Signal Intensity Changes Research Articles

Structural association between heterotopia and cortical lesions visualised with 7 T MRI in patients with focal epilepsy

PurposeTo analyze structural characteristics of malformations of cortical development (MCD) at 7T and 3T MRI. MethodsTwenty-five patients were examined with a 7T MRI-scanner in addition to 3T examinations performed for epilepsy evaluation. 7T sequences included a 3D-T1-weighted (T1w) MPRAGE, 3D-T2w FLAIR, and heavily T2w axial and coronal high-resolution (0.5 × 0.5 × 0.75–1.0 mm3) 2D-TSE sequences. Images were reviewed for 7T MRI imaging characteristics of MCD, visibility and frequency of identified lesions on 7T and on 3T (original reports and second reading). ResultsIn 25 patients 112 lesions were identified (57 gray matter (GM) heterotopia, 37 focal cortical dysplasia (FCD), and 18 other MCD). Imaging characteristics of the 37 FCD were cortical thickening (n = 11); GM-WM border blurring (n = 30); GM signal intensity changes (n = 18); juxtacortical WM signal intensity changes (n = 18); and transmantle WM signal intensity changes (n = 11). None of the 7T MRI sequences was sufficient to detect all types of lesions. Heterotopia were in general isointense to normal GM. Structural associations between 36 heterotopia and overlaying cortex were observed, composed either of a direct connection, vessel-like structures, or GM-like bridges.FCD were mentioned in 30% (11 of 37) of the original reports at 3T, and in 57% (21 of 37) after second reading. FCD connections to subcortical heterotopia were clinically not reported at all. Conclusion7T MRI revealed subtle connections between heterotopia and previous unidentified pathology in overlaying cortex. These findings may be significant for the understanding of the anatomical seizure origin and propagation pathways.

Altered functional connectivity in children with ADHD while performing cognitive control task

Response inhibition is one of the crucial cognitive domains that exhibit deficit in children with ADHD. To further elucidate it, this study examines the task-based functional-connectivity in children with attention deficit hyperactive disorder (ADHD). We acquired the fMRI data of 16 unmedicated children with ADHD and 16 typically developing (TD) children who performed the flanker task. MVPA and seed-based connectivity analysis was performed to identify the abnormal connectivity pattern across the whole brain. MVPA revealed that six important regions, namely the right IFG, right SMA, bilateral precentral gyrus, left DLPFC, and left cerebellum, had abnormal connectivity in children with ADHD while they performed the cognitive control task. Out of these six regions, four were further used for whole-brain seed-based functional connectivity analyses, which revealed patterns of significantly altered connectivity across multiple regions. Signal intensities changes were also extracted to perform BOLD- reaction time (RT) correlation analysis, that suggest positive correlation between left DLPFC and right IFG. Overall, the results suggest that children with ADHD are unable to endure high cognitive control demand. Our findings highlight the utility of analyzing brain connectivity data in identifying the abnormal connectivity in children with ADHD.

Physical Activity Counseling and Documentation by Pediatric Residents in Primary Care: Before and After Introduction of the FITT Principle.

Physician training on physical activity (PA) counseling in patient care is highly variable. The objective of this study was to improve PA counseling by pediatric residents through introduction of the four components of PA, called the FITT principle (frequency, intensity, time, type). Pediatric residents (n=30) received lectures, curriculum content, and an electronic smart-phrase addressing PA in obesity, including the FITT principle. Surveys assessed resident attitudes, and chart reviews (n = 423 over 16 months) identified evidence of PA counseling including FITT principle components preintervention and postintervention. Survey results showed positive attitudes and confidence regarding primary care provider roles in counseling on PA, with no differences postintervention. Chart reviews demonstrated increased documentation on PA frequency postintervention (pre 31.9% vs post 50.9%, P=.00006), but no significant changes in intensity, time or type. In conclusion, a focused PA curriculum promoted PA counseling by pediatric residents, with increased documentation of one component of the FITT principle.

Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction.

Oxygenation-sensitive cardiac magnetic resonance imaging (OS-CMR) is a diagnostic technique that uses the inherent paramagnetic properties of deoxyhemoglobin as an endogenous source of tissue contrast. Used in combination with standardized vasoactive breathing maneuvers (hyperventilation and apnea) as a potent non-pharmacologic vasomotor stimulus, OS-CMR can monitor changes in myocardial oxygenation. Quantifying such changes during the cardiac cycle and throughout vasoactive maneuvers can provide markers for coronary macro- and microvascular function and thereby circumvent the need for any extrinsic, intravenous contrast or pharmacologic stress agents. OS-CMR uses the well-known sensitivity of T2*-weighted images to blood oxygenation. Oxygenation-sensitive images can be acquired on any cardiac MRI scanner using a modified standard clinical steady-state free precession (SSFP) cine sequence, making this technique vendor-agnostic and easily implemented. As a vasoactive breathing maneuver, we apply a 4 min breathing protocol of 120 s of free breathing, 60 s of paced hyperventilation, followed by an expiratory breath-hold of at least 30 s. The regional and global response of myocardial tissue oxygenation to this maneuver can be assessed by tracking the signal intensity change. The change over the initial 30 s of the post-hyperventilation breath-hold, referred to as the breathing-induced myocardial oxygenation reserve (B-MORE) has been studied in healthy people and various pathologies. A detailed protocol for performing oxygen-sensitive CMR scans with vasoactive maneuvers is provided. As demonstrated in patients with microvascular dysfunction in yet incompletely understood conditions, such as inducible ischemia with no obstructive coronary artery stenosis (INOCA), heart failure with preserved ejection fraction (HFpEF), or microvascular dysfunction after heart transplantation, this approach provides unique, clinically important, and complementary information on coronary vascular function.

New advances in medical imaging technology for the evaluation of anthracycline-induced cardiotoxicity.

New advances in medical imaging technology for the evaluation of anthracycline-induced cardiotoxicity.

English

Bacteriophytochromes (BphPs) are light-regulated biliprotein photoreceptors widely occurring in bacteria. BphPs exists in two spectral distinct states: the red-light absorbing state (Pr) and the far-red light-absorbing state (Pfr). BphPs are composed of an N-terminal photosensory core module and a light-controlled C-terminal histidine kinase module. The detailed mechanism on how photoconversion, initiated by a light-triggered isomerization of the biliverdin chromophore, is conducted from the N-terminal to the C-terminal domain and how the histidine kinase is modulated is still not clear. In this work Agp1 from Agrobacterium tumefaciens is used as a model phytochrome. The method of labeling full-length Agp1 mutants with single accessible Cys residue using fluorescence probes is described. Different absorption spectra showed that neither mutagenesis nor fluorescence labeling exerts significant effects on the photoconversion behavior of various Agp1 mutants. The histidine kinase activity assay revealed that the labeled holoproteins exhibit wild-types like autophosphorylation activity that depends on the Pr and the Pfr state. Fluorescence spectroscopic data suggested that fluorescence resonance energy transfer occurs from the donor Atto495 to the acceptor Atto565 in double-labeled Agp1-A362C, K514C, H554C, R603C, I653C, and V674C mutants. Red light irradiation gave rise to small changes on fluorescence emission intensity in some mutants but in some no remarkable inter-subunit distance changes occurred during the photo-conversion from Pr to Pfr in full-length Agp1. In contrast to double-labeled samples, significant changes in fluorescence intensity were observed in single-labeled samples.   Key words: Bacteriophytochromes (BphPs), C-terminal domain, photosensory, phytochrome. 

Low‐Temperature Photoluminescence Investigation of Light‐Induced Degradation in Boron‐Doped CZ Silicon

Light‐induced degradation (LID) in boron‐doped Czochralski grown (CZ) silicon is a severe problem for silicon devices such as solar cells or radiation detectors. Herein, boron‐doped CZ silicon is investigated by low‐temperature photoluminescence (LTPL) spectroscopy. An LID‐related photoluminescence peak is already found while analyzing indium‐doped p‐type silicon samples and is associated with the ASi–Sii defect model. Herein, it is investigated whether a similar peak is present in the spectra of boron‐doped p‐type CZ silicon samples. The presence of change in the photoluminescence signal intensity due to activation of the boron defect is investigated as well. Numerous measurements on boron‐doped samples are made. For this purpose, samples with four different boron doping concentrations are analyzed. The treatments for activation of the boron defect are based on the LID cycle. During an LID cycle, an additional peak or shoulder neither in the areas of the boron‐bound exciton transverse acoustic and nonphonon‐assisted peaks (BTA, BNP) nor in the area of the boron‐bound exciton transverse optical phonon‐assisted peak (BTO) is found. The defect formation also does not lead to a lower photoluminescence (PL) intensity ratio BTO(BE)/ITO(FE).

Blood uptake and urine excretion of nano- and micro-plastics after a single exposure

Nano- and micro-plastic (NMP) pollution has emerged as a global issue; however, uptake in the blood is controversial. Also, there is no evidence that NMPs are excreted via urine. This study was designed to clarify the time course of NMPs absorption in blood and the excretion in urine.Male mice received a single administration of fluorescent polystyrene (PS) beads (100-nm and 3-μm) via tail vein injection, gavage, or pulmonary perfusion. Blood and urine samples were measured 0.5, 1, 2, and 4 h after exposure by confocal laser scanning microscope (CLSM). Transmission electron microscopy (TEM) was performed to corroborate the findings.Fluorescence particles were detected in both blood and urine from the 100-nm and 3-μm PS-treated groups after exposure. In the 3-μm PS treated group, particles with corresponding diameters were detected after intravenous injection and pulmonary perfusion, and particles with a diameter <3 μm were detected in blood samples after gavage. The fluorescent signal in urine was particularly weak and the size was <3 μm. Significant time course changes in fluorescence intensity were demonstrated in blood and urine (P < 0.05) after intravenous injection and pulmonary perfusion in the 100-nm PS-treated group. By contrast, significant changes were detected in the urine (P < 0.05), but not the blood, after gavage. TEM confirmed the presence of particles with corresponding diameters in blood samples; however, the excretion in urine was difficult to confirm for nano-plastics (NPs) and micro-plastics (MPs) because all particles with diameters of approximately 100 nm and 3 μm had irregular shapes and no clear boundaries.Our findings revealed that both NPs and MPs enter the blood circulation through digestive and respiratory pathways. Both 100-nm and 3-μm NMPs may be excreted through urine, but further evidence is needed. The physical and chemical properties of MPs may be impacted by digestive processes in vivo.

The effect of endovascular baroreflex amplification on central sympathetic nerve circuits and cerebral blood flow in patients with resistant hypertension: A functional MRI study.

Endovascular baroreflex amplification (EVBA) by implantation of the MobiusHD is hypothesized to lower blood pressure by decreasing sympathetic activity through the mechanism of the baroreflex. In the present exploratory study we investigated the impact of MobiusHD implantation on central sympathetic nerve circuits and cerebral blood flow (CBF) in patients with resistant hypertension. In thirteen patients, we performed blood oxygenation level-dependent functional magnetic resonance imaging (BOLD fMRI) at rest and during Valsalva maneuvers, before and 3 months after EVBA. Data were analyzed using a whole-brain approach and a brainstem-specific analysis. CBF was assessed using arterial spin labeling MRI. Resting-state fMRI analysis did not reveal significant differences in functional connectivity at 3 months after EVBA. For the Valsalva maneuver data, the whole-brain fMRI analysis revealed significantly increased activation in the posterior and anterior cingulate, the insular cortex, the precuneus, the left thalamus and the anterior cerebellum. The brainstem-specific fMRI analysis showed a significant increase in BOLD activity in the right midbrain 3 months after EVBA. Mean gray matter CBF (partial volume corrected) decreased significantly from 48.9 (9.9) ml/100 gr/min at baseline to 43.4 (13.0) ml/100 gr/min (p = 0.02) at 3 months. This first fMRI pilot study in patients with resistant hypertension treated with EVBA showed a significant increase in BOLD activity during the Valsalva maneuver in brain regions related to sympathetic activity. No notable signal intensity changes were observed in brain areas involved in the baroreflex circuit. Future randomized controlled studies are needed to investigate whether the observed changes are directly caused by EVBA. www.clinicaltrials.gov, identifier: NCT02827032.

Systematic Review of Innovative Diagnostic Tests for Chronic Exertional Compartment Syndrome.

The diagnosis chronic exertional compartment syndrome is traditionally linked to elevated intracompartmental pressures, although uncertainty regarding this diagnostic instrument is increasing. The aim of current review was to evaluate literature for alternative diagnostic tests. A search in line with PRISMA criteria was conducted. Studies evaluating diagnostic tests for chronic exertional compartment syndrome other than intracompartmental pressure measurements were included. Bias and quality of studies were evaluated using the Oxford Levels of Evidence and the QUADAS-2 instrument. A total of 28 studies met study criteria (MRI n=8, SPECT n=6, NIRS n=4, MRI and NIRS together n=1, miscellaneous modalities n=9). Promising results were reported for MRI (n=4), NIRS (n=4) and SPECT (n=3). These imaging techniques rely on detecting changes of signal intensity in manually selected regions of interest in the muscle compartments of the leg. Yet, diagnostic tools and protocols were diverse. Moreover, five studies explored alternative modalities serving as an adjunct, rather than replacing pressure measurements. Future research is warranted as clinical and methodological heterogeneity were present and high quality validation studies were absent. Further optimization of specific key criteria based on a patient's history, physical examination and symptom provocation may potentially render intracompartmental pressure measurement redundant.

External auditory canal and middle ear tumors: characterization by morphology and diffusion features on CT and MRI.

To explore the value of morphology and diffusion features on CT and MRI in the characterization of external auditory canal and middle ear tumors (EAMETs). Forty-seven patients with histologically proved EAMETs (23 benign and 24 malignant) who underwent CT and MRI were retrospectively analyzed in this study. CT and MRI characteristics (including size, shape, signal intensity, border, enhancement degree, and bone changes) and apparent diffusion coefficient (ADC) value were analyzed and compared between benign and malignant EAMETs. Logistic regression, receiver operating characteristic (ROC) curve, and Delong test were performed to assess the diagnostic performance. Compared with benign tumors, the malignant EAMETs are characterized by irregular shape, ill-defined border, invasive bone destruction, and intense enhancement (all p < 0.05). There were no significant differences on the size and signal intensity between benign and malignant tumors. The ADC value of malignant tumors were (879.96 ± 201.15) × 10-6 mm2/s, which was significantly lower than benign ones (p < 0.05). Logistic regression demonstrates the presence of ill-defined margin, invasive bone destruction, and low ADC value (≤ 920.33 × 10-6 mm2/s) have significant relationship with malignant EAMETs. The combination of characterization by morphology and diffusion features on CT and MRI can further improve the diagnostic efficiency when compared with morphology and diffusion features alone (both p < 0.05). Some CT and MRI characteristics are helpful in identifying malignant EAMETs from benign ones (especially ill-defined margin, invasive bone destruction, and low ADC value), and the combination of morphology and diffusion features on CT and MRI has best diagnostic efficiency for discriminating these two entities.

Intraocular Water Movement Visualization Using 1 H-MRI With Eye Drops of O-17-Labeled Saline: First-in-Human Study.

Visualization of aqueous humor flow in MR contrast images using gadolinium is challenging because of the delayed contrast effects associated with the blood-retinal and blood-aqueous humor barriers. However, oxygen-17 water (H2 17 O) might be used as an ocular contrast agent. To observe the distribution of H2 17 O in the human eye, and its flow in and out of the anterior chamber, using dynamic T2-weighted MRI. Prospective. Six ophthalmologically normal volunteers (20-37 years, six females). A 3 T/dynamic T2-weighted MRI. H2 17 O eye drops were administered to the right eye. Time-series images were created by subtracting the image before the eye drops from each of the images obtained after the eye drops. The normalized signal intensity of the right anterior chamber (nAC) was obtained by dividing the signal intensity of the right anterior chamber region by that of the left. The inflow and outflow constants of H2 17 O and H2 17 O concentration were calculated from the nAC. A paired t-test was used to compare the flow-related values and temporal changes in signal intensity. P-values < 0.05 were considered statistically significant. Significantly decreased signal intensity was observed in the right anterior chamber but not the right vitreous body (P=0.39). The nAC signal intensity decreased significantly and then recovered. The inflow and outflow constants were 0.36-0.94 min-1 and 0.023-0.13 min-1 , respectively. The maximum H2 17 O concentration was 0.078%-0.24%. H2 17 O were distributed in the anterior chamber. The H2 17 O inflow into the anterior chamber was significantly faster than that of the outflow. 2 TECHNICAL EFFICACY STAGE: 2.

Management of Chronic Pain and PTSD in Veterans With tDCS+Prolonged Exposure: A Pilot Study

Chronic pain and posttraumatic stress disorder (PTSD) are prevalent comorbid conditions, particularly in Veterans; however, there are few integrated treatments for chronic pain and PTSD. Instead, interventions are typically implemented separately and may involve addictive opioids. Although there are highly effective, non-pharmacological treatments for PTSD, they are plagued by high dropout, which may be exacerbated by comorbid pain, as these PTSD treatments typically require increased activity. Importantly, a noninvasive pain treatment, tDCS (transcranial direct current stimulation) shows indications of effectiveness and may be integrated with psychological treatments, even when delivered via telehealth. This study examines the feasibility and initial efficacy of integrating home telehealth tDCS with prolonged exposure (PE), an evidence-based PTSD treatment. Thirty-nine Veterans were contacted, 31 consented to evaluation, 21 were enrolled, and 16 completed treatment and provided pre- and post-treatment data at one of two Veterans Affairs Medical Centers. Transcranial direct current stimulation sessions corresponded with PE exposure assignments, as there is theoretical reason to believe that tDCS may potentiate extinction learning featured in PE. Patients evinced significant improvement in both pain interference and PTSD symptoms and a trend toward improvement in depression symptoms. However, a significant change in pain intensity was not observed, likely because of the small sample size. The findings provide initial support for the feasibility of an entirely home-based, integrated treatment for comorbid PTSD and pain.

Magnetic resonance imaging features of intrahepatic extramedullary hematopoiesis: Three case reports

BACKGROUNDExtramedullary hematopoiesis rarely occurs within the liver alone, and is easily misdiagnosed. The radiological literature on this disease is exclusively case reports. There is a paucity of literature on the role of magnetic resonance imaging (MRI). The most common imaging modalities used are computed tomography and ultrasound. This report aims to provide more data on the appearance of extramedullary hematopoiesis using MRI to help radiologists establish the diagnosis.CASE SUMMARYThree patients (one male and two females) were incidentally found to have a hepatic mass or nodule, without hepatomegaly or splenomegaly. Laboratory tests including liver function, serum hepatic tumor markers, and hepatitis serologic markers were normal. On MRI scans, all lesions showed lower signal intensity on in-phase images than on out-phase images. One case showed changes in signal intensity on T2 weighted images (WI) and diffusion WI, which shifted from hyperintensity to hypointensity with size enlargement between two rounds of imaging examination. These lesions exhibited different enhancement patterns on dynamic contrast enhancement series.CONCLUSIONThe MRI signal change and in-/out-phase image might provide useful information and help radiologists establish the diagnosis of intrahepatic extramedullary hematopoiesis.

Correlation between superior humeral head migration and proximal long head of biceps tendon pathology in patients with and without rotator cuff tears using magnetic resonance imaging and radiography.

BackgroundThe biomechanical role of the proximal long head of the biceps tendon (PLHB) in glenohumeral joint stability remains controversial. This retrospective study aims to correlate between humeral head migration and PLHB pathology in patients with and without rotator cuff tendon tears using imaging.MethodsSeventy-nine patients who underwent 3T magnetic resonance imaging of the shoulder were retrospectively reviewed. Imaging findings were documented by a fellowship-trained musculoskeletal radiologist. PLHB tendon diameter change, contour irregularity, and signal intensity change were assessed. Rotator cuff status was given a binary assignment of intact vs. torn. Radiographs were used for measurement of the acromiohumeral distance and a cutoff value of 7 mm was set as a lower limit of normal.ResultsIn the cohort of 79 shoulders, 41.8% (33/79) of patients had intact PLHB tendon and rotator cuff, 26.6% (21/79) demonstrated isolated PLHB tendon pathology, 13.9% (11/79) demonstrated isolated rotator cuff tears, and 17.7% (14/79) demonstrated concomitant PLHB tendon pathology and rotator cuff tears. Acromiohumeral distance was preserved in 97.0% (32/33) of patients with intact PLHB tendon and rotator cuff, 28.6% (6/21) of patients with isolated PLHB tendon pathology, 81.8% (9/11) of patients with isolated rotator cuff tears, and 14.3% (2/14) of patients with concomitant PLHB tendon pathology and rotator cuff tears (P < .0001).ConclusionResults of this study have shown that a statistical correlation was present between superior humeral head migration and PLHB tendon pathology with or without rotator cuff tears, compared to rotator cuff pathology alone. Findings suggest that intact PLHB tendon plays an important role in glenohumeral stability.

Characterization and Prediction of Signal Intensity Changes in Normal Liver Parenchyma on Gadoxetic Acid-enhanced MRI Scans after Liver-directed Radiation Therapy.

Purpose To better characterize and understand the significance of focal liver reaction (FLR) development in a large cohort of patients who underwent gadoxetic acid-enhanced MRI after being treated with radiation therapy (RT) for hepatobiliary tumors. Materials and Methods This retrospective study evaluated 100 patients (median age, 65 years [first and third quartiles, 60-69 years]; 80 men) who underwent RT for hepatocellular carcinoma, bile duct tumors, or liver metastases at Mount Sinai Hospital between March 1, 2018, and February 29, 2020. CT simulation scans were fused to MRI scans obtained 1-6 months and 6-12 months after RT, using the hepatobiliary phase of the MRI. To define FLR volume, two radiation oncologists independently delineated the borders of the hypointensity observed on MRI scans in the liver region where RT was delivered. Biologically effective dose (BED) thresholds for the formation of FLRs were calculated, along with albumin-bilirubin (ALBI) scores and grades, and overall survival. Results Most patients developed FLRs, which decreased in volume over time. Median BED threshold values for FLR development were 63.6 Gy at 1-6 months and 88.7 Gy at 6-12 months. While higher baseline ALBI scores were associated with a lower rate of FLRs, there was a significant association between FLR volume and increase in ALBI score at 1-6 months (P = .048). Twelve- and 24-month survival estimates for the cohort were 81% and 48%, respectively. Histopathologic analysis of seven explanted liver specimens demonstrated findings consistent with radiation-induced liver disease. Conclusion FLRs were a clear measure of liver damage after RT and were associated with the development of liver dysfunction and focal radiation-induced liver disease. Keywords: MRI, Radiation Therapy Supplemental material is available for this article. © RSNA, 2022.

EVALUATION OF CYTOTOXIC AND GENOTOXIC EFFECTS OF SAXAGLIPTIN

Saxagliptin (SAX) is an oral drug that is a hypoglycemic (between an anti-diabetic agent) dipeptidyl peptidase-4 inhibitor. In this study, cytotoxic, genotoxic effects and DNA damage of SAX on human lymphocytes were investigated. For this purpose, Single Cell Gel Electrophoresis (SCGE), Micronucleus (MN) and Mitotic Index (MI) tests were used. Based on the daily doses of SAX, 0.017, 0.035, 0.07, 0.14 µg/mL concentrations used for the study. SAX significantly reduced the MI only at the highest concentration (0.14 µg/mL) for 24 hours, and 0.07- and 0.14-µg/mL concentrations for 48 hours. SAX did not cause a statistically significant change in MN frequency (except for concentration 0.14 µg/mL). In the SCGE test, a statistically significant increase of comet tail length was observed at 0.07- and 0.14-µg/mL concentrations. SAX did not cause a statistically significant change in comet tail moment and tail intensity (except for concentration 0.14 µg/mL). As a result, SAX caused statistically differences in the SCGE, MI and MN tests only at the highest concentrations that are not recommended commercial use (except for tail length, 0.035 µg/mL). When the results of all these studies are evaluated together, it can be said that SAX has no aneugenic, mutagenic and clastogenic effects at daily doses in in vitro studies on human lymphocytes.

Trends of Prevalence Estimates and Risk Factors of Depressive Symptoms among Healthcare Workers Over one Year of the COVID-19 Pandemic.

COVID-19 pandemic has an overwhelming psychologic burden on healthcare workers (HCWs). This study aims to investigate the changes in the prevalence, estimates, severity, and risk factors of depressive symptoms among HCWs within the first year of the COVID-19 pandemic. An observational e-survey collected data on HCWs' socio-demographic characteristics, occupational situation, and depressive symptoms as measured by Patient Health Questionnaire-9 (PHQ-9). The e-survey was distributed one month after the onset of the COVID-19 pandemic (onset group) and again after one year (one-year group). A total of 422 HCWs were included (Mean (SD) age, 35.3 (9.9) years; 71.3% males), with 211 (50%) participants in each group. In the total cohort, the mean PHQ-9 score was 8.5, and 36.7% reported clinically significant levels of depressive symptoms with a PHQ-9 score of ≥10. Compared to the onset group, the one-year group reported a higher risk of major depressive disorder (41.7% vs. 31.8%; OR 1.538; 95%CI 1.032-2.291; p=0.034), a higher mean PHQ-9 score (9.5 (6.8) vs. 7.4 (5.3), p<0.001), and more severe depressive symptoms (p<0.005). Participants who were younger, unmarried, underwent testing for COVID-19, reported lower monthly income, did not receive special COVID-19 education, or had lower satisfaction with institutional preparedness had significantly higher depression scores and symptoms in both onset and one-year groups (p<0.05 for each category). Female gender and direct contact with COVID-19 patients or samples were significant risk factors within the onset group. Occupation as a physician, history of COVID-19 testing or infection, and perception of significant changes in work schedule or intensity were significantly associated with higher depression scores and symptoms among the one-year group. This study sheds light on an unspoken but significant rise in prevalence estimates and severity of depressive symptoms among HCWs over a year of the COVID-19 pandemic and shows the vulnerable subgroups for whom a psychological intervention might be warranted.

Comparative Effects Of Stabilizing Exercises and PNF Stretching Of Upper Trapezius On Functional Disability &amp; Pain

Aim: To compare the results of proprioceptive neuromuscular facilitation stretches with stability exercises of upper trapezius in reference to neck ranges, disability level and pain specifically in mobile phone users with neck pain. Methods: Convenient sampling was used with randomization at the time of group allocation and blinding of assessor was made sure. 50 subjects both males and females with neck pain were recruited with 18 to 30 years of age. 2 treatment groups were present each containing equal number of subjects. One group was treated using stretches and other was given stability exercises. Neck disability index was used to record level of disability for neck and Numeric pain rating scale was used for recording pain levels at baseline, 4th and 8th weeks after treatment. Study was completed in 9 months. Results: Both groups showed no important difference with p &gt; 0.05. However, both groups indicated significant changes in pain intensity and neck functionality at 4th and 8th weeks when compared with baseline. Conclusion: Both techniques were equally effective in improving neck ranges, pain levels and neck functionality. Keywords: Mobile Phone, Neck Pain, Proprioceptive Neuromuscular Technique, Stretches, Stabilization.

Comparative study of radiologists vs machine learning in differentiating biopsy-proven pseudoprogression and true progression in diffuse gliomas

Background and PurposeMRI features of tumor progression and pseudoprogression may be indistinguishable especially without enhancing portion of the diffuse gliomas. Our aim is to discriminate these two conditions using radiomics and machine learning algorithm and to compare them with human observations. Materials and MethodsThree consecutive MRI studies before a definitive biopsy in 43 diffuse glioma patients (7 pseudoprogression and 36 true progression cases) who underwent treatment were evaluated. Two neuroradiologists reviewed pre- and post-contrast T1, T2, FLAIR, ADC, rCBV, rCBF, K2, and MTT maps. Patterns of enhancement, ADC maps, rCBV, rCBF, MTT, K2 values, and perilesional FLAIR signal intensity changes were recorded. Odds ratios (OR) for each descriptor, raters' success in predicting true and pseudoprogression, and inter-observer reliability were calculated using the R statistics software. Unpaired Student's t-test and receiver operating characteristic (ROC) analysis were applied to compare the texture parameters and histogram analysis of pseudo- and true progression groups. All first-order and second-order image texture features and shape features were used to train and test the Random Forest classifier (RFC). Observers' success and RFC were compared. ResultsObservers could not identify true progression in the first visit. However, accuracy of the RFC model was 81%. For the second and third visits, the rater's success of prediction was between 62% and 72%. The accuracy for the second and last visit with RFC was 75% and 81%. ConclusionsRandom Forest classifier was more successful than human observations in predicting pseudoprogression using MRI.