Analysis Of Computed Tomography Scans Research Articles

Early Assessment of Treatment Responses During Radiation Therapy for Lung Cancer Using Quantitative Analysis of Daily Computed Tomography

To investigate early tumor and normal tissue responses during the course of radiation therapy (RT) for lung cancer using quantitative analysis of daily computed tomography (CT) scans. Daily diagnostic-quality CT scans acquired using CT-on-rails during CT-guided RT for 20 lung cancer patients were quantitatively analyzed. On each daily CT set, the contours of the gross tumor volume (GTV) and lungs were generated and the radiation dose delivered was reconstructed. The changes in CT image intensity (Hounsfield unit [HU]) features in the GTV and the multiple normal lung tissue shells around the GTV were extracted from the daily CT scans. The associations between the changes in the mean HUs, GTV, accumulated dose during RT delivery, and patient survival rate were analyzed. During the RT course, radiation can induce substantial changes in the HU histogram features on the daily CT scans, with reductions in the GTV mean HUs (dH) observed in the range of 11 to 48 HU (median 30). The dH is statistically related to the accumulated GTV dose (R2>0.99) and correlates weakly with the change in GTV (R2=0.3481). Statistically significant increases in patient survival rates (P=.038) were observed for patients with a higher dH in the GTV. In the normal lung, the 4 regions proximal to the GTV showed statistically significant (P<.001) HU reductions from the first to last fraction. Quantitative analysis of the daily CT scans indicated that the mean HUs in lung tumor and surrounding normal tissue were reduced during RT delivery. This reduction was observed in the early phase of the treatment, is patient specific, and correlated with the delivered dose. A larger HU reduction in the GTV correlated significantly with greater patient survival. The changes in daily CT features, such as the mean HU, can be used for early assessment of the radiation response during RT delivery for lung cancer.

Prevalence, Location, and Size of Maxillary Sinus Septa: Computed Tomography Scan Analysis.

The present study was undertaken to evaluate the anatomy of the maxillary sinus in relation to its position and the height of its septa, using cone beam computed tomography (CBCT). In this descriptive retrospective study, 300 CBCT images of maxillary sinuses of patients with posterior maxillary edentulism were evaluated. The maxillary sinus septa were evaluated in relation to their prevalence, height, and position; t-test and Mann-Whitney tests were used for the analysis of data. Sinus septa were detected in 44% of the subjects, with equal frequencies in the anterior, middle, and posterior positions. The mean height of the septa was 3.6 ± 1.56 mm. In a population of Iranian subjects, in half of the cases, the sinus septa might be present in the anterior, middle, and posterior positions. In order to avoid intraoperative problems during sinus lift procedures, it is necessary to accurately evaluate the sinus, preferably with the use of CBCT Keywords: Cone beam computed tomography, Dental implant, Maxillary sinus septa.

Validation of Videoconference With Smartphones in Telemedicine Facial Trauma Care

The continental size of some countries and heterogeneous hospital network prevents patients who live in remote areas from getting adequate initial assessment of facial trauma. The authors present an alternative model for trauma assessment by videoconference via smartphones and analyze the concordance between telemedicine and face-to-face management. Fifty patients with either a confirmed or suspected diagnosis of facial trauma were independently evaluated by 2 teams of physicians: Face-to-face and telemedicine-based. The face-to-face team attended patients at bedside (physical examination and computed tomography scan analysis). The telemedicine team consisted of a general surgery resident on duty in the emergency room and a plastic surgeon researcher remotely communicating via smartphones. Both teams answered a questionnaire, which contained data concerning patient's epidemiology, physical examination, computed tomography (CT) scan findings, and treatment option to be followed. Data were analyzed and compared regarding the similarity of answers. The sample studied was consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The concurrency of answers for physical examination findings was considered substantial (κ = 0.720). For CT scan findings, it was almost perfect (κ = 0.899); for defining the treatment option, it was almost perfect (κ = 0.891). High concurrency of face CT scan findings was observed after we calculated the positive predictive value (89.9%), negative predictive value (99.3%), sensitivity (94.2%), specificity (98.8%), and accuracy (98.3%). The proposed model to facial assessment trauma by videoconference via smartphones is feasible, showing high concordance level with face-to-face assessment.

Omental ischemia

Omental ischemia is a rare cause of acute abdomen. Clinical diagnosis is usually difficult because clinical signs and symptoms are similar to other common causes of abdominal pain. The most common differential diagnosis is acute appendicitis. Diagnosis is mainly based on ultrasound, and especially computed tomography scan analysis. There is, at present, no standard treatment modality for omental ischemia. When diagnosed by radiological imaging, omental ischemia can be managed conservatively. We hereby review incidence, etiology, pathology, clinical presentation, differential diagnosis, biological anomalies, radiological features, and treatment options of omental ischemia.

Three-Dimensional Computed Tomography Scan Analysis of Anatomical Variations in the Hepatic Veins

Hepatic venous anatomy is a significant component of liver segmental anatomy, and its high variability is a challenge for hepatobiliary surgeons. This was a retrospective study of 98 consecutive patients with no cirrhosis or malignant tumors. IQQA-Liver software was used to display and analyze three-dimensional (3D) images of the hepatic veins and their branches and variations. The average liver volume was 1272.65 ± 322.04 mL; the left hepatic veins drained the smallest parts (21.13 ± 5.41%) of the liver compared with the right (35.58 ± 12.41%) and middle hepatic veins (34.64 ± 8.76%). The most common pattern was that the left hepatic veins shared a common trunk with the middle hepatic veins in 51cases (52.0%). The visualization rate of the inferior right hepatic vein (IRHV) was 43.9%, and its drainage volume was 179.27 ± 128.79 mL. In 11.2% of patients, the drainage volume for the IRHV was larger than for the right hepatic vein (RHV). The patterns of the left hepatic and middle hepatic veins were also observed and classified. Umbilical hepatic veins appeared in 75 cases (76.5%), and anterior fissure hepatic veins appeared in 74 cases (75.5%).The rate of the presence of a separate segment 4 vein was 15.3%, and 77 patients had obvious superficial veins. There was a statistically significant correlation between the diameter of the IRHVs and the drainage volume of the IRHVs and RHVs. More detailed information about the anatomical features and variations of hepatic venous veins in Chinese people was provided using 3D reconstructions, and this will assist in more precise liver surgeries.

INCIDENTAL FINDINGS OF PARANASAL SINUSES IDENTIFIED ON COMPUTER TOMOGRAPHY SCANS

The research work has been dedicated for computer tomography and devoted to the analysis of computer tomography scans. Visual diagnostic methods are widely applied in medicine. Therefore incidental findings are more often. An incidental finding is any abnormality not related to the illness or causes that prompted the diagnostic imaging test. Abnormalities of the paranasal sinuses are frequently encountered as incidental findings during spiral computer tomography evaluation of head and cone beam computer tomography for dental purposes. The growing number of imaging techniques performed per patient causes an increase in the number of incidental findings. How these findings should be managed is far from settled.The aim of this study was to retrospectively analyze the occurrence and type of incidental abnormalities of paranasal sinuses detected by radiographic examinations in the Latvian population of adults.The research work includes retrospective data of three hundred patients. They underwent spiral computer tomography scan of the head referred for non-sinus pathologies in Pauls Stradins Clinical University Hospital in Latvia between February 2015 and October 2015.This is the first report describing incidental findings of paranasal sinuses, the types, the most frequently affected sinuses in Latvian population of adults and also associations between incidental findings and such factors as age, gender, season, septal deviation and enlarged inferior nasal turbinates.

Critical analysis of anatomical landmarks within the sphenoid sinus for transsphenoidal surgery.

The transsphenoidal approach to the sellar region has been introduced more than a 100years ago. It is the accepted standard operative corridor to pathologies of the pituitary gland and surrounding structures. There are anatomical landmarks within the sphenoid sinus that are used for orientation directing to the sella floor or the cavernous sinus. Yet, little data can be found on the consistency of these landmarks. It is the aim of this study to evaluate the reliability of these anatomical landmarks for the surgeon's orientation. A total of 245 computed tomography (CT)volume data sets of the cranium performed according to a standardized protocol were analyzed for study purposes. CT scans of the cranium of 125 patients admitted to the emergency room of our hospital receiving a trauma spiral according to the local protocol were employed as a control group when no pathology in the sellar region was observed. In addition, preoperative CT scans of a group of 120 patients diagnosed with pituitary adenomas between 2009 and 2013 were analyzed. Image analysis of the anatomical landmarks included the minimal intercarotid distance (ICD), diameter of the sphenoid sinus (DSS), direction of the septum sinuum sphenoidalium (SSS), and the distance between vomer and clivus (VCD). The overall mean ICD was 16.2mm, with patients suffering from adenomas showing a mean ICD of 15.8mm compared with an average 16.5mm in the control group. DSS was equal for both groups (adenoma group: mean 31.5mm; controls: mean 31.3mm). Mean VCD was 27.9mm in patients with pituitary adenomas compared with 26.7mm in controls. A septum of the sphenoid sinus located in the midline was found in overall 23% only. SSS was directed into the bony shield of the internal carotid artery in 28% of underlying tumors and in 37% of the control group. This is the first detailed description of landmarks of the sphenoid sinus based on a large radiologic-anatomical analysis of CT scans yielding a wide variation and high inconsistency of these landmarks. From out data, we suggest that the surgeon approaching the sphenoid sinus should handle the anatomical landmarks with care bearing their inconsistency in mind. A thorough planning of the procedure up front is highly recommended. Usage of a navigation system considering the bony structures might as well facilitate as steady the approach to the sellar region in some cases for the patient's sake.

Body composition of the host influences dendritic cell phenotype in patients treated for colorectal cancer.

Dendritic cells (DCs) are antigen-presenting cells that can acquire tumour antigens and initiate cytotoxic T cell reactions. Obesity has been proposed as a cause for tumours escaping immune surveillance, but few studies investigate the impact of other body composition parameters. We examined the relationship of DC phenotype with computer tomography (CT)-defined parameters in patients with colorectal cancer (CRC). DCs were identified within peripheral blood mononuclear cells by flow cytometry as HLA-DR positive and negative for markers of other cell lineages in 21 patients. Analysis of CT scans was used to calculate lumbar skeletal muscle index (LSMI) and mean muscle attenuation (MA). Positive correlation between the LSMI and expression of CD40 in all DCs (r = 0.45; p = 0.04) was demonstrated. The MA was positively correlated with scavenger receptor CD36 [all DCs (r = 0.60; p = 0.01) and myeloid DCs (r = 0.63; p < 0.01)]. However, the MA was negatively correlated with CCR7 expression in all DCs (r = -0.46, p = 0.03.) and with CD83 [all DCs (r = -0.63; p = 0.01) and myeloid DCs (r = -0.75; p < 0.01)]. There were no relationships between the fat indexes and the DC phenotype. These results highlight a direct relationship between muscle depletion and changes in stimulatory, migratory and fatty acid-processing potential of DC in patients with CRC.

Low Muscularity and Myosteatosis Is Related to the Host Systemic Inflammatory Response in Patients Undergoing Surgery for Colorectal Cancer.

We examined the relationships between computed tomography (CT)-defined skeletal muscle parameters and the systemic inflammatory response (SIR) in patients with operable primary colorectal cancer (CRC). Muscle depletion is characterized by a reduced muscle mass (myopenia) and increased infiltration by inter- and intramuscular fat (myosteatosis). It is recognized as a poor prognostic indicator in patients with cancer, but the underlying factors remain unclear. A total of 763 patients diagnosed with CRC undergoing elective surgical resection between 2006 and 2013 were included. Image analysis of CT scans was used to calculate Lumbar skeletal muscle index (LSMI), and mean muscle attenuation (MA). The SIR was quantified by the preoperative neutrophil to lymphocyte ratio (NLR) and albumin levels. Correlation and multivariate regression analysis was performed to identify independent relationships between patient SIR and muscle characteristics. Patients with NLR > 3 had significantly lower LSMI and lower MA than those with NLR < 3 [LSMI = 42.07 cmm vs 44.27 cmm (P = 0.002) and MA = 30.04 Hounsfield unit (HU) vs 28.36 HU (P = 0.016)]. Multivariate logistic regression analysis showed that high NLR [odds ratio (OR) = 1.78 (95% confidence interval [CI]: 1.29-2.45), P < 0.001] and low albumin [OR = 1.80 (95% CI: 1.17-2.74), P = 0.007] were independent predictors of reduced muscle mass. High NLR was significantly related with a low mean MA and hence myosteatosis [OR = 1.60 (95% CI: 1.03-2.49), P = 0.038]. These results highlight a direct association between myopenia, myosteatosis, and the host SIR in patients with operable CRC. A better understanding of factors that regulate muscle changes such as myopenia and myosteatosis may lead to the development of novel therapies that influence a more metabolically "healthy" skeletal muscle and potentially alter cancer outcomes.

Prognostic Value of Semiautomatic CT Volumetry in Patients With Stage I Non-Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy.

The aim of this study was to examine the prognostic value of semiautomated 3-dimensional image analysis-based parameters from pretreatment computed tomography (CT) in patients with non-small cell lung cancer treated with stereotactic body radiation therapy. We evaluated 91 patients. We defined 2 parameters: (1) VOL, extracted tumor volume with a threshold ≥ -400 HU; and (2) ATN, the mean CT attenuation value. The maximum standardized uptake value (SUVmax) was recorded as F-fluorodeoxyglucose positron emission tomography/CT parameter. The prognostic values were assessed using the Kaplan-Meier and a Cox proportional hazards analysis. Overall survival and progression-free survival were significantly worse in patients with larger VOL, higher ATN, and higher SUVmax. VOL was an independent indicator of overall survival, whereas ATN was an indicator of progression-free survival, lymph node recurrence, and distant metastasis. However, SUVmax was not an independent prognostic factor for either outcome. VOL and ATN from 3-dimensional image analysis of CT scans have prognostic values for non-small cell lung cancer patients treated with stereotactic body radiation therapy.

Simple and Economical Method to Create Thoracolumbar Burst Fracture in a Calf Spine Model.

Study DesignCalf spine model study.PurposeTo describe a technique of creating thoracolumbar burst fractures in calf spine model by low weight drop weight.Overview of LiteratureBurst fractures are one of the commonest types of thoracolumbar fractures and their treatment is controversial. Biomechanical studies aid in the decision of treatment of these fractures. A simple method of creation of burst fractures would help these biomechanical studies.MethodsTen specimens of thoracolumbar spines harvested from 6–8 week old calves were weakened at the target vertebra by standardized osteotomy cuts. Burst fractures were created by dropping a 5-kg of weight from a height of 1.2 m using an in-house device. An accelerometer attached to the weight measured the acceleration at the point of impact.ResultsAverage weight and bone mineral density of the specimens was 390 g and 0.67 g/cm2, respectively. Computed tomography scan analysis of the fractures revealed McCormack grade 2 and grade 3 fractures in 5 and 3 specimens, respectively, Dennis type 2B in 4, type 2A burst fractures in 5 specimens and fracture dislocation in 1 specimen, AO type A3.1.1 in 4 specimens, type A3.2.2 in 4 and type A3.3.3 in 2 specimens. Vertical laminar split fracture was seen in 6 specimens. Average acceleration and energy at impact was 9.04 m/sec and 54.24 Nm, respectively.ConclusionsWe describe a technique to create thoracolumbar burst fractures in calf spine by a drop weight method using a device that is simple to operate and easy to construct. The method is consistent and produces fractures similar to those occurring naturally, and can be considered as an alternative method for creating burst fractures in biomechanical studies.

The Efficacy and Safety of Cordyceps militaris in Korean Adults Who Have Mild Liver Dysfunction

Purpose: The aim of this study is to determine the efficacy and safety of Cordyceps militaris in Korean adults with mild liver dysfunction. C. militaris is a mushroom traditionally used for several clinical purposes in East Asian territory, including China, and has been found to be effective in improving liver function through animal studies. Methods: The C. militaris group was administered 1.5 g/day of C. militaris (2 capsules per dose, twice per day) and the placebo group was administered the same volume of placebo. Laboratory test (white blood cell, hemoglobin, platelet, aspartate aminotransferase, alanine aminotransferase, gamma glutamyltranspeptidase, lactic dehydrogenase, alkaline phosphatase, total bilirubin, blood urea nitrogen, creatinine), liver computed tomography (CT) were performed, and visual analogue scale score for subjective symptoms and fatigue severity scale were measured. Results: In analysis of the liver CT scan at 8 weeks after administration compared to baseline, the mean ratio of change of Hounsfield unit of 8 segments of liver increased by an average of 21.43%±45.11% in the C. militaris group and 9.64%±11.41% in the placebo group. Others showed no statistically significant inter-group difference. Conclusion: C. militaris extract was used safely as a functional food in patients with mild liver dysfunction, and is expected to protect against progression of fatty liver or cirrhosis caused by suppression of lipid accumulation in hepatocytes.

Arthroscopic Latarjet procedure: is optimal positioning of the bone block and screws possible? A prospective computed tomography scan analysis

We hypothesized that the arthroscopic Latarjet procedure could be performed with accurate bone block positioning and screw fixation with a similar rate of complications to the open Latarjet procedure. In this prospective study, 105 shoulders (104 patients) underwent the arthroscopic Latarjet procedure performed by the same senior surgeon. The day after surgery, an independent surgeon examiner performed a multiplanar bidimensional computed tomography scan analysis. We also evaluated our learning curve by comparing 2 chronologic periods (30 procedures performed in each period), separated by an interval during which 45 procedures were performed. Of the 105 shoulders included in the study, 95 (90.5%) (94 patients) were evaluated. The coracoid graft was accurately positioned relative to the equator of the glenoid surface in 87 of 95 shoulders (91.5%). Accurate bone-block positioning on the axial view with "circle" evaluation was obtained for 77 of 95 shoulders (81%). This procedure was performed in a lateralized position in 7 of 95 shoulders (7.3%) and in a medialized position in 11 shoulders (11.6%). The mean screw angulation with the glenoid surface was 21°. One patient had transient axillary nerve palsy. Of the initial 104 patients, 3 (2.8%) underwent revision. The analysis of our results indicated that the screw-glenoid surface angle significantly predicted the accuracy of the bone-block positioning (P = .001). Our learning curve estimates showed that, compared with our initial period, the average surgical time decreased, and the risk of lateralization showed a statistically significant decrease during the last period (P = .006). This study showed that accurate positioning of the bone block onto the anterior aspect of the glenoid is possible, safe, and reproducible with the arthroscopic Latarjet procedure without additional complications compared with open surgery.

The prognostic significance and relationship with body composition of CCR7-positive cells in colorectal cancer.

The host local immune response (LIR) to cancer is a determinant of cancer outcome. Regulation of this local response is largely achieved through chemokine synthesis from the tumor microenvironment such as C-Chemokine-Receptor-7 (CCR7). We examined the LIR measured as CCR7 expression, in colorectal cancers (CRC) and explored relationships with body composition (BC) and survival. A study of paraffin-embedded tissue specimens was carried out in 116 patients with non-metastatic CRC. CCR7 expression was determined by immunohistochemistry. Analysis of computer tomography scans was used to calculate BC parameters. Survival analyses and multivariate regression models were used. High CCR7(+) cell density within the tumor stroma and at the margin was significantly associated with increased age, the presence of lymphovascular invasion, higher tumor stage, lymph node metastasis, high Klintrup-Makinen immune score, and myosteatosis. High CCR7(+) cell density in the tumor margin was significantly associated with shorter disease-free (DFS) and overall survival (OS) (P < 0.001). This was also significantly associated with shorter survival in multivariate analysis (HR = 8.87; 95%CI [2.51-31.3]; P < 0.01 for OS and HR = 4.72; 95%CI (1.24-12.9); P = 0.02 for DFS). Our results suggest that a specific immune microenvironment may be associated with altered host's BC and tumor behavior, and that CCR7 may serve as a novel prognostic biomarker.

Influence of Mirrored Computed Tomograms on Decision-Making for Revising Surgically Treated Orbital Floor Fractures

This study evaluated whether intraoperative imaging with computer-assisted virtual reconstruction would be advantageous in reconstructions of orbital floor fractures. The surgeon's intention to revise a reconstructed primary orbital floor fracture by evaluating a postoperative mirrored computed tomographic (CT) scan was analyzed intraoperatively before wound closure, during inpatient hospitalization, and after hospitalization. The inter-rater agreement and the match of intention to revise and actual revision were analyzed. Fifty-one anonymized postoperative CT scans of patients with a unilateral orbital floor fracture were mirrored using software. These computer-assisted virtual reconstructions were consecutively examined by 4 examiners. Seven of these patients underwent a revision. In the first part, the inter-rater agreements for all 3 times were analyzed. In the second part, the examiners' intentions to revise were compared with the actual performed revisions. The overall inter-rater agreements were 0.69 for the intraoperative phase, 0.55 for the in-hospital phase, and 0.39 for the post-hospital phase. The intraoperative inter-rater agreement for each examiner was 0.58 to 0.80. The Fleiss κ value for the in-hospital and post-hospital phases was lower. The comparison of the examiners' intention to revise and the actual revisions showed that 15 to 24 additional would have been revised. In contrast, 6 of 7 actual revisions would have been revised intraoperatively. The missed actual revision was the same case by all 4 examiners. The accordance of intention to revise with the actual revisions decreased during hospitalization and even more after hospitalization. This study showed strong agreement among examiners for revising anatomically incorrectly reduced orbital floor fractures intraoperatively by evaluating postoperative mirrored CT scans. During the in-hospital and post-hospital phases, the restraints against revision seemed to increase, thus leading to poorer inter-rater agreement. This analysis of postoperative CT scans with computer-assisted virtual reconstructions of the orbit would have led to considerably more revisions intraoperatively, but all actual revisions were detected except for 1 case. This case was the same for all 4 examiners. Operation time would have been prolonged in the additional revised cases, but a better anatomic reconstruction would have been achieved. Furthermore, the intraoperative result of the reconstruction would have been controlled instantly and corrected immediately, if needed. This study showed that of 6 of 7 actual revisions, implant placement would have been revised intraoperatively by all 4 examiners, if intraoperative imaging with computer-assisted virtual reconstruction of the orbit would have been applied. Therefore, the authors suggest that intraoperative imaging with computer-assisted virtual reconstruction could be advantageous in the prevention of later revisions of orbital floor fractures. In this study, the threshold to revise implant placement intraoperatively seemed to be lower when using intraoperative imaging with virtual reconstructions, because considerably more cases would have been revised intraoperatively by the examiners. In the in-hospital and post-hospital phases, this threshold increased, suggesting the more important role of clinical findings. It is uncertain whether the actual surgeons would have revised the same cases as the examiners if they had used intraoperative imaging with virtual reconstructions for their deliberation. However, the intraoperative inter-rater agreement was good and cost-intensive postoperative revisions might be prevented.

PWE-319 The relationship with body composition of ccr7-positive cells in colorectal cancer

<h3>Introduction</h3> Emerging data support the link between systemic inflammatory response (IR) and body composition alterations in cancer patients but limited information exists on how the local IR to the tumour is associated to these changes. Regulation of the local IR is largely achieved through chemokine synthesis from the tumour microenvironment such as C-Chemokine-Receptor-7 (CCR7). In the present study, we determined the expression of CCR7 in primary colorectal cancer (CRC) and also correlated the expression of CCR7 with the patients’ clinical and pathological parameters (including their body composition derived from computerised tomography (CT) analysis) to explore the relationship between body composition and tumour immunology in CRC. <h3>Method</h3> A study of paraffin-embedded tissue specimens was carried out in 116 patients with non-metastatic CRC. CCR7 expression was determined by immunohistochemistry. Analysis of computer tomography scans was used to calculate BC parameters. The relationship between CCR7 expression and other clinicopathological parameters was assessed using nonparametric statistics. <h3>Results</h3> The median tumour infiltrating CCR7+ cell density was 15.85% (Inter Quartile Range (IQR) 10.02–21.83%) in the tumour stroma, and 7.17% (IQR 3.90–12.37%) at the tumour margin. CCR7+ cell density of the two areas correlated positively (Spearman r = 0.77; p &lt; 00.001). We divided the cases into high and low CCR7+ groups according to the median value of CCR7 + cell density. High CCR7+ cell density at both the tumour centre and the margin was significantly associated with older age, higher tumour stage, lymph node metastasis and the presence of myosteatosis. High CCR7+ cell density at the tumour margin was also significantly associated with female sex and the presence of lymphovascular invasion. There was no significant association between CCR7+ cell density either at the margin or within an intra-tumoural location with BMI, site of tumour, grade of differentiation, myopenia or visceral adiposity. <h3>Conclusion</h3> We found that a high density of tumour-infiltrating CCR7+ cells was significantly associated with age, histological invasion, higher tumour stage, lymph node metastasis and myosteatosis that are adverse prognostic factors in CRC. These findings may therefore suggest a model whereby the stimulus for the local immune cell response is not only induced by the tumour but also influenced by host-related factors. We have now identified that myosteatosis is also related to an adverse local inflammatory response as measured by a high CCR7 density. To our knowledge these findings are novel and may support the hypothesis that host LIR may influence the development and persistence of myosteatosis. <h3>Disclosure of interest</h3> None Declared.

Dental Abnormalities Caused by Novel Compound Heterozygous CTSK Mutations

Cathepsin K (CTSK) is an important protease responsible for degrading type I collagen, osteopontin, and other bone matrix proteins. The mutations in the CTSK gene can cause pycnodysostosis (OMIM 265800), a rare autosomal recessive bone dysplasia. Patients with pycnodysostosis have been reported to present specific dental abnormalities; however, whether these dental abnormalities are related to dysfunctional CTSK has never been reported. Here we investigated the histologic changes of cementum and alveolar bone in a pycnodysostosis patient, caused by novel compound heterozygous mutations in the CTSK gene (c.87 G>A p.W29X and c.848 A>G p.Y283C). The most impressive manifestations in tooth were extensive periradicular high-density clumps with unclear periodontal space by orthopantomography examination and micro–computed tomography scanning analysis. Hematoxylin/eosin and toluidine blue staining and atomic force microscopy analysis showed that the cementum became significantly thickened, softened, and full of cementocytes. The disorganized bone structure was the main character of alveolar bone. The p.W29X mutation may represent the loss-of-function allele with an earlier termination codon in the precursor CTSK polypeptide. Residue Y283 is highly conserved among papain-like cysteine proteases. Three-dimensional structure modeling analysis found that the loss of the hydroxybenzene residue in the Y283C mutation would interrupt the hydrogen network and possibly affect the self-cleavage of the CTSK enzyme. Furthermore, p.Y283C mutation did not affect the mRNA and protein levels of overexpressed CTSK in COS-7 system but did reduce CTSK enzyme activity. In conclusion, the histologic and ultrastructural changes of cementum and alveolar bone might be affected by CTSK mutation via reduction of its enzyme activity (clinical trial registration: ChiCTR-TNC-10000876).

Implications of sarcopenia in major surgery.

Sarcopenia, defined as a decrease in skeletal muscle mass and strength, is an important risk factor in clinical medicine associated with frailty, mortality, and worse surgical and nonsurgical outcomes. Conventional measures of sarcopenia rely on the subjective "eyeball test" and do not adequately describe risk. Computed tomography (CT) imaging studies may be used to objectively measure sarcopenia and may be used for surgical risk stratification and identification of patients for inclusion in a novel clinical remediation program. We describe results observed in the general, vascular, and liver transplant surgery populations determined by analytic morphomics--an analysis of CT scans in a semiautomated process using MATLAB v13.0. A perioperative optimization program has been implemented with the objective of remediating sarcopenia through improvement of patient mental and physical status prior to surgery. Using analytic morphomics, we have noted significantly higher cost and increased rates of mortality and surgical complications among sarcopenic patients. The training program shows initial success, and among participating patients, we have observed reductions in payer and hospital costs and a decrease in length of hospital stay for patients following surgery. Through analytic morphomics, we are able to quantify markers of sarcopenia and identify patients at risk for increased mortality and poor surgical outcomes. Early identification of patients offers us the opportunity to remediate sarcopenia through perioperative training and support. Participating patients spend less time in the hospital and have lower healthcare costs. This program has the potential to improve the perioperative patient experience and ease financial burdens.

Morphomic analysis as an aid for preoperative risk stratification in patients undergoing major head and neck cancer surgery

BackgroundPatients undergoing major head and neck cancer surgery (MHNCS) may develop significant postoperative complications. To minimize the risk of complications, clinicians often assess multiple measures of preoperative health in terms of medical comorbidities. One emerging method to decrease surgical complications is preoperative assessment of patient frailty measured by specific tissue characteristics. We hypothesize that morphomic characteristics of the temporalis region serve as predictive markers for the development of complications after MHNCS. MethodsWe performed a retrospective review of 69 patients with available computed tomography (CT) imaging who underwent MHNCS from 2006–2012. To measure temporalis region characteristics, we used morphomic analysis of available preoperative CT scans to map out the region. All available CT scans had been performed as part of the patient's routine work-up and were not ordered for morphomic analysis. We describe the correlation among temporalis fat pad volume (TFPV), mean zygomatic arch thickness, and incidence of postoperative complications. ResultsWe noted significant difference in the zygomatic bone thickness and TFPV between patients who had medical complications, surgical complications, or total major complications and those who did not. Furthermore, by use of binary logistic regression, our data suggest decreased TFPV and zygomatic arch thickness are stronger predictors of developing postoperative complications than previously studies preoperative characteristics. ConclusionsWe describe morphomic analysis of the temporalis region in patients undergoing MHNCS to identify patients at risk for complications. Regional anatomic morphology may serve as a marker to objectively determine a patient's overall health. Use of the temporalis region is appropriate in patients undergoing MHNCS because of the availability of preoperative scans as part of routine work up for head and/or neck cancer.

Scapular position after the open Latarjet procedure: results of a computed tomography scan study

The aim of this study was to investigate, through a computed tomography (CT) scan analysis, the effects of the Latarjet procedure on scapular position in an axial plane. Twenty healthy young male subjects (mean age, 22 years; range, 18-27 years) were enrolled as a control group. Twenty young male patients (mean age, 23 years; range, 17-30 years) with recurrent anterior shoulder dislocation were enrolled as the study group. CT cuts at a proper level allowed the identification of an α angle, which defined the tilt of the scapula relative to the anterior-posterior axis. In the control population, the α angles on the right and left shoulders were 48° (44°-52°) and 48° (44°-54°), respectively. In the study group, the preoperative α angles at the affected and healthy shoulders were 49° (46°-52°) and 49° (44°-52°), respectively. At day 45, the corresponding angles were 45° (40°-50°) and 49° (46°-52°). At 6 months, the average α angle of the shoulder operated on was 52° (46°-58°). The α angle value was restored in 5 cases, increased in 9 cases (mean, 8°), and decreased in 6 cases (mean, 3°). A general symmetry of scapular position was observed during CT scan analysis. This balance was lost initially after the Latarjet procedure, with a decrease of the α angle and scapular protraction. Six months after surgery, a small trend toward scapular retraction was conversely observed; however, the data were not statistically significant.