Type 2 diabetes (T2D) is a major worldwide public health concern. Despite a large armamentarium of T2D medications, a large proportion of patients fail to achieve recommended treatment goals for glycemic control. Weight loss has profound beneficial effects on the metabolic abnormalities involved in the pathogenesis of T2D. Accordingly, bariatric surgery, which is the most effective available weight loss therapy, is also the most effective therapy for treating patients with T2D. Surgical procedures that bypass the upper gastrointestinal (UGI) tract are particularly effective in achieving partial and even complete remission of T2D, suggesting that UGI bypass has weight loss-independent effects on glycemic control. Although a number of hypotheses (e.g. a role for multiorgan insulin sensitivity, β-cell function, incretin response, the gut microbiome, bile acid metabolism, intestinal glucose metabolism and browning of adipose tissue) have been proposed to explain the potential unique effects of UGI tract bypass surgery, none has yet been adequately evaluated to determine therapeutic importance in patients with T2D. Here, we review the efficacy of UGI bypass surgery in treating T2D and the mechanisms that have been proposed to explain its potential weight loss-independent therapeutic effects.

Background

As differentiating between lipomas and atypical lipomatous tumors (ALTs) based on imaging is challenging and requires biopsies, radiomics has been proposed to aid the diagnosis. This study aimed to externally and prospectively validate a radiomics model differentiating between lipomas and ALTs on MRI in three large, multi-center cohorts, and extend it with automatic and minimally interactive segmentation methods to increase clinical feasibility.

Methods

Three study cohorts were formed, two for external validation containing data from medical centers in the United States (US) collected from 2008 until 2018 and the United Kingdom (UK) collected from 2011 until 2017, and one for prospective validation consisting of data collected from 2020 until 2021 in the Netherlands. Patient characteristics, MDM2 amplification status, and MRI scans were collected. An automatic segmentation method was developed to segment all tumors on T1-weighted MRI scans of the validation cohorts. Segmentations were subsequently quality scored. In case of insufficient quality, an interactive segmentation method was used. Radiomics performance was evaluated for all cohorts and compared to two radiologists.

Findings

The validation cohorts included 150 (54% ALT), 208 (37% ALT), and 86 patients (28% ALT) from the US, UK and NL. Of the 444 cases, 78% were automatically segmented. For 22%, interactive segmentation was necessary due to insufficient quality, with only 3% of all patients requiring manual adjustment. External validation resulted in an AUC of 0.74 (95% CI: 0.66, 0.82) in US data and 0.86 (0.80, 0.92) in UK data. Prospective validation resulted in an AUC of 0.89 (0.83, 0.96). The radiomics model performed similar to the two radiologists (US: 0.79 and 0.76, UK: 0.86 and 0.86, NL: 0.82 and 0.85).

Interpretation

The radiomics model extended with automatic and minimally interactive segmentation methods accurately differentiated between lipomas and ALTs in two large, multi-center external cohorts, and in prospective validation, performing similar to expert radiologists, possibly limiting the need for invasive diagnostics.

Funding

Hanarth fonds.

The ARIANNA collaboration completed the installation of the hexagonal radio array (HRA) in December 2014, serving as a pilot program for a planned high energy neutrino telescope located about 110 km south of McMurdo Station on the Ross Ice Shelf near the coast of Antarctica. The goal of ARIANNA is to measure both diffuse and point fluxes of astrophysical neutrinos at energies in excess of 1016 eV. Upgraded hardware has been installed during the 2014 deployment season and stations show a livetime of better than 90% between commissioning and austral sunset. Though designed to observe radio pulses from neutrino interactions originating within the ice below each detector, one station was modified to study the low-frequency environment and signals from above. We provide evidence that the HRA observed both continuous emission from the Galaxy and a transient solar burst. Preliminary work on modeling the (weak) Galactic signal confirm the absolute sensitivity of the HRA detector system.

Installation of the ARIANNA Hexagonal Radio Array (HRA) on the Ross Ice Shelf of Antarctica has been completed. This detector serves as a pilot program to the ARIANNA neutrino telescope, which aims to measure the diffuse flux of very high energy neutrinos by observing the radio pulse generated by neutrino-induced charged particle showers in the ice. All HRA stations ran reliably and took data during the entire 2014-2015 austral summer season. A new radio signal direction reconstruction procedure is described, and is observed to have a resolution better than a degree. The reconstruction is used in a preliminary search for potential neutrino candidate events in the data from one of the newly installed detector stations. Three cuts are used to separate radio backgrounds from neutrino signals. The cuts are found to filter out all data recorded by the station during the season while preserving 85.4% of simulated neutrino events that trigger the station. This efficiency is similar to that found in analyses of previous HRA data taking seasons.

The isotopic distribution of nuclei produced in the 50Ti + 249Cf reaction has been studied at the gas-filled recoil separator TASCA at GSI Darmstadt, which separates ions according to differences in magnetic rigidity. The bombardment was performed at an energy around the Bass barrier and with the TASCA magnetic fields set for collecting fusion-evaporation reaction products. Fifty-three isotopes located “north-east” of 208Pb were identified as recoiling products formed in non-fusion channels of the reaction. These recoils were implanted with energies in two distinct ranges; besides one with higher energy, a significant low-energy contribution was identified. The latter observation was not expected to occur according to kinematics of the known types of reactions, namely quasi-elastic, multi-nucleon transfer, deep-inelastic collisions or quasifission. The present observations are discussed within the framework of two-body kinematics passing through the formation of a composite system.