Split-bolus dual-energy CT urography: protocol optimization and diagnostic performance for the detection of urinary stones

Purpose: Prospective protocol optimization, determination of image quality and diagnostic performance of virtual non-enhanced images (VNEI) derived from split-bolus dual-energy computed tomography (DECT) urography in patients with urinary stones. Methods: IRB-approved, prospective study of 100 patients who, after written informed consent, underwent single-energy, non-enhanced CT and split-bolus, contrast-enhanced DECT (30+50mL of contrast media; combined nephro-urographic acquisition). DECT was performed using setting A (80/140kVp) in the first 20, and setting B (100/140kVp) in the second 20 patients. Tin filtration was used in all patients. After a pre-analysis of VNEI quality, 60 additional patients were examined using setting B. Two readers qualitatively and quantitatively determined image quality of all weighted-average DECT images regarding urinary tract opacification (n=100), and all VNEI regarding quality of iodine subtraction and urinary stone detection (n=80). True nonenhanced (TNEI) images were the standard of reference for statistical analysis (inter-reader variability and diagnostic performance characteristics). Results: The urinary tract was completely opacified in 94% (94/100) of patients. Iodine subtraction was improved (p<0.01) and image noise of VNEI was lower (p<0.05) in DECT setting B. On VNEI, 83% (86/104) of urinary stones were correctly identified and 17% (18/104) were missed. Stones missed (2.5mm, 1-4) were significantly smaller than stones correctly identified (5mm, 2-27; p<0.001). Diagnostic accuracy was 98% on a per-renal-unit basis and 96% on a per-patient basis. Inter-reader agreements were excellent (κ=0.91-1.00; ICC=0.86-0.99). Conclusions: Split-bolus DECT urography was technically feasible and quality of VNEI was improved with the 100/140kVp setting. Detection of urinary stones <4mm on VNEI was limite

Physics Potential of a Few Kiloton Scale Neutrino Detector at a Deep Underground Lab in Korea

The demand for underground labs for neutrino and rare event search experiments has been increasing over the last few decades. Yemilab, constructed in October 2022, is the first deep ($\sim$1~km) underground lab dedicated to science in Korea, where a large cylindrical cavern (D: 20~m, H: 20~m) was excavated in addition to the main caverns and halls. The large cavern could be utilized for a low background neutrino experiment by a liquid scintillator-based detector (LSC) where a 2.26 kiloton LS target would be filled. It's timely to have such a large but ultra-pure LS detector after the shutdown of the Borexino experiment so that solar neutrinos can be measured much more precisely. Interesting BSM physics searches can be also pursued with this detector when it's combined with an electron linac, a proton cyclotron (IsoDAR source), or a radioactive source. This article discusses the concept of a candidate detector and the physics potential of a large liquid scintillator detector.Comment: 63 pages, 36 figures, 8 table

Antibodies to nodal/paranodal proteins in paediatric immune-mediated neuropathy

Altres ajuts: This work was partly supported by grants from the "Jubiläumsfonds der Österreichischen Nationalbank," project 16919 (R. Höftberger), the GBS/CIDP Foundation International (J. Wanschitz), Austrian Science Fund FWF, DOC 33-B27 (R. Höftberger, M. Winklehner) and I3334-B27 (R. Höftberger), Hertha Firnberg project number T996-B30 (I. Koneczny), the grant of the Fondo de Investigaciones Sanitarias-Instituto de Salud Carlos III (fondos FEDER) (L. Querol), personal grant of the Pla estratègic de Recerca i Innovació en Salut (PERIS), Departament de Salut, Generalitat de Catalunya (L. Querol), and the German Ministry of Education and Research (BMBF, 01 GM1908A)

Association of Mortality and Risk of Epilepsy With Type of Acute Symptomatic Seizure After Ischemic Stroke and an Updated Prognostic Model

IMPORTANCE: Acute symptomatic seizures occurring within 7 days after ischemic stroke may be associated with an increased mortality and risk of epilepsy. It is unknown whether the type of acute symptomatic seizure influences this risk. OBJECTIVE: To compare mortality and risk of epilepsy following different types of acute symptomatic seizures. DESIGN, SETTING, AND PARTICIPANTS: This cohort study analyzed data acquired from 2002 to 2019 from 9 tertiary referral centers. The derivation cohort included adults from 7 cohorts and 2 case-control studies with neuroimaging-confirmed ischemic stroke and without a history of seizures. Replication in 3 separate cohorts included adults with acute symptomatic status epilepticus after neuroimaging-confirmed ischemic stroke. The final data analysis was performed in July 2022. EXPOSURES: Type of acute symptomatic seizure. MAIN OUTCOMES AND MEASURES: All-cause mortality and epilepsy (at least 1 unprovoked seizure presenting >7 days after stroke). RESULTS: A total of 4552 adults were included in the derivation cohort (2547 male participants [56%]; 2005 female [44%]; median age, 73 years [IQR, 62-81]). Acute symptomatic seizures occurred in 226 individuals (5%), of whom 8 (0.2%) presented with status epilepticus. In patients with acute symptomatic status epilepticus, 10-year mortality was 79% compared with 30% in those with short acute symptomatic seizures and 11% in those without seizures. The 10-year risk of epilepsy in stroke survivors with acute symptomatic status epilepticus was 81%, compared with 40% in survivors with short acute symptomatic seizures and 13% in survivors without seizures. In a replication cohort of 39 individuals with acute symptomatic status epilepticus after ischemic stroke (24 female; median age, 78 years), the 10-year risk of mortality and epilepsy was 76% and 88%, respectively. We updated a previously described prognostic model (SeLECT 2.0) with the type of acute symptomatic seizures as a covariate. SeLECT 2.0 successfully captured cases at high risk of poststroke epilepsy. CONCLUSIONS AND RELEVANCE: In this study, individuals with stroke and acute symptomatic seizures presenting as status epilepticus had a higher mortality and risk of epilepsy compared with those with short acute symptomatic seizures or no seizures. The SeLECT 2.0 prognostic model adequately reflected the risk of epilepsy in high-risk cases and may inform decisions on the continuation of antiseizure medication treatment and the methods and frequency of follow-up

Unusual Phenotype and Disease Trajectory in Kearns–Sayre Syndrome

Objective. To describe unusual course and unusual phenotypic features in an adult patient with Kearns–Sayre syndrome (KSS). Case Report. The patient is a 49-year-old male with KSS, diagnosed clinically upon the core features, namely, onset before the age 20 of years, pigmentary retinopathy, and ophthalmoparesis, and the complementary features, namely, elevated CSF protein, cardiac conduction defects, and cerebellar ataxia. The patient presented also with other previously described features, such as diabetes, short stature, white matter lesions, hypoacusis, migraine, hepatopathy, steatosis hepatis, hypocorticism (hyponatremia), and cataract. Unusual features the patient presented with were congenital anisocoria, severe caries, liver cysts, pituitary enlargement, desquamation of hands and feet, bone chondroma, aortic ectasia, dermoidal cyst, and sinusoidal polyposis. The course was untypical since most of the core phenotypic features developed not earlier than in adulthood. Conclusions. KSS is a multisystem disease, but the number of tissues affected is higher than so far anticipated. KSS should be considered even if core features develop not earlier than in adulthood and if unusual features accompany the presentation

Compact, Low-Cost, Light-Weight, Superconducting, Ironless Cyclotrons for Hadron Radiotherapy

Superconducting cyclotrons are increasingly employed for proton beam radiotherapy treatment (PBRT). The use of superconductivity in a cyclotron design can reduce its mass by an order of magnitude and size by a factor of 3-4 over conventional resistive magnet technology, yielding significant reduction in overall cost of the device, the accelerator vault, and its infrastructure, as well as reduced operating costs. At MIT, previous work was focused on developing a very high field (9 T at the pole face) superconducting synchrocyclotron that resulted in a highly compact device that is about an order of magnitude lighter, and much smaller in diameter than a conventional, resistive cyclotron. The results of the study reported here were focused on a conceptual design for a compact superconducting synchrocyclotron to demonstrate the possibility to further reduce its weight by almost another order of magnitude by eliminating all iron from the device. In the absence of magnetic iron poles, the magnetic field profile in the beam gap is achieved through a set of main superconducting split pair coils energized in series with a set of distributed field-shaping superconducting coils. External magnetic field shielding is achieved through a set of outer, superconducting ring coils, also connected in series with the other coils, to cancel the stray magnetic field. These shielding coils replace the heavy iron yoke which is the conventional method to return the magnetic flux. It is noted that the 10 Gauss surface is located at a radius of about 3.5 m comparable in both ironless and conventional devices, even in the absence of iron in the ironless device. An important result from eliminating all magnetic iron in the flux circuit is the resulting linear relationship between the operating current and the magnetic field intensity. In the case with iron, the saturation of the magnetic field forces operation at one value of magnetic field. This feature design then enables continuous beam energy variation without the use of an energy degrader, thus eliminating secondary radiation during the in-depth beam scanning, increasing the ion current delivered to the patient and improving the beam quality. The beam energy is determined by the magnetic field strength at the extraction radius, and changing the field enables selection of the final beam energy. The magnetic field can be adjusted while maintaining the needed radial field profile

Split-bolus dual-energy CT urography: protocol optimization and diagnostic performance for the detection of urinary stones

PURPOSE: Prospective protocol optimization, determination of image quality and diagnostic performance of virtual non-enhanced images (VNEI) derived from split-bolus dual-energy computed tomography (DECT) urography in patients with urinary stones. METHODS: IRB-approved, prospective study of 100 patients who, after written informed consent, underwent single-energy, non-enhanced CT and split-bolus, contrast-enhanced DECT (30 + 50 mL of contrast media; combined nephro-urographic acquisition). DECT was performed using setting A (80/140 kVp) in the first 20, and setting B (100/140 kVp) in the second 20 patients. Tin filtration was used in all patients. After a pre-analysis of VNEI quality, 60 additional patients were examined using setting B. Two readers qualitatively and quantitatively determined image quality of all weighted-average DECT images regarding urinary tract opacification (n = 100), and all VNEI regarding quality of iodine subtraction and urinary stone detection (n = 80). True nonenhanced (TNEI) images were the standard of reference for statistical analysis (inter-reader variability and diagnostic performance characteristics). RESULTS: The urinary tract was completely opacified in 94% (94/100) of patients. Iodine subtraction was improved (p < 0.01) and image noise of VNEI was lower (p < 0.05) in DECT setting B. On VNEI, 83% (86/104) of urinary stones were correctly identified and 17% (18/104) were missed. Stones missed (2.5 mm, 1-4) were significantly smaller than stones correctly identified (5 mm, 2-27; p < 0.001). Diagnostic accuracy was 98% on a per-renal-unit basis and 96% on a per-patient basis. Inter-reader agreements were excellent (κ = 0.91-1.00; ICC = 0.86-0.99). CONCLUSIONS: Split-bolus DECT urography was technically feasible and quality of VNEI was improved with the 100/140 kVp setting. Detection of urinary stones <4 mm on VNEI was limited

New directions for surrogate models and differentiable programming for High Energy Physics detector simulation

The computational cost for high energy physics detector simulation in future experimental facilities is going to exceed the current available resources. To overcome this challenge, new ideas on surrogate models using machine learning methods are being explored to replace computationally expensive components. Additionally, differentiable programming has been proposed as a complementary approach, providing controllable and scalable simulation routines. In this document, new and ongoing efforts for surrogate models and differential programming applied to detector simulation are discussed in the context of the 2021 Particle Physics Community Planning Exercise (`Snowmass')

Towards ultrahigh resolution OCT based endoscopical pituitary gland and adenoma screening: a performance parameter evaluation

Ultrahigh resolution optical coherence tomography (UHR-OCT) for differentiating pituitary gland versus adenoma tissue has been investigated for the first time, indicating more than 80% accuracy. For biomarker identification, OCT images of paraffin embedded tissue are correlated to histopathological slices. The identified biomarkers are verified on fresh biopsies. Additionally, an approach, based on resolution modified UHR-OCT ex vivo data, investigating optical performance parameters for the realization in an in vivo endoscope is presented and evaluated. The identified morphological features–cell groups with reticulin framework–detectable with UHR-OCT showcase a promising differentiation ability, encouraging endoscopic OCT probe development for in vivo application

Diagnosis of Pituitary Adenoma Biopsies by Ultrahigh Resolution Optical Coherence Tomography Using Neuronal Networks

Objective: Despite advancements of intraoperative visualization, the difficulty to visually distinguish adenoma from adjacent pituitary gland due to textural similarities may lead to incomplete adenoma resection or impairment of pituitary function. The aim of this study was to investigate optical coherence tomography (OCT) imaging in combination with a convolutional neural network (CNN) for objectively identify pituitary adenoma tissue in an ex vivo setting. Methods: A prospective study was conducted to train and test a CNN algorithm to identify pituitary adenoma tissue in OCT images of adenoma and adjacent pituitary gland samples. From each sample, 500 slices of adjacent cross-sectional OCT images were used for CNN classification. Results: OCT data acquisition was feasible in 19/20 (95%) patients. The 16.000 OCT slices of 16/19 of cases were employed for creating a trained CNN algorithm (70% for training, 15% for validating the classifier). Thereafter, the classifier was tested on the paired samples of three patients (3.000 slices). The CNN correctly predicted adenoma in the 3 adenoma samples (98%, 100% and 84% respectively), and correctly predicted gland and transition zone in the 3 samples from the adjacent pituitary gland. Conclusion: Trained convolutional neural network computing has the potential for fast and objective identification of pituitary adenoma tissue in OCT images with high sensitivity ex vivo. However, further investigation with larger number of samples is required