Utility of brain parenchyma density measurement and computed tomography perfusion imaging in predicting brain death

Purpose: To assess the utility of brain parenchyma density measurement on unenhanced computed tomography (CT) in predicting brain death (BD), in order to evaluate the added value of CT perfusion (CTP). Material and methods: A total of 77 patients who were clinically diagnosed as BD and had both CT angiography (CTA) and CTP imaging in the same session were retrospectively reviewed. On unenhanced phase of CTA, density measurement was performed from 23 regions of interests (ROIs) which were located in the following areas: level of basal ganglia (caudate nucleus, putamen, corpus callosum, posterior limb of internal capsule), level of brainstem, greywhite matters on levels of centrum semiovale (CS), high convexity (HC), and cerebellum. CTP images were evaluated qualitatively and independently. Grey matter (GM), white matter (WM), density, and GM/WM density ratio of BD patients were compared with control subjects. Results: Comparing with the normal control group, the GM and WM density at each level and GM/WM density ratio of CS, HC, and cerebellum level were significantly lower in brain-dead patients (p = 0.019 for HC-WM, p < 0.001 for other areas). Using ROC analysis, the highest value of area under curve (AUC) for the GM/WM density ratio was found at the HC level (AUC = 0.907). The sensitivity of the GM/WM density ratio at the HC level was found to be 90% when the cut-off value of 1.25 was identified. Evaluating the GM/WM density ratio together with the CTP results increased the sensitivity further to 98%. Conclusions: The GM/WM density ratio at the HC level on unenhanced CT may be a useful finding to predict BD. Also, the addition of CTP increases the sensitivity of this method

An investigation of the anti-hypertensive effect of mad honey and Rhododendron luteum sweet extract induced by N- ω -Nitro L-Arginine Methyl Ester (L-NAME) in rats

The aim of this study was to investigate the anti-hypertensive effect of mad honey and Rhododendron luteum sweet extracts containing grayanotoxin (GTX)-III in a rat model of hypertension induced by N-ω-nitro L-arginine methyl ester (L-NAME). Thirty Sprague Dawley rats were divided into five groups - control (0.9% NaCl, 1 mL for 30 days, oral gavage [o.g.]), hypertensive (40 mg L-NAME /kg, bw for 30 days, intraperitoneal [i.p.]), standard (40 mg L-NAME /kg, bw for  30 days, i.p. + 20 mg Captopril/kg, bw for the last 15 days, o.g.), treatment I (40 mg L-NAME /kg, bw for 30 days, i.p. + mad honey, 12.5 mg GTX-III /kg, bw for the last 15 days, o.g.), and  treatment II ( 40 mg L-NAME /kg, bw for 30 days, i.p.+ R. luteum blossom extract, 155.8 mg GTX-III /kg, bw for the last 15 days, o.g.). In addition to evaluating blood pressure using the tail-cuff method, some biochemical parameters were also measured in serum samples. Moreover, nitric oxide (NO) and glutathione (GSH) concentrations were also analyzed in heart, liver and kidney tissues to measure tissue damage caused by hypertension. The chromatographic analyses revealed GTX-III levels in mad honey and R. luteum of 24.94±0.10 mg/kg and 155.80±0.10 mg/kg, respectively. Both extracts used for animal application had a significant anti-hypertensive effect compared to the control and captopril groups. The systolic and diastolic values of the mad honey and blossom extract groups were 157.97-164.16 and 119.92-120.47, respectively.

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

Abstract: Objective: To determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses. Methods and materials: Two hundred ninety-one patients (350 adnexal masses) who underwent gynecological MRI at our institution between the 1st of January 2008 and the 31st of December 2018 were reviewed. A random subset (102 patients with 121 masses) was chosen to evaluate the reproducibility and repeatability of readers’ assessments. Readers evaluated non-contrast MRI scans retrospectively, assigned a 5-point score for the risk of malignancy and gave a specific diagnosis. The reference standard for the diagnosis was histopathology or at least one-year imaging follow-up. Diagnostic accuracy of the non-contrast MRI score was calculated. Inter- and intra-reader agreement was analyzed with Cohen’s kappa statistics. Results: There were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (к = 0.73, 95% confidence interval [CI] 0.58–0.86) whilst the intra-reader agreement was excellent (к = 0.81, 95% CI 0.70–0.88). The non-contrast MRI score value of ≥ 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90–0.96). Conclusion: Adnexal mass characterization on MRI without the administration of contrast medium has a high accuracy and excellent inter- and intra-reader agreement. Our results suggest that non-contrast studies may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible. Key Points: • A non-contrast pelvic MRI protocol may allow the characterization of adnexal masses with high accuracy. • The non-contrast MRI score may be used in clinical practice for differentiating benign from malignant adnexal lesions when the lack of intravenous contrast medium precludes analysis with the O–RADS MRI score

Integration of proteomics with CT-based qualitative and radiomic features in high-grade serous ovarian cancer patients: an exploratory analysis

Abstract: Objectives: To investigate the association between CT imaging traits and texture metrics with proteomic data in patients with high-grade serous ovarian cancer (HGSOC). Methods: This retrospective, hypothesis-generating study included 20 patients with HGSOC prior to primary cytoreductive surgery. Two readers independently assessed the contrast-enhanced computed tomography (CT) images and extracted 33 imaging traits, with a third reader adjudicating in the event of a disagreement. In addition, all sites of suspected HGSOC were manually segmented texture features which were computed from each tumor site. Three texture features that represented intra- and inter-site tumor heterogeneity were used for analysis. An integrated analysis of transcriptomic and proteomic data identified proteins with conserved expression between primary tumor sites and metastasis. Correlations between protein abundance and various CT imaging traits and texture features were assessed using the Kendall tau rank correlation coefficient and the Mann-Whitney U test, whereas the area under the receiver operating characteristic curve (AUC) was reported as a metric of the strength and the direction of the association. P values < 0.05 were considered significant. Results: Four proteins were associated with CT-based imaging traits, with the strongest correlation observed between the CRIP2 protein and disease in the mesentery (p < 0.001, AUC = 0.05). The abundance of three proteins was associated with texture features that represented intra-and inter-site tumor heterogeneity, with the strongest negative correlation between the CKB protein and cluster dissimilarity (p = 0.047, τ = 0.326). Conclusion: This study provides the first insights into the potential associations between standard-of-care CT imaging traits and texture measures of intra- and inter-site heterogeneity, and the abundance of several proteins. Key Points: • CT-based texture features of intra- and inter-site tumor heterogeneity correlate with the abundance of several proteins in patients with HGSOC. • CT imaging traits correlate with protein abundance in patients with HGSOC

Integration of proteomics with CT-based qualitative and radiomic features in high-grade serous ovarian cancer patients: an exploratory analysis

Abstract: Objectives: To investigate the association between CT imaging traits and texture metrics with proteomic data in patients with high-grade serous ovarian cancer (HGSOC). Methods: This retrospective, hypothesis-generating study included 20 patients with HGSOC prior to primary cytoreductive surgery. Two readers independently assessed the contrast-enhanced computed tomography (CT) images and extracted 33 imaging traits, with a third reader adjudicating in the event of a disagreement. In addition, all sites of suspected HGSOC were manually segmented texture features which were computed from each tumor site. Three texture features that represented intra- and inter-site tumor heterogeneity were used for analysis. An integrated analysis of transcriptomic and proteomic data identified proteins with conserved expression between primary tumor sites and metastasis. Correlations between protein abundance and various CT imaging traits and texture features were assessed using the Kendall tau rank correlation coefficient and the Mann-Whitney U test, whereas the area under the receiver operating characteristic curve (AUC) was reported as a metric of the strength and the direction of the association. P values < 0.05 were considered significant. Results: Four proteins were associated with CT-based imaging traits, with the strongest correlation observed between the CRIP2 protein and disease in the mesentery (p < 0.001, AUC = 0.05). The abundance of three proteins was associated with texture features that represented intra-and inter-site tumor heterogeneity, with the strongest negative correlation between the CKB protein and cluster dissimilarity (p = 0.047, τ = 0.326). Conclusion: This study provides the first insights into the potential associations between standard-of-care CT imaging traits and texture measures of intra- and inter-site heterogeneity, and the abundance of several proteins. Key Points: • CT-based texture features of intra- and inter-site tumor heterogeneity correlate with the abundance of several proteins in patients with HGSOC. • CT imaging traits correlate with protein abundance in patients with HGSOC

Integration of proteomics with CT-based qualitative and radiomic features in high-grade serous ovarian cancer patients: an exploratory analysis

Abstract: Objectives: To investigate the association between CT imaging traits and texture metrics with proteomic data in patients with high-grade serous ovarian cancer (HGSOC). Methods: This retrospective, hypothesis-generating study included 20 patients with HGSOC prior to primary cytoreductive surgery. Two readers independently assessed the contrast-enhanced computed tomography (CT) images and extracted 33 imaging traits, with a third reader adjudicating in the event of a disagreement. In addition, all sites of suspected HGSOC were manually segmented texture features which were computed from each tumor site. Three texture features that represented intra- and inter-site tumor heterogeneity were used for analysis. An integrated analysis of transcriptomic and proteomic data identified proteins with conserved expression between primary tumor sites and metastasis. Correlations between protein abundance and various CT imaging traits and texture features were assessed using the Kendall tau rank correlation coefficient and the Mann-Whitney U test, whereas the area under the receiver operating characteristic curve (AUC) was reported as a metric of the strength and the direction of the association. P values < 0.05 were considered significant. Results: Four proteins were associated with CT-based imaging traits, with the strongest correlation observed between the CRIP2 protein and disease in the mesentery (p < 0.001, AUC = 0.05). The abundance of three proteins was associated with texture features that represented intra-and inter-site tumor heterogeneity, with the strongest negative correlation between the CKB protein and cluster dissimilarity (p = 0.047, τ = 0.326). Conclusion: This study provides the first insights into the potential associations between standard-of-care CT imaging traits and texture measures of intra- and inter-site heterogeneity, and the abundance of several proteins. Key Points: • CT-based texture features of intra- and inter-site tumor heterogeneity correlate with the abundance of several proteins in patients with HGSOC. • CT imaging traits correlate with protein abundance in patients with HGSOC

Ultrasound-guided targeted biopsies of CT-based radiomic tumour habitats: technical development and initial experience in metastatic ovarian cancer

Funder: Horizon 2020; doi: http://dx.doi.org/10.13039/501100007601Funder: Cancer Research UKFunder: Mark Foundation For Cancer Research; doi: http://dx.doi.org/10.13039/100014599Abstract: Purpose: To develop a precision tissue sampling technique that uses computed tomography (CT)–based radiomic tumour habitats for ultrasound (US)-guided targeted biopsies that can be integrated in the clinical workflow of patients with high-grade serous ovarian cancer (HGSOC). Methods: Six patients with suspected HGSOC scheduled for US-guided biopsy before starting neoadjuvant chemotherapy were included in this prospective study from September 2019 to February 2020. The tumour segmentation was performed manually on the pre-biopsy contrast-enhanced CT scan. Spatial radiomic maps were used to identify tumour areas with similar or distinct radiomic patterns, and tumour habitats were identified using the Gaussian mixture modelling. CT images with superimposed habitat maps were co-registered with US images by means of a landmark-based rigid registration method for US-guided targeted biopsies. The dice similarity coefficient (DSC) was used to assess the tumour-specific CT/US fusion accuracy. Results: We successfully co-registered CT-based radiomic tumour habitats with US images in all patients. The median time between CT scan and biopsy was 21 days (range 7–30 days). The median DSC for tumour-specific CT/US fusion accuracy was 0.53 (range 0.79 to 0.37). The CT/US fusion accuracy was high for the larger pelvic tumours (DSC: 0.76–0.79) while it was lower for the smaller omental metastases (DSC: 0.37–0.53). Conclusion: We developed a precision tissue sampling technique that uses radiomic habitats to guide in vivo biopsies using CT/US fusion and that can be seamlessly integrated in the clinical routine for patients with HGSOC. Key Points: • We developed a prevision tissue sampling technique that co-registers CT-based radiomics–based tumour habitats with US images. • The CT/US fusion accuracy was high for the larger pelvic tumours (DSC: 0.76–0.79) while it was lower for the smaller omental metastases (DSC: 0.37–0.53)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

EFFECTS OF SOME BOTANICAL INSECTICIDES ON THE EGG PARASITOID TRICHOGRAMMA PINTOI VOEGELE (HYMENOPTERA: TRICHOGRAMMATIDAE)

WOS: 000376049000007Egg parasitoids are among the most significant biological control agents of a number of insect pests. Among them, Trichogramma species are the most widely used insect natural enemy in the world. Generally, when it raised the idea of using biological control, the effects of insecticides should be studied under laboratory conditions before the release of beneficial natural enemies. In this study, effects of some botanical insecticides on development and behaviour of Trichogramma pintoi Voegele (Hymenoptera: Trichogrammatidae) were studied. The experiments were conducted on the host Ephestia kuehniella Zeller (Lepidoptera: Pyralidae), at 25 degrees C, 60-70% relative humidity in the laboratory condition. In the experiments, Neem Azal (azadirachtin) and Spruzit Neu (pyrethrum, hotpepperwax (capsaicin) and Orange Guard (d-Limone) were tested. With the use of LC10, LC25, LC50 ve LC90 doses of Neem Azal and Spruzit Neu against parasitized and unparasitized E. kuehniella eggs, insecticide side effects to the parasitoid biology and behavior was designated. Parasitism rate of T. pintoi was negatively affected by application of azadirachtin and pyrethrum. This negative effect was more observed at pyrethrum. Some biological properties of parasitoid also showed differences depending on parasitoid development stage, insecticide and application dose. Emergence ratio of the parasitoid was significantly affected by LC90 of both insecticide. The results also showed that the most sensitive period of parasitoid was larval stage. In adult toxicity experiment, pyrethrum was found to be more toxic than azadirachtin. The results of behavioral experiments show that these botanical insecticides have strong repellent effect to the parasitoid.Scientific and Technological Research Council of TurkeyTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK)This study was supported by the Scientific and Technological Research Council of Turkey