Cross-sectional Surface Area Research Articles

Computed Tomographic Portography with Esophageal Variceal Measurements in the Evaluation of Esophageal Variceal Severity and Assessment of Esophageal Variceal Volume Efficacy

The aim of our study is to evaluate the severity of esophageal varices (EV), based on the computed tomographic portography (CTP) measurement of EV in the distal esophagus and to assess the prediction value of EV volume. A total of 53 EV patients examined by CTP within 4 weeks of upper endoscopy were evaluated, the patients were divided into a nonconspicuous EV group (mild-to-moderate EV, n = 28) and a conspicuous EV group (severe EV, n = 25) according to endoscopy results. The diameter, cross-sectional surface area (CSA), and volume of EV were measured independently using 3D-slicer (Boston) by two experienced abdominal radiologists blinded to endoscopy findings. The averaged values measured by the two observers were used in the final dataset, these indicators' predictive performances were studied by using receiver operating characteristic curve analysis, and the area under the curve (Az) and the cutoff values were calculated to distinguish mild-to-moderate from severe EV. The Az values of volume, diameter and CSA in differentiating severe EV were 0.817, 0.794, and 0.784 for observer-1, corresponding values for observer-2 were 0.796, 0.774, and 0.707, there was almost perfect interobserver agreement for all measurements. All indices were larger in the conspicuous group than the nonconspicuous group in both observers (p ≤ 0.01). In the final dataset, application of a 654.0-mm3-volume criterion yielded sensitivity, specificity of 96%, 50%, application of a 5.2-mm-diameter criterion yielded sensitivity, specificity of 80%, 75%, and application of a 68.6-mm2-CSA criterion yielded sensitivity, specificity of 52%, 93%. The volume of EV could be used as a new effective indictor for evaluating EV, and use of volume, diameter, and CSA of EV based on CTP allows discrimination between mild-to-moderate and severe EV in cirrhotic patients.

Normative ranges of nasal airflow variables in healthy adults.

Virtual surgery planning based on computational fluid dynamics (CFD) simulations of nasal airflow has the potential to improve surgical outcomes for patients with nasal airway obstruction (NAO). Virtual surgery planning requires normative ranges of airflow variables, but few studies to date have quantified inter-individual variability of nasal airflow among healthy subjects. This study reports CFD simulations of nasal airflow in 47 healthy adults. Anatomically accurate three-dimensional nasal models were reconstructed from cone beam computed tomography scans and used for steady-state inspiratory airflow simulations with a bilateral flowrate of 250ml/s. Normal subjective sensation of nasal patency was confirmed using the nasal obstruction symptom evaluation and visual analog scale. Healthy ranges for several CFD variables known to correlate with subjective nasal patency were computed, including unilateral airflow, nasal resistance, airspace minimal cross-sectional area (mCSA), heat flux (HF), and surface area stimulated by mucosal cooling (defined as the area where HF > 50W/m2). The normative ranges were targeted to contain 95% of the healthy population and computed using a nonparametric method based on order statistics. A wide range of inter-individual variability in nasal airflow was observed among healthy subjects. Unilateral airflow varied from 60 to 191ml/s, airflow partitioning ranged from 23.8 to 76.2%, and unilateral mCSA varied from 0.24 to 1.21cm2. These ranges are in good agreement with rhinomanometry and acoustic rhinometry data from the literature. A key innovation of this study are the normative ranges of flow variables associated with mucosal cooling, which recent research suggests is the primary physiological mechanism of nasal airflow sensation. Unilateral HF ranged from 94 to 281W/m2, while the surface area stimulated by cooling ranged from 27.4 to 64.3cm2. These normative ranges may serve as targets in future virtual surgery planning for patients with NAO.

Does Diabetes Mellitus Affect Lumbar Paraspinal Muscle Morphometry

Background: Changes in paraspinal muscle cross-sectional surface area (CSA) have been shown to occur in patients with chronic and acute low back pain. Numerous factors can affect muscle density; however, the relationship between metabolic disease, such as type II diabetes mellitus (DM) and lumbar paraspinal morphometry, has not been examined. Therefore, we set out to compare paraspinal CSA in diabetic patients undergoing lumbar fusion to patients without diabetes. Methods: A retrospective review of 101 patients, who underwent posterior lumbar fusion for degenerative spondylolisthesis, was performed. Data collected included preoperative Oswestry Disability Index, SF-12 physical and mental health scores, and visual analog scale for back pain. Utilizing standard measurement software for the iliocostalis, longissimus, multifidus, and psoas muscles, individual paraspinal muscle CSA was measured on preoperative magnetic resonance imaging. Average CSA measurements were then compared between diabetic and non-diabetic patients utilizing Student’s t-test. Results: Thirteen patients were included in the DM group while 88 composed the non-DM group. There were no differences in age or body mass index between the groups. There were no significant differences in preoperative health-related outcome scores. Average psoas muscle iliocostalis as well as multifidus CSA were not significantly different between the non-DM and DM groups (p=0.09, 0.263, 0.458). The longissimus CSA was significantly decreased in the DM group compared to the non-DM (p=0.004). Conclusions: This study shows that type II DM is associated with decreased paraspinal muscle CSA, but this finding was specific to the longissimus muscle. Our findings suggest that metabolic factors may play an important role in the maintenance of paraspinal muscle balance.

Micellization and Adsorption Properties of New Cationic Gemini Surfactants Having Hydroxyisopropyl Group

A series of cationic gemini surfactants, N,N′-bis(alkyl)-N,N′-bis(2-hydroxypropyl)ethylenediammonium dibromide, [CnH2n+1(CH3CH(OH)CH2)NH(CH2)2NH(CH2CH(OH)CH3)CnH2n+1]Br2 (where n is the tail chain length, n = 9, 12, and 14), referred to as CnC2Cn[iso-Pr(OH)] was synthesized. Via conductometric and tensiometric methods, at different temperatures (283 to 313 K), specific electrical conductivities and surface tensions of the aqueous solutions of these cationic gemini surfactants were determined. According to the obtained values, micellization and adsorption parameters such as critical micellization concentration (CMC), maximum surface excess (Γmax), minimal cross sectional surface area of surfactant polar group (Amin), adsorption efficiency (pC20), surface pressure (π), and binding degree of counterion (β) were calculated. The values of standard Gibbs free energy (ΔG°), enthalpy (ΔH°), and entropy (ΔS°) were also computed. Via the dynamic light scattering method, diameters of aggregates of the synthesized ca...

Novel spiral structured nerve guidance conduits with multichannels and inner longitudinally aligned nanofibers for peripheral nerve regeneration.

Nerve guidance conduits (NGCs) are artificial substitutes for autografts, which serve as the gold standard in treating peripheral nerve injury. A recurring challenge in tissue engineered NGCs is optimizing the cross-sectional surface area to achieve a balance between allowing nerve infiltration while supporting maximum axonal extension from the proximal to distal stump. In this study, we address this issue by investigating the efficacy of an NGC with a higher cross-sectional surface composed of spiral structures and multi-channels, coupled with inner longitudinally aligned nanofibers and protein on aiding nerve repair in critical sized nerve defect. The NGCs were implanted into 15-mm-long rat sciatic nerve injury gaps for 4 weeks. Nerve regeneration was assessed using an established set of assays, including the walking track analysis, electrophysiological testing, pinch reflex assessment, gastrocnemius muscle measurement, and histological assessment. The results indicated that the novel NGC design yielded promising data in encouraging nerve regeneration within a relatively short recovery time. The performance of the novel NGC for nerve regeneration was superior to that of the control nerve conduits with tubular structures. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1410-1419, 2019.

The median to ulnar cross-sectional surface area ratio in carpal tunnel syndrome

ObjectiveTo investigate the use of a sonographic median-to-ulnar cross-sectional area ratio (MUR) in diagnosis of carpal tunnel syndrome (CTS); and to compare the MUR with currently used sonographic parameters, and electrophysiology. MethodsSubjects with CTS and healthy volunteers underwent ultrasound studies of the median and ulnar nerves in the wrist and forearm. Various sonographic parameters and ratios were calculated, and compared between CTS patients and controls. The sensitivity and specificity of the different parameters were compared by plotting receiver operator characteristic curves. Correlations of sonographic results with electrophysiologic studies were calculated. ResultsThe MUR was increased in patients with CTS, in comparison with controls. A cut-point of >2.09 yielded a sensitivity of 86% and specificity of 84%. This was comparable to the currently used ultrasound metrics for CTS. The MUR also correlated with electrophysiologic severity. ConclusionsThe MUR is an effective means of diagnosing CTS and correlates with electrophysiologic severity. SignificanceThis report provides support for the use of the MUR in the sonographic diagnosis of CTS.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P28. Does diabetes mellitus affect lumbar paraspinal muscle morphometry?

BACKGROUND CONTEXT Changes in paraspinal muscle cross-sectional surface area (CSA) have been shown to occur in patients with chronic and acute low back pain. Numerous factors can affect muscle density; however, the relationship between metabolic disease, such as type II diabetes mellitus (DM) and lumbar paraspinal morphometry, has not been examined. Therefore, we set out to compare paraspinal CSA in diabetic patients undergoing lumbar fusion to patients without diabetes. PURPOSE To investigate the association between type II diabetes and lumbar musculature sarcopenia. STUDY DESIGN/SETTING Retrospective cohort. PATIENT SAMPLE Retrospective review of patients with degenerative spondylolisthesis undergoing single-level lumbar fusion. METHODS A retrospective review of 101 patients, who underwent posterior lumbar fusion for degenerative spondylolisthesis, was performed. Data collected included preoperative Oswestry Disability Index (ODI), SF-12 physical and mental health scores, and visual analog scale (VAS) for back pain. Utilizing standard measurement software for the iliocostalis, longissimus, multifidus, and psoas muscles, individual paraspinal muscle CSA was measured on preoperative magnetic resonance imaging (MRI). Average CSA measurements were then compared between diabetic and nondiabetic patients utilizing Student's t-test. RESULTS Thirteen patients were included in the DM group while 88 composed the nonDM group. There were no differences in age or body mass index (BMI) between the groups. There were no significant differences in preoperative ODI, VAS back pain scores, or SF-12 mental or physical health scores. Average psoas muscle CSA was not significantly different between the groups (1091.5 mm2 vs. 938.3 mm2 for nonDM vs. DM, respectively, p=.09). Iliocostalis CSA was 1145.3 mm2 and 1023.5 mm2 for the nonDM and DM groups, respectively (p=.263). The multifidus CSA was 513.4 mm2 and 478.9 mm2 for the nonDM and DM groups, respectively (p=.458). The longissimus CSA was significantly decreased in the DM group, with an average surface area of 574.8 mm2 when compared to, 724.3 mm2 for the nonDM (p=.004). CONCLUSIONS This study is the first to establish that type II DM is associated with decreased paraspinal muscle CSA, but this finding was specific to the longissimus muscle. There is increasing evidence that changes in paraspinal morphometry are implicated in the development of chronic LBP, and our findings suggest that metabolic factors may play an important role in the maintenance of paraspinal muscle balance.

NeuroMorph: A Software Toolset for 3D Analysis of Neurite Morphology and Connectivity

The geometries of axons, dendrites and their synaptic connections provide important information about their functional properties. These can be collected directly from measurements made on serial electron microscopy images. However, manual and automated segmentation methods can also yield large and accurate models of neuronal architecture from which morphometric data can be gathered in 3D space. This technical paper presents a series of software tools, operating in the Blender open source software, for the quantitative analysis of axons and their synaptic connections. These allow the user to annotate serial EM images to generate models of different cellular structures, or to make measurements of models generated in other software. The paper explains how the tools can measure the cross-sectional surface area at regular intervals along the length of an axon, and the amount of contact with other cellular elements in the surrounding neuropil, as well as the density of organelles, such as vesicles and mitochondria, that it contains. Nearest distance measurements, in 3D space, can also be made between any features. This provides many capabilities such as the detection of boutons and the evaluation of different vesicle pool sizes, allowing users to comprehensively describe many aspects of axonal morphology and connectivity.

Nanocomplexes of Magnesium Phenylsiloxanes - Moleculer Structere and Properties

Polyphenylsiloxanes containing magnesium (polymagnesiumphenyl siloxanes) with Si:Mg ratios of 1:1.5 and 1:2 have been synthesized by the exchange reaction in a mixture of benzene (toluene)–dimethyl sulfoxide with yields of 58 and 72%, respectively. The composition and structure of the synthesized polymers have been studied by the methods of positron annihilation spectroscopy (PAS), X-ray diffraction analysis (XRD), 29Si nuclear magnetic resonance (NMR), and infrared spectroscopy (IR). The cross-section surface area (S) (by the Miller–Boyer method) and coherent scattering regions (CSR) volumes have been calculated based on the XRD data. The PAS data allowed calculating the specific volumes of Ps and e+ “traps”. The T3 and T2 signal areas in 29Si NMR spectra enabled us to determine the structure of the unit cell of polymagnesiumphenyl siloxanes (PMgPS). As was demonstrated by the electron microscopy, PMgPSs were in the form of spherical particles of a radius of 50–120 nm. The polymers physical–chemical characteristics were determined from nitrogen adsorption. Based on the specific adsorption area, the radii of spherical particles in a densely packed layer, whose size depends proportionally on the specific polarization potential and the specific area, have been calculated. The calculated size values for spherical particles are similar to those found by the method of electron microscopy. An assumption on a fractal structure of spherical particles has been made on the basis of the calculated data, and data of scanning electron microscopy.

The effects of elevated CO2 on shell properties and susceptibility to predation in mussels Mytilus edulis

For many species, ocean acidification (OA) is having negative physiological consequences on their fitness and resilience to environmental change, but less is known about the ecosystem effects of these changes. Here, we assess how OA conditions predicted for 2100 affects the biological functioning of an important habitat-forming species Mytilus edulis and its susceptibility to predation by a key predator, the gastropod Nucella lapillus. Change in three physiological parameters in Mytilus were assessed: (1) shell thickness and cross-sectional surface area, (2) body volume and (3) feeding rate, as well as susceptibility to predation by N. lapillus. Shell thickness and cross-section area, body volume and feeding rate of Mytilus all reduced under OA conditions indicating compromised fitness. Predation risk increased by ∼26% under OA, suggesting increased susceptibility of mussels to predation and/or altered predator foraging behaviour. Notably, predation of large Mytilus – that were largely free from predation under control conditions – increased by more than 8x under OA, suggesting that body size was no longer a refuge. Our results suggest OA will impact upon ecosystem structure and functioning and the continued provision of ecosystem services associated with Mytilus reefs and the communities associated with them.

An Early Devonian permineralized rhyniopsid from the Battery Point Formation of Gaspé (Canada)

The Emsian deposits of the Battery Point Formation (Gaspe, Canada) host the most diverse Early Devonian flora in North America. While most of this diversity has been described from plant compressions, the permineralized component of the flora is incompletely explored. Based on >15 axes studied in serial sections, we describe a new anatomically preserved rhyniopsid from the Battery Point Formation, Eddianna gaspiana gen. & sp. nov. Eddianna axes are up to 2 mm in diameter and have a well-developed terete xylem strand with potential centrarch maturation (comprising 80% of the cross sectional surface area) that features Sennicaulis-type tracheid wall thickenings. A thin layer interpreted as phloem is preserved around the central xylem and an irregular sclerenchymatous cortex forms longitudinal anastomosing ridges on the outside of the axes. The anatomy of Eddianna axes suggests that they represent lower portions, specialized in efficient water transfer, of a larger plant whose distal regions have yet to be discovered. Eddianna, the first permineralized rhyniopsid described from the Battery Point Formation, is one of only four anatomically preserved plants reported from this unit. These fossils reiterate the potential for additional discoveries of anatomically preserved plants in the Battery Point Formation.

Time-dependent dose distribution changes in prostate brachytherapy with iodine seeds.

115 Background: Prostate brachytherapy with iodine seeds has a lasting dose delivery due to a long half life of I125 (i.e. 2 months). To assess changes in dose metrics over time in low-dose rate prostate brachytherapy with iodine seeds and its relationship with rectal distension. Methods: One hundred and twenty-one post-implant CT scans performed every 2 weeks over 2 months after the treatment procedure were analyzed for dosimetry. Each CT-scan was performed without and with rectal enema. The following rectal parameters were collected to evaluate the influence of rectal distension over time: rectal volume, cross-sectional surface area (CSA) and relative CSA calculated from the first CT-scan chosen as reference (CTref). Results: Mean V150% and V200% of the prostate volume increased significantly over time (p < 0.0001) and were significantly higher on postimplant CT scan performed at day 45 (CT45) (p = 0.024 and p = 0.003, respectively) and CT scan performed at day 60 (CT60) (p = 0.0005 and p < 0.0001, respectively) compared with CTref. All dosimetric parameters for the rectum were significantly increased over time. No rectal parameters were significantly different after rectal enema and there was no difference in doses delivered to the prostate and the rectum after rectal emptying. Conclusions: Increased hot spots in the prostate and the rectum during the 2 months following the procedure with iodine seeds may be related to prostate shrinkage rather than rectal distension. We hypothesize that radioelements with shorter half-life (Pd103 or Cs131) or HDR may give less toxicity, as dose distribution is less time-dependent.

The sarcopenia index: A novel measure of muscle mass in lung transplant candidates.

Frailty, including low muscle mass, is an emerging risk factor for poor outcomes after lung transplant. The sarcopenia index (SI)-(serum creatinine value/cystatin C value)×100-is a novel blood test to approximate muscle mass. We sought to validate SI among lung transplant patients. We retrospectively identified adult lung transplant recipients from 2000 through 2012 at our institution who underwent computed tomography within 1year before transplant and had preserved blood samples. Creatinine and cystatin C values were measured using the samples and used to calculate SI. Muscle mass was estimated by computed tomographic measurement of skeletal muscle cross-sectional surface area (SA) at the L1 to L3 vertebral levels. Correlation between SI and SA was evaluated. Of 28 patients meeting eligibility criteria, most were white (96%) and men (54%). Median (interquartile range) body mass index, SI, and SA were 25.9 (22-30) kg/m2 , 106 (91-119), and 157 (113-195) cm2, respectively. The Pearson correlation coefficient between SI and SA was significant at L2 (0.43; P=.02) and L3 (0.41; P=.03). Sarcopenia index is a potentially objective measure for estimating muscle mass that is noninvasive and less expensive. Sarcopenia index could be considered in lung transplant candidate selection following prospective validation in larger cohorts.

At harvest prediction of the susceptibility of potato varieties to blackspot after impact over long-term storage

The paper presents a prediction method of the susceptibility blackspot damage after impact of potato varieties for three- and seven-month storage of potato tubers at a temperature of 4 °C based on the geometric parameter of the microstructure of tuber parenchyma determined at harvest. Similar sized and shaped potato tubers of twenty eight cultivars harvested in 2012 and 2013 were analysed. Analyses of the tuber parenchyma microstructure were carried out using an optical confocal microscope for ten tubers of each variety. Cylindrical samples with a thickness of 1 mm and a diameter of 10 mm were collected from the perimedullary zone. Microscopic images of the structure were analysed. The size parameter of the cell cross-section surface area was determined two days after harvest, and the susceptibility of each variety to blackspot after impact was assessed after three and seven months of storage. The mean post-harvest size of the tuber parenchyma cells and the susceptibility to blackspot during storage are related. Tubers of varieties with smaller cells of the perimedullary zone tissue exhibited greater blackspot susceptibility during storage.

Quantification of volumetric, surface area and linear airway changes after orthognathic surgery: a preliminary study.

PurposeThe aim of this study was to conduct a retrospective evaluation of the volumetric, cross-sectional surface area and the linear airway changes in healthy subjects undergoing orthognathic surgery.Materials and methodsA total of 10 patients were included in this study and categorized into two groups. The first group consisted of five patients who underwent maxillary and mandibular advancements (MMA) with genioplasty. The remaining five patients who underwent maxillary advancement with mandibular setback (MAMS) comprised the second group. The changes in airway volume, surface area, and linear values obtained from defined hard and soft tissue parameters were evaluated using preoperative and postoperative cone-beam computed tomography. A paired t-test was used to explore the statistical significance.ResultsA statistically significant increase in the airway volume (34.3%) was observed in the MMA group. The changes in the MAMS group were not statistically significant, although an average volumetric decrease of 8.8% was observed. The minimal axial surface area measurements in the MMA group at the levels of the soft palate and the tongue were significantly increased (56.8% and 44.9%, respectively). However, MAMS resulted in no significant changes at these levels (11.2% and 9.1% decrease, respectively). Linear changes showed a statistically significant increase in the airway in the MMA group, whereas the same measurements failed to produce significant changes in the MAMS group.ConclusionAs there were no significant changes in the measured parameters, surgeons can have greater confidence that MAMS does not have any negative influence on the airway.

Motor and sensory morbidity associated with the anterolateral thigh perforator free flap.

To quantify changes in motor function, sensation, and lower extremity quality of life following anterior lateral thigh free flap (ALT) resection. This mixed methods study contained both a prospective cohort arm (n = 20) and retrospective cross-sectional arm (n = 20). In both arms, patients underwent formal motor and sensation testing of the ipsilateral and contralateral thigh by sphygmomanometry and monofilament testing. In the prospective arm, data was collected preoperatively and at the 6-month and 1-year follow-up visits. In the retrospective arm, consecutive patients with a minimum of 6-month postoperative follow-up were enrolled. Postoperatively, 82% of participants endorsed some degree of numbness and tingling at the donor site. On monofilament testing, patients from the prospective arm showed decreased sensibility of the midthigh at both the 6- and 12-month assessment (P < 0.01). Two-point discrimination scores were moderately correlated with the cross-sectional surface area of the flap. Donor thighs demonstrated a similar peak isometric quadriceps contraction (retrospective [retro]: 47 ± 24 mmHg, prospective [pro]: 90 ± 36 mmHg) to the unoperated thighs (retro: 43 mmHg ± 22, pro: 69 ± 35.3 mmHg, P = 0.49). When stratified by perforator anatomy, no significant differences were noted. Subjective donor site morbidity measured with the lower extremity function scale demonstrated no statistically significant difference between the preoperative and 12-month postoperative assessment. The ALT flap offers minimal donor site morbidity. Reduced sensibility of the ALT flap is a common complaint among patients. Quadriceps strength is not significantly affected by an ALT free flap harvest. 4. Laryngoscope, 128:1057-1061, 2018.

Maintenance of Distal Intestinal Structure in the Face of Prolonged Fasting: A Comparative Examination of Species From Five Vertebrate Classes.

It was recently shown that fasting alters the composition of microbial communities residing in the distal intestinal tract of animals representing five classes of vertebrates [i.e., fishes (tilapia), amphibians (toads), reptiles (leopard geckos), birds (quail), and mammals (mice)]. In this study, we tested the hypothesis that the extent of tissue reorganization in the fasted distal intestine was correlated with the observed changes in enteric microbial diversity. Segments of intestine adjacent to those used for the microbiota study were examined histologically to quantify cross-sectional and mucosal surface areas and thicknesses of mucosa, submucosa, and tunica muscularis. We found no fasting-induced differences in the morphology of distal intestines of the mice (3days), quail (7days), or geckos (28days). The toads, which exhibited a general increase in phylogenetic diversity of their enteric microbiota with fasting, also exhibited reduced mucosal circumference at 14 and 21 days of fasting. Tilapia showed increased phylogenetic diversity of their enteric microbiota, and showed a thickened tunica muscularis at 21 days of fasting; but this morphological change was not related to microbial diversity or absorptive surface area, and thus, is unlikely to functionally match the changes in their microbiome. Given that fasting caused significant increases and reductions in the enteric microbial diversity of mice and quail, respectively, but no detectable changes in distal intestine morphology, we conclude that reorganization is not the primary factor shaping changes in microbial diversity within the fasted colon, and the observed modest structural changes are more related to the fasted state. Anat Rec, 300:2208-2219, 2017. © 2017 Wiley Periodicals, Inc.

Proposal of a new radiological classification system for spinal meningiomas as a descriptive tool and surgical guide

Objectives1) To provide neurosurgeons and radiologists with a new quantitative and anatomical method to describe spinal meningiomas (SM) consistently.2) To provide a guide to the surgical approach needed and amount of bony resection required based on the proposed classification.3) To report the distribution of our 58 cases of SM over different Stages and Subtypes in correlation to the surgical treatment needed for each case.4) To briefly review the literature on the rare non-conventional surgical corridors to resect SM. Patients and methodsWe reviewed the literature to report on previously published cohorts and classifications used to describe the location of the tumor inside the spinal canal. We reviewed the cases that were published prior showing non-conventional surgical approaches to resect spinal meningiomas. We proposed our classification system composed of Staging based on maximal cross-sectional surface area of tumor inside canal, Typing based on number of quadrants occupied by tumor and Subtyping based on location of the tumor bulk to spinal cord. Extradural and extra-spinal growth were also covered by our classification. We then applied it retrospectively on our 58 cases. Results12 articles were published illustrating overlapping terms to describe spinal meningiomas. Another 7 articles were published reporting on 23 cases of anteriorly located spinal meningiomas treated with approaches other than laminectomies/laminoplasties. 4 Types, 9 Subtypes and 4 Stages were described in our Classification System. In our series of 58 patients, no midline anterior type was represented. Therefore, all our cases were treated by laminectomies or laminoplasties (with/without facetectomies) except a case with a paraspinal component where a costotransversectomy was needed. ConclusionSpinal meningiomas can be radiologically described in a precise fashion. Selection of surgical corridor depends mainly on location of tumor bulk inside canal.

Endoscopic Suturing of the Gastric Pylorus to Delay Gastric Emptying and Treat Obesity: A Pilot Study in Obese Patients: 2017 Presidential Poster Award

Introduction: Obesity is increasingly in prevalence in the United States and is commonly associated with many serious medical conditions including cardiovascular disease, diabetes, hypertension, osteoarthritis and sleep apnea. The primary treatment objective for obese patients is weight reduction. Even moderate weight loss produces significant health benefits and has been associated with marked reductions in the health risk. Methods: We enrolled consecutive patients who were referred for endoscopic therapeutic procedures for the treatment of obesity. A total of 7 patients were enrolled. Patient's weight and BMI were measured preprocedure and repeated every 4 weeks post-procedure for a total duration of 24 weeks. A gastric emptying scan was also performed prior to and 4 weeks after the suturing procedure. Steps of suturing procedure: An endoscope with a mounted suturing device (Apollo OverStitch) was advanced through an over-tube to the pylorus. One to two sutures were placed at the 2 O'clock and 4 O'clock position to narrow the pylorus by approximately 50%. The sutures are secured using suture anchors. EndoFLIP® was used just before and immediately after the procedure to measure the change in pyloric cross sectional surface area (CSA). Results: There was a significant decrease in weight (223.71lbs±13.69, 216.57lbs±13.88 p=0.01) and BMI (36.80±1.91, 35.50 ± 2.05, p=0.003) at 4 weeks. There was a significant decrease in CSA of the pylorus immediately after the pyloric suturing procedure (258mm2 ±16, 80.93 mm2 ±4.43, p < 0.001). There was a significant decrease in gastric emptying at 2 hours pre and post pyloric suturing (30.97±2.87, 47.47±7.38, p < 0.049). However, upon repeat endoscopy at 12 weeks the sutures were no longer in place and the CSA of the pylorus had returned to the preprocedure values. After 4 weeks, subjects started to regain weight; both weight and BMI returned towards preprocedure values. The study was terminated prior to full enrollment because of the lack of observed durability. Conclusion: The concept of pyloric suturing to narrow the pylorus to treat obesity is a novel and effective therapy. However, due to technical limitations (suture anchors can hold only up to 4 pounds and appear to let go over time) the sutures pulled out of the pyloric muscle after 4 weeks. We anticipate that changing the suture anchor, may allow for long term durability.

Calretinin interneuron density in the caudate nucleus is lower in autism spectrum disorder.

Autism spectrum disorder is a debilitating condition with possible neurodevelopmental origins but unknown neuroanatomical correlates. Whereas investigators have paid much attention to the cerebral cortex, few studies have detailed the basal ganglia in autism. The caudate nucleus may be involved in the repetitive movements and limbic changes of autism. We used immunohistochemistry for calretinin and neuropeptide Y in 24 age- and gender-matched patients with autism spectrum disorder and control subjects ranging in age from 13 to 69 years. Patients with autism had a 35% lower density of calretinin+ interneurons in the caudate that was driven by loss of small calretinin+ neurons. This was not caused by altered size of the caudate, as its cross-sectional surface areas were similar between diagnostic groups. Controls exhibited an age-dependent increase in the density of medium and large calretinin+ neurons, whereas subjects with autism did not. Diagnostic groups did not differ regarding ionized calcium-binding adapter molecule 1+ immunoreactivity for microglia, suggesting chronic inflammation did not cause the decreased calretinin+ density. There was no statistically significant difference in the density of neuropeptide Y+ neurons between subjects with autism and controls. The decreased calretinin+ density may disrupt the excitation/inhibition balance in the caudate leading to dysfunctional corticostriatal circuits. The description of such changes in autism spectrum disorder may clarify pathomechanisms and thereby help identify targets for drug intervention and novel therapeutic strategies.