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Background: Iron rims (IRs) surrounding white matter lesions (WMLs) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without iron rim lesions (IRLs) have been reported so far. Objective: To assess whether the presence and number of IRLs in patients with clinically isolated syndrome (CIS) and multiple sclerosis (MS) are associated with long-term disability or progressive disease. Methods: Ninety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7 T magnetic resonance imaging (MRI). Expanded Disability Status Scale (EDSS) was used to calculate Age-related Multiple Sclerosis Severity Score (ARMSS) at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using Susceptibility weighted imaging (SWI)-filtered phase images. Results: In all, 132 IRLs were detected in 42 patients (46%); 9% of WMLs had IRs; 54% of the cohort had no rims, 30% had 1–3 rims and 16% had ⩾4. Patients with IRL had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability, especially in patients with ⩾4 IRLs. IRLs have a greater impact on disability compared to the WML number and volume. Conclusion: The presence and number of perilesional IR on MRI hold prognostic value for long-term clinical disability in MS.

Connecting the wellbore and reservoir rock systems through perforating is the primary mechanism to provide a flow path for hydrocarbons. In stimulation, this pathway becomes two dimensional (in functionality) because it is required to facilitate injection of fracturing fluids and production of reservoir fluids. Ineffective perforation can add of near-wellbore complexities. In this study, we looked at different perforation techniques from classical to recent contemporary. We investigated both stimulation and intervention aspects to provide pros and cons for these techniques and evaluate their effectiveness. Six challenging scenarios in stimulation were detailed with lessons learnt, best practices, and guidelines. These included deviated wells, soft rock formations, double pipe completions, fracture diversion requirement, horizontal wells with plug-and-perforate completions, and a mature asset. The workflows included perspectives such as perforating, fracture pressure analysis, and diagnostic injections. Efficient workflows for the well engineering cycle were also developed for the case when the injection rate cannot be established due to the inefficient wellbore−rock connection. Contingency interventions and bottomhole assembly (BHA) configurations were investigated with the goal of enabling a flexible strategy in a single intervention run to enhance injectivity.Currently, operational efficiency and business needs are paramount. This work presents integrated understanding, established practices, and resulting workflows to manage tradeoff and optimize the net present value of integrated projects.

Background: Diabetes mellitus (DM) is the most common chronic disorder among the Saudi population; it reaches up to 20% of the population. Alternative medicine (AM) use among the Saudi population is more common among the elderly due to some beliefs. This study aimed to assess the prevalence of AM use among diabetic patients and their adverse effects, and to raise awareness about these acts. Methods: A cross-sectional study was conducted to assess the use of AM among diabetic patients in Al Kharj, Saudi Arabia. We interviewed 558 people with diabetes of both genders and all ages in hospitals and primary care clinics in Al Kharj, Saudi Arabia. Results: A total of 558 diabetic patients participated in the present study. Most included patients (61.6%) were type II DM. Only 17.9% of the patients were using AM, while 66.4% were not, and 15.7% had used AM prior. Only 4.7% of the diabetic patients preferred AM use, while 24.4% preferred modern medicine use. 12.8% of the participants reported that AM could cause adverse effects. Most patients were regular in drug use (70%), while only 6.8% were not committed to drug use. Conclusion: The present study found the prevalence of AM use among diabetic patients to be 17.9%. Only 4.7% of the diabetic patients preferred AM use. The most used AM were fennel flower, honey, and herbs. Gender and education were significant factors in AM use among diabetic patients.

BackgroundType 2 diabetes mellitus impacts the brain microstructural environment. Diffusion tensor imaging (DTI) has been widely used to characterize white matter microstructural abnormalities in type 2 diabetes but fails to fully characterise disease effects on complex white matter tracts. Neurite orientation dispersion and density imaging (NODDI) has been proposed as an alternative to DTI with higher specificity to characterize white matter microstructures. Although NODDI has not been widely applied in diabetes, this biophysical model has the potential to investigate microstructural changes in white matter pathology.Aims and objectives(1) To investigate brain white matter alterations in people with type 2 diabetes using DTI and NODDI; (2) To assess the association between white matter changes in type 2 diabetes with disease duration and diabetes control as reflected by glycated haemoglobin (HbA1c) levels.MethodsWe examined white matter microstructure in 48 white matter tracts using data from the UK Biobank in 3,338 participants with type 2 diabetes (36% women, mean age 66 years) and 30,329 participants without type 2 diabetes (53% women, mean age 64 years). The participants had undergone 3.0T multiparametric brain imaging, including T1 weighted imaging and diffusion imaging for DTI and NODDI. Region of interest analysis of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), orientation dispersion index (ODI), intracellular volume fraction (ICVF), and isotropic water fraction (IsoVF) were conducted to assess white matter abnormalities. A general linear model was applied to evaluate intergroup white matter differences and their association with the metabolic profile.ResultReduced FA and ICVF and increased MD, AD, RD, ODI, and IsoVF values were observed in participants with type 2 diabetes compared to non-type 2 diabetes participants (PPPDiscussionNODDI detected microstructural changes in brain white matter in participants with type 2 diabetes. The revealed abnormalities are proxies for lower neurite density and loss of fibre orientation coherence, which correlated with longer disease duration and an index of poorly controlled blood sugar. NODDI contributed to DTI in capturing white matter differences in participants with type 2 diabetes, suggesting the feasibility of NODDI in detecting white matter alterations in type 2 diabetes.ConclusionType 2 diabetes can cause white matter microstructural abnormalities that have associations with glucose control. The NODDI diffusion model allows the characterisation of white matter neuroaxonal pathology in type 2 diabetes, giving biophysical information for understanding the impact of type 2 diabetes on brain microstructure.

Objectives: The present study is aimed at determining the effect of cigarette smoking (CS) on serum uric acid (UA) levels quantitatively before and after smoking cessation among people with MS (pwMS). Additionally, a possible correlation between UA levels and both disability progression and disease severity was also investigated. A retrospective cross-sectional study was conducted using the Nottingham University Hospitals MS Clinics database. It involves 127 people with definite MS recorded when reporting the latest smoking status and the clinical diagnosis. All necessary demographics and clinical characteristics were collected. We found that smoker pwMS had significantly lower serum UA levels than non-smoker pwMS (p-value = 0.0475), and this reduction was recovered after smoking cessation (p-value = 0.0216). However, the levels of disability or disease severity were not correlated with the levels of serum UA in current smoker pwMS, measured by the expanded disability status scale (EDSS; r = −0.24; p-value = 0.38), multiple sclerosis impact scale 29 (MSIS-29; r = 0.01; p-value = 0.97) and MS severity score (MSSS; r = −0.16; p-value = 0.58), respectively. Our result suggests that the reduction in UA levels is more likely a consequence of oxidative stress triggered by many risk factors, including CS, and could be considered a potential indicator of smoking cessation. In addition, the absence of a correlation between UA levels and disease severity and disability suggests that UA is not an optimal biomarker for disease severity and disability prediction among current smoker, ex-smoker or non-smoker pwMS.

Last year, the oil and gas industry was hit with one of the biggest challenges in the history of the industry — COVID-19. This has been a pandemic no one imagined would cripple the whole world and threaten our very existence. It caused an imbalance to the oil supply and demand where the global oil market had more than it could use or store, which drove oil prices to a record low. Despite this, projects in development have to be completed to accommodate the future rise in demand that is expected to occur after the pandemic. This paper will showcase how the rigless operations in Saudi Arabia in the oil and gas fields managed to continue with their activities toward tackling this challenge by capitalizing on two main principles. The first principle was business continuity management; preparing a strategic and operational framework to actively increase resilience to prevent suspension of the rigless operations or services, and thereby fulfilling the industry demand and preventing a cash flow interruption to the stakeholders. The second principle was the risk management process (RMP); identifying, monitoring, and managing all risks related to COVID-19, which minimized, and in some cases eliminated, its impact on the rigless operations. Both principles were the main pillars to first preserve lives and second to assure business continuity, which resulted in the continuation of the rigless operation and the profitability under the COVID-19 challenge for the company. COVID-19 was a risk no one accounted for. It was a true test to business continuity management and the risk management process. The integration of both processes in the oil industry, and specifically in rigless operations for the first time due to this pandemic, was essential to overcome the COVID-19 crises in addition to tailoring specific steps to address this challenge. Therefore, the rigless operations continued with planned activities while preserving people's lives.

To date, there are no definite imaging predictors for long-term disability in multiple sclerosis (MS). Magnetic resonance imaging (MRI) is the key prognostic tool for MS, primarily at the early stage of the disease. Recent findings showed that white matter lesion (WML) counts and volumes could predict long-term disability for MS. However, the prognostic value of MRI in the early stage of the disease and its link to long-term physical disability have not been assessed systematically and quantitatively. A meta-analysis was conducted using studies from four databases to assess whether MS lesion counts and volumes at baseline MRI scans could predict long-term disability, assessed by the expanded disability status scale (EDSS). Fifteen studies were eligible for the qualitative analysis and three studies for meta-analysis. T2 brain lesion counts and volumes after the disease onset were associated with disability progression after 10 years. Four or more lesions at baseline showed a highly significant association with EDSS 3 and EDSS 6, with a pooled OR of 4.10 and 4.3, respectively. The risk increased when more than 10 lesions were present. This review and meta-analysis confirmed that lesion counts and volumes could be associated with disability and might offer additional valid guidance in treatment decision making. Future work is essential to determine whether these prognostic markers have high predictive potential.

Introduction Early identification of patients at high risk of progression could help with a personalised treatment strategy. Magnetic resonance imaging (MRI) measures have been proposed to predict long-term disability in multiple sclerosis (MS), but a reliable predictor that can be easily implemented clinically is still needed. Aim Assess MRI measures during the first 5 years of the MS disease course for the ability to predict progression at 10+ years. Methods Eighty-two MS patients (53 females), with ≥10 years of clinical follow-up and having two MRI scans, were included. Clinical data were obtained at baseline, follow-up and at ≥10 years. White matter lesion (WML) counts and volumes, and four linear brain sizes were measured on T2/FLAIR ‘Fluid-Attenuated-Inversion-Recovery’ and T1-weighted images. Results Baseline and follow-up inter-caudate diameter (ICD) and third ventricular width (TVW) measures correlated positively with Expanded Disability Status Scale, ≥10 or more of WMLs showed a high sensitivity in predicting progression, at ≥10 years. A steeper rate of lesion volume increase was observed in subjects converting to secondary progressive MS. The sensitivity and specificity of both ICD and TVW, to predict disability at ≥10 years were 60% and 64%, respectively. Conclusion Despite advances in brain imaging and computerised volumetric analysis, ICD and TVW remain relevant as they are simple, fast and have the potential in predicting long-term disability. However, in this study, despite the statistical significance of these measures, the clinical utility is still not reliable.

IntroductionIdentifying accurate prognostic imaging biomarkers in multiple sclerosis (MS) is crucial. Iron rims (IR) surrounding white matter lesions (WML) are suggested to predict a more severe disease course. Only small longitudinal cohorts of patients with and without IRL have been reported so far.ObjectiveTo assess if the presence and number of IRL in patients with CIS and MS are associated with worse long-term clinical disability.MethodsNinety-one CIS/MS patients were recruited between 2008 and 2013 and scanned with 7T MRI. Age-Related Multiple Sclerosis Score (ARMSS), a validated measure of disease severity, was calculated for patients at the time of scan and at the latest clinical follow-up after 9 years. WMLs were assessed for the presence of IRL using SWI-filtered phase images.Results132 IRLs were detected in 42 patients (46%). 9% of WMLs had IR. 54% of the cohort had no rims, 30% had 1-3 rims and 16% had ≥4. Patients with IRL at baseline had a higher EDSS and ARMSS. Presence of IRL was also a predictor of long-term disability especially in those patients with ≥4 IRL. The effect of IRL on disability was greater than the baseline WML numbers, another known prognostic biomarker.ConclusionThe presence and number of perilesional IR at a baseline scan hold prognostic value for long term clinical disability in MS.

Objective: To explore the impact of different lung cancer treatment modalities on survival time and mortality rates in older patients. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to identify lung cancer patients aged ≥50 years old in the United States. Descriptive statistics and trend charts from 2000 to 2016 were generated. Regression analysis was performed among lung cancer patients to explore the association between survival time and treatment utilization (chemotherapy, radiation, and surgery). A regression model was also applied to explore the association between treatment modalities and odds of dying. Results: A total of 826,217 patients were diagnosed with lung cancer between 2000-2016. The number of lung cancer cases increased by 7%, and the average annual frequency was 48,529 cases per year. Survival, mortality, and treatment utilization varied over the years based on demographic, clinical characteristics, and social status. Five-year survival rate was less than 10% among the study population, and 84% of included lung cancer patients died. Chemotherapy was more commonly used (62%), followed by radiation (35%) and surgical interventions (22%). Chemotherapy and surgery showed a survival advantage. The odds of dying were two times higher among patients treated with surgery than those who were not (OR: 2.62, 95%Cl: 2.58- 2.67). Conclusion: This study highlighted the importance of considering treatment modalities and individual patient characteristics, which may impact survival times and mortality rates among older lung cancer patients.

Type 1 and type 2 diabetes mellitus have an impact on the microstructural environment and cognitive functions of the brain due to its microvascular/macrovascular complications. Conventional Magnetic Resonance Imaging (MRI) techniques can allow detection of brain volume reduction in people with diabetes. However, conventional MRI is insufficiently sensitive to quantify microstructural changes. Diffusion Tensor Imaging (DTI) has been used as a sensitive MRI-based technique for quantifying and assessing brain microstructural abnormalities in patients with diabetes. This systematic review aims to summarise the original research literature using DTI to quantify microstructural alterations in diabetes and the relation of such changes to cognitive status and metabolic profile. A total of thirty-eight published studies that demonstrate the impact of diabetes mellitus on brain microstructure using DTI are included, and these demonstrate that both type 1 diabetes mellitus and type 2 diabetes mellitus may affect cognitive abilities due to the alterations in brain microstructures.

Background: Multiple sclerosis (MS) is an autoimmune, inflammatory, demyelinating and degenerative disease of the central nervous system (CNS). To date, there is no definitive imaging biomarker for diagnosing MS. The current diagnostic criteria are mainly based on clinical relapses supported by the presence of white matter lesions (WMLs) on MRI. However, misdiagnosis of MS is still a significant clinical problem. The paramagnetic, iron rims (IRs) around white matter lesions have been proposed to be an imaging biomarker in MS. This study aimed to carry out a systematic mapping review to explore the detection of iron rim lesions (IRLs), on clinical MR scans, and describe the characteristics of IRLs presence in MS versus other MS-mimic disorders. Methods: Publications from 2001 on IRs lesions were reviewed in three databases: PubMed, Web of Science and Embase. From the initial result set 718 publications, a final total of 38 papers were selected. Results: The study revealed an increasing interest in iron/paramagnetic rims lesions studies. IRs were more frequently found in periventricular regions and appear to be absent in MS-mimics. Conclusions IR is proposed as a promising imaging biomarker for MS.