The purpose of the study was to assess the performance of readers in diagnosing thoracic anomalies on standard chest radiographs (CXRs) with and without a deep-learning-based AI tool (Rayvolve) and to evaluate the standalone performance of Rayvolve in detecting thoracic pathologies on CXRs. This retrospective multicentric study was conducted in two phases. In phase 1, nine readers independently reviewed 900 CXRs from imaging group A and identified thoracic abnormalities with and without AI assistance. A consensus from three radiologists served as the ground truth. In phase 2, the standalone performance of Rayvolve was evaluated on 1500 CXRs from imaging group B. The average values of AUC across the readers significantly increased by 15.94%, with AI-assisted reading compared to unaided reading (0.88 ± 0.01 vs. 0.759 ± 0.07, p < 0.001). The time taken to read the CXRs decreased significantly, by 35.81% with AI assistance. The average values of sensitivity and specificity across the readers increased significantly by 11.44% and 2.95% with AI-assisted reading compared to unaided reading (0.857 ± 0.02 vs. 0.769 ± 0.02 and 0.974 ± 0.01 vs. 0.946 ± 0.01, p < 0.001). From the standalone perspective, the AI model achieved an average sensitivity, specificity, PPV, and NPV of 0.964, 0.844, 0.757, and 0.9798. The speed and performance of the readers improved significantly with AI assistance.

Objective. The intend of the present study was to assess the diagnostic performance of strain elastography in investigating the thyroid nodule malignancy taking the surgical biopsy as a gold standard reference test. Methods. The study included 120 patients with 123 thyroid nodules, of which 67 had total thyroidectomy. The American College of Radiology Thyroid Imaging Reporting and Data Systems (ACR-TIRADS) were evaluated for all nodules. All suspicious nodules were referred for a fine needle aspiration cytology (FNAC) if they fulfilled the required size. Strain elastography was performed for each suspicious nodule. Ultrasound-guided FNAC was performed for all suspicious nodules. Total thyroidectomy was performed in those whom the suspicious nodules were proven by FNAC. Results. Strain ratio had a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of 84%, 81%, 95%, 85%, and 84%, respectively, with a cut point 1.96. Elasticity score had a sensitivity, specificity, PPV, NPV, and diagnostic accuracy of 100%, 80%, 95%, 85% and 87%, respectively, with a cut point 0.96. The elasticity score had a statistically significantly odds ratio for detecting the benignity 3.9 C. I (1.6-9.3). Conclusion. Strain elastography has a high diagnostic performance in detecting the malignant as well as benign nodules, thus it can limit the rate of unneeded FNAC or surgery especially among B3 and B4 groups with indeterminate cytology.

OBJECTIVE: The European Thyroid Imaging Reporting and Data System (EU-TIRADS) allows for selective fine needle aspiration cytology (FNAC). In 2017, EU-TIRADS was implemented as part of a nationwide standardized care bundle for thyroid cancer in Western Sweden with a population of approximately 1.7 million. The objective of this study was to investigate the clinical value of EU-TIRADS attempting to reduce the number of unnecessary FNACs in referred patients with thyroid nodules.
METHODS: The study cohort consisted of all patients referred to Sahlgrenska University Hospital due to a palpable, newly detected or growing thyroid nodules or a positron emission tomography-positive finding for examination with thyroid ultrasound and selective cytology between 2018 and 2022. Medical records on EU-TIRADS classification, corresponding FNAC results, and histopathologic diagnosis were retrospectively collected. Adherence to the EU-TIRADS guidelines, use of selective FNAC, and rate of malignancy in patients who underwent surgery were assessed.
RESULTS: In total, 1246 thyroid nodules in 990 patients were evaluated. The distributions of EU-TIRADS 2 to 5 (number [percentage]) for all examined nodules were 63 (5%), 462 (37%), 443 (36%), and 278 (22%), respectively. FNAC was omitted in 7% of the investigated patients. FNAC was performed in 124 nodules (10%) despite not fulfilling the EU-TIRADS criteria or absence of positron emission tomography-positive findings. The rate of malignancy was 33% and 1/50 in patients who underwent \"unnecessary\" FNAC.
CONCLUSIONS: Implementation of EU-TIRADS in routine management of thyroid nodules led to the selective use of FNAC; however, the clinical impact was limited. This study provides real-world data on the value and magnitude of diagnostic improvement by implementing EU-TIRADS in clinical practice.

Calcification of aortic valve leaflets is a growing mortality threat for the 18 million human lives claimed globally each year by heart disease. Extensive research has focused on the cellular and molecular pathophysiology associated with calcification, yet the detailed composition, structure, distribution and etiological history of mineral deposition remains unknown. Here transdisciplinary geology, biology and medicine (GeoBioMed) approaches prove that leaflet calcification is driven by amorphous calcium phosphate (ACP), ACP at the threshold of transformation toward hydroxyapatite (HAP) and cholesterol biomineralization. A paragenetic sequence of events is observed that includes: (1) original formation of unaltered leaflet tissues: (2) individual and coalescing 100\'s nm- to 1 μm-scale ACP spherules and cholesterol crystals biomineralizing collagen fibers and smooth muscle cell myofilaments; (3) osteopontin coatings that stabilize ACP and collagen containment of nodules preventing exposure to the solution chemistry and water content of pumping blood, which combine to slow transformation to HAP; (4) mm-scale nodule growth via ACP spherule coalescence, diagenetic incorporation of altered collagen and aggregation with other ACP nodules; and (5) leaflet diastole and systole flexure causing nodules to twist, fold their encasing collagen fibers and increase stiffness. These in vivo mechanisms combine to slow leaflet calcification and establish previously unexplored hypotheses for testing novel drug therapies and clinical interventions as viable alternatives to current reliance on surgical/percutaneous valve implants.

BACKGROUND: Laser ablation (LA) is a minimally invasive treatment. It has been widely used since the early 2000s to induce volume reduction of symptomatic benign thyroid nodules. Up to 40% of laser-treated nodules have been reported to achieve a volume reduction of <50% (technique inefficacy) at 12 months and tend to regrow over time.
OBJECTIVE: This study aimed to assess the optimal baseline volume and energy to be delivered to minimize technique inefficacy.
METHODS: This was a retrospective study. Data were collected, including baseline volume, energy delivered, and 12-month volume reduction ratio (VRR) of spongiform nodules (EU-TIRADS 2) treated with LA between 2010 and 2020. Based on these data, the optimal baseline volume and energy to be delivered were calculated to maximize the rate of nodules with technique efficacy (VRR ≥ 50% at 12-month follow-up).
RESULTS: A total of 205 patients with spongiform nodules were included in this study. The energy delivered was positively associated with VRR. However, no association was observed between baseline volume and VRR. Delivering energy ≥500 J/mL to nodules with a mean baseline volume of 11.4 ± 4 mL resulted in technique efficacy in 83% of cases.
CONCLUSIONS: Treating spongiform nodules with a baseline volume of ≤15 mL and delivering energy ≥500 J/mL are key factors for achieving a relevant rate of technique efficacy.

BACKGROUND: Complications of temporary and permanent fillers have been extensively studied. However, there is a lack of comparative data regarding poly-L-lactic acid (PLLA), calcium hydroxyapatite (CaHA), and polycaprolactone (PCL) known as collagen biostimulators.
OBJECTIVE: This study addressed the complications of collagen biostimulators concerning their diagnosis, type of product, treatment, and monitoring.
METHODS: An electronic questionnaire was sent to Brazilian dermatologic ultrasound experts to identify complications related to biostimulators. The type of biostimulator, location of application, number of vials injected, application plan, time between injection treatment and complication, injector profile, treatment, and prognosis were assessed.
RESULTS: Fifty-five cases were identified, of which 49.1% were caused by PLLA-Elleva®, 23.6% by CaHA (alone or combined with hyaluronic acid), 20.0% by PLLA-Sculptra®, and 7.3% by PCL. The most affected area was the face (72.7%), with nodules being the most common clinical form (89.1%), generally occurring late (60.0%) (>1 month). Only one case was injected at an incorrect depth (musculoaponeurotic system-SMAS). Despite several treatments, including saline (45.5%), hyaluronidase (25.5%), diluted corticosteroids (23.6%), and energy-based devices (10.9%), only five cases showed complete resolution. Hyaluronidase was beneficial in complications related to fillers when there was an association of calcium hydroxyapatite with hyaluronic acid (p < 0.01).
CONCLUSIONS: Complications from collagen biostimulators were more common on the face, typically manifesting about 1 month after treatment. These issues seemed to be related more to the properties of the products rather than inadequate technique. Furthermore, hyaluronidase demonstrated efficacy only in cases where there was an association with HA.

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UNASSIGNED: Early detection of lung cancer through accurate diagnosis of malignant lung nodules using chest CT scans offers patients the highest chance of successful treatment and survival. Despite advancements in computer vision through deep learning algorithms, the detection of malignant nodules faces significant challenges due to insufficient training datasets.
UNASSIGNED: This study introduces a model based on collaborative deep learning (CDL) to differentiate between cancerous and non-cancerous nodules in chest CT scans with limited available data. The model dissects a nodule into its constituent parts using six characteristics, allowing it to learn detailed features of lung nodules. It utilizes a CDL submodel that incorporates six types of feature patches to fine-tune a network previously trained with ResNet-50. An adaptive weighting method learned through error backpropagation enhances the process of identifying lung nodules, incorporating these CDL submodels for improved accuracy.
UNASSIGNED: The CDL model demonstrated a high level of performance in classifying lung nodules, achieving an accuracy of 93.24%. This represents a significant improvement over current state-of-the-art methods, indicating the effectiveness of the proposed approach.
UNASSIGNED: The findings suggest that the CDL model, with its unique structure and adaptive weighting method, offers a promising solution to the challenge of accurately detecting malignant lung nodules with limited data. This approach not only improves diagnostic accuracy but also contributes to the early detection and treatment of lung cancer, potentially saving lives.

Rice fallow black gram is grown under the residual moisture situation as a relay crop in heavy texture montmorillonite clay soil under zero till condition. Since the crop is raised during post monsoon season, the crop often experiences terminal stress due to limited water availability and no rainfall. Surface irrigation in montmorillonite clay soil is determent to pulse crop as inundation causes wilting. Therefore, zero tilled rice fallow black gram has to be supplemented with micro irrigation at flowering stage (35 days after sowing) to alleviate moisture stress and to increase the productivity as well. Hence micro farm pond in a corner of one ha field was created to harvest the rain water during monsoon season and the same was utilized to supplement the crop with lifesaving irrigation through mobile sprinkler at flowering stage for the crop grown under conservation agriculture. Soil cracking is also the common phenomena of montmorillonite clay soil where evaporations losses would be more through crack surfaces. The present study was therefore conducted to study the changes in the soil physical properties, crop establishment and productivity in conjunction with mechanized sowing and harvest and supplemental mobile sprinkler irrigation. Sowing of black gram by broadcasting 10 days prior to the manual harvest of rice, manual drawn single row seed drill after the machine harvest of rice and sowing by broadcasting at 4 days prior to machine harvest of rice was experimented separately and in combination with lifesaving irrigation. Results indicated that the number of wheel passes and lifesaving irrigation had a very strong impact on soil penetration resistance and soil moisture. Combined harvester followed by no till seed drill increased the soil penetration resistance in all the layers (0-5 cm, 5-10 cm and 10-15 cm). Two passes of wheel increased the mean soil penetration resistance from 407 KPa to 502 KPa. The soil penetration resistance (0-5 cm) at harvest shown that black gram sown by manual broadcasting 10 days prior to manual harvest of paddy supplemented with life irrigation on 30 DAS reduced the soil penetration resistance from 690 Kpa to 500 Kpa, 740 Kpa to 600 Kpa and 760 Kpa to 620 Kpa respectively at 0-5 cm, 5-10 cm and 10-15 cm layer. In general, moisture depletion rate was rapid in the surface layer of 0-5 cm as compared to other layers of 5-10 cm and 10-15 cm up to 30 DAS (Flowering stage). The moisture content and the soil penetration resistance had an inverse relationship. The soil penetration resistance also had an inverse relationship with the root length in which the root length lowers as the soil penetration resistance increases. The soil crack measured at 60 DAS was deeper with no till seed drill (width of 3.94 cm and depth of 13.67 cm) which was mainly due to surface layer compaction. The relative water content, specific leaf weight and chlorophyll content were significantly improved through the supplemental irrigation given on 30 DAS irrespective of crop establishment methods. The results further indicated that compaction of ploughed layer in the moist soil due to combined harvester and no till seed drill had a negative impact on yield (457 kg ha-1), which was improved by 19.03 per cent due to increased soil moisture with supplemental irrigation. The mean yield increase across different treatments due to supplemental lifesaving irrigation through mobile sprinkler was 20.4 per cent.

Immunity and senescence play a crucial role in the functioning of the legume symbiotic nodules. The miss-regulation of one of these processes compromises the symbiosis leading to death of the endosymbiont and the arrest of the nodule functioning. The relationship between immunity and senescence has been extensively studied in plant organs where a synergistic response can be observed. However, the interplay between immunity and senescence in the symbiotic organ is poorly discussed in the literature and these phenomena are often mixed up. Recent studies revealed that the cooperation between immunity and senescence is not always observed in the nodule, suggesting complex interactions between these two processes within the symbiotic organ. Here, we discuss recent results on the interplay between immunity and senescence in the nodule and the specificities of this relationship during legume-rhizobium symbiosis.