assessment

Cardiovascular disease (CVD), including coronary artery disease and stroke, is the leading cause of death worldwide. Advances in primary and secondary prevention of CVD have improved patient prognoses and outcomes, however, it is imperative that the clinician and patient engage in early risk factor screening and preventive management of modifiable risk factors for CVD. In addition to blood lipid and blood pressure lowering medications, aspirin has been a long-standing therapy targeted to the prevention of CVD based on its antiplatelet and anti-inflammatory activity. However, recent articles and reports on updates to clinical guidelines for the primary prevention of CVD have resulted in confusion about aspirin recommendations. This review aims to assess the latest guidance on aspirin in CVD prevention and how to identify appropriately at-risk patients who may benefit from low-dose aspirin therapy as part of their CVD preventive healthcare choices. Additionally, this review will provide practical application guidance about clinician-patient conversations to clearly explain the benefits and risks of aspirin use and ensure a patient-centric decision to initiate aspirin therapy.

Introduction: We strongly believe that rs-fMRI using independent component analysis (ICA) must be considered as a technique to be systematically used in the near future, as positron emission tomography (PET TC) is today. Unfortunately, this technique is not yet used in Italy because, despite the studies just summarized, it is considered “experimental” and not routine without reasonable justification!Aim of the Study: We present two cases studied with these techniques, after the informed consent obtained by the patients1) A young woman from Sicily, in whom an rs-fMRI revealed her severe personality disorder, was found capable of insight and strong-willed and was therefore found guilty by the criminal court of the murder of her young son, with a strange motive: rs-fMRI cannot be considered part of the assessment because it is so far considered experimental. PET-TAC was also classified as routine in Italy after a long legal discussion. We hope that all these studies, which are now summarized in this review, will be considered useful, at least in Europe, when a judge has to decide whether to sentence a person with psychological or psychiatric problems or to consider them as a person to be treated in a specific residential home (called REMS in Italy).2) Another woman from Bergamo, after having killed a neighbor of hers, was, instead, considered not guilty because of her inability to want to kill him, and so admitted to a particular structure (REMS: residence to execution of security measures) to treat her problem, front temporal dementia, with a severe neuropsychiatric disorder (NPS), diagnosed after the crimen was fulfilled.Conclusions: These two interesting cases demonstrate that in Italy nowadays, we do not have a homogeneous methodology to investigate the ability to understand and want, limiting the study only to personality tests. Here we describe new techniques that may help in this objective.

With the increase in incidence and prevalence of myeloid neoplasms in India, it has become a necessity to understand its molecular mechanisms, acquisition of genomic alterations, and understand its primary and secondary resistance pathways which ultimately impact the decision of therapeutics. The objective of this review is to investigate the molecular aspects of this disease type and identify the biomarkers that help with diagnosis, risk assessment, prognosis, and selecting the best line of treatment for a specific myeloid neoplasm. Advancements and innovations in molecular technologies from simplest Real-Time PCR to high throughput next-generation sequencing have played a vital role in screening the most common mutations and fusions to the novel and rare. Molecular technologies have helped to enumerate the genomic landscape of myeloid malignancies. The understanding of both- the mechanisms and the technology is a strong combination as it has helped revolutionize precision oncology and helped in giving better therapeutic choices with better clinical outcomes. The importance of cellular morphology, clinical symptoms, and molecular pathology in assessing the risk of myeloid malignancies is emphasized and summarized in the review. The review concludes that understanding molecular pathogenesis can be improved by using clinical-pathological-molecular strategies for diagnosis and therapy decision-making.

One of the most important emerging pollutants is pharmaceutical active compounds, which may be responsible, for example, for ecotoxicological changes and microbiological resistance. Wastewater treatment plants are not adequately equipped to remove all of the emerging pollutants contained in the wastewater. The ultrafiltration process has been proven to be effective in traditional wastewater treatment, so it is important to assess the performance of such a technique in the partial elimination of pharmaceutical compounds to avoid contamination. In this work, an assessment of ultrafiltration process operating conditions for eliminating six pharmaceutical compounds: Ibuprofen, Acetaminophen, Naproxen, Diclofenac, Caffeine, and trimethoprim, present in different types of water is performed. Experimental design is a systematic and structured approach to conducting experiments, and its application can significantly improve the study of membrane technology, reducing the number of assays necessary to obtain meaningful results. The statistical principles application ensures that the results obtained are reliable and representative of the true effects of the variables being studied. Its application helps to obtain valid conclusions from the data and provides a solid basis for making decisions or recommendations regarding the tests and variables to take into account. Membrane processes can involve complex interactions between several factors. Experimental design helps to identify and understand these interactions, allowing researchers to discern the combined effects of different variables. This is crucial to accurately predict and optimize membrane performance.In this work, ANOVA analysis has been carried out in order to determine the influence of membrane cut-off, solution pH, and feed concentration, as well as their interactions, in permeate flux and the rejection index. The results obtained show similar behavior for Ibuprofen, Naproxen, Diclofenac, and Trimethoprim, being the pH the most important factor. However, no significant factors were found for the acetaminophen and the Caffeine.

Background: Diabetic peripheral neuropathy is a symmetrical length-dependent sensorimotor polyneuropathy due to chronic hyperglycemia. The World Health Organization (WHO) identified diabetes as a major global health concern. Diabetic neuropathy is characterized by motor dysfunctions (weakness and atrophy) especially at the distal muscles of lower limbs, and impaired dynamic muscular control in type 2 diabetes patients. Symptoms start in a distal-to proximal pattern in the feet, and ankle and proximally in the hip and knee for both flexors and extensors. Proximal muscle weakness affects postural stability. Dorsiflexor weakness causes increased hip, knee flexion and metatarsophalangeal extension in the initial swing whereas weakness in plantar flexors causes a greater amount of hip and knee flexion during the stance phase.Methodology: 34 subjects with Diabetic Peripheral Neuropathy who fulfilled all the inclusion criteria were recruited for the study. Ethical standards have been maintained and informed consent was taken. Subjects were randomly assigned by lottery method into two groups, intervention, and control with 17 in each. Since it is a single blinded study subjects were blinded about the interventions provided. Pre and post-test scores were taken before and after 4 weeks using Surface Electromyography (sEMG), Kinovea Software, Functional Gait Assessment (FGA) and Short Form -36 (SF-36).Results: The pre and post-score values of the kinematics of gait, Functional Gait Assessment, and Short Form - 36 were analyzed using a Paired t-test and Wilcoxon Signed Rank test within the group analysis, Mann- Whitney U test and Independent t-test for between the group analysis. Both groups displayed notable variations, whereas the intervention group exhibited more significant differences (p < 0.05). Thus, it can be inferred that lower extremity training significantly improves gait kinematics and quality of life in diabetic neuropathy.Conclusion: Lower extremity training is effective in improving the kinematics of gait and quality of life in diabetic neuropathy.

Introduction: Corticosteroid therapy is widely used in dermatology for treating various conditions. In France, the cost of corticosteroid treatment varies, and in Mali, a significant prevalence of corticosteroid-treated diseases has been reported. Given the prolonged treatment duration often required, understanding the cost implications in resource-limited settings is crucial.Patients and methods: This descriptive cross-sectional study took place at the dermatology department of the University Hospital Center of Dermatology in Bamako. Data were prospectively collected from patients undergoing corticosteroid therapy over one year. Variables included sociodemographic data, clinical information, and medication costs.Results: During the study period, 24 cases of dermatoses treated with corticosteroids were identified among 125 hospitalized patients, representing a prevalence of 19.2%. Most patients were women (58.3%), with an average age of 37.5 years. Lichen planus (54.2%) and pemphigus (37.5%) were the most common pathologies. Many patients had extensive lesions before treatment, but the majority responded well to corticosteroids.Discussion: Despite study limitations, such as its descriptive nature, it provided valuable insights into the economic evaluation of long-term corticosteroid therapy. The predominance of women, the age distribution, and the prevalence of specific dermatoses were highlighted. The study also revealed the substantial financial burden of corticosteroid treatment, primarily driven by direct costs.Conclusion: The study underscores the financial challenges associated with long-term corticosteroid therapy in dermatology in Mali. The high costs adversely affect patients and their families, especially considering the socioeconomic status of many patients. Moreover, the findings emphasize the importance of comprehensive care strategies and the need for accessible healthcare solutions to address these challenges effectively.

Introduction: Hypertension is the strongest independent predictor of Coronary Artery Disease (CAD) identified by Computed tomography of coronary arteries (CTCA). In this study, CTCA-assessed Coronary Calcium Scoring (CCS) was studied in hypertensive subjects referred for CTCA.Methods: After excluding TAVI and graft assessment patients, the individual electronic health records of 410 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age of 58.7 years. Risk factors were recorded including smoking (38%), hyperlipidaemia (33%), positive family history (22%), systemic hypertension (48%), diabetes mellitus (30%), and male gender (46%). Referral criteria, ethnicity, cardiac, and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate, and severe disease, as seen on CTCA. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared according to the number of coronary arteries affected and the severity of CAD in each artery. Results: Out of all CTCA reports, 200 (48.8%) CCS were interpreted in the very low-risk category, 80 (19.5%) low risk, 58 (14.1%) moderate risk, 23 (5.6%) moderately high risk and 49 (12.0%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate, and severe CAD (p = 0.015 and p < 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (p = 0.03). There was no significant difference in the CCS between hypertensives with chest pain and hypertensives without chest pain. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensive and non-hypertensive subjects for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries.Conclusion: Hypertensive patients with a high CCS were associated with a higher incidence of severe CAD independent of the presence of chest pain. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension, in the progress of coronary artery disease. 

Background: Long-term care for patients with chronic kidney disease, whether in the pre or post-dialysis period, has a destructive impact on patients and their caregivers that can significantly worsen their quality of life. Objectives: To assess the quality of life (QOL) among caregivers of children suffering from chronic kidney disease and to identify the possible factors affecting their quality of life. Subjects and methods: Between March 2023 and May 2023, a cross-sectional questionnaire-based study was conducted at King Saud Medical City for caregivers of all pediatric patients aged from 6 months to 14 years with CKD stage-3B and beyond who have been followed up for at least three months in the pre or post-dialysis period since 2015. The study applied the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate the caregivers’ quality of life. Result: A total of 95 caregivers were involved in the study. The age ranged between 24 and 53 years, with an arithmetic mean of 39.3 and a standard deviation of (± 6.6) years, and almost two-thirds (65.3%) were Saudi nationals. Most pediatric patients were on peritoneal renal dialysis (41%), whereas 29.5% were on hemodialysis. The mean and SD of the overall score was 56.10 ± 17.40 out of a possible range of 0-100. Regarding its domains, the highest score was observed regarding the social domain (62.11 ± 21.12), whereas the lowest was the physical domain (49.55 ± 18.42). After controlling for confounding, married, high socio-economic, and more educated caregivers have higher QOL scores than singles, low socio-economic, and lower knowledgeable caregivers, and the three factors together were responsible for approximately 41% variability of the QOL score (r – square = 0.406). Bivariate Pearson correlation showed significant correlations among different quality-of-life domains (p < 0.001). Conclusion: There was a significant association between quality-of-life scores and demographic characteristics of chronic kidney disease caregivers; they need the highest support to cope with their delicate patients. 

Spinal muscular atrophy is an autosomal recessive neuromuscular disorder characterized by progressive muscle weakness and atrophy. It is one of the most common single-gene disorders with an incidence rate of approximately 1 in 10,000 live births. The clinical manifestations are progressive hypotonia and muscle weakness due to the degeneration of alpha neurons in the anterior horn cells of the spinal cord and motor nuclei in the lower brain stem. Depending on the severity of the symptoms, SMA has five subtypes. Supportive measures can be offered for respiratory, gastrointestinal, and musculoskeletal complications. Carrier testing for all couples is recommended and this can be done by Multiplex Ligation-dependent Probe Amplification (MLPA). Prenatal diagnosis can be offered to carrier couples. Therapies must be given within the newborn period for maximum benefit and before the loss of motor neurons. It is achieved by identifying the SMA babies through Newborn screening. Several new FDA-approved drugs can reduce the progression of symptoms in SMA. However, they cannot offer a definite cure. Clinical follow-up and Neurological assessment demonstrate that SMA children can attain developmental milestones after receiving treatment, which is never normally attained in untreated cases. In utero SMA treatment with Zolgensma would enhance the survival rate and favorable neurological outcomes in the future. Base editing and Gene editing with CRISPR-Cas technologies to target the mutations and restore functional and stable SMN protein levels are the future hopes for a permanent cure of SMA.

The present study aims to assess and compare the quality of drinking water according to WHO Standards and then illustrate the resulting diseases. Eight samples have been taken from selective different schools in the Mount Lebanon Region. The laboratory tests of the collected samples were performed to determine various physical (e.g., temperature, pH, electrical conductivity, etc.), chemical (Ca+2, Cl-, Fe, Mg2+, NO3, Na+, SO2-4), and microbial such as E. coli, coliform, and non-coliform. Several techniques were used for the analysis including Atomic Absorption Spectrometry, Flame Photometer, and Total Organic Carbon (TOC). The resulting water quality was compared with the standard limits. Each school has different defects according to specific contamination that existed. To save local residents and according to the results of this study, regular monitoring for water quality was proposed; besides more water filtration plants should be installed to provide safe drinking for children’s health.

Background: Acute leukemia is the result of clonal transformation and proliferation of a hematopoietic progenitor giving rise to poorly differentiated neoplastic cells. Reactive oxygen species play a role in maintaining the quiescence, self-renewal, and long-term survival of hematopoietic stem cells, but it is unclear how they would affect disease onset and progression. The aim is to evaluate, at the transcriptional and systemic level, the oxidative-inflammatory status in newly diagnosis acute leukemia patients. Methods: Seventy acute leukemia patients [26 acute lymphoblastic leukemia (ALL), 13 Acute Promyelocytic Leukemia (APL), and 31 Acute Myeloid Leukemia (AML)] and forty-one healthy controls were analyzed. Malondialdehyde and catalase activity were evaluated. Gene expression of NRF2, SOD, PRDX2, CAT, IL-6, and TNF-α was analyzed by real-time PCR.Results: Malondialdehyde concentration was similar in all groups studied. Catalase activity was significantly higher in AML and APL patients compared to controls, while ALL showed similar activity to the healthy group. NRF2, CAT, and PRDX2 expression levels were similar between groups, SOD expression was downregulated in all acute leukemia patients. TNF-α expression was lower in AML groups than in healthy individuals, and IL-6 mRNA expression was downregulated in ALL and APL.Conclusion: This is the first report that correlates transcriptional and systemic parameters associated with the oxidative inflammatory status in newly diagnosed acute leukemia. Some of the parameters evaluated could be used as biomarkers in the selection of an effective therapeutic strategy and will open new directions for the follow-up and evolution of this disease.

This manuscript presents a compelling case of renal tuberculosis in a 15-year-old male, elucidating the intricate diagnostic hurdles and strategic management approaches encountered. The patient initially presented with nonspecific symptoms, including intermittent low-grade fever, weight loss, fatigue, and diffuse skin rashes, which were initially managed as suspected enteric fever. However, as the patient’s condition deteriorated, a comprehensive diagnostic exploration revealed renal tuberculosis. The report meticulously outlines the clinical presentation, diagnostic evaluation, and therapeutic trajectory, emphasizing the enigmatic nature of symptoms and advocating for a multidimensional diagnostic paradigm integrating clinical, radiological, microbiological, and histopathological assessments.Furthermore, this case report provides a comprehensive review of urogenital tuberculosis, discussing its epidemiological underpinnings, clinical manifestations, diagnostic methodologies, and therapeutic tenets. It underscores the paramount significance of early recognition and prompt initiation of treatment in forestalling complications and optimizing patient outcomes.This case report enriches the medical discourse by shedding light on the diagnostic intricacies and therapeutic imperatives pertinent to renal tuberculosis, especially in the younger demographic. We believe that the findings will contribute significantly to the understanding and management of this disease.

This study investigates into the historical evolution and contemporary applications of Computed Tomography (CT) in renal stone estimation, with a focus on the innovative use of CT to quantify renallcalculiistrain for estimating potentiallsymptomatic incidents.Historically, CT has played a pivotal role in diagnosing renal calculi, offering unparalleled sensitivity and specificity in detecting stones of varying composition and size. However, the clinical significance of renal calculi extends beyond mere detection, prompting researchers to explore novel approaches to predict symptomatic events associated with stone disease. This research aimed to determine the right way to classify asymptomatic radiographic calculi strain on computed tomography (CT) scans in Al-Hussein Teaching Hospital, Al-Muthanna, Iraq. A survey was made available to calculi formers who had a CT scan during asymptomatic after a calculi clinical assessment. A survey and a study of medical records revealed symptomatic calculi route incidents after a CT scan. The amount of calculus, the biggest calculi thickness, electronic total calculi size (TSV), and two-pronged calculus were measured radiographically and linked as predictors of calculi events. There were 55 calculi formers in the study, and 61% had a calculi event one year after the CT scan. The calculus number was (0–1, 2–3, 4–6, 7), the highest calculi diameter was (0–2, 3–4, 5–7, 8 mm), and 48% had bilateral calculus. The number of calculus per quartile had a danger ratio of 1.30 (p = 0.001), the largest calculi diameter had a hazard ratio of 1.26 (p  0.001), TSV had a hazard ratio of 1.38 (p = 0.001), and bilateral calculus had a hazard ratio of 1.80 (p = 0.001). Only TSV wass an unbiased measure offsymptomaticceventssin multivariable regression (HR = 1.35 per quartile, p = 0.01). TSV-related incidents were also unaffected by demographics, urinary chemistry, or calculi composition. A drastic rise in TSV between CT scans (> 31 mm3/year) expected additional eventssin the 49 patients with interim events (HR = 2.8, p = 0.05). For calculating calculi pressure on CT scan, automated TSV is more accurate for asymptomatic events than physical approaches.

This ethnobotanical study aims to investigate and document the indigenous knowledge on using traditional medicinal plants to cure human diseases in southern Ethiopia, south Omo zone Baka dawla Ari district at Kure and Bitsmal community. In this study, 77 plant species that belong to 68 genera and 35 plant families were identified by 110 local community members and 10 traditional healers of the study area to treat 32 human diseases. According to the analyzed result of the study three families (Lamiaceae, Solanaceae, and Fabaceae) are equally leading families each with nine species (11.69%) followed by Euphorbiaceae with five species (6.5%) and Asteraceae with four species (5.2%) in the study area. The result of this study also shows that most of the traditional medicines were taken in the mouth (oral) at 61.5% followed by topical (26,4%) and inhalation form (12.1%). The findings of this study show that most traditional plants were collected from the forest (45.5%) followed by the backyard (26%) and herbs are the most popular (59%) followed by shrubs (27%) plant habits. According to the result of this study, leaves are the dominant traditional medicinal plant parts used (55%) followed by roots (11.2%). preference ranking of medicinal plants in the study shows Solanum incanum ranked first indicating that it was the most effective in curing stomach pain followed by Verbena officinalis and the highest informant consensus factor value (0.57) was recorded by Malaria, Evil eye, snake bite, sudden disease categories.

Aim: To evaluate the effectiveness of an ayurvedic gel in tooth pain reduction due to dental caries. Materials and methods: This in vivo cross-over design study enrolled adults with at least one tooth with caries and a symptom of pain after the application of an ice stimulus. Two hundred patients were screened and eligible patients were enrolled in the study. Forty-five subjects completed washout phases before each recall visit. During each recall visit, subjects evaluated pain relief following an ice bar stimulus and one random finger-tip application of a treatment i.e. Ayurveda Herbal gel containing clove oil, camphor, and menthol (Ayurveda Herbal Gel Group), and two control formulations: a gel without active ingredients and commercial olive oil as a surrogate of home remedy. At each assessment, subjects used a stopwatch to record the onset of pain relief and tooth pain using visual analog scores (VAS), dental pain scores (DPS), and relief from tooth pain by dental pain relief scores (DPRS). After each treatment, subjects recorded their satisfaction with the provided treatment using a four-point satisfaction index. Data were tabulated and statistical analysis was performed with (ANCOVA) and two-way ANOVA with a p - value of 0.05 considered statistically significant. Results: Forty-five subjects (28 males and 17 females) completed the entire study without any adverse events. Application of the Ayurveda gel resulted in a significantly faster onset of pain relief (2.47 min) in comparison to the onset of pain relief after 4 minutes recorded with the controls (p < 0.05). Subjects reported lower VAS and DPS scores over the study period of evaluation when using the Ayurveda gel compared to the application of each control formulation. Subjects also reported greater relief of pain and greater satisfaction after the application of the Ayurveda gel as compared to the controls. Conclusion: Significantly better tooth pain relief from caries was observed from an Ayurveda Herbal gel than from controls.

Ischemic Heart Disease (IHD) remains a significant cause of morbidity and mortality worldwide. We present a case report of a 54-year-old individual presenting with symptoms suggestive of IHD, including palpitations and chest heaviness. Utilizing a Spandan device at home, the patient detected anteroseptal and lateral wall ischemia, prompting consultation with a cardiologist. Subsequent diagnostic evaluations revealed Left Ventricular Hypertrophy (LVH), concentric LVH, regional wall motion abnormality, and Grade I diastolic dysfunction. Hypertension and dyslipidemia were identified as prominent risk factors, with additional findings of carotid artery disease. Management strategies included antihypertensive medications, lipid-lowering therapy, and lifestyle modifications. This case underscores the complexity of diagnosing and managing IHD, highlighting the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes.

This paper reviews the transformative impact of Artificial Intelligence (AI) on civil engineering. It explores AI's fundamental concepts and its applications across structural analysis, construction management, transportation, geotechnical engineering, and sustainability. The review highlights AI's role in automating tasks, predicting outcomes, and optimizing designs throughout project lifecycles. Recent advancements in AI-driven technologies for structural health monitoring, predictive maintenance, and risk assessment are discussed, along with challenges like data quality and model interpretability. Future trends such as autonomous construction and digital twins are examined, emphasizing the need for continued research and interdisciplinary collaboration. In conclusion, this paper offers insights for leveraging AI to address evolving challenges and opportunities in civil engineering, fostering innovation, sustainability, and resilience in infrastructure development.

Introduction: Pneumothorax is a life-threatening condition that requires prompt recognition and therapy to prevent deterioration. Radiologist workload often precludes rapid assessment of the usual diagnostic modality, the chest radiograph, particularly after hours. The aim was to develop a deep learning model using a segmentation-based Deep Convolutional Neural Network (DCNN) to detect pneumothorax on chest radiographs to provide rapid and accurate pneumothorax diagnosis.Methods: This is a retrospective study of spontaneous pneumothorax at a single center, containing 130 positive and 70 negative radiographs. Subsequent manual contour mapping was performed to draw a mask of the pneumothorax. These image pairs were used to train a DCNN model (a modified AlexNet) after pretraining on the ImageNet dataset.Results: The DCNN achieved an accuracy of 0.83, with sensitivity of 98.1%, and specificity of 68.5%.Conclusion: This segmentation-based DCNN accuracy is comparable to previous categorization-based CDNN models, despite using a smaller sample size for training, while including the benefits of visual representation for clinician feedback. Segmentation-based DCNNs show promise in the development of accurate and clinically useful models for medical imaging.

Purpose: This study aimed to determine the relevance of first- and high-order radiomic features derived from Diffusion-Weighted Imaging (DWI) and Apparent Diffusion Coefficient (ADC) maps for predicting treatment response in patients with Undifferentiated Pleomorphic Sarcoma (UPS).Methods: This retrospective study included 33 extremity UPS patients with pre-surgical DWI/ADC and surgical resection. Manual volumetric tumor segmentation was performed on DWI/ADC maps acquired at Baseline (BL), Post-Chemotherapy (PC), and Post-Radiation Therapy (PRT). The percentage of pathology-assessed treatment effect (PATE) in surgical specimens categorized patients into responders (R; PATE ≥ 90%; 16 patients), partial-responders (PR; 89% - 31% PATE; 10 patients), and non-responders (NR; PATE ≤ 30%; 7 patients). 107 radiomic features were extracted from BL, PC, and PRT ADC maps. Statistical analyses compared R vs. PR/NR.Results: Pseudo-progression at PC and universal stability at PRT were observed in R and PR/NR based on RECIST, WHO, and volumetric assessments. At PRT, responders displayed a 35% increase in ADC mean (p = 0.0034), a 136% decrease in skewness (p = 0.0001), and a 363% increase in the 90th percentile proportion (p = 0.0009). Comparing R vs. PR/NR at BL, statistically significant differences were observed in glrlm_highgraylevelrunemphasis (p = 0.0081), glrlm_shortrunhighgraylevelemphasis (p = 0.0138), gldm_highgraylevelemphasis (p = 0.0138), glcm_sumaverage (p = 0.0164), glcm_jointaverage (p = 0.0164), and glcm_autocorrelation (p = 0.0193). At PC, firstorder_meanabsolutedeviation (p = 0.0078), firstorder_interquartilerange (p = 0.0109), firstorder_variance (p = 0.0109),    and firstorder_robustmeanabsolutedeviation (p = 0.0151) provided statistically significant differences.Conclusion: Observing a high post-therapeutic ADC mean, low skewness, and high 90th percentile proportion with respect to baseline is predictive of successfully treated UPS patients presenting > 90% PATE. Highly significant higher-order radiomic results include glrlm-highgraylevelrunemphasis (BL) and first-order-mean absolute deviation (PC).

Chronic infection with the hepatitis C virus (HCV) is estimated to affect 58 million people worldwide and around 700,000 individuals in Brazil. Various non-invasive markers of hepatic fibrosis have been proposed, such as transient hepatic elastography (THE) using FibroScan®. However, the reliability of the performance, by operators in the training phase is undetermined, which hinders its applicability in clinical practice. Objectives: The present study aimed to evaluate the impact of training an inexperienced operator to perform the examinations using FibroScan® in patients with chronic hepatitis C. Specifically, the frequency of unreliable results throughout the training was assessed. Methods: This is a cross-sectional study with retrospective data collection including compensated chronic hepatitis C patients who underwent the examinations using FibroScan® between March 2014 and December 2016, performed by two researchers. Included patients were divided into two groups based on the operator's experience in the examination: the Experienced Examiner (EE) group and the Examiner in Training (ET) group, with the latter divided into two phases: phase 1, consisting of the first 100 examinations, and phase 2, comprising subsequent examinations. For the reliability analysis, parameters such as success rate (SR), interquartile range (IQR) to median (Md) ratio (IQR/Md), and reliability criteria of Castéra, et al. and Boursier, et al. were used. Results: Between March 2014 and December 2016, 771 adult HCV-infected individuals were evaluated and divided into EE group (n = 161), ET phase 1 (n = 100), and ET phase 2 (n = 158), showing similar demographic, clinical, and laboratory characteristics. SR and IQR/Md ratios were similar among EE, ET phase 1, and ET phase 2 groups. The proportion of reliable results was comparable in all three groups, using Castéra, et al. reliability criteria (92.5%, 92.0%, and 97.5%, respectively) and Boursier, et al. criteria (96.9%, 95.0%, and 98.1%, respectively). Conclusion: A short training period (up to 100 examinations) seems to be sufficient for them to have good clinical applicability in the hands of an operator with initial experience in the method