Tanwilhelmsen1971

Background/aims This study aimed to compare the diagnostic performances of Liver Imaging Reporting and Data System (LI-RADS) 2018 and Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 criteria on magnetic resonance imaging (MRI) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Methods This retrospective study included 273 treatment-naïve patients (71 patients with extracellular contrast agent [ECA]-MRI and 202 patients with hepatobiliary agent [HBA]-MRI; 352 lesions including 263 HCCs) with high risk of HCC who underwent contrast-enhanced MRI between 2016 and 2017. Two readers evaluated all lesions according to the criteria of LI-RADS 2018 and KLCA-NCC 2018. The per-lesion diagnostic performances were compared using the generalized estimating equation method. Results On ECA-MRI, the sensitivity and specificity of LI-RADS 2018 and KLCA-NCC 2018 were not significantly different (LR-5 vs. definite HCC 75.8% vs. 69.4%, P=0.095 and 95.8% vs. 95.8%, P>0.999; LR-5/4 vs. definite/probable HCC 87.1% vs.83.9%, P=0.313 and 87.5% vs. 91.7%, P=0.307). On HBA-MRI, definite HCC of KLCA-NCC 2018 showed significantly higher sensitivity (79.1% vs. 68.2%, P less then 0.001) than LR-5 of LI-RADS 2018 without a significant difference in specificity (93.9% vs. 95.4%, P=0.314). Terephthalic Definite/probable HCC of KLCA-NCC 2018 had higher specificity (92.3% vs. 80.0%, P=0.003) than LR-5/4 of LI-RADS 2018. The sensitivity was lower for definite/probable HCC than for LR-5/4 without statistical significance (85.6% vs. 88.1%, P=0.057). Conclusions On ECA-MRI, LI-RADS 2018 and KLCA-NCC 2018 showed comparable diagnostic performances. On HBA-MRI, definite HCC of KLCA-NCC 2018 provided better sensitivity than LR-5 category of LI-RADS 2018 without compromising the specificity, while definite/probable HCC of KLCA-NCC 2018 revealed higher specificity than LR-5/4 of LI-RADS 2018 for diagnosing HCC.Genomic surveillance is an important aspect of contemporary disease management but has yet to be used routinely to monitor endemic disease transmission and control in low- and middle-income countries. Rabies is an almost invariably fatal viral disease that causes a large public health and economic burden in Asia and Africa, despite being entirely vaccine preventable. With policy efforts now directed towards achieving a global goal of zero dog-mediated human rabies deaths by 2030, establishing effective surveillance tools is critical. Genomic data can provide important and unique insights into rabies spread and persistence that can direct control efforts. However, capacity for genomic research in low- and middle-income countries is held back by limited laboratory infrastructure, cost, supply chains and other logistical challenges. Here we present and validate an end-to-end workflow to facilitate affordable whole genome sequencing for rabies surveillance utilising nanopore technology. We used this workflow in Kenya, Tanzania and the Philippines to generate rabies virus genomes in two to three days, reducing costs to approximately £60 per genome. This is over half the cost of metagenomic sequencing previously conducted for Tanzanian samples, which involved exporting samples to the UK and a three- to six-month lag time. Ongoing optimization of workflows are likely to reduce these costs further. We also present tools to support routine whole genome sequencing and interpretation for genomic surveillance. Moreover, combined with training workshops to empower scientists in-country, we show that local sequencing capacity can be readily established and sustainable, negating the common misperception that cutting-edge genomic research can only be conducted in high resource laboratories. More generally, we argue that the capacity to harness genomic data is a game-changer for endemic disease surveillance and should precipitate a new wave of researchers from low- and middle-income countries.Mitral valve insufficiency or mitral regurgitation (MR) is characterized by the reversal of blood flow from the left ventricle (LV) to the left atrium (LA), typically in the systolic phase of the cardiac cycle. It continues to be a significant issue in cardiovascular health worldwide. Serial advancements in the diagnostic tools, clinical management, and treatment of this valvular lesion have changed the clinical approach over the last several decades. The mitral valve apparatus is a complex but dynamic structure and consists of the mitral annulus, two leaflets, chords, and papillary muscles, which is surrounded by complex anatomy in LA and LV. Disruption in the structural integrity or functional mechanism of this apparatus with or without the involvement of surrounding structures results in MR. This activity will review various aspects of this common clinical cardiovascular entity, including diagnosis, evaluation, and management.Diabetes mellitus (DM) is a disease spectrum ranging from the classic insulinopenic type 1 diabetes (T1DM) at one end to the classic insulin-resistant type 2 diabetes (T2DM) at the other. Latent autoimmune diabetes of adults (LADA) is a form of DM with features of both T1DM and T2DM and has therefore been termed Type 1.5 DM. In Japan, the synonym used is slowly progressive insulin-dependent type 1 diabetes mellitus (SPIDDM). The American Diabetes Association (ADA) lists LADA as T1DM that evolves more slowly than the classic disease and does not recognize it as a specific type of DM. The World Health Organization's term for LADA is 'slowly evolving immune-related diabetes.' LADA is, by definition, a disease of adults. The Immunology for Diabetes Society (IDS) has specified three criteria for the diagnosis of LADA Although attractive, this set of criteria has been challenged, especially because the choice of insulin as a treatment is highly physician dependent. It is immunologically similar to T1DM as antibodies to islet beta cells are present, albeit at lower titers, and immune destruction progresses at a much slower rate when compared to classic T1DM. The majority of these patients present with hyperglycemia that is not dramatic like T1DM and is misdiagnosed and managed as T2DM. Only later is it realized that they have poor control with many conventional agents, especially sulfonylureas, and eventually require insulin therapy. LADA itself is a heterogeneous disease where some patients have high antibody titers, a low BMI, and progress to insulin therapy faster and others who have low antibody titers, features of insulin resistance like higher BMI, and progress more slowly to requiring insulin. Early recognition of LADA is paramount so that appropriate strategies are employed to delay beta-cell destruction and reduce complications. This article reviews the advances in the pathophysiology of LADA and its implications in the evaluation and treatment.