Full Body Research Articles

Energy Expenditure, Body Composition, and Skeletal Muscle Oxidative Capacity in Patients with Myotonic Dystrophy Type 1.

Myotonic dystrophy type 1 (DM1) patients are at risk for metabolic abnormalities and commonly experience overweight and obesity. Possibly, weight issues result from lowered resting energy expenditure (EE) and impaired muscle oxidative metabolism. This study aims to assess EE, body composition, and muscle oxidative capacity in patients with DM1 compared to age-, sex- and BMI-matched controls. A prospective case control study was conducted including 15 DM1 patients and 15 matched controls. Participants underwent state-of-the-art methodologies including 24 h whole room calorimetry, doubly labeled water and accelerometer analysis under 15-days of free-living conditions, muscle biopsy, full body magnetic resonance imaging (MRI), dual-energy x-ray absorptiometry (DEXA), computed tomography (CT) upper leg, and cardiopulmonary exercise testing. Fat ratio determined by full body MRI was significantly higher in DM1 patients (56 [49-62] %) compared to healthy controls (44 [37-52] % ; p = 0.027). Resting EE did not differ between groups (1948 [1742-2146] vs (2001 [1853-2425>] kcal/24 h, respectively; p = 0.466). In contrast, total EE was 23% lower in DM1 patients (2162 [1794-2494] vs 2814 [2424-3310] kcal/24 h; p = 0.027). Also, DM1 patients had 63% less steps (3090 [2263-5063] vs 8283 [6855-11485] steps/24 h; p = 0.003) and a significantly lower VO2 peak (22 [17-24] vs 33 [26-39] mL/min/kg; p = 0.003) compared to the healthy controls. Muscle biopsy citrate synthase activity did not differ between groups (15.4 [13.3-20.0] vs 20.1 [16.6-25.8] μM/g/min, respectively; p = 0.449). Resting EE does not differ between DM1 patients and healthy, matched controls when assessed under standardized circumstances. However, under free living conditions, total EE is substantially reduced in DM1 patients due to a lower physical activity level. The sedentary lifestyle of DM1 patients seems responsible for the undesirable changes in body composition and aerobic capacity.

Optimal Distal Tendon Insertion Point for Elbow Flexion in Free-Functioning Gracilis Muscle Transfer for Panbrachial Plexus Injuries: A Cadaveric Study

Following pan-brachial plexus injuries, restoration of elbow flexion is widely accepted as the reconstructive priority. A gracilis free functioning muscle transfer (FFMT) can be used to restore elbow flexion alone with insertion into the biceps brachii (BIC) or brachioradialis (BRD) tendons or restore combined elbow and finger flexion with a more distal insertion into the flexor digitorum profundus (FDP) tendons. Using cadaveric experiments, we determined the peak instantaneous moment arm for each insertion option. Six simulated gracilis transfer surgeries were performed using both arms of three fresh-frozen full body cadaveric specimens (age: 79 + 10 years. 2 female). The gracilis muscles from both legs were harvested and transferred to the contralateral upper extremity. The elbow was manually moved through three flexion-extension cycles while the instantaneous moment arm was calculated from measurements of gracilis excursion and elbow joint angle for the three distal insertion sites. Peak instantaneous moment arm for all three insertions occurred at an elbow angle between 83° to 92° with a magnitude ranging from 33 mm to 54 mm. The more distal (FDP/BRD) insertions produced a significantly greater (∼1.5 times) peak elbow flexion instantaneous moment arm compared to the BIC insertion. Based on the instantaneous moment arm, the gracilis FFMT distal insertion locations could result in greater reconstructed elbow flexion strength. In addition, direct measurement of the shape and magnitude of the moment arm curve for differing insertion sites allows high resolution surgical planning and model testing. This study presents the first direct experimental quantification of the gracilis FFMT instantaneous moment arm. The experimental evidence supports the use of FDP/BRD insertion locations by providing a quantitative explanation for the increased elbow flexion torque observed clinically in patients with a gracilis FFMT and distal FDP insertion.

Independent and Hybrid Magnetic Manipulation for Full Body Controlled Soft Continuum Robots

Fully soft continuum magnetic (FSCMs) microrobots with highly deformable structures have emerged as a potential solution to robotically controlled endovascular interventions. The microrobot's structure is made of magneto-responsive material, which offers full body control under a magnetic field instead of limited tip deformation. The shape control for these microrobots enables steering in complex paths with limited contact with the environment. We studied full body control under fields generated using up to two robotically controlled permanent magnets and in combination with an electromagnetic system. The effect of different parameters, such as the number of permanent magnets, position of the permanent magnets and intensity and direction of the electromagnetic field, on the robot's shape has been experimentally investigated. A mathematical model to predict tip deformation angle (TDA) was introduced and verified experimentally (root mean square error (RMSE) 6.5). Ten different characteristic body shapes were identified based on the curvature of the soft robot. Based on the obtained data, a proof-of-concept demo is presented for the full body controlled soft robots. The accuracy of steering soft robots on a continuous path with all three magnetic control strategies was investigated. The results show that the proposed method effectively enables shape forming and minimizes contact with the surrounding environment (the average distance to the centerline was 1.24 mm). The proposed approach hold promises to elevate endovascular interventions towards the least invasive surgery.

Head movement and its relation to hearing.

Head position at any point in time plays a fundamental role in shaping the auditory information that reaches a listener, information that continuously changes as the head moves and reorients to different listening situations. The connection between hearing science and the kinesthetics of head movement has gained interest due to technological advances that have increased the feasibility of providing behavioral and biological feedback to assistive listening devices that can interpret movement patterns that reflect listening intent. Increasing evidence also shows that the negative impact of hearing deficits on mobility, gait, and balance may be mitigated by prosthetic hearing device intervention. Better understanding of the relationships between head movement, full body kinetics, and hearing health, should lead to improved signal processing strategies across a range of assistive and augmented hearing devices. The purpose of this review is to introduce the wider hearing community to the kinesiology of head movement and to place it in the context of hearing and communication with the goal of expanding the field of ecologically-specific listener behavior.

Representational momentum of biological motion in full-body, point-light and single-dot displays

Observing the actions of others triggers, in our brain, an internal and automatic simulation of its unfolding in time. Here, we investigated whether the instantaneous internal representation of an observed action is modulated by the point of view under which an action is observed and the stimulus type. To this end, we motion captured the elliptical arm movement of a human actor and used these trajectories to animate a photorealistic avatar, a point-light stimulus or a single dot rendered either from an egocentric or an allocentric point of view. Crucially, the underlying physical characteristics of the movement were the same in all conditions. In a representational momentum paradigm, we then asked subjects to report the perceived last position of an observed movement at the moment in which the stimulus was randomly stopped. In all conditions, subjects tended to misremember the last configuration of the observed stimulus as being further forward than the veridical last showed position. This misrepresentation was however significantly smaller for full-body stimuli compared to point-light and single dot displays and it was not modulated by the point of view. It was also smaller when first-person full body stimuli were compared with a stimulus consisting of a solid shape moving with the same physical motion. We interpret these findings as evidence that full-body stimuli elicit a simulation process that is closer to the instantaneous veridical configuration of the observed movements while impoverished displays (both point-light and single-dot) elicit a prediction that is further forward in time. This simulation process seems to be independent from the point of view under which the actions are observed.

DP11 Dermal plexiform spindle cell lipoma: a perplexing entity

Abstract We present a 66-year-old man who presented to dermatology with an unusual lesion. An outdoor worker with prior history of melanoma, the patient was referred with a new pigmented lesion adjacent to his melanoma scar. This was identified as a seborrhoeic keratosis and the patient was reassured. Following a full body examination, an incidental lesion was identified on the left anterior shoulder. The lesion measured 9 × 7 mm, was dermal-based, dome-shaped, soft to palpation and skin coloured with light peripheral pigmentation. The lesion was featureless upon dermoscopic examination. The clinical differential diagnosis included neurofibroma and an intradermal naevus. The lesion was narrowly excised. Histological examination revealed an ill-defined, wedge-shaped dermal lesion with tumour fascicles with a vaguely plexiform arrangement. The widely separated fascicles comprised loosely arranged spindle cells, mature adipocytes and scant collagen fibres with a myxoid stroma. The spindle cells were stained diffusely with CD34 immunohistochemistry. The adipocytes and a proportion of spindle cells (around 20–30%) were stained with S100. The features were in keeping with a dermal plexiform spindle cell lipoma. Spindle cell lipoma is an uncommon benign, histologically distinct tumour, accounting for 1.5% of all adipocytic neoplasms. More common within the subcutis, it is rare for these lesions to present with a purely intradermal location. Dermal spindle cell lipomas tend to be less cellular than their subcutaneous counterpart. This coupled with the variable representation of the three constituent lesion components (spindle cells, mature adipocytes and fibromucinous stroma) results in a wide range of possible differential diagnoses. The plexiform variant of spindle cell lipoma (PSCL) is a poorly recognized form with even greater potential for misdiagnosis, particularly with plexiform neurofibroma—­leading to an erroneous diagnosis of neurofibromatosis. Dermal PSCL is an exceptionally rare diagnosis with only eight cases reported in the literature thus far. Here, we report a further case of dermal plexiform spindle cell lipoma, with, for the first-time, corresponding clinical images. In our summary, we discuss in detail the potential diagnostic pitfalls of this rare tumour and how to best employ immunohistochemical staining to avoid them.

Water consumption by rinse-off cosmetic products: The case of the shower.

This article measures and discusses the effects of different shower gels on the consumption of water used during a shower. A sensory panel was created for quantifying water consumption associated with the use of shower gels. Fifteen French panellists were recruited (age: 59 ± 7, height: 163 cm ± 9 and weight: 68 kg ± 20) and trained to assess rinsed skin in a standardized way. Effective panellists were then asked to assess 25 shower gels covering the variety of existing products on the market. Results showed that the average volume was 4.77 L for heating the water and wetting the body and 4.15 L for rinsing the shower gel off the full body. We observed a significant shower gel effect (p < 0.0001) with the water volume needed to rinse the 25 shower gels ranging 3.21 L to 5.65 L. This paper demonstrates the impact of shower gel formulation on water consumption during a shower. It thus demonstrates the importance of formulating shower gels to reduce the total amount of water needed to shower. It also introduces the distinction between 'useful water' which refers strictly to the volume of water objectively needed to rinse off a product and the 'used water' which refers to the total shower volume of water. This distinction helps to better strategize actions in order to reduce water consumption from rinse-off cosmetic products used during showers.

Automated full body tumor segmentation in DOTATATE PET/CT for neuroendocrine cancer patients.

Neuroendocrine tumors (NETs) are a rare form of cancer that can occur anywhere in the body and commonly metastasizes. The large variance in location and aggressiveness of the tumors makes it a difficult cancer to treat. Assessments of the whole-body tumor burden in a patient image allow for better tracking of disease progression and inform better treatment decisions. Currently, radiologists rely on qualitative assessments of this metric since manual segmentation is unfeasible within a typical busy clinical workflow. We address these challenges by extending the application of the nnU-net pipeline to produce automatic NET segmentation models. We utilize the ideal imaging type of 68Ga-DOTATATE PET/CT to produce segmentation masks from which to calculate total tumor burden metrics. We provide a human-level baseline for the task and perform ablation experiments of model inputs, architectures, and loss functions. Our dataset is comprised of 915 PET/CT scans and is divided into a held-out test set (87 cases) and 5 training subsets to perform cross-validation. The proposed models achieve test Dice scores of 0.644, on par with our inter-annotator Dice score on a subset 6 patients of 0.682. If we apply our modified Dice score to the predictions, the test performance reaches a score of 0.80. In this paper, we demonstrate the ability to automatically generate accurate NET segmentation masks given PET images through supervised learning. We publish the model for extended use and to support the treatment planning of this rare cancer.

Kinematic differences between left- and right-handed cricket fast bowlers during the bowling action.

Despite differences between left- and right-handed athletes in other sports, minimal evidence exists regarding biomechanical similarities and differences between left- and right-handed cricket fast bowlers performing an equivalent task. This study aimed to compare the kinematics between left and right-handed fast bowlers performing an equivalent task (i.e. bowling 'over the wicket' to a batter of the same handedness as the bowler). Full body, three-dimensional kinematic data for six left-handed and 20 right-handed adolescent, male, fast bowlers were collected using the Xsens inertial measurement system. Time-normalised joint and segment angle time histories from back foot contact to follow-through ground contacts were compared between groups via statistical parametric mapping. Whole movement and subphase durations were also compared. Left-handed players displayed significantly more trunk flexion from 49%-56% of the total movement (ball release occurred at 54%; p = 0.037) and had shorter back foot contact durations on average (0.153 vs 0.177 s; p = 0.036) compared to right-handed players. Left- and right-handed bowlers displayed similar sagittal plane kinematics but appeared to use non-sagittal plane movements differently around the time of ball release. The kinematic differences identified in this study can inform future research investigating the effect of hand dominance on bowling performance and injury risk.

Self-Exposure on Instagram and BMI: Relations With Body Image Among Both Genders.

Social media users can actively choose how they portray themselves and review the information they share to form and manage positive impressions on their audience. A high Body Mass Index (BMI) can lead to a bias of attention towards self-reported unattractive personal body areas. This dysfunctional body-related attention can lead to increased body dissatisfaction. Concerning social networks, people who usually post more photos on Instagram more frequently show higher body satisfaction. The main objective of this work was to analyze the relationship between BMI in young people, their own exposition on Instagram, positive body image and certain psychological variables: self-esteem, coping and well-being. The population-based sample consisted of 687 young Instagram users aged between 18 to 35 years old. The results found in this work revealed that BMI had a significant influence on the body exposure on Instagram in both genders, as well as in body image and certain psychological variables, such as coping and well-being. Moreover, we found that there is not a direct relation between BMI and the exposure of the entire body on Instagram. This relationship exists through positive body image, appearance care and management appearance behaviors. These results imply that positive body image affects body's exposure, so people with obesity or overweight tend to upload less photos with half or full body visible than people with normal weight or underweight. This is not because of their weight, but their valuation and appreciation of their bodies.

PIPER adult comfort: an open-source full body human body model for seating comfort assessment and its validation under static loading conditions.

Introduction: In this paper we introduce an adult-sized FE full-body HBM for seating comfort assessments and present its validation in different static seating conditions in terms of pressure distribution and contact forces. Methods: We morphed the PIPER Child model into a male adult-sized model with the help of different target sources including his body surface scans, and spinal and pelvic bone surfaces and an open sourced full body skeleton. We also introduced soft tissue sliding under the ischial tuberosities (ITs). The initial model was adapted for seating applications with low modulus soft tissue material property and mesh refinements for buttock regions, etc. We compared the contact forces and pressure-related parameters simulated using the adult HBM with those obtained experimentally from the person whose data was used for the model development. Four seat configurations, with the seat pan angle varying from 0° to 15° and seat-to-back angle fixed at 100°, were tested. Results: The adult HBM could correctly simulate the contact forces on the backrest, seat pan, and foot support with an average error of less than 22.3N and 15.5N in the horizontal and vertical directions, which is small considering the body weight (785N). In terms of contact area, peak, and mean pressure, the simulation matched well with the experiment for the seat pan. With soft tissue sliding, higher soft tissue compression was obtained in agreement with the observations from recent MRI studies. Discussion: The present adult model could be used as a reference using a morphing tool as proposed in PIPER. The model will be published openly online as part of the PIPER open-source project (www.PIPER-project.org) to facilitate its reuse and improvement as well as its specific adaptation for different applications.

(056) Theo Mei Technique (TMT) – A Specific Method Eliminating or Reducing Menstrual Ppain

Abstract Introduction A large portion of women experience significant menstrual pain for one to three days every month that interferes with daily activities and sleep causing lost time from work, school, family or other activities and reduced productive life. Objective Provide women a natural solution to reduce or eliminate period pain using the body’s own hormones (endorphins and oxytocin) without the side effects medicinal approaches. Methods Triggering the body’s pain fighting hormones is the central theme. There are two key elements of this technique (TMT): multiple self-induce orgasms and specific time spacing. A woman’s body is capable of multiple orgasms and each time releases the necessary hormones to fight pain. The intensity of each orgasm greatly contributes to the amount of endorphins released and typically is apparent by full body shaking contractions. The timing of the orgasms allows the hormones to distribute throughout the body and builds upon the previous hormone amounts. The technique was explained in detail to each patient to ensure a consistent understanding level and methodology. Each participant provided feedback how much pain was reduced and how long this effect lasted if the pain reoccurred. They also provided other observations about physiological changes or effects from the technique. Results This research study has spanned 42 months with 46 participants. Some of the women have been using TMT for 36 – 42 months, most of the women for at least 15 months and more recently three additional women for 4 months. The women ages ranged from 21 to 48 years. There are nine related combinations (mother /daughter/sister). After each patient completed the technique the effects were immediate and each patient reported an exhilarated feeling for the first time being free of period pain. The data revealed each time the patient used TMT the pain was completely eliminated. Duration of effects lasted from 7 to 10 hours. If the patient felt pain returning the patient simply repeated the technique for another painless span of time. All the participants continue to voluntarily use this technique each month. The participants voluntarily provide information concerning quality of sexual activity and gynecological health changes (typically improved). The authors and participants were surprised how completely this technique worked. The results show this technique is very effective in eliminating the pain women suffer during menstruation. The patients felt medications were not needed and stopped using them on their own. The intensity of the technique and repeated use also strengthened the pelvic floor muscles. The study is collecting more data about the additional benefits of this technique. Conclusions The participants in this research study group significantly improved their lives by using TMT every month. All of these women are essentially pain free during their monthly period. The TMT effects were obvious to others around the participants and kept asking what had changed. The effectiveness of long term participation of these patients has not diminished. Disclosure No

P50 ODD CONNECTIONS

Abstract A 40 yo man was admitted to the ER due to typical oppressive chest pain at rest; he had no previous medical history and he denied any cardiovascular risk factor, including family history of cardiac disease. He was actually a sportsman, practicing martial arts. The basal ECG showed sinus rhythm, and an early repolarization pattern with no pathological features. Physical examination revealed a continuous cardiac murmur (2/6) along the sternal border and no other pathological signs. Three consecutive HsTnI determinations resulted negative. He was evaluated by the cardiologist, and a bedside echocardiogram resulted unremarkable. Due to the typical characteristics of the symptoms, an exercise ECG was performed, and the results were suspicious for inducible ischemia at high workloads. He was then admitted to our Cardiology ward, where he underwent a coronary angiography that showed a really surprising and unexpected anatomy: numerous coronary fistulas arising from various tracts (mid–LAD, intermediate coronary artery, conal branch of RCA, and distal Cx). A CT coronary angiogram was then performed, showing some ectasic vascular malformations between different coronary arteries, between coronaries and the pulmonary artery, and also a vascular anomaly connecting a bronchial artery with the right pulmonary artery. We subsequently performed a full body CT angiogram and a cerebral MR angiography, that excluded the presence of extrathoracic arteriovenous malformations. This case shows an extremely rare coronary congenital anomaly (accounting for 0.08–0.4% of all congenital heart disease), that generally goes underdetected in the first decades of life of these subjects. In this case, the typical anginal symptoms (probably due to coronary “steal” mechanism) arose suspicion that lead to the, albeit least expected, odd diagnosis. The treatment of symptomatic coronary fistulas is percutaneous/surgical closure. The patient was referred to our Tertiary Centre GUCH department, where a multidisciplinary discussion will decide the best therapeutic strategy.

718 Estimation of Total Body Surface Area Burns in a Bilateral Above-Knee Amputee Patient

Abstract Introduction The burn injury extension estimate is necessary for the initial IV fluid resuscitation planning, however, current Wallace rule of nines, Lund &amp; Browder charts as well as smartphone applications are based anatomical models with full body integrity. The purpose of this paper is to accurately estimate the TBSA burned in a bilateral asymmetric above-knee amputee patient. Methods An amputation is defined as major amputation when the level is at or proximal ankle or wrist. We present a case example of an 80-year-old patient with a past medical history of long-standing type 2 diabetes mellitus with inadequate metabolic control, left above-knee amputation seven years ago, as well as a contralateral asymmetric above-knee amputation seven months before hospital admission. The patient was brought to the emergency department one hour after suffering burn injuries by fire at his shelter. Upon his arrival inhalational injury was ruled out, and at physical examination second and third-degree burns were noted circumferentially on both above-knee stumps, genitalia, right flank, lower abdomen and back, right hands and forearm, as well as left hand digits (Figure 1A-B). Initial TBSA burned was estimated using the E-burn application yielding a 27% extension; however, this percentage would correspond to patient with full integrity of both lower limbs (Figure 2A) Results This is the first major amputee burned patient of 285 cases admitted for in-hospital treatment at our institution from March 2020 to October 2022. After performing an online search on MEDLINE/Pubmed (keywords: TBSA, estimation, amputated) we found only one published paper in 2020 which presented a Correction Factor (CF) formula for a hypothetical burn patient with bilateral and symmetric fore-quarter amputation. We estimated the amputated surface area (13.7%) with e-burn, to calculate the major amputee CF published in 2020 and test it on a clinical setting. By means of the following formula (Figure 1C): CF = 100 / (100 - % of amputated body part) CF = 100 / (100 – 13.7) CF = 100 / (86.3) = 1.15 Finally, the initial TBSA burnt was multiplied by the CF to adjust it accordingly to major amputations of the patient, as follows: Originally estimated TBSA burnt (27%) x CF (1.15) = 31.05 % (Figure 2B-C) Conclusions This case report serves as an example of the clinical application of the Correction Factor for major amputees burn patients which can be easily estimated with the aid of smartphone applications such as e-burn in mismatched bilateral amputations. Applicability of Research to Practice To our knowledge this is the first clinical application of the major amputee CF, which its simplified estimation by means of E-burn could be of use for burn centers with higher volume.

Limited Effects of Age on the Use of the Ankle and Counter-Rotation Mechanism in the Sagittal Plane

During standing the center of mass (CoM) can be controlled relative to the base of support by applying ankle moments to shift the center of pressure (CoP mechanism). An additional mechanism is the counter-rotation mechanism, i.e., changing the angular momentum of segments around the CoM to change the direction of the ground reaction force. In this study, we assessed anteroposterior balance performance and the related use of these postural control mechanisms in children, younger and older adults. Sixteen children (6-9y), 17 younger adults (18-24y) and eight older adults (65-80y) performed bipedal upright standing trials of 16 seconds on a rigid surface and on three balance boards that could freely move in the sagittal plane, varying in height (15-19 cm). Full body kinematics were measured. Performance related outcome measures, i.e., the number of trials with balance loss and the Root Mean Square of the time series of the CoM acceleration (due to the CoP and counter-rotation mechanism) and the contributions of the CoP and counter-rotation mechanism to the CoM acceleration (in %) were calculated. Furthermore, selected kinematic measures, i.e., the orientation of the board and head and the Mean Power Frequency of board orientation and of CoM acceleration were calculated. Compared to younger adults, children and older adults showed a poorer balance performance. Across age groups and conditions, the contribution of the CoP mechanism to the total CoM acceleration was dominant, i.e., 95%-108%. The contribution of the counter-rotation mechanism was limited, i.e., 19%-31% (with totals higher than 100% indicating opposite effects of both mechanisms), since the counter-rotation mechanism would conflict with stabilizing the head in space. Furthermore, children did use the counter-rotation mechanism relatively more to accelerate the CoM compared to younger adults as they are possibly still learning to limit the contribution of the counter-rotation mechanism.

Machine learning full 3-D lower-body kinematics and kinetics on patients with osteoarthritis from electromyography

Osteoarthritis (OA) is a degenerative disease that causes severe pain and reduces the range of motion of the joint, decreasing the quality of life for millions of individuals in the United States. Electromyography (EMG) sensors have been widely studied in biomechanics, showing applications in prosthetics, robotics, and control. While complex musculoskeletal models have been well established, the attempt of directly correlating EMG with kinematics and kinetics is still quite limited. Particularly, little work has been conducted on OA patients. In this work, we propose a method for estimating lower body joint angles (JAs) and ground reaction forces (GRFs) from surface-EMG sensors during a step-down task for individuals diagnosed with OA. The JAs and GRFs were measured by a Vicon motion capture system and force plates, respectively. EMG, JAs, and GRFs were used to train an echo state network (ESN) which afforded JAs with relative errors of 3.78% and 3.71% and the GRFs with relative errors of 3.619% and 4.596% for training and testing datasets, respectively. This study suggests the high fidelity of the ESN in automatically predicting full lower body kinematics and kinetics from the EMG signals. The results of this work promote the development of an EMG-controlled lower limb rehabilitation robot system for patients with OA.

Abstract #1406879: Not Always PCOS: A Case of Virilizing Steroid Cell Ovarian Tumor

Ovarian steroid cell tumors (SCTs) are a rare type of sex-cord stromal tumors that account for 0.1% of all ovarian tumors. These tumors can occur at any age and typically secrete hormones such as androstenedione and testosterone. We report a young woman with known microprolactinoma who presented with secondary amenorrhea and virilization and was found to have a steroid secreting ovarian SCT. A 32-year-old nulligravid woman with history of infertility presented for evaluation for amenorrhea. Three years ago, she developed oligomenorrhea and was subsequently found to have hyperprolactinemia and an 8mm pituitary microadenoma. Thyroid function tests and IGF-1 at the time were normal, no other workup was obtained. She was started on cabergoline, though after developing full body hives was switched to bromocriptine. Despite prolactin normalization from 69.9 to 14.7 ng/mL and shrinkage of pituitary adenoma to 7mm after 1 year of therapy, she developed amenorrhea, acne, and new facial hair. Her testosterone was found elevated 212ng/dL and she states was then diagnosed with PCOS. In light of no clinical improvement and mental health issues, she self-discontinued her bromocriptine and was lost to follow up. Upon current presentation she reported last menstrual period 24 months ago, continued acne and facial hair, and now temporal hair loss and deepening voice. Ferriman-Gallwey score was 20/36. She did not have clinical signs of Cushing’s syndrome. Repeat prolactin was 195ng/mL, pituitary MRI showed 3mm microadenoma, and bromocriptine was resumed. Workup for her hyperandrogenism revealed testosterone of 137ng/dL (ref 8-60), androstenedione 972 ng/dL (41-262), DHEA-S 284 mcg/dL (84.8-378), 17-OH-progesterone 23ng/dL, and hCG <0.5mIU/mL. Late night salivary cortisol levels were elevated to 0.213, 0.429, and 0.552mcg/dL (<0.090) with ACTH 27.3pg/mL (9.72-63.3). CT scan showed normal adrenal glands. A pelvic ultrasound revealed a 2.2cm left ovarian vascular mass. She underwent left salpingo-oophorectomy and pathology confirmed a 2.4cm benign steroid cell tumor. Follow up after surgery is currently ongoing. Amenorrhea despite prolactin normalization and signs of severe hyperandrogenism such as testosterone >150ng/dL, male pattern baldness, and vocal deepening should prompt physicians to consider androgen-secreting tumors. Our patient was found to have a rare ovarian SCT—these tumors can lead to precocious puberty in adolescents, virilization in adults, Cushing’s syndrome, and infertility. Our patient reports significant clinical improvement postoperatively.

A Case of Stiff Person Syndrome with Response to Methotrexate Therapy for Lymphoma (P4-5.023)

<h3>Objective:</h3> N/A <h3>Background:</h3> Stiff person syndrome (SPS) is a rare neurologic disorder with prevalence of one to two patients per million, characterized by progressive muscle stiffness, rigidity, and spasm involving the axial muscles, resulting in impaired gait and balance. Most patients have autoantibodies against the glutamic acid decarboxylase (GAD) enzyme. Antibodies directed against GABA(A) receptor-associated protein, and the glycine-α1 receptor also occur. The paraneoplastic form of SPS usually is associated with lung, breast or lymphoma and are usually GAD antibody negative. Treatment is mainly focused on symptomatic relief by using benzodiazepines and immunomodulators (steroids, IVIg, rituximab, mycophenolate, plasma exchange), but optimal treatments for refractory cases are unclear. <h3>Design/Methods:</h3> We report a 57 yo woman who initially presented in 2015 with intermittent proximal RLE stiffness and pain that progressed to become constant and bilateral. Her gait and posture were affected with bent forward posture. She then developed full body spasms that were associated with severe pain, triggered by stress, startle, or certain movements. Brain and full spine MRI were normal, with positive glycine receptor antibodies. The patient received IVIG with partial improvement in symptoms in 2018 and rituximab was added in 2019, but she remained impaired, requiring a standing rollator to ambulate. She developed bilateral blurry vision with floaters in 2020. Vitrectomy found ocular lymphoma and brain MRI showed enhancement typical for lymphoma. She achieved complete remission with high dose methotrexate, rituximab and consolidative transplant and her SPS symptoms markedly improved during methotrexate monotherapy to the point of ambulating without assistive devices and remained stable six months after transplant. <h3>Results:</h3> N/A <h3>Conclusions:</h3> Methotrexate may have activity in refractory SPS, and transplant may achieve durable responses and is under current study. <b>Disclosure:</b> Dr. Birjandian has nothing to disclose. Dr. Graber has a non-compensated relationship as a Editorial Board member with Neuro-Oncology: Practice, published by Oxford that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Journal of Pain and Symptom Management that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Certification Exam Committee Member with United Council of Neurogical Subspecialties that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Question of the Day ’app’ committee with American Academy of Neurology that is relevant to AAN interests or activities. Dr. Graber has a non-compensated relationship as a Editorial Board Member with Practical Neurology (BMC) that is relevant to AAN interests or activities.

Full body video-based self-avatars for mixed reality: from E2E system to user study

In this work, we explore the creation of self-avatars through video pass-through in mixed reality (MR) applications. We present our end-to-end system, including custom MR video pass-through implementation on a commercial head-mounted display (HMD), our deep learning-based real-time egocentric body segmentation algorithm, and our optimized offloading architecture, to communicate the segmentation server with the HMD. To validate this technology, we designed an immersive VR experience where the user has to walk through a narrow tile path over an active volcano crater. The study was performed under three-body representation conditions: virtual hands, video pass-through with color-based full-body segmentation, and video pass-through with deep learning full-body segmentation. This immersive experience was carried out by 30 women and 28 men. To the best of our knowledge, this is the first user study focused on evaluating video-based self-avatars to represent the user in a MR scene. Results showed no significant differences between the different body representations in terms of presence, with moderate improvements in some Embodiment components between the virtual hands and full-body representations. Visual Quality results showed better results from the deep-learning algorithms in terms of the whole body perception and overall segmentation quality. In this study, we provide some discussion regarding the use of video-based self-avatars and some reflections on the evaluation methodology. The proposed E2E solution is in the boundary of the state-of-the-art, so there is still room for improvement before it reaches maturity. However, this solution serves as a crucial starting point for MR applications where users can feel immersed and interact with their own bodies.

Left supraclavicular Lymphadenopathy as initial presentation of prostate Adenocarcinoma: An unusual presentation of a common cancer

Left supraclavicular lymphadenopathy is an ominous finding of physical examination. An underlying malignancy is found in about 50% of cases. This case report describes a male patient admitted for acute heart failure and respiratory infection. During physical examination a large left supraclavicular mass was identified. There were no symptoms or other findings suggesting malignancy. A full body Computed Tomography (CT) scan imaging revealed generalized lymphadenopathy. The histopathological examination of a cervical lymphadenopathy suggested metastasis of a poorly differentiated carcinoma. Prostate specific antigen level was very high (325 µg/L). The digital rectal examination and prostate biopsy confirmed the diagnosis of prostate adenocarcinoma. Even though this is an uncommon presentation of a very frequent disease, finding a supraclavicular lymphadenopathy in male patients should raise the suspicion of metastatic prostate cancer.