Contrast Media Reduction in Computed Tomography With Deep Learning Using a Generative Adversarial Network in an Experimental Animal Study

alexandrossfakianakis shared this article with you from Inoreader Contrast Media Reduction in Computed Tomography With Deep Learning Using a Generative Adversarial Network in an Experimental Animal Study via Investigative Radiology - Current Issue Objective This feasibility study aimed to use optimized virtual contrast enhancement through generative adversarial networks (GAN) to reduce the dose of iodine-based contrast medium (CM) during abdominal computed tomography (CT) in a large animal model. Methods Multiphasic abdominal low-kilovolt CTs (90 kV) with low (low CM, 105 mgl/kg) and normal contrast media doses (normal CM, 350 mgl/kg) were performed with 20 healthy Göttingen minipigs on 3 separate occasions for a total of 120 examinations. These included an early arterial, late arterial, portal venous, and venous contrast phase. One animal had to be excluded because of incomplete examinations. Three of the 19 animals were randomly selected and withheld for validation (18 studies). Subsequently, the GAN was trained for image-to-image conversion from low CM to normal CM (virtual CM) with the remaining 16 animals (96 examinations). For validation, region of interest measurements were performed in the abdominal aorta, inferior vena cava, portal vein, liver parenchyma, and autochthonous back muscles, and the contrast-to-noise ratio (CNR) was calculated. In addition, the normal CM and virtual CM data were presented in a visual Turing test to 3 radiology consultants. On the one hand, they had to decide which images were derived from the normal CM examination. On the other hand, they had to evaluate whether both images are pathological consistent. Results Average vascular CNR (low CM 6.9 ± 7.0 vs virtual CM 28.7 ± 23.8, P View on Web

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Voriconazole‐induced severe skin allergy and neurological adverse event in a liver failure patient: A case report

alexandrossfakianakis shared this article with you from Inoreader Voriconazole‐induced severe skin allergy and neurological adverse event in a liver failure patient: A case report via Journal of Clinical Pharmacy and Therapeutics Severe allergy and neurological adverse events were appeared on the 19th day, which was the next day after voriconazole injection. The adverse events were alleviated after voriconazole withdraw for 1 week. VCZ: voriconazole, 0.4 g on the 18th day, followed by 0.2 g once daily, ALP: alprazolam, 0.2 g, per night, PT: piperacillin-tazobactam, 2.5 g every 12 h, IC: Imipenem cilastatin, 0.5 g every 8 hours, ENT: entecavir, 0.5 mg once daily, ADE: ademetionine, 0.25 g once daily, VAN: Vancomycin, 1 g every 12 h. Abstract What Is Known and Objective Triazole antifungal-associated severe skin allergy has received little attention. Here we report a case of an acute-on-chronic liver failure (ACLF) patient with diffused skin allergy pervading from the chest, abdomen, back, knees to perineum, with red colour and partially desquamation as well as a neurological adverse (insomnia) event after voriconazole treatment. Case Summary A 40-year-old man with liver failure in our hospital had received voriconazole for invasive fungal infection therapy, and while waiting for liver transplantation exhibited a severe diffuse rash and a neurological adverse event. What Is New and Conclusion To the best of our knowledge, this is the first report of a liver failure patient who suffered a severe allergy accompanied with a neurological adverse event after voriconazole administration. View on Web

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Impact of Ischemia Duration on Lower Limb Salvage in Combat Casualties

alexandrossfakianakis shared this article with you from Inoreader Impact of Ischemia Duration on Lower Limb Salvage in Combat Casualties via Annals of Surgery - Most Popular Articles Introduction: The 6-hour threshold to revascularization of an ischemic limb is ubiquitous in the trauma literature, however, contemporary evidence suggests that this threshold should be less. This study aims to characterize the relationship between the duration of limb ischemia and successful limb salvage following lower extremity arterial trauma. Methods: This is a cohort study of the United States and UK military service members injured while serving in Iraq or Afghanistan between 2003 and 2013. Consecutive patients who sustained iliac, femoral, or popliteal artery injuries, and underwent surgery to attempt revascularization, were included. The association between limb outcome and the duration of limb ischemia was assessed using the Kaplan-Meier method. Results: One hundred twenty-two patients (129 limbs) who sustained iliac (2.3%), femoral (56.6%), and popliteal (41.1%) arterial injuries were included. Overall, 87 limbs (67.4%) were successfully salvaged. The probability of limb salvage was 86.0% when ischemia was ≤1 hour; 68.3% when between 1 and 3 hours; 56.3% when between 3 and 6 hours; and 6.7% when >6 hours (P View on Web

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Development and Implementation of the Cochlear Implant Quality of Life (CIQOL) Functional Staging System

alexandrossfakianakis shared this article with you from Inoreader Development and Implementation of the Cochlear Implant Quality of Life (CIQOL) Functional Staging System via The Laryngoscope The purpose of this study was to develop and implement a functional staging system using the Cochlear Implant Quality of Life (CIQOL) framework to improve the interpretation of real-world outcomes for adult cochlear implant users. Using a mixed-methods approach that engaged primary stakeholders (CI users) and clinicians, the CIQOL functional staging system was created and used to monitor improvement from pre-CI to 6-months post-CI activation. Results from this study can be used during discussions of expectation with potential CI users to provide enhanced insight regarding realistic outcomes and the anticipated timing for improvements. Objectives The purpose of this study is to develop and implement a functional staging system using the Cochlear Implant Quality of Life (CIQOL) framework. The CIQOL-35 Profile was developed and validated following a rigorous research design and found to be more comprehensive and psychometrically sound than previous patient-reported outcome measures (PROMs) applied to adult CI users. However, interpreting the CIQOL-35 Profile (and all PROMs) relative to real-world functioning remains difficult for patients and clinicians, which limits the capacity of PROMs to direct clinical care. To address this limitation, a functional staging system based on PROM scores was developed to provide detailed descriptions of patients' self-reported abilities (clinical vignettes) without sacrificing the inherent value of the psychometrically derived scores. The current study (1) creates an evidence-based CIQOL functional staging system using advanced psychometric techniques, (2) confirms the clarity and meaningfu lness of the staging system with patients, and (3) implements the staging system to measure CIQOL stage progression using data from a longitudinal study design. Methods Item response theory (IRT) analyses of CIQOL-35 Profile data from 705 experienced adult CI users and expert opinion were used to determine the cut-scores that separated adjacent stages for the six CIQOL-35 domains (communication, emotional, entertainment, environment, listening effort, and social). The research team then created clinical vignettes based on item response patterns for each stage. Semi-structured key informant interviews were conducted with 10 adult CI users to determine the clarity and meaningfulness of the CIQOL stages and associated clinical vignettes. Finally, we prospectively collected CIQOL-35 Profile scores from 42 CI users prior to cochlear implantation and then at 3- and 6-months post-CI activation to measure CIQOL stage progression. Results Psychometric analyses identified five statistically distinct stages for the communication domain and three stages for all other domains. Using IRT analysis results for guidance, research team members independently identified the cut-scores that represented transitions between the functional stages for each domain with excellent agreement (κ = 0.98 [95% confidence interval 0.96–0.99]). Next, the key informant interviews revealed that CI users found the clinical vignettes to be clear and only minor changes were required. Participants also agreed that stage progression represented meaningful improvements in functional abilities. Finally, 88.1% of 42 patients in the prospective cohort (n = 37) improved from pre-CI functional stage by at least one functional stage in one or more domains. The communication domain had the greatest number of patients improve by one or more stages (59.5%) and the social domain the fewest (25.6%). There was also a trend for les s improvement at 3- and 6-months post-CI activation for patients at higher pre-CI functional stages, even though higher stages were achievable. Conclusion The new CIQOL functional staging system provides an evidence-based understanding of the real-world functional abilities of adult CI users from pre-CI to 3- to 6-months post-CI activation across multiple domains. In addition, study results provide the proportion of CI users in each stage at each timepoint. Results can be used during discussions of expectations with potential CI users to provide enhanced insight regarding realistic outcomes and the anticipated timing for improvements. The use of the CIQOL functional staging system also presents an opportunity to develop individualized goal-based rehabilitation strategies that target barriers to stage advancement faced by CI users. Level of Evidence 2 Laryngoscope, 2022 View on Web

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Rapid and reliable inactivation protocols for the diagnostics of emerging viruses: the example of SARS‐CoV‐2 and monkeypox virus

alexandrossfakianakis shared this article with you from Inoreader Rapid and reliable inactivation protocols for the diagnostics of emerging viruses: the example of SARS‐CoV‐2 and monkeypox virus via Journal of Medical Virology ABSTRACT The emergence and sustained transmission of novel pathogens are exerting an increasing demand on the diagnostics sector worldwide, as seen with the ongoing SARS-CoV-2 pandemic and the more recent public health concern of monkeypox virus (MPXV) since May 2022. Appropriate and reliable viral inactivation measures are needed to ensure the safety of personnel handling these infectious samples. In the present study, 7 commercialized diagnosis buffers, heat [56°C and 60°C], and sodium dodecyl sulfate detergent [SDS; 2.0%, 1.0%, and 0.5% final concentrations] were tested against infectious SARS-CoV-2 and MPXV culture isolates on Vero cell culture. Cytopathic effects were observed up to 7 days post-inoculation and viral load evolution was measured by semi-quantitative PCR. WHO recommends an infectious titer reduction of at least 4 log10. As such, the data show efficacious SARS-CoV-2 inactivation by all investigated methods, with >6.0 log10 reduction. MPXV inactivation was also validated with all investigated methods with 6.9 log10 reduction, although some commercial buffers required a longer incubation period to yield complete inactivation. These results are valuable for facilities, notably those without BSL-3 capabilities, that need to implement rapid and reliable protocols common against both SARS-CoV-2 and MPXV. This article is protected by copyright. All rights reserved. View on Web

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Development of a multi‐recombinase polymerase amplification assay for rapid identification of COVID‐19, Influenza A and B

alexandrossfakianakis shared this article with you from Inoreader Development of a multi‐recombinase polymerase amplification assay for rapid identification of COVID‐19, Influenza A and B via Journal of Medical Virology Abstract Background The coronavirus disease 2019 (COVID-19) pandemic caused extensive loss of life worldwide. Further, the COVID-19 and influenza mix-infection had caused great distress to the diagnosis of the disease. To control illness progression and limit viral spread within the population, a real-time reverse-transcription PCR (RT-PCR) assay for early diagnosis of COVID-19 was developed, but detection was time-consuming (4-6 h). Methods To improve the diagnosis of COVID-19 and influenza, we herein developed a recombinase polymerase amplification (RPA) method for simple and rapid amplification of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19 and Influenza A (H1N1, H3N2) and B (influenza B). Genes encoding the matrix protein (M) for H1N1, and the hemagglutinin (HA) for H3N2, and the polymerase A (PA) for Influenza B, and the nucleocapsid protein (N), the RNA-dependent-RNA polymerase (RdRP) in the open reading frame 1a b (ORF1ab) region, and the envelope protein (E) for SARS-CoV-2 were selected, and specific primers were designed. We validated our method using SARS-CoV-2, H1N1, H3N2 and influenza B pseudovirus standards and RNA samples extracted from COVID-19 and Influenza A/B (RT-PCR-verified) positive patients. Results The method could detect SARS-CoV-2 pseudovirus standard DNA quantitatively between 102 and 105 copies/mL with a log linearity of 0.99 in 22 min. And this method also be very effective in simultaneous detection of H1N1, H3N2 and influenza B. Clinical validation of 100 cases revealed a sensitivity of 100% for differentiating COVID-19 patients from healthy controls when the specificity was set at 90%. Conclusion These results demonstrate that this nucleic acid testing method is advantageous compared with traditional PCR and other isothermal nucleic acid amplification methods in terms of time and portability. This method could potentia lly be used for detection of SARS-CoV-2, H1N1, H3N2 and influenza B, and adapted for point-of-care (POC) detection of a broad range of infectious pathogens in resource-limited settings. This article is protected by copyright. All rights reserved. View on Web

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Assessing transmission risks and control strategy for monkeypox as an emerging zoonosis in a metropolitan area

alexandrossfakianakis shared this article with you from Inoreader Assessing transmission risks and control strategy for monkeypox as an emerging zoonosis in a metropolitan area via Journal of Medical Virology Abstract Objective To model the spread of Monkeypox (MPX) in a metropolitan area for assessing the risk of possible outbreaks, and identifying essential public health measures to contain the virus spread. Methods The animal reservoir is the key element in the modelling of a zoonotic disease. Using a One Health approach, we model the spread of the MPX virus in humans considering potential animal hosts such as rodents (e.g., rats, mice, squirrels, chipmunks, etc.) and emphasize their role and transmission of the virus in a high-risk group, including gay and bisexual men-who-have-sex-with-men (gbMSM). From model and sensitivity analysis, we identify key public health factors and present scenarios under different transmission assumptions. Findings We find that the MPX virus may spill over from gbMSM high-risk groups to broader populations if efficiency of transmission increases in the higher-risk group. However, the risk of outbreak can be greatly reduced if at least 65% of symptomatic cases can be isolated and their contacts traced and quarantined. In addition, infections in an animal reservoir will exacerbate MPX transmission risk in the human population. Conclusion Regions or communities with a higher proportion of gbMSM individuals need greater public health attention. Tracing and quarantine (or "effective quarantine" by post-exposure vaccination) of contacts with MPX cases in high-risk groups would have a significant effect on controlling the spreading. Also, monitoring for animal infections would be prudent. This article is protected by copyright. All rights reserved. View on Web

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