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Clinical Radiology May 2024In the rapidly evolving field of artificial intelligence (AI) for radiology, with a plethora of vendor options and use-cases and evidence claims to sift through, the... (Review)
Review
In the rapidly evolving field of artificial intelligence (AI) for radiology, with a plethora of vendor options and use-cases and evidence claims to sift through, the pressing question is how to effectively implement the right tool for enhanced patient care? This article presents a structured approach to AI deployment, drawing from a comprehensive case study in South West London. We underscore the necessity of forming a dedicated AI team with a clear vision and assertive leadership to navigate such complexities. Central to our discussion is the significance of crafting an AI implementation plan, with an overarching aim to augment patient care, promote operational efficiency, and lay down standardized protocols for seamless AI adoption. By presenting a blueprint for AI implementation within the National Health Service (NHS), we intend to demystify the process for radiology departments across the UK, enabling them to make informed decisions and empowering their staff to embrace and leverage AI responsibly ensuring that patient welfare remains at the heart of innovation. Thus, having a framework to follow when implementing an AI solution that addresses a vision for scalable adoption, core team members with diversity of skillset, staff engagement and education, plan for vendor selection, and change management is crucial for success.
PubMed: 38942706
DOI: 10.1016/j.crad.2024.05.018 -
Radiography (London, England : 1995) Jun 2024Alzheimer's disease (AD), the most common cause of dementia, presents a global health crisis with its prevalence expected to triple worldwide by 2050, emphasizing the...
INTRODUCTION
Alzheimer's disease (AD), the most common cause of dementia, presents a global health crisis with its prevalence expected to triple worldwide by 2050, emphasizing the urgent need for early diagnosis to delay progression and improve patient quality of life. Our project aims to detect AD in its early phase by identifying subtle neuroanatomical changes with Radiomics features, offering a more accurate diagnosis.
METHODS
The AssemblyNet segmentation model was used to analyze brain changes by employing anonymized T1 MRI scans from 416 patients. For each segmented label we extracted Radiomic features. After preprocessing of Radiomic features we trained four models, Gradient Booster, Random Forest, Support Vector Classifier, and XGBoost, in a 70%/20%/10% train, validation and test split. All models were hyperparameter tuned with GridSearch, Cross validation and evaluated with accuracy on the test data.
RESULTS
208 T1-weighted MRI scans were segmented, with 132 segmentation labels per patient, 1130 Radiomic features per segmentation, totalling in over 31 million features. For all four models we achieved accuracies between 0.71 and 0.86, and the machine learning model with highest accuracy were XGBoost, achieving an accuracy at 0.86 on the segmentation of the left inferior lateral ventricle.
CONCLUSION
Our study's use of segmentation on T1-weighted MRI scans resulted promising accuracies for early AD diagnosis with the machine learning model XGBoost, peaking at 0.86 accuracy. Future research should aim to expand datasets and refine methodologies for broader applicability.
IMPLICATION FOR PRACTICE
Implementing Radiomics for early AD detection using T1-weighted MRI scans could substantially improve diagnostic accuracy, enabling earlier interventions that may delay disease progression and improve outcomes, thereby requiring radiographers to adopt more advanced imaging techniques and analysis tools, as well as additional training to effectively interpret complex Radiomic data.
PubMed: 38942647
DOI: 10.1016/j.radi.2024.06.016 -
Best Practice & Research. Clinical... Jun 2024Identifying metabolic and cardiovascular risks of gender-affirming hormone therapy (GAHT) is challenging due to other confounding variables that affect patient outcomes... (Review)
Review
Identifying metabolic and cardiovascular risks of gender-affirming hormone therapy (GAHT) is challenging due to other confounding variables that affect patient outcomes and the diversity of treatment regimes. Masculinising hormone therapy produces atherogenic lipid profiles, while effects on other metabolic parameters are not consistent. There is insufficient evidence to conclude if cardiovascular disease risk among transmen is increased. The effects of feminising hormone therapy on metabolic parameters do not demonstrate a consistent pattern in the available literature. However, the risk of venous thromboembolism is greater in transwomen than in cis-gender men and women with a possible increase in cardiovascular disease risk. It is recommended to discuss the potential effects of GAHT on cardiovascular health and encourage patients seeking GAHT to adopt a healthy lifestyle. Performing baseline and periodic assessments of cardiovascular risk factors would enable early identification and interventions. In high-risk individuals, the cardiovascular effects of hormonal regimes might impact the treatment decision.
PubMed: 38942618
DOI: 10.1016/j.beem.2024.101907 -
Human Reproduction Update Jun 2024Chemotherapy-associated ovarian damage (CAOD) is one of the most feared short- and long-term side effects of anticancer treatment in premenopausal women. Accumulating...
BACKGROUND
Chemotherapy-associated ovarian damage (CAOD) is one of the most feared short- and long-term side effects of anticancer treatment in premenopausal women. Accumulating detailed data show that different chemotherapy regimens can lead to disturbance of ovarian hormone levels, reduced or lost fertility, and an increased risk of early menopause. Previous studies have often focused on the direct effects of chemotherapeutic drugs on ovarian follicles, such as direct DNA damage-mediated apoptotic death and primordial follicle burnout. Emerging evidence has revealed an imbalance in the ovarian microenvironment during chemotherapy. The ovarian microenvironment provides nutritional support and transportation of signals that stimulate the growth and development of follicles, ovulation, and corpus luteum formation. The close interaction between the ovarian microenvironment and follicles can determine ovarian function. Therefore, designing novel and precise strategies to manipulate the ovarian microenvironment may be a new strategy to protect ovarian function during chemotherapy.
OBJECTIVE AND RATIONALE
This review details the changes that occur in the ovarian microenvironment during chemotherapy and emphasizes the importance of developing new therapeutics that protect ovarian function by targeting the ovarian microenvironment during chemotherapy.
SEARCH METHODS
A comprehensive review of the literature was performed by searching PubMed up to April 2024. Search terms included 'ovarian microenvironment' (ovarian extracellular matrix, ovarian stromal cells, ovarian interstitial, ovarian blood vessels, ovarian lymphatic vessels, ovarian macrophages, ovarian lymphocytes, ovarian immune cytokines, ovarian oxidative stress, ovarian reactive oxygen species, ovarian senescence cells, ovarian senescence-associated secretory phenotypes, ovarian oogonial stem cells, ovarian stem cells), terms related to ovarian function (reproductive health, fertility, infertility, fecundity, ovarian reserve, ovarian function, menopause, decreased ovarian reserve, premature ovarian insufficiency/failure), and terms related to chemotherapy (cyclophosphamide, lfosfamide, chlormethine, chlorambucil, busulfan, melphalan, procarbazine, cisplatin, doxorubicin, carboplatin, taxane, paclitaxel, docetaxel, 5-fluorouraci, vincristine, methotrexate, dactinomycin, bleomycin, mercaptopurine).
OUTCOMES
The ovarian microenvironment shows great changes during chemotherapy, inducing extracellular matrix deposition and stromal fibrosis, angiogenesis disorders, immune microenvironment disturbance, oxidative stress imbalances, ovarian stem cell exhaustion, and cell senescence, thereby lowering the quantity and quality of ovarian follicles. Several methods targeting the ovarian microenvironment have been adopted to prevent and treat CAOD, such as stem cell therapy and the use of free radical scavengers, senolytherapies, immunomodulators, and proangiogenic factors.
WIDER IMPLICATIONS
Ovarian function is determined by its 'seeds' (follicles) and 'soil' (ovarian microenvironment). The ovarian microenvironment has been reported to play a vital role in CAOD and targeting the ovarian microenvironment may present potential therapeutic approaches for CAOD. However, the relation between the ovarian microenvironment, its regulatory networks, and CAOD needs to be further studied. A better understanding of these issues could be helpful in explaining the pathogenesis of CAOD and creating innovative strategies for counteracting the effects exerted on ovarian function. Our aim is that this narrative review of CAOD will stimulate more research in this important field.
REGISTRATION NUMBER
Not applicable.
PubMed: 38942605
DOI: 10.1093/humupd/dmae020 -
Methods in Enzymology 2024Plants are prolific producers of terpenoids. Terpenoid biosynthesis is initiated by terpene synthases (TPS). In plants, two types of terpenes synthase genes are...
Plants are prolific producers of terpenoids. Terpenoid biosynthesis is initiated by terpene synthases (TPS). In plants, two types of terpenes synthase genes are recognized: typical plant TPS genes and microbial-terpene synthase like-genes (MTPSL). While TPS genes are ubiquitous in land plants, MTPSL genes appear to be restricted to non-seed land plants. Evolutionarily, TPS genes are specific to land plants, whereas MTPSL genes have related counterparts in other organisms, especially fungi and bacteria. The presence of microbial type TPS in plants, fungi and bacteria, with the latter two often being associated with plants, poses a challenge in accurately identifying bona fide MTPSL genes in plants. In this chapter, we present bioinformatic procedures designed to identify MTPSL genes in sequenced plant genomes and/or transcriptomes. Additionally, we outline validation methods for confirming the identified microbial-type TPS genes as genuine plant genes. The method described in this chapter can also be adopted to analyze microbial type TPS in organisms other than plants.
Topics: Alkyl and Aryl Transferases; Computational Biology; Plants; Terpenes; Phylogeny; Genes, Plant; Plant Proteins; Bacteria
PubMed: 38942508
DOI: 10.1016/bs.mie.2024.02.014 -
Methods in Enzymology 2024Chemoenzymatic synthesis of non-natural terpenes using the promiscuous activity of terpene synthases allows for the expansion of the chemical space of terpenoids with...
Chemoenzymatic synthesis of non-natural terpenes using the promiscuous activity of terpene synthases allows for the expansion of the chemical space of terpenoids with potentially new bioactivities. In this report, we describe protocols for the preparation of a novel aphid attractant, (S)-14,15-dimethylgermacrene D, by exploiting the promiscuity of (S)-germacrene D synthase from Solidago canadensis and using an engineered biocatalytic route to convert prenols to terpenoids. The method uses a combination of five enzymes to carry out the preparation of terpenoid semiochemicals in two steps: (1) diphosphorylation of five or six carbon precursors (prenol, isoprenol and methyl-isoprenol) catalyzed by Plasmodium falciparum choline kinase and Methanocaldococcus jannaschii isopentenyl phosphate kinase to form DMADP, IDP and methyl-IDP, and (2) chain elongation and cyclization catalyzed by Geobacillus stearothermophilus (2E,6E)-farnesyl diphosphate synthase and S. canadensis (S)-germacrene D synthase to produce (S)-germacrene D and (S)-14,15-dimethylgermacrene D. Using this method, new non-natural terpenoids are readily accessible and the approach can be adopted to produce different terpene analogs and terpenoid derivatives with potential novel applications.
Topics: Terpenes; Alkyl and Aryl Transferases; Plasmodium falciparum; Animals; Biocatalysis; Substrate Specificity; Aphids
PubMed: 38942504
DOI: 10.1016/bs.mie.2024.03.015 -
PDA Journal of Pharmaceutical Science... Jun 2024The Risk Knowledge Infinity (RKI) Cycle Framework was featured as part of the ICH-sanctioned training materials supporting the recent issuance of ICH Q9(R1) To support...
The Risk Knowledge Infinity (RKI) Cycle Framework was featured as part of the ICH-sanctioned training materials supporting the recent issuance of ICH Q9(R1) To support ICH Q9(R1) understanding and adoption, this paper presents a case study on the application of the RKI Cycle, based on an underlying out-of-specification investigation. This case study provides a stepwise walk-through of the cycle to illustrate how key concepts within the ICH Q9(R1) revision can be achieved through better connecting quality risk management and knowledge management with a framework such as the RKI Cycle.
Topics: Risk Management; Humans; Knowledge Management; Quality Control; Drug Industry
PubMed: 38942476
DOI: 10.5731/pdajpst.2023.012931 -
Annals of Allergy, Asthma & Immunology... Jun 2024Asthma is a prevalent health concern among Illinois children and management is significantly influenced by social determinants. Seventeen states have adopted stock...
BACKGROUND
Asthma is a prevalent health concern among Illinois children and management is significantly influenced by social determinants. Seventeen states have adopted stock inhaler laws, but implementation varies widely.
OBJECTIVE
To assess critical barriers to implementation and address sustainability of stock inhaler programming in school-based asthma care in IL.
METHODS
Semi-structured interviews were conducted with high asthma burden school districts in IL to assess barriers in implementing stock inhaler policies and resultant programming. Thematic analysis was performed, using Atlas.ti to identify and code "threats" to future sustainability. Data was synthesized and presented to stakeholders for barrier mitigation. A schematic flow chart outlining steps to support sustainability was created.
RESULTS
Eighteen interviews were conducted with key community partners across eight Illinois school districts, representing rural, urban, and suburban areas. Analysis revealed 25 barriers, with several identified as "threats" to future sustainability, including liability concerns, follow-up care assurance, funding/resources, pharmacy dispensing practices, district-level readiness to change, and nurse staffing. Stakeholders formed a statewide coalition to address these barriers, increase awareness, plan evaluations, and advise on state funding allocation. A national stock inhaler toolkit tailored to school administrative needs was developed to support sustainability efforts.
CONCLUSION
Strategic stakeholder and community engagement are vital for establishing and sustaining stock inhaler programs that adhere to policy mandates. Many districts face challenges initiating and maintaining such programs without critical barrier mitigation and support. Collaborative solutions are necessary to ensure effective school-based asthma management and mitigate persistent pediatric asthma health disparities.
PubMed: 38942380
DOI: 10.1016/j.anai.2024.06.023 -
Annals of Vascular Surgery Jun 2024Advanced endovascular techniques, such as fenestrated stent grafts, are nowadays available that permit minimally invasive treatment of complex abdominal aortic... (Review)
Review
Expert-based narrative review on contemporary use of an off-the-shelf multibranched endograft for endovascular treatment of thoracoabdominal aortic aneurysms: device design, anatomical suitability, technical tips, peri-operative care, clinical applications, and real-world experience.
Advanced endovascular techniques, such as fenestrated stent grafts, are nowadays available that permit minimally invasive treatment of complex abdominal aortic aneurysms. However, thoracoabdominal aortic aneurysm (TAAA) patients have anatomic limitations to fenestrated stent-grafts, given a large lumen, i.e. the gap between the endograft and the inner aortic wall. This has led to the development of branched endovascular aneurysm repair (BEVAR) as the ideal option for such patients. The Zenith t-Branch multibranched endograft (Cook Medical, Bloomington, Ind), which has been commercially available in Europe to treat TAAA since June 2012, represents a feasible off-the-shelf (OTS) alternative for treatment of such pathologies, especially in the urgent setting, for patients who cannot wait the time required for manufacturing and delivery of custom-made endografts. The device's anatomical suitability should be considered, especially for female patients with smaller iliofemoral vessels. Several tips may help deal with particularly complex scenarios (such as, for instance, in case of narrow inner aortic lumens or when treating patients with failure of prior EVAR), and a broad array of techniques and devices must be available to ensure technical and clinical success. Despite promising early outcomes, concerns remain particularly regarding the risk for spinal cord ischemia and further assessment of long-term durability is needed, including the rate of target vessel instability and need for secondary interventions. As the published evidence mainly comes from retrospective registries, it is likely that reported outcomes may suffer from an intrinsic bias as most procedures reported to date have been caried out at high-volume aortic centers. Nonetheless, with the never-ceasing adoption of new and refined techniques, outcomes are expected to ameliorate.
PubMed: 38942377
DOI: 10.1016/j.avsg.2024.05.006 -
The Science of the Total Environment Jun 2024The construction and building sector is one of the largest contributors to the global carbon emissions. Therefore, it is imperative to accurately assess the carbon...
The construction and building sector is one of the largest contributors to the global carbon emissions. Therefore, it is imperative to accurately assess the carbon emissions of buildings throughout the life cycle. Many studies conducted life cycle assessment (LCA) of buildings to evaluate carbon emissions. However, due to the lack of dynamic data, most studies adopted the static LCA methodology, which neglected the dynamic variations during life cycle stages of a building. Unlike previous studies that collected static data from questionnaires and documents, the present study aims to establish a novel dynamic life cycle assessment (D-LCA) framework for buildings by incorporating the building information modeling (BIM) and the building energy modeling program (BEMP) into the static LCA. First, a static LCA is established as the baseline scenario that covers the "cradle-to-grave" life cycle stages. A BIM model is established using Revit to obtain the inventory of building materials. The Designer Simulation Toolkit (DeST) is used as a BEMP to simulate the operating energy consumption of the studied building, taking into account changes in energy mix, climate change, and occupant behavior. At the same time, the DeST results are further used as a data input for dynamic scenarios. The D-LCA framework is applied to a high-rise commercial building in China. This study found that the difference between static and dynamic scenarios was up to 66.7 %, mainly reflected in the dynamic energy consumption during the operation phase, indicating the inaccuracy of traditional static LCA. Therefore, a D-LCA by integrating BIM and BEMP can facilitate dynamic modeling and improve the accuracy and reliability of LCA for buildings.
PubMed: 38942319
DOI: 10.1016/j.scitotenv.2024.174284