Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Social contracts and precautions activate different neurological systems: An fMRI investigation of deontic reasoning

We conducted an event-related, functional MRI investigation of 12 male’s and 12 female’s reasoning about conditional deontic rules, rules regulating people’s behavior. We employed two different types of rules: social contracts and nonsocial, precautionary rules. Although the rules and the demands of the task were matched in terms of their logical\ud structure, reasoning about social contracts and precautions activated a different constellation of neurological structures. The regions differentially activated by social contracts included dorsomedial PFC (BA 6/8), bilateral ventrolateral PFC (BA 47), the left angular gyrus (BA 39),\ud and left orbitofrontal cortex (BA 10). The regions differentially activated by precautions included bilateral insula, the left lentiform nucleus, posterior cingulate (BA 29/31), anterior cingulate (BA 24) and right postcentral gyrus (BA 3). Collectively, reasoning about prescriptive\ud rules activated the dorsomedial PFC (BA 6/8). The results reinforce the view that human reasoning is not a unified phenomenon, but is content-sensitive

Integral calculus problem solving: an fMRI investigation

Only a subset of adults acquires specific advanced mathematical skills, such as integral calculus. The representation of more sophisticated mathematical concepts probably evolved from basic number systems; however its neuroanatomical basis is still unknown. Using fMRI, we investigated the neural basis of integral calculus while healthy subjects were engaged in an integration verification task. Solving integrals activated a left-lateralized cortical network including the horizontal intraparietal sulcus, posterior superior parietal lobe, posterior cingulate gyrus, and dorsolateral prefrontal cortex. Our results indicate that solving of more abstract and sophisticated mathematical facts, such as calculus integrals, elicits a pattern of brain activation similar to the cortical network engaged in basic numeric comparison, quantity manipulation, and arithmetic problem solving

Implementation of an International Vessel Wall MR Plaque Imaging Research Network: Experience with the ChAMPION Study

Background and Objective: Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide. High-resolution Vessel Wall MR imaging (VW-MR) is commonly used to study ICAS, but in order to accelerate advances in the field of VW-MR ICAS research, the establishment of a multicenter research network is needed. We introduce our experience in establishing a collaborative international VW-MR ICAS research network in China and North America using an innovative, disease-specific ICAS imaging phantom for standardization of VW-MR sequences at the sites. Methods: Both the Medical University of South Carolina and Peking Union Medical College functioned as Central Coordinating Centers in the network. PUMC identified research centers within China that had the potential for collaboration on VW-MR ICAS research based on networking and prior experience. All selected centers refined MRI sequences using an ICAS phantom with study principal investigators virtually present in real-time during scanning. MRI sequences were efficiently calibrated utilizing the broad expertise of all members of the research team. All centers further validated MRI sequences with human subjects. Results: We identified 11 Chinese hospitals as the potential collaborating sites for the network. Of the 11 selected sites, six sites were able to complete the required VW-MR scanning and sequence refinement using the ICAS phantom and subsequent human subjects. Conclusion: The study demonstrated the feasibility of establishing a cross-continent collaborative VW-MR research network and the use of a disease-specific phantom to facilitate convenient and efficient sequence modification for image quality standardization, which is needed for future multicenter VW-MR studies

Implementation of an International Vessel Wall MR Plaque Imaging Research Network: Experience with the ChAMPION Study

Background and Objective: Intracranial atherosclerosis (ICAS) is one of the most common causes of stroke worldwide. High-resolution Vessel Wall MR imaging (VW-MR) is commonly used to study ICAS, but in order to accelerate advances in the field of VW-MR ICAS research, the establishment of a multicenter research network is needed. We introduce our experience in establishing a collaborative international VW-MR ICAS research network in China and North America using an innovative, disease-specific ICAS imaging phantom for standardization of VW-MR sequences at the sites. Methods: Both the Medical University of South Carolina and Peking Union Medical College functioned as Central Coordinating Centers in the network. PUMC identified research centers within China that had the potential for collaboration on VW-MR ICAS research based on networking and prior experience. All selected centers refined MRI sequences using an ICAS phantom with study principal investigators virtually present in real-time during scanning. MRI sequences were efficiently calibrated utilizing the broad expertise of all members of the research team. All centers further validated MRI sequences with human subjects. Results: We identified 11 Chinese hospitals as the potential collaborating sites for the network. Of the 11 selected sites, six sites were able to complete the required VW-MR scanning and sequence refinement using the ICAS phantom and subsequent human subjects. Conclusion: The study demonstrated the feasibility of establishing a cross-continent collaborative VW-MR research network and the use of a disease-specific phantom to facilitate convenient and efficient sequence modification for image quality standardization, which is needed for future multicenter VW-MR studies

Machine learning assisted DSC-MRI radiomics as a tool for glioma classification by grade and mutation status

Combining MRI techniques with machine learning methodology is rapidly gaining attention as a promising method for staging of brain gliomas. This study assesses the diagnostic value of such a framework applied to dynamic susceptibility contrast (DSC)-MRI in classifying treatment-na\uefve gliomas from a multi-center patients into WHO grades II-IV and across their isocitrate dehydrogenase (IDH) mutation status