Notes

Reconsidering the Medawar paradigm placental viviparity was around for eons, even during vertebrates; with out a "problem": What makes Tregs very important to preeclampsia in wonderful apes?
To identify intra-lesion imaging heterogeneity biomarkers in multi-parametric Magnetic Resonance Imaging (mpMRI) for breast lesion diagnosis.

Dynamic Contrast Enhanced (DCE) and Diffusion Weighted Imaging (DWI) of 73 female patients, with 85 histologically verified breast lesions were acquired. Non-rigid multi-resolution registration was utilized to spatially align sequences. Four (4) DCE (2
post-contrast frame, Initial-Enhancement, Post-Initial-Enhancement and Signal-Enhancement-Ratio) and one (1) DWI (Apparent-Diffusion-Coefficient) representations were analyzed, considering a representative lesion slice. 11 1
-order-statistics and 16 texture features (Gray-Level-Co-occurrence-Matrix (GLCM) and Gray-Level-Run-Length-Matrix (GLRLM) based) were derived from lesion segments, provided by Fuzzy C-Means segmentation, across the 5 representations, resulting in 135 features. Least-Absolute-Shrinkage and Selection-Operator (LASSO) regression was utilized to select optimal feature subsets, subsequently fed intion heterogeneity, across mpMRI lesion segments with 1st-order-statistics and texture features (GLCM and GLRLM based), offers a valuable diagnostic tool for breast cancer.
Cognitive impairment is not uncommon in patients with multiple system atrophy (MSA). This study investigated the cortical metabolic changes of MSA and the cortical structure associated with cognitive impairment.

The study included probable/definite MSA patients who underwent fluorodeoxyglucose positron emission tomography and cognitive evaluation based on mini-mental status examination (MMSE). Cerebral metabolism of the entire MSA patients (n=88) was compared with healthy controls (n=19) by voxel-wise statistical parametric mapping. Eight brain regions of interest (ROIs) were selected accordingly the dorsolateral prefrontal, medial superior frontal, insular, posterior parietal, precuneus, lateral temporal, medial temporal, and posterior cingulate regions. Using validated population-based norms, MSA patients were divided by MMSE z-scores into MSA with cognitive dysfunction (MSA-D, n=30) and without cognitive dysfunction (MSA-ND, n=58). Regional metabolism of the selected ROIs was compared between the MSA-D and MSA-ND groups by logistic regression models. Correlations between the regional metabolism of the selected ROIs and MMSE z-scores were analyzed with a linear regression model.

Voxel-wise analysis showed hypometabolism in the frontal, temporal, parietal, and limbic areas in MSA patients than in controls. ROI-based comparisons showed that metabolism in the posterior cingulate (P=0.006) and medial temporal (P=0.039) regions was significantly lower in the MSA-D than in the MSA-ND group. The degree of posterior cingulate metabolism correlated significantly with MMSE z-score (P=0.023).

MSA shows fronto-temporo-parietal cortical involvement. Hypometabolism of the limbic regions is associated with cognitive impairment in MSA.
MSA shows fronto-temporo-parietal cortical involvement. Hypometabolism of the limbic regions is associated with cognitive impairment in MSA.
During the helicopter transportation of patients suspected of large vessel occlusion (LVO), an accurate and rapid decision-making process is required.

We attempted to create an algorithm for the pre-hospital diagnosis of the presence of LVO in patients suspected of stroke using data from patients transported urgently by helicopter.

One hundred and sixty-five patients transported by helicopter were divided into two subgroups a training dataset and a validation dataset. We extracted clinical information obtained on site, the unadjusted score of the National Institutes of Health Stroke Scale, and previously reported pre-hospital scales as an LVO screen. On the basis of the analyses of these factors, an algorithm was devised to predict the presence of LVO and its predictive accuracy was evaluated using the validation dataset.

Ischemic stroke with LVO was diagnosed in 36 out of 121 cases (29.8%) in the training dataset and in 10 out of 44 cases (22.7%) in the validation dataset. Combining five factors (conjugate deviation, upper limb paresis, atrial fibrillation, Japan Coma Scale ≥ 200, and systolic blood pressure ≥ 180), an algorithm was created to classify cases into six groups with different likelihoods of LVO presence. The algorithm predicted correctly 6 out of 10 cases in the validation dataset. find more Furthermore, it definitively ruled out 17 out of 34 cases in the validation dataset.

Using the newly created algorithm, emergency staff could easily and accurately distinguish patients suitable for urgent endovascular thrombectomy from patients with non-LVO or stroke mimics.
Using the newly created algorithm, emergency staff could easily and accurately distinguish patients suitable for urgent endovascular thrombectomy from patients with non-LVO or stroke mimics.
Carotid atherosclerosis and likely pathogenic patent foramen ovale (PFO) are two potential embolic sources in patients with embolic stroke of undetermined source (ESUS). The relationship between these two mechanisms among ESUS patients remains unclear.

To investigate the relation between carotid atherosclerosis and likely pathogenic PFO in patients with ESUS. We hypothesized that ipsilateral carotid atherosclerotic plaques are less prevalent in ESUS with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO.

The presence of PFO was assessed with transthoracic echocardiography with microbubble test and, when deemed necessary, through trans-oesophageal echocardiography. The presence of PFO was considered as likely incidental if the RoPE (Risk of Paradoxical Embolism) score was 0-6 and likely pathogenic if 7-10.

Among 374 ESUS patients (median age 61years, 40.4% women), there were 63 (49.6%) with likely incidental PFO, 64 (50.4%) with likely pathogenic PFO and 165 (44.1%) with ipsilateral carotid atherosclerosis. The prevalence of ipsilateral carotid atherosclerosis was lower in patients with likely pathogenic PFO (7.8%) compared to patients with likely incidental PFO (46.0%) or patients without PFO (53.0%) (p<0.001). After adjustment for multiple confounders, the prevalence of ipsilateral carotid atherosclerosis remained lower in patients with likely pathogenic PFO compared to patients with likely incidental PFO or without PFO (adjusted OR=0.32, 95%CI0.104-0.994, p=0.049).

The presence of carotid atherosclerosis is inversely related to the presence of likely pathogenic PFO in patients with ESUS.
The presence of carotid atherosclerosis is inversely related to the presence of likely pathogenic PFO in patients with ESUS.
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