Imaging Score Research Articles

Exploration of Preliminary Objective Triage by Menopause Score and CA 125 Result Prior to Accelerating Fast-Track Booking for Suspected Ovarian Cancer-A Role for the Pathway Navigator?

The 28-days-to-diagnosis pathway is the current expected standard of care for women with symptoms of ovarian cancer in the UK. However, the anticipated conversion rate of symptoms to cancer is only 3%, and use of the pathway is increasing. A rapid triage at the moment of receipt of the referral might allow resources to be allocated more appropriately. In secondary care, multidisciplinary teams (MDTs) use the risk of malignancy index (RMI) score, (multiply menopausal status pre = 1 or post = 3 × ultrasound score = 0 - 3 × the CA 125 level), using a score of >200, to triage urgency and management in possible ovarian cancer cases. The most powerful determinant of the RMI score variables is CA 125 level, an objective number. Could a simple modification of the RMI score retain a high sensitivity for cancer whilst improving specificity and, consequently, decrease the morbidity of false-positive classification? To test this hypothesis, a retrospective evaluation of an ovarian two-week-wait telephone clinic of one consultant gynaecological oncologist was undertaken. Enquiry re menopause status was scored as one for pre- and three for postmenopausal or uncertain. CA 125 levels of >67 u/mL for premenopausal and >23 u/mL for postmenopausal women were used to precipitate urgent cross-sectional imaging requests and MDT opinions. These CA 125 cut thresholds were calculated using an assumption that the RMI imaging score, regardless of whether the result was available, could be three. We contemplate that women who did not exceed a provisional RMI score of >200 might be informed they are extremely unlikely to have cancer, removed from the malignancy tracker and appropriate follow-up arranged. One hundred and forty consecutive cases were analysed; 43% were deemed premenopausal and 57% postmenopausal. Twenty of the women had cancer, eighteen (90%) of whom had an RMI > 200. One hundred and twenty were benign, and only twenty-three (19%) classified as urgent cases in need of accelerated referral to imaging. In contrast, CA 125 > 35 u/mL, whilst retaining the sensitivity of 90%, misclassified 36 (30%) of the benign cases. It is possible that a telephone triage via a questionnaire determining menopausal status and the CA 125 result could offer a sensitivity for cancer of 90% and urgent expert review of under 20% of benign cases. This rapid initial telephone assessment could be presented by a trained pathway navigator, physician associate or nurse specialist. Substantial savings in NHS cancer services resources, anxieties all around and reduced patient morbidity may occur as a result.

Nepali Image Captioning: Generating Coherent Paragraph-Length Descriptions Using Transformer

The advent of deep neural networks has made the image captioning task more feasible. It is a method of generating text by analyzing the different parts of an image. A lot of tasks related to this have been done in the English language, while very little effort is put into this task in other languages, particularly the Nepali language. It is an even harder task to carry out research in the Nepali language because of its difficult grammatical structure and vast language domain. Further, the little work done in the Nepali language is done to generate only a single sentence, but the proposed work emphasizes generating paragraph-long coherent sentences. The Stanford human genome dataset, which was translated into Nepali language using the Google Translate API is used in the proposed work. Along with this, a manually curated dataset consisting of 800 images of the cultural sites of Nepal, along with their Nepali captions, was also used. These two datasets were combined to train the deep learning model. The task involved working with transformer architecture. In this setup, image features were extracted using a pretrained Inception V3 model. These features were then inputted into the encoder segment after position encoding. Simultaneously, embedded tokens from captions were fed into the decoder segment. The resulting captions were assessed using BLEU scores, revealing higher accuracy and BLEU scores for the test images.

Diagnostic Value of Dual-Energy CT Virtual Noncalcium for the Assessment of Bone Marrow Edema of Wrist in Patients with Rheumatoid Arthritis

To evaluate the value of dual-energy CT (DECT) virtual noncalcium (VNCa) images in the diagnosis of wrist bone marrow edema (BME) in patients with rheumatoid arthritis (RA). 43 patients with wrist involvement in active RA prospectively underwent DECT and MRI. Functional DECT images reconstruction yielded VNCa images. MRI served as the reference standard for diagnosing BME. BME diagnosis differences between VNCa images and MRI were compared. Differences in CT values between BME and normal bone marrow were assessed. The optimal CT value for detecting BME in VNCa images was determined through ROC curve analysis. The correlation between VNCa images scores and RA disease activity was evaluated. There was a high agreement between VNCa images and MRI in diagnosing BME (Kappa=0.831). VNCa images showed a significant difference in CT values between BME and normal bone marrow (P<0.001). A cut-off value of -54.8 HU yielded a sensitivity, specificity, and accuracy of 90.72%, 94.30%, and 93.33%, respectively, for detecting BME on VNCa images. The area under the ROC curve was 0.937 for distinguishing BME from normal bone marrow. Conventional CT images showed no statistically significant difference (P=0.174) in CT values between BME and normal bone marrow. The VNCa images BME scores were positively correlated with RA disease activity (r=0.399). The DECT VNCa technique demonstrates its potential for diagnosing wrist BME in patients with RA and provides a valuable tool for assessing disease activity in RA. The DECT VNCa technique has the ability to distinguish between BME and normal bone marrow. The VNCa images BME scores were positively correlated with the disease activity in RA.

Neuroticism and openness exhibit an anti-correlation pattern to dissociable default mode network: using resting connectivity and structural equation modeling analysis.

The default mode network (DMN) can be subdivided into ventral and dorsal subsystems, which serve affective cognition and mental sense construction, respectively. An internally dissociated pattern of anti-correlations was observed between these two subsystems. Although numerous studies on neuroticism and openness have demonstrated the neurological functions of the DMN, little is known about whether different subsystems and hubs regions within the network are engaged in different functions in response to the two traits. We recruited 223 healthy volunteers in this study and collected their resting-state functional magnetic resonance imaging (fMRI) and NEO Five-Factor Inventory scores. We used independent component analysis (ICA) to obtain the DMN, before further decomposing it into the ventral and dorsal subsystems. Then, the network coherence of hubs regions within subsystems was extracted to construct two structural equation models (SEM) to explore the relationship between neuroticism and openness traits and DMN. We observed that the ventral DMN could significantly predict positive openness and negative neuroticism. The dorsal DMN was diametrically opposed. Additionally, the medial prefrontal cortex (mPFC) and middle temporal gyrus (MTG), both of which are core hubs of the subnetworks within the DMN, are significantly positively correlated with neuroticism and openness. These findings may point to a biological basis that neuroticism and openness are engaged in opposite mechanisms and support the hypothesis about the functional dissociation of the DMN.

Body image perception and physical activity behavior among adult population: Application of trans-theoretical model of behavior change.

The human body changes during life, but research on how sociodemographic characteristics and physical activity (PA) related to all aspects of body image are still unclear and there is conflict in the relevant results. This study aims to examine gender-specific body image perception and physical activity in relation to BMI and sociodemographic characteristics among health employees who worked in health and medical care centers. The study was a population-based cross-sectional survey of 170 health employees (55 men and 115 women) in Binaloud, Iran. Participants completed a self-administered questionnaire, which consisted of a self-administered Multidimensional Body-Self Image Questionnaire (MBSRQ) and stages of change scales. The full version of Marcus-TTM based on the stages of physical activity changes was used based on 5 items related to regular physical activity behavior and intentions. There were no significant differences between men and women in total body image score, body area satisfaction, and attitude. Disease orientation (p = 0.02) and health orientation (p = 0.05) were the only significant differences between men and women. The number of children, level of education, BMI, and PA had a stronger influence on body image concerns and body dissatisfaction. PA and 7 of the 10 subclasses of MBSRQ (appearance evaluation, fitness evaluation, fitness orientation, health evaluation, health orientation, and illness orientation) showed a significant difference (P<0.05) between participants in the five TTM stages. The ideal body image and body satisfaction may differ by the number of children, level of education, gender, BMI, and PA. Evidence from this study supports that participants' stages of change affect their physical activity and body image perception. This result suggests a need for conducting work/home place intervention to promote adults' body image perception and body area satisfaction based on the usage-specific stage under consideration.

Magnetic resonance imaging scoring system of the lower limbs in adult patients with suspected idiopathic inflammatory myopathy

PurposeWe aim to propose a visual quantitative score for muscle edema in lower limb MRI to contribute to the diagnosis of idiopathic inflammatory myopathy (IIM).Material and methodsWe retrospectively evaluated 85 consecutive patients (mean age 57.4 ± 13.9 years; 56.5% female) with suspected IIM (muscle weakness and/or persistent hyper-CPK-emia with/without myalgia) who underwent MRI of lower limbs using T2-weighted fast recovery-fast spin echo images and fat-sat T2 echo planar images. Muscle inflammation was evaluated bilaterally in 11 muscles of the thigh and eight muscles of the leg. Edema in each muscle was graded according to a four-point Likert-type scale adding up to 114 points ([11 + 8)] × 3 × 2). Diagnostic accuracy of the total edema score was explored by assessing sensitivity and specificity using the area under the ROC curve. Final diagnoses were made by a multidisciplinary Expert Consensus Panel applying the Bohan and Peter diagnostic criteria whenever possible.ResultsOf the 85 included patients, 34 (40%) received a final diagnosis of IIM (IIM group) while 51 (60%) received an alternative diagnosis (non-IIM group). A cutoff score ≥ 18 was able to correctly classify patients having an IIM with an area under the curve of 0.85, specificity of 96%, and sensitivity of 52.9%.ConclusionOur study demonstrates that a quantitative MRI score for muscle edema in the lower limbs (thighs and legs) aids in distinguishing IIM from conditions that mimic it.

Structural and functional changes following brain surgery in pediatric patients with intracranial space-occupying lesions.

We explored the structural and functional changes of the healthy hemisphere of the brain after surgery in children with intracranial space-occupying lesions. We enrolled 32 patients with unilateral intracranial space-occupying lesions for brain imaging and cognitive assessment. Voxel-based morphometry and surface-based morphometry analyses were used to investigate the structural images of the healthy hemisphere. Functional images were analyzed using regional homogeneity, amplitude of low-frequency fluctuations, and fractional-amplitude of low-frequency fluctuations. Voxel-based morphometry and surface-based morphometry analysis used the statistical model built into the CAT 12 toolbox. Paired t-tests were used for functional image and cognitive test scores. For structural image analysis, we used family-wise error correction of peak level (p < 0.05), and for functional image analysis, we use Gaussian random-field theory correction (voxel p < 0.001, cluster p < 0.05). We found an increase in gray matter volume in the healthy hemisphere within six months postoperatively, mainly in the frontal lobe. Regional homogeneity and fractional-amplitude of low-frequency fluctuations also showed greater functional activity in the frontal lobe. The results of cognitive tests showed that psychomotor speed and motor speed decreased significantly after surgery, and reasoning increased significantly after surgery. We concluded that in children with intracranial space-occupying lesions, the healthy hemisphere exhibits compensatory structural and functional effects within six months after surgery. This effect occurs mainly in the frontal lobe and is responsible for some higher cognitive compensation. This may provide some guidance for the rehabilitation of children after brain surgery.

A Robust Method for the Unsupervised Scoring of Immunohistochemical Staining.

Immunohistochemistry is a powerful technique that is widely used in biomedical research and clinics; it allows one to determine the expression levels of some proteins of interest in tissue samples using color intensity due to the expression of biomarkers with specific antibodies. As such, immunohistochemical images are complex and their features are difficult to quantify. Recently, we proposed a novel method, including a first separation stage based on non-negative matrix factorization (NMF), that achieved good results. However, this method was highly dependent on the parameters that control sparseness and non-negativity, as well as on algorithm initialization. Furthermore, the previously proposed method required a reference image as a starting point for the NMF algorithm. In the present work, we propose a new, simpler and more robust method for the automated, unsupervised scoring of immunohistochemical images based on bright field. Our work is focused on images from tumor tissues marked with blue (nuclei) and brown (protein of interest) stains. The new proposed method represents a simpler approach that, on the one hand, avoids the use of NMF in the separation stage and, on the other hand, circumvents the need for a control image. This new approach determines the subspace spanned by the two colors of interest using principal component analysis (PCA) with dimension reduction. This subspace is a two-dimensional space, allowing for color vector determination by considering the point density peaks. A new scoring stage is also developed in our method that, again, avoids reference images, making the procedure more robust and less dependent on parameters. Semi-quantitative image scoring experiments using five categories exhibit promising and consistent results when compared to manual scoring carried out by experts.

Development and validation of a novel scoring system for acute ischemic stroke

BackgroundThis study aimed to assess the clinical application of the Artery Occlusion Image Score (AOIS), a new metric based on computed tomographic angiography (CTA) that reflects the severity of occlusive changes in the main intracranial arteries.Materials and MethodsPatients diagnosed with acute ischemic stroke (AIS) were divided into three groups: anterior circulation infarcts (ACI group), posterior circulation infarcts (PCI group), and both anterior and posterior circulation infarcts (ACI + PCI group). The sensitivity and specificity of AOIS were evaluated using the Basilar Artery on Computed Tomography Angiography (BATMAN) score, the Clot Burden Score (CBS), and the National Institutes of Health Stroke Scale (NIHSS) as comparators through receiver-operating characteristic (ROC) curve analysis.ResultsThe final analysis included 439 consecutive patients. In the ACI group, AOIS demonstrated high sensitivity (86.3%) and specificity (85.0%) and outperformed CBS in predicting patient prognosis. In the PCI group, AOIS also showed high sensitivity (88.9%) and specificity (90.0%) and outperformed BATMAN in predicting patient prognosis. In the ACI + PCI group, AOIS positively correlated with the NIHSS score (Spearman’s ρ = 0.602, P < .001). Additionally, the scoring time of AOIS did not significantly differ from CBS and BATMAN.ConclusionAOIS is a convenient and reliable method for guiding treatment and predicting outcomes in patients with ACI or/and PCI. Furthermore, AOIS is the first CTA-based scoring system that covers both the anterior and posterior circulation, providing a convenient and reliable evaluation for patients with concurrent acute ischemic stroke in both circulations.

Clinical and Radiological Outcomes After Combined ACL and MPFL Reconstruction Versus Isolated ACL Reconstruction for ACL Injury With Patellar Instability

Background: An anterior cruciate ligament (ACL) injury accompanied by patellar instability (PI) is a topic that has gained orthopaedic surgeons’ attention recently. Untreated PI is reportedly associated with worse clinical outcomes after isolated ACL reconstruction (ACLR) in patients after an ACL injury with PI. Nevertheless, the appropriate surgical approach and its long-term therapeutic effects in these patients remain unclear. Purpose: (1) To compare the clinical and radiological outcomes between isolated ACLR (iACLR) and combined ACLR and medial patellofemoral ligament reconstruction (cAMR) in patients after an ACL injury with PI and (2) to explore the correlations between these 2 procedures and clinical and radiological outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 106 patients diagnosed with an ACL injury accompanied by PI between January 2016 and April 2021 were analyzed in this study. There were 34 patients excluded because of missing postoperative radiological data. Among the remaining 72 patients, 34 patients underwent iACLR, while 38 patients underwent cAMR. Demographic characteristics, intraoperative findings, and patient-reported outcomes (Lysholm score, subjective International Knee Documentation Committee score, and Tegner activity score) were prospectively collected. Patellar alignment parameters and worsening patellofemoral osteoarthritis (PFOA) features (evaluated with the modified Whole-Organ Magnetic Resonance Imaging Score) were analyzed longitudinally on magnetic resonance imaging. The Kujala score was used to evaluate the functional recovery of the patellofemoral joint, and redislocations of the patella were prospectively recorded. Finally, multivariate logistic regression analysis was used to explore the correlations between these 2 procedures and clinical (not achieving the minimal detectable change [MDC] for the Lysholm score) and radiological (worsening PFOA features) outcomes. Results: The mean follow-up duration was 28.9 ± 6.2 and 27.1 ± 6.8 months for the iACLR and cAMR groups, respectively (P = .231). Significantly higher Lysholm scores (88.3 ± 9.9 vs 82.1 ± 11.1, respectively; P = .016) and subjective International Knee Documentation Committee scores (83.6 ± 11.9 vs 78.3 ± 10.2, respectively; P = .046) were detected in the cAMR group compared with the iACLR group postoperatively. The rates of return to preinjury sports were 20.6% and 44.7% in the iACLR and cAMR groups, respectively (difference, 24.1% [95% CI, 3.3%-45.0%]; P = .030). Moreover, the rates of worsening PFOA features were 44.1% and 18.4% in the iACLR and cAMR groups, respectively (difference, 25.7% [95% CI, 4.9%-46.4%]; P = .018). In addition, significantly higher Kujala scores (87.9 ± 11.3 vs 80.1 ± 12.0, respectively; P = .006), lower redislocation rates (0.0% vs 11.8%, respectively; difference, 11.8% [95% CI, 0.9%-22.6%]; P = .045), and significantly better patellar alignment were detected in the cAMR group compared with the iACLR group postoperatively. Furthermore, multivariate logistic regression analysis determined that iACLR and partial lateral meniscectomy were significantly correlated with not achieving the MDC for the Lysholm score and worsening PFOA features in our study population. Conclusion: In patients after an ACL injury with PI, cAMR yielded better clinical and radiological outcomes compared with iACLR, with better patellar stability and a lower proportion of worsening PFOA features. Furthermore, not achieving the MDC for the Lysholm score and worsening PFOA features were significantly correlated with iACLR and partial lateral meniscectomy. Our study suggests that cAMR may be a more appropriate procedure for patients after an ACL injury with PI, which warrants further high-level clinical evidence.

Decision regret, and other mental health outcomes, following fertility preservation in the transgender individual compared to the cisgender woman.

This study aimed to (1) determine differences in depression, anxiety, body image, quality-of-life (QOL), and decision regret scale (DRS) scores in transgender individuals undergoing fertility preservation (FP) compared to those who decline and (2) determine if DRS score following FP varies between transgender individuals and cisgender women. Sixteen transgender birth-assigned (BA) females and 13 BA males, undergoing FP consultation at an academic center between January 2016 and November 2019, were compared to each other and cisgender cohorts with pre-existing data: 201 women undergoing elective oocyte cryopreservation (EOC) between 2012 and 2016 and 44 women with cancer undergoing FP between 1993 and 2007. Outcomes included demographics; validated scales for depression, anxiety, body image, QOL (see below) in the trans cohort; DRS score in all three cohorts. Of 29 transgender individuals participating, 10 BA females (62%) and 12 BA males (92%) underwent FP. Beck Depression Inventory II, Hospital Anxiety and Depression Scale, Body Image Scale for Transsexuals, Satisfaction with Life Scale, Short Form Health Survey-36, and DRS scores were not significantly different between trans individuals who underwent FP and those who declined. On univariate modeling, regret was significantly lower in transpeople undergoing FP compared to those who did not (OR 0.118, p = 0.03). BA female and BA male transpatients undergoing FP reported DRS median scores 5 (mean 9) and 7.5 (mean 15), respectively, both were not significantly different from cisgender women (p = 0.97, p = 0.25) nor from each other (p = 0.43). Depression, anxiety, body image, and QOL, in a group of individuals presenting for FP consultation, appear similar between transpeople undergoing FP and not, while regret is significantly lower in those choosing FP. FP is an option for transgender individuals without significant differences in regret compared to cisgender women.

Changes in patient-reported satisfaction and quality-of-life 6 months after rhinoplasty

Rhinoplasty is a challenging and demanding procedure in plastic surgery. Surgical success, patient satisfaction, and improved quality-of-life are important outcomes. This study aimed to evaluate patient-reported satisfaction with appearance, treatment, and decision outcomes as well as quality-of-life after rhinoplasty using validated questionnaires. The role of patient demographics on outcomes was also studied. Patients who underwent a primary rhinoplasty were selected for this cohort study. Patient-reported satisfaction with appearance, treatment, and decision as well as quality-of-life were evaluated with the Utrecht Questionnaire and FACE-Q at intake and 6months postoperatively. Overall, 380 patients were included. Patients reported a more positive subjective perception of nasal appearance (VAS score) at 6months post-surgery compared with preoperative scores (7.9±1.6 vs 3.2±1.4, p<0.05). Furthermore, higher quality-of-life and body image scores were observed at 6months postoperatively compared with preoperative scores (7.7±3.5 vs 15.2±4.4, p<0.05). Patients reported high satisfaction with treatment outcome (70.3±23.4) as well as with their decision to undergo surgery (75.9±23.4) on a scale of 0-100 at 6months postoperatively. Patients reached similar postoperative scores regardless of their intake scores. Patients ≥30years and patients with a history of cosmetic surgery were less satisfied postoperatively. Despite differences in appearance satisfaction at intake, most patients showed greater satisfaction with appearance, treatment, and decision outcomes as well as quality-of-life 6months postoperatively. However, older age and a history of cosmetic surgery influenced these outcomes negatively. These factors should be considered during preoperative management of outcome expectations.

MRI-based cartilage changes and clinical effectiveness of autologous intra-articular platelet-rich plasma injections in symptomatic patients with moderate osteoarthritis of the knee

BackgroundAn autologous blood product containing a high percentage of various growth factors, cytokines, and modulating factors such as platelet-rich plasma (PRP) is thought to play a role in chondral remodeling by promoting the production of cartilage matrix molecules and repairing and regenerating articular cartilage. In symptomatic patients with moderate osteoarthritis (OA) of the knee, we aimed to investigate MRI-based cartilage changes and the clinical efficacy of autologous intra-articular PRP injections.ResultsThirty-three patients with grades 2 and 3 OA of knees as per Kellgren and Lawrence OA classification underwent three consecutive PRP injections at monthly intervals. These patients were followed up monthly for the first 3 months, and then after every 3 months at 6 months, 9 months, and 12 months. There was statistically significant improvement in joint pain and functionality with the visual analogue scale (VAS) scores showing a reduction from 7 ± 2 at baseline to 2.76 ± 1.34 at 12 months and Western Ontario and McMaster Universities Osteoarthritis Index Score (WOMAC) scores declining from 77.91 ± 1 1.6 at baseline to 23.61 ± 19.1 at 12 months (p < 0.05). The reduction in VAS and WOMAC scores was maximum during the first 3 months after PRP therapy. MRI showed a statistically insignificant improvement in cartilage thickness [Whole Organ Magnetic Resonance Imaging Score (WORMS) 3.15 ± 1.41 to 3.3 ± 0.84) (p > 0.05)].ConclusionsPRP had a positive effect on pain alleviation and patient functioning, but there was no significant change in articular cartilage as measured by MRI.

Cerebral circulation time on DSA after thrombectomy associated with hemorrhagic transformation in acute ischemic stroke.

To investigate the association between cerebral circulation time (CCT) on digital subtraction angiography immediately after thrombectomy and hemorrhagic transformation (HT) in acute ischemic stroke (AIS). Retrospectively enrolled consecutive AIS patients presented with large vessel occlusion who received thrombectomy and achieved successful recanalization between January 2019 and June 2021. The time interval from the beginning of the siphon segment of internal carotid artery visualization until the end of the arterial phase during cerebral angiography was calculated as CCT. The independent association of CCT with HT was evaluated using logistic regression analyses. The receiver operating characteristic curve was analyzed to evaluate the association between CCT and HT. Two hundred and twenty-four patients were included, of whom 86 (38.4%) suffered HT. Compared with patients without HT, patients with HT were of advanced age, less commonly male, had more diabetes mellitus, had higher baseline National Institutes of Health Stroke Scale score, lower Alberta Stroke Program Early Computed Tomographic Score, and shorter CCT (P < 0.05). Multivariable logistic regression suggested that CCT was independently associated with HT (adjusted odds ratio, 0.170; 95% confidence interval, 0.004-0.450; P < 0.001). According to the receiver operating characteristic curve, the optimal cut-off value for the strong correlation between CCT and HT was 1.72s, which had 76.6% sensitivity, 81.6% specificity, and the area under the curve was 0.846. Shorter post-thrombectomy CCT was independently associated with HT.

(293) Observed Relationship Between Testosterone Levels and Perceived Body Image

Abstract Introduction A positively perceived body image is an important part of one’s conception of oneself and one’s own identity, abilities, and worth. Past research has shown an inverse relationship between testosterone concentration and one’s sense of self, as manifested by increased depression. We hypothesized, therefore, that a subjectively negative self-image would be associated with the objective findings of hypogonadism (low testosterone). Objective To investigate the relationship between one’s own serum testosterone and a personal assessment of one’s body image and satisfaction. Methods An electronic survey was delivered through REDCap to patients at our urology clinic with a recent testosterone value documented in the observation interval 1/1/2020-12/31/2022. The survey included components of the following validated surveys: the Self-Rated Bodily Attractiveness Survey, the Male Body Image Self-Conscious Scale, and the Body Esteem Scale. Specifically, we asked each patient about their perceived bodily attractiveness as it pertains to sexual intercourse as well as specific inquiries about feelings towards specific body parts. Each answer choice corresponded to a five-point Likert-Scale, enabling respondents to indicate their level of agreement or disagreement. We then retrospectively recorded the most recent testosterone value recorded in each respondent’s electronic medical record. T-tests were utilized to compare testosterone values for men with high versus low survey scores using SPSS. Results The men who reported a positive cumulative body image score from the survey had an average testosterone of 749.15 ng/dL, whereas men who had a negative body image score from our survey had an average testosterone of 340.67 ng/dL. Importantly, these testosterone values were statistically significant from each other, as indicated by a t-value of 2.58 and a p-value of .0095. To establish clear distinctions between the positive and negative body image cohorts, we set threshold scores for each group: the positive body image cohort was defined as individuals scoring at least 34 out of 45 (≥ 75%), while the negative body image cohort comprised those with scores no higher than 30 out of 45. Interestingly, there were no respondents whose cumulative scores fell within the range of 30 to 34. The positive body image cohort had an average score of 39.92 out of 45, while the negative body image cohort had an average score of 23.00 out of 45. Conclusions Based on our findings, it appears that men with hypogonadism, as characterized by low testosterone, may be more likely to experience a negative body image. This relationship is supported by this cohort’s response to several questionnaires addressing one’s own assessment of self-worth. Men with low testosterone versus eugonadal controls scored significantly lower in surveys addressing bodily attractiveness, male body image self-consciousness, and body esteem. These results highlight the relationship between low testosterone and body image, contributing to our understanding of the psychological factors that can influence well-being in men. Healthcare professionals should be aware of the potential implications and challenges faced by individuals with hypogonadism, addressing concurrently both their hormonal deficiencies and their negative sense of self. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Larry Lipshultz: AbbVie (Consultant) American Medical Systems/Boston Scientific (Speaker) Aytu BioScience (Consultant) Contraline, Inc. (Consultant) Endo Pharmaceuticals (Consultant/Speaker) Inherent Biosciences (Advisor) Lipocine (Consultant).

Association Between Seizures and Neurodevelopmental Outcome at Two and Five Years in Asphyxiated Newborns With Therapeutic Hypothermia

ObjectiveTo investigate the association between the presence and severity of seizures in asphyxiated newborns and their neurodevelopmental outcome at ages two and five years. MethodsRetrospective data analysis from a prospectively collected multicenter cohort of 186 term-born asphyxiated newborns undergoing therapeutic hypothermia (TH) in 11 centers in the Netherlands and Belgium. Seizures were diagnosed by amplitude-integrated electroencephalography (EEG) and raw EEG signal reading up to 48 hours after rewarming. Neurodevelopmental outcome was assessed by standardized testing at age two and five years. Primary outcome was death or long-term neurodevelopmental impairment (NDI) including cerebral palsy. Associations were calculated using univariate and multivariate logistic regression analyses adjusting for Thompson score and a validated brain magnetic resonance imaging (MRI) score. ResultsSeventy infants (38%) had seizures during TH or rewarming, and 44 (63%) of these needed two or more antiseizure medications (ASMs). Overall mortality was 21%. Follow-up data from 147 survivors were available for 137 infants (93%) at two and for 94 of 116 infants (81%) at five years. NDI was present in 26% at two and five years. Univariate analyses showed a significant association between seizures and death or NDI, but this was no longer significant after adjusting for Thompson and MRI score in the multivariate analysis; this was also true for severe seizures (need for two or more ASMs) or seizures starting during rewarming. ConclusionThe presence or severity of seizures in newborns undergoing TH for hypoxic-ischemic encephalopathy was not independently associated with death or NDI up to age five years after adjusting for several confounders.

Non-linear Effect of Preexisting Cranial Adjacent Disc Degeneration on Cumulative 12-year Revision Risk Following Lumbar Fusions.

Retrospective analysis of prospectively collected data. To evaluate how preexisting adjacent segment degeneration status impacts revision risk for adjacent segment disease (ASD) after lumbar fusions. ASD incurs late reoperations after lumbar fusion surgeries. ASD pathogenesis is multifactorial. Preexisting adjacent segment degeneration measured by Pfirrmann is suggested as one of the predisposing factors. We sought to find deeper insights into this association by using a more granular degeneration measure, the Combined imaging score (CIS). A total of 197 consecutive lumbar fusions for degenerative pathologies were enrolled in a prospective follow-up (median 12 years). Preoperative cranial adjacent segment degeneration status was determined using Pfirrmann and CIS, which utilizes both radiographs and magnetic resonance imaging. Based on CIS, patients were trichotomized into tertiles (CIS <7, CIS 7-10, and CIS >10). The cumulative ASD revision risk was determined for each tertile. After adjusting for age, sex, body mass index, sacral fixation, and fusion length, hazard ratios (95% confidence intervals, CI) for ASD revisions were determined for each Pfirrmann and CIS score. Patients in the intermediate CIS tertile had a cumulative ASD revision risk of 25.4% (17.0% to 37.0%), while both milder degeneration (CIS <7) [13.2% (6.5% to 25.8%)] and end-stage degeneration (CIS >10) [13.6% (7.0% to 25.5%)] appeared to be protective against surgical ASD. Pfirrmann failed to show a significant association with ASD revision risk. Adjusted analysis of CIS suggested increased ASD revisions after CIS 7, which turned contrariwise after CIS 10. The effect of preexisting adjacent segment degeneration on ASD reoperation risk is not linear. The risk seems to increase with advancing degeneration but diminish with end-stage degeneration. Therefore, end-stage degenerative segments may be considered to be excluded from fusion constructs. Therapeutic Level III.

Pathology of knee osteoarthritis pain: contribution of joint structural changes and pain sensitization to movement-evoked pain in knee osteoarthritis.

Movement-evoked pain (MEP) is the primary symptom in patients with knee osteoarthritis (KOA). This study aimed to investigate the contribution of joint structural changes and pain sensitization to the mechanisms of MEP in patients with KOA. A total of 86 patients were assessed for demographic characteristics, osteoarthritis severity, Whole-Organ Magnetic Resonance Imaging Score-Hoffa synovitis and bone marrow lesions, pressure pain threshold and temporal summation of pain at the knee and forearm, Central Sensitization Inventory-9, and MEP. In measure of MEP, knee pain was scored using a numerical rating scale (NRS, 0-10) before and every minute during a 6-minute walking test (6MWT), and the MEP index was defined as the change in NRS pain score from baseline to the sixth minute of walking. On average, pain during 6MWT increased by 1.4 ± 1.5 points on the NRS relative to baseline, with 30.2% of patients showing an increase of 2 points or more. The hierarchical linear regression analysis revealed that Hoffa synovitis, pressure pain threshold at the forearm, and temporal summation of pain at the knee were associated with the MEP index. The findings of this study suggest that both synovitis and neural mechanisms, such as pain sensitization, play a role in the development of MEP in KOA.

Abstract TP148: The Hemispheric-Aspects Scale: An Expanded Scan Assessment System Appropriate for ICA Occlusions

Background: Distinctive aspects of acute ischemic stroke (AIS) due to internal carotid artery occlusion (ICAO) include severe presenting deficits, extensive infarct volumes, frequent poor functional outcome, and mortality. Decision-making for thrombectomy, hemicraniectomy, and palliative care depends crucially upon infarct extent but the most widely used current image rating scale, ASPECTS, assesses only 10 regions confined to the MCA field. Methods: We developed the hemispheric-ASPECTS (H-ASPECTS) rating scale that assesses the entire extent of the ICA-supplied brain. The 16-point H-ASPECTS score adds to original MC-ASPECTS (10 regions), assessments of 3 ACA regions, 2 supratentorial PCA regions (thalamus, occipital - potentially fetal ICA-supplied), and 1 anterior choroidal artery region (Figure). We rated initial and 24h CT/MR in consecutive AIS-ICAO patients. Results: Among the AIS-ICAO patients (n=17), age was 68.5 (±15.8), 52.9% female, NIHSS median 20 (IQR 14-22). Occlusion locations were: carotid T 47%; cervical 47%; isolated intracranial ICA 6%. Treatment included EVT ± IV lysis in 59% and hemicraniectomy in 6%. Time from last known well to 1st imaging was 9.6h and 2nd imaging 35h. On 1st imaging H-ASPECTS scores were median 12 (IQR 11-14); on 2nd imaging 10 (IQR 6.5-12.5). Involvement of regions outside MCA, detected by the H-ASPECTS, occurred in 47% of patients, including ACA in 35%, PCA in 12%, and AChA in 6%. Second image H-ASPECTS correlated strongly with discharge mRS, r=0.66 (p=0.007). Conclusions: H-ASPECTS expands the scope of AIS imaging scores, captured abnormalities outside the MCA field in 47% of patients with ICAO, and correlated well with discharge disability level outcome. The additional information H-ASPECTS provides may enhance decision-making in ICAO patients with large ischemic cores, including for endovascular thrombectomy and hemicraniectomy.

Combining a risk factor score designed from electronic health records with a digital cytology image scoring system to improve bladder-cancer detection (Preprint)

Combining a risk factor score designed from electronic health records with a digital cytology image scoring system to improve bladder-cancer detection (Preprint)