Anatomical Regions Research Articles

Efficacy and Safety of Ruxolitinib Cream by Anatomic Region in Children Aged 2 to 11 Years With Atopic Dermatitis: Results From TRuE-AD3

Atopic dermatitis (AD) is a chronic, pruritic inflammatory skin disease. Ruxolitinib (Janus kinase [JAK]1/JAK2 inhibitor) cream has demonstrated efficacy and safety in patients aged ≥2 years with AD. In adolescents (aged ≥12 y) and adults with AD, application of ruxolitinib cream resulted in significant improvements across all anatomic regions vs vehicle. The objective of this analysis was to evaluate the efficacy and safety of ruxolitinib cream by anatomic region in the randomized, double-blind, phase 3 TRuE-AD3 study (NCT04921969). Children aged 2–11 years with AD for ≥3 months and an Investigator’s Global Assessment score of 2/3 were randomized 2:2:1 to apply 0.75% or 1.5% ruxolitinib cream twice daily (BID) or vehicle BID for 8 weeks. Efficacy was evaluated using the Eczema Area and Severity Index (EASI) subscores for head/neck, trunk, upper limbs, and lower limbs. Of 330 patients in TRuE-AD3, the mean (SD) age was 6.5 (2.9) years, and 179 patients (54.2%) were female; the mean (SD) EASI score was 8.6 (5.4). Improvements in EASI score were demonstrated with 0.75% and 1.5% ruxolitinib cream vs vehicle at first observation (Week 2), with statistically significant differences (at 0.05 alpha level and all P values below are nominal) at Week 8 in the head and neck (−0.63 [P=0.0108] and −0.70 [P=0.0011] vs −0.41), trunk (−0.98 [P=0.0310] and −1.18 [P=0.0003] vs −0.70), upper limbs (−1.81 [P<0.0001] and −2.06 [P<0.0001] vs −1.18), and lower limbs (−2.91 [P<0.0001] and −3.23 [P<0.0001] vs −1.43). Improvements in induration/papulation/edema, erythema, excoriation, and lichenification were observed for both strengths of ruxolitinib cream vs vehicle in all regions at Week 2, with statistical significance (at 0.05 alpha level) in nearly all AD signs and regions at Week 8. Ruxolitinib cream was well tolerated in both treatment groups (n=264), with 4.5% of patients experiencing application site reactions, which was similar to the frequency of application site reactions (4.3%) among patients with head/neck involvement (n=161) . In conclusion, ruxolitinib cream demonstrated significant improvements in AD vs vehicle in children with AD across anatomic regions, including on the head/neck, and was well tolerated. (Funding, Incyte Corporation)

Comparison of clinical performance between late and standard total-body [68Ga]Ga-PSMA-11 in biochemical recurrent prostate cancer.

Enhanced lesion detection in prostate cancer is observed with late [68Ga]Ga-PSMA-11 PET/CT imaging compared to standard [68Ga]Ga-PSMA-11 PET/CT imaging (50-100min p.i.). However, the poor image quality of late imaging using short axial field of view (SAFOV) PET/CT has hindered its sole clinical adoption. Conversely, the image quality of late imaging with a long axial field of view (LAFOV) [68Ga]Ga-PSMA-11 PET/CT fulfills clinical diagnostic requirements. Nonetheless, the diagnostic efficacy of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis and its impact on treatment decisions, compared to standard LAFOV [68Ga]Ga-PSMA-11 PET/CT, remains unclear. This study aims to compare the rate of PET positivity between late and standard LAFOV [68Ga]Ga-PSMA-11 PET/CT and to evaluate the influence of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis on treatment decisions relative to standard scans. From January 2021 to April 2024, 127 patients with biochemical recurrence of prostate cancer post-radical prostatectomy were enrolled to undergo both standard and late LAFOV [68Ga]Ga-PSMA-11 PET/CT scans at Shanghai Renji Hospital. We compared the rate of PET positivity between the two modalities at the patient level and across different anatomical regions. We assessed the added diagnostic value of late LAFOV [68Ga]Ga-PSMA-11 PET/CT and its impact on modifying patient treatment plans. The image quality of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis in all patients met clinical diagnostic requirements. The rate of PET positivity of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis were significantly higher than those of standard LAFOV [68Ga]Ga-PSMA-11 PET/CT (80.31% [102/127] vs. 65.35% [83/127]; P < 0.001). Late LAFOV [68Ga]Ga-PSMA-11 PET/CT demonstrated higher lesion SUVmax (16.69 ± 16.42 vs. 11.91 ± 10.72, P < 0.001) and TBR (6.26 ± 7.21 vs. 3.44 ± 3.57, P < 0.001) compared to standard LAFOV scans. Additionally, 14.17% (18/127) of patients experienced changes in their treatment regimen due to the superior detection capabilities of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to the standard scan. The rate of PET positivity of late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to standard LAFOV [68Ga]Ga-PSMA-11 PET/CT highlight its potential as a valuable diagnostic tool for biochemically recurrent prostate cancer. This study paves the way for using late LAFOV [68Ga]Ga-PSMA-11 PET/CT with forced diuresis for prostate cancer imaging in daily clinical practice, facilitating more accurate and timely diagnoses.

Management of venous aneurysms and the vascular surgical treatment options : Selection of representative case constellations illustrating experiences at acenter for vascular surgery

Venous aneurysms are arare entity in vascular surgery, which are mostly described in individual case series and meta-analyses generated from them. The treatment concepts are diverse and surgical treatment is highlighted due to the risk of thrombosis and pulmonary embolism. There is still an ongoing debate regarding the postoperative necessity and duration of anticoagulation. Case series of aconsecutive patient cohort with venous aneurysms from the last 18years in acenter of (highly specialized care) vascular surgery including i)own experiences obtained in daily vascular surgical practice and ii)aselected and current literature search of relevant references on possible and, in particular, established diagnosis-specific therapeutic concepts. Between 2005 and 2023, atotal of 11cases of venous aneurysms were reported in patients aged 30-84years (mean: 52.5, median: 50), with 1 patient requiring surgery for a recurrence after 2years. The gender ratio was 7:3 (m:f) and the popliteal vein was the most frequently affected anatomical region with 36.4%, followed by the internal jugular vein and axillary/subclavian vein each with 18.2%. Aneurysms of the inferior vena cava, the common iliac vein and the cubital vein occurred only once. Surgical treatment of the aneurysms was performed in 9cases. The surgical methods used were i)tangential resection of the aneurysm wall and continuous purse-string suture, ii)resection of the aneurysm and interposition of an 8‑mm GORE-TEX® vascular graft prosthesis (Gore, Putzbrunn, Germany), iii)ligation of the aneurysm and iv)ligation with subsequent resection of the aneurysm. The rarity of venous aneurysms should be a reason to register these cases centrally (possibly, nationwide diagnosis-related register). Surgical treatment is usually unproblematic and associated with few complications. The risk of pulmonary embolism appears to be significantly increased in venous aneurysms of the extremities, pelvic veins and inferior vena cava, while venous aneurysms of the head and neck are significantly less prone to this. Perioperative and postoperative anticoagulation has been adapted to the development of specific anticoagulants and novel drugs, in favor of treatment with direct oral anticoagulants (DOAC). In personal experience, immediate postoperative heparin perfusion (low dose) and subsequent therapeutic bridging with low-molecular-weight heparin before switching to an anticoagulant for outpatient clinic-based care appears to safeguard the perioperative phase with respect to keeping the surgery-related complication rate (e.g., thrombosis, bleeding) low.

SURGICAL RESECTION OF A COMPLEX TUBERCULUM SELLAE MENINGIOMA ENCASING MAJOR ARTERIES

Introduction Though constituting only a minor proportion (1%) of sellar masses, suprasellar meningiomas pose a significant diagnostic challenge within the region of sellar and suprasellar tumors. Pituitary adenomas, at nearly 90% prevalence, dominate this anatomical region. Distinguishing these two entities is paramount, as both clinical presentation and, to some extent, biochemical profiles exhibit notable overlap. Accurate preoperative differentiation is critical due to the contrasting behaviors of these tumors. Meningiomas, with their robust vascularity supplied by dural and osseous arteries, present a heightened risk of intraoperative hemorrhage. Clinical Case A 53-year-old woman presented with a two-month history of worsening headaches and gradual vision loss. Neurological examination revealed only visual acuity decline. Her hormone profile showed elevated prolactin but lacked clinical features of prolactin excess, suggesting a possible prolactin-secreting pituitary macroadenoma. A contrast-enhanced MRI confirmed a significant sellar and suprasellar mass with homogeneous enhancement, extending to the right paramedian region and encasing the right internal carotid artery (ICA) at its critical segment involving the cavernous and supraclinoid portions. Furthermore, the right middle meningeal artery (M1) and anterior cerebral artery (A1) originated from this same location, highlighting the high surgical risk. Surgical resection was deemed necessary. The patient underwent a right pterional craniotomy, revealing a grayish, extradural soft mass lesion encasing the ICA bifurcation. Careful microsurgical dissection with basal devascularization was performed, followed by near-complete tumor removal using an ultrasonic aspirator to minimize damage to the encased arteries. Postoperative follow-up CT scan confirmed successful near-total tumor ablation. Conclusion This case underscores the critical role of meticulous preoperative diagnosis in managing complex sellar tumors. While pituitary adenomas dominate this region, suprasellar meningiomas, despite their rarity, demand a high index of suspicion. Overlapping clinical and biochemical presentations highlight the reliance on advanced imaging for accurate differentiation. The intricate vascularity of meningiomas, as exemplified by the encasement of critical arteries in this case, necessitates meticulous surgical technique with devascularization strategies. This successful near-complete tumor removal emphasizes the importance of such surgical expertise in navigating these diagnostically challenging sellar lesions.

Geometric Morphometric Analysis of Plastinated Brain Sections Using Computer-Based Methods: Evaluating Shrinkage and Shape Changes.

Plastination preserves biological specimens for long-term and geometric morphometry analyzes shape differences with advanced statistical methods. This study primarily aimed to statistically quantify shrinkage in brain sections following plastination. The secondary goal was to present the shrinkage occurring in both tissues and cavities of specific anatomical structures using geometric morphometry. Fourteen sections from each of nine male bovine brains underwent silicone plastination using the standard technique, which involves four stages: fixation, dehydration, forced impregnation, and curing. The shrinkage percentage in plastinated sections was measured using ImageJ, while geometric morphometry was used for shape analysis. Correlation analysis was performed to reveal the relationship between ventricle area and shrinkage percentage. Significant shrinkage was observed in each brain section. A positive correlation was observed between the shrinkage on the sections and ventricular area. However, with the exception of section number 9, this correlation was not statistically significant for the remaining sections. Furthermore, the strength of the correlation exhibited variability across different sections. Using geometric morphometric, shrinkage, and associated shape variations in specific anatomical regions within the serial brain sections were illustrated with visual graphics. Shape analysis revealed the most pronounced shrinkage in the sulcus coronalis, sulcus suprasylvius rostralis, ventral surface of the thalamus, and the third ventricle. Additionally, the cornu ammonis (hippocampus) exhibited the most significant shrinkage and shape variation. While morphometric analyses did not reveal significant shrinkage in cavity-like structures, geometric morphometric analyses demonstrated significant shrinkage in the third ventricle. This study is unique in that it is the first to comprehensively demonstrate, using geometric morphometry, the morphological changes that occur in brain tissue during plastination. The findings, when combined with graphical and statistical data analysis, emphasize the effectiveness of geometric morphometry as a powerful tool for elucidating shape changes in plastination research.

Abstract 4147644: Regional Distribution and Overlap of Left Atrial Epicardial Adipose Tissue and Fibrosis

Background: Left atrial epicardial adipose tissue (LA-EAT) and fibrosis are implicated in the pathophysiology of the atrial fibrillation (AF) substrate. Hypothesis: The distribution of fibrosis and LA-EAT differs across various regions of the LA. Aims: Ascertain whether high fibrosis regions coincide with high EAT regions. Identify specific anatomical regions in which LA-EAT and fibrosis tend to co-localize. Methods: LA-EAT was imaged using MRI Dixon sequences and images were segmented axially using the software contouring tools. LGE-MRI was used for LA fibrosis quantification and segmentation. The regions of fibrosis and fat were then co-registered with the atrial geometry and projected onto the left atrial shell. A universal atrial coordinates (UAC) approach was then used to systematically delineate anatomical LA regions in a manner independent of inter-individual variabilities in scale and shape. Specifically, the LA was divided into 10 regions (left and right versions of: posterior-inferior, posterior-superior, roof, anterior-superior, and anterior-inferior). Levene’s test and ANOVA were used to check for any statistically significant variability. Results: Nineteen patients were recruited (94% male; median age 72[62-74]; BMI 32.1±6.3; LA volume index 71.0±21.5mL/m 2 ).LA fibrosis was highest in the left posterior superior segment, right anterior inferior, and left posterior inferior (39.3±16.2%,34.7±26.8%, and 25.7±20.9% respectively;F=1.9,p=0.15). LA-EAT was most prominent in the right anterior superior, left posterior inferior, and left anterior inferior segments (38.1±25.3%,35.6±18.4%,and 33.1±18.9% respectively; F=0.94, p= 0.39). Spatial co-localization of fat and fibrosis was highest in the left posterior inferior region (8.95±2.1%), followed by the left posterior superior, right anterior superior, and left anterior inferior region (7.9±2.1%,7.2±1.7%,and 6.3±1.6% respectively; F= 0.29, p=0.83 ). Conclusion: LA fibrosis and EAT have differing regional preponderances, impacting the AF substrate through infiltrative and paracrine effects. This fibro-fatty remodeling creates structural and conduction abnormalities, forming stable reentrant circuits and perpetuating AF by providing varied pathways and refractory periods.

Utilization of Computed Tomography at the Aydin Adnan Menderes University Faculty of Veterinary Medicine Research and Application Hospital: An Analysis of Preliminary Results on Patient Demographics and Case Distribution

This study examines the distribution of computed tomography (CT) usage at Aydin Adnan Menderes University Faculty of Veterinary Medicine Research and Application Hospital between 2023 and 2024. CT, a widely adopted diagnostic tool in veterinary medicine, allows for detailed imaging of internal organs and anatomical structures, enhancing the diagnosis of complex cases. The study analyzed data from 143 animals, including dogs, cats, and other species, to assess the frequency of CT scans based on species, age, sex, breed, and imaged anatomical regions. A total of 350 CT scans were reviewed, with dogs (n=87) undergoing the majority of scans (200), followed by cats (n=50) with 175 scans, and other species accounting for 26 scans. Cranium, thorax, and abdomen were the most frequently imaged regions across all species. The study found that older animals, particularly large-breed dogs and male cats, required more imaging, while younger animals (0-6 months) underwent fewer CT scans. The findings emphasize the need for tailored diagnostic approaches based on species, age, and sex to improve early detection and treatment outcomes in veterinary practice. Furthermore, the study highlights the potential for expanding CT use in non-traditional veterinary species, with the goal of improving diagnostic precision. The results provide important insights for enhancing veterinary services through the strategic application of CT imaging.

Limfatičke malformacije

Lymphatic malformations are abnormal cystic dilatations of lymphatic vessels. They are present at birth, but often can only be detected later in life. Simple lymphatic malformations are limited to certain anatomical regions, while complex diffuse abnormalities can affect the entire organism. Simple lymphatic malformations are divided into macrocystic (cysts &gt;1cm) and microcystic (cysts &lt;1cm). According to the ISSVA classification from 2015, the term lymphangioma is abandoned and the term lymphatic malformation is introduced, which is intended to clearly indicate that it is not a tumor formation. The clinical course is characterized by long asymptomatic periods with short-term inflammatory or infectious episodes and episodes of intracystic bleeding. In the case of voluminous changes, the diagnosis can be made at the transition from the second to the third trimester of pregnancy by ultrasound examination or fetal magnetic resonance. Ultrasound and magnetic resonance imaging are diagnostic methods of choice in the postpartum period as well. The purpose of the treatment is not to completely remove the formation, but to limit the symptoms to the extent that would preserve functionality and provide an appropriate appearance. Treatment methods are the expectant method for asymptomatic disease, sclerotherapy, surgical resection, drug treatment, laser treatment and physical therapy measures. When there is no life-threatening airway obstruction, sclerosing is the method of choice. Bleomycin as a sclerosant provides good results with mild side effects. Therapy with rapamycin (sirolimus) allows for a large percentage of reduction in formation, but it is important to monitor possible side effects

RADT-05. VASCULAR OVERLAP PROVIDES PROTECTION FROM GAMMA-KNIFE-INDUCED RADIATION NECROSIS IN A METASTATIC BRAIN TUMOR COHORT

Abstract INTRODUCTION Radiation necrosis (RN) is a long-term complication of Gamma-Knife (GK) Radiosurgery, an established treatment for metastatic brain tumors. Few dosimetric parameters have shown to predict RN, including tumor target volume, treatment dose, and V12 Gy (volume of normal brain receiving 12 Gy). Vascularity has yet to be explored as an independent predictor of RN. OBJECTIVE To evaluate the role of vascular overlap in GK-induced RN. METHODS All metastatic brain tumor patients treated with GK between 2014-2019 were retrospectively screened for post-treatment radiographic RN. Vascular overlap, defined by the MCA-ACA and MCA-PCA border regions, was determined by two blinded neurosurgeons and one radiation oncologist. Multivariate logistic regression analysis was performed to determine factors predictive of RN using variables determined significant by univariate analysis and clinical relevance. Covariates included V12 as a binary variable (≥8 vs. &amp;lt;8 cm3), vascular overlap, supratentorial location, and eloquent location. RESULTS 6% (20/321) of all metastatic brain tumor patients developed RN and were included for analysis, with the final cohort being 60% (12/20) female with a mean age of 59 years, comprising 77 lesions. V12 (≥8 cm3) showed a significant increase in risk of developing RN [OR = 8.18; (coef, 95% CI: 2.10 (0.49, 3.72), p=0.011)]. Conversely, vascular overlap showed a protective effect against RN [OR = 0.23 (-1.49 (-2.79, -0.19), p=0.024)], with a lower rate of RN in areas of vascular overlap (10%) than non-vascular overlap (26%). Neither supratentorial location [OR = 3.31 (1.20 (-0.76, 3.16), p=0.231)] nor location within eloquent brain [OR = 0.96 (-0.04 (-1.48, 1.39), p=0.95)] showed significance. CONCLUSION For the first time, we show that patients with metastatic brain lesions in anatomical regions of vascular overlap treated with GK are less likely to develop RN. Future work should validate these findings with the goal of optimizing radiation dosing to mitigate RN incidence and recurrence rates.

TMIC-30. FOREBRAIN TO HINDBRAIN INVASION IN GLIOBLASTOMA IS DIRECTED BY ANATOMICALLY DISTINCT REACTIVE ASTROCYTES

Abstract Initial detection of glioblastoma (GBM) often reveals a large mass in the forebrain; however, the hazard for many patients lies in extensive invasion that can extend far from the primary tumor. New evidence suggests that end-stage GBM coincides with malignant infiltration of the pons and brainstem. Mechanisms that direct tumor cells from initial positions within the forebrain to terminal positions in the brainstem are largely unknown. Our analysis indicates that spatially defined, reactive astrocytes instruct GBM cells to either proliferate or invade. During development, astrocytes help establish directional gradients and boundaries that mediate proper routing of migrating neural cells and extending axons. We posit that onco-reactive astrocytes re-engage these guidance programs to direct tumor cells to the brainstem. To test this hypothesis, we exposed a series of human GBM models to media conditioned by cortical, midbrain, or brainstem reactive astrocytes. When treated with cortical conditioned media, tumor cells were driven into a state of hyper-proliferation, which mirrored early-stage forebrain tumor generation. In contrast, midbrain and brainstem conditioned medias suppressed proliferation and enhanced the rate of tumor cell migration. RNA sequencing corroborated these functional data, identifying cell division programs augmented in GBM cells exposed to cortical astrocyte conditioned media. This contrasted with axon development and guidance programs enriched in GBM cells exposed to midbrain and especially brainstem conditioned medias. Finally, mRNA and protein analysis identified region-specific engagement with the Eph-ephrin guidance system patterned along a forebrain to hindbrain trajectory. These data support a new hypothesis that GBM tumors recapitulate a form of neurodevelopment, invading specific anatomic regions based on cues generated by resident reactive astrocytes.

Durable improvements in atopic dermatitis in the head and neck and across other anatomic regions with rocatinlimab

In a randomized phase 2b trial (NCT03703102) for adult patients with moderate-to-severe atopic dermatitis (AD), treatment with the T cell rebalancing anti-OX40 receptor antibody rocatinlimab (AMG 451/KHK4083) led to significant improvements in clinical measurements versus placebo including whole-body Eczema Area and Severity Index (EASI) score. AD manifestations can impact variable anatomic regions, and involvement of the head and neck, a sensitive, hard-to-treat area, can negatively impact quality of life. In this post hoc analysis, we investigated response to rocatinlimab treatment across anatomic regions, including the head and neck. Least squares mean change from baseline to Week 56 in EASI score was analyzed by anatomic region (head and neck, trunk, upper extremities, or lower extremities) for patients with baseline moderate-to-severe AD in the respective anatomic region, using mixed models for repeated measures. Rocatinlimab groups were compared with placebo at Week 16. The proportion of patients achieving at least 75% reduction from baseline in EASI (EASI-75) was calculated. Probability of relapsing in EASI-75 during the off-treatment follow-up period (Weeks 36–56) was estimated using a Kaplan − Meier approach. At Week 16, decrease from baseline in mean EASI score was greater with all rocatinlimab regimens versus placebo across all anatomic regions for patients with baseline moderate-to-severe AD in the respective region (all P < 0.001). EASI scores continued to improve on treatment after Week 16 and were maintained during the off-treatment period across all regions. Among patients with baseline moderate-to-severe AD in the head and neck (n = 219; rocatinlimab, n = 174; placebo, n = 45), mean difference (rocatinlimab vs placebo) at Week 16 in LS mean percent change in head and neck EASI score ranged from − 30.4% to − 42.6% across treatment regimens. In patients who received rocatinlimab from the start of the trial, 47% − 71% achieved EASI-75 in the head and neck at Week 36. Among EASI-75 responders at Week 36, the probability of relapsing in EASI-75 in any region was low (< 25% in the head and neck) 20 weeks after treatment discontinuation until Week 56.Rocatinlimab treatment led to durable improvements in AD across multiple anatomic regions, including the sensitive head and neck region.Graphical abstract

Analysis of First Professional Written Short-Answer Questions of Four Public Universities of Bangladesh in Regional Anatomy

Background: Analysis of written question papers may reveal the assessment pattern and teaching- learning method of the undergraduate curriculum. Written examination is the most essential assessment tool in the MBBS curriculum and the subjective knowledge of the undergraduates’ can be well assessed by the written assessment. Therefore, analyses of written question papers may reveal the assessment pattern and teaching learning method of undergraduate curriculum. The present study has assessed the weightage given to the different components of cognitive domain in SAQs in the First Professional MBBS Examination in Regional Anatomy under four public universities of Bangladesh. Objective: To determine the frequencies of question-segments addressing different levels of cognitive domain in the First Professional MBBS written examination in Regional Anatomy of five years (2014-2018) of four public universities of Bangladesh. Methods: This descriptive type of research was conducted in the Department of Anatomy, BSMMU, Dhaka. Anatomy written short-answer questions (SAQs) both paper I and paper II from 2014 to 2018 of four public universities of Bangladesh were analyzed to determine the frequency of ‘question-segment’s addressing different levels of cognitive domain according to undergraduate medical curriculum. Results: On analysis it was found that 91.42% ‘question-segments’ were remember-level and 8.58% were understand-level. No ‘question-segment’ was found that have addressed apply-, analyze-, evaluate- or create-levels of cognitive domain. Conclusion: The research revealed that higher levels of cognitive domain was not addressed properly in the undergraduate written question papers, so, goals of undergraduate curriculum were poorly achieved. Mediscope 2024;11(2): 52-57

How many is enough? Measuring the number of FAST exams needed by emergency medicine trainees to reach competence

BackgroundFor patients with blunt abdominal trauma, the Focused Assessment with Sonography in Trauma (FAST) exam is the initial imaging modality employed to diagnose and risk stratify. A positive FAST exam in this patient population denotes intraperitoneal hemorrhage. In a hemodynamically unstable patient, it necessitates rapid surgical intervention. Ultrasound is highly dependent on the operator’s ability to obtain quality images for interpretation. Failure to obtain adequate images prevents accurate interpretation and reduce its diagnostic accuracy. Previous studies evaluating whether the FAST exam can be improved solely by experience had conflicting results. None of those studies used an objective method to evaluate the FAST exam’s quality. Our study aimed to objectively determine the number of FAST exams required by an emergency medicine (EM) resident to reach sufficient quality for independent scanning.Methods59 first-year EM residents from a single site were included in this study. All FAST exams that were saved in the Qpath archival system by the 59 EM residents, whether the exam was performed for educational or clinical purposes, were reviewed, and scored using a Task-Specific Checklist (TSC) score. This score is an objective way to assess the proficiency and quality of the FAST scan. The TSC was based on whether the imaging of 24 specific anatomic landmarks, split into four anatomic regions, was completed successfully or not. The AEMUS (Advanced EM Ultrasonography) faculty provided feedback to trainees wither electronically via Qpath or at the bedside. According to the quality of ultrasound imaging and competence (QUICK Score), if the average TSC score for the first 10 exams was 18 or higher, the resident was considered an expert. However, if the resident failed to achieve that score, we skipped the first exam performed by the resident and the average score for the second through eleventh exams was then calculated. If the resident did not achieve the desired result, the first and second exams were skipped and the average score for the remaining 10 exams was determined. This sequence was repeated until the resident achieved an average score of 18 or higher on their TSC score.ResultsIn total, 663 FAST scans performed by EM residents were scored. The average number of FAST exams needed for independent scanning is 11.23 (95% CI, 10.6-11.85). 66.1% of enrolled residents achieved an average score of 18 or higher in their first 10 FAST exams, and 33.8% of residents required more than 10 scans. The average scores for the right upper quadrant (RUQ), left upper quadrant (LUQ), pelvic, and subxiphoid views were 5 (95% CI, 4.88–5.1), 4.7 (95% CI, 4.59–4.8), 5.1 (95% CI, 4.96–5.24), and 3.7 (95% CI 3.6–3.8) respectively.ConclusionThis study demonstrated that when constructive feedback on each FAST exam was given, the average first-year emergency medicine resident achieves competency in performing FAST exams independently after completing 10–12 (average of 11.23) FAST exams. Further research is required to validate the findings.

Felid scavenging in forensic taphonomic research: An experimental approach

Animal scavenging on human remains presents a major challenge at a forensic scene. These lasting changes can influence the interpretation of a post-mortem interval, the overall state of the remains and any associated evidence, impacting the integrity of the scene. Therefore, identifying taphonomic related changes due to animal scavenging is important to understand the post-deposition sequence of events. However, knowing where to look is challenging and animal scavenging studies are difficult to create. Therefore, this study worked in collaboration with zoological institutes in the UK to capture the scavenging changes to horse bone, focussing on the locations of scavenging on bone and the characteristics left. This study focused on large felid (cheetah, lion, tiger, leopard) scavenging, which is less documented in comparison to canine scavenging. This research demonstrated the distribution patterns of tooth activity associated with large felid scavenging is consistent with those reported in the taphonomic literature on lions. Specifically, pits, punctures, scalloping and furrowing were found and characteristics were frequently noted at the borders and flat regions of bones. This study adds to the forensic discussion of scavenging. While focussing on large cats, the work demonstrates anatomical regions that may be affected by scavenging and the visual cues that may help identify animal interaction over human.

Is Apical Enlargement with Single Reciprocating Instruments the Key to Success in Endodontic Retreatment?

Modern endodontics has provided significant advancements, particularly in the treatment and retreatment of root canals. However, the complete removal of obturation material during retreatment remains a challenge, especially in the apical third of root canals, where complex anatomy imposes limitations. This study aimed to evaluate the effectiveness of using WaveOne Gold reciprocating instruments of different diameters and kinematics (brushing motion and pecking motion) for removing obturation material from root canals during retreatment, with a particular focus on the apical third. Thirty human maxillary molars with separate roots were selected and divided into four groups. Root canals were prepared and obturated using different WaveOne Gold instruments (Primary and Medium) and then retreated with larger diameter instruments using different kinematics. The removal of obturation material was evaluated through cone beam computed tomography (CBCT). The results were statistically analyzed using ANOVA and logistic regression. Statistical analysis revealed no significant differences between the groups regarding the type of instrument or kinematics applied. Residual obturation material was observed in approximately 60% of the samples, regardless of instrument diameter or kinematics used, indicating that complete removal of obturation material from the apical portion of root canals remains a substantial challenge. The use of larger diameter instruments, such as the WaveOne Gold Medium, and the application of brushing motion kinematics did not prove significantly more effective in removing obturation material compared to smaller diameter instruments. These findings highlight the need to explore new approaches and technologies to optimize obturation material removal, especially in complex anatomical regions like the apical third of root canals.

No Increased Injury Risk on Artificial Turf in Finnish Premier Division Football.

To compare the injury risk between natural grass and artificial turf in the male Finnish premier division (Veikkausliiga) matches during the 2019 league season. A retrospective reanalysis of prospectively collected season-long injury surveillance cohort study. Finnish elite-level male football. All 12 teams of Veikkausliiga participated in the study. All players were eligible to participate. Two hundred thirty-six players took part in the follow-up between February and November 2019. Matches were played between April and November 2019. Injury data were collected using standard injury reports from the team medicals and weekly player questionnaires. Individual player exposure in matches was collected. Artificial turf was classified as exposure and natural grass as control in the analyses. Match-related injury incidence and incidence rate ratios (IRR) with 95% confidence intervals (CI) on natural grass and artificial turf. A total of 113 injuries (65 on artificial turf, 48 on natural grass) in 167 matches (90 on artificial turf, 77 on natural grass) were included. Injury incidence was 27.2/1000 hours on artificial turf and 23.9/1000 hours on natural grass and (IRR, 1.1; 95% CI, 0.8-1.7). There was no difference in injury types, anatomical regions, injury recurrence, injury severity, or injury contact. Forwards may have had an increased injury incidence on artificial turf compared with natural grass (IRR, 3.4; 95% CI, 1.0-11.8). This study supports previous reports that there is no significant increase in the overall risk of injury in professional football played on artificial turf compared with that on natural grass.

Efficiency of infrared pyrometer and infrared thermography for assessing body surface temperature in hair sheep

The objectives of this study were: (i) to verify and compare the coat surface temperature (CST) of regions of interest (ROI) measured through infrared pyrometer (IRP) and thermography (IRT) under two environmental conditions, to evaluate (ii) reliability and (iii) sensitivity of the two infrared equipments to the environmental effect. Twenty hair ewes (Ovis aries), multiparous, non-lactating, non-pregnant, with body weight 59.38 ± 6.23 kg and body score condition ranging from 2.5 to 4.5 were evaluated. All CST, in both infrared methods, were higher (P < 0.001) in the afternoon (2 to 3 p.m.), with the exception of eyes surface temperature (TSEY) from IRT, which was higher (P < 0.001) in the morning (8 to 9 a.m.). Regarding the infrared methods at different times (twice a day, morning and afternoon), of the day, CST values for all ROIs were significantly higher (P < 0.001) in thermography, regardless of the time shift, except for ear pinna surface temperature (TSE) and rectum surface temperature (TSR), which showed no significant difference (P > 0.05) between the infrared methods during the morning shift. The thermal environment significantly influences (P < 0.001) the surface temperature of various anatomical regions in both infrared methods. The correlation coefficients between IRT and IRP were moderate. The IRT is more sensitive to the thermal environment, as it presented higher canonical coefficients in the environmental variables. Among surface temperatures, eye surface temperature is the most influenced by variables in the thermal environment, especially THI. All three methods (digital thermometer-DT, IRT and IRP) showed >80 % of the data variation in the first two components. Using the DT, we observed an association between vaginal temperature (VT) and RT with air temperature (AT) and temperature humidity index (THI), which was similar to the infrared thermography pattern, in which all ROIs were highly correlated with AT and THI. The opposite was observed in the pyrometer, in which an association between eye temperature and RH and lower factor loadings of the other ROIs with AT and THI in the first component was observed. In conclusion, while IRP and IRT showed similar performance in the morning, IRT proved to be more accurate in the afternoon, demonstrating a higher success rate in classifying the group of origin. Therefore, it is concluded that IRT is more reliable than IRP in detecting surface temperature changes under high temperatures.

Prognostic value of gray–white matter ratio measured by brain MRI-based CT structures in comatose patients after cardiac arrest

BackgroundPost-cardiac arrest care advancements have improved resuscitation outcomes, but many survivors still face severe neurological deficits or death from brain injury. Herein, we propose a consistent prognosis prediction approach using magnetic resonance imaging (MRI) to analyze anatomical regions represented by the gray and white matter, and subsequently apply it on computed tomography (CT) to calculate the gray–white matter ratio (GWR). We compared this novel method with traditional measures to validate its ability to predict the prognosis of patients resuscitated after cardiac arrest. MethodsConducted retrospectively at two South Korean tertiary university hospitals from January 2018 to December 2022, the study included adult cardiac arrest survivors treated with therapeutic target temperature management. Patients underwent brain CT within 2 h and brain MRI within 3 days of return of spontaneous circulation. The outcome was the neurological status at discharge. Statistical analyses included receiver operating characteristic curve analysis and determining cutoff values to predict poor neurological outcomes. ResultsOverall, 51 of the 421 adult comatose cardiac arrest survivors examined met the inclusion criteria. Among these, 33 and 18 exhibited good and poor neurological outcomes, respectively. Demographic and cardiac arrest characteristics were compared between the two groups, revealing significant differences. Analyses of gray and white matter attenuation and GWR measurements highlighted significant differences between the good and poor outcome groups. ConclusionOur study introduces a novel method for measuring GWR using MRI-based brain CT, demonstrating superior prognostic accuracy in predicting neurological outcomes in patients with post-cardiac arrest syndrome compared to traditional methods.

OpenMAP-T1: A Rapid Deep-Learning Approach to Parcellate 280 Anatomical Regions to Cover the Whole Brain.

This study introduces OpenMAP-T1, a deep-learning-based method for rapid and accurate whole-brain parcellation in T1-weighted brain MRI, which aims to overcome the limitations of conventional normalization-to-atlas-based approaches and multi-atlas label-fusion (MALF) techniques. Brain image parcellation is a fundamental process in neuroscientific and clinical research, enabling a detailed analysis of specific cerebral regions. Normalization-to-atlas-based methods have been employed for this task, but they face limitations due to variations in brain morphology, especially in pathological conditions. The MALF techniques improved the accuracy of the image parcellation and robustness to variations in brain morphology, but at the cost of high computational demand that requires a lengthy processing time. OpenMAP-T1 integrates several convolutional neural network models across six phases: preprocessing; cropping; skull-stripping; parcellation; hemisphere segmentation; and final merging. This process involves standardizing MRI images, isolating the brain tissue, and parcellating it into 280 anatomical structures that cover the whole brain, including detailed gray and white matter structures, while simplifying the parcellation processes and incorporating robust training to handle various scan types and conditions. The OpenMAP-T1 was validated on the Johns Hopkins University atlas library and eight available open resources, including real-world clinical images, and the demonstration of robustness across different datasets with variations in scanner types, magnetic field strengths, and image processing techniques, such as defacing. Compared with existing methods, OpenMAP-T1 significantly reduced the processing time per image from several hours to less than 90 s without compromising accuracy. It was particularly effective in handling images with intensity inhomogeneity and varying head positions, conditions commonly seen in clinical settings. The adaptability of OpenMAP-T1 to a wide range of MRI datasets and its robustness to various scan conditions highlight its potential as a versatile tool in neuroimaging.

Analyzing Discrepancies and Correlations in Soft and Hard Tissue Asymmetry: A Focused Study on Hemifacial Microsomia and Isolated Microtia.

This study aims to thoroughly investigate the distinctions and relationships between facial hard and soft tissue asymmetry, as well as their variations within different conditions and age groups. This cross-sectional study analyzed pre-treatment computed tomography (CT) images from 120 male patients aged 5 to 12 years with unilateral HFM (Pruzansky-Kaban types I and IIA) or isolated microtia. The 120 patients were categorized into four groups by condition (HFM or isolated microtia) and age (5-7, 8-12 years). Segmentation and extraction of anatomical landmarks were performed using Mimics software, followed by generating root-mean-square (RMS) values for facial asymmetry. Statistical analysis, including the Wilcoxon signed-rank test and Spearman correlation coefficient, was conducted to assess differences and correlations in asymmetry. The study found that soft tissue asymmetry was generally greater than hard tissue asymmetry across all facial regions. The complexity of regional asymmetry correlations increased with age in HFM patients but decreased in isolated microtia patients. Significant correlations between hard and soft tissues were observed within the same anatomical regions, particularly in HFM patients aged 8-12 years. The intricate interplay between hard and soft tissues was observed in HFM and isolated microtia patients. Personalized analysis of the causes of asymmetry in different regions is crucial for the formulation of effective treatment plans. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .