Diffuse Pattern Research Articles

Do Habitat MRI and Fractal Analysis Help Distinguish Triple-Negative Breast Cancer From Non-Triple-Negative Breast Carcinoma.

Purpose: To determine whether multiparametric MRI-based spatial habitats and fractal analysis can help distinguish triple-negative breast cancer (TNBC) from non-TNBC. Method: Multiparametric DWI and DCE-MRI at 3T were obtained from 142 biopsy- and surgery-proven breast cancer with 148 breast lesions (TNBC = 26 and non-TNBC = 122). The contrast-enhancing lesions were divided into 3 spatial habitats based on perfusion and diffusion patterns using K-means clustering. The fractal dimension (FD) of the tumour subregions was calculated. The accuracy of the habitat segmentation was measured using the Dice index. Inter- and intra-reader reliability were evaluated with the intraclass correlation coefficient (ICC). The ability to predict TNBC status was assessed using the receiver operating characteristic curve. Results: The Dice index for the whole tumour was 0.81 for inter-reader and 0.88 for intra-reader reliability. The inter- and intra-reader reliability were excellent for all 3 tumour habitats and fractal features (ICC > 0.9). TNBC had a lower hypervascular cellular habitat and higher FD 1 compared to non-TNBC (all P < .001). Multivariate analysis confirmed that hypervascular cellular habitat (OR = 0.88) and FD 1 (OR = 1.35) were independently associated with TNBC (all P < .001) after adjusting for rim enhancement, axillary lymph nodes status, and histological grade. The diagnostic model combining hypervascular cellular habitat and FD 1 showed excellent discriminatory ability for TNBC, with an AUC of 0.951 and an accuracy of 91.9%. Conclusions: The fraction of hypervascular cellular habitat and its FD may serve as useful imaging biomarkers for predicting TNBC status.

Takotsubo cardiomyopathy in India and its electrocardiography (ECG) comparison to myocardial infarction

BackgroundOwing to the limited research on Takotsubo Cardiomyopathy (TCM) in Asia, we aim to evaluate in detail the clinical profiles, lab parameters, investigations, and major adverse cardiovascular events (MACE) seen in patients with TCM in the Indian subcontinent. Additionally, we have compared the electrocardiographic findings of patients with TCM to those of patients with myocardial infarction (MI).ResultsThe average age of the patients affected was found to be 60 ± 11 years. Women (87.5%) and patients with hypertension (40%) were found to be at an increased risk of developing the syndrome. The most common presenting symptom was dyspnea (48%) following a trigger most commonly emotional (45%). ST elevation and significant T wave inversions were observed in 40% of patients with TCM. Echocardiography revealed a low left ventricular ejection fraction of 43 ± 9%. Coronary angiography was normal in 60%, the rest had mild/subcritical stenoses. The 6-month MACE was 20% and the mortality rate was 7.5%. Follow-up echocardiography of patients with TCM showed improvement in EF in 75% patients.ConclusionsTCM was majorly seen in postmenopausal women following an emotional trigger, but a variety of other triggers were noted. T-wave inversions in TCM follow a diffuse pattern in contrast to specific leads seen in MI. Normal or subcritical stenosis in coronaries at presentation, along with a low EF which improves on follow up provide greater evidence for the diagnosis of TCM.

Genetic insights of H9N2 avian influenza viruses circulating in Mali and phylogeographic patterns in Northern and Western Africa.

Avian influenza viruses (AIVs) of the H9N2 subtype have become widespread in Western Africa since their first detection in 2017 in Burkina Faso. However, the genetic characteristics and diffusion patterns of the H9N2 virus remain poorly understood in Western Africa, mainly due to limited surveillance activities. In addition, Mali, a country considered to play an important role in the epidemiology of AIVs in the region, lacks more comprehensive data on the genetic characteristics of these viruses, especially the H9N2 subtype. To better understand the genetic characteristics and spatio-temporal dynamics of H9N2 virus within this region, we carried out a comprehensive genetic characterization of H9N2 viruses collected through active surveillance in live bird markets in Mali between 2021 and 2022. We also performed a continuous phylogeographic analysis to unravel the dispersal history of H9N2 lineages between Northern and Western Africa. The identified Malian H9N2 virus belonged to the G1 lineage, similar to viruses circulating in both Western and Northern Africa, and possessed multiple molecular markers associated with an increased potential for zoonotic transmission and virulence. Notably, some Malian strains carried the R-S-N-R motif at their cleavage site, mainly observed in H9N2 strains in Asia. Our continuous phylogeographic analysis revealed a single and significant long-distance lineage dispersal event of the H9N2 virus to Western Africa, likely to have originated from Morocco in 2015, shaping the westward diffusion of the H9N2 virus. Our study highlights the need for long-term surveillance of H9N2 viruses in poultry populations in Western Africa, which is crucial for a better understanding of virus evolution and effective management against potential zoonotic AIV strain emergence.

Proteomic and transcriptomic profiling of brainstem, cerebellum and olfactory tissues in early- and late-phase COVID-19.

Neurological symptoms, including cognitive impairment and fatigue, can occur in both the acute infection phase of coronavirus disease 2019 (COVID-19) and at later stages, yet the mechanisms that contribute to this remain unclear. Here we profiled single-nucleus transcriptomes and proteomes of brainstem tissue from deceased individuals at various stages of COVID-19. We detected an inflammatory type I interferon response in acute COVID-19 cases, which resolves in the late disease phase. Integrating single-nucleus RNA sequencing and spatial transcriptomics, we could localize two patterns of reaction to severe systemic inflammation, one neuronal with a direct focus on cranial nerve nuclei and a separate diffuse pattern affecting the whole brainstem. The latter reflects a bystander effect of the respiratory infection that spreads throughout the vascular unit and alters the transcriptional state of mainly oligodendrocytes, microglia and astrocytes, while alterations of the brainstem nuclei could reflect the connection of the immune system and the central nervous system via, for example, the vagus nerve. Our results indicate that even without persistence of severe acute respiratory syndrome coronavirus 2 in the central nervous system, local immune reactions are prevailing, potentially causing functional disturbances that contribute to neurological complications of COVID-19.

Imaging predictors of 4q12 amplified and RB1 mutated glioblastoma IDH-wildtype.

Recent studies have identified that glioblastoma IDH-wildtype consists of different molecular subgroups with distinct prognoses. In order to accurately describe and classify gliomas, the Visually AcceSAble Rembrandt Images (VASARI) system was developed. The goal of this study was to evaluate the VASARI characteristics in molecular subgroups of IDH-wildtype glioblastoma. A retrospective analysis of glioblastoma IDH- wildtype with comprehensive next-generation sequencing and pre-operative and post-operative MRI was performed. VASARI characteristics and 205 genes were evaluated. Multiple comparison adjustment by the Bejamin-Hochberg false discovery rate (BH-FDR) was performed. A 1:3 propensity score match (PSM) with a Caliper of 0.2 was done. 178 patients with GBM IDH-WT met the inclusion criteria. 4q12 amplified patients (n = 20) were associated with cyst presence (30% vs. 12%, p = 0.042), decreased hemorrhage (35% vs. 62%, p = 0.028), and non-restricting/mixed (35%/60%) rather than restricting diffusion pattern (5%), meanwhile, 4q12 non-amplified patients had mostly restricting (47.4%) rather than a non-restricting/mixed diffusion pattern (28.4%/23.4%). This remained statistically significant after BH-FDR adjustment (p = 0.002). PSM by 4q12 amplification showed that diffusion characteristics continued to be significantly different. Among RB1-mutant patients, 96% had well-defined enhancing margins vs. 70.6% of RB1-WT (p = 0.018), however, this was not significant after BH-FDR or PSM. Patients with glioblastoma IDH-wildtype harboring 4q12 amplification rarely have restricting DWI patterns compared to their wildtype counterparts, in which this DWI pattern is present in ~ 50% of patients. This suggests that some phenotypic imaging characteristics can be identified among molecular subtypes of IDH-wildtype glioblastoma.

MRI-based tumor shrinkage patterns after early neoadjuvant therapy in breast cancer: correlation with molecular subtypes and pathological response after therapy

BackgroundMRI-based tumor shrinkage patterns (TSP) after neoadjuvant therapy (NAT) have been associated with pathological response. However, the understanding of TSP after early NAT remains limited. We aimed to analyze the relationship between TSP after early NAT and pathological response after therapy in different molecular subtypes.MethodsWe prospectively enrolled participants with invasive ductal breast cancers who received NAT and performed pretreatment DCE-MRI from September 2020 to August 2022. Early-stage MRIs were performed after the first (1st-MRI) and/or second (2nd-MRI) cycle of NAT. Tumor shrinkage patterns were categorized into four groups: concentric shrinkage, diffuse decrease (DD), decrease of intensity only (DIO), and stable disease (SD). Logistic regression analysis was performed to identify independent variables associated with pathologic complete response (pCR), and stratified analysis according to tumor hormone receptor (HR)/human epidermal growth factor receptor 2 (HER2) disease subtype.Results344 participants (mean age: 50 years, 113/345 [33%] pCR) with 345 tumors (1 bilateral) had evaluable 1st-MRI or 2nd-MRI to comprise the primary analysis cohort, of which 244 participants with 245 tumors had evaluable 1st-MRI (82/245 [33%] pCR) and 206 participants with 207 tumors had evaluable 2nd-MRI (69/207 [33%] pCR) to comprise the 1st- and 2nd-timepoint subgroup analysis cohorts, respectively. In the primary analysis, multivariate analysis showed that early DD pattern (OR = 12.08; 95% CI 3.34–43.75; p < 0.001) predicted pCR independently of the change in tumor size (OR = 1.37; 95% CI 0.94–2.01; p = 0.106) in HR+/HER2− subtype, and the change in tumor size was a strong pCR predictor in HER2+ (OR = 1.61; 95% CI 1.22–2.13; p = 0.001) and triple-negative breast cancer (TNBC, OR = 1.61; 95% CI 1.22–2.11; p = 0.001). Compared with the change in tumor size, the SD pattern achieved a higher negative predictive value in HER2+ and TNBC. The statistical significance of complete 1st-timepoint subgroup analysis was consistent with the primary analysis.ConclusionThe diffuse decrease pattern in HR+/HER2− subtype and stable disease in HER2+ and TNBC after early NAT could serve as additional straightforward and comprehensible indicators of treatment response.Trial registration: Trial registration at https://www.chictr.org.cn/. Registration number: ChiCTR2000038578, registered September 24, 2020.

TN-MR: topic-aware neural network-based mobile application recommendation

PurposeWith the increasing number of mobile applications, efficiently recommending mobile applications to users has become a challenging problem. Although existing mobile application recommendation approaches based on user attributes and behaviors have achieved notable effectiveness, they overlook the diffusion patterns and interdependencies of topic-specific mobile applications among user groups. mobile applications among user groups. This paper aims to capture the diffusion patterns and interdependencies of mobile applications among user groups. To achieve this, a topic-aware neural network-based mobile application recommendation method, referred to as TN-MR, is proposed.Design/methodology/approachIn this method, first, the user representations are enhanced by introducing a topic-aware attention layer, which captures both the topic context and the diffusion history context. Second, it exploits a time-decay mechanism to simulate changes in user interest. Multitopic user representations are aggregated by the time decay module to output the user representations of cascading representations under multiple topics. Finally, user scores that are likely to download the mobile application are predicted and ranked.FindingsExperimental comparisons and analyses were conducted on the actual 360App data set, and the results demonstrate that the effectiveness of mobile application recommendations can be significantly improved by using TN-MR.Originality/valueIn this paper, the authors propose a mobile application recommendation method based on topic-aware attention networks. By capturing the diffusion patterns and dependencies of mobile applications, it effectively assists users in selecting their applications of interest from thousands of options, significantly improving the accuracy of mobile application recommendations.

Geotemporal Fluorophore Biodistribution Mapping of Colorectal Cancer: Micro and Macroscopic Insights.

Fifty consenting patients undergoing treatment for suspected/confirmed colorectal neoplasia provided near infrared (NIR) video and imagery of transanally recorded and ex vivo resected rectal lesions following intravenous ICG administration (0.25 mg/kg), with a subgroup providing tissue samples for microscopic (including near infrared) analysis. Computer vision techniques detailed macroscopic 'early' (<15 min post ICG administration) and 'late' (>2 h) tissue fluorescence appearances from surgical imagery with digital NIR scanning (Licor, Lincoln, NE, USA) and from microscopic analysis (Nikon, Tokyo, Japan) undertaken by a consultant pathologist detailing tissue-level fluorescence distribution over the same time. Significant intra-tumoural fluorescence heterogeneity was seen 'early' in malignant versus benign lesions. In all 'early' samples, fluorescence was predominantly within the tissue stroma, with uptake within plasma cells, blood vessels and lymphatics, but not within malignant or healthy glands. At 'late' stage observation, fluorescence was visualised non-uniformly within the intracellular cytoplasm of malignant tissue but not retained in benign glands. Fluorescence also accumulated within any present peritumoural inflammatory tissue. This study demonstrates the time course diffusion patterns of ICG through both benign and malignant tumours in vivo in human patients at both macroscopic and microscopic levels, demonstrating important cellular drivers and features of geolocalisation and how they differ longitudinally after exposure to ICG.

Interference of holon strings in 2D Hubbard model

The 2D Hubbard model with large repulsion is an important problem in condensed matter physics. At half filling, its ground state is an antiferromagnet (AMF). The dope AMF below half filling is believed to capture the physics of high Tc superconductors. And the fermion excitation of this dope AMF is theorized as splitting up into holons and spinons that carry charge and spin separately. It is believed that these exotic holons and spinons are the origins of the unusual properties of high Tc superconductors. Despite the interests in holons and spinons, the direct observations of these excitations remain difficult in solid state experiments. Here, we show that with the rapid advances in the experimental techniques in cold atoms, the direct observation of holons is possible in quantum quench dynamic processes in cold atom settings. We show that the well-known holon-strings generated by the motion of a holon as well as their interferences can be detected by the measurements spin–spin correlations and demonstrate the presence of the Marshall phase associated with a holon string reflecting an underlying AMF background. Moreover, we show that the interferences of the holon strings make a holon propagate anisotropically, with a diffusion pattern clearly distinct from that of spinless fermions. At the same time, we show that these interferences lead to a large suppression in magnetic order in the region swept through by the strings (even to about 95% for some bond). We further demonstrate the Marshall phase of the holon-strings by comparing the dynamics of holon in the tJ model with that of the so-called σtJ -model, which is the tJ model with the Marshall phase removed. The holons in these models propagate entirely differently.

Perineural differentiation in neurotized nevi

BackgroundPerineuriomatous melanocytic nevi are rare and this may indicate the similar embryological source of melanocytes and peripheral nerves in the neural crest. Neurotized melanocytic nevi may resemble nerve sheath tumors histologically, and show schwannian differentiation. However, literature on whether neurotized nevi differentiate into perineural cells is controversial. We examined our cases of neurotized nevi for evidence of perineural differentiation. Materials and methodsA total of 100 benign nevi with large neurotized component (microscopically involved a low power field 4.2 mm in diameter) were prospectively evaluated in excisional biopsy samples. Immunohistochemical stainings for EMA, Claudin1, Glut1 and neurofilament were performed. ResultsPerineural differentiation was immunohistochemically detected in the neurotized component of the nevi in 61% of the cases with EMA and in all the cases with Glut1 and Claudin1. Axonal differentiation was not detected with neurofilament. The expression pattern, especially with Glut1, was usually in form of partial or complete staining surrounding the Meissner's corpuscle-like structure (MCLS). Also, a linear/curvilinear staining pattern was observed particularly with Claudin1. A diffuse staining pattern with EMA, Glut1 and Claudin1 was detected in a case with a microscopically distinct whorl structure, and in which spindle cells are separated from the superficial epithelioid melanocytes with an abrupt transition histologically. These findings of the case are compatible with previous reports of perineuromatous nevus. ConclusionPerineural differentiation is not uncommon and immunohistochemically observed in all nevi with a relatively large component of neurotization. To prevent misdiagnosing desmoplastic melanoma and overtreating patients, it is crucial to be aware of perineuromatous nevi.

The Role of Magnetic Resonance Imaging in the Preoperative Staging and Treatment of Invasive Lobular Carcinoma

IntroductionInvasive lobular carcinoma (ILC) is known for its diffuse growth pattern and its associated challenges in diagnosing. Magnetic resonance imaging (MRI) is the most accurate imaging modality and might aid in improving preoperative staging compared to full field digital mammography (FFDM) and ultrasound (US), however current literature is inconsistent. The aim of this paper is to evaluate the accuracy of MRI staging compared to FFDM/US and pathology results. MethodsIn this single-centre retrospective study, all patients diagnosed with ILC between 2014 and 2019 who underwent preoperative MRI were included. Specific parameters studied were: (1) the need for second-look targeted biopsies, (2) detection of new tumors (ie, contralateral or multifocal), (3) changes in cTNM-classification, and (4) impact on final treatment plan. Bland-Altman plots were used to compare the tumor sizes measured on MRI and FFDM/US with actual pathological tumor sizes. ResultsNinety-nine patients were included. After performing preoperative MRI, 9 (9.1%) multifocal tumors were diagnosed after additional biopsies. Contralateral tumors were detected twice (2.0%) and cN classification was upgraded in 7 cases (7.1%). Surgical treatment or neoadjuvant treatment plans were changed in 16 patients (16.1%). Compared to histopathological results, FFDM/US underestimated tumor size with a mean of 0.4 cm (Limit of agreement (LoA): -2.8 cm to 2.0 cm) whereas MRI overestimated tumor size with a mean of 0.6 cm (LoA: -1.9 cm to 3.0 cm). ConclusionsIn our study, mean differences in tumor size measurements using FFDM/US and MRI were comparable, with similar random errors. MRI correctly diagnosed multifocal and contralateral tumors more often and provided a better cN staging.

Account credibility inference based on news-sharing networks

The spread of misinformation poses a threat to the social media ecosystem. Effective countermeasures to mitigate this threat require that social media platforms be able to accurately detect low-credibility accounts even before the content they share can be classified as misinformation. Here we present methods to infer account credibility from information diffusion patterns, in particular leveraging two networks: the reshare network, capturing an account’s trust in other accounts, and the bipartite account-source network, capturing an account’s trust in media sources. We extend network centrality measures and graph embedding techniques, systematically comparing these algorithms on data from diverse contexts and social media platforms. We demonstrate that both kinds of trust networks provide useful signals for estimating account credibility. Some of the proposed methods yield high accuracy, providing promising solutions to promote the dissemination of reliable information in online communities. Two kinds of homophily emerge from our results: accounts tend to have similar credibility if they reshare each other’s content or share content from similar sources. Our methodology invites further investigation into the relationship between accounts and news sources to better characterize misinformation spreaders.

Spatial autocorrelation of stunting prevalence among children under five years in West Bandung Regency in 2022

Purpose: This study aims to determine whether there is spatial autocorrelation based on the prevalence of stunting and their spatial diffusion pattern. It also aims to find areas that will become stunting hotspots and cold spots area in West Bandung Regency in 2022. &#x0D; Method: This research employed an ecological study design using spatial analysis to estimate and analyze the distribution pattern of stunting prevalence in the West Bandung Regency in 2022. The data used results from a child monitoring record in Posyandu (Integrated Service Post) carried out by the West Bandung Regency Health Office regarding the prevalence of stunting among children under five years. This study used Moran Index and Local Indicators Autocorrelation (LISA) for spatial pattern analysis. &#x0D; Results: This study shows that there is negative spatial autocorrelation, or the distribution of stunting prevalence forms a random pattern (I&lt;E). This study also indicates that there is statistically no spatial correlation between sub-district areas based on stunting prevalence in West Bandung Regency in 2022 (p-value &gt; 0,05). There is no hotspot and cold spot area of stunting in West Bandung Regency in 2022. &#x0D; Conclusion: The prevalence of stunting in West Bandung Regency in 2022 is not spatially related between sub-district areas, with a random or scattered pattern. The area that is the main priority for intervention is Saguling Subdistrict, the subdistrict with the highest prevalence of stunting. The intervention program implemented in Cililin Subdistrict can be implemented in Saguling Subdistrict to reduce stunting prevalence.

EBV-positive Nodal T-Cell and NK-Cell Lymphoma: A Study of 26 Cases Including a Subset With Strong CD30 Expression Mimicking Anaplastic Large Cell Lymphoma.

Epstein-Barr virus (EBV)-positive nodal T-cell and NK-cell lymphoma is a rare neoplasm of cytotoxic T-cell or NK-cell lineage. Here, we report 26 cases affecting 14 men and 12 women with a median age of 52 years. All patients presented with disease involving multiple lymph nodes, and 20 of 22 (91%) fully staged patients had advanced Ann Arbor stage disease. Spleen, liver, and bone marrow were involved in 70%, 50%, and 52% of cases, respectively. These patients had a dismal prognosis with a median survival of 30 days. Histologically, lymph nodes were replaced by lymphoma in a diffuse pattern. Lymphoma cells were variable in size and large cell morphology was seen in 62% of cases. The neoplastic cells were CD4-/CD8- in 14 (54%) cases and CD4-/CD8+ in 12 (46%) cases. CD56 was positive in 14 (54%) cases. CD30 was positive in 20 (77%) cases; a strong and diffuse pattern was observed in 14 (54%) cases, mimicking, in part, anaplastic large cell lymphoma (ALCL). CD30 expression was associated with younger age and large cell morphology. In summary, EBV+ nodal T-cell and NK-cell lymphoma is an aggressive disease with a poor prognosis. These neoplasms are heterogeneous at the morphologic and immunophenotypic levels. Diffuse and strong expression of CD30 could potentially lead to a misdiagnosis of ALCL if EBV evaluation is not performed. Distinguishing between EBV+ nodal T-cell and NK-cell lymphoma from ALCL is important because treatment strategy and prognosis differ. CD30 expression offers a potential therapeutic target for patients with this aggressive disease.

Spatio-temporal sequence prediction of CO2 flooding and sequestration potential under geological and engineering uncertainties

CO2 injection for subsurface hydrocarbon development not only enhances oil and gas recovery but also enables CO2 sequestration in the subsurface. It is essential to develop effective methods for evaluating the potential of CO2 flooding and sequestration. Despite the existence of methods for predicting the effectiveness of hydrocarbon development using historical production data, insufficient emphasis has been placed on adequately incorporating geological and engineering uncertainty information to enhance prediction accuracy. To address this issue, a novel spatial-temporal ResNet (ST-ResNet) model is proposed for predicting hydrocarbon production, CO2 sequestration volume and CO2 diffusion pattern in the subsurface, which represent the CO2 flooding and sequestration potential. First, high-dimensional reservoir property fields are parameterized using the combined method of principal component analysis and discrete cosine transform (PCA-DCT). Second, the spatial sequence information of various reservoir property fields is extracted with features based on residual neural network (ResNet). Then, the time series information such as dynamic well control parameters is encoded with stacked BiLSTM (SBiLSTM). Specifically, the ST-ResNet model incorporates the above modules to overcome the limitations of collaborative consideration of temporal and spatial information involved in subsurface hydrocarbon development. Comparison between simulation and prediction results on the 2D/3D reservoir model reveals a significant achievement in prediction accuracy by the ST-ResNet model (with R2 and SSIM scores of 0.947, 0.911 and 0.937, 0.922, respectively). In comparison to CNN, LSTM and their combined approach CNN-LSTM, the ST-ResNet model demonstrates an improvement of 3% to 5% in R2, along with reductions of 20% to 30% in MAE and 15% to 25% in RMSE, respectively. These results highlight the superior stability and generalization of the ST-ResNet model. The contribution of this work is to provide a more accurate and efficient prediction tool to guide the integrated development of CO2 flooding and sequestration in subsurface hydrocarbon reservoirs, which facilitates decision-making processes for engineers.

Geographic disparity of pathophysiological coronary artery disease characteristics: Insights from ASET trials

BackgroundThe geographical disparity in the pathophysiological pattern of coronary artery disease (CAD) among patients undergoing percutaneous coronary intervention (PCI) is unknown. ObjectivesTo elucidate the geographical variance in the pathophysiological characteristics of CAD. MethodsPhysiological indices derived from angiography-based fractional flow reserve pullbacks from patients with chronic coronary syndrome enrolled in the ASET Japan (n = 206) and ASET Brazil (n = 201) studies, which shared the same eligibility criteria, were analysed.The pathophysiological patterns of CAD were characterised using Murray law-based quantitative flow ratio (μQFR)-derived indices acquired from pre-PCI angiograms. The diffuseness of CAD was defined by the μQFR pullback pressure gradient index. ResultsSignificant functional stenoses pre-PCI (μQFR ≤0.80) were more frequent in ASET Japan compared to ASET Brazil (89.9% vs. 67.5%, p < 0.001), as were rates of a post-PCI μQFR <0.91 (22.1% vs. 12.9%, p = 0.013). In the multivariable analysis, pre-procedural μQFR and diffuse disease were independent factors for predicting a post-PCI μQFR <0.91, which contributed to the different rates of post-PCI μQFR ≥0.91 between the studies. Among vessels with a post-PCI μQFR <0.91, a consistent diffuse pattern of CAD pre- and post-PCI occurred in 78.3% and 76.7% of patients in ASET Japan and Brazil, respectively; only 6.3% (Japan) and 10.0% (Brazil) of vessels had a major residual gradient. Independent risk factors for diffuse disease were diabetes mellitus in ASET Japan, and age and male gender in Brazil. ConclusionsThere was geographic disparity in pre-procedural angiography-based pathophysiological characteristics. The combined pre-procedural physiological assessment of vessel μQFR and diffuseness of CAD may potentially identify patients who will benefit most from PCI.

Pulmonary hemorrhage as a presentation of AL amyloidosis secondary to multiple myeloma: a case report

Abstract Background The convergence of pulmonary hemorrhage, pulmonary amyloidosis, and multiple myeloma is uncommon. Amyloidosis can affect the pulmonary parenchyma in a diffuse, tracheobronchial, or parenchymal pattern and may rarely be associated with pulmonary hemorrhage. Additionally, pulmonary amyloidosis is not a frequent manifestation of multiple myeloma. We present a case of a male patient with pulmonary hemorrhage as the initial manifestation of AL pulmonary amyloidosis, and ultimately, confirmation of multiple myeloma through bone marrow biopsy. Case presentation The clinical case involves a 60-year-old male with no significant medical history, who was admitted presenting a clinical picture evolving over 6 months characterized by hemoptoic cough, accompanied by dyspnea, a decrease in functional capacity, and constitutional symptoms. Thoracic CT images revealed multilobar ground-glass opacities with suspected alveolar hemorrhage. In response to this clinical presentation, bronchoalveolar lavage with cytology was performed, revealing the presence of hemosiderin-laden macrophages. Given the complexity of the case, further investigation included a wedge biopsy of the lung. The pathological report indicated an atypical lymphoplasmacytoid proliferation with deposits of eosinophilic amorphous material, suggestive of amyloidosis. Congo red staining confirmed the presence of amyloid material. Elevated Kappa light chains were detected in both serum and urine, with an increased K/L ratio. Immunoglobulins G and M were found to be decreased. As part of the comprehensive assessment, a bone marrow biopsy was conducted, confirming the diagnosis of multiple myeloma with 10% atypical plasma cells. In light of this diagnosis, appropriate treatment has been initiated to address this intricate medical condition effectively. Conclusion The present case report provides an illustrative perspective on an uncommon presentation of pulmonary amyloidosis secondary to multiple myeloma, with the initial manifestation being pulmonary hemorrhage. The findings from both the physical examination and laboratory tests were consistent with pulmonary amyloidosis, and definitive confirmation of the multiple myeloma diagnosis was achieved through bone marrow biopsy. This case highlights the significance of considering pulmonary amyloidosis as a potential cause of hemoptysis, especially in patients with associated risk factors for multiple myeloma. Early recognition of this clinical association is pivotal for precise diagnosis and prompt therapeutic intervention. The complexity of this case underscores the importance of a comprehensive diagnostic approach in unraveling intricate medical conditions.

Fulminant hemorrhagic course of a thalamic H3 K27-altered diffuse midline glioma in an adult patient: illustrative case.

H3 K27-altered diffuse midline gliomas (DMGs) are rare tumors, which are, regardless of their histological appearance, classified as World Health Organization grade 4 tumors. They are characterized by a diffuse growth pattern, midline anatomical location, and poor prognosis. Although DMGs occur predominantly in childhood, these tumors can also be found in young adults. The authors present a case of a 29-year-old patient who was found unconscious with a Glasgow Coma Scale score of 4, along with abnormal extensor movements and bilateral middilated nonreactive pupils. Computed tomography revealed obstructive hydrocephalus due to an acute hemorrhage in a right thalamic lesion. To drain the hydrocephalus and relieve the ongoing central herniation, emergent placement of a right-sided, and later a left-sided, extraventricular drain was performed. Despite the postoperative resolution of hydrocephalus, the patient died shortly after because of the central brain herniation that had occurred. Brain autopsy revealed a H3 K27-altered DMG in the right thalamus. Although typically described in the pediatric population and located in the pons, H3 K27-altered DMG should also be considered in young adult patients with midline lesions, particularly if they are located in the thalamus or brainstem. In rare cases, H3 K27-altered DMG may present with an acute tumor-related hemorrhage, leading to a fulminant clinical course.

Patterns in spatial diffusion of residential heat pumps in Switzerland

The diffusion of granular renewable energy technologies displays spatial heterogeneity within countries. The study examines the distribution of residential heat pumps across 2148 Swiss municipalities in 2021, utilising a database covering 95.8 % of Swiss residential buildings. The study focuses on understanding the sociodemographic, technoeconomic and housing factors behind the spatial diffusion of heat pumps, using stepwise regression and spatial statistical analysis. Higher diffusion of residential heat pumps is found in less populated areas with larger shares of agricultural area and detached houses, suggesting a pronounced urban-rural disparity. Economic factors like income and electricity price show limited influence on residential heat pump diffusion in Switzerland, except for a negative impact of unemployment rates. Significant variations among Swiss cantons (states) in residential heat pump diffusion are observed, potentially influenced by regional policies. Spatial analysis indicates the presence of spatial spillovers as well. These findings could guide Swiss policymakers in effectively promoting heat pump diffusion, considering local and regional specificities. The methodology is adaptable and transferable to other geographical and socioeconomic contexts and alternative granular renewable energy technologies.

The Evolution of Intellectual Capital Research – a Bibliometric Analysis of Highly-cited Papers

This study presents and evaluates the development of research on intellectual capital (IC) using bibliometric analysis of highly cited research papers. It also uses social network analysis (SNA) to decipher the complex patterns of collaboration, influence, and knowledge diffusion in the field of IC research. Data for the SNA were extracted from the top 1% of highly cited papers identified through bibliometric analysis. The extracted data were processed using BibExcel, which allowed for the extraction of important metadata, statistical calculations, and an in-depth examination of the selected documents. Pajek, a network analysis tool, was used to visualize and understand the complex network of these influential articles. Our analysis shows the evolution of intellectual capital from a niche interest in the mid-20th century to a dynamically growing field of study. The number of publications increased from double digits in the early 1990s to over a hundred publications per year in the early 2000s. From the mid-2000s to the present, the field experienced almost exponential growth, peaking in 2022 with 796 publications. Analysis of the 103 most cited papers in intellectual capital identified a total of 212 authors. Remarkably, 92% of these authors contributed to only one publication each. The co-authorship analysis unveils a decentralized structure characterized by several smaller research clusters embedded within the broader network. The results of this study enhance our comprehension of intellectual capital research by identifying influential authors, highly cited journals, and co-publication networks, thereby providing valuable insights into the field's dynamics.