locally advanced thymomas. For metastatic thymomas, only few chemotherapeutic options are available. We report 2 cases of patients with metastatic thymic malignancies with a dramatic response on pemetrexed treatment. The choice for this antifolate therapy is based upon a small series. Because metastatic thymic neoplasm is a rare disease, large randomised trials are not feasible. Case reports on the treatment of these malignancies are very important and can provide readers with the opportunity to deal with rare dis- eases.

Comparative effectiveness of different hepatocellular carcinoma screening intervals or modalities:a systematic review and meta-analysis

Background:Current guidelines recommend hepatocellular carcinoma(HCC)screening in high-risk populations.However,the ideal HCC screening interval and screening modality have not been determined.This study aimed to compare the screening efficacy among different modalities with various intervals.Methods:PubMed and other nine databases were searched through June 30,2021.Binary outcomes were pooled using risk ratio(RR)with 95%confidence intervals(CIs).Survival rates were also pooled using RR with 95%CIs because most eligible studies only provided the number of survival patients instead of hazard ratio.Results:In all,13 studies were included.Two random controlled trials(RCTs)and six cohort studies compared screening intervals for ultrasonography(US)screening and found no significant differences between shorter(3-or 4-month)and longer(6-or 12-month)screening intervals in terms of early HCC proportion,HCC significant mortality,1-year survival rate;screening at 6-month interval significantly increased the proportion of early HCC(RR=1.17,95%confidence interval[CI]:1.08-1.26)and prolonged the 5-year survival rate(RR=1.39,95%CI:1.07-1.82)relative to the 12-month interval results.Three other RCTs and two cohort studies compared different screening modalities in cirrhosis or chronic hepatitis B,which indicated no statistical differences in the proportion of early HCC(RR=0.89,95%CI:0.40-1.96)and HCC mortality(RR=0.69,95%CI:0.23-2.09)between the biannual US and annual computed tomography(CT screening).Biannual US screening showed a lower proportion of early HCC than biannual magnetic resonance imaging(MRI)(RR=0.60,95%CI:0.37-0.97)and biannual US combined with annual CT(RR=1.31,95%CI:1.13-1.51)screening.The proportion of early HCC in the contrast-enhanced US group was slightly higher than that in the B-mode US(RR=1.08,95%CI:1.00-1.23)group.Conclusions:The evidence suggests that 6 months may be the best HCC screening interval for US screening.The effectiveness of CT and MRI is better than US during same screening intervals.However,MRI and CT are more expensive than US,and CT also can increase the risk of radiation exposure.The selection of CT or MRI instead of US should be carefully considered.Registration:No.CRD42020148258 at PROSPERO website(https://www.crd.york.ac.uk/PROSPERO/).

Neuroimaging modalities in the detection of Alzheimer’s disease-associated biomarkers

Alzheimer’s disease(AD)is the most common cause of dementia.Neuropathological changes in AD patients occur up to 10–20 years before the emergence of clinical symptoms.Specific diagnosis and appropriate intervention strategies are crucial during the phase of mild cognitive impairment(MCI)and AD.The detection of biomarkers has emerged as a promising tool for tracking the efficacy of potential therapies,making an early disease diagnosis,and prejudging treatment prognosis.Specifically,multiple neuroimaging modalities,including magnetic resonance imaging(MRI),positron emission tomography,optical imaging,and single photon emissioncomputed tomography,have provided a few potential biomarkers for clinical application.The MRI modalities described in this review include structural MRI,functional MRI,diffusion tensor imaging,magnetic resonance spectroscopy,and arterial spin labelling.These techniques allow the detection of presymptomatic diagnostic biomarkers in the brains of cognitively normal elderly people and might also be used to monitor AD disease progression after the onset of clinical symptoms.This review highlights potential biomarkers,merits,and demerits of different neuroimaging modalities and their clinical value in MCI and AD patients.Further studies are necessary to explore more biomarkers and overcome the limitations of multiple neuroimaging modalities for inclusion in diagnostic criteria for AD.

A Comprehensive Survey for Privacy-Preserving Biometrics: Recent Approaches, Challenges, and Future Directions

The rapid growth of smart technologies and services has intensified the challenges surrounding identity authenti-cation techniques.Biometric credentials are increasingly being used for verification due to their advantages over traditional methods,making it crucial to safeguard the privacy of people’s biometric data in various scenarios.This paper offers an in-depth exploration for privacy-preserving techniques and potential threats to biometric systems.It proposes a noble and thorough taxonomy survey for privacy-preserving techniques,as well as a systematic framework for categorizing the field’s existing literature.We review the state-of-the-art methods and address their advantages and limitations in the context of various biometric modalities,such as face,fingerprint,and eye detection.The survey encompasses various categories of privacy-preserving mechanisms and examines the trade-offs between security,privacy,and recognition performance,as well as the issues and future research directions.It aims to provide researchers,professionals,and decision-makers with a thorough understanding of the existing privacy-preserving solutions in biometric recognition systems and serves as the foundation of the development of more secure and privacy-preserving biometric technologies.

Colorectal cancer screening:The value of early detection and modern challenges

The screening of colorectal cancer(CRC)is pivotal for both the prevention and treatment of this disease,significantly improving early-stage tumor detection rates.This advancement not only boosts survival rates and quality of life for patients but also reduces the costs associated with treatment.However,the adoption of CRC screening methods faces numerous challenges,including the technical limitations of both noninvasive and invasive methods in terms of sensitivity and specificity.Moreover,socioeconomic factors such as regional disparities,economic conditions,and varying levels of awareness affect screening uptake.The coronavirus disease 2019 pandemic further intensified these challenges,leading to reduced screening participation and increased waiting periods.Additionally,the growing prevalence of early-onset CRC necessitates innovative screening approaches.In response,research into new methodologies,including artificial intelligence-based systems,aims to improve the precision and accessibility of screening.Proactive measures by governments and health organizations to enhance CRC screening efforts are underway,including increased advocacy,improved service delivery,and international cooperation.The role of technological innovation and global health collaboration in advancing CRC screening is undeniable.Technologies such as artificial intelligence and gene sequencing are set to revolutionize CRC screening,making a significant impact on the fight against this disease.Given the rise in early-onset CRC,it is crucial for screening strategies to continually evolve,ensuring their effectiveness and applicability.

A 63-Year-Old Male with D-Transposition of the Great Arteries Who Had an Early Form of the Arterial Switch Operation

We describe a 63-year-old male who appears to have undergone an early form of the arterial switch operation for D-transposition of the great arteries performed in the mid-1960s.We review the clinical and imaging data that support our conclusion.He had a diagnostic cardiac catheterization which demonstrated severe pulmonary hypertension responsive to epoprostenol and oxygen.Our case may represent one example of the experimental surgical work done prior to Dr.Adibe Jatene’s description of thefirst successful arterial switch performed in 1975.

It’s Time for New Insights into Renovascular Hypertension at the Molecular Level

At the cellular level, reduced kidney perfusion in atherosclerotic renal arthery disease (ARVD), induces hypoxia, activation of the renin-angiotensin-aldosterone system (RAAS) and cytokine activation. Impaired blood flow in the kidneys creates a microenvironment triggering significant cytokine production, contributing to vascular damage and endothelial disfunction. Interactions between cytokines and endothelial, glomerular, and tubular cells often result in increased vessel permeability, and fibrosis, and contribute to the development of chronic kidney disease (CKD). Molecules such as endothelins, prostaglandins, and nitric oxide play a crucial role at the molecular level. The imbalance between vasoconstrictor and vasodilator factors contributes to vascular dysfunction. Oxidative stress and inflammatory processes at the cellular level contribute to endothelial damage and structural changes in blood vessels. Mineralocorticoid receptor antagonists (MRAs) therapy in the context of ARVD holds promise in reducing fibrosis, promoting angiogenesis and enhancing overall outcomes in patients with this pathology. Recent data also indicates the antioxidative, anti-inflammatory, and antifibrotic effects of SGLT2 inhibitors. They reduce oxidative stress caused by hypoxic conditions and enhance renal perfusion, contributing to the preservation of cellular function. Studies employing Blood Oxygen Level-Dependent (BOLD) imaging have identified adaptations to reduced blood flow, volume, and glomerular filtration rate in post-stenotic kidneys that preserve oxygenation in the medulla and cortex during medical therapy. Data from the literature indicate that despite the partial recovery of renal hypoxia and restoration of blood flow after revascularization, inflammatory cytokines and injury biomarkers remain elevated, and the glomerular filtration rate (GFR) does not recover in ARVD. Restoration of vascular patency alone has failed to reverse tubulointerstitial damage and partially explains the limited clinical benefit of renal stenting. Considering these findings, BOLD MR imaging emerges as a technique capable of providing insights into the critical juncture of irreversibility in ARVD. However, further research is needed to monitor renal hypoxia following renal artery stenting and the inflammatory response over an extended period in conjunction with optimal therapy involving MRAs and SGLT2 agonists. The aim of research at the molecular level enables the identification of potential therapeutic modalities targeting specific molecular pathways, opening the door to innovative approaches in treating renovascular hypertension.

Sparse Modal Decomposition Method Addressing Underdetermined Vortex-Induced Vibration Reconstruction Problem for Marine Risers

When investigating the vortex-induced vibration(VIV)of marine risers,extrapolating the dynamic response on the entire length based on limited sensor measurements is a crucial step in both laboratory experiments and fatigue monitoring of real risers.The problem is conventionally solved using the modal decomposition method,based on the principle that the response can be approximated by a weighted sum of limited vibration modes.However,the method is not valid when the problem is underdetermined,i.e.,the number of unknown mode weights is more than the number of known measurements.This study proposed a sparse modal decomposition method based on the compressed sensing theory and the Compressive Sampling Matching Pursuit(Co Sa MP)algorithm,exploiting the sparsity of VIV in the modal space.In the validation study based on high-order VIV experiment data,the proposed method successfully reconstructed the response using only seven acceleration measurements when the conventional methods failed.A primary advantage of the proposed method is that it offers a completely data-driven approach for the underdetermined VIV reconstruction problem,which is more favorable than existing model-dependent solutions for many practical applications such as riser structural health monitoring.

Three-Dimensional Sound Source Location Algorithm for Subsea Leakage Using Hydrophone

Leakages from subsea oil and gas equipment cause substantial economic losses and damage to marine ecosystem,so it is essential to locate the source of the leak.However,due to the complexity and variability of the marine environment,the signals collected by hydrophone contain a variety of noises,which makes it challenging to extract useful signals for localization.To solve this problem,a hydrophone denoising algorithm is proposed based on variational modal decomposition(VMD)with grey wolf optimization.First,the average envelope entropy is used as the fitness function of the grey wolf optimizer to find the optimal solution for the parameters K andα.Afterward,the VMD algorithm decomposes the original signal parameters to obtain the intrinsic mode functions(IMFs).Subsequently,the number of interrelationships between each IMF and the original signal was calculated,the threshold value was set,and the noise signal was removed to calculate the time difference using the valid signal obtained by reconstruction.Finally,the arrival time difference is used to locate the origin of the leak.The localization accuracy of the method in finding leaks is investigated experimentally by constructing a simulated leak test rig,and the effectiveness and feasibility of the method are verified.

Current Modalities of Fibrosis Assessment in Non-alcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease (NAFLD) is a burgeoning global health concern.In the subset of NAFLD patients with non-alcoholic steatohepatitis (NASH),the presence of significant fibrosis at index assessment is associated with poor prognosis and increased mortality.Hence,there is a growing need to accurately assess and stage fibrosis.Liver biopsy,the current gold standard,has limitations with sampling error and is invasive,with associated inherent risk.This has led to a host of non-invasive means of assessing fibrosis,which has garnered relevance in a disease that requires serial assessment of fibrosis longitudinally over time.This review discusses,comprehensively,the various tools available to the clinician for the assessment of fibrosis,including the various scoring systems used in liver biopsy,the non-invasive means of serum biomarkers,such as the highly-validated NAFLD fibrosis score,and the imaging-based modalities,such as transient elastography and magnetic resonance elastography.

Application of machine learning in ophthalmic imaging modalities

In clinical ophthalmology,a variety of image-related diagnostic techniques have begun to offer unprecedented insights into eye diseases based on morphological datasets with millions of data points.Artificial intelligence(AI),inspired by the human multilayered neuronal system,has shown astonishing success within some visual and auditory recognition tasks.In these tasks,AI can analyze digital data in a comprehensive,rapid and non-invasive manner.Bioinformatics has become a focus particularly in the field of medical imaging,where it is driven by enhanced computing power and cloud storage,as well as utilization of novel algorithms and generation of data in massive quantities.Machine learning(ML)is an important branch in the field of AI.The overall potential of ML to automatically pinpoint,identify and grade pathological features in ocular diseases will empower ophthalmologists to provide high-quality diagnosis and facilitate personalized health care in the near future.This review offers perspectives on the origin,development,and applications of ML technology,particularly regarding its applications in ophthalmic imaging modalities.

Different fundus imaging modalities and technical factors in AI screening for diabetic retinopathy:a review

Background:Effective screening is a desirable method for the early detection and successful treatment for diabetic retinopathy,and fundus photography is currently the dominant medium for retinal imaging due to its convenience and accessibility.Manual screening using fundus photographs has however involved considerable costs for patients,clinicians and national health systems,which has limited its application particularly in less-developed countries.The advent of artificial intelligence,and in particular deep learning techniques,has however raised the possibility of widespread automated screening.Main text:In this review,we first briefly survey major published advances in retinal analysis using artificial intelligence.We take care to separately describe standard multiple-field fundus photography,and the newer modalities of ultrawide field photography and smartphone-based photography.Finally,we consider several machine learning concepts that have been particularly relevant to the domain and illustrate their usage with extant works.Conclusions:In the ophthalmology field,it was demonstrated that deep learning tools for diabetic retinopathy show clinically acceptable diagnostic performance when using colour retinal fundus images.Artificial intelligence models are among the most promising solutions to tackle the burden of diabetic retinopathy management in a comprehensive manner.However,future research is crucial to assess the potential clinical deployment,evaluate the cost-effectiveness of different DL systems in clinical practice and improve clinical acceptance.

Long-term outcomes of brainstem arteriovenous malformations after different management modalities: a single-centre experience

Objective The aims of this study are to clarify the long-term outcomes of brainstem arteriovenous malformations(AVMs)after different management modalities.Methods The authors retrospectively reviewed 61 brainstem AVMs in their institution between 2011 and 2017.The rupture risk was represented by annualised haemorrhagic rate.Patients were divided into five groups:conservation,microsurgery,embolisation,stereotactic radiosurgery(SRS)and embolisation+SRS.Neurofunctional outcomes were evaluated by the modified Rankin Scale(mRS).Subgroup analysis was conducted between different management modalities to compare the long-term outcomes in rupture or unruptured cohorts.Results All of 61 brainstem AVMs(12 unruptured and 49 ruptured)were followed up for an average of 4.5 years.The natural annualised rupture risk was 7.3%,and the natural annualised reruptured risk in the ruptured cohort was 8.9%.13 cases were conservative managed and 48 cases underwent intervention(including 6 microsurgery,12 embolisation,21 SRS and 9 embolisation+SRS).In the selection of interventional indication,diffuse nidus were often suggested conservative management(p=0.004)and nidus involving the midbrain were more likely to be recommended for intervention(p=0.034).The risk of subsequent haemorrhage was significantly increased in partial occlusion compared with complete occlusion and conservative management(p<0.001,p=0.036,respectively).In the subgroup analysis,the follow-up mRS scores of different management modalities were similar whether in the rupture cohort(p=0.064)or the unruptured cohort(p=0.391),as well as the haemorrhage-free survival(p=0.145).In the adjusted Bonferroni correction analysis of the ruptured cohort,microsurgery and SRS could significantly improve the obliteration rate compared with conservation(p<0.001,p=0.001,respectively)and SRS may have positive effect on avoiding new-onset neurofunctional deficit compared with microsurgery and embolisation(p=0.003,p=0.003,respectively).Conclusions Intervention has similar neurofunctional outcomes as conservation in these brainstem AVM cohorts.If intervention is adopted,partial obliteration should be avoided because of the high subsequent rupture risk.