ACR Appropriateness Criteria® Nonvariceal Upper Gastrointestinal Bleeding: 2024 Update.

This document summarizes the relevant literature for the selection of the initial imaging in five clinical scenarios in patients with suspected or known nonvariceal upper gastrointestinal bleeding (UGIB). These clinical scenarios include suspected nonvariceal UGIB without endoscopy performed; endoscopically confirmed nonvariceal UGIB with clear source but treatment not possible or continued bleeding after endoscopic treatment; endoscopically confirmed nonvariceal UGIB without a confirmed source; suspected nonvariceal UGIB with negative endoscopy; and postsurgical or post-traumatic nonvariceal UGIB when endoscopy is contraindicated. The appropriateness of imaging modalities as they apply to each clinical scenario is rated as usually appropriate, may be appropriate, and usually not appropriate to assist the selection of the most appropriate imaging modality in the corresponding clinical scenarios of nonvariceal UGIB.

Evaluation of Parasight All-in-One system for the automated enumeration of helminth ova in canine and feline feces.

Background:  Digital imaging combined with deep-learning-based computational image analysis is a growing area in medical diagnostics, including parasitology, where a number of automated analytical devices have been developed and are available for use in clinical practice.

Methods: The performance of Parasight All-in-One (AIO), a second-generation device, was evaluated by comparing it to a well-accepted research method (mini-FLOTAC) and to another commercially available test (Imagyst). Fifty-nine canine and feline infected fecal specimens were quantitatively analyzed by all three methods.

ACR Appropriateness Criteria® Screening for Abdominal Aortic Aneurysm.

Abdominal aortic aneurysm (AAA) is a significant vascular disease found in 4% to 8% of the screening population. If ruptured, its mortality rate is between 75% and 90%, and it accounts for up to 5% of sudden deaths in the United States. Therefore, screening of AAA while asymptomatic has been a crucial portion of preventive health care worldwide.

ACR Appropriateness Criteria® Pulmonary Arteriovenous Malformation (PAVM): 2023 Update.

Pulmonary arteriovenous malformations (PAVMs) occur in 30% to 50% of patients with hereditary hemorrhagic telangiectasia. Clinical presentations vary from asymptomatic disease to complications resulting from the right to left shunting of blood through the PAVM such as paradoxical stroke, brain abscesses, hypoxemia, and cardiac failure. Radiology plays an important role both in the diagnosis and treatment of PAVM.

Relative egg extraction efficiencies of manual and automated fecal egg count methods in equines.

The World Association for the Advancement of Veterinary Parasitology recently released new recommendations for the design of fecal egg count (FEC) reduction tests for livestock. These provide suggestions as to the number of animals to be sampled and the minimum number of eggs that must be counted to produce statistically meaningful results. One of the considerations for study design is the multiplication factor of the FEC method to be used; methods with lower multiplication factors require fewer animals to be sampled because they are presumed to count more eggs per test.

How VA Innovative Partnerships and Health Care Systems Can Respond to National Needs: NOSE Trial Example.

Background: At the onset of COVID-19, essential supplies were not obtainable from manufacturers. This caused patients and clinicians to have additional risk and exposure to COVID-19 in some settings and the wasting of critical materials when testing was unavailable in other settings.

Observations: The Veterans Health Administration (VHA) developed and enacted contingency plans for depleted supplies under both its First Mission-to care for veterans-and its Fourth Mission- to support the American health care system in times of crisis.

ACR Appropriateness Criteria® Lower Extremity Arterial Claudication-Imaging Assessment for Revascularization: 2022 Update.

Arterial claudication is a common manifestation of peripheral artery disease. This document focuses on necessary imaging before revascularization for claudication. Appropriate use of ultrasound, invasive arteriography, MR angiography, and CT angiography are discussed.

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery): 2022 Update.

Breast cancer is the most common malignancy in women in the United States, with surgical options including lumpectomy and mastectomy followed by breast reconstruction. Deep inferior epigastric perforator (DIEP) flap is a muscle-sparing perforator free flap breast reconstruction technique, which uses the deep inferior epigastric artery (DIEA) perforators to create a vascular pedicle. Multiple perforators are identified by preoperative imaging, which are typically ranked based on size, location, and intramuscular course.

Algorithms used in medical image segmentation for 3D printing and how to understand and quantify their performance.

Background: 3D printing (3DP) has enabled medical professionals to create patient-specific medical devices to assist in surgical planning. Anatomical models can be generated from patient scans using a wide array of software, but there are limited studies on the geometric variance that is introduced during the digital conversion of images to models. The final accuracy of the 3D printed model is a function of manufacturing hardware quality control and the variability introduced during the multiple digital steps that convert patient scans to a printable format.

A novel workflow to fabricate a patient-specific 3D printed accommodative foot orthosis with personalized latticed metamaterial.

Patients with diabetes mellitus are at elevated risk for secondary complications that result in lower extremity amputations. Standard of care to prevent these complications involves prescribing custom accommodative insoles that use inefficient and outdated fabrication processes including milling and hand carving. A new thrust of custom 3D printed insoles has shown promise in producing corrective insoles but has not explored accommodative diabetic insoles.

A Biofabrication Strategy for a Custom-Shaped, Non-Synthetic Bone Graft Precursor with a Prevascularized Tissue Shell.

Critical-sized defects of irregular bones requiring bone grafting, such as in craniofacial reconstruction, are particularly challenging to repair. With bone-grafting procedures growing in number annually, there is a reciprocal growing interest in bone graft substitutes to meet the demand. Autogenous osteo(myo)cutaneous grafts harvested from a secondary surgical site are the gold standard for reconstruction but are associated with donor-site morbidity and are in limited supply.

A doubling of atmospheric CO2 mitigates the effects of severe drought on maize through the preservation of soil water.

Background And Aims: Drought limits maize production in many regions of the world, and this is likely to intensify in future. Elevated atmospheric CO2 (eCO2) can mitigate this by reducing stomatal conductance and water loss without reducing yield. The magnitude of this effect depends on the interaction of eCO2 and drought severity, but scarce data collected under severe drought conditions limit predictions of future maize production.

Establishing 3D Printing at the Point of Care: Basic Principles and Tools for Success.

As the medical applications of three-dimensional (3D) printing increase, so does the number of health care organizations in which adoption or expansion of 3D printing facilities is under consideration. With recent advancements in 3D printing technology, medical practitioners have embraced this powerful tool to help them to deliver high-quality patient care, with a focus on sustainability. The use of 3D printing in the hospital or clinic at the point of care (POC) has profound potential, but its adoption is not without unanticipated challenges and considerations.

Establishing Quality and Safety in Hospital-based 3D Printing Programs: Patient-first Approach.

The adoption of three-dimensional (3D) printing is rapidly spreading across hospitals, and the complexity of 3D-printed models and devices is growing. While exciting, the rapid growth and increasing complexity also put patients at increased risk for potential errors and decreased quality of the final product. More than ever, a strong quality management system (QMS) must be in place to identify potential errors, mitigate those errors, and continually enhance the quality of the product that is delivered to patients.

Yeast DNA polymerase η possesses two PIP-like motifs that bind PCNA and Rad6-Rad18 with different specificities.

In translesion synthesis (TLS), specialized DNA polymerases, such as polymerase (pol) η and Rev1, are recruited to stalled replication forks. These polymerases form a multi-protein complex with PCNA, Rad6-Rad18, and other specialized polymerases. Pol η interacts with PCNA and Rev1 via a PCNA-interacting protein (PIP) motif in its C-terminal unstructured region.

3D Printing Applications for Transcatheter Aortic Valve Replacement.

Purpose Of Review: A combination of evolving 3D printing technologies, new 3D printable materials, and multi-disciplinary collaborations have made 3D printing applications for transcatheter aortic valve replacement (TAVR) a promising tool to promote innovation, increase procedural success, and provide a compelling educational tool. This review synthesizes the knowledge via publications and our group's experience in this area that exemplify uses of 3D printing for TAVR.

Recent Findings: Patient-specific 3D-printed models have been used for TAVR pre-procedural device sizing, benchtop prediction of procedural complications, planning for valve-in-valve and bicuspid aortic valve procedures, and more.

Control of DNA Damage Bypass by Ubiquitylation of PCNA.

DNA damage leads to genome instability by interfering with DNA replication. Cells possess several damage bypass pathways that mitigate the effects of DNA damage during replication. These pathways include translesion synthesis and template switching.

Invasive grasses of sub-Antarctic Marion Island respond to increasing temperatures at the expense of chilling tolerance.

Background And Aims: Global warming has large effects on the performance and spatial distribution of plants, and increasingly facilitates the spread of invasive species. Particularly vulnerable is the vegetation of cold environments where indigenous plants selected for cold tolerance can have reduced phenotypic plasticity and associated lower capacity to respond to warming temperatures. In contrast, invasive species can be phenotypically plastic and respond positively to climate change, but at the expense of stress tolerance.

Frequent fires prime plant developmental responses to burning.

Coping with temporal variation in fire requires plants to have plasticity in traits that promote persistence, but how plastic responses to current conditions are affected by past fire exposure remains unknown. We investigate phenotypic divergence between populations of four resprouting grasses exposed to differing experimental fire regimes (annually burnt or unburnt for greater than 35 years) and test whether divergence persists after plants are grown in a common environment for 1 year. Traits relating to flowering and biomass allocation were measured before plants were experimentally burnt, and their regrowth was tracked.

Methods for verification of 3D printed anatomic model accuracy using cardiac models as an example.

Background: Medical 3D printing has brought the manufacturing world closer to the patient's bedside than ever before. This requires hospitals and their personnel to update their quality assurance program to more appropriately accommodate the 3D printing fabrication process and the challenges that come along with it.

Results: In this paper, we explored different methods for verifying the accuracy of a 3D printed anatomical model.

How Medical Students' Compassionate Values Influence Help-Seeking Barriers.

Theory: Despite high rates of psychiatric illnesses, medical students and medical professionals often avoid psychological help. Stigma may prevent medical students from seeking psychological help when experiencing distress, which may hinder their job performance and mental health. Compassionate values-preferred principles that guide attitudes and behaviors to focus on the wellness of others-may be a relevant predictor of medical students' perceptions of psychological help.

C anatomy can evolve via a single developmental change.

C photosynthesis is a complex trait that boosts productivity in warm environments. Paradoxically, it evolved independently in numerous plant lineages, despite requiring specialised leaf anatomy. The anatomical modifications underlying C evolution have previously been evaluated through interspecific comparisons, which capture numerous changes besides those needed for C functionality.

Pre-procedural fit-testing of TAVR valves using parametric modeling and 3D printing.

Background: Successful transcatheter aortic valve replacement (TAVR) requires an understanding of how a prosthetic valve will interact with a patient's anatomy in advance of surgical deployment. To improve this understanding, we developed a benchtop workflow that allows for testing of physical interactions between prosthetic valves and patient-specific aortic root anatomy, including calcified leaflets, prior to actual prosthetic valve placement.

Methods: This was a retrospective study of 30 patients who underwent TAVR at a single high volume center.

Principles of three-dimensional printing and clinical applications within the abdomen and pelvis.

Improvements in technology and reduction in costs have led to widespread interest in three-dimensional (3D) printing. 3D-printed anatomical models contribute to personalized medicine, surgical planning, and education across medical specialties, and these models are rapidly changing the landscape of clinical practice. A physical object that can be held in one's hands allows for significant advantages over standard two-dimensional (2D) or even 3D computer-based virtual models.