Diagnostic Assessment Research Articles

Assessment of multi-modal magnetic resonance imaging for glioma based on a deep learning reconstruction approach with the denoising method.

Deep learning reconstruction (DLR) with denoising has been reported as potentially improving the image quality of magnetic resonance imaging (MRI). Multi-modal MRI is a critical non-invasive method for tumor detection, surgery planning, and prognosis assessment; however, the DLR on multi-modal glioma imaging has not been assessed. To assess multi-modal MRI for glioma based on the DLR method. We assessed multi-modal images of 107 glioma patients (49 preoperative and 58 postoperative). All the images were reconstructed with both DLR and conventional reconstruction methods, encompassing T1-weighted (T1W), contrast-enhanced T1W (CE-T1), T2-weighted (T2W), and T2 fluid-attenuated inversion recovery (T2-FLAIR). The image quality was evaluated using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness. Visual assessment and diagnostic assessment were performed blindly by neuroradiologists. In contrast with conventionally reconstructed images, (residual) tumor SNR for all modalities and tumor to white/gray matter CNR from DLR images were higher in T1W, T2W, and T2-FLAIR sequences. The visual assessment of DLR images demonstrated the superior visualization of tumor in T2W, edema in T2-FLAIR, enhanced tumor and necrosis part in CE-T1, and fewer artifacts in all modalities. Improved diagnostic efficiency and confidence were observed for preoperative cases with DLR images. DLR of multi-modal MRI reconstruction prototype for glioma has demonstrated significant improvements in image quality. Moreover, it increased diagnostic efficiency and confidence of glioma.

The Utility of Neuromuscular Assessment to Identify ADHD Among Patients with a Complex Symptom Picture

Objective: Diagnostic assessment of ADHD is challenging due to comorbid psychopathologies and symptoms overlapping with other psychiatric disorders. In this study, we investigate if a distinct pattern of neuromuscular dysregulation previously reported in ADHD, can help identifying ADHD in psychiatric patients with diverse and complex symptoms. Method: We explored the impact of neuromuscular dysregulation, as measured by The Motor Function Neurologic Assessment (MFNU), on the likelihood of being diagnosed with ADHD, affective disorder, anxiety disorder, or personality disorder among adults (n = 115) referred to a psychiatric outpatient clinic. Results: Logistic regression revealed that neuromuscular dysregulation was significantly associated with ADHD diagnosis only (OR 1.15, p < .01), and not with affective-, anxiety-, or personality disorders. Sensitivity and specificity for ADHD at different MFNU scores is provided. Conclusions: A test of neuromuscular dysregulation may promote diagnostic accuracy in differentiating ADHD from other psychiatric disorders in patients with an overlapping symptom picture. This may have important implications for clinical practice. More studies are needed.

373. FLIPPING THE SCRIPT: ENDOFLIPPING THROUGH ESOPHAGEAL CHALLENGES WITH A TWIST!

Abstract Background High-resolution esophageal manometry (HRM) is the gold standard for studying esophageal motility disorders but isn't universally available, and it's also reported as invasive and uncomfortable. The EndoFLIP system offers a dynamic evaluation of the esophagogastric junction (EGJ), crucial for patients with inconclusive HRM or undergoing endoscopic or surgical therapy such as myotomy or fundoplication. EndoFLIP is a practical tool in patients with dysphagia with normal upper endoscopy, allowing diagnostic assessment during the same procedure, and better selecting patients for subsequent HRM. Methods We conducted a retrospective study where we analyzed EndoFLIP procedures performed at a tertiary center from January 2022 to February 2024, for multiple indications, including characterization of findings on HRM, primary investigation of patients with dysphagia undergoing diagnostic upper endoscopy, motility study in patients intolerant to HRM, and post-therapeutic endoscopic/surgical assessment. Results Sixty-nine patients submitted to EndoFLIP procedures were included (39.1% male; 60.9% female) with a median age of 62 years. The primary indication was dysphagia, with 17.3% of patients being intolerant or referred with inconclusive HRM. EndoFLIP enabled diagnosis in all patients, even with an inconclusive HRM. Endoflip was performed on patients with treated achalasia with recurrence of dysphagia (16%), of which 55% exhibited reduced distensibility of EGJ. The evidence of reduced distensibility allowed patient selection for further treatment. Seven patients underwent EndoFLIP to characterize EGJOO. Comparing paired data from HRM and EndoFLIP, overall concordance was only 47,1%. Endoflip showed a large discordance for the EGJOO group, with 50% having normal findings and 20% confirming EGJOO. 43,8% of patients diagnosed with EGJOO confirmed by EndoFLIP underwent endoscopic therapy during the same procedure, allowing the diagnosis and treatment at the same time. Four patients with gastroesophageal reflux disease, intolerant to HRM and proposed for Nissen fundoplication, underwent EndoFLIP for EGJ and esophageal motility evaluation. Currently, they are proposed for surgery due to the normal findings on EndoFLIP. Conclusion The use of EndoFLIP in evaluating esophageal motility disorders presents a paradigm shift, overcoming the limitations of traditional methods like HRM. Our retrospective study demonstrates its pivotal role in diagnosing and managing patients with dysphagia submitted to diagnostic endoscopy, especially post-interventions like achalasia or Nissen fundoplication. With its ability to provide comprehensive assessments and guide tailored treatments, EndoFLIP emerges as a valuable tool in clinical practice. Its impact on patient management, evidenced by alterations in treatment strategies in over 80% of cases, underscores its significance.

A single center experience on PI3K/AKT/MTOR signaling defects: Towards pathogenicity assessment for four novel defects.

Phosphoinositide 3 kinases (PI3K) are lipid kinases expressed in lymphocytes/myeloid cells. PI3K/AKT/mTOR signaling defects present with recurrent infections, autoimmunity, lymphoproliferation, and agammaglobulinemia. To characterize the PI3K/AKT/mTOR pathway defects and perform pathway analyses to assess novel variant pathogenicity. We included 12 patients (heterozygous PIK3CD (n = 9) and PIK3R1 (n = 1) (activated PI3K delta syndrome (APDS) with gain-of-function mutations) and homozygous PIK3R1 variant (n = 2)), performed clinical/laboratory/genetic evaluation, and flow cytometric PI3K/AKT/mTOR pathway analyses. Median age at onset of complaints was 17.5 months (3 months to 12 years) and at diagnosis was 15.7 years (2.5-37) in APDS. Median diagnostic delay was 12.9 years (1.6-27). Recurrent respiratory tract infections (90%), lymphoproliferation (70%), autoimmune/inflammatory findings (60%), and allergy (40%) were common in APDS. Recurrent viral infections were present in 4/10 and malignancy (non-Hodgkin lymphoma and testicular yolk sac tumor) was present in 2/10 in APDS. Low CD4+ T cells(5/8) with increased CD4+ effector memory (8/8) and CD4+ TEMRA cells (6/8) were present in the given number of APDS patients. We diagnosed tubulointerstitial nephritis, Langerhans cell histiocytosis, and late-onset congenital adrenal hyperplasia in APDS. Allergic findings, lymphoproliferation/malignancy, and high IgM were present in the APDS but not in PIK3R1 deficiency. Low IgM/IgG/CD19+ B cell counts were characteristic in patients with PIK3R1 homozygous loss-of function mutations. Differential diagnosis with combined immunodeficiency and diseases of immune dysregulation make molecular genetic analysis crucial for diagnosing mTOR pathway defects. It is easy to differentiate APDS and homozygous PIK3R1 defects with specific laboratory features. Additionally, mTOR pathway functional analysis is a definitive diagnostic and pathogenicity assessment tool for novel APDS mutations.

Machine Learning Streamlines the Morphometric Characterization and Multiclass Segmentation of Nuclei in Different Follicular Thyroid Lesions: Everything in a NUTSHELL

The diagnostic assessment of thyroid nodules is hampered by the persistence of uncertainty in borderline cases and further complicated by the inclusion of noninvasive follicular tumor with papillary-like nuclear features (NIFTP) as a less aggressive alternative to papillary thyroid carcinoma (PTC). In this setting, computational methods might facilitate the diagnostic process by unmasking key nuclear characteristics of NIFTP. The main aims of this work were to (1) identify morphometric features of NIFTP and PTC that are interpretable for the human eye and (2) develop a deep learning model for multiclass segmentation as a support tool to reduce diagnostic variability. Our findings confirmed that nuclei in NIFTP and PTC share multiple characteristics, setting them apart from hyperplastic nodules (HP). The morphometric analysis identified 15 features that can be translated into nuclear alterations readily understandable by pathologists, such as a remarkable internuclear homogeneity for HP in contrast to a major complexity in the chromatin texture of NIFTP and to the peculiar pattern of nuclear texture variability of PTC. A few NIFTP cases with available next-generation sequencing data were also analyzed to initially explore the impact of RAS-related mutations on nuclear morphometry. Finally, a pixel-based deep learning model was trained and tested on whole-slide images of NIFTP, PTC, and HP cases. The model, named NUTSHELL (NUclei from Thyroid tumors Segmentation to Highlight Encapsulated Low-malignant Lesions), successfully detected and classified the majority of nuclei in all whole-slide image tiles, showing comparable results with already well-established pathology nuclear scores. NUTSHELL provides an immediate overview of NIFTP areas and can be used to detect microfoci of PTC within extensive glandular samples or identify lymph node metastases. NUTSHELL can be run inside WSInfer with an easy rendering in QuPath, thus facilitating the democratization of digital pathology.

The allocation of patients with personality disorders to a suitable treatment approach: The development of a checklist based on patients' life stories.

Treatment assignment for patients with personality disorders (PDs) involves a complex process consisting of diagnostic assessment and deciding on the most appropriate psychotherapeutic treatment. This article describes the development of a checklist for systematic analysis of life stories to support reflective and transparent assignment of patients to either dialectical behavioral therapy (DBT) or schema-focused therapy (SFT). In a first study, an email survey, focus group, and member check were conducted among eight clinical experts to identify relevant dimensions in life stories in patients with PDs. In a second study, a checklist based on these dimensions was developed in three rounds of testing with nine clinical experts and nine psychology students. Checklist results were compared to actual assigned treatment for 20 patients. Systematic evaluation of life stories, is promising in supporting the allocation of patients with PDs to a suitable treatment approach by focusing on specific and consensual dimensions in patients' life stories.

English Preservice Teachers’ Perceptions of Listening Comprehension Difficulties

This study examines the perceptions of listening comprehension difficulties among English preservice teachers at a university in Thailand. Survey-based research was conducted using a questionnaire designed by Ahkam Hasan Assaf. The questionnaire consisted of 45 close-ended questions on a five-point Likert scale. Out of 98 English preservice teachers selected through simple random sampling, 63 respondents completed an online questionnaire. Data were analyzed using descriptive statistics. The results indicated that the greatest difficulties were associated with the physical setting (M=3.84) as the most challenging, followed by content of spoken text (M=3.77), the speaker (M=3.72), failure to concentrate (M=3.51), difficulties related to the listener (M=3.49), and linguistic features (M=3.45). Rated as moderate, the importance of listening skill (M=3.05) was rated the least. The study reveals how individual learner differences impact listening comprehension and trigger the need for effective educational approaches, such as diagnostic assessments to identify specific listening challenges faced by students, allowing for customized listening exercises. Additionally, curriculum designers can incorporate diverse and comprehensive listening components to directly target these difficulties. This also emphasizes the need for enhanced teacher training programs that focus on pedagogical strategies, including adaptive teaching methods and effective use of technology, to improve the engagement and effectiveness of listening lessons.

Utility of routine preoperative laboratory testing for patients undergoing minor gynaecologic surgical procedures: interim analysis of their impact on intraoperative and postoperative complications.

Despite discouragement from many scientific societies, routine preoperative testing remains a common practice. Minor gynaecological surgery, being widely performed in everyday practice, represents an opportunity for implementing cost-reduction policies by avoiding unnecessary diagnostic assessments. To assess whether performing routine preoperative blood tests affects postoperative complications and cost-effectiveness in patients undergoing minor gynaecological surgery. An interim subgroup analysis of a retrospective study conducted by Fondazione Policlinico Gemelli (Rome) and Azienda Sanitaria Universitaria Friuli Centrale (Udine) was performed. Patients who underwent surgery under general anaesthesia were included. The studied population was divided based on the preoperative work up. Clinical data, surgical features and complications were collected. Intraoperative and postoperative complications, healthcare expenditure in two groups. Subgroup analysis included 1191 patients in Centre A (Rome) who underwent routine complete preoperative tests and 500 patients in Centre B (Udine), who underwent exams only if indicated. Population characteristics were similar in two groups. Postoperative complications were observed in 1.2% and 1.4% of cases in Group A and Group B, respectively (p=0.70). Severe complications occurred in 0.3% of cases in Group A and 0.4% in Group B. Group B showed a cost saving of approximately 70 Euros per procedure (p < 0.001). Preliminary data indicate that routine perioperative assessment did not reduce complication rates, hospital readmissions or surgical reinterventions. Given the high number of procedures, performing specific preoperative tests only when indicated may result in significant cost reduction. This study selectively highlights the potential benefits to overall public health expenditure that could be achieved through stricter adherence to guidelines on preoperative assessment in minor gynaecological surgery.

LVI-PathNet: Segmentation-classification pipeline for detection of lymphovascular invasion in whole slide images of lung adenocarcinoma

Lymphovascular invasion (LVI) in lung cancer is a significant prognostic factor that influences treatment and outcomes, yet its reliable detection is challenging due to interobserver variability. This study aims to develop a deep learning model for LVI detection using whole slide images (WSIs) and evaluate its effectiveness within a pathologist's information system. Experienced pathologists annotated blood vessels and invading tumor cells in 162 WSIs of non-mucinous lung adenocarcinoma sourced from two external and one internal datasets. Two models were trained to segment vessels and identify images with LVI features. DeepLabV3+ model achieved an Intersection-over-Union of 0.8840 and an area under the receiver operating characteristic curve (AUC-ROC) of 0.9869 in vessel segmentation. For LVI classification, the ensemble model achieved a F1-score of 0.9683 and an AUC-ROC of 0.9987. The model demonstrated robustness and was unaffected by variations in staining and image quality. The pilot study showed that pathologists' evaluation time for LVI detecting decreased by an average of 16.95%, and by 21.5% in “hard cases”. The model facilitated consistent diagnostic assessments, suggesting potential for broader applications in detecting pathological changes in blood vessels and other lung pathologies.

Feasibility of implementing a school entry hearing screening programme in the South-East District, Botswana

Objective To assess the feasibility of implementing a school entry hearing screening programme in the South-East District, Botswana. Design A feasibility study design was used. Trained screeners conducted smartphone-based pure tone audiometry screening at 25 dB HL, at 1, 2, and 4 kHz using calibrated headphones. Learners with “refer” results after an immediate rescreen were referred and scheduled for diagnostic hearing assessment at the local hospital. Attendance at diagnostic appointments was encouraged through multiple contacts with the families. Study sample The study participants were 403 Grade 1 learners from eight public primary schools. Results The overall referral rate for diagnostic hearing assessment was 4.7%, with a referral uptake rate of 90%. The sensitivity and specificity of the hearing screening protocol were 93.3% and 86.4%, respectively. The positive and negative predictive values were 82.4% and 95%, respectively. The average cost per learner screened was US$ 10.75. Conclusions School entry hearing screening programmes can be successfully implemented in the South-East District, Botswana. Lessons learnt from this study can potentially guide phased implementation of school hearing screening programmes in other districts.

The Use of Non-Cognitive Diagnostic Assessment on Students' Listening Skills

The Use of Non-Cognitive Diagnostic Assessment on Students' Listening Skills

Antenatal and postpartum depression in women who conceived after infertility treatment: a longitudinal study

ABSTRACT Background Although the association between a history of infertility treatment and perinatal depression has been investigated, most research has been cross-sectional and has not used diagnostic assessment tools. Aims This study investigates longitudinally the association between a history of infertility treatment and perinatal depression using WHO-Composite International Diagnostic Interview 3.0 (WHO-CIDI 3.0) and the Edinburgh Postnatal Depression Scale (EPDS). Methods This study used data (N = 2,435) from the control group of a randomised controlled trial on a sample of pregnant women. Survival analysis was used to examine the influence of infertility treatment on perinatal depressive disorder evaluated by WHO-CIDI 3.0. The EPDS scores at four time points (T1 [baseline]: 18 ± 2 weeks gestation, T2: 32 weeks gestation, T3: 1 week postpartum, T4: 3 months postpartum) were analysed using generalised mixed model analysis. Results The risk of experiencing a major depressive episode evaluated by WHO-CIDI 3.0 did not significantly differ between women conceiving through infertility treatment and those conceiving spontaneously (adjusted hazard ratio = 1.64, p = 0.109). The longitudinal analysis demonstrated that EPDS scores significantly increased at T3 and T4 among women conceiving through infertility treatment compared with those conceiving spontaneously (adjusted estimates of fixed effect from T1 to T3: 1.17, p < 0.01; from T1 to T4: 0.71, p = 0.022). Conclusion Women conceiving through infertility treatment were not found to have a higher risk of diagnosable perinatal depressive disorder than those conceiving naturally. However, a history of infertility treatment can marginally increase sub-clinical postpartum depressive symptoms.

Identification and Analysis of Differentially Expressed Genes Associated with Ferroptosis an d HIV in PASMCs Based on Bioinformatics.

HIV-associated pulmonary arterial hypertension (HIV-PAH), a rare and fatal condition within the pulmonary arterial hypertension spectrum, is linked to HIV infection. While ferroptosis, an iron-dependent cell death form, is implicated in various lung diseases, its role in HIVPAH development remains unclear. Leveraging Gene Expression Omnibus data, we identified differentially expressed genes (DEGs) in pulmonary arterial smooth muscle cells, including HIV-related DEGs (HIV-DEGs) and ferroptosis-related HIV-DEGs (FR-HIV-DEGs). PPI network analysis of FR-HIV-DEGs using CytoHubba in Cytoscape identified hub genes. We conducted functional and pathway enrichment analyses for FR-HIV-DEGs, HIV-DEGs, and hub genes. Diagnostic value assessment of hub genes utilized ROC curve analysis. Key genes were further screened, and external validation was performed. Additionally, we predicted a potential ceRNA regulatory network for key genes. 1372 DEGs were found, of which 228 were HIV-DEGs, and 20 were FR-HIV-DEGs. TP53, IL6, PTGS2, IL1B (downregulated), and PPARG (upregulated) were the five hub genes that were screened. TP53, IL6, and IL1B act as ferroptosis drivers, PTGS2 as a ferroptosis marker, and PPARG as a ferroptosis inhibitor. Enrichment analysis indicated biological processes enriched in "response to oxidative stress" and pathways enriched in "human cytomegalovirus infection." Key genes IL6 and PTGS2 exhibited strong predictive value via ROC curve analysis and external validation. The predicted ceRNA regulatory network identified miRNAs (has-mir-335-5p, has-mir-124-3p) targeting key genes and lncRNAs (XIST, NEAT1) targeting these miRNAs. This study advances our understanding of potential mechanisms in HIV-PAH pathogenesis, emphasizing the involvement of ferroptosis. The findings offer valuable insights for future research in HIV-PAH.

Impact of altitude on the development of low bone mineral density and osteoporosis in individuals aged 50 years and older: protocol for a multicentre prospective cohort study

IntroductionOsteoporotic fractures are a leading cause of disability and contribute significantly to medical care costs worldwide. Variations in bone mineral density and the risk of osteoporosis are notably influenced by...

Prognostic value of electroanatomic-guided endomyocardial biopsy in patients with myocarditis, arrhythmogenic cardiomyopathy and non dilated left ventricular cardiomyopathy

A wide variety of non-invasive and invasive techniques for SCD risk stratification in non ischemic cardiomyopathy (NICM) have been proposed, including left ventricular (LV) ejection fraction, QRS duration, late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) and invasive electrophysiologic study with or without three-dimensional electroanatomic mapping (3D-EAM), to identify and characterize the arrhythmogenic substrate. There is still no clear consensus on the risk stratification in this clinical setting.The aim of our study is to characterize the 3D-EAM substrate in patients with the same clinical presentation of unexplained complex VAs and NICM using CMR, three-dimensional electranatomic mapping (3D-EAM) in association with endomyocardial biopsy (EMB) and genetic screening, as a more precise and early diagnostic assessment may provide important subsequent prognostic impact. The study was designed as a prospective multi-center observational evaluation and the patient follow-up was scheduled at 6 months interval. We enrolled 125 patients distinct into four different group by complete diagnostic work-up: myocarditis, non-dilated left ventricular cardiomyopathy, arrhythmogenic cardiomyopathy and control group. The four groups were compared in terms of clinical, imaging and 3D-EAM data. At multivariate analysis sustained VT/VF on admission [HR: 3.64 (1.79–7.4), p < 0.001], total bipolar scar area of left and right ventricle detected by 3D-EAM [HR: 2.24 (1.13–4.49), p = 0.02], histological diagnosis of myocarditis by 3D-EAM guided endomyocardial biopsy (EBM) [HR: 2.79 (1.04–7.44), p = 0.01] were independent predictors of complex VAs or death at follow-up. 3D-EAM guided EMB represent not only a valid diagnostic tool to identify the arrhythmogenic substrate in patients with NICM and ventricular arrhythmic phenotype but also an important predictor of complex Vas at long term follow-up.

Identifying key genes against rutin on human colorectal cancer cells via ROS pathway by integrated bioinformatic analysis and experimental validation

Colorectal cancer (CRC) poses a significant global health challenge, characterized by substantial prevalence variations across regions. This study delves into the therapeutic potential of rutin, a polyphenol abundant in fruits, for treating CRC. The primary objectives encompass identifying molecular targets and pathways influenced by rutin through an integrated approach combining bioinformatic analysis and experimental validation. Employing Gene Set Enrichment Analysis (GSEA), the study focused on identifying potential differentially expressed genes (DEGs) associated with CRC, specifically those involved in regulating reactive oxygen species, metabolic reprogramming, cell cycle regulation, and apoptosis. Utilizing diverse databases such as GEO2R, CTD, and Gene Cards, the investigation revealed a set of 16 targets. A pharmacological network analysis was subsequently conducted using STITCH and Cytoscape, pinpointing six highly upregulated genes within the rutin network, including TP53, PCNA, CDK4, CCNEB1, CDKN1A, and LDHA. Gene Ontology (GO) analysis predicted functional categories, shedding light on rutin's potential impact on antioxidant properties. KEGG pathway analysis enriched crucial pathways like metabolic and ROS signaling pathways, HIF1a, and mTOR signaling. Diagnostic assessments were performed using UALCAN and GEPIA databases, evaluating mRNA expression levels and overall survival for the identified targets. Molecular docking studies confirmed robust binding associations between rutin and biomolecules such as TP53, PCNA, CDK4, CCNEB1, CDKN1A, and LDHA. Experimental validation included inhibiting colorectal cell HT-29 growth and promoting cell growth with NAC through MTT assay. Flow cytometric analysis also observed rutin-induced G1 phase arrest and cell death in HT-29 cells. RT-PCR demonstrated reduced expression levels of target biomolecules in HT-29 cells treated with rutin. This comprehensive study underscores rutin's potential as a promising therapeutic avenue for CRC, combining computational insights with robust experimental evidence to provide a holistic understanding of its efficacy.

Deep evidential fusion with uncertainty quantification and reliability learning for multimodal medical image segmentation

Single-modality medical images generally do not contain enough information to reach an accurate and reliable diagnosis. For this reason, physicians commonly rely on multimodal medical images for comprehensive diagnostic assessments. This study introduces a deep evidential fusion framework designed for segmenting multimodal medical images, leveraging the Dempster–Shafer theory of evidence in conjunction with deep neural networks. In this framework, features are first extracted from each imaging modality using a deep neural network, and features are mapped to Dempster–Shafer mass functions that describe the evidence of each modality at each voxel. The mass functions are then corrected by the contextual discounting operation, using learned coefficients quantifying the reliability of each source of information relative to each class. The discounted evidence from each modality is then combined using Dempster’s rule of combination. Experiments were carried out on a PET-CT dataset for lymphoma segmentation and a multi-MRI dataset for brain tumor segmentation. The results demonstrate the ability of the proposed fusion scheme to quantify segmentation uncertainty and improve segmentation accuracy. Moreover, the learned reliability coefficients provide some insight into the contribution of each modality to the segmentation process.

Features that characterize monoclonal light chain ("myeloma") cast nephropathy with immunofluorescence challenges and emphasis on electron microscopy.

Renal disease is a common cause of morbidity and mortality in patients with plasma cell dyscrasias. The serum-free light chain assay is used in patients, mostly older, with unexplained acute kidney injury to screen for potential myeloma cast nephropathy. This study consists of a systematic review of diagnostic features in myeloma cast nephropathy. The morphological features of tubular casts in patients with multiple myeloma have not been systematically analyzed. This study focuses on the morphology of these casts, emphasizing ultrastructural features, in a series of 23 patients with light chain ("myeloma") cast nephropathy and compared them with casts in 10 patients with various diseases. The immunofluorescence data were correlated with morphological findings to provide diagnostic assessments and practice guidelines. The ultrastructural features identified as diagnostic of casts associated with myeloma included: amyloid and crystals in the casts, multiple well-defined fracture planes forming a complex jigsaw puzzle arrangement of cast contents, indicative of the fragility of the immunoglobulin light chains involved, and reactive tubular cells lining the tubules with the casts. These features were seen in 95.2% of MCN cases and none of the casts in other renal conditions. Myeloma casts exhibited light chain monoclonality in a significant percentage of the MCN cases and often no staining for IgA or IgM. In contrast, the majority of non-myeloma casts stained for both kappa and lambda light chains, lgA, and lgM, and showed ultrastructurally a rather uniform finely to coarsely granular electron density occasionally admixed with cellular debris.

Implementasi Kegiatan Projek Penguatan Profil Pelajar Pancasila (P5) pada Kurikulum Merdeka dalam Mencegah Perilaku Bullying Pelajar di SMKN 6 Medan

Bullying is one of the serious problems in the world, where it can damage the physical and mental well-being of the parties involved. The problem of bullying cannot be ignored, especially in a school environment where at those ages a person is experiencing growth that is very important for their future. Prevention of bullying can also be done through activities in schools, one of which is the Pancasila Student Strengthening Project (P5) program. This research was conducted by describing findings in the field related to P5 activities in preventing bullying behavior. This research is descriptive research with a qualitative approach. Data collection through socialization (workshops), field observations, provision of diagnostic and formative assessments, and in-depth interviews with informants of research objects. Data analysis is carried out in stages of data reduction, data presentation, and conclusion drawing. Build their mind and body to be able to provide information about bullying so that participants can respond wisely in the future. The methods used are socialization (workshop), observation, discussion, brainstorming, challenges and project benefits. The selection of students at vocational schools as the object of research is due to the rampant bullying of students in schools

A new era of high-resolution CT diagnostics of the lung: improved image quality, detailed morphology, and reduced radiation dose with high-resolution photon-counting CT of the lungs compared to high-resolution energy-integrated CT.

High-resolution computed tomography (HRCT) is dependent on detailed morphology in diagnostic assessment of interstitial lung diseases. Photon-counting CT (PCCT) enables improved resolution while reducing radiation. To compare if the image quality, detailed morphology, and radiation dose in HRCT of the lung improves with PCCT compared to energy-integrated CT (EICT). HRCT with PCCT in patients with body mass index (BMI) from normal to obese, previously examined with different EICT were included. They were evaluated in a five-step scale for image quality according to Quality Criteria for CT (Diagnostic Requirement of the ImPACT group-European standardization). In addition, ground-glass opacities, bronchiectasis, emphysema, nodules, and subpleural detailed morphology (≤1 cm from the pleural border) were evaluated by three independent thoracic and/or pediatric radiologists. Visual grading characteristics (VGC) were used for comparison of image quality and detailed morphology and Fleiss kappa for intra-observer variability. Dose-length product (DLP) and CT dose index-volume (CTDIvol) were collected to calculate effective radiation dose. HRCT with PCCT in 52 women and 48 men (mean age=67.2 ± 13.6 years; age range=27-87 years; BMI=26.9 kg/m2; range=18.6-45 kg/m2) previously examined with EICT (mean age=65.3 ± 13.6 years; age range=27-85 years; BMI=27 kg/m2; range=18.9-45 kg/m2) were included. There were significant differences in image quality for all entities in favor of PCCT. The radiation dose was reduced with PCCT by 47% in all, particularly pronounced in obese with 48.5%. Image quality, detailed morphology, and radiation dose, particularly in obese patients, were significantly improved in HRCT with PCCT compared to conventional EICT. The new technique enables visualization of subpleural structures.