Early Volume Research Articles

An analysis of early volume resuscitation and the association with prolonged mechanical ventilation.

Previous studies have found that intravenous fluid administration within the first 24 h may be associated with prolonged mechanical ventilation (PMV). We examined the association between initial 24 h fluids and PMV in combat casualties. This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry (DODTR). We included casualties with at least 24 h on the ventilator and no significant traumatic brain injury. The definition of PMV and associations were constructed using univariable and multivariable logistic regression models. We identified 1508 casualties available for analysis for this study - 1275 in the non-PMV cohort (<9 days on ventilator vs. 233 in the PMV cohort (≥9 days on ventilator). Explosives comprised the most common mechanism of injury for both groups (72% vs. 75%) followed by firearms (21% vs. 16%). The composite injury severity score (ISS) was lower in the non-PMV cohort (18 vs. 30, p < .001). There were lower volumes of all resuscitation fluid within the first 24 h in the non-PMV cohort. When adjusting for composite ISS and mechanism of injury in a multivariable logistic regression model with PMV as the outcome, crystalloid volume (unit odds ratio [UOR] 1.07) and colloid volume (UOR 1.03) were both associated with PMV. We found that volume of resuscitation fluids were substantially higher in the PMV cohort. Our findings suggest the need for caution with the routine use of crystalloid and colloid in the first 24 h of resuscitation.

Concurrent mutations of germline GPR101 and somatic USP8 in a pediatric giant pituitary ACTH adenoma: a case report

BackgroundCushing’s disease (CD) is rare in pediatric patients. It is characterized by elevated plasma adrenocorticotropic hormone (ACTH) from pituitary adenomas, with damage to multiple systems and development. In recent years, genetic studies have shed light on the etiology and several mutations have been identified in patients with CD.Case presentationA girl presented at the age of 10 years and 9 months with facial plethora, hirsutism and acne. Her vision and eye movements were impaired. A quick weight gain and slow growth were also observed. Physical examination revealed central obesity, moon face, buffalo hump, supra-clavicular fat pads and bruising. Her plasma ACTH level ranged between 118 and 151 pg/ml, and sella enhanced MRI showed a giant pituitary tumor of 51.8 × 29.3 × 14.0 mm. Transsphenoidal pituitary debulk adenomectomy was performed and immunohistochemical staining confirmed an ACTH-secreting adenoma. Genetic analysis identified a novel germline GPR101 (p.G169R) and a somatic USP8 (p. S719del) mutation. They were hypothesized to impact tumor growth and function, respectively.ConclusionsWe reported a rare case of pediatric giant pituitary ACTH adenoma and pointed out that unusual concurrent mutations might contribute to its early onset and large volume.

Science and Business Developments

Science and Business Developments

Early Thyroid Volume Reduction in Subacute Thyroiditis Can be a Potential Indicator for Hypothyroidism.

BackgroundThyroid volume has been reported to decrease significantly after episodes of subacute thyroiditis (SAT); however, the relationship between thyroid volume and hypothyroidism remains unclear. This study assessed the association between thyroid volume changes and the hypothyroid phase in patients with SAT, a condition that can progress to persistent hypothyroidism.MethodsThis retrospective study evaluated 37 patients diagnosed with SAT at the Department of Endocrinology and Metabolism of Chonnam National University Hwasun Hospital (CNUHH) between 2016 and 2021. Since we could not determine the clinical characteristics of patients with SAT before their episodes, 120 healthy individuals who underwent thyroid ultrasonography during regular check-ups from 2019 to 2021 at CNUHH were selected for comparison. Subgroup analyses were performed on patients with SAT with and without the hypothyroid phase during their clinical course.ResultsThyroid volume was significantly greater in SAT patients at the first visit than in controls (p<0.05), and it decreased constantly throughout the follow-up period. Subgroup analysis showed that the initial thyroid volumes were similar in patients with SAT with and without the hypothyroid phase. However, SAT patients with the hypothyroid phase had significantly smaller thyroid volumes at the 1 month (p=0.025) and 3 month (p=0.006) follow-up visits. The reduction rate of the thyroid volume was significantly different within the first month (p=0.009).ConclusionA greater reduction in thyroid volume in SAT patients within 1 month of episode had a higher chance of developing a subsequent hypothyroid phase, which can lead to persistent hypothyroidism. Serial thyroid ultrasonography in patients with SAT, especially within the first month, may help in predicting the disease course of SAT.

Associations between Mitral Annular and Left Atrial Volume Changes in Healthy Adults-Detailed Analysis from the Three-Dimensional Speckle-Tracking Echocardiographic MAGYAR-Healthy Study.

Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) is one of the newest development in non-invasive imaging offering simultaneous 3D evaluation of atria and valvular annuli. 3DSTE was used to analyze correlations between left atrial (LA) volume changes and mitral annular (MA) dimensions and functional properties in healthy adult subjects. A total of 297 healthy subjects were enrolled in this retrospective cohort study, from which insufficient quality of images was responsible for the exclusion of 98 cases (33%). The remaining study population consisted of 199 healthy adults without valvular regurgitation/stenosis in sinus rhythm (mean age: 33.5 12.7 years, 104 males, body mass index: 24.7 1.2 kg/ , systolic and diastolic blood pressure: 118.2 3.4 mmHg and 78.3 4.5 mmHg, respectively). Two-dimensional Doppler echocardiography and 3DSTE were performed in all cases. Larger LA volumes were associated with more dilated MA dimensions with its reduced function. Elevated LA stroke volumes could be demonstrated only in systole and end-diastole, while increased LA emptying fraction was present only in end-diastole. Reduced MA fractional area change was associated with larger diastolic LA volumes, smaller early diastolic LA stroke volume, in addition all LA emptying fractions were smaller as well. Correlations could be demonstrated between LA and MA parameters. 3DSTE is suitable not only for chamber quantifications, but also for the assessment of valvular annular dimensions. Strong relationship exists between LA volumes and MA dimensions and functional properties.

Duration of Ischemia Affects Outcomes Independent of Infarct Size in Stroke.

Delays in endovascular reperfusion for patients with large vessel occlusion stroke are known to worsen outcomes, and the mechanism is believed to be time-dependent expansion of the ischemic infarction. In this study, we hypothesize that delays in onset to reperfusion (OTR) assert an effect on outcomes independent of effects of final infarct (FI). We performed a subgroup analysis from the prospective multicenter COMPLETE (International Acute Ischemic Stroke Registry With the Penumbra System Aspiration Including the 3D Revascularization Device; Penumbra, Inc) registry for 257 patients with anterior circulation large vessel occlusion who underwent endovascular therapy with successful reperfusion (modified treatment in cerebral infarction score 2b/3). FI was measured by Alberta Stroke Program Early CT score and volume on 24- to 48-hour computed tomography or magnetic resonance imaging. The likelihood of 90-day good functional outcome (modified Rankin scale 0-2) was assessed by OTR and absolute risk difference (ARD) was estimated using multivariable logistic regressions adjusting for patient characteristics including FI. In univariable analysis, longer OTR was associated with a decreased likelihood of good functional outcome (ARD -3% [95% CI -4.5 to -1.0]/h delay). In multivariable analysis accounting for FI, the association between OTR and functional outcome remained significant (ARD -2% [95% CI -3.5 to -0.4]/h delay) with similar ARD. This finding was maintained in the subset of patients with FI imaging using CT only, using Alberta Stroke Program Early CT Score or volumetric FI measurements, and also in patients with larger versus smaller FIs. The impact of OTR on outcomes appears to be mostly through a mechanism that is independent of FI. Our findings suggest that although the field has moved toward imaging infarct core definitions of eligibility for endovascular treatment, time remains an important predictor of outcome, independent of infarct core.

Decreasing tracheal system volume during intermolt development in grasshoppers

One major reason for the evolutionary success of insects is their unique tracheal respiratory system. However, during development when oxygen demands are high, the tracheal system may not be able to deliver adequate oxygen to the tissues. For example, in developing American locusts (Schistocerca americana), body mass can double during the intermolt period. Also during the intermolt period, jumping performance decreases while jumping muscle lactate production increases, suggesting increased oxygen delivery problems at the end of the instar. We hypothesized that decreased oxygen delivery during the instar is due to increasing body mass within the rigid exoskeleton compressing the air‐filled tracheal system. To test this hypothesis, we identified early and late female sixth instar S. americana. Similar to previous work, body mass increased during the instar from 0.73g to 1.3g (78% increase) while femur length remained constant at 19.3mm. Using a Bruker SkyScan1272 micro‐computed tomography (uCT) system, we scanned early and late sixth instars (n=5). uCT image (TIF) files were reconstructed using NRecon and the tracheal system was segmented using Amira 3D and Biomedisa. Total body and tracheal volumes were analyzed using Amira 3D. Although total body volume increased by 53% during the instar, tracheal volume decreased by 145%. Early instar tracheal volume was 0.31 mL, while late instar tracheal volume was 0.05 mL. Therefore, the relative proportion of tracheal volume to body volume ratio decreases from 44% to 5.2% during the instar. Our finding that tracheal volume decreases during the intermolt period supports previous work showing that late stage grasshoppers rely more on anaerobic metabolism during repeated jumping.

Early volume loss of skeletal muscle after esophagectomy: a risk for late-onset postoperative pneumonia.

Late-onset postoperative pneumonia (LOPP) after esophagectomy is poorly understood. This study was designed to clarify the features and risk factors for this event. Patients who underwent esophagectomy for esophageal cancer between 2006 and 2016 were included. LOPP was defined as radiologically proven pneumonia that occurred over 3months after surgery, and clinically relevant late-onset postoperative pneumonia (CR-LOPP) was defined as LOPP that required administration of oxygen and antibiotics in the hospital and/or more intensive treatment. The total psoas muscle area (TPA) was measured using preoperative and postoperative (at 3months after surgery) computed tomography scan images. Potential risk factors for CR-LOPP were investigated. Among 175 study patients, 46 (26.3%) had LOPP, 29 (16.6%) of whom exhibited CR-LOPP with a cumulative incidence of 15.6% at 3years and 22.4% at 5years. Four (13.8%) of these patients died of LOPP. Univariable analysis showed that clinical stage ≥III (P = 0.005), preoperative prognostic nutritional index (PNI) <45 (P = 0.035), arrhythmia (P = 0.014), postoperative hospital stay ≥40days (P = 0.003), and percent decrease of TPA more than 5% (P < 0.001) were associated with CR-LOPP but not early onset postoperative pneumonia. Multivariable analysis revealed that clinical stage ≥III (hazard ratio [HR] 3.01, P = 0.004), postoperative hospital stay ≥40days (HR 2.51, P = 0.015), and percent decrease of TPA >5% (HR 9.93, P < 0.001) were independent risk factors for CR-LOPP. CR-LOPP occurred in over 20% of patients at 5years, and early postoperative loss of TPA was a potential trigger for this delayed complication.

Telemedicine in Neurosurgery During the COVID-19 Outbreak: Where We Are 1 Year Later

BackgroundTelemedicine use skyrocketed in March 2020 on implementation of shelter-in-place measures owing to the coronavirus disease 2019 (COVID-19) pandemic. Within the past year, shelter-in-place measures were lifted and the COVID-19 vaccine was released, resulting in many neurosurgeons returning to in-person outpatient clinics. This study aimed to determine the extent of usage of telemedicine in neurosurgery 1 year into the COVID-19 pandemic.MethodsA retrospective cohort study of patients who received neurosurgical care at a single institution from February 1 to April 18 of the years 2020 and 2021 was performed. The inclusion criteria were met by 11,592 patients. During the 2 study periods, 1465 patients underwent surgery, 7083 were seen in clinic via an in-person meeting, and 3044 were assessed via telemedicine.ResultsAt 1 year after the COVID-19 outbreak, telemedicine usage was at 81.3% of the initial volume on implementation of shelter-in-place measures. In-person outpatient visits increased 40.2% from the early pandemic volume. Among the 4 neurosurgery divisions, telemedicine usage remained high in tumor and functional neurosurgery, significantly increased in vascular neurosurgery, and decreased in spine neurosurgery.ConclusionsTelemedicine use in neurosurgery clinics continues 1 year after the COVID-19 outbreak. Even after the lifting of shelter-in-place measures, many neurosurgeons still use telemedicine, while the operative volume remains stable. Owing to the limited physical examination that can be performed via current telemedicine platforms, telemedicine use in spine neurosurgery is lower than peak use during the early pandemic, while use has remained high among tumor, vascular, and functional neurosurgery.

National Institutes of Health Stroke Scale Correlates Well with Initial Intracerebral Hemorrhage Volume

The US Centers for Medicare and Medicaid Services (CMS) currently publicly reports hospital-quality, risk-adjusted mortality measure for ischemic stroke but not intracerebral hemorrhage (ICH). The NIHSS, which is captured in CMS administrative claims data, is a candidate metric for use in ICH risk adjustment and has been shown to predict clinical outcome with accuracy similar to the ICH Score. Correlation between early NIHSS and initial ICH volume would further support use of the NIHSS for ICH risk adjustment. Among 372 ICH patients enrolled in a large multicenter trial (FAST-MAG), the relation between early NIHSS and early ICH volume was assessed with correlation and linear trend analysis. Overall, there was strong correlation between NIHSS and ICH volume, r=0.77 (p<0.001), and for every 10cc increase in ICH the NIHSS increased by 4.5 points. Correlation coefficients were comparable in all subgroups, but magnitude of NIHSS increase with ICH unit volume increase was greater with left than right hemispheric ICH, with presence rather than absence of IVH, with imaging done within the first hour than second hour after last known well, with men than women, and with younger than older patients. Early NIHSS neurologic deficit severity values correlate strongly with initial ICH hematoma volume. As with ischemic stroke, lesion volume increases produce greater NIHSS change in the left than right hemisphere, reflecting greater NIHSS sensitivity to left hemisphere function. These findings provide further support for the use of NIHSS in risk-adjusted mortality measures for intracerebral hemorrhage.

Simulating phosphorus leaching from two agricultural soils as affected by different rates of phosphorus application based on the geochemical model PHREEQC.

Phosphorus (P) leaching from agricultural soils, in consequence of long-term utilization of P fertilizers, decreases the water quality and leads to eutrophication. The effect of monopotassium phosphate (MKP) at the rates of 0, 50, 200, 400, and 800mg P kg-1 on P and certain cations leaching from two agricultural soils (loam and sandy loam soils) was investigated in a laboratory study. Soil treatments were packed in columns with 5cm in diameter, up to 10cm. Soil columns were leached using distilled water solution for 20 pore volumes, and the leachates were analyzed for pH, electrical conductivity (EC), calcium (Ca), sodium (Na), potassium (K), and P. To simulate the concentrations of K and P in leachates, the PHREEQC model was utilized. In addition, the P vertical distribution in different depths of the soil columns after the leaching experiment was investigated using Olsen-extractable P (Olsen-P). Generally, as the MKP rates increased, the mean(mean of 20 pore volumes) value of pH and Ca concentration in leachates decreased, but the mean value of EC, Na, and K concentrations in leachates increased. In early pore volumes, the P concentration in all treatments begins to rise, then begins to fall. The application of different rates of MKP fertilizer increased the cumulative amount of P leached in both studied soils. Significant relations were obtained for the rates of MKP application and the cumulative amount of P leached. Overall, the model did a good job of simulating K and P concentrations in leachates, as well as the trend of K and P leaching. In both treated soils with increasing of fertilizer rates, the Olsen-P status in all depths increased, and the P content increased with depth. The Olsen-P contents before the leaching experiment for each treatmentwere predicted, and power equations significantly described its relation with mean P concentration in leachates. Higher application rates of MKP (400 and 800mg P kg-1) resulted in much higher P concentrations in leachates than the threshold value (0.1mgl-1), and these rates should not be used in agricultural soils, whereas applying 50mg P kg-1 to agricultural soil could be a reasonable rate for preventing P losses.

Embryonic and early postnatal cranial bone volume and tissue mineral density values for C57BL/6J laboratory mice.

BackgroundLaboratory mice are routinely used in craniofacial research based on the relatively close genetic relationship and conservation of developmental pathways between humans and mice. Since genetic perturbations and disease states may have localized effects, data from individual cranial bones are valuable for the interpretation of experimental assays. We employ high‐resolution microcomputed tomography to characterize cranial bones of C57BL/6J mice at embryonic day (E) 15.5 and E17.5, day of birth (P0), and postnatal day 7 (P7) and provide estimates of individual bone volume and tissue mineral density (TMD).ResultsAverage volume and TMD values are reported for individual bones. Significant differences in volume and TMD during embryonic ages likely reflect early mineralization of cranial neural crest‐derived and intramembranously forming bones. Although bones of the face and vault had higher TMD values during embryonic ages, bones of the braincase floor had significantly higher TMD values by P7.ConclusionsThese ontogenetic data on cranial bone volume and TMD serve as a reference standard for future studies using mice bred on a C57BL/6J genetic background. Our findings also highlight the importance of differentiating “control” data from mice that are presented as “unaffected” littermates, particularly when carrying a single copy of a cre‐recombinase gene.

Abstract WP78: National Institutes Of Health Stroke Scale Correlates Well With Initial Intracerebral Hemorrhage Volume

Introduction: The US Centers for Medicare and Medicaid Services (CMS) currently publicly reports hospital-quality, risk-adjusted mortality measure for ischemic stroke but not intracerebral hemorrhage (ICH). The NIHSS, which is captured in CMS administrative claims data, is a candidate metric for use in ICH risk adjustment and has been shown to predict clinical outcome with accuracy similar to the ICH Score. Correlation between early NIHSS and initial ICH volume would further support use of the NIHSS for ICH risk adjustment. Methods: Among consecutive ICH patients enrolled in a large multicenter trial (FAST-MAG), the relation between early NIHSS and early ICH volume was assessed with correlation and linear trend analysis, in all patients and separately in; left vs right; IVH-positive vs IVH-negative, hyperacute (≤60min) vs acute (61-120min) imaging; men vs women; and younger (&lt;65y) vs older (≥65y). Results: Among 372 patients with ICH, age was 65y (SD 13), 67% were men, early NIHSS was 16 (IQR 9-25) and initial ICH volume was 14.9 cc (IQR 6.1-36.4). Overall, there was substantial correlation between NIHSS and ICH volume, r=0.77 (p&lt;0.001), and for every 10cc increase in ICH the NIHSS increased by 4.5 points. Correlations remained substantial and similar in all subgroups (Table), but magnitude of NIHSS change with ICH volume alteration varied, including greater NIHSS change with ICH unit volume increase in left than right hemisphere, absence of IVH, earlier (≤60min) than later presentation (61-120min), men than women, and younger than older patients (Table). Conclusion: Early NIHSS deficit severity values correlate strongly with initial ICH hematoma volume. As with ischemic stroke, lesion volume increases produce greater NIHSS changes in the left than right hemisphere, reflecting greater NIHSS sensitivity to left hemisphere function. These findings provide further support for the use of the NIHSS in risk-adjusted mortality measures for intracerebral hemorrhage.

Early Brain Volume Changes After Stroke: Subgroup Analysis From the AXIS-2 Trial.

Background and PurposeThe evolution of total brain volume early after stroke is not well understood. We investigated the associations between age and imaging features and brain volume change in the first month after stroke.MethodsWe retrospectively studied patients with acute ischemic stroke enrolled in the AXIS-2 trial. Total brain volume change from hyperacute MRI data to the first month after stroke was assessed using unified segmentation in SPM12. We hypothesized that age, ischemic brain lesion size, and white matter (WM) changes were associated with larger brain volume change. Enlarged perivascular spaces (EPVSs) and white matter hyperintensities (WMHs) were rated visually and the presence of lacunes was assessed.ResultsWe enrolled 173 patients with a mean age of 67 ± 11 years, 44% were women. There was a median 6 ml decrease in volume (25th percentile −1 ml to 75th percentile 21 ml) over time, equivalent to a median 0.5% (interquartile range [IQR], −0.07%−1.4%), decrease in brain volume. Age was associated with larger brain volume loss (per 10 years of age, 5 ml 95% CI 2–8 ml). Baseline diffusion weighted imaging (DWI) lesion volume was not associated with greater volume loss per 10 ml of lesion volume, change by 0 ml (95% CI −0.1 to 0.1 ml). Increasing Fazekas scores of deep WMH were associated with greater tissue loss (5 ml, 95% CI 1–10 ml).ConclusionsTotal brain volume changes in a heterogenous fashion after stroke. Volume loss occurs over 1 month after stroke and is associated with age and deep WM disease. We did not find evidence that more severe strokes lead to increased early tissue loss.

Automated segmentation analysis of 3DUS placental volumes yields an early biomarker of fetal growth potential

Placental volume (PV), obtained by 3D ultrasound (3DUS) as early as the first trimester, have been associated with fetal growth outcomes, such as small for gestational age and macrosomia. However, significant, manual post-processing is generally required to obtain a volume measure, limiting the potential for PV to serve a clinical role. Recently, we have developed and validated an automated segmentation algorithm, based on convolutional neural networks that can calculate PV without any manual input. Herein, we sought to determine if automated early PV measures are associated with birthweight and neonatal anthropometric measures of fat deposition. In this prospective cohort, 3DUS volume sets of the placenta were obtained at 11-16 weeks gestation and followed to delivery. Neonatal birth weight (BW) and centile (BW%) were recorded. When feasible, trained research staff obtained neonatal length (BL), head (HC), abdominal (AC), right upper mid arm (RAC) circumferences within 48 hours of birth. 3DUS volumes were processed using the automated segmentation algorithm to yield a PV measure, which was then normalized to gestational age (PVGA). Data was analyzed to determine any associations between PV and PVGA with neonatal measures. 96 singleton pregnancies were included with a mean PV of 91.6 (SD:28.8) cc obtained at a mean GA of 13.9 (1.04) wks. Mean GA at delivery was 38.7(1.6) wks with mean BW of 3122 (528) gm. PV and PVGA were both significantly correlated with BW and BW%. 52 subjects underwent neonatal anthropometry. PV and PVGA were significantly correlated with neonatal BL, HC, and RAC. Table. This study demonstrates that an automated segmentation tool that estimated early placental volume can yield an early biomarker of fetal growth potential. Despite numerous large studies aimed at customizing fetal growth curves, there remains no universally validated tool. An automated tool that delivers an early biomarker of an individual fetus’ growth potential has the potential for achieving a precision medicine approach for monitoring fetal growth and guiding surveillance.

On the early behavior and microstructure of oil well cement paste incorporating with carbon nanotubes cured at a high temperature

With the rapid development of shale gas/oil exploitation, hostile downhole condition asks for more flexible and ductile oil well cement paste (OWCP). This study is devoted to investigating the influence of multi-walled carbon nanotubes (MWCNTs) on the rheological behavior, early mechanical properties and volume stability of OWCP by means of different experimental methodologies. Multiple microstructural techniques are employed to further understand the reinforcing mechanism of MWCNTs on the performances of OWCP. The results show that the optimal dosage of MWCNTs is 0.6wt.‰. The rheological behavior of MWCNTs/OWCP slurry at low shearing rate is improved after the addition of 0.6wt.‰MWCNTs. The mechanical properties and autogenous shrinkage of MWCNTs/OWCP composites are enhanced after the addition of the optimal dosage of MWCNTs, MWCNTs/OWCP composites with addition of 0.6wt.‰MWCNTs exhibit more flexible and ductile than plain OWCP. The additional nucleation sites provided by MWCNTs, the role of bridging effect and pull-out effect by MWCNTs, and the high curing temperature are all responsible for the enhanced mechanical properties of MWCNTs/OWCP composites. Owing to the addition of MWCNTs, the relationship between the compressive strengths of MWCNTs/OWCP composites and gel/space ratios does not exhibit exponential form. However, the addition of MWCNTs does not alter the Avrami-type exponential relationship between the degree of hydration and curing ages, moreover, it does not alter the linear relationship between the mercury intrusion porosity and gel/space ratio.

Samuel Johnson: Selected Works. Ed. Robert DeMaria Jr., Stephen Fix, and Howard D. Weinbrot.

<i>Samuel Johnson: Selected Works</i>. Ed. Robert DeMaria Jr., Stephen Fix, and Howard D. Weinbrot.

Predictive role of lymphoscintigraphy undergoing lymphovenous anastomosis in patients with lower extremity lymphedema: a preliminary study

BackgroundWe investigated whether preoperative lymphoscintigraphy could predict the treatment response of unilateral lymphovenous anastomosis (LVA) in patients with lower extremity lymphedema.Materials and methodsA total of 17 patients undergoing lymphoscintigraphy subsequent to LVA was included. As qualitative lymphoscintigraphic indicators, ilioinguinal lymph node uptake, main lymphatic vessel, collateral vessel, and four types of dermal backflow patterns (absent; distal only; proximal only; whole lower limb) were evaluated. Lymph node uptake ratio, extremity uptake ratio, and injection site clearance ratio were obtained as quantitative lymphoscintigraphic indicators at 1 and 2-h after injection. To evaluate therapy response, the volume difference ratio of the whole lower limb at 3 months (early response) and 1 year (late response) was measured. Volume difference ratios (continuous variable and binary variable with a cut-off value of zero) were compared according to the lymphoscintigraphic variables.ResultsThe group with whole lower limb dermal backflow had a greater volume change than the other groups (p = 0.047). The group with dermal backflow in the whole lower limb OR only in the distal part had a higher rate of volume reduction than the group with dermal backflow only in the proximal part OR absent (p = 0.050). The 2-h extremity uptake ratio was the only indicator that positively correlated with early and late volume difference ratio (p = 0.016, p = 0.001). The rate of volume decrease at 1 year was high in patients with high 2-h extremity uptake ratio (p = 0.027). As the amount of dermal backflow increases, the postoperative therapeutic effect increases (p = 0.040).ConclusionsPreoperative lymphoscintigraphy is useful to predict both early and late therapy response in patients with lower extremity lymphedema undergoing LVA. Both dermal backflow pattern and extremity uptake ratio may be predictive lymphoscintigraphic indicators.

Darryl P. Domingo. The Rhetoric of Diversion in English Literature and Culture, 1690–1760.

Darryl P. Domingo. <i>The Rhetoric of Diversion in English Literature and Culture, 1690–1760</i>.

Adverse childhood experiences associate with early post-trauma thalamus and thalamic nuclei volumes and PTSD development in adulthood

Adverse childhood experiences (ACEs) potentially contribute to posttraumatic stress disorder (PTSD) after adult trauma exposure, but underlying brain changes remain unclear. The present study tested relationships between ACEs, whole thalamus and thalamic nuclei volumes, and post-trauma stress symptoms (PTSS) after adult trauma. Trauma survivors (n = 101) completed the Childhood Trauma Questionnaire (CTQ), the PTSD checklist-special stressor version 5 (PCL), and a structural magnetic resonance imaging (sMRI) scan within post-trauma 2 weeks. At post-trauma 3 months, survivors completed a second PCL survey and a PTSD diagnosis interview using the Clinician-Administered PTSD Scale (CAPS). CTQ scores significantly positively correlated with PCL scores at post-trauma 2 weeks and 3 months (respective p's < 0.01 and < 0.001). CTQ scores significantly negatively correlated with whole thalamus and 7 thalamic nuclei volumes at post-trauma 2 weeks in the PTSD (N = 50), but not the non-PTSD (N = 51) group. Whole thalamus and 22 nuclei volumes significantly negatively correlated with PCL scores at post-trauma 3 months in the PTSD, but not the non-PTSD group. These results suggest ACEs negatively influence early post-trauma thalamic volumes which, in turn, are negatively associated with PTSS in survivors who develop PTSD.