Laterality Index Research Articles

Dysphagia is commonly assessed with qualitative and image-based diagnostic tools, which are often costly, technically demanding, and limited in their ability to support individualized rehabilitation. Electroencephalography (EEG) has recently emerged as a quantitative, cost-effective, and accessible alternative to characterize sensorimotor activity during swallowing, though its potential in dysphagic populations has not been systematically explored. This study investigated neural dynamics in 50 post-stroke dysphagic patients, 32 post-stroke non-dysphagic controls, and 21 healthy adults performing a swallowing task. EEG recordings from primary motor regions (C3, Cz, C4) were analyzed using event-related spectral perturbation (ERSP) to quantify alpha (8–13 Hz) and beta (15–30 Hz) event-related desynchronization, alongside hemispheric lateralization indices. Group comparisons revealed significantly reduced beta desynchronization in both post-stroke groups compared to healthy participants, with additional alpha and beta deficits at C3 and Cz distinguishing dysphagic patients from non-dysphagic controls. Dysphagic patients further exhibited abnormal lateralization not observed in other groups. These findings identify distinct alterations in motor cortical dynamics and hemispheric balance in dysphagia, supporting EEG-derived biomarkers as promising tools for diagnosis and clinical follow-up. The accessibility of EEG reinforces its potential integration into routine workflows to enable objective and personalized management of post-stroke dysphagia.

Evidence of language network reorganization and compromised cognitive functioning in pediatric patients with focal refractory epilepsy.

Methodological considerations for quantifying brain asymmetry using neuroimaging techniques.

Sustainable recovery of cellulose from lotus seedpods: Integrating process optimization and environmental-preliminary economic analysis.

RAMP lesions are common meniscal injuries associated with anterior cruciate ligament (ACL) tears, and growing interest has focused on their impact on functional outcomes following surgical repair. This study evaluated the short-term effects of surgical repair of RAMP lesions in terms of balance, fall risk, and knee function scores in patients who have undergone anterior cruciate ligament reconstruction (ACLR). Seven patients who underwent RAMP lesion repair in addition to ACLR were included in the study. Balance parameters (OSI, Overall Stability Index; APSI, Anterior Posterior Stability Index; MLSI, Medial Lateral Stability Index) and fall risk (FRI, Fall Risk Index) were assessed using the Biodex Balance System, while knee function was evaluated using the Tegner Activity Level and Lysholm Knee Score preoperatively and at the 6th postoperative week. Six of the patients were male, one was female, and the mean age was 26.8 years (18-35). All followed the same postoperative rehabilitation protocol. OSI decreased from 0.48 (0.1-1.1) to 0.17 (0.1-0.3), APSI from 0.28 (0-0.5) to 0.11 (0.1-0.2), MLSI from 0.22 (0.1-0.5) to 0.12 (0.1-0.3), and FRI from 0.7 (0.4-1.3) to 0.48 (0.2-0.8) (all p < 0.05). Tegner score increased from 2.14 (0-4) to 4.14 (3-5), and Lysholm score from 48.85 (25-80) to 78.14 (64-95) (both p < 0.05). RAMP lesion repair was associated with significant improvements in postural stability during the early postoperative period, reduced fall risk, and improved knee function scores following ACLR.

The aim of this study was to compare the anatomical parameters in patients with anterior cruciate ligament (ACL) rerupture after reconstruction with those without. This retrospective study included patients who underwent primary ACL reconstruction using a quadrupled semitendinosus and gracilis tendon autograft between January 2017 and January 2021. Patients who required revision due to rerupture (n = 51) were then compared with age- and sex-matched controls without rerupture (n = 52). Radiological parameters were measured using standard lateral knee radiographs and magnetic resonance imaging (MRI). Measurements included femoral/tibial tunnel angles (FTA/TTA), tibial tunnel anteroposterior position (TTAPL), posterior tibial slope (PTS), lateral tibial plateau subluxation (LTPSu), lateral femoral condyle index (LFCI), as well as various other anatomical parameters such as tibial plateau morphology, meniscal pathology, and notch dimensions. Correlation and logistic regression analyses were performed. Significant differences were observed between the rerupture and control groups in TTA (71.7 ± 9.2 vs. 78.4 ± 12.8; p = 0.046), TTAPL (0.4 ± 0.1 vs. 0.4 ± 0.1; p = 0.043), LTPS (8.0 ± 4.7 vs. 5.8 ± 4.2; p = 0.015), MTPSu (2.1 ± 2.2 vs. 1.5 ± 2.4; p = 0.029), and LFCI (0.8 ± 0.1 vs. 0.7 ± 0.0; p < 0.001). In the final logistic regression model (χ² = 52.969; Nagelkerke R² = 0.536), TTA (OR = 0.93, p = 0.007), TTAPL (OR = 1.088, p = 0.088), LTS (OR = 1.116, p = 0.043), and LFCI (OR = 6.36 × 10100, p = 0.001) remained as independent predictors. The overall classification accuracy of the model was 79.6%. Several anatomical parameters-including a smaller TTA, more anterior tibial tunnel positioning, increased lateral tibial plateau slope, and a higher lateral femoral condyle index-were found to be independently associated with ACL graft rerupture. These radiological risk factors should be carefully evaluated during surgical planning and postoperative follow-up to reduce the likelihood of graft failure. Level III, retrospective comparative study.

Disclosure: A. Attre: None. P. Sztachelski: None. A. Arigala: None. B. Esayag-Tendler: None.Introduction: Primary Hyperaldosteronism (PA) is a leading cause of secondary hypertension amenable to specific therapy. We describe a case of PA with contrasting findings on imaging and biochemical marker via simultaneous bilateral AVS contrast. Case: A 68-year-old man was diagnosed with PA based on an aldosterone level of 41.7 ng/dL, plasma renin activity of <0.1 ng/mL/hr, and a potassium of 3.4 mmol/L. A pre-AVS CT found a 1.5 cm low-attenuation (<10 HUs) nodule in the left adrenal gland with an unremarkable right adrenal gland. Results: The bilateral simultaneous pre- and post-ACTH adrenal venous sampling (AVS) in 2024 showed a right-to-left lateralization index (LI) of 15.70, discordant with the left adrenal nodule noted on imaging. The patient underwent a right adrenalectomy, and his post-operative aldosterone had decreased to 5.4 ng/dL. The pathology team identified a 1.3 cm right adrenal nodule that was not detected on the CT scan, providing confidence in the AVS findings. Discussion: This case provides an example of the criticality of AVS data in clinical decision-making, especially when imaging is discordant, inconclusive, or misleading. AVS provides quantitative evidence for aldosterone hypersecretion lateralization, which can be more telling than imaging alone. Of course, inaccuracies in AVS results can occur with poor supervision or deviations from standard protocols, so we urge colleagues to remain vigilant and exercise appropriate clinical judgment. This case also highlights the importance of supervising the protocol throughout the entire procedure, including collection, appropriate labeling of samples, and patient monitoring. Not all adrenal nodules in a patient with PA are functional, and it is important to rely on biochemical data. While medication management is common with the use of mineralocorticoid receptor antagonists, surgical management is recommended for cases of PA with a confirmed unilateral etiology.Presentation: Sunday, July 13, 2025

Disclosure: Y. Liu: None. C. Lee: None. D. Van Rooyen: None. J. Rege: None. P. Vibhatavata: None. A. Udager: None. W.E. Rainey: None. A. Turcu: None.Background: Over 90% of aldosterone-producing adenomas (APAs) harbor somatic mutations in genes with impact on aldosterone synthesis. These mutations facilitate inappropriate intracellular Ca2+ entrance, which subsequently boosts aldosterone production. Detailed histopathological studies of APAs have shown morphologic and enzymatic heterogeneity across genotypes, which translate into differences in phenotype and steroidogenic potential. Steroid profiling of peripheral blood could serve as a non-invasive method for primary aldosteronism subtyping, and they might offer pre-operative prognostic value. The most prevalent aldosterone-driver mutations are found in KCNJ5 (encodes the potassium channel Kir3.4) and CACNA1D (encodes the voltage-dependent L-type Ca2+ channel subunit 1D). In contrast, mutations in ATP1A1 and ATP2B3, which encode for the Na+/K+ ATPase α-1 subunit and a Ca2+ ATPase 3, respectively, are relatively rare, and because of their lower prevalence, previous studies have clustered these as ATPase mutations. Objective: To compare the clinical phenotype and steroid profiles of patients with APAs harboring ATP1A1 and ATP2B3 mutations. Methods: The study included patients with primary aldosteronism who: 1) underwent adrenal vein sampling-guided adrenalectomy, and 2) were identified to harbor APAs with pathogenic variants in ATP1A1 and ATP2B3 (based on aldosterone synthase immunohistochemistry-guided next-generation sequencing). Clinical data were collected from medical records. Liquid chromatography-tandem mass spectrometry was used to quantify 17 steroids in peripheral and adrenal vein blood, both before and after cosyntropin stimulation. Results: We identified 59 patients with APAs harboring ATPase mutations, including 47 in ATP1A1 and 12 in ATP2B3. Age, sex, and race distribution was similar between the two groups. The groups also displayed similar BMI, blood pressure, aldosterone concentrations, and tumor size. Patients with ATP2B3 mutations had more dramatic lateralization on adrenal vein sampling, both at baseline (lateralization index, LI: 36.8 vs. 8.6, p=0.01) and after cosyntropin stimulation (LI: 32.7 vs. 10.2, p=0.003). Serum for steroid profiling was available in 19 patients with ATP1A1 and 6 patients with ATP2B3. The latter group showed higher concentrations of 18-oxocortisol, aldosterone, and several other steroids. Adrenal vein sampling-guided adrenalectomy led to biochemical cure in all patients with ATP2B3 mutations, but only 74% of those with ATP1A1 mutations. Conclusion: APAs harboring ATP1A1 and ATP2B3 mutations share similarities in demographic distribution and phenotype, but those with ATP2B3 mutations tend to have higher hormonal activity, more profound lateralization, and higher likelihood of post-operative biochemical cure.Presentation: Sunday, July 13, 2025

Abstract Disclosure: Z. Yuhao: None. H. Minzhi: None. L. Zhenjie: None. J. Yongli: None. Z. Tianyue: None. X. Xiaohong: None. S. Xiaoxiao: None. A 57-year-old male with a 19-year history of hypertension visited the clinic four years ago due to refractory hypertension with hypokalemia. His blood pressure (BP) was 184/113 mmHg, and his K+ was 1.9 mmol/L. After symptomatic treatment, he was referred to our center. Upon re-evaluation, his aldosterone was 2220 pg/mL, renin was 12.2 uIU/mL, and the aldosterone-to-renin ratio (ARR) was 182 (pg/mL)/(uIU/mL). His creatinine reached 94.2 μmol/L. A CT scan revealed bilateral adrenal adenomas (right: 23×21 mm, left: 20×17 mm), and renal artery stenosis was ruled out. Both the captopril and saline tests failed to suppress aldosterone. Adrenal venous sampling (AVS) suggested bilateral aldosterone secretion (lateralization index = 1.3, right/left). The patient was treated with spironolactone 40 mg BID→60 mg TID, nifedipine 30 mg BID, irbesartan 150 mg QD, and potassium chloride 1 g TID→2 g TID. Despite this regimen, his home blood pressure monitoring (HBPM) remained at 160/100 mmHg, with aldosterone at 2280 pg/mL, renin at 83.6 uIU/mL, and ARR at 27.27 (pg/mL)/(uIU/mL). In this period, he developed gynecomastia, erectile dysfunction, hypertensive renal damage (creatinine 120.8 μmol/L, UACR 38.82 mg/g.cr), and ventricular hypertrophy (IVS 1.71 cm). After multidisciplinary discussion, the patient underwent right adrenal artery embolization in July 2023. Postoperatively, his aldosterone decreased to 813 pg/mL, renin increased to 288.5 uIU/mL. His HBPM improved to 145/85 mmHg with reduced doses of spironolactone. However, six months later, his HBPM increased again to 160/100 mmHg, and medications were adjusted to spironolactone 40 mg BID, finerenone 20 mg QD, nifedipine 30 mg BID, irbesartan 150 mg QD, and potassium chloride 1 g BID. His biochemical results showed aldosterone at a2260 pg/mL, renin at 75.6 uIU/mL, ARR at 29.89 (pg/mL)/(uIU/mL), and the renal impairment (creatinine 119.2 μmol/L, UACR 541.25 mg/g.cr). A Ga-68 Pentixafor PET-CT revealed high CXCR4 expression in the left adrenal gland (23×21 mm, SUVmax 35.74) and a postoperative nodule on the right (19×16 mm, SUVmax 9.72). Given the increasing difficulty of medical treatment, further operation was considered. The patient refused surgery and opted for left adrenal artery embolization again.The second procedure was performed in December 2024. After this, his aldosterone was 402 pg/mL, renin was 15.8 uIU/mL, ARR was 25.4 (pg/mL)/(uIU/mL), K+was 3.96 mmol/L, without no signs of corticosteroid insufficiency. His medication regimen included spironolactone 20 mg BID, finerenone 20 mg QD, nifedipine 30 mg BID, irbesartan 150 mg QD, and KCl 1 g BID, maintaining HBPM below 140/80 mmHg. Conclusion: For refractory bilateral primary aldosteronism, bilateral adrenal artery embolization lowers aldosterone levels and reduces antihypertensive medications as a palliative therapy without causing corticosteroid insufficiency. Presentation: Monday, July 14, 2025

Abstract Disclosure: Y. Marcus-Perlman: None. G. Shefer: None. I. Kori: None. M. Ingbir: None. Y. Greenman: None. N. Stern: None. AVS is crucial for diagnosing primary aldosteronism (PA), relying on cortisol-based selectivity and lateralization indices (SI/LI). However, variability in cortisol levels and aldosterone-cortisol co-secretion can hinder diagnostic accuracy. A multicomponent lateralization index incorporating 17-hydroxyprogesterone (17OHP) and the contralateral suppression index (CSI) may improve subtype differentiation between aldosterone-producing adenoma (APA) and bilateral hyperaldosteronism (BHA). In this study, AVS without cosyntropin stimulation was conducted on 27 patients, with 25 successful procedures (14 APA, 11 BHA). Clinical and laboratory data highlighted key differences: APA patients exhibited lower plasma renin activity (0.06 ± 0.04 vs. 0.17 ± 0.13ng/ml/min) and higher aldosterone concentration (38 ± 20 vs. 25 ± 10.3 ng/dL) than BHA patients. APA patients also showed elevated aldosterone-to-cortisol (19.7 ± 14.2 vs. 1.9 ± 0.5), aldosterone-to-17OHP (35.3 ± 44 vs. 4.5 ± 5.2), and aldosterone-to-DHEAS ratios (26.7 ± 33.9 vs. 2.63 ± 1.7). Metabolic abnormalities, including diabetes (3 cases) and impaired fasting glucose (7 cases), and abnormal 1mg dexamethasone suppression test (1 case) were more prevalent in APA than in BHA (1 and 2 cases, respectively). Surgical intervention was performed in 12 APA patients, compared to 1 in the BHA group. We suggest a multicomponent index that improves the interpretation of AVS when LI values are borderline. Index includes cortisol-corrected LI (cutoff&amp;gt;4), 17OHP LI (cutoff&amp;gt;5), and CSI (≤0.5 for cortisol or 17OHP-corrected CSI&amp;lt;3). For example, in a suspected APA case with borderline cortisol LI (2.96), the addition of aldosterone/17OHP LI (&amp;gt;5) and CSI (&amp;lt;0.5) solidified the diagnosis which was then confirmed by surgical cure. Conversely, reliance on marginally positive lateralization such as cortisol LI (4.01) and 17OHP LI (5.14) was offset by high CSI &amp;gt;4 which correctly predicted poor postoperative outcomes. Notably, indices derived from DHEA-S were not helpful in refining diagnoses. These findings highlight the advantage of integrating 17OHP-derived LI and CSI into AVS analyses to enhance diagnostic precision for PA subtyping. Further studies are needed to establish refined cutoff values and to facilitate routine use of 17OHP in clinical practice. Presentation: Monday, July 14, 2025

Disclosure: N. Sharma: None. M. Neff: None. J. Lin: None. J. Foster: None. J. Sandhu: None. E. Hilborn: None. E. Garcia: None. Z.C. Hannoush: None. A. Ayala: None. S. Rodgers: None. Z. Miller: None.Introduction: Potassium-sparing diuretics (KSD), such as spironolactone and eplerenone, preserve serum potassium levels but elevate renin, altering the aldosterone-to-renin ratio (A:R). Adrenal vein sampling (AVS) differentiates unilateral aldosterone-producing adenomas from bilateral adrenal hyperplasia in primary aldosteronism. Ongoing KSD use during AVS may lower the lateralization index, complicating interpretation, and increasing misdiagnosis risk. Although guidelines recommend stopping KSD before AVS, issues like rebound hypokalemia may necessitate continued use. This study evaluates the effects of KSD on lab values, lateralization, and clinical outcomes in AVS patients. We hypothesize that KSD use during AVS does not significantly affect clinical outcomes. This study compares pre-procedure lab values, imaging, surgical, and BP outcomes in patients on vs. off KSD to refine AVS protocols. Methods: A retrospective study was conducted with 75 AVS patients, grouped by KSD use (30 on, 45 off). Pre-procedure labs, including serum sodium (Na), potassium (K), plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and A:R, were collected. Blood pressure (BP) was measured before and after AVS-guided adrenalectomy. A Mann-Whitney U test analyzed K and BP changes within 3 months pre- and post-adrenalectomy. Statistical significance was p < 0.05. Results: Among 75 patients, 31 underwent adrenalectomy with 64.5% on KSD. The gender ratio was M:F = 2:3. Median age 59.0 (IQR 53.0-66.0), antihypertensive use 3.0 (IQR 2.0-4.0), pre-procedure Na 141.0 (IQR 139.0-142.0), pre K 4.0 (IQR 3.5-4.4), pre PAC 21.5 (IQR 15.25-34.25), A:R ratio 86.1 (IQR 55.58-98.90), pre adrenalectomy systolic BP 142.0 (IQR 126.0-154.0), pre diastolic BP 82.0 (IQR 75.0-90.0). Post adrenalectomy K median 4.7 (IQR 4.4-5.0), post systolic BP 131.0 (IQR 122.0-136.0), post diastolic BP 83.0 (IQR 71.0-87.0). Comparative analysis showed no significant change in K levels post-adrenalectomy for KSD vs non-KSD (p = 0.546). No significant BP changes were observed (systolic p = 0.67; diastolic p = 0.136). These findings indicate that while KSD may increase serum potassium levels, the impact is not significant. Conclusion: Our findings suggest that KSD use before AVS-guided adrenalectomy does not significantly alter potassium levels post-procedure and no significant differences were observed in systolic or diastolic BP outcomes, suggesting that KSD use does not impact the final clinical outcome post-adrenalectomy. Our study indicates that KSD use should not influence procedural decision-making, as its discontinuation does not alter post-surgical BP outcome. This challenges the necessity of strict pre-AVS discontinuation protocols, and further research is needed to assess whether current guidelines for AVS should be revised for patients needing ongoing KSD therapy.Presentation: Monday, July 14, 2025

Disclosure: M. Lizarazo Jimenez: None. Y. Rodriguez: None. D. Soto Camargo: None. A. Florez: None. L. Kattah Martinez: None. L. Bustamante Gómez: None.Introduction: Rhabdomyolysis is an uncommon but potentially life-threatening complication of severe hypokalemia and may be the initial presentation of underlying endocrine disorders such as primary hyperaldosteronism. Although many patients with hyperaldosteronism are asymptomatic or present with mild hypertension, severe hypokalemia (K⁺ <2 mmol/L) can result in profound muscle injury and rhabdomyolysis, with symptoms including myalgia, weakness, and elevated creatine kinase levels. In this case, rhabdomyolysis was the key clinical manifestation that prompted further investigation. Clinical Case: We report the case of a 52-year-old man with a history of hypertension, admitted with muscle weakness and laboratory-confirmed rhabdomyolysis (CPK: 21,023 U/L; AST: 611 U/L; ALT: 126 U/L; LDH: 767 U/L) with severe hypokalemia (serum potassium: 1.85 mEq/L). Initial screening for primary hyperaldosteronism revealed a negative aldosterone/renin ratio (plasma aldosterone: 8.56 ng/dL; plasma renin concentration: 3.0 ng/L [RR: >5.7]). Further workup revealed elevated urinary cortisol (60 nmol/24h [RR: 20-150]) and ACTH levels >20 pg/mL, suggesting ACTH-dependent hypercortisolism. A pituitary MRI revealed a 13 × 9 mm right paramedian macroadenoma. Inferior petrosal sinus sampling was attempted but was non-diagnostic due to inadequate catheterization, despite elevated basal ACTH gradients (selectivity index left: 17.17; right: 19.38). Confirmatory cortisol suppression tests were normal, ruling out Cushing’s disease (post-dexamethasone cortisol: 0.9 µg/dL [RR: <1.8]; late-night salivary cortisol: <1.5 µg/dL [RR: <1.5]; ACTH: 6.99 pg/mL [RR: 7.2-63.3]). Further evaluation included an adrenal CT, which identified an 18 × 11 mm right adrenal nodule (−4 Hounsfield units, consistent with adenoma). Repeat biochemical testing showed suppressed plasma renin activity (<0.14 ng/mL/h [RR: 0.2-1.6]) and elevated plasma aldosterone (40.8 ng/dL [RR: <15 in normotensive individuals]), with a positive aldosterone/renin ratio (ARR: 291.4; RR: >30 when using PRA). Adrenal vein sampling showed a lateralization index of 21.25 toward the right, confirming a right-sided aldosterone-producing adenoma with no cortisol co-secretion. Adrenalectomy was indicated, resulting in resolution of both hypertension and hypokalemia. Conclusion: This case highlights the diagnostic challenge of severe hypokalemia-induced rhabdomyolysis as an initial manifestation of underlying primary hyperaldosteronism, particularly when confounded by overlapping endocrine abnormalities. Although hypokalemia is a hallmark of hyperaldosteronism, it is not pathognomonic and requires comprehensive clinical and biochemical evaluation. The combination of hormonal assays, imaging, and adrenal vein sampling was essential for diagnosis and management in this complex presentation.Presentation: Monday, July 14, 2025

Optimization of the densification process of agricultural residues is important to produce high-quality briquettes. In this study, the physical and mechanical characteristics of corncob briquettes were investigated to determine the influence of densification variables. The significance of the die temperature, compaction pressure, hold time and particle size on the density, water resistance index (WRI), lateral compressive strength (LCS) and impact resistance index (IRI) were determined using response surface methodology. Corncob briquettes had densities that ranged from 400 to 770 kg/m3 whereas the WRI had values between 1.13% and 66.47%. The LCS ranged from 0.05 to 2.39 MPa, and IRI was between 5 and 200. The particle size has significant effect on all briquette properties. The pressure is also significant to the density and the LCS whereas the hold time is significant to the WRI and LCS. The compaction pressure interacted with particle size to significantly affect the LCS and IRI. From multi-response optimization, the optimum densification variables were 14.1 MPa, 132.9 °C and 15 min for compaction pressure, die temperature, and hold time, respectively, with particle size lower than 2.36 mm. Optimum densification variables resulted in density, WRI, LCS and IRI of 755.4 kg/m3, 26.4%, 2.37 MPa and 169, respectively.

Optimal treatment of primary aldosteronism (PA) requires precise subtyping, usually performed by adrenal vein sampling (AVS) using cortisol to assess selectivity. Circadian and stress-induced variability or cortisol co-secretion may limit interpretability of cortisol-based assessment. It was hypothesised that metanephrine could be used as an alternative to cortisol to improve the interpretability of AVS. In this retrospective analysis of 102 consecutive patients with PA who underwent AVS, we compared cortisol- and metanephrine-based selectivity and lateralisation rates using different cut-offs. The study also included patients with repeated sampling as well as those with and without cortisol co-secretion. Using cortisol, bilaterally selective AVS was achieved in 90.2% of patients. Applying a selectivity index cut-off of ≥25 for metanephrine and ≥2 for cortisol, 83.6% of samples showed consistent selectivity classification. Non-selective samples were similarly frequent with metanephrine and cortisol (19.3 vs 18.9%). Rates of bilateral selectivity and lateralisation did not differ significantly between patients with and without cortisol co-secretion using either parameter. Lateralisation indices showed an 81% concordance between both markers. At follow-up, of six patients with discordant results operated following cortisol-based AVS (despite metanephrine indicating bilateral disease), biochemical cure was missing in one, partial in another, and complete in three patients. In conclusion, metanephrine is an alternative for AVS interpretation that might be useful in cases of limited cortisol interpretability. However, in a reference centre with optimised AVS protocols, metanephrine did not demonstrate superiority over cortisol. Given cost and availability considerations, cortisol remains the standard, with metanephrine as a supplement in selected cases.

Renal function after adrenalectomy in patients with primary aldosteronism.

Osteotomy across arcuate line in ilium needs prudence in curved periacetabular osteotomy.

The functional and structural language-associated brain network in patients with temporal lobe epilepsy and atypical language organization.

Objective: Preeclampsia poses a major risk to feto-maternal well-being, particularly in low-resource settings where access to predictive biomarkers is limited. This study evaluated placental laterality and uterine artery Doppler indices as affordable, non-invasive predictors of preeclampsia. Methodology: A prospective seven-month study (January–July 2022) was conducted at the Fetal Assessment Centre, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Korle Bu Teaching Hospital, Accra, Ghana. Normotensive pregnant women between 18–24 weeks underwent ultrasound studies for placental location and uterine artery doppler indices and were followed until delivery. Sociodemographic data were analysed using descriptive statistics, while chi-square tests were used for bivariate analysis. Screening tests for sensitivity and specificity in predicting preeclampsia were performed for lateral placentation and abnormal doppler velocimetry. Statistical significance was set at p &lt; 0.05. Results: Of 132 women completing the study, 6.1% (8/132) developed preeclampsia, all with severe features. Preeclampsia incidence was significantly higher with lateral compared to central placentas [12.1% (8/66) vs 0.0% (0/66), p = 0.003]. Among women with lateral placentas, abnormal pulsatility and resistive indices, systolic/diastolic ratios, bilateral diastolic notching, and positive combined tests were significantly associated with preeclampsia development (62.5% vs 14.0%, p = 0.007; 62.5% vs 18.0%, p = 0.015; 100.0% vs 52.0%, p = 0.016; 100.0% vs 8.0%, p = 0.017; 62.5% vs 6.0%, p = 0.006, respectively). Conclusion: Combining placental laterality with uterine artery doppler indices provides a cost-effective, accessible method for early preeclampsia prediction in resource-limited settings, potentially improving feto-maternal outcomes through timely intervention.

ABSTRACT This study investigates the seismic resilience of an existing reinforced concrete (RC) dual-system during the 2023 Kahramanmaraş earthquakes. The shear wall-frame dual building was designed according to the Turkish guidelines (TEC 2007) and experienced negligible damage during the earthquakes, whereas all neighboring buildings collapsed. The case study building is modeled in SAP2000® adopting a lumped plasticity approach. The 3D building model was subsequently subjected to pushover and nonlinear time-history analyses (NTHAs) using real ground motions recorded during the first and strongest mainshock of the Kahramanmaraş earthquakes ( M w = 7.7 Pazarcik earthquake). The results from the NTHAs indicate that the maximum inter-story drift (IDR) ratios on all floors of the case study building remained below the Immediate Occupancy performance level (IDR = 1.0%). Moreover, the dual-system building designed with TEC 2007 survived the earthquakes without damage, even when the design earthquake scenarios exceeded those considered in the new and more stringent TBEC 2018 (i.e. a 475 return period). The limited damage experienced by the RC dual-system building can be largely attributed to its high wall index (WI = 1.5% and 1.84%) and high average lateral stiffness index (H/T ≥45.3), which are above the minimum values (ρ = 0.6% and H/T ≥45) suggested in previous research. This study also highlights the critical importance of site-specific ground motion selection, particularly in the context of Hatay province, where the seismic demands exhibited significant variability and intensity. This study contributes to a better understanding of the resilience of RC shear wall-frame buildings in seismic zones.

BackgroundVirtual Reality (VR) feedback is increasingly integrated into Brain-Computer Interface (BCI) applications, enhancing the Sense of Embodiment (SoE) toward virtual avatars and fostering more vivid motor imagery (MI). VR-based MI-BCIs hold promise for motor rehabilitation, but their effectiveness depends on neurofeedback quality. Although SoE may enhance MI training, its role as a priming strategy prior to VR-BCI has not been systematically examined, as prior work assessed embodiment only after interaction. This study investigates whether embodiment priming influences MI-BCI outcomes, focusing on event-related desynchronization (ERD) and BCI performance.MethodsUsing a within-subject design, we combined data from a pilot study with an extended experiment, yielding 39 participants. Each completed an embodiment induction phase followed by MI training with EEG recordings. ERD and lateralization indices were analyzed across conditions to test the effect of prior embodiment.ResultsEmbodiment induction reliably increased SoE, yet no significant ERD differences were found between embodied and control conditions. However, lateralization indices showed greater variability in the embodied condition, suggesting individual differences in integrating embodied feedback.ConclusionOverall, findings indicate that real-time VR-based feedback during training, rather than prior embodiment, is the main driver of MI-BCI performance improvements. These results corroborate earlier findings that real-time rendering of embodied feedback during MI-BCI training constitutes the primary mechanism supporting performance gains, while highlighting the complex role of embodiment in VR-based MI-BCIs.