To investigate the role of ultrasound (US) in the evaluation of intrinsic and extrinsic ligaments of the wrist with magnetic resonance arthrography (MRA) as the reference standard.
This prospective ...study included patients referred for MRA after wrist trauma. US examination was performed just before MRA. On the dorsal and palmar sides of the wrist, the intrinsic interosseus and midcarpal, extrinsic, and collateral ligaments were evaluated. MRA was performed on a 1.5-T unit. In the first 20 patients included, ligament thickness was independently assessed using US and MRA and thickness reproducibility was calculated. Ligament integrity was evaluated in all patients.
38 patients (22 men, 16 women; mean age: 38 years) were included. Ligament thickness reproducibility ranged between 44% for the palmar ulnocapitate ligament and 71% for the palmar scaphotriquetral ligament. US had a sensitivity, specificity, positive and negative predictive values, and accuracy of 100% in the identification of tears of the palmar (n=8) and dorsal (n=3) bands of the scapholunate ligament and the ulnar collateral ligament (n=3). It had a sensitivity of 100%, specificity of 97%, positive predictive value of 50%, negative predictive value of 100%, and accuracy of 97% in the identification of tears of the palmar ulnolunate ligament (n=1).
Compared to MRA, US showed good reproducibility in the assessment of wrist ligament thickness and similar accuracy with respect to identifying tears of the scapholunate, palmar ulnolunate, and ulnar collateral ligaments.
Abstract Purpose To systematically review the use of artificial intelligence (AI) in musculoskeletal (MSK) ultrasound (US) with an emphasis on AI algorithm categories and validation strategies. ...Material and Methods An electronic literature search was conducted for articles published up to January 2024. Inclusion criteria were the use of AI in MSK US, involvement of humans, English language, and ethics committee approval. Results Out of 269 identified papers, 16 studies published between 2020 and 2023 were included. The research was aimed at predicting diagnosis and/or segmentation in a total of 11 (69%) out of 16 studies. A total of 11 (69%) studies used deep learning (DL)-based algorithms, three (19%) studies employed conventional machine learning (ML)-based algorithms, and two (12%) studies employed both conventional ML- and DL-based algorithms. Six (38%) studies used cross-validation techniques with K-fold cross-validation being the most frequently employed ( n = 4, 25%). Clinical validation with separate internal test datasets was reported in nine (56%) papers. No external clinical validation was reported. Conclusion AI is a topic of increasing interest in MSK US research. In future studies, attention should be paid to the use of validation strategies, particularly regarding independent clinical validation performed on external datasets.
Objective
Adipose tissue plays a role in the novel coronavirus disease 2019 (COVID‐19). Epicardial adipose tissue (EAT), a unique visceral fat, presents with a high degree of inflammation in severe ...COVID‐19. Whether and how adipose tissue may respond to the COVID‐19 therapies is unknown.
Methods
The difference in computed tomography‐measured EAT and subcutaneous (SAT) attenuation, defined as mean attenuation expressed in Hounsfield units (HU), was retrospectively analyzed in 72 patients (mean SD age was 59.6 12.4 years, 50 patients 69% were men) at the hospital admission for COVID‐19 and 99 days (interquartile range = 71‐129) after discharge.
Results
At the admission, EAT‐HU was significantly correlated with blood glucose levels, interleukin 6, troponin T levels, and waist circumference. EAT‐HU decreased from −87.21 (16.18) to −100.0 (11) (p < 0.001), whereas SAT‐HU did not change (−110.21 12.1 to −111.11 27.82; p = 0.78) after therapy. Changes in EAT‐HU (expressed as ∆) significantly correlated with dexamethasone therapy (r = −0.46, p = 0.006) and when dexamethasone was combined with tocilizumab (r = −0.24, p = 0.04).
Conclusions
Dexamethasone therapy was associated with significant reduction of EAT inflammation in COVID‐19 patients, whereas SAT showed no changes. Anti‐inflammatory therapies targeting visceral fat may be helpful in COVID‐19.
Objectives
To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR).
...Methods
A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed.
Results
Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25–39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient’s lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively.
Conclusion
Training in CM use and management ADR should be implemented in the training of radiology residents.
Critical relevance statement
We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions.
Key points
• This survey investigated training of young radiologists about use of contrast media and management adverse reactions.
• Most young radiologists claimed they did not receive dedicated training.
• An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy.
Graphical Abstract
•Fingolimod phosphate is the bioactive molecule in Nieman-Pick and mucolipidosis IV.•Fingolimod phosphoramidate prodrugs were designed and synthesised for efficient delivery of Fingolimod ...phosphate.•Two Fingolimod prodrugs were shown to be activated in neuronal cell lysate.•A fluorescent prodrug has been prepared and evaluated for liposome-prodrug interaction studies.•The remarkable emissive properties of fluorescent tagged prodrug 18 allowed to monitor and prove the successful interaction with liposomes evaluated as cell membrane models with different lipid compositions. This is of importance as a preliminary experiment for the future application of the compound in living cells.
FTY720 (Fingolimod, Gilenya, 1), a structural analog of sphingosine (2) was the first orally administered drug approved for the treatment of multiple sclerosis (MS). However, the phosphate derivative of Fingolimod, namely Fingolimod-1-phosphate (FTY720-1P, 3) is the biologically active molecule in MS as well as in various lysosomal storage diseases such as mucolipidosis IV and Nieman-Pick. In all cases, Fingolimod requires to be phosphorylated, resembling the natural sphingosine phosphate (4), to accomplish its therapeutic/biological effects. Here, we report the synthesis of a small library of prodrugs that could provide the efficient delivery of 3, the bioactive species. Moreover, to gain insight about the biological behaviour of these novel candidates within human body such as cell and brain blood barrier penetration we have prepared and spectroscopically characterised a fluorescent tagged version of one of the new prodrugs. The behavior of our prodrugs with respect to biological membranes was evaluated by studying the interaction between the fluorescent prodrug 18 and DOPC/DPPC liposome models.
Background: Elevated serum levels of the thymus and activation-regulated chemokine/CCL17 (TARC) reflect tumor burden in classical HL at diagnosis and their reduction during treatment can predict ...prognosis. Interim PET, performed after 2 cycles of ABVD (PET2), proved to be highly effective in identifying advanced-stage HL patients at risk of failure by continuing ABVD (Gallamini A et al. J Clin Oncol 2007;25:3746), whereas their prognosis could be improved by shifting to BEACOPP escalated (Gallamini A et al. Haematologica 2017;102s: S413). Nevertheless, a not negligible fraction of patients (13%-15%) despite a negative PET2 is reported to experience failure with ABVD, and only 60% of patients are expected to be salvaged by BEACOPP escalated. Therefore, the evaluation of biomarkers like serum TARC levels, an easy to perform and relatively inexpensive procedure, could be useful to assess risk of disease progression in patients treated with a PET-adapted strategy. The aim of this study was to evaluate the correlation of PFS and early serum TARC levels reduction in patients with advanced-stage HL treated according to HD0607 PET-driven trial.
Methods
HD0607 trial was a prospective open label phase II study treating, from June 2008 to June 2014, 782 newly diagnosed advanced-stage HL patients with 2 cycles of ABVD, followed by PET2; PET2-negative patients continued with 4 cycles ABVD and PET2-positive patients were randomized to 4 cycles BEACOPP escalated followed by 4 cycles BEACOPP standard with or without Rituximab. Serum TARC levels were measured by commercially available ELISA test kits (R&D System, Minneapolis, USA) on frozen sera of patients at baseline and after 2 ABVD cycles (T2). The value of 800 pg/mL, representing the 99th centile of TARC distribution in a group of 156 independent healthy subjects, was considered as cut-off value discriminating between normal and abnormal TARC values. The Wilcoxon Mann Whitney test was used to analyze the association between median TARC values and PET2 results or treatment outcome. Kaplan-Meyer curves and log-rank test were used to assess differences in PFS according to TARC levels. Cox model was used for multivariate analysis.
Results
The serum TARC levels were assessed in 243 patients at baseline and after 2 ABVD cycles. Main patient characteristics were as follows: males/females: 122/121, median age: 31 years (range, 16-60), B symptoms: 86%, bulky disease (>5cm): 59%, stage IIB: 43%, stage III: 31%, stage IV: 26%, IPS>3: 14%. Median (IQ range) TARC values at baseline and after 2 ABVD were: 37855 (13990-73312) and 444 (277-723) pg/mL, respectively. A positive PET2 was recorded in 47/243 (19%) patients and 46/243 (19%)patients experienced disease failure. Median (IQ range) T2 values were significantly higher in PET2-positive patients compared to their counterpart (703, IQ 389-2517 vs 424, IQ 250-656; p<.001), and in patients with progression or relapse compared to those in continuous CR (580, IQ 308-1297 vs 429, IQ 277-661; p=.01). With the selected cut-off of 800 pg/mL, the sensitivity and specificity of T2 in predicting PET2 results and treatment outcome were 0.43, 0.82 and 0.41, 0.82, respectively.
As shown in Figure 1, after a median follow-up of 3.6 years, the 3-year PFS for patients with T2 ≤ vs >800 pg/mL was significantly different: 85% vs 66% (p<.001), and T2>800 pg/mL was able to identify patients with a worse prognosis also among those with a negative PET2 (3-year PFS: 77% vs 88%; p=.03). In univariate and multivariate analysis T2 > 800 pg/mL, positive PET2 and IPS>3 significantly affected PFS. T2 was a significant independent predictor of outcome in both the whole study population (HR 2.26; 95% CI :1.22-4.20) and in the PET2 negative patients (HR 2.37; 95% CI: 1.06-5.26).
Conclusions
Early reduction of serum TARC levels, after 2 ABVD cycles, are associated with a favorable outcome in patients treated with a PET-driven strategy. Evaluation of T2 may help identifying those patients at risk of treatment failure despite a negative PET2.
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Viviani:Takeda Italia: Speakers Bureau; Takeda International: Research Funding. Zanotti:Deciphera: Consultancy. Corradini:Sanofi: Honoraria; Roche: Honoraria; Gilead: Honoraria; Takeda: Honoraria; Novartis: Honoraria; Janssen: Honoraria; Celgene: Honoraria; Amgen: Honoraria. Rambaldi:Novartis, Amgen, Celgene, Sanofi: Other: Travel, Accomodations, Expenses; Novartis, Roche/Genentech, Amgen, Italfarmaco: Consultancy.
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