Levels T1 Research Articles

Case report: Combined transcutaneous spinal cord stimulation and physical therapy on recovery of neurological function after spinal cord infarction

The case of a 37-year-old woman who suffered from spinal cord infarction (SI), resulting in a complete spinal cord injury (AIS A, neurological level T10), and autonomic dysfunction is presented. This study aimed to assess the effect of transcutaneous Spinal Cord Electrical Stimulation (tSCS) on improving motor, sensory, and autonomic function after SI. During the first 8 months, tSCS was applied alone, then, physical therapy (PT) was included in the sessions (tSCS+PT), until completion of 20 months. Compared to baseline, at 20 months, an increase in ISNCSCI motor (50 vs. 57) and sensory scores (light touch, 72 vs. 82; pinprick, 71 vs. 92) were observed. Neurogenic Bladder Symptoms Score (NBSS) changed from 27 at baseline to 17 at 20 months. ISAFSCI scores in sacral autonomic function improved from 0 pts (absent function) to 1 pt. (altered function) indicating better sphincter control. EMG recordings during volitional movements, including overground stepping with 80% of body weight support showed activity in gluteus medialis, tensor fascia latae, sartorius, rectus femoris, biceps femoris, tibialis anterior, and gastrocnemius medialis, indicating a partial reversion of paralysis. RMS analysis indicated higher activity during “tSCS on” compared to “tSCS off” during overground stepping in bilateral rectus femoris (p < 0.001) and gastrocnemius medialis (p < 0.01); and unilateral biceps femoris, and tibialis anterior (p < 0.001). As this is the first report on the use of tSCS in the case of SI, future studies in a case series are warranted.

Subcutaneous and Visceral Adipose Tissue Reference Values From the Framingham Heart Study Thoracic and Abdominal CT.

Computed tomography (CT) captures the quantity, density, and distribution of subcutaneous and visceral (SAT and VAT) adipose tissue compartments. These metrics may change with age and sex. The study aims to provide age-, sex-, and vertebral level-specific reference values for SAT on chest CT and for SAT and VAT on abdomen CT. This secondary analysis of an observational study describes SAT and VAT measurements in participants of the Framingham Heart Study without known cancer diagnosis who underwent at least 1 of 2 CT examinations between 2002 and 2011. We used a previously validated machine learning-assisted pipeline and rigorous quality assurance to segment SAT at the fifth, eighth, and tenth thoracic vertebra (T5, T8, T10) and SAT and VAT at the third lumbar vertebra (L3). For each metric, we measured cross-sectional area (cm2) and mean attenuation (Hounsfield units [HU]) and calculated index (area/height2) (cm2/m2) and gauge (attenuation × index) (HU × cm2/m2). We summarized body composition metrics by age and sex and modeled sex-, age-, and vertebral level-specific reference curves. We included 14,898 single-level measurements from up to 4 vertebral levels of 3797 scans of 3730 Framingham Heart Study participants (1889 [51%] male with a mean [standard deviation] age of 55.6 ± 10.6 years; range, 38-81 years). The mean VAT index increased with age from 65 (cm2/m2) in males and 29 (cm2/m2) in females in the <45-year-old age group to 99 (cm2/m2) in males and 60 (cm2/m2) in females in >75-year-old age group. The increase of SAT with age was less pronounced, resulting in the VAT/SAT ratio increasing with age. A free R package and online interactive visual web interface allow access to reference values. This study establishes age-, sex-, and vertebral level-specific reference values for CT-assessed SAT at vertebral levels T5, T8, T10, and L3 and VAT at vertebral level L3.

Intercostal nerve electrodiagnostic testing in rib fractures.

Intercostal nerve injury can occur after rib fractures, resulting in denervation of the abdominal musculature. Loss of innervation to the rectus abdominis and intercostal muscles can cause pain, atrophy, and eventual eventration, which may be an underrecognized and thus undertreated complication of rib fractures. We investigated the clinical utility of intercostal nerve electrodiagnostic testing following rib fractures to diagnose and localize nerve injury at levels T7 and below. Five patients with displaced bicortical rib fractures involving the 7th-11th ribs and clinical eventration of the ipsilateral abdominal wall underwent intercostal nerve conduction studies (NCS) and needle electromyography (EMG) on the affected side. EMG of the rectus abdominis and intercostal muscles was performed with ultrasound guidance, and ultrasound measurements of rectus abdominis thickness were obtained to assess for atrophy. Average patient age was 59.4 years and average body mass index (BMI) was 31.5 kg/m2. Intercostal NCS and EMG were able to reliably diagnose and localize intercostal nerve damage after rib fractures. Ultrasound demonstrated an average rectus abdominis transverse cross-sectional thickness of 0.534 cm on the affected side, compared with 1.024 cm on the non-affected side. Intercostal electrodiagnostic studies can diagnose and localize intercostal nerve damage after displaced rib fractures. Musculoskeletal ultrasound can be used to diagnose and quantify rectus abdominis atrophy and to accurately and safely guide needle EMG to the intercostal and rectus abdominis muscles.

Diurnal variation of heart rate variability in individuals with spinal cord injury

BackgroundHeart rate variability (HRV) may provide objective information about cardiogenic autonomic balance in individuals with spinal cord injury (SCI). The aim of this study was to characterize the diurnal variation of HRV in individuals with SCI at lesion level T6 and above and lesion level below T6.MethodsThis was a retrospective analysis of a prior cross-sectional study. Individuals with chronic SCI underwent 24 h recording of the time between consecutive R waves (RR interval) to derive parameters of HRV as follows: standard deviation of all normal-to-normal R–R intervals (SDNN) and square root of the mean of the squared differences between successive R–R intervals (RMSSD) (time domain); and high frequency power (HF), low-frequency power (LF), very low frequency power (VLF), ultra-low frequency power (ULF) and total power (TP) (frequency domain). Changes in the magnitude of HRV outcomes over the 24 h period were investigated using a novel multi-component cosinor model constrained to the form of a three-harmonic Fourier series.ResultsParticipants were grouped as lesion level T6 and above (n = 22) or below T6 (n = 36). Most of them were male (n = 40, 69%) and the median age (interquartile range) was 50.5 (28) years. Both groups exhibited similar diurnal patterns in most HRV metrics. The lowest values occurred in the late afternoon (4–6 pm) and gradually increased, peaking around midnight to early morning (1–6 am). Exceptions included RMSSD, which peaked before midnight, and ULF, which showed a double peak pattern that peaked from 11 am to 1 pm and 4–6 am in participants with lesion level at T6 and above. The HRV values in participants with lesion level T6 and above were generally lower than participants with lesion level below T6, except for peak values of RMSSD, HF and LF.ConclusionThis study demonstrated substantial diurnal variation of HRV in participants with SCI in both groups of participants. In clinical and research settings, diurnal variations in HRV must be taken into consideration.

Investigating Fryette's mechanics in computed tomography scans: an analysis of vertebrae spinal physiology using open-sourced datasets and three-dimensional vertebral orientation.

Fryette's mechanics is taught as a simplistic model of coupled vertebral movement, fundamental in osteopathic practice. This study seeks to better understand the likelihood of Fryette's model by calculating vertebral orientation in computed tomography (CT) scans. Given previous findings oflow angular coupled movements during overall spinal motion, static calculations provide a unique perspective on the likelihood of Fryette's mechanics. This analysis aims to evaluate the efficacy of Fryette's principles in predicting vertebral positioning in CT scans by comparing their 3-dimensional (3D) orientation to movements described by Fryette. 3D models of 953 thoracic and lumbar vertebrae were obtained from 82 CT scans within the VerSe`20 open-source dataset. A stepwise algorithm generated three unique symmetry planes for each vertebra, offering 3D angular orientation with respect to the vertebral level below. A total of 422 vertebrae were omitted from the analysis due to the presence of pathologies significant enough to affect their motion, inaccurate symmetry plane calculations, or absence of vertebral level below. The remaining 531 vertebra were analyzed to compare quantitative coupled positioning against expected coupled spinal movements in line with Fryette's mechanics. One-sample proportional z-scoring was implemented for all vertebral levels with an ∝=0.05 and a null hypothesis of Fryette's primed positioning occurring by chance of 50 %. Further analysis was performed with individual z-scoring for each individual level to see which levels were statistically significant. Data from the VerSe`20 dataset revealed that 56.9 % of successfully analyzed vertebrae demonstrated positions compatible with Fryette's mechanics (p=0.0014, power=89 %). The 302 vertebral levels that did display coupled positioning consisted of Type I (166 vertebrae) and Type II (136 vertebrae) compatible with Fryette's mechanics. Levels that demonstrated statistical significance consisted of T5 (p=0, power=99 %), T6 (p=0.0023, power=77 %), T7 (p=0.041, power=46 %), and T10 (p=0.017, power=60 %). Our analysis suggests that the static positions of vertebrae in CT scans may align with Fryette's descriptions, although not very often. Notably, vertebral levels T5-T7 and T10 exhibit strong evidence of their static positions aligning with expected movements, warranting further investigation into the Fryette phenomenon at these levels. Future studies should explore the dynamic implications of these findings to enhance our understanding of spinal biomechanics.

Effect of i.v. Magnesium Sulphate versus i.v. Dexamethasone on Intraoperative Haemodynamic and Postoperative Analgesia after Spinal Anaesthesia in Lower Limb Surgeries: A Randomised Clinical Study

Introduction: Intrathecal adjuvants have gained favour in recent years with the goal of extending the duration of a block. Among these, Dexamethasone possesses anti-inflammatory and analgesic action and can be given as an adjuvant to local anaesthetics to enhance the efficacy of regional anaesthesia, as well as to decrease the intensity of shivering. The addition of Magnesium sulphate (MgSO4 ) to spinal anaesthesia helps in improving postoperative analgesia in an orthopaedic setting. Aim: To compare the effects of Intravenously (i.v.) MgSO4 and i.v. dexamethasone on intraoperative haemodynamics, the time to achieve dermatome T10 intraoperatively, and to compare postoperative Visual Analogue Scale (VAS) scores between the two groups at 1, 3, 6, 12, and 24 hours after surgery. Materials and Methods: This randomised clinical trial was conducted, and patients were randomly divided into two groups. Group M (n=40): MgSO4 40 mg/kg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. Group D (n=40): Dexamethasone 8 mg given 15 minutes before spinal anaesthesia in 100 mL normal saline infusion i.v. The parameters assessed included haemodynamic parameters, time to achieve dermatome T10 intraoperatively, postoperative VAS score at 1, 3, 6, 12, and 24 hours after surgery, and any side-effects like sedation, respiratory depression, nausea, vomiting, pruritus, urinary retention, bradycardia, and hypotension. Statistical testing was conducted using the statistical software Statistical Package for Social Sciences (SPSS) 28.0. Results: There was no significant difference in demographic variables (age and gender) between the two groups (p-value&gt;0.05). However, the decrease in mean heart rate, Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), and Mean Arterial Blood Pressure (MAP) was greater in group D compared to group M at different time intervals (p-value&lt;0.05). Additionally, dermatome level T10 was achieved earlier in group D by approximately two minutes compared to group M (6.95±0.39 minutes versus 5.03±0.16 minutes, respectively, p-value&lt;0.001). Conclusion: An i.v. infusion of 8 mg dexamethasone in 100 mL normal saline was more effective compared to an i.v. infusion of 40 mg/kg MgSO4 in terms of achieving more stable haemodynamics intraoperatively and achieving the T10 dermatome level earlier.

Revisiting MOMS criteria for prenatal repair of spina bifida: upper gestational-age limit should be raised and assessment of prenatal motor function rather than anatomical level improves prediction of postnatal function.

To determine if the lower-extremity neurological motor function level in fetuses with open spina bifida deteriorates within the 4-week interval between a first prenatal motor assessment at around 22 weeks of gestation and a second evaluation, prior to 'late' prenatal surgery, defined as surgery at 26-28 weeks and, in certain situations, up to 30 weeks, and to assess the association between prenatal presurgical motor-function level, anatomical level of the lesion and postnatal motor-function level. This was a two-center cohort study of 94 singleton fetuses with open spina bifida which underwent percutaneous repair using the skin-over-biocellulose for antenatal fetoscopic repair (SAFER) technique between December 2016 and January 2022. All women underwent two prenatal systematic ultrasound evaluations, approximately 4 weeks apart, with the second one being performed less than 1 week before surgery, and one postnatal evaluation via physical examination within 2 months of birth. Motor-function classification was from spinal level T12 to S1, according to key muscle function. Each leg was analyzed separately; in case of discrepancy between the two legs, the worst motor-function level was considered for analysis. Motor-function-level evaluations were compared with each other and with the anatomical level as observed on ultrasound. Independent predictors of a postnatal reduction in motor-function level were assessed using a logistic regression model. Prenatal motor-function level was assessed at a median gestational age of 22.5 (interquartile range (IQR), 20.7-24.3) and 26.7 (IQR, 25.4-27.3) weeks, with a median interval of 4.0 (IQR, 2.4-6.0) weeks. The median gestational age at surgery was 27.0 (IQR, 25.9-27.6) weeks and the postnatal examination was at median age of 0.8 (IQR, 0.3-5.4) months. There was no significant difference in motor-function level between the two prenatal evaluations (P = 0.861). We therefore decided to use the second prenatal evaluation for comparison with postnatal motor function and anatomical level. Overall, prenatal and postnatal motor function evaluations were significantly different from the anatomical level (preoperative assessment, P = 0.0015; postnatal assessment, P = 0.0333). Comparing prenatal with postnatal motor-function level, we found that 87.2% of babies had similar or improved motor function compared with that prior to prenatal surgery. On logistic regression analysis, lower anatomical level of defect and greater difference between anatomical level and prenatal motor-function level were identified as independent predictors of postnatal motor function (odds ratio, 0.237 (95% CI, 0.095-0.588) (P = 0.002) and 3.44 (95% CI, 1.738-6.813) (P < 0.001), respectively). During a 4-week interval between first ultrasound evaluation and late fetal surgical repair of open spina bifida, motor function does not change significantly, suggesting that late repair, ≥ 26 weeks, does not impact negatively on motor-function outcome. Compared with the anatomical level of the lesion, preoperative neurological motor-function assessment via ultrasound is more predictive of postnatal motor function, and should be included in preoperative counseling. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Myosteatosis predicts short-term mortality in patients with COVID-19: A multicenter analysis

ObjectivesBody composition on computed tomography can predict prognosis in patients with COVID-19. The reported data are based on small retrospective studies. The aim of the present study was to analyze the prognostic relevance of skeletal muscle parameter derived from chest computed tomography for prediction of 30-d mortality in patients with COVID-19 in a multicenter setting. MethodsThe clinical databases of three centers were screened for patients with COVID-19 between 2020 and 2022. Overall, 447 patients (142 female; 31.7%) were included into the study. The mean age at the time of computed tomography acquisition was 63.8 ± 14.7 y and median age was 65 y. Skeletal muscle area and skeletal muscle density were defined on level T12 of the chest. ResultsOverall, 118 patients (26.3%) died within the 30-d observation period. Of the patient sample, 255 patients (57.0%) were admitted to an intensive care unit and 122 patients needed mechanical ventilation (27.3%). The mean skeletal muscle area of all patients was 96.1 ± 27.2 cm² (range = 23.2–200.7 cm²). For skeletal muscle density, the mean was 24.3 ± 11.1 Hounsfield units (range = –5.6 to 55.8 Hounsfield units). In survivors, the mean skeletal muscle density was higher compared with the lethal cases (mean 25.8 ± 11.2 versus 20.1 ± 9.6; P < 0.0001). Presence of myosteatosis was independently associated with 30-d mortality: odds ratio = 2.72 (95% CI, 1.71–4.32); P = 0.0001. ConclusionsMyosteatosis is strongly associated with 30-d mortality in patients COVID-19. Patients with COVID-19 with myosteatosis should be considered a risk group.

Diagnosis of sarcopenia on thoracic computed tomography and its association with postoperative survival after anatomic lung cancer resection

Computer tomography-derived skeletal muscle index normalized for height in conjunction with muscle density enables single modality-based sarcopenia assessment that accounts for all diagnostic criteria and cutoff recommendations as per the widely accepted European consensus. Yet, the standard approach to quantify skeletal musculature at the third lumbar vertebra is limited for certain patient groups, such as lung cancer patients who receive chest CT for tumor staging that does not encompass this lumbar level. As an alternative, this retrospective study assessed sarcopenia in lung cancer patients treated with curative intent at the tenth thoracic vertebral level using appropriate cutoffs. We showed that skeletal muscle index and radiation attenuation at level T10 correlate well with those at level L3 (Pearson’s R = 0.82 and 0.66, p < 0.001). During a median follow-up period of 55.7 months, sarcopenia was independently associated with worse overall (hazard ratio (HR) = 2.11, 95%-confidence interval (95%-CI) = 1.38–3.23, p < 0.001) and cancer-specific survival (HR = 2.00, 95%-CI = 1.19–3.36, p = 0.009) of lung cancer patients following anatomic resection. This study highlights feasibility to diagnose sarcopenia solely by thoracic CT in accordance with the European consensus recommendations. The straightforward methodology offers easy translation into routine clinical care and potential to improve preoperative risk stratification of lung cancer patients scheduled for surgery.

Influence of electroacupuncture of "Dazhui"（GV14） and "Mingmen" （GV4） on expressions of NL1 and NF-200 in spinal cord injury rats

To observe the effect of electroacupuncture(EA) on activities of A2 type astrocytes(A2s)and A1 type astrocytes (A1s) , expressions of neurofilament protein 200 (NF-200, a marker of axon regeneration), nexin 1(NL1, a marker of synaptic regeneration), and regeneration of Nissl bodies in rats with spinal cord injury (SCI), so as to explore its mechanisms underlying improvement of SCI. A total of 75 male SD rats were rando-mized into sham operation, model, antibody neutralizing (AN), EA and EA+AN groups, with 15 rats in each group. The SCI model was established by using an infinite field impactor to deliver an about 200 k dyne weight onto the exposed spinal cord after making a dorsal laminectomy at vertebral level T10. EA (2 Hz, 1 mA) was applied to"Dazhui"(GV14) and "Mingmen"(GV4) for 20 min, once daily for 28 days. After modeling, intraspinal injection of neutralizing antibodies IL-1α, TNF-α and complement 1q (C1q, 2 μL) to the injured spinal locus for inhibition of A1 type astrocytes (A1s) was conducted on the 1st, 7th , 14th and 21st day for rats of AN and EA+AN groups. BBB rating scale was used to evaluate hindlimb locomotor function on day 1, 7, 14, 21 and 28 after modeling. The activation of A2s (its specific marker S100a10), astrocyte (its specific marker glial fibrillary acidic protein, GFAP), and A1s (its specific marker C3) in the spinal cord was detected by immunofluorescence, and the protein expressions of NF-200 and NL1 in the spinal cord detected by Western blot and immunohistochemistry, separately, and the neuronal regeneration was observed after Nissl staining. After SCI, the BBB scores at 1 , 7, 14, 21 and 28 day, and the immunoactivity of NL1 and NF-200 were significantly decreased (P<0.01), and the fluorescence intensity of double labelled S100a10 (A2s)/GFAP and C3, and the expression of NF-200 were considerably increased in the model group (P<0.05, P<0.01). In contrast to the model group, the BBB scores at 7, 14, 21 and 28 day, and the immunoactivity of NL1 and NF-200, and the fluorescence intensity of A2s/GFAP in the AN, EA and AN+EA groups, and the expressions of NL1 in the EA and AN+EA groups, and expression of NF-200 protein in the AN+EA group were evidently increased (P<0.05, P<0.01), and the fluorescence intensity of C3 was strikingly decreased in the EA group (P<0.01). The effect of AN+EA was significantly superior to that of single AN and EA in increasing BBB scores at 14, 21 and 28 day, and in up-regulating the immunoactivity of NF-200(P<0.01, P<0.05). Nissl staining showed damaged structure of the gray matter of the spinal cord, atrophy of the Nissl body, and pyknosis of neurons, which was milder in the AN and EA groups, particularly in the AN+EA group. EA at GV14 and GV4 may promote activation of A2s and promote regeneration of axons and synapses in SCI model rats.

Spinal Dural Arteriovenous Fistula in a Pediatric Patient with History of Endovascular Therapy Failure: A Case Report

Spinal Dural Arteriovenous Fistula (SDAVF) cases in children are extremely rare and pose a high risk for intraoperative hemorrhage. The clinical manifestation and imaging results may be vague and deceptive, frequently mistaken for other conditions such as demyelinating or spinal degenerative illnesses. SDAVF's cause is not well understood. Here, we present the case of a 10-year-old male patient with SDAVF who did not improve after endovascular therapy. The patient complained of weakness in the lower extremities, skin thickness, tingling sensations, and painful bowel movements and urination. The patient underwent endovascular embolization due to spinal AVF from the 9th thoracic vertebrae until the sacral vertebrae one month earlier. But no significant clinical improvement was found. The vital signs of the patient were within normal limits. An MRI showed a flow-void lesion with tortuosity in the dorsal spinal area at the 9th and 10th thoracic vertebrae. Because an embolization procedure was performed on the patient, which resulted in no significant improvement, it was planned for the patient to undergo an MRI and MRA evaluation. An MRI and MRA later showed the formation of an extramedullary intradural cyst at levels T9 to T10 of the thoracic vertebrae. Decompression surgery (left hemilaminectomy) and tumor extirpation were thereafter carried out on the patient after the routine laboratory test was performed. After the procedure, the patient showed improvement and could carry out everyday activities independently at 10 months post-operatively. The failure of endovascular therapy can be attributed to several factors, such as the surgeon’s experience, tools, and embolization technique, and follow-up treatment by surgery.

Percutaneous versus open posterior stabilization and decompression in AOSpine-type A3 thoracolumbar fractures with neurological deficit

BackgroundThis retrospective cohort study aimed to compare the clinical and radiological outcomes between two treatment strategies focusing on non-osteoporotic AOSpine-type A3 fractures of the thoracolumbar spine with neurological deficits at levels T11 to L2.MethodsIn total, 67 patients between 18 and 60 years of age who were treated operatively with either of the two treatment strategies were included. One treatment strategy included open posterior stabilization and decompression, whereas the other was based on percutaneous posterior stabilization and decompression via a tubular retraction system. Demographic data, surgical variables, and further parameters were assessed. Patient-reported outcomes (PROs), including the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and the American Spinal Injury Association (ASIA) impairment score, were measured to assess functional outcomes. The regional Cobb angle (CA), the anterior height ratio of the fractured vertebrae (AHRV), and the degree of canal encroachment (DCE) were assessed. The ASIA score was used to assess neurological function recovery. The follow-up period was at least 12 months.ResultsSurgical time and postoperative hospital stay were significantly shorter in the minimally invasive surgery (MIS) group. Intraoperative blood loss was significantly less in the MIS group. Regarding radiological outcome, CA and AHRV at the time of follow-up did not show a significant difference. DCE at the time of follow-up was significantly improved in the MIS group. Lower VAS scores and better ODIs were observed in the MIS group at the 6-month follow-up, but similar outcomes were observed at the 12-month follow-up. The ASIA score was similar between both groups at the 12-month follow-up.ConclusionsBoth treatment strategies are safe and effective; however, MIS could provide earlier pain relief and better functional outcomes compared with OS.

Orthotic walking outcome of persons with motor complete low thoracic spinal cord injury-a retrospective study.

Retrospective study. To analyse the orthotic walking outcome of patients with Low Thoracic Spinal Cord Injury (LT-SCI). The Rehabilitation Institute at Christian Medical College, Vellore, India. Data between January 2005 and June 2015 were retrospectively collected from electronic medical reports of patients with motor complete LT- SCI who were admitted for the comprehensive rehabilitation program. The orthotic walking outcome of these patients was measured by the Walking index for SCI version II (WISCI II). Demographical and clinical parameters were measured and their association with the walking outcome was analyzed using regression analysis. A total of 430 patients were identified within the study period. Eighty-five percent of people (n = 365) achieved walking at the time of discharge (WISCI II level 12 = 260 and level 9 = 105). Out of 11 demographical and clinical parameters considered, eight of them were found to be significant predictors of walking in the univariate analysis. Age less than 30 years had the highest odds of predicting WISCI II level 9 and level 12 than those older in the multivariate analysis (OR 17.58; 95% CI 7.35-42.03). Single neurological level T12 increased the chance of achieving WISCI II level 12 by 10 times (OR 10.2; 95% CI 3.8-27.36). Orthotic walking for persons with motor complete low thoracic spinal cord injury is an achievable goal through a comprehensive rehabilitation program. The factors identified in this study will help rehabilitation professionals strategically select the ideal candidate for orthotic gait training.

Comparison of CT derived body composition at the thoracic T4 and T12 with lumbar L3 vertebral levels and their utility in patients with rectal cancer

BackgroundComputed tomography (CT) derived body composition measurements of sarcopenia are an emerging form of prognostication in many disease processes. Although the L3 vertebral level is commonly used to measure skeletal muscle mass, other studies have suggested the utilisation of other segments. This study was performed to assess the variation and reproducibility of skeletal muscle mass at vertebral levels T4, T12 and L3 in pre-operative rectal cancer patients. If thoracic measurements were equivalent to those at L3, it will allow for body composition comparisons in a larger range of cancers where lumbar CT images are not routinely measured.Research methodsPatients with stage I – III rectal cancer, undergoing curative resection from 2010 – 2014, were assessed. CT based quantification of skeletal muscle was used to determine skeletal muscle cross sectional area (CSA) and skeletal muscle index (SMI). Systematic differences between the measurements at L3 with T4 and T12 vertebral levels were evaluated by percentile rank differences to assess distribution of differences and ordinary least product regression (OLP) to detect and distinguish fixed and proportional bias.ResultsEighty eligible adult patients were included. Distribution of differences between T12 SMI and L3 SMI were more marked than differences between T4 SMI and L3 SMI. There was no fix or proportional bias with T4 SMI, but proportional bias was detected with T12 SMI measurements. T4 CSA duplicate measurements had higher test–retest reliability: coefficient of repeatability was 34.10 cm2 for T4 CSA vs 76.00 cm2 for T12 CSA. Annotation time (minutes) with L3 as reference, the median difference was 0.85 for T4 measurements and -0.03 for T12 measurements. Thirty-seven patients (46%) had evidence of sarcopenia at the L3 vertebral level, with males exhibiting higher rates of sarcopenia. However, there was no association between sarcopenia and post-operative complications, recurrence or hospital LOS (length of stay) in patients undergoing curative resection.ConclusionsQuantifying skeletal muscle mass at the T4 vertebral level is comparable to measures achieved at L3 in patients with rectal cancer, notwithstanding annotation time for T4 measurements are longer.

Desmoid Fibromatosis Infiltrating Left Adrenal Gland and Kidney

Desmoid fibromatosis is a rare, benign, locally aggressive fibroblastic proliferation that may occur in almost any anatomical location. Due to its rarity and unpredictable clinical course, there has not been a standard guideline for treatment. We encountered a case of desmoid fibromatosis in our center. A 25 years old lady with no previous comorbid was referred for a symptomatic, rapidly growing left-sided abdominal mass. Otherwise, she denied any bowel-related symptoms or constitutional manifestation. Clinically, the abdominal was soft, but a 10x10 cm mass was palpable over the left flank. Imaging showed a large well-defined lobulated solid-cystic mass extending from vertebral level T10 to L5, measuring 10.5x15x23cm. The mass was in close proximity to the left adrenal gland, left kidney, pancreas, and spleen. Ultrasound guided biopsy interpreted it as a fibroblastic or myelofibroblastic tumour, favouring desmoid fibromatosis. Surgery was then performed where the mass was removed along with the left adrenal gland and kidney. Post-operative care was complicated with pulmonary embolism, pancreatitis, and abdominal collection, which was subsequently drained under ultrasound guidance. She was then referred to the oncology team for radiotherapy.

Production of organic Saffron (Crocus sativus) using biofertilizer and vermicompost

An experiment was conducted at SKUAST-Kashmir during 2018–19 and field trials were conducted at Dryland Agriculture research Station of SKUAST-K and Saffron Research Station, Pampore, Jammu and Kashmir. Results of the present investigation revealed that application of vermicompost, biofertilizer alone or in combination were beneficial in increasing commercial production of saffron. It encouraged more blossoms, which directly influenced the yield of saffron in both locations. At the Dryland Agriculture Research Station, SKUAST-Kashmir application of Azotobacter @11.5 g + 115 g sand + recommended dose of vermicompost of FYM recorded highest number of flowers/plot (139), fresh flower weight (40.10g), and pistil weight (1.17g), followed by treatment level T6 (Azotobacter @11.5 g + 115 g sand + recommended dose of vermicompost of kitchen waste), similar T10 (Azospirillum @11.5 g + 115 g sand + suggested amount of FYM vermicompost). Similar trends in the results were seen at the Pampore Saffron Research Station. Significant changes between treatments for all the features were found in the analysis of variance for the floral and corm properties. For all features, with the exception of the number of flowers, flower weight, and corm weight, location impacts were also significant.

Low thoracic skeletal muscle index is associated with negative outcomes in 244 patients with respiratory COVID-19

Sarcopenia is associated with negative outcomes in intensive care unit (ICU) patients and during chronic diseases. We aimed to evaluate if low skeletal muscle index (SMI) measured by computed tomography (CT) at the thoracic level is associated with poor outcomes in hospitalized patients with respiratory COVID-19. Patients admitted to the hospital between March 1st and June 9, 2020 with a confirmed diagnosis of respiratory COVID-19 in the Emergency Department were included in this retrospective cohort study. SMI was assessed from a transverse CT image at the T12 level. We analysed the association between thoracic SMI and mortality, ICU admissions, infections, length of stay and gravity scores. We included 244 patients, whose median age was 62 (20-95) years, mean body mass index was 28,6kg/m2, and 34% were obese patients. 102 patients (41,8%) had low thoracic SMI. On multivariable analysis, low thoracic SMI was associated with more infections (OR=1,88 [1,06-2,98]) and increased length of stay (OR=1,87 [1,14-3,49]) but not with mortality (OR=1.37 [0.54-3.52]), whereas it was inversely associated with ICU admission (OR=5,56 [1,96-16,67]. Low SMI measured by CT at the thoracic level T12 is associated with negative outcomes in patients with respiratory COVID-19.

Influence of Different Concentrations of Jeevamrutha on Growth, Yield and Quality Parameters of Chilli (Capsicum annum L.)

An experiment on the “Influence of Different Concentrations of Jeevamrutha on Growth, Yield and Quality Parameters of Chilli (Capsicum annum L.)” was conducted in Kharif season adapting Factorial randomized block design (FRBD) consisting of 10 treatments and replicated thrice during July to November 2021, in Horticulture research Farm, Department of Horticulture, Naini Agricultural Institute, Sam Higginbottom University of Agriculture, Technology and Sciences, Prayagraj (U.P) India. Results regarding the present investigation shows that cultivation of chilli with different concentrations of Jeevamrutha found as the best option for higher productivity whereas the treatment with concentration of 10% Spray of Jeevamrutha in variety TMPH-443 that is T5 (TMPH-443 + 10% Spray of Jeevamrutha) showed the best results in terms of Plant height at 30 DAT (39.59 cm) and at last harvest (59.65 cm), Days to 50% Flowering (35.92 days), Days to First Harvest (56.03 days), Fruit Length (7.21cm), Fruit Weight (5.80 g), Fruit Girth (3.27 cm), Number of Fruits Plant-1 (78.67 fruits), Average Fruit Yield Plant-1 (0.46 kg), Fruit Yield ha-1 (5.07t), TSS (8.10°B), were observed is dark green/green in colour (133). At level T10 with same concentration in different variety (TMPH-449) showed the nearest results. Hence the T5 (TMPH-443 + 10% Spray of Jeevamrutha) is best suited for the farmers in terms of growth, yield, quality and net returns.

TWIICE One powered exoskeleton: effect of design improvements on usability in daily life as measured by the performance in the CYBATHLON race

BackgroundSpinal cord injury leading to paraplegia affects the mobility and physiological well-being of one in a thousand people. Powered exoskeletons can temporarily restore the ability to walk. Their relevance in daily life is still limited because of low performance beyond ground that is even. CYBATHLON is an international competition promoting improvements in assistive technology. In this article, we present the latest design and results of testing of TWIICE One version 2018, one of the competing devices in the 2020 race.MethodsA person with a motor-complete spinal cord injury at thoracic level T10 participated as race pilot. Training ahead of the race took place over one week at a rate of 2 h per day. The time to perform each of the seven tasks of the competition was recorded together with the number of repetitions. Performance is compared over the training period and against the 2016 race results.ResultsProgression was observed in all tasks and accounted for by both user training and technology improvements. Final competition rank was second out of seven participating teams, with a record time of 4′40". This represents an average improvement of 40% with respect to comparable obstacles of the 2016 race, explaining the two ranks of improvement since then.ConclusionThese results help understand which features had a positive impact on the real-life performance of the device. Understanding how design affects performance is key information to create devices that really improve the life of people living with paraplegia.

La anestesia subaracnoidea no produce disfunción ventricular izquierda transitoria en pacientes mayores de 60 años sin enfermedad cardiovascular

BackgroundElderly patients are undergoing surgery more frequently than ever. In this population, spinal anesthesia, which is known to cause sympathetic blockade associated with arterial vasodilation, is proposed as an excellent option. However, its effects on left ventricular systolic function have not been studied. ObjectivesTo evaluate left ventricular systolic function by transthoracic echocardiography in patients older than 60 years, without prior cardiovascular disease, under spinal anesthesia. Patients and methodsProspective observational study with a total of 54 patients older than 60 years without prior cardiovascular disease, in whom, after the completion of subarachnoid anesthesia with hyperbaric 0.5% bupivacaine with sensory block equal to or greater than T10, left ventricular systolic function was measured using MAPSE. In addition, CI-IVC, LVOT-VTI and CO were measured. Values at 5 minutes after the blockade were compared with those obtained previously. ResultsA 3.3% decrease in MAPSE and a slight decrease in LVOT-VTI and CO were found, with no statistical or clinical significance. The 14.8% of the patients presented MAP equal to or less than 60mmHg. Comparison of echocardiographic changes between hypotensive and non-hypotensive patients was not statistically significant or clinically relevant. DiscussionOur study shows that spinal anesthesia with anesthetic level T10 or higher in patients older than 60 years without cardiovascular disease is a safe technique since it does not significantly alter echocardiographic parameters measuring left ventricular systolic function.