Level 1B Research Articles

Long-Term Durability of Tunneled Hemodialysis Catheters: Outcomes from a Single Institution 22-Year Experience.

To describe long-term physical durability of tunneled hemodialysis catheters, highlighted in the 2019 Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines as a specific area for future research. Tunneled hemodialysis catheters with known outcomes and dwell times > 1year were entered into this retrospective study. Data includes demographics, complications, catheter type, dwell time, reason for removal, access site, and placement via exchange or de novo. Catheter durability < 1year dwell was analyzed as a secondary aim. 272 catheters in 229 patients were included. Dwell times ranged from 366 to 3,802days (median 504), totaling 162,439 catheter days. 17 (6%) catheters > 1year dwell had broken external components. For these, dwell times until breaking ranged from 377 to 1,436days (median 489), totaling 10,434 catheter days. 5 had a broken hub, 11 had a broken clamp, and 1 had broken hub and clamp. 12 were Ash Split Cath (n = 240) and 5 were Arrow-Clark VectorFlow (n = 32). In the durability < 1year sub-analysis, 6,515 catheters with dwell times < 1year in 3,693 patients were included, totaling 425,018 catheter days. 48 were damaged, with 24 broken hubs, 17 broken clamps, and 7 holes. Median time to breakage was 110days. 38 were Ash Split Cath (n = 5,636) and 10 Arrow-Clark VectorFlow (n = 812). In both analyses, breakage was limited to hubs, clamps, and extensions. Tunneled hemodialysis catheters are exceptionally durable, rarely requiring removal for hub-related issues after one year. Breakdown was not observed as a long-term durability issue. Further, broken external components can be replaced using external repair kits. Level 2b, Retrospective Study.

Forest canopy cover estimation with machine learning using GEDI and Landsat data in the Western Marmara Region, Türkiye

Abstract Forests play a crucial role in carbon dioxide absorption, biodiversity preservation, and climate regulation. Timely and precise maps detailing tree cover attributes are vital tools for the fields of environmental research and natural resource management. This study addresses the challenge of accurately estimating forest canopy cover by integrating Global Ecosystem Dynamics Investigation (GEDI) and Landsat data in the Eastern Marmara Region of Türkiye. Despite the advancements in remote sensing technologies such as light detection and ranging (LiDAR) and optical sensors, and the importance of forest canopy cover in assessing forest health and carbon stocks, there is limited research on utilizing spaceborne GEDI Level 2B data for forest canopy cover mapping. Six different machine learning methods were employed, namely Classification and Regression Trees (CART), Categorical Boosting (CTB), Light Gradient Boosting Machines (LGBM), Multilayer Perceptron (MLP), Random Forest (RF), and Extreme Gradient Boosting (XGB), to generate forest canopy cover maps using Landsat 8 and 9 satellite images with a variety of vegetation indices and texture features. Model performances were evaluated using metrics such as R2, Root Mean Square Error (RMSE), and Median Absolute Error (MdAE), with statistical significance assessed via Friedman and Wilcoxon signed-rank tests. The results of the tests indicated that the XGB (R2 = 0.5570, RMSE = 0.1603, MdAE = 0.0885) and RF (R2 = 0.5497, RMSE = 0.1617, MdAE = 0.0896) algorithms, which were trained with GEDI Level 2B data, provided greater accuracy in forest canopy cover estimation compared to the other algorithms. This study offers insight into the prediction performance of GEDI Level 2B spaceborne LiDAR data in conjunction with XGB and RF algorithms for forest canopy cover estimation and underscores the significance of integrating advanced remote sensing data for forest monitoring.

Manual wheelchair training programs: a scoping review of educational approaches and intended learning outcomes

BackgroundTraining programs grounded in educational theory offer a systematic framework to facilitate learning and outcomes. This scoping review aims to map the educational approaches documented for manual wheelchair training and to record intended learning outcomes and any relationships between learning theories, instructional design and outcomes.MethodsEight databases; Cochrane’s Library, EMBASE, CINAHL, PubMed, Scopus, EmCare, Medline, ProQuest Nursing and Allied Health Database and grey literature were searched in September 2023, with citation chaining for relevant papers. Included papers related to manual wheelchair training programs/protocols describing intended wheelchair training outcomes for adults and/or caregivers. Data extracted included study characteristics, type of intervention, explicit learning theories, instructional design principles and intended learning outcomes. The International Classification of Functioning and Kirkpatrick’s evaluation framework were used to organise intended outcomes.ResultsOf the forty-four articles included in this review, only fourteen explicitly used a learning theory in the instructional design of training. Training outcomes most commonly related to changes in knowledge/skills of manual wheelchair users (Level 2b of Kirkpatrick’s evaluation (n = 43), with less emphasis on participatory outcomes. Training designs incorporating Social Cognitive Theory (n = 8) were more likely to explore long term training outcomes, compared with other training designs.ConclusionWheelchair training programs that are designed using learning theory are more likely to produce learning outcomes that are retained and meaningfully applied. Such longer terms outcomes could have systemic cost and efficiency implications, such as reduction in wheelchair falls and readmissions to hospital. Deliberate integration of learning theory into manual wheelchair training design is recommended to support broad outcomes and long-term learning. This design could synergise different learning theories.

Bolus-Tracked Biphasic Contrast-Enhanced CT Imaging Following Microwave Liver Ablation Improves Ablation Zone Conspicuity and Semi-automatic Segmentation Quality.

Contrast-enhanced CT (CECT) may be performed immediately following microwave liver ablation for assessment of ablative margins. However, practices and protocols vary among institutions. Here, we compare a standardized bolus-tracked biphasic CECT protocol and compare this with a single venous phase fixed delay protocol for ablation zone (AZ) assessment. An institutional review board approved study performed at a specialist cancer centre. A prospective cohort of patients undergoing bolus-tracked biphasic imaging was compared with a retrospective cohort of patients who underwent fixed delay venous phase imaging. AZ conspicuity and segmentation quality were semi-quantitatively scored using Five-point Likert scales. Time between ablation and image acquisition was recorded for each AZ and was correlated to AZ conspicuity and segmentation quality. Forty patients, median age 59years (IQR 48-66years), 24 men, underwent microwave ablation of 68 liver tumours. AZ conspicuity was higher in the bolus-tracked (n = 33) vs. fixed delay (n = 35) cohorts, 4.5 vs. 2.5, P < 0.0001. Commensurate segmentation quality was also higher, 5.0 vs. 3.0 respectively, P < 0.0001. Ordinal regression showed that image quality scores declined by 3-4% for each minute that passes after ablation, particularly for arterial phase images, where regression coefficients were - 0.04, P = 0.007, and -0.03, P = 0.012 for conspicuity and segmentation quality, respectively. Bolus-tracked biphasic contrast-enhanced CT protocols improve both conspicuity and semi-automatic segmentation quality of microwave liver ablation zones, particularly if imaged soon after ablation. Level 2b; exploratory prospective cohort study.

Occupational Therapy Interventions and Early Engagement for Patients in Intensive Care: A Systematic Review.

Patients in intensive care units (ICUs) experience complex functional, physical, and cognitive needs that affect their engagement in activities of daily living (ADLs). Occupational therapy practitioners are uniquely positioned to address these needs to optimize patients' functional recovery. To examine occupational therapy-specific interventions as they relate to early engagement for patients in the ICU. CINAHL, PubMed, ProQuest, OTseeker, and Cochrane Library databases. The Cochrane methodology was used to collect, evaluate, and analyze articles, then reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for conducting a systematic review. Articles published from January 2012 to December 2021 evaluating adults who received occupational therapy interventions in ICUs with Level 1b, 2b, or 3b evidence were included. Nine articles met the inclusion criteria and the research objective. Findings showed moderate evidence for ADLs, physical rehabilitation, and cognitive interventions in promoting functional outcomes for patients in the ICU. This systematic review introduces the term early engagement to describe occupational therapy-specific interventions for patients recovering in the ICU and supports occupational therapy's role in this setting. Further research is needed to strengthen the evidence for occupational therapy-specific interventions and early engagement in the ICU. Plain-Language Summary: Patients in the intensive care unit experience complex needs that affect their participation in activities of daily living (ADLs). Current research demonstrates moderate evidence for early engagement with ADLs, physical rehabilitation, and cognitive interventions performed by occupational therapy practitioners. This systematic review introduces the term early engagement, which captures how occupational therapy practitioners provide holistic interventions for patients in the intensive care unit to promote patient well-being and functional recovery.

The Metabolic Treatabolome and Inborn Errors of Metabolism Knowledgebase therapy tool: Do not miss the opportunity to treat!

Inborn errors of metabolism (IEMs) are rare genetic conditions with significant morbidity and mortality. Technological advances have increased therapeutic options, making it challenging to remain up to date. A centralized therapy knowledgebase is needed for early diagnosis and targeted treatment. This study aimed to identify all treatable IEMs through a scoping literature review, followed by data extraction and analysis according to the Treatabolome principles. Knowledge of treatable IEMs, therapeutic categories, efficacy, and evidence was integrated into the Inborn Errors of Metabolism Knowledgebase (IEMbase), an online database encompassing all IEMs. The study identified 275 treatable IEMs, 18% of all currently known 1564 IEMs, according to the International Classification of Inherited Metabolic Disorders. Disorders of fatty acid and ketone body metabolism had the highest treatability (67%), followed by disorders of vitamin and cofactor metabolism (60%), and disorders of lipoprotein metabolism (42%). The most common treatment strategies were pharmacological therapy (34%), nutritional therapy (34%), and vitamin and trace element supplementation (12%). Treatment effects were most commonly observed in nervous system abnormalities (34%), metabolism/homeostasis abnormalities (33%), and growth (7%). Predominant evidence sources included case reports with evidence levels 4 (48%) and 5 (12%), and individual cohort studies with evidence level 2b (12%). Our study generated the Metabolic Treatabolome 2024. IEMs are the largest group of monogenic disorders amenable to disease-modifying therapy. With drug repurposing efforts and advancements in gene therapies, this number will expand. IEMbase now provides up-to-date, comprehensive information on clinical and biochemical symptoms and therapeutic options, empowering patients, families, healthcare professionals, and researchers in improving patient outcomes.

Long-Term Outcome in Cervical Lymph Node-Positive Nasopharyngeal Carcinoma Following Intensity Modulated Radiation Therapy With One-Step Cervical Nodal Clinical Target Volume Delineation by Geometric-Anatomic Expansion From Nodal Gross Target Volume: A Double-Center Experience.

To report long-term results of patients with cervical node-positive (CLN+) nasopharyngeal carcinoma (NPC) treated with intensity modulated radiation therapy with one-step nodal clinical target volume (CTVn) delineation by geometric-anatomic expansion from the nodal gross target volume (GTVn). Patients with CLN+ NPC treated with the same one-step-CTVn delineation in two Chinese academic centers were pooled for this study. GTVn was prescribed to 70 Gy equivalent, CTVn1 was omitted, CTVn2 was prescribed to 45 to 55 Gy equivalent, and defined as GTVn + 3 mm geometric expansion (5 mm if radiological extranodal extension-positive [rENE+]) + elective nodal regions defined by anatomic boundary of cervical nodal levels. Regional control (RC) and overall survival (OS) were analyzed. Fifteen randomly selected cases were recontoured for CTVn according to the 2018 International Guidelines (2018-IG). Dose/volume was compared between the two clinical target volume delineation methods. A total of 807 patients were included (center 1, n = 459; center 2, n = 348). Five-year RC and OS were 95.8% and 86.2%, respectively. Thirty-four patients developed regional failure, and 13/34 (38%) were outside CTVn2: level VIII (parotid node) (9/13), Ib (4/13), and IV (2/13). Seven out of these 9 level VIII failures had pre-existing "equivocal" nodes. All 4 level 1b failures had "equivocal" nodes with very advanced rENE or large (>5 cm) nodal mass in level II. Compared with the 2018-IG, our strategy resulted in significant reduction in nodal volumes received therapeutic (V70) (mean, 100.7 vs. 27.5 cc; P < .001) and prophylactic (V45) (mean, 343.5 vs. 261.2 cc; P < .001) doses and further dose reduction in surrounding organs at risks. Our one-step-CTVn delineation by geometric-anatomic expansion from GTVn appears to be a safe and efficient approach in CLN+ NPC, with excellent RC and potential dosimetric benefits in selected patients. Caution is needed for parotid sparing in patients with pre-existing "equivocal" nodes or level Ib sparing in cases with advanced rENE or large (>5 cm) nodal mass in level II.

Heterotopic High-Grade Salivary duct Carcinoma Likely Arising within Cervical Lymph Nodes

Abstract Introduction/Objective Salivary duct carcinoma arising in heterotopic salivary gland tissue is an extremely rare occurrence, with less than five cases reported in the literature. We present a unique case of heterotopic high-grade salivary duct carcinoma likely arising within cervical lymph nodes. Methods/Case Report A 56-year-old male presented with enlarged cervical lymph nodes for few months. Physical examination was unremarkable. Computerized tomography (CT) scan of head and neck showed two enlarged level 1B lymph nodes, measuring 1.0 and 1.4 cm, with unremarkable salivary glands. Patient had left cervical level II lymph node biopsy that showed metastatic poorly differentiated carcinoma. Immunohistochemically, the tumor cells were positive for GATA3, cytokeratin 903, androgen receptor, p16 (variable nonspecific), and were negative for TTF-1, p40, p63, ER, PR and NKX3.1, favoring salivary gland ductal carcinoma. Positron emission tomography (PET) CT scan showed a hypermetabolic left submandibular gland and level 2A lymph nodes. Subsequently, the patient underwent left modified radical neck dissection. Sectioning of the submandibular gland revealed no discrete lesions. Multiple, firm to rubbery lymph nodes ranging from 0.4 cm to 2.3 cm, with tan-pink cut surfaces were identified. Microscopic examination showed normal submandibular salivary gland parenchyma. However, eight out of nineteen lymph nodes were positive for metastatic high-grade salivary duct carcinoma comprising tumor cells forming nests and cords with ample eosinophilic cytoplasm, pleomorphic round to oval nuclei and numerous mitotic figures. Several benign and malignant lymph nodes in levels I, II and IV showed heterotopic salivary gland tissue. Immunohistochemical stains for androgen receptor and p40 were positive and negative respectively, supported the final diagnosis of high-grade salivary duct carcinoma. Results (if a Case Study enter NA) NA Conclusion Given the absence of carcinoma in the completely sampled submandibular gland, the origin of the intra- nodal tumor deposits was most likely to be heterotopic salivary gland tissue. This case emphasizes the importance of meticulous pathological sampling required for definitive diagnosis.

Physical Therapy for Knee Pain Relief Induces Changes in Gut Microbiome Composition: A Secondary Analysis of Data From a Randomized Controlled Trial.

Aerobic exercise alters gut microbiome composition, yet the impact of gentle physiotherapy on gut microbiome and its relation to muscle strengthening and physical function remains unexplored. Physiotherapy exercises modulate gut microbiome composition and changes in gut microbes are linked to improvements in muscle strength or function. Secondary data analysis of samples from a randomized controlled trial. Level 2b. Data from a 6-week randomized controlled trial of physiotherapy for knee pain were analyzed. Gut microbiota profiling utilized 16S sequencing. We compared intervention and control (usual care) groups using microbial diversity metrics. Amplicon sequence variants (ASVs) that changed after the program were identified with ALDEX2, and correlations between these ASVs and measures of physical function, muscle strength, and interleukin-6 (IL-6) were explored. No diversity changes were observed between standard care (n = 43) and physiotherapy (n = 34). Physiotherapy led to significant increases in Alistipes, Bacteroides, Clostridium sensu stricto 1, and Faecalibacterium ASVs. Of these, Clostridium sensu stricto 1 and Faecalibacterium were associated with postintervention muscle strength. Increase in Faecalibacterium was correlated with a decrease in IL-6 in the physiotherapy group. Physiotherapy had modest effects on gut microbiome composition affecting 4 taxa. Increases in muscle strength were correlated with increases in 2 taxa including Faecalibacterium. Faecalibacterium was also linked to reduced inflammation. Improved walking speed was linked to an increase in Alistipes with no differences found for strength or squatting ability. Improved gut microbiome composition is linked to better overall health outcomes, including enhanced immune function, reduced inflammation, and improved metabolic health. This is particularly relevant for patients with osteoarthritis, who are known to have a high prevalence of cardiometabolic comorbidities. Integrating physiotherapy protocols that positively influence the gut microbiome can thus enhance overall patient outcomes.

8390 It's not Cancer: Establishing the Diagnosis of Hyaline Trabecular Tumor

Abstract Disclosure: R.A. Zielinski: None. M. Khalifa: None. M. Dillon: None. M. Kaur: None. Background: Hyaline trabecular tumor (HTT) is a rare benign follicular thyroid neoplasm characterized by extensive intra-trabecular hyaline stromal material. Resemblances to other follicular neoplasms create difficulty in distinguishing HTT from its more nefarious counterparts such as medullary thyroid cancer (MTC) and papillary thyroid cancer (PTC).Clinical Case:Our patient is a 56-year-old female with Hashimoto’s thyroiditis diagnosed in her twenties who has been on different strengths of levothyroxine based on her fluctuating TSH. A thyroid ultrasound done to evaluate left-sided neck fullness on physical exam showed a solid, hypoechoic 2.3 cm x 1.4 x 0.9 cm left middle thyroid nodule without calcifications (TI-RADS 4) and benign-appearing lymph nodes, the largest of which was 1.5 cm at level 1B. Cytology from a thyroid FNA biopsy was suspicious for PTC, Bethesda category IV. A thyrosure genetic panel was negative for genetic mutations. FNA biopsy of the 1.5 cm lymph node was negative for malignancy. The patient was referred for thyroid lobectomy but instead elected to undergo total thyroidectomy with level VI lymph node dissection. Pathology revealed a 2.2 cm HTT in the left lobe, scattered psammoma bodies in adjacent soft tissue, and a 0.2 cm multifocal papillary microcarcinoma in the right lobe. The microcarcinoma had negative margins, no lymphatic or vascular invasion, and 7/7 benign level VI lymph nodes; staging it as pT1aN0. Immunohistochemistry staining was positive for TTF-1 and thyroglobulin and negative for calcitonin, chromogranin, and synaptophysin. Post-thyroidectomy she was started on Tirosint 175 mcg daily with good response. No I-131 treatment was pursued due to the microcarcinoma being categorized as low risk.Discussion and Conclusion: HTT is a benign neoplasm and management is usually conservative with surgical excision. The diagnosis of HTT by cytology alone is challenging due to the presence of nuclear clearing, grooves and intranuclear pseudo-inclusions that may be mistaken for PTC or MTC. Cell membrane immunoreactivity of MIB1 monoclonal to Ki67 and the molecular identification of the novel PAX8-GLIS1 or PAX8-GLIS3 fusions may aid in making the correct diagnosis.

Timing of Fracture Fixation in Ankle Fracture-Dislocations.

Ankle fracture-dislocations may require delayed internal fixation. Our aim was to compare acute open reduction and internal fixation (ORIF) with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. Factors that affect the rates of re-operation and Surgical site infection (SSI) were identified. In this retrospective cohort study, patients were included with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic center in the Netherlands. This study included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher body mass index (BMI) and open fractures had a significant positive correlation with re-operation while diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible.Level of Evidence: Therapeutic level 2B (retrospective cohort study).

An Analgesic Technique for Orogastric Tube Insertion in Newborns: DOLATSONG, a Randomized Multicentric Controlled Trial.

Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure. Objective: To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure. Prospective, controlled, randomized, multicentered and open label study. Three neonatal intensive care units in France (2 level 3 units and 1 level 2B). Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique ( n = 36) and experimental technique ( n = 35). Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN- Douleur Aiguë du Nouveau-né ; APN-Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models. All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group ( P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015). This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.

Indications and scientific support for supratentorial unilateral decompressive craniectomy for different subgroups of patients: A scoping review.

Even though supratentorial unilateral decompressive craniectomy (DC) has become the gold standard neurosurgical procedure aiming to provide long term relief of intractable intracranial hypertension, its indication has only been validated by high-quality evidence for traumatic brain injury and malignant middle cerebral artery infarction. This scoping review aims to summarize the available evidence regarding DC for these two recognized indications, but also for less validated indications that we may encounter in our daily clinical practice. A scoping review was conducted on Medline / Pubmed database from inception to present time looking for articles focused on 7 possible indications for DC indications. Studies' level of evidence was assessed using Oxford University level of evidence scale. Studies' quality was assessed using Newcastle-Ottawa scale for systematic reviews of cohort studies and Cochrane Risk of Bias Tool for randomized controlled trials. Two randomized trials (level 1b) reported the possible efficacy of unilateral DC and the mitigated efficiency of bifrontal DC in the trauma setting. Five systematic reviews meta-analyses (level 2a) supported DC for severely injured young patients with acute subdural hematoma probably responsible for intraoperative brain swelling, while one randomized controlled trial (level 1b) showed comparable efficacy of DC and craniotomy for ASH with intraoperative neutral brain swelling. Three randomized controlled trials (level 1b) and two meta-analyses (level 1a and 3a) supported DC efficacy for malignant ischemic stroke. One systematic review (level 3a) supported DC efficacy for malignant meningoencephalitis. One systematic review meta-analysis (level 3a) supported DC efficacy for malignant cerebral venous thrombosis. The mitigated results of one randomized trial (level 1b) did not allow to conclude for DC efficacy for intracerebral hemorrhage. One systematic review (level 3a) reported the possible efficacy of primary DC and the mitigated efficacy of secondary DC for aneurysmal subarachnoid hemorrhage. Too weak evidence (level 4) precluded from drawing any conclusion for DC efficacy for intracranial tumors. To date, there is some scientific background to support clinicians in the decision making for DC for selected cases of severe traumatic brain injury, acute subdural hematoma, malignant ischemic stroke, malignant meningoencephalitis, malignant cerebral venous thrombosis, and highly selected cases of aneurysmal subarachnoid hemorrhage.

Contralateral submental artery island flap for oral tongue reconstruction — a retrospective study in patients with oral tongue squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related death in developing countries. The oral tongue is the most common site involved by OSCC. About a third of the patients have neck nodal metastasis at presentation. Reconstruction of the oral tongue after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, harvesting the submental flap based on contralateral facial vessels is possible, without compromising oncological safety. We discuss the feasibility and outcomes of contralateral submental artery island flap for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months. ResultsOf the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy prior to surgery. 33 underwent bilateral neck dissection. Two patients had partial flap loss which was managed conservatively. There were five patients who had either locoregional or distant recurrence, none in the flap site. Three had pathological positive nodes at contralateral level 1b and two had pathologically positive nodes in contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up. ConclusionIn the properly selected patient, the contralateral submental artery island flap offers an oncologically safe and technically simpler alternative for free flap reconstruction.

Updated OMI Glyoxal Column Measurements Using Collection 4 Level 1B Radiances

AbstractThis study presents new glyoxal (CHOCHO) products from the Ozone Monitoring Instrument (OMI) by utilizing updated level 1B irradiance/radiance data (Collection 4) and an updated glyoxal retrieval algorithm. The adoption of Collection 4 contributes to the reduction of artificial signals in differential glyoxal slant column densities (dSCDs) and improved fitting root mean square, and the updated retrieval settings result in fewer negative values of glyoxal dSCDs over oceans and less noisy dSCDs in the South Atlantic Anomaly. On‐line calculations of air mass factors consider interactive physical processes between input parameters. To address persistent trends in glyoxal SCDs over the Pacific Ocean that remain despite these updates, a trend correction is implemented. We evaluate the updated OMI glyoxal products using inter‐comparisons with GOME‐2A/2B glyoxal products. OMI glyoxal products exhibit good spatial and temporal agreement with GOME‐2A/2B, with correlation coefficients of 0.75–0.78 globally and 0.84–0.85 over source regions. Small biases are observed in OMI glyoxal vertical column densities, ranging from −0.2 ± 5.7% to 9 ± 3% in low and high glyoxal conditions, respectively, against GOME‐2A/2B. These advancements contribute to the reliability and accuracy of OMI glyoxal products, enhancing their utility for atmospheric studies and enabling a 20‐year‐long data record suitable for climate studies.

Long-Term Validation of Aeolus Level-2B Winds in the Brazilian Amazon

The Atmospheric Dynamics Mission ADM-Aeolus was successfully launched in August 2018 by the European Space Agency (ESA). The Aeolus mission carried a single instrument, the first-ever Doppler wind lidar (DWL) in space, called Atmospheric LAser Doppler INstrument (ALADIN). Aeolus circled the Earth, providing vertical profiles of horizontal line-of-sight (HLOS) winds on a global scale. The Aeolus satellite’s measurements filled critical gaps in existing wind observations, particularly in remote regions such as the Brazilian Amazon. This area, characterized by dense rainforests and rich biodiversity, is essential for global climate dynamics. The weather patterns of the Amazon are influenced by atmospheric circulation driven by Hadley cells and the Intertropical Convergence Zone (ITCZ), which are crucial for the distribution of moisture and heat from the equator to the subtropics. The data provided by Aeolus can significantly enhance our understanding of these complex atmospheric processes. In this long-term validation study, we used radiosonde data collected from three stations in the Brazilian Amazon (Cruzeiro do Sul, Porto Velho, and Rio Branco) as a reference to assess the accuracy of the Level 2B (L2B) Rayleigh-clear and Mie-cloudy wind products. Statistical validation was conducted by comparing Aeolus L2B wind products and radiosonde data covering the period from October 2018 to March 2023 for Cruzeiro do Sul and Porto Velho, and from October 2018 to December 2022 for Rio Branco. Considering all available collocated winds, including all stations, a Pearson’s coefficient (r) of 0.73 was observed in Rayleigh-clear and 0.85 in Mie-cloudy wind products, revealing a strong correlation between Aeolus and radiosonde winds, suggesting that Aeolus wind products are reliable for capturing wind profiles in the studied region. The observed biases were −0.14 m/s for Rayleigh-clear and −0.40 m/s for Mie-cloudy, fulfilling the mission requirement of having absolute biases below 0.7 m/s. However, when analyzed annually, in 2022, the bias for Rayleigh-clear was −0.95 m/s, which did not meet the mission requirements.

Detección de posibles zonas desertificadas usando serie y mapa de tendencia del NDVI estimado por sensor AVHRR de satélites NOAA (1982-2019)

The present work we report the detection of possible desertification zones through the series and trend map of NDVI and VCI from the AVHRR sensor of the NOAA satellite series for the period from 1982 to 2019. The data used were acquired from the CLASS/NOAA portal, level 1b, have a spatial resolution of 1 km and temporal resolution of 12 hours. Processing algorithms were developed to estimate monthly NDVI and VCI. Seven possible desertification zones were identified by elaborating series and decadal trend maps of the VCI, in which five zones were located in the coastal region, specifically in the limits of agricultural zones, where the zones with the highest negative decadal trend were Piura (-0.29 dec-1), Chiclayo (-0.36 dec-1) and Chicama (-0.27 dec-1) during the period from 1997 to 2006 while, in the jungle region, the highest negative trend was recorded in Huepetuhe, district of Madre de Dios with a value of -0.25 dec-1 in the period from 2007 to 2018. It is proposed that, among the possible desertified areas, the areas in the coastal region (Piura, Chiclayo, Chicama, Pisco and Majes) were generated by intensive agriculture while, the possible desertification of the areas of Pucallpa and Huepetuhe were generated by urban expansion.

What is the Safe Observation Period for Image-Guided Percutaneous Liver Biopsies?

Current observation period post-liver biopsy is typically 4h. This study investigates the safety of reducing the observation period after percutaneous liver biopsy. Patients who underwent percutaneous liver biopsy between 2017 and 2022 in the Radiology Department of a tertiary centre were included in this retrospective, institutional review board-approved study. Patient demographics, procedure details and complication data were collected from the electronic medical records. Complications were graded according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification. Conditional survival probabilities were calculated for the 4-h observation period. Among 1125 patients, 275 complications were seen; 255 grade 1, 15 grade 2 and five grade 3. Post-procedural pain represented 93% (256) of complications, whereas post-procedural haemorrhage occurred in 17 (6%) patients: 13 were of grade 2 severity requiring prolonged observation, and 4 were of grade 3 severity. Of these grade 3 complications, two required blood transfusion whereas two required embolization. A total of 215 (78%) complications occurred within 1h, 244 (89%) within 2h of observation. 16 (94%) of 17 post-procedural haemorrhages occurred within 2h post-biopsy. If complication-free after 2h, the probability of experiencing a complication within the next 2h was 4%. The majority of complications were identified within 2h of observation. Complications recognised after this period were largely pain-related, with only one grade 3 complication seen (post-procedural haemorrhage).Our findings suggest 2h of post-procedural observation may be safe. Level 2B, Retrospective Cohort Study.

Optimizing clinical outcomes with stellate ganglion block and trauma-informed care: A review article.

For decades, thousands of active-duty service members have sought treatment for trauma exposure. Stellate ganglion block (SGB) is a fast-acting nerve block documented in medical literature for nearly a century that has shown promise as a potentially life-altering treatment for post-traumatic stress (PTS). This review aims to answer the practical questions of those who support individuals suffering from trauma: (1) SGB's safety profile (2) efficacy data (3) potential advantages and limitations, (4) a cross-cultural application example, (5) and the use of SGB in combination with talk therapy to optimize clinical outcomes. The current body of literature, to include several large case series, meta-analyses, and a sufficiently powered randomized controlled trial, were reviewed, and presented to describe the history of SGB for emotional trauma symptoms and address the objectives of this review. Critical consideration is given to the safety and efficacy data on SGB and the evolution in safety-related technologies. Advantages such as decreased barriers to care, rapid onset, and decreased dropout and limitations such as treatment non-response, potential adverse effects, and misconceptions about the treatment are then described. Finally, the cross-cultural application of SGB is explored based on the deployment of SGB in Israel. SGB is associated with level 1B evidence and a reassuring safety profile. Evolving the model of care through the combined use of effective biological treatments like SGB with trauma informed talk therapy offers a hopeful path forward for supporting those who suffer from post-traumatic stress.

5 years of Sentinel-5P TROPOMI operational ozone profiling and geophysical validation using ozonesonde and lidar ground-based networks

Abstract. The Sentinel-5 Precursor (S5P) satellite operated by the European Space Agency has carried the TROPOspheric Monitoring Instrument (TROPOMI) on a Sun-synchronous low-Earth orbit since 13 October 2017. The S5P mission has acquired more than 5 years of TROPOMI nadir ozone profile data retrieved from the level 0 to 1B processor version 2.0 and the level 1B to 2 optimal-estimation-based processor version 2.4.0. The latter is described in detail in this work, followed by the geophysical validation of the resulting ozone profiles for the period May 2018 to April 2023. Comparison of TROPOMI ozone profile data to co-located ozonesonde and lidar measurements used as references concludes to a median agreement better than 5 % to 10 % in the troposphere. The bias goes up to −15 % in the upper stratosphere (35–45 km) where it can exhibit vertical oscillations. The comparisons show a dispersion of about 30 % in the troposphere and 10 % to 20 % in the upper troposphere to lower stratosphere and in the middle stratosphere, which is close to mission requirements. Chi-square tests of the observed differences confirm on average the validity of the ex ante (prognostic) satellite and ground-based data uncertainty estimates in the middle stratosphere above about 20 km. Around the tropopause and below, the mean chi-square value increases up to about four, meaning that the ex ante TROPOMI uncertainty is underestimated. The information content of the ozone profile retrieval is characterised by about five to six vertical subcolumns of independent information and a vertical sensitivity (i.e. the fraction of the information that originates from the measurement) nearly equal to unity at altitudes from about 20 to 50 km, decreasing rapidly at altitudes above and below. The barycentre of the retrieved information is usually close to the nominal retrieval altitude in the 20–50 km altitude range, with positive and negative offsets of up to 10 km below and above this range, respectively. The effective vertical resolution of the profile retrieval usually ranges within 10–15 km, with a minimum close to 7 km in the middle stratosphere. Increased sensitivities and higher effective vertical resolutions are observed at higher solar zenith angles (above about 60°), as can be expected, and correlate with higher retrieved ozone concentrations. The vertical sensitivity of the TROPOMI tropospheric ozone retrieval is found to depend on the solar zenith angle, which translates into a seasonal and meridian dependence of the bias with respect to reference measurements. A similar although smaller effect can be seen for the viewing zenith angle. Additionally, the bias is negatively correlated with the surface albedo for the lowest three ozone subcolumns (0–18 km), despite the albedo's apparently slightly positive correlation with the retrieval degrees of freedom in the signal. For the 5 years of TROPOMI ozone profile data that are available now, an overall positive drift is detected for the same three subcolumns, while a negative drift is observed above (24–32 km), resulting in a negligible vertically integrated drift.