Definite Pattern Research Articles

Differences Between Patients with Probable UIP and Definite UIP on HRCT in Idiopathic Pulmonary Fibrosis: A Real-World Cohort Study

Background: Both a probable usual interstitial pneumonia (UIP) pattern (p-UIP) and a definite UIP pattern (d-UIP) on high-resolution computed tomography (HRCT) are sufficient to establish a diagnosis of idiopathic pulmonary fibrosis (IPF) without the need for a surgical lung biopsy, according to the 2022 IPF guidelines. However, it remains unknown whether patients with p-UIP and d-UIP have similar disease behaviors and clinical courses. Material and Methods: We retrospectively collected clinical data of patients with IPF and divided the patients into two groups according to their HRCT patterns: a p-UIP group and a d-UIP group. The baseline characteristics, survival rates, and pulmonary function tests were compared between the two groups. The risk factors for mortality were determined by Cox regression in p-UIP and d-UIP separately. Results: There were 304 patients in the p-UIP group and 480 patients in the d-UIP group. Patients in the d-UIP group were more likely to have smoking histories (p < 0.001) and had lower baseline FVC% (74% vs. 77%, p = 0.021) and DLCO% (50% vs. 58%, p < 0.001). Survival rates were higher in p-UIP compared with d-UIP (p = 0.004). There were no differences in changes in FVC% or DLCO% between the two groups. Baseline DLCO% was the only independent risk factor for mortality in p-UIP. Baseline FVC% was independently associated with mortality in d-UIP. Symptom of cough was a risk factor for disease progression (OR = 1.2, p = 0.002) in p-UIP, while symptom of dyspnea might be associated with disease progression in d-UIP (OR = 2.7, p = 0.065). Male patients (OR = 1.88, p = 0.002) with a smoking history (OR = 1.16, p = 0.002) were at higher risk of developing d-UIP. Conclusions: We observed the different disease trajectories between p-UIP and d-UIP. P-UIP on HRCT might identify a subgroup of IPF patients who are in the early stage with a better prognosis.

Scaling Correlation Analysis of Particulate Matter Concentrations of Three South Indian Cities

Analyzing the fluctuations of particulate matter (PM) concentrations and their scaling correlation structures are useful for air quality management. Multifractal characterization of PM2.5 and PM10 of three cities in India wase considered using the detrended fluctuation procedure from 2018 to 2021. The cross-correlation of PM concentration in a multifractal viewpoint using the multifractal cross-correlation analysis (MFCCA) framework is proposed in this study. It was observed that PM2.5 was more multifractal and complex than PM10 at all the locations. The PM–gaseous pollutant (GP) and PM–meteorological variable (MV) correlations across the scales were found to be weak to moderate in different cities. There was no definite pattern in the correlation of PM with different meteorological and gaseous pollutants variables. The nature of correlation in the pairwise associations was found to be of diverse and mixed nature across the time scales and locations. All the time series exhibited multifractality when analyzed pairwise using multifractal cross-correlation analysis. However, there was a reduction in multifractality in individual cases during PM–GP and PM–MV paired analyses. The insights gained into the scaling behavior and cross-correlation structure from this study are valuable for developing prediction models for PMs by integrating them with machine learning techniques.

Clinical and Dermoscopic Characteristics of Cutaneous Chondroid Syringoma: A Systematic Review

Introduction: Cutaneous chondroid syringoma (CS) is a rare benign mixed skin tumor originating from sweat glands. Despite its rarity, accurate diagnosis and management are crucial due to its potential for malignant transformation. Objective: This study aims to provide comprehensive insights into the main features of cutaneous CS, encompassing its epidemiology, clinical presentation, and particularly, dermoscopic findings. Methods: A systematic review was conducted to identify relevant literature on CS up to November 2023. Data extraction included clinical and histopathological characteristics from case reports and small case series. Results: The systematic review identified 347 unique CS cases, predominantly benign. Clinical features included a predilection for the head and neck region, with variations in morphology observed. Dermoscopic patterns, although limited, revealed recurrent features aiding diagnosis. Malignant CS cases constituted a notable subset, exhibiting distinct clinical and histopathological features. Conclusion: Cutaneous chondroid syringoma presents with characteristic clinical and histopathological features, necessitating comprehensive diagnostic approaches. Dermoscopy emerges as a valuable tool, although further research is needed to establish definitive patterns. Treatment primarily involves wide local excision, with collaboration among clinicians essential for optimal management. Future studies are warranted to address existing knowledge gaps and enhance understanding of this rare skin neoplasm.

Evaluating OSPE as a Formative Assessment Tool for Medical Students

Introduction. Objective structured practical examination (OSPE) is a globally recognized and widely implemented assessment method used for evaluating students in practical examinations. It requires examinees to complete various tasks within a set time frame, each assessed against predetermined criteria designed to measure practical skills and attitudes. This study aimed to assess the effectiveness of the OSPE as a tool for internal assessment in the subject of Anatomy for first-year MBBS students, comparing its performance against the traditional practical examination (TPE) method. Methods. In this prospective study, an OSPE tool specific to Anatomy was developed and validated for face and content to ensure that the OSPE stations were standardized and well-constructed. The part-leaving test covered the Thorax and Brain chapters using both the TPE and OSPE methods. A Bland-Altman plot was employed to assess the agreement between the quantitative assessments of both methods. Additionally, a 5-point Likert scale was utilized to gauge the perceptions of both students and faculty members regarding the assessment methods. Results. The analysis revealed a significant difference between the scores obtained from OSPE and TPE. The intraclass correlation coefficients for reliability between TPE and OSPE were 0.81 for the Thorax chapter and 0.84 for the Brain chapter. Additionally, the Bland-Altman plots illustrating the scores from both assessment methods indicated low bias and no definite pattern. While no significant outliers were identified for the Brain part, the Thorax part exhibited outliers at a rate of 6.43%, suggesting the presence of low-impact erratic variables. The Chi-square test for student perceptions yielded significant results for the entire questionnaire. In contrast, faculty perceptions showed significant results for all questions except for two. Conclusions. Due to the high intraclass correlation coefficients between TPE and OSPE and the absence of bias, systematic errors, and erratic variables, OSPE is a promising assessment tool. Students perceived that OSPE decreased the chances of failure and that the questions asked in OSPE were more relevant compared to the traditional method. Faculty members also noted that OSPE provided reasonably high transparency and decreased subjective bias compared to TPE. Considering these factors, it can be concluded that OSPE is a viable potential tool to replace TSE.

Machine learning model for predicting the cold-heat pattern in Kampo medicine: a multicenter prospective observational study.

The purpose of this study was to predict the four cold-heat patterns in patients who have the subjective symptoms of the cold-heat pattern described in the International Classification of Diseases Traditional Medicine Conditions - Module 1 by applying a machine learning algorithm. Subjects were first-visit Kampo outpatients at six institutions who agreed to participate in this multicenter prospective observational study. The cold pattern model and the heat pattern model were created separately with 148 symptoms, body mass index, blood pressure (systolic and diastolic), age, and sex. Along with a single cold or heat pattern, the tangled heat/cold pattern is defined as being predicted by both cold and heat patterns, while the moderate (heat/cold) pattern is defined as being predicted by neither the cold pattern nor the heat pattern. We included 622 participants (mean age ±standard deviation, 54.4 ± 16.9; with female 501). The accuracy, macro-recall, precision, and F1-score of a combination of the two prediction models were 96.7%, 93.2%, 85.6%, and 88.5% respectively. The important items were compatible with the definitions of the cold-heat pattern. We developed a prediction model on cold-heat patterns with data from patients whose subjective cold/heat-related symptoms matched the cold-heat pattern diagnosis by the physician.

FAM13A polymorphism is associated with a usual interstitial pneumonia pattern in patients with systemic sclerosis-associated interstitial lung disease.

The MUC5B promoter single nucleotide polymorphism (SNP) rs35705950 has been associated with idiopathic pulmonary fibrosis (IPF) and rheumatoid arthritis (RA)-related interstitial lung disease (ILD), but not with systemic sclerosis (SSc)-ILD. We hypothesized that the MUC5B promoter polymorphism or other IPF susceptibility loci are associated with an increased risk for the uncommon SSc-usual interstitial pneumonia (UIP) endophenotype, rather than SSc-ILD in general. We performed a cross-sectional study of SSc-ILD patients from 4 US Scleroderma Programs to investigate the frequency of MUC5B rs35705950 and 12 additional IPF susceptibility loci. SSc-ILD patients were stratified by high resolution chest CT (HRCT) imaging findings into UIP and non-UIP groups. Analysis of HRCTs performed by a thoracic radiologist blinded to participants' characteristics classified each scan as definite UIP, probable UIP, indeterminate, or alternative diagnosis, according to American Thoracic Society criteria. Four-hundred eighty-nine SSc-ILD patients were included; 80% were female and 75% were White. Twenty-three (4.7%) patients had a definite UIP pattern. The MUC5B SNP rs35705950 was not associated with a definite UIP pattern in SSc-ILD. In contrast, patients carrying 2 copies of the IPF risk gene FAM13A minor allele rs2609255 had significantly higher odds of a definite UIP pattern compared with the other patterns (OR 3.40, 95% CI 1.19-9.70), and compared with an alternative diagnosis (OR 3.65, 95% CI 1.25-10.65). We demonstrated a novel association between FAM13A and SSc-UIP. Contrary to IPF and RA-ILD, the MUC5B promoter polymorphism was not associated with a definite UIP pattern in SSc-ILD.

6365 An Atypical Case Of Large Metastatic Pheochromocytoma With Negative Catecholamine Secretion

Abstract Disclosure: D. Caesario: None. J.K. Fernandes: None. Introduction: Pheochromocytomas (PCCs) are rare tumors arising from chromaffin cells of the adrenal medulla. Diagnosis is suggested by clinical presentations and confirmed by biochemical hypersecretion of metanephrines (MN) and catecholamines (CA). We report an atypical case of large metastatic PCC with normal MN and CA. Case Report: A 61-year-old female presented with uncontrolled HTN despite taking amlodipine, losartan, and carvedilol. No other symptoms reported. She had presented 12 years prior with an 8.7 cm left adrenal mass (AdM) that was incidentally found on CT scan, but she was lost to follow-up. Repeat imaging for her current presentation revealed enlargement of left AdM to 15 cm, centrally necrotic, with absolute washout of 63%. There was extensive local regional involvement, including possible invasion of the pancreas; abutment to left kidney, left renal vein, left hepatic lobe, and stomach; encasement and possible invasion of the splenic vein; and formation of perisplenic collateral vessels. Metastatic lesions were also seen in the liver, bones, and lungs. DOTATATE PET/CT scan showed variable uptake, not a definitive pattern for PCC or neuroendocrine tumor (NET). Labs showed normal levels of plasma fractionated MN and CA, dopamine, renin, aldosterone, cortisol, ACTH, and DHEA-S. Chromogranin A (CgA) was elevated to >8000 ng/dL. Biopsy taken from one of the liver lesions was consistent with metastatic PCC. No family history of NET. Genetic testing was offered, but was deferred. Due to the large tumor burden, she was determined to be nonsurgical and started on systemic therapy with sunitinib. Doxazosin was also added, which better controlled her BP. After 9 months of sunitinib therapy, a repeat CT scan showed overall stable metastatic lesions, but the left AdM had enlarged to 16 cm. Given the slowly worsening disease, patient was switched to temozolomide. She is still actively being treated and monitored today. Discussion: The clinical features of PCC result from excessive CA secretion. HTN is the hallmark of CA release, but the amount, type, and pattern of CA secretion is extremely variable, leading to varied clinical presentations. CgA secretion is also elevated in PCC, but is generally a non-specific marker as its level is also increased in multiple NETs and non-endocrine medical conditions. About 9% of patients with PCC may have normal biochemical workup, with this being even rarer in malignant cases. In general, the amount of CA, MN, and CgA released by the tumor is also positively correlated with the tumor size. The case above is unique in that despite the large tumor burden the patient only presented with HTN and had normal MN and CA levels. Her CgA was significantly elevated, which could correlate with the tumor size, but was interestingly the only marker elevated. It appears that CgA could be a useful adjunct in the diagnosis of PCC, especially in cases where PCC appeared to be non-secretory. Presentation: 6/3/2024

A novel isolation technique for sweetpotato starch and its application in thermal property characterization.

The utilization of sweetpotato starch in the food industry is significantly influenced by the granule size of the starch. To isolate sweetpotato starch fractions with different sizes, an efficient isolation method is in demand. The differences in thermal properties of starch fractions with different sizes from various sweetpotato varieties were revealed insufficiently. In this study, we devised a time-saving isolation technique to effectively isolate sweetpotato starch fractions based on granule sizes. The new technique was proved applicable for sweetpotato varieties with different flesh colors. The amylose contents of the isolated starch fractions were in the range 16.49-23.27%. A positive association was observed between amylose content, relative crystallinity of starch fractions and their granule size. Conversely, both the swelling power and water solubility at 95 °C displayed a consistent decline from more than 30 g g-1 to lower than 20 g g-1 as the granule size increased. Tp, To and Tc decreased gradually with an increase of starch granule size, while the medium- or small-sized starch fractions showed higher ΔH. In the first stage of thermogravimetric analysis curves, the weight of the small-sized starch fractions decreased the slowest, but no definite pattern was detected in the second or third stage. Therefore, the newly established technique and the results of this study will help better understand the properties of sweetpotato starch fractions with different sizes and certainly provide guidelines for the utilization of sweetpotato starch in food processing and product development. © 2024 Society of Chemical Industry.

Searching for Continuous n-Clusters with Boolean Reasoning

A bicluster consists of a subset of rows and columns of a given matrix, whose intersection defines the region (bicluster) of values of precisely defined condition. Through the decades, a variety of biclustering techniques have been successfully developed. Recently, it was proved that many possible patterns defined in two-dimensional data could be found with the application of Boolean reasoning. The provided theorems showed that any existing pattern in the data could be unequivocally encoded as an implicant of a proper Boolean function. Moreover, a prime implicant of that function encoded the inclusion-maximal (non-extendable) pattern. On the other hand, the definition of some two-dimensional patterns may be easily extended to three-dimensional patterns (triclusters) as well as to any number of dimensions (n-clusters). This paper presents a new approach for searching for three- and higher-dimensional simple patterns in continuous data with Boolean reasoning. Providing the definition of the Boolean function for this tasks, it is shown that the similar correspondence—implicants encode patterns, and prime implicants encode inclusion-maximal patterns—has a strong mathematical background: the proofs of appropriate theorems are also presented in this paper.

Asymptomatic Primary Hyperparathyroidism: A Misnomer.

Primary hyperparathyroidism (PHPT) is an endocrine disorder marked by elevated secretion of parathyroid hormone (PTH), which results in hypercalcemia and may cause complications in the kidneys and bones. Diagnosing this condition involves ruling out secondary causes and understanding the complexities of the laboratory values associated with PHPT. The disease has become more recognizable to clinicians in an earlier phase thanks to updated screening guidelines. At present, patients can be diagnosed with "classic," "normocalcemic," "normohormonal," or "asymptomatic" PHPT. Many patients are diagnosed through incidental findings of elevated calcium levels or PTH levels during routine blood tests rather than through the presentation of classic symptoms. If asked, patients will invariably harbor subtle or subclinical manifestations despite the absence of overt symptoms. There is debate on whether truly asymptomatic hyperparathyroidism exists.1 We explore the definition and clinical patterns of asymptomatic hyperparathyroidism and propose concise recommendations for recognizing these patients.

Assessment of quality of life in IPF Patients: a multicenter observational study.

This study aimed to examine how dyspnea, cough, sleep disruption, anxiety, depression, and physiological factors affect the quality of life in newly diagnosed, untreated IPF patients. This study is a multicenter observational study. Patients not receiving antifibrotic treatment were included. To assess patients' quality of life, Leicester Cough Questionnaire (LCQ), St. George's Respiratory Questionnaire (SGRQ), Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Borg Dyspnea Index (BDI), Modified Medical Research Council Dyspnea Scale (MMRC) score, Composite Physiological Index (CPI), Gender Age and physiology (GAP) score, and Pittsburgh Sleep Quality Index (PSQI) were administered. Among 88 patients (mean age: 67.6±8.5 years), 81.9% were diagnosed with IPF through HRCT, 14.8% through surgery, and 3.4% via cryobiopsy. The average disease duration was 2.2±2.9 years. Over 50% experienced moderate to severe depression, and 40% had moderate to severe anxiety. In the IPF group, 13.6% had possible usual interstitial pneumonia (UIP), and 81.8% had definite UIP pattern. No significant differences were found between UIP groups in various scores. Anxiety and depression correlated negatively with respiratory function and positively with MMRC score and BDI. Sleep quality scores had similar correlations. Patients with good sleep quality had better respiratory parameters (p=0.013), lower MMRC (p=0.004), BDI (p=0.026), and CPI (p=0.047). -Conclusion: A notable number of IPF patients in follow-up show symptoms of anxiety and depression. Moreover, declining respiratory function not only diminishes sleep quality but also elevates dyspnea scores.

Dynamics of tumor evolution after Gammaknife radiosurgery for sporadic vestibular schwannoma: defining volumetric patterns characterizing individual trajectory.

Definition of tumor control and treatment failure after Gammaknife radiosurgery (GKRS) for vestibular schwannoma (VS) is still debated. The lack of knowledge on the dynamics of tumor evolution can lead to misinterpretation and subsequent inappropriate second treatment. The aim of this study was to evaluate the post-GKRS dynamics of evolution of tumor volume, and characterize volumetric patterns. We included patients with sporadic VS treated by GKRS with an MRI follow-up of minimum 3 years. A clustering in 2 steps was performed: definition of the patterns of evolution based on a subset of patients with the most comprehensive follow-up, then assignment of the remaining patients on a best fit basis. The minimum length of follow-up was assessed by measuring the consistency of the clusters over time (Adjusted Rand Index and Normalized Mutual Information). An analysis of the discriminant variables was finally performed. 1,607 patients were included (median follow-up: 67 months). Five patterns were defined with one pattern gathering almost all cases of treatment failure. The clustering at 5 years afforded the highest consistency with long-term follow-up. Discriminant variables for clusters were: sex, initial symptoms, delay of diagnosis, Koos grading, fundus invasion, and number of isocenters. The definition of these robust distinct patterns is likely to help tremendously the physicians to distinguish tumor control from potential failure. We advocate for no retreatment decision before 5 years post-GKRS. Further investigations are required to decide if the dynamics of evolution can be predicted at GKRS on an individual basis.

SimpleSets: Capturing Categorical Point Patterns with Simple Shapes.

Points of interest on a map such as restaurants, hotels, or subway stations, give rise to categorical point data: data that have a fixed location and one or more categorical attributes. Consequently, recent years have seen various set visualization approaches that visually connect points of the same category to support users in understanding the spatial distribution of categories. Existing methods use complex and often highly irregular shapes to connect points of the same category, leading to high cognitive load for the user. In this paper we introduce SimpleSets, which uses simple shapes to enclose categorical point patterns, thereby providing a clean overview of the data distribution. SimpleSets is designed to visualize sets of points with a single categorical attribute; as a result, the point patterns enclosed by SimpleSets form a partition of the data. We give formal definitions of point patterns that correspond to simple shapes and describe an algorithm that partitions categorical points into few such patterns. Our second contribution is a rendering algorithm that transforms a given partition into a clean set of shapes resulting in an aesthetically pleasing set visualization. Our algorithm pays particular attention to resolving intersections between nearby shapes in a consistent manner. We compare SimpleSets to the state-of-the-art set visualizations using standard datasets from the literature.

Association between mandibular prognathism and Matrilin-1, bone morphogenic protein, Tyr67Asn, homeobox protein hox-A2, Rho-GTPase activating protein, and Myosin 1H genes in the Indian population.

Mandibular prognathism (MP) patients present with aesthetic concerns and functional issues, including difficulties in mastication and pronunciation. Studies revealed that mandibular prognathism had definitive Mendelian inheritance patterns. This study aimed to ascertain distinct genetic markers associated with mandibular prognathism in individuals of Indian descent, focusing on exploring the prevalent genetic variations associated with certain genes. This study sought to identify the association of the following gene markers with mandibular prognathism: 1) Matrilin-1 (MATN1) (rs1065755), 2) Bone morphogenic protein 3 (BMP-3) (Tyr67Asn), 3) Homeobox protein hox-A2 (HOXA2) (Val327Ile), 4) Rho-GTPase activating protein (ARHGAP 21) (Gly1121Ser), 5) Myosin 1H (MYO1H) (rs10850110).

Movement pattern definitions for resistance training behavior measurement in diabetes.

Type 2 diabetes can result in debilitating vascular complications, and resistance training (RT) is an effective therapy for improving cardiovascular outcomes. However, only 10-30% of adults meet the public health guidance for RT. While current RT guidelines focus on targeting major muscle groups, guidance specific to simplified movement categorization may augment understanding of RT programming and improve uptake and outcomes. Current movement pattern definitions and descriptions lack clarity, accuracy, and consistency. This paper proposes movement definitions and descriptions to be used for RT intervention design and prescription, and includes the following categories: hip, knee, ankle, vertebral column, vertical push, horizontal push, vertical pull, and horizontal pull. These categories are intended to aid clinicians, researchers, and trainers in RT surveillance and RT intervention design for improving vascular complications in type 2 diabetes. Simplified RT program design using these categories may also facilitate greater RT program understanding and adherence for patients.

Is there an "optimal" diet for prevention of inflammatory bowel disease?

Nutritional epidemiological studies have evolved from a focus of single nutrients to diet patterns to capture the protective role of healthy diets on chronic disease development. Similarly, in inflammatory bowel disease (IBD), a healthy diet may be protective against its development in individuals with genetic susceptibility, but the definitions of the optimal diet pattern deserve further exploration. Hence, this review article presents evidence, mainly from prospective cohort studies, for the role of diet quality based on adherence to dietary guidelines, traditional and modern diet patterns in the prevention of IBD. Findings from a limited number of studies on diet quality suggest that high diet quality scores are associated with lower risk of developing Crohn's disease, but the data are inconsistent for ulcerative colitis (UC). There are signals that a Mediterranean diet pattern reduces the risk of Crohn's disease but, again, the data are inconsistent and further studies are much needed. Finally, the evidence is conflicting regarding the role of food additives, with difficulties in the assessment of their intake, namely non-nutritive sweeteners and emulsifiers, precluding accurate assessment of a relationship with IBD risk. In contrast, emerging evidence for a role of ultra-processed food in the development of Crohn's disease but not UC is identified. Given the potential influence of diet quality, a Mediterranean diet and ultra-processed food intake on the risk of Crohn's disease, assessment and implementation of dietary advice for these patients need to be tailored. The search for an optimal diet for UC remains elusive and further research for increasing the evidence in the area is greatly needed.

Improving Short-Term, Near-Surface Temperature Forecasts by Integrating Weather Pattern Information into Model Output Statistics

Abstract Dynamical numerical weather prediction has remarkably improved over the last decades. Yet postprocessing techniques are needed to calibrate forecasts which are based on statistical and machine learning techniques. With recent advances in the derivation of year-round, large-scale atmospheric circulations, or weather regimes, the question arises of whether this information can be valuable within forecast postprocessing methods. This paper investigates this by proposing a bias correction scheme to integrate the atmospheric circulation state derived from empirical orthogonal functions, referred to as weather patterns, for deterministic short-term, near-surface temperature forecasts based on least absolute shrinkage and selection operator (LASSO) regression. We propose a computational study which first evaluates different weather pattern definitions (spatial domain) to improve temperature forecasts in Europe. As a bias could be associated with the weather pattern at the model initialization time or at the realization time of the forecast, both variants are tested in this study. We show that forecasted weather patterns with the identical spatial domain as the forecast show best skill reaching mean-square-error skill improvements of up to 3% (day ahead) or 1% (week ahead). Only considering land surface improvements in Europe, improvements of 4%–6% for day-ahead forecasts and 1%–5% for week-ahead forecasts are observable. We believe that this study not only introduces a simple yet effective tool to reduce bias in temperature forecasts but also contributes to the active discussion of how valuable weather patterns are and how to use them within forecast calibration techniques.

House price convergence in the very long run

AbstractWe examine the house price convergence across 12 OECD countries over the period 1905–2016. Using novel quantile unit root tests which allow for smooth breaks via a Fourier expansion series, we find that nine countries show the presence of relative house price convergence at all the quantiles. Focusing on several specific quantiles, 11 countries have significant convergence tendencies. Moreover, there are four definite patterns related to shocks in the relative house prices across quantiles.

Оценка частоты возникновения засухи в Файзабадском районе (Таджикистан) в зависимости от метеорологических условий

The results of the analysis of the manifestation of drought in the Faizabad region based on calculations of the standardized precipitation and evapotranspiration index (SPEI) are presented. It has been established that there is no definite pattern in the occurrence of drought, even for a long period. By comparing the number and duration of droughts in the Fayzabad district with the climatic characteristics of the Fayzabad district, a close dependence of drought on the average annual temperature and precipitation has been established.

Clinical impact of CEUS on non-characterizable observations and observations with intermediate probability of malignancy on CT/MRI in patients at risk for HCC

BackgroundHepatocellular carcinoma (HCC) is a unique cancer allowing tumor diagnosis with identification of definitive patterns of enhancement on contrast-enhanced imaging, avoiding invasive biopsy. However, it is still unclear to what extent Contrast-Enhanced Ultrasound (CEUS) is a clinically useful additional step when Computed tomography (CT) or Magnetic resonance imaging (MRI) are inconclusive.MethodsA prospective international multicenter validation study for CEUS Liver Imaging Reporting and Data System (LI-RADS) was conducted between January 2018 and August 2021. 646 patients at risk for HCC with focal liver lesions were enrolled. CEUS was performed using an intravenous ultrasound contrast agent within 4 weeks of CT/MRI. Liver nodules were categorized based on LI-RADS (LR) criteria. Histology or one-year follow-up CT/MRI imaging results were used as the reference standard. The diagnostic performance of CEUS was evaluated for inconclusive CT/MRI scan in two scenarios for which the AASLD recommends repeat imaging or imaging follow-up: observations deemed non-characterizable (LR-NC) or with indeterminate probability of malignancy (LR-3).Results75 observations on CT or MRI were categorized as LR-3 (n = 54) or LR-NC (n = 21) CEUS recategorization of such observations into a different LR category (namely, into one among LR-1, LR-2, LR-5, LR-M, or LR-TIV) resulted in management recommendation changes in 33.3% (25/75) and in all but one (96.0%, 24/25) observation, the new management recommendations were correct.ConclusionCEUS LI-RADS resulted in management recommendations change in substantial number of liver observations with initial indeterminate CT/MRI characterization, identifying both non-malignant lesions and HCC, potentially accelerating the diagnostic process and alleviating the need for biopsy or follow-up imaging.ClinicalTrials.gov number, NCT03318380.