Greater Elevation Research Articles

An Animal Ex Vivo Model Comparing Two Different Methods of Sinus Floor Elevation with Great Elevation Heights: Macroscopic, Microscopic and Radiological Analysis.

Maxillary sinus pneumatization increases with age and tooth loss, leading to a reduction in the maxillary alveolar ridge, which often results in insufficient bone height for the proper placement of dental implants. This study focused on performing maxillary sinus elevations in ex vivo bisected pig heads using novel access and elevation devices, comparing these with the osteotome sinus floor elevation (OSFE) technique. An experimental study was conducted using 20 ex vivo adult pig heads. The sinus elevations were divided into two groups: 10 heads were treated using the osteotome technique, and 10 heads were treated using a new device, which consists of a syringe with latex and saline solution, as well as a burr system for membrane access and control. In the osteotome technique, perforations of the Schneiderian membrane were observed, whereas the inflatable balloon device did not cause any lacerations. OSFE resulted in sinus membrane perforations at greater elevation heights, while the new balloon device successfully elevated the membrane without tearing it. Within the limitations of this study, maxillary sinus lifts using the new balloon technique proved to be minimally invasive procedures.

The Interplay of Nitric Oxide and Nitrosative Modifications in Maize: Implications for Aphid Herbivory and Drought Stress.

Nitric oxide (NO) and other reactive nitrogen species (RNS) are considered to be signaling molecules in higher plants involved in the regulation of growth and development processes. However, the molecular mechanisms of their formation, removal, and participation in plant responses to adverse environmental stimuli remain largely unclear. Therefore, the aim of this study was to assess the influence of selected single stresses and combined stresses (i.e., Rhopalosiphum padi L. aphid infestation, drought, aphid infestation, and drought) and post-stress recovery on the contents of NO and peroxynitrite anion (ONOO-), as well as the levels of mRNA and protein nitration (i.e., the 8-nitroguanine and protein 3-nitrotyrosine amounts, respectively), in maize seedlings (Zea mays L.). Moreover, the expression patterns of the two tested genes (nos-ip, encoding nitric oxide synthase-interacting protein, and nr1, encoding nitrate reductase 1) involved in NO metabolism in maize plants were quantified. We identified significant intervarietal, time-course, and stress-dependent differences in the levels of the quantified parameters. Under the investigated stress conditions, the aphid-resistant Waza cv. seedlings were characterized by a higher and earlier NO accumulation and mRNA nitration level and an increased expression of the two target genes (nos-ip and nr1), compared to the aphid-susceptible Złota Karłowa cv. seedlings. Conversely, the Złota Karłowa plants responded with a greater elevation in the content of ONOO- and protein 3-nitrotyrosine than the Waza cv. plants The multifaceted role of NO and its derivatives in maize plants challenged by single and combined stresses, as well as during post-stress recovery, is discussed.

Response of Circulating Free Cellular DNA to Repeated Exercise in Men with Type 1 Diabetes Mellitus

Background: Intense exercise leads to neutrophil extracellular traps (NETs) formation, which triggers cell disintegration. NET, as well as other processes of apoptosis, necrosis, and spontaneous secretion, result in increased levels of cell-free DNA (cf-DNA) in the circulation. An increment of cf-DNA is also observed in autoimmune diseases, such as type 1 diabetes mellitus (T1DM). Repeated exhaustive exercises are an impulse for physiological adaptation; therefore, in this case–control study, we compared the exercise-induced increase in cf-DNA in men with T1DM and healthy controls to determine the development of the tolerance to exercise. Methods: Volunteers performed a treadmill run to exhaustion at a speed matching 70% of their personal VO2 max at three consecutive visits, separated by a 72 h resting period. Blood was collected before and after exercise for the determination of plasma cell-free nuclear and mitochondrial DNA (cf n-DNA, cf mt-DNA) by real-time PCR, blood cell count and metabolic markers. Results: Each bout of exhaustive exercise induced a great elevation of cf n-DNA levels. An increase in cf mt-DNA was observed after each run. However, the significance of the increase was noted only after the second bout in T1DM participants (p < 0.02). Changes in cf-DNA concentration were transient and returned to baseline values during 72 h of resting. The exercise-induced increment in circulating cf n-DNA and cf mt-DNA was not significantly different between the studied groups (p > 0.05). Conclusions: Cf-DNA appears to be a sensitive marker of inflammation, with a lower post-exercise increase in individuals with T1DM than in healthy men.

Sleep disorder symptoms and suicidal urges among US Marines seeking suicide treatment: Findings from an intensive daily assessment study

BackgroundRates of suicide in United States Marines are among the highest in the military, and sleep disorder symptoms are a known risk factor for suicide in the military. Intensive ecological momentary assessments (EMA) might improve the ability to detect periods that are characterized by increased suicidal ideation. Marines who were at high risk for suicide were intensively assessed for one month on sleep, suicidal urges, posttraumatic stress disorder (PTSD) and depression symptoms. MethodsU.S. Marines (N = 40) who had a past month suicide attempt or suicidal urges with intent were sent EMA for 28 days. Mixed effects models explored associations among daily sleep, suicidal urges, PTSD, and depression symptoms. ResultsWorsened sleep indicators on a given night significantly predicted higher maximum values of suicide urges the following day. Worse sleep quality the prior night was moderately associated with more severe PTSD symptoms and depression symptoms. Greater severity of PTSD symptoms and depression symptoms were strongly associated with both the maximum value and the range of suicide urges. PTSD and depression symptoms mediated the relationship between sleep quality and suicidal urges. Participants reported that 0000–0300 had the greatest elevation in endorsement of highest suicide urges. LimitationsThis study had a small sample size may not generalize beyond active duty Marines. ConclusionsPoor sleep quality and other sleep markers were an important risk factor for suicidal urges among U.S. Marines. This relationship was mediated by exacerbations in PTSD and depression symptoms. Interventions are needed to interrupt suicide risk during and following nights with poor sleep.

Comparative steroidogenic effects of hexafluoropropylene oxide trimer acid (HFPO-TA) and perfluorooctanoic acid (PFOA): Regulation of histone modifications

As a widely used alternative to perfluorooctanoic acid (PFOA), hexafluoropropylene oxide trimer acid (HFPO-TA) has been detected in the environment and humans; however, little is known regarding its male reproductive toxicity. To compare the effects of HFPO-TA on steroid hormone synthesis with PFOA, we exposed Leydig cells (MLTC-1) to non-lethal doses (0.1, 1, and 10 μM) of PFOA and HFPO-TA for 48 h. It was found that the levels of steroid hormones, 17α-hydroxyprogesterone (OHP), androstenedione (ASD), and testosterone (T) were significantly increased in 1 and 10 μM of PFOA and HFPO-TA groups, with greater elevation being observed in the HFPO-TA groups than in the PFOA groups at 10 μM. We further showed that the two rate-limiting steroidogenic genes (Star and Cyp11a1) were up-regulated, while Hsd3b, Cyp17a1, and Hsd17b were down-regulated or unchanged after PFOA/HFPO-TA exposure. Moreover, PFOA exposure significantly up-regulated histone H3K4me1/3 and H3K9me1, while down-regulated H3K4me2 and H3K9me2/3 levels. By contrast, H3K4me2/3 and H3K9me2/3 were enhanced, while H3K4me1 and H3K9me1 were repressed after HFPO-TA treatment. It was further confirmed that H3K4me1/3 were increased and H3K9me2 was decreased in Star and Cyp11a1 promoters by PFOA, while HFPO-TA increased H3K4me2/3 and decreased H3K9me1 in the two gene promoters. Therefore, we propose that low levels of PFOA/HFPO-TA enhance the expression of Star and Cyp11a1 by regulating H3K4 and H3K9 methylation, thus stimulating the production of steroid hormones in MLTC-1 cells. Collectively, HFPO-TA exhibits stronger effects on steroidogenesis compared to PFOA, which may be ascribed to the distinct regulation of histone modifications. These data suggest that HFPO-TA does not appear to be a safer alternative to PFOA on the aspect of male reproductive toxicity.

Performance investigation of n-type PERT bifacial solar photovoltaic module installed at different elevations

In recent years, bifacial solar photovoltaic (bPV) cells have gained much interest in the solar PV market as they produce additional electrical energy at a marginally higher cost. Their ability to generate additional energy mainly depends on their rear side response. Module elevation, albedo, row spacing, and frame structure are the few factors that affect its rear side response and thus the overall efficiency. In this research work, the performance of a bPV module installed at the geographical location of latitude 9.673° N, and longitude 77.964° E is analyzed with different module elevations. Module elevation is one of the key installation parameters that causes the non-uniformity in the rear side irradiance. At low elevations, the non-uniformity is higher and starts reducing with the increase in elevation, reaching a negligible value at greater elevations. The experimental results showed that for the module elevation of above 1m, the non-uniformity is reduced to 5 % from 12 % at 0.25m. The peak power output for the elevation of above 1m is around 375W at which the bifaciality factor is about 25 %. Overall, it is observed that the bifacial solar PV module at a higher optimum elevation produces lesser non-uniformity and a higher energy yield.

Photosynthesis-related Parameters in Leucobryum aduncum Moss Bags as Bioindicators of Environmental Stress Caused by Road Traffic

The physiological response in moss samples is often used as an early warning signal of environmental stress caused by air pollution. This study aimed to test the efficiency of photosynthesis-related parameters in Leucobryum aduncum moss bags as bioindicators of environmental stress related to road traffic. The moss samples were collected and prepared in a relatively unpolluted area and then transplanted at 7 sites in forested, rural, and urban areas. The moss samples were picked up after being exposed for 1 and 3 months for physiological measurements. The results showed that the average values of all physiological parameters were highest in the forested area and lowest in the urban area. All parameters at most roadside (R site) sites were lower or significantly lower than those at the site away from the road (A site). This was particularly true for the 3-month exposure period, suggesting that the length of exposure should be longer than 1 month, but exposure up to 3 months could fully damage the photosystem II (PSII) and destroy the moss bags. The vitality index (VI) also clearly indicated that the moss bags were more affected in the urban area, at the R sites, and at the 3-month exposure. Among all six parameters, the most susceptible parameter was the chlorophyll fluorescence parameter (Fv/Fm), followed by the total carotenoids, chlorophyll a, total chlorophylls, chlorophyll b, and chlorophyll a degradation (OD435/OD415). The moss bag technique used in this study did not negatively affect the studied physiological parameters, but a great elevation difference could affect the moss bag physiology. This study illustrated that the photosynthesis-related parameters of L. aduncum moss bags can be used as effective bioindicators of environmental stress caused by road traffic. This study is among the priority studies of moss bioindication of air pollution in Thailand and can pave the way for future studies.

Association between air temperature and unintentional drowning risk in the United Kingdom 2012–2019: A nationwide case-crossover study

ObjectiveDrowning is a leading cause of death. The World Health Organization (WHO) and United Nations (UN) emphasise the need for population-level data-driven approaches to examine risk factors to improve water safety policies. Weather conditions, have the potential to influence drowning risk behaviours as people are more likely to spend time around water and/or undertake risky activities in aquatic spaces as a behavioural thermoregulatory response (e.g., seeking coolth). MethodsA case-crossover approach assessed associations between changes in daily maximum air temperature (data from the nearest weather station to each drowning event) and unintentional drowning risk using anonymous data from the validated UK Water Incident Database 2012–2019 (1945 unintentional deaths, 82% male). Control days were selected using a unidirectional time-stratified approach, whereby seven and 14 days before the hazard day were used as the controls. ResultsMean maximum air temperature on case and control days was 15.36 °C and 14.80 °C, respectively. A 1 °C increase in air temperature was associated with a 7.2% increase in unintentional drowning risk. This relationship existed for males only. Drowning risk was elevated on days where air temperature reached 15–19.9 °C (Odds Ratio; OR: 1.75), 20–24.9 °C (OR: 1.87), and ≥ 25 °C (OR: 4.67), compared with days <10 °C. The greatest elevations in risk appeared to be amongst males and when alcohol intoxication was suspected. Precipitation showed no significant association with unintentional drowning risk. ConclusionsIdentifying such relationships highlights the value of considering weather conditions when evaluating environmental risk factors for drowning, and may inform water safety policy and allocating resources to prevention and rescue.

PHENOLOGICAL ANALYSIS OF THE WESTERN HIMALAYAN FOREST USING TEMPORAL REMOTE SENSING DATA

Abstract. The Himalayan range is considered to include the highest mountains on earth, with a widely recognized assortment of flora and fauna. The Indian Himalayan range spread over 10 states, of which being Uttarakhand, has the largest forest cover of 48.5% of the total area forest. In Doon Valley, the phenological behavior and variations of several forest types have been studied using the Normalized Difference Vegetation Index (NDVI) and Temporal Normalized Phenology Index (TNPI) along with elevation, surface temperature, slope, and aspect data into consideration. A two-scale method has been employed to study forest phenology, using Sentinel-2 data at 10 m spatial resolution for local-scale studies and MODIS NDVI data at 250 m spatial resolution to find large-scale phenological patterns. The framework used in this study is based on Google Earth Engine (GEE) which has potential applications at various spatial and temporal scales. Multiple phenological phases and phenological metrics have been identified and examined within the duration from December 2018 to May 2023. The investigation concluded that phenological behaviors were considerably affected by environmental and topographic variables such as elevation, surface temperature, slope, and aspect. Significant changes in phenology were recorded at low altitudes; however, less fluctuation was reported at medium to higher elevations due to remoteness at greater elevations. Using NDVI from open-source MODIS and Sentinel-2 datasets, TNPI has been successfully tested for this forest region. The findings showed that this study opens new opportunities for trend analysis of forest health and productivity.

Effects of testosterone replacement on lipid profile, hepatotoxicity, oxidative stress, and cognitive performance in castrated wistar rats.

Androgen deficiency is associated with multiple biochemical and behavioral disorders. This study investigated the effects of testosterone replacement and Spirulina Platensis association on testosterone deficiency-induced metabolic disorders and memory impairment. Adult male rats were randomly and equally divided into four groups and received the following treatments for 20 consecutive days. non-castrated rats received distilled water. Castrated group received distilled water. Testosterone treated group: castrated rats received 0.20 mg of testosterone dissolved in corn oil by subcutaneous injection (i.p.). Spirulina co-treated group: castrated rats received 0.20 mg of testosterone (i.p.) dissolved in corn oil followed by 1000 mg/kg of Spirulina per os. Data showed that castration induced an increase in plasma ALT, AST, alkaline phosphatase (PAL), cholesterol, and triglycerides level. Castrated rats showed a great elevation in SOD and CAT activities and MDA and H2O2 levels in the prostate, seminal vesicles, and brain. Testosterone deficiency was also associated with alteration of the spatial memory and exploratory behaviour. Testosterone replacement either alone or with Spirulina combination efficiently improved most of these biochemical parameters and ameliorated cognitive abilities in castrated rats. Testosterone replacement either alone or in combination with Spirulina improved castration-induced metabolic, oxidative, and cognitive alterations.

Abstract 16047: Quantifying the Cardiovascular Burden of Extreme Heat: A Meta-Analysis of Over 400 Laboratory-Based Heat Exposure Studies

Background: Heat waves are associated with increased fatalities from cardiovascular events, which has been attributed to increased cardiac strain secondary to the effects of heat on cardiac function. However, our understanding of these adjustments has come primarily from laboratory research employing insulated/encapsulated heating modalities (hot water perfusion suits). We evaluated whether the cardiac responses seen in this work reflect those experienced in studies exposing participants to high ambient temperatures. Methods: We systematically reviewed studies published up to January 2023 examining cardiac outcomes in adults rendered hyperthermic with water perfusion suits or unencapsulated exposure in a climate chamber. Mixed effects meta-analyses were conducted to evaluate whether changes in each outcome with increasing core temperature were modified by heating modality. We also estimated associations (natural spline) between ambient heat index and thermal and cardiac responses in the climate chamber studies. Results: 584 effect estimates of the heat-induced increase in heart rate (primary outcome) from 406 studies were included (~6800 participant exposures). Heart rate was 7 beats/min [95% CI: 3, 13] greater in the perfusion suit vs. climate chamber studies for similar increases in core temperature (P&lt;0.001). Likewise, there were greater elevations in cardiac output (slope difference: 1.2 L/min/°C [0.1, 2.3]), systolic pressure (14 mm Hg/°C [3, 24]), and rate pressure product (2923 mm Hg·beats/min/°C [1027, 4808]) with rises in core temperature in the perfusion suit compared to climate chambers studies (P≤0.036). In the climate chamber studies, core temperature and heart rate increased as much as 1.0°C [0.8, 1.3] and 31 beats/min [16, 37] (P&lt;0.001) in conditions reflective of deadly North American heat waves (heat index: 50-67°C). Conclusions: Our understanding of the effect of heat on cardiovascular responses primarily comes from encapsulated heating modalities, which we show overestimate heat-induced cardiac burden. To support public health research on extreme heat, we provide the first empirical estimates demonstrating considerable thermal and cardiac strain is experienced in conditions reflective of deadly heat waves.

Consumed from within? Social and ecological drivers of internal clearings in Ethiopian Orthodox church forests

AbstractIn a largely deforested landscape, thousands of small pockets of indigenous forest remain in Ethiopia's northern highlands. These “church forests” are maintained by Ethiopian Orthodox church communities, and they provide valuable reserves of indigenous species diversity and ecosystem services. However, there are important trade‐offs between the different ecosystem services church forests provide: the size of community‐made clearings within church forests used for prayer and other church services have to be balanced with services derived from intact forest cover and dense vegetation. This research uses a spatial, social–ecological model to examine patterns in church forest size and vegetation density across 2743 church forests in the Amhara Region. Results suggest that larger internal clearings correlate with larger forest area, and clearings also scale with population size. We also find that greater elevation and distance to population centers are associated with higher church forest density, while greater community wealth is associated with reduced forest density and area. These trends initially suggest that internal clearings can support conservation efforts, but they are nuanced by prevalent non‐native Eucalyptus planting and increasing internal deforestation for graveyard space for wealthier communities. Additionally, we find that internal clearings are an important source of omitted variable bias in estimating the relationship between density and area in church forests. As a consequence, incorporating church clearings into social–ecological models leads to meaningful differences in church forest density and area estimates. Ultimately, this study suggests that church forests in Ethiopia may be sustained rather than consumed from within.

Non-Invasive Risk Assessment and Prediction of Mortality in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Objectives: Heart rate turbulence (HRT) and T-wave alternans (TWA), non-invasive markers of cardiac autonomic dysfunction, and ventricular repolarization abnormality, reportedly, predict the risk of cardiovascular death after myocardial infarction. We investigated whether pre-operative assessment of HRT and/or TWA could predict long-term mortality following coronary artery bypass graft (CABG) surgery. Methods: From May 2010 to December 2017, patients undergoing elective CABG and receiving 24 h ambulatory electrocardiogram monitoring 1 to 5 days prior to CABG surgery were prospectively enrolled. Pre-operative HRT and TWA were measured using a 24 h ambulatory electrocardiogram. The relative risk of cardiac or overall death was assessed according to abnormalities of HRT, TWA, or left ventricular ejection fraction (LV EF). Results: During the mean follow-up period of 4.6 ± 3.9 years, 40 adjudicated overall (5.9%/yr) and 5 cardiac deaths (0.9%/yr) occurred in 146 enrolled patients (64.9 ± 9.3 years; 108 males). Patients with abnormal HRT exhibited significantly higher relative risks of cardiac death (adjusted hazard ratio [HR] 24.9, 95% confidence interval [CI] 1.46-427) and all-cause death (adjusted HR 5.77, 95% CI 2.34-14.2) compared to those with normal HRT. Moreover, abnormal HRT plus abnormal TWA and LV EF < 50% was associated with a greater elevation in cardiac and overall mortality risk. The predictive role of abnormal HRT with/without abnormal TWA for all-cause death was likely more prominent in patients with mildly reduced (35 to 50%) or preserved (≥50%) LV EF. Abnormal HRT plus abnormal TWA and LV EF < 50% showed high negative predictive value in cardiac and overall mortality risk. Conclusions: Assessment of pre-operative HRT and/or TWA predicted mortality risk in patients undergoing elective CABG. Combined analysis of HRT, TWA, and LVEF enhanced the prognostic power. In particular, the predictive value of HRT was enhanced in patients with preserved or mid-range LV EF.

Physiological responses to 9 hours of heat exposure in young and older adults. Part II: Autophagy and the acute cellular stress response.

With rising global temperatures, heat-related mortality is increasing, particularly among older adults. Although this is often attributed to declines in thermoregulatory function, little is known regarding the effect of age on the cellular processes associated with mitigating heat-induced cytotoxicity. We compared key components of the cellular stress response in 19 young (19-31 yr; 10 female) and 37 older adults (61-78 yr; 10 female) during 9 h of heat exposure (40°C, 9% relative humidity). Mean body temperature (Tbody) was calculated from core and skin temperatures. Changes in proteins associated with autophagy, apoptotic signaling, acute inflammation, and the heat shock response were assessed via Western blot in peripheral blood mononuclear cells harvested before and after exposure. Tbody increased by 1.5 (SD 0.3)°C and 1.7 (0.3)°C in the young and older adults, respectively. We observed similar elevations in autophagy-related proteins (LC3-II and LC3-II/I) in young and older adults (both P ≥ 0.121). However, the older adults displayed signs of autophagic dysfunction, evidenced by a 3.7-fold [95% CI: 2.4, 5.6] greater elevation in the selective autophagy receptor p62 (P < 0.001). This was paired with elevations in apoptotic responses, with a 1.7-fold [1.3, 2.3] increase in cleaved caspase-3 in the older relative to young adults (P < 0.001). Older adults also exhibited diminished heat shock protein 90 responses (0.7-fold [0.5, 0.9] vs. young, P = 0.011) and, at any given level of thermal strain (Tbody area under the curve), elevated tumor necrosis factor-α (1.5-fold [1.0, 2.5] vs. young, P = 0.008). Attenuated autophagic responses may underlie greater vulnerability to heat-induced cellular injury in older adults.NEW & NOTEWORTHY We demonstrate for the first time that peripheral blood mononuclear cells from older adults exhibit signs of autophagic impairments during daylong (9 h) heat exposure relative to their younger counterparts. This was paired with greater apoptotic signaling and inflammatory responses, and an inability to stimulate components of the heat shock response. Thus, autophagic dysregulation during prolonged heat exposure may contribute to age-related heat vulnerability during hot weather and heat waves.

Key factors associated with response in the treatment of liver metastatic melanoma by cryoablation combined with PD-1 blockade therapy: The Cryo-Fire-001 study.

e21500 Background: Liver metastasis remains a challenge in the treatment of advanced stage melanoma through immunotherapy. Although our previous study showed cryoablation could enhance the efficacy of PD-1 blockade therapy in the treatment of melanoma patients with liver metastasis, the key factors correlated with survival and treatment response remains unknown. Methods: Between 2018 and 2022, 45 melanoma patients receiving combined PD-1 blockade therapy and cryoablation of liver metastasis were retrospectively analyzed. The technical parameters of cryoablation, the sequence of the combined treatment, tumor characteristics, important immune markers and their correlations with treatment response were evaluated. The associations between key factors and overall survival (OS) were determined by Cox regression. Results: Of the 45 patients, the 3-month overall response rate (RECIST 1.1 criteria) is 26.7%. Multivariate analysis showed the number of metastatic organs ( &gt; 2 vs ≤2; HR 3.54; 95% CI 1.32-9.49; P = 0.012), pretreatment LDH level ( &gt; 300 vs ≤300 U/L; HR 4.59; 95% CI 1.78-11.85; P = 0.002) and diameter of ablated lesion ( &gt; 30 vs ≤30 mm; HR 3.27; 95% CI 1.17-9.15; P= 0.024) were independent unfavorable prognostic factors for OS. Further analysis showed patients with larger intrahepatic tumors ablated had larger tumor size (P &lt; 0.001). A scatter plot by the two key variables showed patients with intrahepatic tumor size less than 45 mm and size of ablated lesion less than 30 mm had a marginally higher rate of 3-month response (10/28, 35.7%) compared to those not (2/17, 11.7%; P = 0.076). Large diameter of ablated lesion ( &gt; 30 mm) require more ablation needles and cause greater elevation in the level of IL-6, CD8+T cell to Treg cell ratio and neutrophil to lymphocyte ratio after cryoablation while these changes disappeared when tested one month later. Conclusions: Fine selection based on baseline characteristics of patients and size of intrahepatic lesion for cryoablation are essential to achieve a high response rate during cryoablation-PD-1 combination treatment for liver metastatic melanoma.

Change in skeletal muscle mass is associated with hepatic steatosis in nonalcoholic fatty liver disease

The association between nonalcoholic fatty liver disease (NAFLD) and sarcopenia is known. We aimed to determine the association between skeletal muscle mass changes and NAFLD status. This retrospective single-center study analyzed patients who underwent health screening twice between November 2009 and December 2017, with a temporal gap of 6 ± 0.5 years. The degree of sarcopenia was assessed using appendicular skeletal muscle mass (ASM) adjusted for weight and body mass index (BMI). Changes in hepatic steatosis and fibrosis status were evaluated using noninvasive serum markers. Patients with a decrease in ASM/BMI (n = 353) had increased hepatic steatosis index (HSI) and fatty liver index (FLI) scores during 6 years (p < 0.05). The baseline sarcopenia group had a greater elevation in NAFLD fibrosis score (NFS) over 6 years than those without baseline sarcopenia. ASM changes over 6 years showed a negative correlation with variations in HSI (β = − 0.96 in ASM/Weight and -28.93 in ASM/BMI) and FLI (β = − 5.44 in ASM/Weight and − 167.12 in ASM/BMI). Subgroup analyses showed similar results according to sex and age. Sarcopenia may worsen steatosis and vice versa. Skeletal muscle status can be used to predict the course of NAFLD and establish individualized treatment strategies.

PC35. PATIENT REPORTED OUTCOMES AND NIPPLE POSITION FOLLOWING NIPPLE-SPARING MASTECTOMY (NSM): A PROSPECTIVE EXAMINATION OF PREPECTORAL AND SUBPECTORAL PATIENTS

PURPOSE: Nipple-sparing mastectomy (NSM) is becoming more popular. The role of pocket dissection (prepectoral vs subpectoral) in implant-based reconstruction on patient reported outcomes (PRO’s) and nipple position following NSM has not yet been explored. We hypothesize that prepectoral reconstruction results in superior PRO’s and more anatomical nipple position compared to subpectoral reconstructions following NSM. METHODS: Surgical details and short-term complication in NSM patients from 2018 to 2021 were prospectively collected. PROs were obtained preoperatively, 6 and 12 months postoperatively. Nipple displacement from baseline was analyzed using three-dimensional(3D) surface imaging by three independent researchers. RESULTS: 216 patients who underwent 391 NSM were divided into two cohorts, subpectoral and prepectoral. There were no differences in demographics or comorbidities between cohorts. Prepectoral patients (N=83 (86%) vs. 54 (44%); p<0.001) reported better physical well-being of the chest preoperatively (median 76, IQR 67,92 vs 72, IQR 64,80; p=0.022). No other differences in PRO’s or complications were observed. Linear regression suggested that radiation is the most important factor impacting satisfaction following NSM. 3D photographs for 97 patients were analyzed and 175 nipple positions were measured in 3 dimensions. Controlling for implant size, there was greater elevation and less projection of the nipple compared to baseline in subpectoral cohort (elevation: median -16 mm, IQR -24,-7 vs -3 mm, IQR -12,5; p<0.001; projection: median -1 mm, IQR -9,6 vs -6 mm, IQR -14,4; p=0.002). CONCLUSION: Implant pocket did not impact PRO’s or short-term complications in patients who underwent NSM. Patients with prepectoral reconstruction had less nipple displacement and more nipple projection following NSM.

Autophagy: A newly discovered protective mechanism in the marine rotifer Brachionus plicatilis in response to BDE-47 exposure

2,2′,4,4′-Tetrabromodiphenyl ether (BDE-47) is a persistent organic pollutant that spreads widely in the marine environment. Our previous studies found that it had adverse effects on the marine rotifer Brachionus plicatilis and caused a series of stress responses. The present study was performed to verify the occurrence of autophagy and explore its role in B. plicatilis’ coping with BDE-47 exposure. Rotifers were exposed to 0.05, 0.2, 0.8, and 3.2 mg/L BDE-47 for 24 h, respectively. Detections of the autophagy marker protein LC3 by western blot and autophagosomes by MDC staining demonstrated the occurrence of autophagy. The levels of autophagy were significantly increased in BDE-47-treated groups with a peak in 0.8 mg/L group. A series of indicators responded to BDE-47 exposure, including reactive oxygen species (ROS), GSH/GSSG ratio, superoxide dismutase (SOD) activity, and malonaldehyde (MDA), collectively indicating the occurrence of oxidative stress. The potential interplay between autophagy and oxidative stress in B. plicatilis was explored in the 0.8 mg/L group through a series of additions. The ROS level was significantly decreased by the addition of the ROS generation inhibitor diphenyleneiodonium chloride, to a level even lower than that in the blank control, and concomitantly, autophagosome was almost undetectable, indicating that a certain level of ROS was essential for the occurrence of autophagy. Autophagy was weakened by the addition of the autophagy inhibitor 3-methyladenine coincident with the great elevation of ROS, indicating that activated autophagy contributed to reducing the ROS level. Additional proof of this relation was obtained from the direct opposite effects of the autophagy inhibitor bafilomycin A1 and the autophagy activator rapamycin: the former increased the MDA content significantly, whereas the latter decreased it significantly. The combined results suggested that autophagy alleviated oxidative stress and might be a newly discovered protective mechanism in B. plicatilis coping with BDE-47 exposure.

Linking Patterns of Intraoperative Neuromonitoring (IONM) Alerts to the Odds of a New Postoperative Neurological Deficit: Analysis of 27,808 Cervical Spine Procedures From a National Multi-institutional Database.

Retrospective review of a national multi-institutional database of 27,808 extradural cervical spine procedures performed between January 2017 and May 2021. Characterize intraoperative neuromonitoring alerts by the patterns of modalities and nerves/muscles involved and quantify risk of new-onset neurological deficit for patients with a primary diagnosis of myelopathy, stenosis, or radiculopathy. Phenotyping alert patterns and linking those patterns with risk is needed to facilitate clinical decision-making. Cases with alerts were categorized by patterns of modalities or nerves/muscles involved, and alert status at closure. Unadjusted odds ratios (ORs) for new-onset neurological deficit were calculated. A mixed-effects logistic regression model controlling for demographic and operative factors, with random intercepts to account for clustering in outcomes by surgeon and surgical neurophysiologist was also used to calculate ORs and probabilities of neurological deficit. There was significantly increased risk of a new neurological deficit for procedures involving posterior compared with anterior approaches (OR: 1.82, P=0.001) and procedures involving three levels compared with one (OR: 2.17, P=0.001). Odds of a deficit were lower for patients with radiculopathy compared with myelopathy (OR: 0.69, P=0.058). Compared with cases with no alerts, those with unresolved Spinal Cord alerts were associated with the greatest elevation in risk (OR: 289.05) followed by unresolved C5-6 Nerve Root (OR: 172.7), C5-T1 Nerve Root/Arm (OR: 162.89), C7 Nerve Root (OR:84.2), and C8-T1 Nerve Root alerts (OR:75.49, all P<0.001). Significant reductions in risk were seen for resolved Spinal Cord, C5-6 Nerve Root, and C8-T1 nerve alerts. Overall, unresolved motor evoked potential and somatosensory evoked potential alerts were associated with the greatest elevation in risk (OR:340.92) followed by unresolved motor evoked potential-only (OR:140.6) and unresolved somatosensory evoked potential-Only alerts (OR:78.3, all P<0.001). These relationships were similar across diagnostic cohorts. Risk elevation and risk mitigation after an intraoperative neuromonitoring alert during surgery is dependent on the type and pattern of alert.

Insights from the first winter weather observations near Mount Everest's summit

Insights from the first winter weather observations near Mount Everest's summit