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Pelvicoabdominal plexiform neurofibroma is a rare and complicated form of type 1 neurofibromatosis (NF1), distinguished by developing benign nerve sheath tumors in the pelvis and abdomen. A male patient, aged 26, came to our center with dysuria, abdominal bloating, rectal mucosa prolapses, and trouble walking and moving legs. Physical examination revealed a palpable mass of solid consistency fixed in the pelvic cavity to the abdominal cavity. A large and extensive mass in the pelvic to the abdominal region can be evaluated with multimodality radiological imaging, including ultrasound, computed tomography, and magnetic resonance imaging. Imaging is crucial for diagnosis, evaluation of extension, and early detection of potential malignant transformation in these patients. The patient was scheduled for palliative surgical resection due to the extensive mass; however, he did not survive while waiting for the operation. Pathology examination and immunohistochemical staining revealed positive S-100 protein, indicating the neural crest originate lesion. We report the clinical and radiological features of plexiform neurofibroma in a young male patient, confirmed by pathology examination.

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Identifying biomarkers for computer-aided diagnosis (CAD) is crucial for early intervention of psychiatric disorders. Multi-site data have been utilized to increase the sample size and improve statistical power, while multi-modality classification offers significant advantages over traditional single-modality based approaches for diagnosing psychiatric disorders. However, inter-site heterogeneity and intra-modality heterogeneity present challenges to multi-site and multi-modality based classification. In this paper, brain functional and structural networks (BFNs/BSNs) from multiple sites were constructed to establish a joint multi-site multi-modality framework for psychiatric diagnosis. To do this we developed a hypergraph based multi-source domain adaptation (HMSDA) which allowed us to transform source domain subjects into a target domain. A local ordinal structure based multi-task feature selection (LOSMFS) approach was developed by integrating the transformed functional and structural connections (FCs/SCs). The effectiveness of our method was validated by evaluating diagnosis of both schizophrenia (SZ) and autism spectrum disorder (ASD). The proposed method obtained accuracies of 92.2 %±2.22 % and 84.8 %±2.68 % for the diagnosis of SZ and ASD, respectively. We also compared with 6 DA, 10 multi-modality feature selection, and 8 multi-site and multi-modality methods. Results showed the proposed HMSDA+LOSMFS effectively integrated multi-site and multi-modality data to enhance psychiatric diagnosis and identify disorder-specific diagnostic brain connections.

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INTRODUCTION: Data-driven medical research (DDMR) needs multimodal data (MMD) to sufficiently capture the complexity of clinical cases. Methods for early multimodal data integration (MMDI), i.e. integration of the data before performing a data analysis, vary from basic concatenation to applying Deep Learning, each with distinct characteristics and challenges. Besides early MMDI, there exists late MMDI which performs modality-specific data analyses and then combines the analysis results. METHODS: We conducted a scoping review, following PRISMA guidelines, to find and analyze 21 reviews on methods for early MMDI between 2019 and 2024. RESULTS: Our analysis categorized these methods into four groups and summarized group-specific characteristics that are relevant for choosing the optimal method combination for MMDI pipelines in DDMR projects. Moreover, we found that early MMDI is often performed by executing several methods subsequently in a pipeline. This early MMDI pipeline is usually subject to manual optimization. DISCUSSION: Our focus was on structural integration in DDMR. The choice of MMDI method depends on the research setting, complexity, and the researcher team's expertise. Future research could focus on comparing early and late MMDI approaches as well as automating the optimization of MMDI pipelines to integrate vast amounts of real-world medical data effectively, facilitating holistic DDMR.

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In this paper, we study facial expression recognition (FER) using three modalities obtained from a light field camera: sub-aperture (SA), depth map, and all-in-focus (AiF) images. Our objective is to construct a more comprehensive and effective FER system by investigating multimodal fusion strategies. For this purpose, we employ EfficientNetV2-S, pre-trained on AffectNet, as our primary convolutional neural network. This model, combined with a BiGRU, is used to process SA images. We evaluate various fusion techniques at both decision and feature levels to assess their effectiveness in enhancing FER accuracy. Our findings show that the model using SA images surpasses state-of-the-art performance, achieving 88.13% ± 7.42% accuracy under the subject-specific evaluation protocol and 91.88% ± 3.25% under the subject-independent evaluation protocol. These results highlight our model's potential in enhancing FER accuracy and robustness, outperforming existing methods. Furthermore, our multimodal fusion approach, integrating SA, AiF, and depth images, demonstrates substantial improvements over unimodal models. The decision-level fusion strategy, particularly using average weights, proved most effective, achieving 90.13% ± 4.95% accuracy under the subject-specific evaluation protocol and 93.33% ± 4.92% under the subject-independent evaluation protocol. This approach leverages the complementary strengths of each modality, resulting in a more comprehensive and accurate FER system.

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Severe tricuspid regurgitation (TR) is a pathological condition associated with worse cardiovascular outcomes. In the vicious cycle of right ventricular compensation and maladaptation to TR, the development of right ventricle (RV) dysfunction has significant prognostic implications, especially in patients undergoing surgical or percutaneous treatments. Indeed, RV dysfunction is associated with increased operative morbidity and mortality in both surgical and percutaneously treated patients. In this context, the identification of clinical or subtle right ventricle dysfunction plays a critical role inpatient selection and timing of surgical or percutaneous tricuspid valve intervention. However, in the presence of severe TR, evaluation of RV function is challenging, given the increase in preload that may lead to an overestimation of systolic function for the Frank-Starling law, reduced reliability of pulmonary artery pressure estimation, the sensitivity of RV to afterload that may result in afterload mismatch after treatment. Consequently, conventional echocardiographic indices have some limitations, and the use of speckle tracking for right ventricular free wall longitudinal strain (RV-FWLS) analysis and the use of 3D echocardiography for RV volumes and ejection fraction estimation are showing promising data. Cardiac magnetic resonance (CMR) represents the gold standards for volumes and ejection fraction evaluation and may add further prognostic information. Finally, cardiac computer tomography (CCT) provides measurements of RV and annulus dimensions that are particularly useful in the transcatheter field. Identification of subtle RV dysfunction may need, therefore, more than one imaging technique, which will lead to tip the balance between medical therapy and early intervention towards the latter before disease progression. Therefore, the aim of this review is to describe the main imaging techniques, providing a comprehensive assessment of their role in RV function evaluation in the presence of severe TR.

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Background/Objectives: In patients with chronic primary mitral regurgitation (MR), postoperative persistent left ventricular (LV) dysfunction underlines the lack of a sensitive parameter that can identify subclinical LV dysfunction and optimize the timing of intervention. Left ventricular global longitudinal strain (LV-GLS) is a measure of the longitudinal left ventricular systolic function, with prognostic significance. Its role in the follow-up of asymptomatic patients with MR is, however, poorly defined. The aim of this study was to assess the relative changes in LV-GLS in a cohort of MR patients and to correlate these changes with the need for intervention during a follow-up period. Methods: We conducted a prospective study on a cohort of 218 patients, divided into three subgroups according to MR severity (mild, moderate, severe). LV-GLS was measured at baseline and every six months during a median follow-up period of 30 months. The composite endpoint was the occurrence of heart failure symptoms, hospitalization for heart failure, LVEF < 60%, LVEDD > 45 mm, new onset atrial fibrillation, or cardiovascular death. Results: Patients with moderate and severe MR had a significantly lower GLS at baseline than those with mild MR (19.5% and 19.1% versus 22.3%, p < 0.01) despite a normal LVEF in all subgroups. The relative decrease in LV-GLS occurred earlier (at 12 months vs. 24 months) and was more evident in patients with moderate and severe MR (13.6% and 14.5%, respectively) versus patients with mild MR (6.72%). The baseline LV-GLS being under 18% and a relative decrease of over 10% in GLS were independent predictors of a composite outcome (HR = 1.59, CI 95% 1.17-2.86; HR = 1.74, CI 95% 1.2-2.91, p < 0.01). Conclusions: LV-GLS is a valuable monitoring tool for asymptomatic MR patients, a relative decrease > 10% in GLS may be predictive for the need for valve intervention.

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Background: Amyloidosis can affect the heart, causing arrhythmia, thromboembolic events, and sudden cardiac death. Coronary sinus thrombosis is an uncommon though life-threatening condition which requires early identification and management. Case summary: A 72-year-old Caucasian man, who recovered from out-of-hospital cardiorespiratory arrest, was diagnosed with coronary sinus thrombosis using cardiac imaging techniques. He had no history of invasive procedures and was diagnosed with cardiac amyloidosis based on an extra-cardiac biopsy positive for light chain amyloid, with consistent clinical, echocardiographic, and magnetic resonance criteria. Discussion: A high frequency of intracardiac thrombosis is seen in amyloidosis. However, coronary sinus thrombosis is an uncommon complication. A multimodality imaging approach appears to be useful for the early diagnosis of coronary sinus thrombosis. The low specificity of the clinical signs, as well as the fast impairment of the patients, could result in fatal complications such as acute myocardial infarction, arrhythmia, and sudden death. Early screening, particularly in high-risk patients, as well as the use of early anticoagulant therapy, could reduce the associated morbidity and mortality.

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Gastric cancer (GC) is one of the most frequent reasons for cancer-related death worldwide. The multimodal therapeutic strategies are now pragmatically tailored to each patient, especially in advanced GC. A radical but safe gastrectomy remains the cornerstone of the GC treatment. Moreover, the quality-of-life (QoL) outcome measures are now routinely utilized in order to select optimal type of gastrectomy, as well as reconstruction method. Postoperative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. The postoperative complications prolong hospital stay and may result in poor QoL, thus eliminating the completion of perioperative adjuvant therapy. Therefore, avoiding morbidity is not only relevant for the immediate postoperative course, but can also affect long-term oncological outcome. Measuring outcome enables surgeons to: monitor their own results; compare quality of treatment between centres; facilitate improvement both for surgery alone and combined treatment; select optimal procedure for an individual patient. Textbook oncological outcome is a composite quality measure representing the ideal hospitalization for gastrectomy, as well as stage-appropriate (perioperative) adjuvant chemotherapy. Standardized system for recording complications and adherence to multimodality treatment guidelines are crucial for achieving the ultimate goal of surgical quality-improvement that can benefit patients QoL and long-term outcomes after fast and uneventful hospitalization for gastrectomy.

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BACKGROUND: Cardiac fibromas are extremely rare in adults. The preferred treatment is surgical resection, but antiarrhythmic medications or heart transplantation have also been used previously. The cardiac imaging, particularly MRI, can be useful to help delineate between primary cardiac tumors, and surgical factors such as the extent/size of the fibroma, involvement of the coronary arteries or mitral apparatus and amount of residual myocardium influence whether surgical resection is feasible. CASE PRESENTATION: A 42-year-old male presented with a wide-complex tachycardia, unresponsive to amiodarone. An echocardiogram was performed which showed a possible posterior wall mass. A cardiac MRI showed a well circumscribed lateral wall intracardiac fibroma, measuring 5.2 × 5.1 × 3.8 cm with preserved function. Surgical resection was successful, and he was discharged without a defibrillator. CONCLUSIONS: Cardiac fibromas are encapsulated tumors which do not infiltrate myocardium and should be surgically resected if possible.

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Studies exploring the brain correlates of behavioral symptoms in the frontotemporal dementia spectrum (FTD) have mainly searched for linear correlations with single modality neuroimaging data, either structural magnetic resonance imaging (MRI) or fluoro-deoxy-D-glucose positron emission tomography (FDG-PET). We aimed at studying the two imaging modalities in combination to identify nonlinear co-occurring patterns of atrophy and hypometabolism related to behavioral symptoms. We analyzed data from 93 FTD patients who underwent T1-weighted MRI, FDG-PET imaging, and neuropsychological assessment including the Neuropsychiatric Inventory, Frontal Systems Behavior Scale, and Neurobehavioral Rating Scale. We used a data-driven approach to identify the principal components underlying behavioral variability, then related the identified components to brain variability using a newly developed method fusing maps of grey matter volume and FDG metabolism. A component representing apathy, executive dysfunction, and emotional withdrawal was associated with atrophy in bilateral anterior insula and putamen, and with hypometabolism in the right prefrontal cortex. Another component representing the disinhibition versus depression/mutism continuum was associated with atrophy in the right striatum and ventromedial prefrontal cortex for disinhibition, and hypometabolism in the left fronto-opercular region and sensorimotor cortices for depression/mutism. A component representing psychosis was associated with hypometabolism in the prefrontal cortex and hypermetabolism in auditory and visual cortices. Behavioral symptoms in FTD are associated with atrophy and altered metabolism of specific brain regions, especially located in the frontal lobes, in a hierarchical way: apathy and disinhibition are mostly associated with grey matter atrophy, whereas psychotic symptoms are mostly associated with hyper-/hypo-metabolism.

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The current review described a 55-year woman using 28 months to finish her surgery-based radiation-free multimodality treatment journey to fight International Federation of Gynaecology & Obstetrics (FIGO) 2018 clinical stage IIA2 (cT2aN0M0) squamous cell carcinoma (SCC) of the cervix. She received six cycles of perioperative adjuvant therapy, including three cycles of neoadjuvant therapy (NAT) and three cycles of postoperative adjuvant therapy by using combination of dose-dense chemotherapy (CT, weekly paclitaxel 80 mg/m2+triweekly cisplatin 40 mg/m2), immunotherapy (IO, triweekly pembrolizumab 200 mg) and half-dose anti-angiogenic agent (triweekly bevacizumab 7.5 mg/kg) plus interval radical surgery (radical hysterectomy + bilateral salpingo-oophorectomy + bilateral pelvic lymph node dissection + para-aortic lymph node sampling) and following maintenance therapy with monthly 22 cycles of half-dose of IO (pembrolizumab 100 mg) and concomitant 4 cycles of single-agent CT (paclitaxel 175 mg/m2) and 18 cycles of half-dose anti-angiogenic agent (bevacizumab 7.5 mg/kg). During the cervical SCC fighting journey, two unwanted adverse events (AEs) occurred. One was pseudo-progressive disease during the NAT treatment and pathology-confirmed upgrading FIGO stage IIIC1p (ypT2a1N1M0) after radical surgery and the other was the occurrence of hypothyroidism during the post operative adjuvant therapy. Based on this case we presented, we review the recent trend in the management of women with locally advanced cervical cancer (LACC) using the radiation-free but surgery-based multimodality strategy and highlight the strengths and limitations about perioperative adjuvant therapy with dose-dense CT + IO + half-dose anti-angiogenic agent and maintenance treatment of half-dose IO combining with short-term single agent CT and following long-term half-dose anti-angiogenic agent. All underscore the possibility that women with LACC have an opportunity to receive surgery-based RT-free multi-modality strategy to manage their diseases with satisfactory results. Additionally, the evolving role of IO plus CT with/without anti-angiogenic agent functioning as either primary treatment or adjuvant therapy for the treatment of advanced CC has been in process continuously. Moreover, the patient's positive response to IO, pembrolizumab as an example, both during the primary and maintenance therapy, highlights the importance of integrating IO into CT regimens for CC, especially in cases where conventional therapies, RT as an example, are insufficient or who do not want to receive RT-based treatment. The sustained disease-free status of the patient over several years reinforces the potential of IO to significantly increase long-term survival outcomes in CC patients, particularly for those with LACC.

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When people talk about kinship systems, they often use co-speech gestures and other representations to elaborate. This paper investigates such polysemiotic (spoken, gestured, and drawn) descriptions of kinship relations, to see if they display recurring patterns of conventionalization that capture specific social structures. We present an exploratory hypothesis-generating study of descriptions produced by a lesser-known ethnolinguistic community to the cognitive sciences: the Paamese people of Vanuatu. Forty Paamese speakers were asked to talk about their family in semi-guided kinship interviews. Analyses of the speech, gesture, and drawings produced during these interviews revealed that lineality (i.e., mother's side vs. father's side) is lateralized in the speaker's gesture space. In other words, kinship members of the speaker's matriline are placed on the left side of the speaker's body and those of the patriline are placed on their right side, when they are mentioned in speech. Moreover, we find that the gesture produced by Paamese participants during verbal descriptions of marital relations are performed significantly more often on two diagonal directions of the sagittal axis. We show that these diagonals are also found in the few diagrams that participants drew on the ground to augment their verbo-gestural descriptions of marriage practices with drawing. We interpret this behavior as evidence of a spatial template, which Paamese speakers activate to think and communicate about family relations. We therefore argue that extending investigations of kinship structures beyond kinship terminologies alone can unveil additional key factors that shape kinship cognition and communication and hereby provide further insights into the diversity of social structures.

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BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition characterized by IgG4-positive plasma cell infiltration that can affect multiple organs, including the cardiovascular system. The diagnosis of IgG4-RD relies on a combination of clinical, serological, radiological, and pathological findings. However, due to the varied and insidious clinical presentations, normal IgG4 levels in a significant percentage of patients, and frequent multi-organ involvement, imaging plays a crucial role in the diagnosis of IgG4-RD. The aim of study is to comprehensively examine the imaging findings in IgG4-related cardiovascular disease for accurate diagnosis and appropriate treatment. METHODS: A systematic search was conducted across electronic databases, PubMed, Scopus, and Web of Sciences, until 1 September 2023, following PRISMA guidelines by searching major databases for studies reporting detailed cardiovascular imaging findings in IgG4-RD. RESULTS: The search yielded 68 studies (60 case reports, 5 case series, 2 cross-sectional, 1 case-control) with 120 cases of cardiovascular IgG4-RD. Most of the cases were male, averaging 62.8 years. The common initial symptoms were dyspnea and chest pain. The most common imaging finding was vasculopathy, including vessel wall thickening, periarteritits, periaortitis, aortitis, stenosis, ectasia, aneurysm formation, intramural hemorrhage, fistula formation, and dissection, followed by pericardial involvement and mediastinal masses. Case series and cross-sectional studies also showed vasculopathy being the most common finding on various imaging modalities, including angiography and PET/CT, highlighting the complex pathology of IgG4-RD. CONCLUSION: This study evaluated current IgG4-RD articles, revealing a higher prevalence in men and vasculopathy as the most common cardiovascular complication.

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The focus of this perspective paper is on relationships between sound-producing body motion and corresponding perceived sound features, guided by the idea of shapes as the common denominator of these two domains. The term shape is used to denote graphical-pictorial renderings of phenomena that we perceive or imagine, and may have physical manifestations as tracings on paper or on screen, or as gesticulations, or just as imagined tracings in our minds. Shapes give us intermittent snapshots of unfolding motion and sound fragments, and the point of shapes is to make ephemeral sound and motion features tractable as more permanent objects. Shapes of perceived sound include dynamic, spectral, textural, pitch-related, harmonic, etc. features as shapes, whereas shapes of sound-producing motion include both motion trajectories and postures of sound-producing effectors, i.e., of fingers, hands, arms, etc., or mouth, lips, and tongue.

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BACKGROUND: In patients with congenitally corrected transposition of the great arteries (ccTGA), assessment of readiness for double switch operation (DSO) after pulmonary arterial band (PAB) placement involves cardiac MRI (cMRI) to measure LV ejection fraction (EF) and mass and cardiac catheterization (cath) to assess LV:RV pressure ratio (LV:RVp). We described the relationships between echocardiographic and cath/cMRI measures of readiness for DSO, and developed risk factors for LV dysfunction after DSO based on echocardiographic measures of ventricular arterial coupling (VAC). METHODS: We reviewed patients with ccTGA undergoing LV retraining at a DSO referral center. We compared EF measured by echo to cMRI, and LV:RVp measured by echo to cath with Bland-Altman (BA) analysis. We analyzed the relationship between preoperative VAC markers and postoperative echocardiogram using end-systolic elastance (EES), and a novel marker consisting of the product of EF and the LV:RVp (EFPR). RESULTS: We included 31 patients with 56 evaluations for DSO, 24 of which underwent DSO. Echo EF correlated well with cMRI (r= 0.79), and BA slightly overestimated cMRI (mean difference +3%). Echo EF had moderate ability to identify normal cMRI EF (AUC of 0.80) and at optimal cutpoint of echo EF threshold of 61%, there was 71% sensitivity and 76% specificity to detect cMRI LVEF >=55%. Echo LV:RVp correlated well with cath (r=0.77) and slightly underestimated cath (mean difference of -0.11). Echo LV:RVp had good ability to identify adequate LV:RVp by cath (AUC=0.95) and at optimal echo cutpoint of 0.75 had 100% Sensitivity and 85% specificity to detect a catheterization LV:RVp above 0.9. Echo-based criteria for DSO readiness (echo EF of 61% and LV:RVp of 0.75) demonstrated specificity of 97% and positive predictive value of 96% for published criteria of DSO readiness (cMRI EF of 55% and cath LV:RVp of 0.9). EES and EFPR correlated with post DSO EF (rho= 0.72 and 0.60). EFPR of 0.51 demonstrated 78% sensitivity and 100% specificity for post DSO LV dysfunction (EF < 55%). Age at first PAB also strongly correlated with post DSO EF (rho=0.75). No patient with first PAB under age 1 years exhibited post DSO LV dysfunction. CONCLUSIONS: Echocardiographic measures of EF and LV:RVp are reliable indicators of reference standard modalities, and can guide management during retraining. Preoperative VAC markers EES and EFPR may be useful markers of post-DSO LV dysfunction. Echo LV:RVp > 0.75 are likely to meet pressure-generation criteria for DSO and should be considered for referral for cath and cMRI evaluation for DSO. PAB placement before 1 year of life may optimize LV outcomes in patients considered for DSO.

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Aortic regurgitation (AR) is associated with left ventricular volume and pressure overload, resulting in eccentric left ventricular (LV) remodeling and enlargement. This condition may be well tolerated for years before the onset of myocardial dysfunction and symptoms. Echocardiography plays a crucial role in the diagnosis of AR, assessing its mechanism and severity, and detecting LV remodeling. The assessment of AR severity is challenging and frequently requires the integration of information from multiple different measurements to assess the severity. Recent data suggests that echocardiographically derived LV volumes (end-systolic volume index > 45 ml/m2), an ejection fraction threshold of <60%, and abnormal global longitudinal strain may help identify early dysfunction and may be used to improve clinical outcomes. Consequently, these parameters can identify candidates for surgery. Cardiac magnetic resonance imaging is emerging as a valuable tool for assessing severity when it remains unclear after an echocardiographic evaluation. This review emphasizes the importance of imaging, particularly echocardiography, in the evaluation of AR. It focuses on various echocardiographic parameters, including technical details, and how to integrate them for assessing the mechanism and severity of AR, as well as LV remodeling.

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BACKGROUND: Deep learning reconstruction (DLR) with denoising has been reported as potentially improving the image quality of magnetic resonance imaging (MRI). Multi-modal MRI is a critical non-invasive method for tumor detection, surgery planning, and prognosis assessment; however, the DLR on multi-modal glioma imaging has not been assessed. PURPOSE: To assess multi-modal MRI for glioma based on the DLR method. MATERIAL AND METHODS: We assessed multi-modal images of 107 glioma patients (49 preoperative and 58 postoperative). All the images were reconstructed with both DLR and conventional reconstruction methods, encompassing T1-weighted (T1W), contrast-enhanced T1W (CE-T1), T2-weighted (T2W), and T2 fluid-attenuated inversion recovery (T2-FLAIR). The image quality was evaluated using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and edge sharpness. Visual assessment and diagnostic assessment were performed blindly by neuroradiologists. RESULTS: In contrast with conventionally reconstructed images, (residual) tumor SNR for all modalities and tumor to white/gray matter CNR from DLR images were higher in T1W, T2W, and T2-FLAIR sequences. The visual assessment of DLR images demonstrated the superior visualization of tumor in T2W, edema in T2-FLAIR, enhanced tumor and necrosis part in CE-T1, and fewer artifacts in all modalities. Improved diagnostic efficiency and confidence were observed for preoperative cases with DLR images. CONCLUSION: DLR of multi-modal MRI reconstruction prototype for glioma has demonstrated significant improvements in image quality. Moreover, it increased diagnostic efficiency and confidence of glioma.