A Case of Enfortumab Vedotin-Associated Diabetic Ketoacidosis With Severe Insulin Resistance in a Nondiabetic Woman.

Enfortumab vedotin is a novel antibody-drug conjugate (ADC) approved to treat urothelial carcinoma. One rarely reported adverse effect has been life-threatening diabetic ketoacidosis (DKA) driven by profound insulin resistance. We report a case of a 62-year-old nondiabetic woman with metastatic urothelial carcinoma who experienced DKA following her third dose of enfortumab vedotin, with extreme insulin requirements of > 1000 units daily, and full resolution of insulin requirement by day 7 of admission.

Treatment Approaches for Melanomas That Relapse After Adjuvant or Neoadjuvant Therapy.

Purpose Of Review: Effective adjuvant treatment with immunotherapy and targeted therapy has significantly improved outcomes for patients with resectable locally advanced or metastatic melanoma, but a substantial proportion unfortunately relapse. Here, we review available data and explore evolving research which might impact decision-making in this setting.

Recent Findings: Small retrospective studies have explored pattern of disease relapse and observed outcomes of subsequent treatment.

Patient-Derived Explants as a Precision Medicine Patient-Proximal Testing Platform Informing Cancer Management.

Precision medicine approaches that inform clinical management of individuals with cancer are progressively advancing. Patient-derived explants (PDEs) provide a patient-proximal platform that can be used to assess sensitivity to standard of care (SOC) therapies and novel agents. PDEs have several advantages as a patient-proximal model compared to current preclinical models, as they maintain the phenotype and microenvironment of the individual tumor.

Artificial intelligence modelling in differentiating core biopsies of fibroadenoma from phyllodes tumor.

Breast fibroepithelial lesions (FEL) are biphasic tumors which consist of benign fibroadenomas (FAs) and the rarer phyllodes tumors (PTs). FAs and PTs have overlapping features, but have different clinical management, which makes correct core biopsy diagnosis important. This study used whole-slide images (WSIs) of 187 FA and 100 PT core biopsies, to investigate the potential role of artificial intelligence (AI) in FEL diagnosis.

Enhancement of needle visualization and localization in ultrasound.

Purpose: This scoping review covers needle visualization and localization techniques in ultrasound, where localization-based approaches mostly aim to compute the needle shaft (and tip) location while potentially enhancing its visibility too.

Methods: A literature review is conducted on the state-of-the-art techniques, which could be divided into five categories: (1) signal and image processing-based techniques to augment the needle, (2) modifications to the needle and insertion to help with needle-transducer alignment and visibility, (3) changes to ultrasound image formation, (4) motion-based analysis and (5) machine learning.

Results: Advantages, limitations and challenges of representative examples in each of the categories are discussed.

Mind perception and stereotype attribution of corporations and charities.

People generally attribute less mind to groups than to individuals. Previous research has also shown differences of mind perception between different types of groups, such that not-for-profit organizations were viewed as having more minds than for-profit organizations. In this paper, we ascertained this mind perception differences and further examined its underlying mechanisms and concomitant consequences.

The effect of subgroup homogeneity of efficacy on contribution in public good dilemmas.

This paper examines how to maximize contribution in public good dilemmas by arranging people into homogeneous or heterogeneous subgroups. Past studies on the effect of homogeneity of efficacy have exclusively manipulated group composition in their experimental designs, which might have imposed a limit on ecological validity because group membership may not be easily changed in reality. In this study, we maintained the same group composition but varied the subgroup composition.

Robust and semantic needle detection in 3D ultrasound using orthogonal-plane convolutional neural networks.

Purpose: During needle interventions, successful automated detection of the needle immediately after insertion is necessary to allow the physician identify and correct any misalignment of the needle and the target at early stages, which reduces needle passes and improves health outcomes.

Methods: We present a novel approach to localize partially inserted needles in 3D ultrasound volume with high precision using convolutional neural networks. We propose two methods based on patch classification and semantic segmentation of the needle from orthogonal 2D cross-sections extracted from the volume.

CASPER: computer-aided segmentation of imperceptible motion-a learning-based tracking of an invisible needle in ultrasound.

Purpose: This paper presents a new micro-motion-based approach to track a needle in ultrasound images captured by a handheld transducer.

Methods: We propose a novel learning-based framework to track a handheld needle by detecting microscale variations of motion dynamics over time. The current state of the art on using motion analysis for needle detection uses absolute motion and hence work well only when the transducer is static.

Medical Instrument Detection in 3-Dimensional Ultrasound Data Volumes.

Ultrasound-guided medical interventions are broadly applied in diagnostics and therapy, e.g., regional anesthesia or ablation.

Detection of an invisible needle in ultrasound using a probabilistic SVM and time-domain features.

We propose a novel learning-based approach to detect an imperceptible hand-held needle in ultrasound images using the natural tremor motion. The minute tremor induced on the needle however is also transferred to the tissue in contact with the needle, making the accurate needle detection a challenging task. The proposed learning-based framework is based on temporal analysis of the phase variations of pixels to classify them according to the motion characteristics.

Spectral analysis of the tremor motion for needle detection in curvilinear ultrasound via spatiotemporal linear sampling.

Purpose: This paper presents a new approach to detect a standard handheld needle in ultrasound-guided interventions.

Methods: Our proposal is to use natural hand tremor, which causes minute displacement of the needle, to detect the needle in ultrasound B-mode images. Subtle displacements arising from tremor motion have a periodic pattern which is usually imperceptible to the naked eye in the B-mode image.

Expectation and cooperation in prisoner's dilemmas: The moderating role of game riskiness.

This paper investigated the effect of risk orientation, game riskiness, and expectation of cooperation on cooperation in one-shot prisoner's dilemmas (PD). Participants in pairs played PD games that varied on game riskiness such that for half of the games cooperation was more risky than defection (more risky games) while for another half cooperation was less risky (less risky games). They estimated how likely it was that the other player was going to cooperate (expectation of cooperation) before they made their cooperation/defection decision on each game.

Operationalising elaboration theory for simulation instruction design: a Delphi study.

Objective: The aim of this study was to assess the feasibility of incorporating the Delphi process within the simplifying conditions method (SCM) described in elaboration theory (ET) to identify conditions impacting the complexity of procedural skills for novice learners.

Methods: We generated an initial list of conditions impacting the complexity of lumbar puncture (LP) from key informant interviews (n = 5) and a literature review. Eighteen clinician-educators from six different medical specialties were subsequently recruited as expert panellists.

Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus.

Described here is a novel approach to needle localization in 3-D ultrasound based on automatic detection of small changes in appearance on movement of the needle stylus. By stylus oscillation, including its full insertion into the cannula to the tip, the image processing techniques can localize the needle trajectory and the tip in the 3-D ultrasound volume. The 3-D needle localization task is reduced to two 2-D localizations using orthogonal projections.

Enhanced needle localization in ultrasound using beam steering and learning-based segmentation.

Segmentation of needles in ultrasound images remains a challenging problem. In this paper, we introduce a machine learning-based method for needle segmentation in 2D beam-steered ultrasound images. We used a statistical boosting approach to train a pixel-wise classifier for needle segmentation.

Transmembrane and coiled-coil domain family 1 is a novel protein of the endoplasmic reticulum.

The endoplasmic reticulum (ER) is a continuous membrane network in eukaryotic cells comprising the nuclear envelope, the rough ER, and the smooth ER. The ER has multiple critical functions and a characteristic structure. In this study, we identified a new protein of the ER, TMCC1 (transmembrane and coiled-coil domain family 1).

Z-DOC: a serious game for Z-plasty procedure training.

We present Z-DOC, a (prototype) serious game for training plastic surgery residents the steps comprising the Z-plasty surgical procedure. Z-DOC employs touch-based interactions and promotes competition amongst multiple players/users thus promote engagement and motivation. It is hypothesized that by learning the Z-plasty procedure in an interactive, engaging, and fun gaming environment, trainees will have a much better understanding of the procedure than by traditional learning modalities.

Human mesenchymal stem-cell behaviour on direct laser micropatterned electrospun scaffolds with hierarchical structures.

Direct laser machining and electrospinning are utilized to obtain a bi-layered hybrid scaffold with hierarchical topographical features to mimic extracellular matrix-like microenvironment of cells. Adult bone marrow derived human mesenchymal stem cells (hMSCs) are cultured in vitro in these hybrid scaffolds, and cell orientation, proliferation, viability, and differentiation are evaluated. The results show that this novel hybrid scaffold not only supports cell growth like traditional scaffolds, but also elicits positive responses from the cells, like lineage commitment and alignment, which are essential features of future scaffolds.

Stability of pain-related medications, metabolites, and illicit substances in urine.

Background: Effective urine drug testing requires an understanding of the stability of medications, metabolites and other substances excreted in the urine matrix. When the testing results do not fit the clinical picture, physicians frequently request repeat testing of the original specimen in order to corroborate the results. We determined the stability in urine of various medications, metabolites, and illicit substances commonly requested for testing by physicians treating patients with pain and pain-related disorders.

Synthesis, structure, and physical properties for a series of trigonal bipyramidal M(II)-Cl complexes with intramolecular hydrogen bonds.

A series of transition metal chloro complexes with the tetradentate tripodal tris(2-amino-oxazoline)amine ligand (TAO) have been synthesized and characterized. X-Ray structural analyses of these compounds demonstrate the formation of the mononuclear complexes [M(II)(TAO)(Cl)](+), where M(II) = Cr, Mn, Fe, Co, Ni, Cu and Zn. These complexes exhibit distorted trigonal-bipyramidal geometry, coordinating the metal through an apical tertiary amine, three equatorial imino nitrogen atoms, and an axial chloride anion.

Preparation and structures of dinuclear complexes containing M(II)-OH centers.

The synthesis of M(II)(2) complexes (M(II)=Co, Mn) with terminal hydroxo ligands has been achieved utilizing a dinucleating ligand containing a bridging pyrazolate unit and appended (neopentyl)aminopyridyl groups. Structural studies on the complexes revealed that the M(II)-OH units are positioned in a syn-configuration, placing the hydroxo ligands in close proximity (ca. 3 Å apart), which may be a prerequisite for water oxidation.

Direct laser machining-induced topographic pattern promotes up-regulation of myogenic markers in human mesenchymal stem cells.

The engineering of tissue is preferably done with stem cells, which can be differentiated into the tissue of interest using biochemical or physical cues. While much effort has been focused on using biological factors to regulate stem cell differentiation, recently interest in the contribution of physical factors has increased. In this work, three-dimensional (3-D) microchannels with topographic micropatterns were fabricated by femtosecond laser machining on a biodegradable polymer (poly(L-lactide-co-ε-caprolactone)) substrate.