Diagnostic performance of MRI radiomics for classification of Alzheimer's disease, mild cognitive impairment, and normal subjects: a systematic review and meta-analysis

BACKGROUND

Alzheimer's disease (AD) is a debilitating neurodegenerative disease. Early diagnosis of AD and its precursor, mild cognitive impairment (MCI), is crucial for timely intervention and management. Radiomics involves extracting quantitative features from medical images and analyzing them using advanced computational algorithms. These characteristics have the potential to serve as biomarkers for disease classification, treatment response prediction, and patient stratification. Of note, Magnetic resonance imaging (MRI) radiomics showed a promising result for diagnosing and classifying AD, and MCI from normal subjects. Thus, we aimed to systematically evaluate the diagnostic performance of the MRI radiomics for this task.

METHODS AND MATERIALS

A comprehensive search of the current literature was conducted using relevant keywords in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases from inception to August 5, 2023. Original studies discussing the diagnostic performance of MRI radiomics for the classification of AD, MCI, and normal subjects were included. Method quality was evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and the Radiomics Quality Score (RQS) tools.

RESULTS

We identified 13 studies that met the inclusion criteria, involving a total of 5448 participants. The overall quality of the included studies was moderate to high. The pooled sensitivity and specificity of MRI radiomics for differentiating AD from normal subjects were 0.92 (95% CI [0.85; 0.96]) and 0.91 (95% CI [0.85; 0.95]), respectively. The pooled sensitivity and specificity of MRI radiomics for differentiating MCI from normal subjects were 0.74 (95% CI [0.60; 0.85]) and 0.79 (95% CI [0.70; 0.86]), respectively. Also, the pooled sensitivity and specificity of MRI radiomics for differentiating AD from MCI were 0.73 (95% CI [0.64; 0.80]) and 0.79 (95% CI [0.64; 0.90]), respectively.

CONCLUSION

MRI radiomics has promising diagnostic performance in differentiating AD, MCI, and normal subjects. It can potentially serve as a non-invasive and reliable tool for early diagnosis and classification of AD and MCI.

Arterial Oxygen Saturation: A Vital Sign?

ABSTRACT

The physical examination is a key part of a continuum that extends from the history of the present illness to the therapeutic outcome. An understanding of the pathophysiological mechanism behind a physical sign is essential for arriving at the correct diagnosis. Early detection of deteriorating physical/vital signs and their appropriate interpretation is thus the key to achieve correct and timely management. By definition, vital signs are "the signs of life that may be monitored or measured, namely pulse rate, respiratory rate, body temperature, and blood pressure." Vital signs are the simplest, cheapest and probably the most inexpensive information gathered bedside in outpatient or hospitalized patients. The pulse oximeter was introduced in the 1980s. It is an accurate and non-invasive method for the measurement of arterial hemoglobin oxygen saturation (SaO2). Pulse oximetry-based arterial oxygen saturation can be effectively used bedside in in-hospital and ambulatory patients with diagnosed or suspected lung disease. The present pandemic of COVID-19 should be considered as a wake-up call. Articles related to arterial oxygen saturation and its importance as a vital sign in patient care were searched online especially in PubMed. Available studies were studied in full length and data was extracted. Discussion: A. Clinical Utility of Oxygen Saturation Monitoring: There are many studies reporting the clinical applicability and usefulness of pulse oximetry in the early detection of hypoxemic events during intraoperative and postoperative periods. B. Role of clinical expertise accompanied by knowledge of physiology: A diagnostic sign is useful only if it is interpreted accurately and applied appropriately while evaluating a patient. The World Health Organisation also appreciates these facts and published "The WHO Pulse Oximetry Training Manual." Understanding the physiology behind and overcoming limitations of the diagnostic sign by clinical expertise is important. While using pulse oximetry, a clinician needs to keep in mind the sigmoidal nature of the oxygen-Hb dissociation curve. Considering these benefits of SaO2 measurement, there have been several references in the past to consider oxygen saturation as the fifth vital sign. In the present pandemic oxygen saturation i.e., SpO2 (arterial oxygen saturation) measured by pulse oxymeter, has been the single most important warning and prognostic sign be it for households, offices, street vendors, hospitals or governments. Measurement of trends of SaO2 added with respiratory rate will provide clinicians with a holistic overview of respiratory functions and multidimensional conditions associated with hypoxemia.

Prospective Evaluation of Locoregional Control in Oral Cavity Squamous Cell Carcinoma with Infratemporal Fossa Involvement Treated with Surgery and Adjuvant Concurrent Chemoradiotherapy

PURPOSE/OBJECTIVE(S)

Oral cavity squamous cell carcinoma (OCSCC) is the most common head and neck cancer in India. Definitive surgery with or without post-op radiotherapy (PORT) with or without chemotherapy (CT) provides better outcomes in locally advanced OCSCC as compared to definitive chemoradiotherapy. T4b OCSCC with infra temporal fossa (ITF) involvement has varied outcome depending on the extent of ITF involvement, with low and mid ITF having relatively favorable prognosis. We aimed to prospectively evaluate outcomes in patients of OCSCC with low or mid ITF involvement treated with curative surgery followed by adjuvant concurrent chemoradiotherapy (CCRT).

MATERIALS/METHODS

A total of 20 patients of T4b OCSCC (as per AJCC 8th edition) with low or mid ITF involvement were included in this single arm prospective interventional study from January 2021 to October 2022. Patients with involvement of skull base, carotid artery, prevertebral fascia and/or pterygomaxillary fissure were excluded. All patients were treated with definitive surgery with ITF clearance followed by adjuvant CCRT as indicated. Loco-regional control (LRC), Disease free survival (DFS), Overall survival (OS) were assessed using Kaplan-Meier survival analysis. Acute toxicities were assessed according to the CTCAE v5.0.

RESULTS

Patient characteristics are summarized in table 1. Median follow-up was 11.5 months (4-21months). All patients received adjuvant CCRT with weekly cisplatin 40mg/m2 to a median number of 6 cycles (5-7 cycles). Median RT dose was 64Gy (60-64Gy). All patients tolerated treatment well. Grade 3 oral mucositis, odynophagia were seen in 8 (40%) patients each and skin toxicity, oral pain in 6 (30%) and 5 (25%) patients respectively. No grade 4 toxicities were observed LRC at three month was 73.68% with 4 local and 1 locoregional failure only. LRC at one year was 36.8% with 8 local, 1 locoregional, 2 locodistant and 1 distant failure only. Median DFS was 10.4 months. Median OS was not reached; four patients died. LRC at three months was better for patients with low ITF disease as compared to mid ITF disease (85.7% vs. 40% (p = 0.04) and at one year was 42.8% vs. 40% (p = 0.50).

CONCLUSION

Selected patient of locally advanced OCSCC with low ITF involvement may benefit from trimodality therapy of surgery with ITF clearance followed by adjuvant CCRT. Acute toxicity profile was acceptable in our study.

Radiomics; A Potential Next "Omics" in Psychiatric Disorders; An Introduction

Psychiatric disorders remain one of the most debilitating conditions; however, most patients are never diagnosed and do not seek treatment. Despite its massive burden on modern society and the health system, many hurdles prevent proper diagnosis and management of these disorders. The diagnosis is primarily based on clinical symptoms, and efforts to find appropriate biomarkers have not been practical. Through the past years, researchers have put a tremendous effort into finding biomarkers in "omics" fields: genomics, transcriptomics, proteomics, metabolomics, and epigenomics. This article reviews the evolving field of radiomics and its role in diagnosing psychiatric disorders as the sixth potential "omics." The first section of this paper elaborates on the definition of radiomics and its potential to provide a detailed structural study of the brain. Following that, we have provided the latest promising results of this novel approach in a broad range of psychiatric disorders. Radiomics fits well within the concept of psychoradiology. Besides volumetric analysis, radiomics takes advantage of many other features. This technique may open a new field in psychiatry for diagnosing and classifying psychiatric disorders and treatment response prediction in the era of precision and personalized medicine. The initial results are encouraging, but radiomics in psychiatry is still in its infancy. Despite the extensive burden of psychiatric disorders, there are very few published studies in this field, with small patient populations. The lack of prospective multi-centric studies and heterogeneity of studies in design are the significant barriers against the clinical adaptation of radiomics in psychoradiology.

ALK-positive histiocytosis involving the cavernous sinus: A deceptive radiologic mimic of meningioma

Anaplastic lymphoma kinase (ALK)-positive histiocytosis is an uncommon condition, recently considered a separate condition from other histiocytosis by WHO 5th edition. It can involve intracranial structures. This manuscript describes a case of ALK-positive histiocytosis of the cavernous sinus, focusing on the radiologic and pathologic presentation of the entity. Our case had MRI manifestations mimicking meningioma, metastasis, and Langerhans histiocytosis. On CT imaging, benign osseous remodeling of the cavernous sinus was detected, which can be helpful in differentiating it from more common meningioma.

Radiomics Outperforms Clinical and Radiologic Signs in Predicting Spontaneous Basal Ganglia Hematoma Expansion: A Pilot Study

Prediction of the hematoma expansion (HE) of spontaneous basal ganglia hematoma (SBH) from the first non-contrast CT can result in better management, which has the potential of improving outcomes. This study has been designed to compare the performance of "Radiomics analysis," "radiology signs," and "clinical-laboratory data" for this task. We retrospectively reviewed the electronic medical records for clinical, demographic, and laboratory data in patients with SBH. CT images were reviewed for the presence of radiologic signs, including black-hole, blend, swirl, satellite, and island signs. Radiomic features from the SBH on the first brain CT were extracted, and the most predictive features were selected. Different machine learning models were developed based on clinical, laboratory, and radiology signs and selected Radiomic features to predict hematoma expansion (HE). The dataset used for this analysis included 116 patients with SBH. Among different models and different thresholds to define hematoma expansion (10%, 20%, 25%, 33%, 40%, and 50% volume enlargement thresholds), the Random Forest based on 10 selected Radiomic features achieved the best performance (for 25% hematoma enlargement) with an area under the curve (AUC) of 0.9 on the training dataset and 0.89 on the test dataset. The models based on clinical-laboratory and radiology signs had low performance (AUCs about 0.5-0.6).

Effect of Overweight and Obesity on Periodontal Treatment Intensity

INTRODUCTION

Obesity is associated with greater utilization of medical resources, but it is unclear if a similar relationship exists for dental care.

OBJECTIVES

This retrospective cohort study compared periodontal disease treatment among obese, overweight, and normal-weight patients attending an urban US dental school clinic.

METHODS

Periodontal, demographic, and medical history data for 3,443 adult patients examined between July 1, 2010, and July 31, 2019, were extracted from electronic health records. Body mass index (BMI) was computed from self-reported height and weight and categorized as obese (≥30 kg/m²), overweight (25-29.9 kg/m²), or normal (18-24.9 kg/m²). Periodontal disease was categorized using clinical probing measures. Procedure codes defined treatment type (surgical, nonsurgical, local chemotherapeutics, or none). Logistic regression models controlling for initial periodontal disease severity, age, gender, tobacco use, history of diabetes, dental insurance type, and follow-up (log of days) estimated odds ratios (ORs) and 95% confidence intervals (CIs) of any treatment among obese and overweight relative to normal-weight patients. The association between BMI and a periodontal treatment intensity score, based on treatment type, number of teeth treated, and number of visits, was evaluated with multivariable negative binomial regression.

RESULTS

Mean age at baseline was 44 ± 15 y, and severe periodontal disease was present in 32% of obese, 31% of overweight, and 21% of normal-weight patients. Average follow-up was 3.9 ± 1.6 y. Obese and overweight patients were more likely to have nonsurgical scaling and root planing or surgical procedures than normal-weight patients. Adjusted odds of any treatment were higher among obese (OR = 1.34; 95% CI, 1.14-1.72) and overweight (OR = 1.18; 95% CI, 0.97-1.42) relative to normal weight. Obese and overweight patients had 40% and 24% higher treatment intensity scores, respectively, than normal-weight patients.

CONCLUSION

These results indicate obese and overweight individuals require more intensive periodontal treatment compared to normal-weight individuals, independent of initial disease severity.

KNOWLEDGE OF TRANSFER STATEMENT

The results of this study can be used by dental providers and policymakers to better understand patient characteristics that influence the variability in frequency and length of periodontal treatment. Knowledge of a patient's body mass index may be useful in identifying patients who possibly will have a poorer periodontal prognosis.

Computational Docking Studies of MAPK1 Target Protein Responsible for Heart Failure Using Catechin as Natural Inhibitor

Mitogen-activated protein kinases (MAPKs) are major thespians that have been the subject of in-depth research over the last few decades among the several intracellular signaling networks that regulate the pathophysiology and development of the heart. Heart failure is one of the most common reasons for hospitalization and is a serious public health issue. Heart failure mostly affects the elderly, and as life expectancy increases and chronic medical conditions are better managed, more people are expected to develop the condition. The thrust to investigate alternative traditional medicine has attracted much attention as there are many negative effects of the current pharmacological treatments that are being used to control the problem of heart failure. The protein's original configuration and the ligand combination both had binding energies of -5.62 kcal/mol, which may pave the way for future use of the knowledge about the responsible protein and optimization of their lead molecule for an alternative treatment for the cases of heart failure. But further research is needed, for the validation of the data in wet labs, larger trials and in-vitro studies, to establish its drug-likeliness and their applications.

Analysis of the Thomson and Troian velocity slip for the flow of ternary nanofluid past a stretching sheet

In this article, the flow of ternary nanofluid is analysed past a stretching sheet subjected to Thomson and Troian slip condition along with the temperature jump. The ternary nanofluid is formed by suspending three different types of nanoparticles namely [Formula: see text] and [Formula: see text] into water which acts as a base fluid and leads to the motion of nanoparticles. The high thermal conductivity and chemical stability of silver was the main cause for its suspension as the third nanoparticle into the hybrid nanofluid [Formula: see text]. Thus, forming the ternary nanofluid [Formula: see text]. The sheet is assumed to be vertically stretching where the gravitational force will have its impact in the form of free convection. Furthermore, the presence of radiation and heat source/sink is assumed so that the energy equation thus formed will be similar to most of the real life applications. The assumption mentioned here leads to the mathematical model framed using partial differential equations (PDE) which are further transformed to ordinary differential equations (ODE) using suitable similarity transformations. Thus, obtained system of equations is solved by incorporating the RKF-45 numerical technique. The results indicated that the increase in the suspension of silver nanoparticles enhanced the temperature and due to density, the velocity of the flow is reduced. The slip in the velocity decreased the flow speed while the temperature of the nanofluid was observed to be increasing.

Improved Measurement of Solar Neutrinos from the Carbon-Nitrogen-Oxygen Cycle by Borexino and Its Implications for the Standard Solar Model

We present an improved measurement of the carbon-nitrogen-oxygen (CNO) solar neutrino interaction rate at Earth obtained with the complete Borexino Phase-III dataset. The measured rate, R_{CNO}=6.7_{-0.8}^{+2.0}  counts/(day×100  tonnes), allows us to exclude the absence of the CNO signal with about 7σ C.L. The correspondent CNO neutrino flux is 6.6_{-0.9}^{+2.0}×10^{8}  cm^{-2} s^{-1}, taking into account the neutrino flavor conversion. We use the new CNO measurement to evaluate the C and N abundances in the Sun with respect to the H abundance for the first time with solar neutrinos. Our result of N_{CN}=(5.78_{-1.00}^{+1.86})×10^{-4} displays a ∼2σ tension with the "low-metallicity" spectroscopic photospheric measurements. Furthermore, our result used together with the ^{7}Be and ^{8}B solar neutrino fluxes, also measured by Borexino, permits us to disfavor at 3.1σ C.L. the "low-metallicity" standard solar model B16-AGSS09met as an alternative to the "high-metallicity" standard solar model B16-GS98.

The bidirectional relationship between growth and appetite regulation in the first year of life

 

Childhood obesity is a public health crisis. Even though appetite traits in infancy were associated with childhood adiposity, whether early weight gain can influence later appetite has not been researched. Our aim was to prospectively examine the bidirectional association between growth and appetite traits during the first year of life. We followed up 450 healthy term infants for 12 months (m). Appetite traits at 4 weeks (wk), 6m and 12m were assessed using the Baby and Child Eating Behaviour Questionnaires. Infant feeding, anthropometric, socioeconomic and demographic data were also collected. Infant weight-for-age z-scores (WFAZ) were calculated using the WHO 2006 growth reference. Growth was assessed as conditional WFAZ change (cWFAZc) by saving the residuals from linear regression models of WFAZ at each successive time point versus WFAZ at the earlier time point. Multivariable linear regression was used to analyse bidirectional associations between cWFAZc (0-4wk, 4wk-6m, 6-12m) and appetite traits Enjoyment of Food (EF), Food Responsiveness (FR), Satiety Responsiveness (SR) and Slowness in Eating (SE) at 4wk, 6m and 12m. All models were adjusted for relevant confounders. At 4wk, SR score was associated with lower (β:-0.16; 95% CI:-0.28,-0.03), and FR score with higher (β:0.10; 95% CI:0.01,0.19) cWFAZc from 4wk to 12m. SR score at 6m was inversely associated with cWFAZc from 6-12m (β:-0.09; 95% CI:-0.16,-0.01). Conversely, higher cWFAZc between 4wk-6m was associated with higher EF (β:0.10; 95% CI:0.01,0.19) and FR (β:0.16; 95% CI:0.04,0.29) scores at 12m. cWFAZc between 6m-12m was inversely associated with SR at 12m (β:-0.18; 95% CI:-0.35,-0.01). Our results suggest that the growth acceleration hypothesis, where faster growth in infancy leads to later obesity, may be mediated by an up-regulation of appetite traits at 12m. This highlights the public health importance of avoiding growth acceleration in infancy as a way to curb the childhood obesity epidemic.

Key messages

• Weight gain in early infancy impacts appetite regulation in the first year of life and up-regulation of appetite traits at 12 months predisposes to childhood obesity.

• Avoiding growth acceleration in infancy can decrease the risk for childhood obesity.

Radiological and Clinical Findings of Non-bifurcating Carotid Artery With Aberrant Course: A Case Report and Review of the Literature

A non-bifurcating carotid artery is a rare variation in the carotid circulation. Here we present a rare case of a non-bifurcating carotid artery with an aberrant course of the internal carotid artery incidentally discovered in a patient who presented to the trauma center after a fall. To our knowledge, this is the first reported case of a non-bifurcating carotid artery with an aberrant course of the internal carotid artery. The embryonic mechanisms of this variation and the available literature regarding this condition are also reviewed. Knowing this variation is necessary before considering vascular intervention of the neck and ear surgery to avoid vascular injury and complications.

First Directional Measurement of Sub-MeV Solar Neutrinos with Borexino

We report the measurement of sub-MeV solar neutrinos through the use of their associated Cherenkov radiation, performed with the Borexino detector at the Laboratori Nazionali del Gran Sasso. The measurement is achieved using a novel technique that correlates individual photon hits of events to the known position of the Sun. In an energy window between 0.54 to 0.74 MeV, selected using the dominant scintillation light, we have measured 10 887_{-2103}^{+2386}(stat)±947(syst) (68% confidence interval) solar neutrinos out of 19 904 total events. This corresponds to a ^{7}Be neutrino interaction rate of 51.6_{-12.5}^{+13.9}  counts/(day·100  ton), which is in agreement with the standard solar model predictions and the previous spectroscopic results of Borexino. The no-neutrino hypothesis can be excluded with >5σ confidence level. For the first time, we have demonstrated the possibility of utilizing the directional Cherenkov information for sub-MeV solar neutrinos, in a large-scale, high light yield liquid scintillator detector. This measurement provides an experimental proof of principle for future hybrid event reconstruction using both Cherenkov and scintillation signatures simultaneously.

Emerging Applications of Radiomics in Neurological Disorders: A Review

Radiomics has achieved significant momentum in radiology research and can reveal image information invisible to radiologists' eyes. Radiomics first evolved for oncologic imaging. Oncologic applications (histopathology, tumor grading, gene mutation analysis, patient survival, and treatment response prediction) of radiomics are widespread. However, it is not limited to oncologic analysis, and any digital medical images can benefit from radiomics analysis. This article reviews the current literature on radiomics in non-oncologic, neurological disorders including ischemic strokes, hemorrhagic stroke, cerebral aneurysms, and demyelinating disorders.

The Role of Machine Learning and Radiomics for Treatment Response Prediction in Idiopathic Normal Pressure Hydrocephalus

Introduction Ventricular shunting remains the standard of care for patients with idiopathic normal pressure hydrocephalus (iNPH); however, not all patients benefit from the shunting. Prediction of response in advance can result in improved patient selection for ventricular shunting. This study aims to develop a machine learning predictive model for treatment response after shunt placement using the clinical and radiomics features. Methods In this retrospective pilot study, the medical records of iNPH patients who underwent ventricular shunting were evaluated. In each patient, the "idiopathic normal pressure hydrocephalus grading scale" (iNPHGS) and a "Modified Rankin Scale" were calculated before and after surgery. The subsequent treatment response was calculated as the difference between the iNPHGS scores before and after surgery. iNPHGS score reduction of two or more than two were considered as treatment response. The presurgical MRI scans were evaluated by radiologists, the ventricular systems were segmented on the T2-weighted images, and the radiomics features were extracted from the segmented ventricular system. Using Orange data mining open-source platform, different machine learning models were then developed based on the presurgical clinical features and the selected radiomics features to predict treatment response after shunt placement. Results After the implementation of the inclusion criteria, 78 patients were included in this study. One hundred twenty radiomics features were extracted, and the 12 best predictive radiomics features were selected. Using only clinical data (iNPHGS and Modified Rankin Scale), the random forest model achieved the best performance in treatment prediction with an area under the curve (AUC) of 0.71. Adding the Radiomics analysis to the clinical data improved the prediction performance, with the support vector machine (SVM) achieving the highest rank in treatment prediction with an AUC of 0.8. Adding age and sex to the analysis did not improve the prediction. Conclusion Using machine learning models for treatment response prediction in patients with iNPH is feasible with acceptable accuracy. Adding the Radiomics analysis to the clinical features can further improve the predictive performance. SVM is likely the best model for this task.

Navigating parental leave as a leader in radiology: Commentary on challenges and strategies

Navigating parental leave can be challenging in all fields of medicine, but it can be especially challenging for leaders balancing clinical, research, and administrative duties. As women take on more leadership roles, we have the opportunity to better define the current challenges and identify potential strategies for navigating successful parental leave while balancing the demands of leadership. This manuscript provides a commentary on the challenges and strategies for navigating parental leave in leadership positions in radiology, an important topic for shaping how parental leave is both viewed and valued in the future. Specifically, we highlight challenges and strategies for administrative responsibilities, reporting personnel, emails, microaggressions, research, empowerment, and prioritization.

N95 respirator decontamination: a study in reusability

The coronavirus disease 2019 (COVID-19) pandemic had caused a severe depletion of the worldwide supply of N95 respirators. The development of methods to effectively decontaminate N95 respirators while maintaining their integrity is crucial for respirator regeneration and reuse. In this study, we systematically evaluated five respirator decontamination methods using vaporized hydrogen peroxide (VHP) or ultraviolet (254 nm wavelength, UVC) radiation. Through testing the bioburden, filtration, fluid resistance, and fit (shape) of the decontaminated respirators, we found that the decontamination methods using BioQuell VHP, custom VHP container, Steris VHP, and Sterrad VHP effectively inactivated Cardiovirus (3-log10 reduction) and bacteria (6-log10 reduction) without compromising the respirator integrity after 2-15 cycles. Hope UVC system was capable of inactivating Cardiovirus (3-log10 reduction) but exhibited relatively poorer bactericidal activity. These methods are capable of decontaminating 10-1000 respirators per batch with varied decontamination times (10-200 min). Our findings show that N95 respirators treated by the previously mentioned decontamination methods are safe and effective for reuse by industry, laboratories, and hospitals.

Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1

Purpose

COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management.

Methods

This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021.

Results

Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05).

Conclusion

: Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

POS0655 LONG-TERM SAFETY AND EFFICACY OF UPADACITINIB IN PATIENTS WITH RHEUMATOID ARTHRITIS: 3-YEAR RESULTS FROM THE SELECT-EARLY STUDY

Background:

Upadacitinib (UPA), an oral Janus kinase inhibitor, demonstrated significant improvements in signs, symptoms, and structural inhibition as monotherapy (mono) vs methotrexate (MTX) in MTX-naïve patients (pts) with rheumatoid arthritis (RA) through 48 weeks (wks).1

Objectives:

To report the efficacy and safety of UPA vs MTX mono up to 156 wks in pts with RA from the ongoing long-term extension (LTE) of the SELECT-EARLY trial.

Methods:

During the 48-wk double-blind study period, pts were randomized to UPA 15 or 30 mg once daily (QD) or MTX (titrated to 20 mg/wk by Wk 8). At Wk 26, pts who did not achieve Clinical Disease Activity Index (CDAI) remission (≤2.8) and had <20% improvement from baseline in tender or swollen joint count received blinded rescue therapy (addition of MTX for UPA groups and UPA 15 or 30 mg for MTX group). In the LTE, pts received open-label treatment once the last pt reached Wk 48. Efficacy assessments up to Wk 156 were summarized by randomized group and included American College of Rheumatology (ACR) responses, remission and low disease activity (LDA) measures, and change in modified Total Sharp Score (mTSS; up to 96 wks). Treatment-emergent adverse events (AEs) per 100 pt-years (PY) for pts on continuous mono were summarized through 156 wks. Non-responder imputation was used for binary endpoints for missing data and when pts received rescue therapy or prematurely discontinued the study drug.

Results:

Of 945 pts randomized and treated, 775 entered the LTE on study drug (including 57 rescued pts; MTX, 33; UPA 15 mg, 17; UPA 30 mg, 7). Overall, 161 (21%) pts discontinued during the LTE. At Wk 156, higher proportions of pts randomized to UPA achieved a 20/50/70% improvement in ACR response (ACR20/50/70), LDA, and remission vs MTX (Figure 1). Change from baseline in mTSS at Wk 96 favored UPA vs MTX (data not shown). Most AEs were numerically more frequent with UPA 30 mg. The overall rate of serious infection was numerically higher with UPA vs MTX (Table 1). Herpes zoster (HZ), neutropenia, non-melanoma skin cancer (NMSC), and creatine phosphokinase (CPK) elevation were more frequent with UPA vs MTX. Two active tuberculosis (TB) events were reported in each UPA arm; 3 adjudicated gastrointestinal (GI) perforation events were observed in the UPA 30 mg arm. Adjudicated major adverse cardiovascular events (MACEs) or venous thromboembolic events (VTEs) were comparable across treatment arms.

Conclusion:

UPA monotherapy showed sustained clinically meaningful responses including remission vs MTX through Wk 156 but higher rates of several AEs, including HZ, neutropenia, and CPK elevations; no new safety risks were observed compared with previous results.1,2

References:

[1]van Vollenhoven R, et al. Ann Rheum Dis 2019;78:376–7; 2. Cohen SB, et al. Ann Rheum Dis 2020;annrheumdis-2020-218510.

Table 1.

Safety overview

E/100 PY (95% CI)MTX mono(n=314; PY=601.9)UPA 15 mg QD mono(n=317; PY=703.4)UPA 30 mg QD mono(n=314; PY=687.6)Any AE240.2(228.0, 252.9)268.0(256.0, 280.4)292.5(279.8, 305.5)Any serious AE10.8 (8.3, 13.8)12.2 (9.8, 15.1)16.3 (13.4, 19.6)Any AE leading to discontinuation of study drug6.5 (4.6, 8.9)7.3 (5.4, 9.5)7.7 (5.8, 10.1)Any deatha0.7 (0.2, 1.7)0.9 (0.3, 1.9)1.0 (0.4, 2.1)Serious infection2.5 (1.4, 4.1)3.3 (2.1, 4.9)4.4 (2.9, 6.2)Opportunistic infection excluding TB and HZ0.2 (0.0, 0.9)0.1 (0.0, 0.8)0.3 (0.0, 1.1)HZ0.8 (0.3, 1.9)4.5 (3.1, 6.4)4.7 (3.2, 6.6)Active TB00.3 (0.0, 1.0)0.3 (0.0, 1.1)NMSC00.4 (0.1, 1.2)1.0 (0.4, 2.1)Malignancy other than NMSC1.0 (0.4, 2.2)0.6 (0.2, 1.5)1.2 (0.5, 2.3)Hepatic disorder14.1 (11.3, 17.5)12.5 (10.0, 15.4)15.0 (12.2, 18.2)GI perforationb000.4 (0.1, 1.3)Neutropenia2.2 (1.2, 3.7)4.5 (3.1, 6.4)5.7 (4.0, 7.8)CPK elevation1.8 (0.9, 3.3)7.7 (5.8, 10.0)15.4 (12.6, 18.6)MACEb0.3 (0.0, 1.2)0.4 (0.1, 1.2)0.6 (0.2, 1.5)VTEb0.3 (0.0, 1.2)0.4 (0.1, 1.2)0.6 (0.2, 1.5)

Data were censored at the time of MTX or UPA addition for rescued pts

aIncludes treatment-emergent (≤30 days after the last dose of study drug) and non-treatment-emergent deaths. bAdjudicated

Acknowledgements:

AbbVie funded this study; contributed to its design; participated in data collection, analysis, and interpretation of the data; and in the writing, review, and approval of the abstract. No honoraria or payments were made for authorship. Medical writing support was provided by Russell Craddock, PhD, of 2 the Nth (Cheshire, UK), and was funded by AbbVie.

Disclosure of Interests:

Ronald van Vollenhoven Speakers bureau: AbbVie, AstraZeneca, Biotest, Bristol-Myers Squibb, Galapagos, Gilead, GSK, Janssen, Pfizer, Sanofi, Servier, UCB, and Viela Bio, Consultant of: AbbVie, AstraZeneca, Biogen, Biotest, Bristol-Myers Squibb, Galapagos, Gilead, GSK, Janssen, Pfizer, Sanofi, Servier, UCB, and Viela Bio, Grant/research support from: Bristol-Myers Squibb, GSK, Eli Lilly, Pfizer, Roche, and UCB, Tsutomu Takeuchi Speakers bureau: AbbVie, AYUMI, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Dainippon Sumitomo, Eisai, Gilead, Mitsubishi Tanabe, Novartis, Pfizer, and Sanofi, Consultant of: Astellas, Chugai, and Eli Lilly, Grant/research support from: AbbVie, Asahi Kasei, Astellas, Chugai, Daiichi Sankyo, Eisai, Mitsubishi Tanabe, Nippon Kayaku, Shionogi, Takeda, and UCB, Jacob Aelion Grant/research support from: AbbVie, Amgen, AstraZeneca, Bristol-Myers Squibb, Celgene, Eli Lilly, Galapagos/Gilead, Genentech, GSK, Horizon, Janssen, Mallinckrodt, Nektar, Nichi-Iko, Novartis, Pfizer, Regeneron, Roche, Sanofi, Selecta, and UCB, Nilmo Chávez Speakers bureau: AbbVie, Janssen, and Pfizer, Consultant of: AbbVie, Janssen, and Pfizer, Grant/research support from: AbbVie, Galapagos, Gilead, Pfizer, and Sanofi, Pablo Mannucci Walter Consultant of: AbbVie, Grant/research support from: AbbVie, Bristol-Myers Squibb, Eli Lilly, Genentech/Roche, GSK, Janssen, and UCB, Atul Singhal Consultant of: AbbVie, Aclaris, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Gilead, Idorsia, Novartis, Oscotec, Pfizer, Regeneron, Roche/Genentech, Sanofi, Selecta, Takeda, UCB, and Viela Bio, Grant/research support from: AbbVie, Aclaris, Amgen, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Gilead, Idorsia, Novartis, Oscotec, Pfizer, Regeneron, Roche/Genentech, Sanofi, Selecta, Takeda, UCB, and Viela Bio, Jerzy Swierkot Speakers bureau: AbbVie, Accord, BMS, Janssen, MSD, Pfizer, Roche, Sandoz, and UCB, Consultant of: AbbVie, Accord, BMS, Janssen, MSD, Pfizer, Roche, Sandoz, and UCB, Grant/research support from: AbbVie, Accord, BMS, Janssen, MSD, Pfizer, Roche, Sandoz, and UCB, Alan Friedman Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Nasser Khan Shareholder of: May own stocks or options in AbbVie, Employee of: AbbVie, Yihan Li Shareholder of: May own stocks or options in AbbVie, Employee of: AbbVie, Xianwei Bu Shareholder of: May own stocks or options in AbbVie, Employee of: AbbVie, Justin Klaff Shareholder of: May own stock or options in AbbVie, Employee of: AbbVie, Vibeke Strand Consultant of: AbbVie, Amgen, Arena, AstraZeneca, Bayer, Bristol-Myers Squibb, Boehringer Ingelheim, Celltrion, Eli Lilly, Genentech/Roche, Gilead, GSK, Ichnos, Inmedix, Janssen, Kiniksa, MSD, Myriad Genetics, Novartis, Pfizer, Regeneron, Sandoz, Sanofi, Setpoint, and UCB

Cataract surgical reach: Falling short to catch white cataracts!

Purpose:

The aim of this study was to know proportion of white cataracts from among patients coming for cataract surgery, and to find causes delaying uptake of cataract surgery.

Methods:

A hospital-based, prospective study enrolled patients of senile cataract between April 2018 and March 2019. The proportion of white cataract was calculated and underlying causes delaying uptake of cataract surgery studied.

Results:

White cataracts constituted 13.5% of total 3634 senile cataract patients, with gender disparity disfavoring women. Bilateral white cataract was presentation in 39 (8%) patients and lens-related glaucoma in 24 (5%) patients. Pseudophakia in the other eye was single most common cause of delay.

Conclusion:

A large proportion of white cataracts suggest that penetration of cataract surgical services in not reaching to the most eligible individual.

Current Status and Quality of Machine Learning-Based Radiomics Studies for Glioma Grading: A Systematic Review

INTRODUCTION

Radiomics now has significant momentum in the era of precision medicine. Glioma is one of the pathologies that has been extensively evaluated by radiomics. However, this technique has not been incorporated into clinical practice. In this systematic review, we selected and reviewed the published studies about glioma grading by radiomics to evaluate this technique's feasibility and its challenges.

MATERIAL AND METHODS

Using seven different search strings, we considered all published English manuscripts from 2015 to September 2020 in PubMed, Embase, and Scopus databases. After implementing the exclusion and inclusion criteria, the final papers were selected for the methodological quality assessment based on our in-house Modified Radiomics Standard Scoring (RQS) containing 43 items (minimum score of 0, maximum score of 44). Finally, we offered our opinion about the challenges and weaknesses of the selected papers.

RESULTS

By our search, 1,177 manuscripts were found (485 in PubMed, 343 in Embase, and 349 in Scopus). After the implementation of inclusion and exclusion criteria, 18 papers remained for the final analysis by RQS. The total RQS score ranged from 26 (59% of maximum possible score) to 43 (97% of maximum possible score) with a mean of 33.5 (76% of maximum possible score).

CONCLUSION

The current studies are promising but very heterogeneous in design with high variation in the radiomics software, the number of extracted features, the number of selected features, and machine learning models. All of the studies were retrospective in design; many are based on small datasets and/or suffer from class imbalance and lack of external validation data-sets.

Skull Base Osteomyelitis: A Comprehensive Imaging Review

Skull base osteomyelitis is a relatively rare condition, generally occurring as a complication of advanced otologic or sinus infection in immunocompromised patients. Skull base osteomyelitis is generally divided into 2 broad categories: typical and atypical. Typical skull base osteomyelitis occurs secondary to uncontrolled infection of the temporal bone region, most often from necrotizing external otitis caused by Pseudomonas aeruginosa in a patient with diabetes. Atypical skull base osteomyelitis occurs in the absence of obvious temporal bone infection or external auditory canal infection. It may be secondary to advanced sinusitis or deep face infection or might occur in the absence of a known local source of infection. Atypical skull base osteomyelitis preferentially affects the central skull base and can be caused by bacterial or fungal infections. Clinically, typical skull base osteomyelitis presents with signs and symptoms of otitis externa or other temporal bone infection. Both typical and atypical forms can produce nonspecific symptoms including headache and fever, and progress to cranial neuropathies and meningitis. Early diagnosis can be difficult both clinically and radiologically, and the diagnosis is often delayed. Radiologic evaluation plays a critical role in the diagnosis of skull base osteomyelitis, with CT and MR imaging serving complementary roles. CT best demonstrates cortical and trabecular destruction of bone. MR imaging is best for determining the overall extent of disease and best demonstrates involvement of marrow space and extraosseous soft tissue. Nuclear medicine studies can also be contributory to diagnosis and follow-up. The goal of this article was to review the basic pathophysiology, clinical findings, and key radiologic features of skull base osteomyelitis.

Susceptibility-Weighted Imaging in Neurodegenerative Disorders: A Review

As human life expectancy increases, there is an increased prevalence of neurodegenerative disorders and dementia. There are many ongoing research trials for early diagnosis and management of dementia, and neuroimaging is a critical part of such studies. However, conventional neuroimaging often fails to provide enough diagnostic findings in patients with neurodegenerative disorders. In this context, different MRI sequences are currently under investigation to facilitate the accurate diagnosis of such disorders. Susceptibility-weighted imaging (SWI) is an innovative MRI technique that utilizes "magnitude" and "phase" images to produce an image contrast that is sensitive for the detection of susceptibility differences of the tissues. As many neurodegenerative disorders are associated with accelerated iron deposition and/or microhemorrhages in different parts of the brain, SWI can be applied to detect these diagnostic clues. For instance, in cerebral amyloid angiopathy, SWI can demonstrate cortical microhemorrhages, which are predominantly in the frontal and parietal regions. Or in Parkinson disease, abnormal swallow-tail sign on high-resolution SWI is highly diagnostic. Also, SWI is a useful sequence to detect the low signal intensity of precentral cortices in patients with amyotrophic lateral sclerosis. Being familiar with SWI findings in neurodegenerative disorders is critical for an accurate diagnosis. In this paper, the authors review the technical parameters of SWI, physiologic, and pathologic iron deposition in the brain, and the role of SWI in the evaluation of neurodegenerative disorders in daily practice.

Third-Molar Status and Risk of Loss of Adjacent Second Molars

The prophylactic removal of asymptomatic third molars is a common but controversial procedure often rationalized as necessary to prevent future disease on adjacent teeth. Our objective in this retrospective cohort study of adult men was to examine whether second-molar loss differed by baseline status of the adjacent third molar, taking into account the individual's overall state of oral hygiene, caries, and periodontitis. We analyzed data from participants of the VA Dental Longitudinal Study who had at least 1 second molar present at baseline and 2 or more triennial dental examinations between 1969 and 2007. We classified second molars by third-molar status in the same quadrant: unerupted, erupted, or absent. Tooth loss and alveolar bone loss were confirmed radiographically. Caries and restorations, calculus, and probing depth were assessed on each tooth. We estimated the hazards of second-molar loss with proportional hazards regression models for correlated data, controlling for age, smoking, education, absence of the first molar, and whole-mouth indices of calculus, caries, and periodontitis. The analysis included 966 men and 3024 second molar/first molar pairs. Follow-up was 22 ± 11 y (median 24, range 3-38 y). At baseline, 163 third molars were unerupted, 990 were erupted, and 1871 were absent. The prevalence of periodontitis on the second molars did not differ by third-molar status. The prevalence of distal caries was highest on the second molars adjacent to the erupted third molars and lowest on the second molars adjacent to the unerupted third molars. Relative to the absent third molars, adjusted hazards of loss of second molars were not significantly increased for those adjacent to erupted (hazard ratio [HR] = 0.96, 95% confidence interval [CI] = 0.79-1.16) or unerupted (HR = 1.25, 95% CI = 0.91-1.73) third molars. We found similar results when using alveolar bone loss as the periodontitis indicator. Our findings suggest that retained third molars are not associated with an increased risk of second-molar loss in adult men.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)

Introduction:

Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction.

Material and Methods:

Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association.

Results:

A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels.

Conclusion:

Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.

Brainstem Encephalitis. The Role of Imaging in Diagnosis

Encephalitis is a relatively challenging rare condition caused by a diverse group of etiologies. Brainstem encephalitis/Rhombencephalitis (BE), which affects the cerebellum, pons, and medulla, is even less common and more challenging for diagnosis and treatment. At this time, there is scattered data about BE in the literature, mainly in the form of case reports and case series. In this manuscript, the imaging presentation of BE is reviewed with the help of case examples. Many imaging presentations are not pathognomonic for BE; however, in many cases, clinical presentation, the spatial distribution of lesions, and other associated radiological lesions can provide the radiologists and clinician the clues to an accurate diagnosis.

Quantum Backaction on kg-Scale Mirrors: Observation of Radiation Pressure Noise in the Advanced Virgo Detector

The quantum radiation pressure and the quantum shot noise in laser-interferometric gravitational wave detectors constitute a macroscopic manifestation of the Heisenberg inequality. If quantum shot noise can be easily observed, the observation of quantum radiation pressure noise has been elusive, so far, due to the technical noise competing with quantum effects. Here, we discuss the evidence of quantum radiation pressure noise in the Advanced Virgo gravitational wave detector. In our experiment, we inject squeezed vacuum states of light into the interferometer in order to manipulate the quantum backaction on the 42 kg mirrors and observe the corresponding quantum noise driven displacement at frequencies between 30 and 70 Hz. The experimental data, obtained in various interferometer configurations, is tested against the Advanced Virgo detector quantum noise model which confirmed the measured magnitude of quantum radiation pressure noise.

Neuroimaging of the Pituitary Gland: Practical Anatomy and Pathology

The pituitary gland is a small endocrine organ located within the sella turcica. Various pathologic conditions affect the pituitary gland and produce endocrinologic and neurologic abnormalities. The most common lesion of the pituitary gland is the adenoma, a benign neoplasm. Dedicated MR imaging of the pituitary is radiologic study of choice for evaluating pituitary gland and central skull region. Computed tomography is complimentary and allows for identification of calcification and adjacent abnormalities of the osseous skull base. This review emphasizes basic anatomy, current imaging techniques, and highlights the spectrum of pathologic conditions that affect the pituitary gland and sellar region.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.

Critical illness-associated cerebral microbleed in a patient with sickle cell disease: A case report and review of the literature

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.

Prevalence of Sigmoid Sinus Dehiscence and Diverticulum among Adults with Skull Base Cephaloceles

BACKGROUND AND PURPOSE

Cephaloceles are relatively rare conditions caused by a congenital and/or acquired skull defect. The incidence of associated venous brain anomalies with regard to cephaloceles remains to be fully elucidated. Accordingly, we sought to assess the prevalence of sigmoid sinus dehiscence and diverticula in patients with spontaneous skull base cephaloceles.

MATERIALS AND METHODS

Our institutional data base was retrospectively queried from 2005 to 2018. Patients in whom spontaneous skull base cephaloceles were identified were ultimately included in the study cohort. These patients subsequently had their sigmoid sinuses re-evaluated with focused attention on the possible presence of dehiscence and/or diverticula.

RESULTS

We identified 56 patients: 12 men and 44 women. After re-evaluation of the sigmoid sinuses, evidence of dehiscence and/or diverticula was noted in 21 patients. The right sigmoid sinus was involved in 11 patients, and the left sigmoid sinus was involved in 7 patients, including 3 cases of diverticulum. In 3 patients, evidence of bilateral sigmoid sinus dehiscence and diverticula was noted. Female sex was associated with sigmoid sinus dehiscence and diverticula by univariate analysis (P = .019). By linear regression, cephalocele volume was negatively associated with sigmoid sinus dehiscence and diverticula (coefficient, -2266, P value < .007, adjusted R ² = 0.1077). By univariate logistic regression using average cephalocele volume as a cutoff, we demonstrate a statistically significant finding of lower volumes being associated with sigmoid sinus dehiscence and diverticula with an odds ratio of 3.58 (P = .05).

CONCLUSIONS

The prevalence of sigmoid sinus dehiscence and diverticula in patients with cephalocele is high. Female sex is associated with sigmoid sinus dehiscence and diverticula. The cephalocele volume appears to be inversely proportional to sigmoid sinus dehiscence and diverticula.

Factors affecting early-life intestinal microbiota development

OBJECTIVES

This paper reviews the published evidence on early-life intestinal microbiota development, as well as the different factors influencing its development before, at, and after birth. A literature search was done using PubMed, Cochrane and EMBASE databases. A growing body of evidence indicates that the intrauterine environment is not sterile as once presumed, but that maternal-fetal transmission of microbiota occurs during pregnancy. The consecutive order of bacteria with which the gastrointestinal tract is colonized will influence the outcome of community assembly and the ecological success of individual colonizers. The genetic background of the infant may also strongly influence microbial colonization of the gastrointestinal tract. The composition and development of infant gut microbiota can be influenced by many prenatal factors, such as maternal diet, obesity, smoking status, and use of antibiotic agents during pregnancy. Mode of delivery is generally accepted as a major factor determining the initial colonization. Breast milk stimulates the most balanced microbiome development for the infant, mainly because of its high content of unique oligosaccharides. Feeding is another important factor to determine intestinal colonization. Compared with breastfed infants, formula-fed infants have an increased richness of species. Initial clinical studies show that infant formulas supplemented with specific human milk oligosaccharides (HMOs) -2´-fucosyllactose alone or in combination with lacto-n-neotetraose are structurally identical to those in breast milk. HMOs increase the proportion of infants with a high bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants, lead to plasma immune marker profiles similar to those of breast-fed infants and to lower morbidity and antibiotics use. Further clinical studies with the same, others or more HMOs are needed to confirm these clinical effects. A growing number of studies have reported on how the composition and development of the microbiota during early life will affect risk factors related to health up to and during adulthood. If exclusive breastfeeding is not possible, the composition of infant formula should be adapted to stimulate the development of a bifidobacterial-dominated gut microbiota typical of that observed in breastfed infants. The main components in breast milk that stimulate the growth of specific bifidobacteria are HMOs.

Prospects for observing and localizing gravitational-wave transients with Advanced LIGO, Advanced Virgo and KAGRA

We present our current best estimate of the plausible observing scenarios for the Advanced LIGO, Advanced Virgo and KAGRA gravitational-wave detectors over the next several years, with the intention of providing information to facilitate planning for multi-messenger astronomy with gravitational waves. We estimate the sensitivity of the network to transient gravitational-wave signals for the third (O3), fourth (O4) and fifth observing (O5) runs, including the planned upgrades of the Advanced LIGO and Advanced Virgo detectors. We study the capability of the network to determine the sky location of the source for gravitational-wave signals from the inspiral of binary systems of compact objects, that is binary neutron star, neutron star-black hole, and binary black hole systems. The ability to localize the sources is given as a sky-area probability, luminosity distance, and comoving volume. The median sky localization area (90% credible region) is expected to be a few hundreds of square degrees for all types of binary systems during O3 with the Advanced LIGO and Virgo (HLV) network. The median sky localization area will improve to a few tens of square degrees during O4 with the Advanced LIGO, Virgo, and KAGRA (HLVK) network. During O3, the median localization volume (90% credible region) is expected to be on the order of 10 5 , 10 6 , 10 7 Mpc 3 for binary neutron star, neutron star-black hole, and binary black hole systems, respectively. The localization volume in O4 is expected to be about a factor two smaller than in O3. We predict a detection count of 1 - 1 + 12 ( 10 - 10 + 52 ) for binary neutron star mergers, of 0 - 0 + 19 ( 1 - 1 + 91 ) for neutron star-black hole mergers, and 17 - 11 + 22 ( 79 - 44 + 89 ) for binary black hole mergers in a one-calendar-year observing run of the HLV network during O3 (HLVK network during O4). We evaluate sensitivity and localization expectations for unmodeled signal searches, including the search for intermediate mass black hole binary mergers.

Increasing the Astrophysical Reach of the Advanced Virgo Detector via the Application of Squeezed Vacuum States of Light

Current interferometric gravitational-wave detectors are limited by quantum noise over a wide range of their measurement bandwidth. One method to overcome the quantum limit is the injection of squeezed vacuum states of light into the interferometer's dark port. Here, we report on the successful application of this quantum technology to improve the shot noise limited sensitivity of the Advanced Virgo gravitational-wave detector. A sensitivity enhancement of up to 3.2±0.1  dB beyond the shot noise limit is achieved. This nonclassical improvement corresponds to a 5%-8% increase of the binary neutron star horizon. The squeezing injection was fully automated and over the first 5 months of the third joint LIGO-Virgo observation run O3 squeezing was applied for more than 99% of the science time. During this period several gravitational-wave candidates have been recorded.

Search for Subsolar Mass Ultracompact Binaries in Advanced LIGO's Second Observing Run

We present a search for subsolar mass ultracompact objects in data obtained during Advanced LIGO's second observing run. In contrast to a previous search of Advanced LIGO data from the first observing run, this search includes the effects of component spin on the gravitational waveform. We identify no viable gravitational-wave candidates consistent with subsolar mass ultracompact binaries with at least one component between 0.2  M_{⊙}-1.0  M_{⊙}. We use the null result to constrain the binary merger rate of (0.2  M_{⊙}, 0.2  M_{⊙}) binaries to be less than 3.7×10^{5}  Gpc^{-3} yr^{-1} and the binary merger rate of (1.0  M_{⊙}, 1.0  M_{⊙}) binaries to be less than 5.2×10^{3}  Gpc^{-3} yr^{-1}. Subsolar mass ultracompact objects are not expected to form via known stellar evolution channels, though it has been suggested that primordial density fluctuations or particle dark matter with cooling mechanisms and/or nuclear interactions could form black holes with subsolar masses. Assuming a particular primordial black hole (PBH) formation model, we constrain a population of merging 0.2  M_{⊙} black holes to account for less than 16% of the dark matter density and a population of merging 1.0  M_{⊙} black holes to account for less than 2% of the dark matter density. We discuss how constraints on the merger rate and dark matter fraction may be extended to arbitrary black hole population models that predict subsolar mass binaries.