Longest Axis Research Articles

Energetic and economic analysis for improving greenhouse energy efficiency

Protected agriculture is one of the prominent agricultural techniques. It allows for creating an adapted microclimate to the plant growth, which leads to high quality and off-season production. Instead, a significant amount of energy is required. This study aims to provide the potential of energy saving based on the optimal selection of the greenhouse design under Fez City’s climatic conditions (Morocco). For this purpose, a dynamic model of a gothic-arch-shaped greenhouse is created in EnergyPlus environment. The impact of four different orientations (0°, 90°, 45° and - 45°) on greenhouse energy needs is first investigated. The selected design is further improved by using a thermal insulation blankets system operating during the coldest months and deploying from the sunset to sunrise. To define the prospect of the energy saving, two variables were primarily evaluated: the greenhouse inside air temperature variation and thermal loads prompted by creating the optimum microclimate for tomato plant. Finally, an economic analysis is performed. The results show that 0° relative north (longer axis) is the optimal orientation for a gothic-arch greenhouse and that the thermal insulation blankets allow for reducing 17 % of the greenhouse heating needs under the climate conditions of Fez

Barrel Instability in Binary Asteroids

Abstract Most close-in planetary satellites are in synchronous rotation, which is usually the stable end-point of tidal despinning. Saturn’s moon Hyperion is a notable exception by having a chaotic rotation. Hyperion’s dynamical state is a consequence of its high eccentricity and its highly prolate shape. As many binary asteroids also have elongated secondaries, chaotic rotation is expected for moons in eccentric binaries, and a minority of asteroidal secondaries may be in that state. The question of secondary rotation is also important for the action of the binary Yarkovsky–O’Keefe–Radzievskii–Paddack (BYORP) effect, which can quickly evolve orbits of synchronous (but not nonsynchronous) secondaries. Here we report results of a large set of short numerical simulations which indicate that, apart from synchronous and classic chaotic rotation, close-in irregularly shaped asteroidal secondaries can occupy an additional, intermediate rotational state. In this “barrel instability” the secondary slowly rolls along its long axis, while the longest axis is staying largely aligned with the primary–secondary line. This behavior may be more difficult to detect through lightcurves than a fully chaotic rotation, but would likewise shut down BYORP. We show that the binary’s eccentricity, separation measured in secondary’s radii and the secondary’s shape are all important for determining whether the system settles in synchronous rotation, chaotic tumbling, or barrel instability. We compare our results for synthetic asteroids with known binary pairs to determine which of these behaviors may be present in the near-Earth asteroid binary population.

186 Low Frequency, High Complexity: Skill Retention Following Proficiency-Based Transesophageal Echocardiography Simulation Training

Focused transesophageal echocardiography (TEE) is now recommended during cardiac arrest in the emergency department. Implementation of TEE in cardiac arrest management requires additional training for a relatively low frequency and high complexity procedure. Thus, focused TEE curricula requires high proficiency retention rates to succeed. Retention rates of newly acquired TEE knowledge and skill after high fidelity simulation in emergency physicians (EMPs) are unknown. This study’s primary objective was to determine retention of TEE proficiency. This is an observational study at an academic medical center of TEE naïve EMP faculty using high fidelity TEE simulation. EMP were trained in TEE using web-based didactics and monthly hands-on sessions with a TEE simulator (HeartWorks®) for 4 months. Skills were assessed monthly via direct observation from a TEE expert until proficiency was achieved. Proficiency was defined as the ability to name, describe, and obtain 8 hands-on TEE images during the monthly examinations. The COVID-19 pandemic created a natural wash-out phase where EMPs did not perform any actual or simulated TEE for 6 months after initial TEE training. Unadvertised assessment of TEE skill occurred at months 7 and 8 after initial TEE training to test skill decay. During the assessment, EMPs had two attempts to recall the name of each TEE view, describe probe manipulation needed to achieve the view, and then obtain each view on the TEE simulator. No memory aids, discussion, or feedback were provided during the assessment. Time to obtain all 8 TEE views on the simulator was measured. This analysis is limited to the three most critical TEE views in cardiac arrest: midesophageal 4 chamber (4Ch), midesophageal long axis (LAX), and transgastric left ventricular short axis (TG). Seven EMP were evaluated individually at both 7 and 8 months after initial training. At month 7, correct name recall of the 3 views (4Ch, LAX, TG) was 71%, 57%, and 86% respectively. Correct probe manipulation description of the 3 views (4Ch, LAX, TG) was 86%, 29% and 29%. On the simulator, all three views were obtained by all participants on the first attempt. The average time to obtain all 8 TEE views was 7.3 minutes and 4.6 minutes during the first and second attempts, respectively. During the 8th month assessment, correct name recall of the 3 views (4Ch, LAX, TG) was 100%, 71%, and 100% respectively. Correct probe manipulation description of the 3 views (4Ch, LAX, TG) were 100%, 71%, and 86%. On the hands-on simulator, the three views (4Ch, LAX, TG) were correctly obtained 100%, 86%, and 100% on the first attempt and all participants obtained all three views correctly on the second attempt. The average time to obtain all 8 TEE views was 5.7 minutes and 4.0 minutes during the first and second attempts respectively. Focused, proficiency-based training on a TEE simulator results in durable skills after 6 months. Hands-on image acquisition skills were retained at a greater rate than the names of each view or probe manipulation recall. Time to obtain TEE views decreases over time as participants continued testing on the TEE simulator. These findings can inform curriculum design as widespread utilization of TEE increases.

Desmoid fibromatosis of the breast; a rare case report.

IntroductionDesmoid tumor is an uncommon tumor with variable spectrum ranged from being a locally lesion to an aggressive and destructive one. The current case aims to report a rare condition of desmoid type fibromatosis of the breast.Presentation of caseA 59-year-old female presented with a right breast mass for 9-months. Mammography showed a small speculated iso-hyper dense mass, just anterior to the pectoralis muscle measuring about 15 mm (M5) in longest axis. Ultrasound examination revealed an irregular mass with internal vascularity and posterior shadowing in the right breast with a single borderline lymph node (25 ∗ 14 mm of 4 mm cortex). Wide local excision with sentinel axillary lymph nodes biopsy was performed. Histopathological examination of the specimen confirmed the diagnosis of desmoid type fibromatosis of the breast.DiscussionThe etiology of this tumor is unknown, however, physical, hormonal and genetic factors have a significant role in the development of desmoid tumor.ConclusionDesmid type fibromatosis of the breast is an uncommon, benign, locally aggressive fibroblastic tumor with lack of metastatic potential, it may present with features of malignancy.

The enhanced adsorption of Ampicillin and Amoxicillin on modified montmorillonite with dodecyl dimethyl benzyl ammonium chloride: Experimental study and density functional theory calculation

The quaternary ammonium surfactant-dodecyl benzyl ammonium chloride (DDBAC) was applied to modify Ca-montmorillonite (Ca-Mt) to obtain organo D-Mt that was used as the adsorbent for micropollutants-ampicillin (AMP) and amoxicillin (AMX). The XRD characterization indicated that DDBAC intercalated the interlayer space of Ca-Mt. When the amount of modifier was 1.4 CEC, the basal spacing enlarged from 1.53 nm to 2.97 nm, and the arrangement of modifier molecules were sloped in the interlayer of Ca-Mt along the longest axis. The saturated adsorption capacity of D-Mt-1.4 for AMP and AMX was 30.86 mg/g and 13.29 mg/g, respectively, while the saturated adsorption capacity of Ca-Mt for two contaminants was only 0.36 mg/g and 0.16 mg/g, respectively. The adsorption of the two pollutants was more consistent with Freundlich adsorption isotherm second-order kinetic model, and the thermodynamic study suggested that adsorption was more likely to occur at higher temperatures, which means that the adsorption of two pollutants was a spontaneous endothermic process. Moreover, Multiwfn wavefunction program based on Density Functional Theory (DFT) was applied to reveal the microadsorption mechanism of D-Mt to two pollutant molecules. This work confirmed that Ca-Mt functionalized by DDBAC was promising adsorbents for micro-contaminants of antibiotics and the insight of the adsorption mechanism from the atomic level, providing theoretical guidance for architecting high performance adsorbent.

Dose-dense brentuximab vedotin plus ifosfamide, carboplatin, and etoposide for second-line treatment of relapsed or refractory classical Hodgkin lymphoma: a single centre, phase 1/2 study

Relapsed or refractory classical Hodgkin lymphoma could be treated with multiagent salvage chemotherapy followed by autologous haematopoietic stem-cell transplantation. The aim of this study is to establish the safety and activity of dose-dense brentuximab vedotin combined with ifosfamide, carboplatin, and etoposide (BV-ICE) chemotherapy in second-line treatment of classical Hodgkin lymphoma. We conducted a single-arm, open-label, phase 1/2 study of dose-dense BV-ICE at the Seattle Cancer Care Alliance, University of Washington (Seattle, WA, USA). Eligibility criteria were age 18 years or older; diagnosis of first relapse, primary refractory classical Hodgkin lymphoma after one previous line of therapy; measurable disease of at least 1 cm in the longest axis, CT of chest, abdomen, and pelvis with PET within the past 28 days; Eastern Cooperative Oncology Group performance status of 0-1; and adequate organ function. A 3 + 3 dose escalation study was done for the phase 1 part of the trial to establish the maximum tolerated dose to be used for the phase 2 study. Brentuximab vedotin was delivered on days 1 and 8 at either 1·2 mg/kg (dose level 1) or 1·5 mg/kg (dose level 2) intravenously (capped at 150 mg) with standard dosing of ICE on days 1-3 (ifosfamide 5 g/m2 plus mesna 5 g/m2 intravenously over 24 h on day 2, carboplatin area under the curve 5 on day 2 in one intravenous injection, and etoposide 100 mg/m2 on days 1-3 in one intravenous injection per day) for two 21-day cycles. The primary endpoint was to establish the recommended phase 2 dose (phase 1 part) and complete response rate after two cycles, with a prespecified target of 78% (phase 2 part). Safety analysis was done in all enrolled participants and the primary activity analysis was done in all patients with evaluable response data. This study is registered with ClinicalTrials.gov (NCT02227199); enrolment and study treatment are complete. Between Oct 16, 2014, and Feb 10, 2020, we enrolled 45 patients with a median age of 31 years (IQR 28-45). The recommended phase 2 dose of brentuximab vedotin was established to be 1·5 mg/kg. After a median follow-up of 3·1 years (IQR 1·7-4·1), 32 (74%; 95% CI 58·8-86·5) of 43 evaluable patients had complete responses after two cycles of treatment. Grade 3-4 haematological toxic effects were common, including neutropenia (33 [73%]), anaemia (six [13%]), and thrombocytopenia (36 [80%]). The most common grade 3-4 non-haematological toxic effects were febrile neutropenia (four [9%]), sepsis (six [13%]), increased alanine aminotransferase (five [11%]), hyperglycaemia (three [7%]), pulmonary embolism (two [4%]), and increased aspartate aminotransferase (two [4%]). There was one (2%) on-treatment death due to multisystem organ failure that was considered treatment related. Serious adverse events occurred in 13 (29%) patients. Our data suggest that dose-dense BV-ICE is a rapidly administered and active salvage regimen for patients with relapsed or refractory classical Hodgkin lymphoma despite a complete response in this trial lower than the prespecified phase 2 target. Although cross-trial comparisons should be made with caution, activity results seem to be similar to previously presented brentuximab vedotin chemotherapy salvage combinations delivered over much longer durations and can be considered in young (<60 years), transplantation-eligible patients for second-line therapy. Seagen, Lymphoma Research Foundation, National Institutes of Health/National Cancer Institute, and generous philanthropic donations to the University of Washington from numerous individuals and families in support of lymphoma research.

Morphology of Rain Clusters Influencing Rainfall Intensity over Hainan Island

Continuous observations from geostationary satellites can show the morphology of precipitation cloud systems in quasi-real-time, but there are still large deviations in the inversion of precipitation. We used binary-connected area recognition technology to identify meso-β-scale rain clusters over Hainan Island from 1 June 2000 to 31 December 2018, based on Global Precipitation Measurement (GPM) Integrated Multi-satellitE Retrievals for GPM data. We defined and statistically analyzed the parameters of rain clusters to reveal the typical morphological and precipitation characteristics of rain clusters, and to explore the relationship between the parameters and rainfall intensity of rain clusters. We found that the area and long axis of rain clusters over land were larger than those over the ocean, and that continental rain clusters were usually square in shape. Rain clusters with a larger area and longer axis were concentrated on the northern side of the mountains on Hainan Island and the intensity of rain was larger on the northern and eastern sides of the mountains. The variation of continental rain clusters over time was more dramatic than the variation of oceanic clusters. The area and long axis of rain clusters was larger between 14:00 and 21:00 from April to September and the long axis of the oceanic rain clusters increased in winter. There were clear positive correlations between the area, long axis and shape of the rain clusters and the maximum rain rate. The area and long axis of continental rain clusters had a higher correlation with the rain rate than those of oceanic clusters. The establishment of a relationship between the morphology of rain clusters and precipitation helps us to understand the laws of precipitation and improve the prediction of precipitation in this region.

Forming syncytia by vegetative cell fusions in the coralline red alga Neopolyporolithon reclinatum (Rhodophyta, Hapalidiales)

ABSTRACT Light microscopy and transmission electron microscopy were used to examine the developmentally important but little studied process of red algal vegetative cell fusion. Cell fusions were pervasive in the coralline alga Neopolyporolithon reclinatum; aggregates composed of as many as 15 laterally fused perithallial cells were reconstructed from paradermal sections. Fusions did not occur in a consistent pattern or orientation. Oblique fusions between cells of different perithallial tiers integrated the thallus both horizontally and vertically. Ultrastructural study showed that the fusion process was initiated by the formation of a blunt, truncated projection of the cell surface. A thin layer of new wall was deposited on the sides of the projections, but no other distinctive structural cellular features that might be associated with localized decalcification of the wall between cells were detected. Microfibrillar wall components were removed during growth of the fusion protuberance. After cell fusion, a reorganized cytoskeleton formed a connected network bridging the fusion zone and cell lumens. A dominant cytoplasmic strand, if present, spanned the longest axis of the cell, which was longitudinal in unfused cells but was oblique or transverse in laterally fused cells. The frequency of cells involved in fusions, the number of conjoined cells within a fused assemblage, and the integration of the merged cells by a shared cytoskeletal network demonstrated that the fusion process in this alga remodelled the thallus, converting filaments of uninucleate cells into a highly integrated anatomy composed also of vertically and horizontally connected, multinucleate syncytia.

Incidence of posterior vessel wall puncture during ultrasound guided vascular access: Short axis versus long axis approach.

Background and Aims:Posterior vessel wall puncture (PVWP) is a common complication of ultrasound (US) guided central venous cannulation. We evaluated and compared the frequency of PWVP of internal jugular vein using short axis (SA) and long axis (LA) approach of US-guided needle cannulation. As a secondary objective incidence of carotid puncture was assessed.Material and Methods:Prospective, single-blinded, cross over, observational study at Urban Level I Neuroanesthesiology and Critical Care Department. Residents receiving standard education on ultrasound-guided central venous cannulation were asked to place an US-guided catheter using either short axis or long axis approach on a human torso mannequin. During the procedure, the path of the needle was carefully observed by the investigator for any PVWP and carotid puncture without interference with the placement procedure. The confidence level of the resident for the intraluminal placement of the needle tip was measured on a 10-point Likert scale.Results:Forty residents participated in the study. The incidence of PVWP in SA and LA group was 40% and 17.5% respectively and was statistically significant (p = 0.026). There was no incidence of carotid artery puncture in either of the group. The mean confidence of intraluminal placement of needle was significantly higher in the LA group (8.32) as compared to the SA group (5.95).Conclusion:Lower incidence of PVWP was seen in LA as compared to the SA approach during US-guided IJV cannulation in phantom in residents having previous experience of CVC (central venous cannulation) in landmark technique only. Participants were more confident about intraluminal needle placement in the LA group compared to the SA group.

EPCT-18. A TWO-PART, PHASE 1 STUDY OF RHENIUM-186 NANOLIPOSOME (186RNL) DELIVERED BY CONVECTION ENHANCED DELIVERY FOR RECURRENT, REFRACTORY, OR PROGRESSIVE EPENDYMOMA AND HIGH-GRADE GLIOMA (HGG) AND NEWLY DIAGNOSED DIFFUSE INTRINSIC PONTINE GLIOMA (DIPG)

Ependymoma, HGG, and DIPG are gliomas that are often difficult to treat, frequently aggressive, and often carry an extremely poor prognosis. While external beam radiation therapy (EBRT) remains a central component of the management of pediatric gliomas, it is limited by tolerance of the surrounding normal brain tissue. Rhenium-186 NanoLiposome (186RNL) permits the selective delivery of beta-emitting radiation of high specific activity with excellent retention in the tumor. In a Phase 1 trial in adults with recurrent glioblastoma (NCT01906385), the mean absorbed dose to the tumor when coverage was 75% or greater (n=10) was 392 Gy (CI 306 – 478). Thus far, the therapy has been well tolerated, no dose-limiting toxicity has been observed, and no treatment-related serious adverse events have occurred despite markedly higher absorbed doses than typically delivered by EBRT (n=18).MethodsThis is a two-part, Phase 1 dose-finding study followed by an expansion cohort to explore efficacy. Part 1 will enroll up to 18 subjects to determine the maximum feasible dose (MFD) of 186RNL administered by convection enhanced delivery (CED). Tumor size will be limited to a diameter of 4 cm in the longest axis and a volume of 34 mL. The dose limiting toxicity period (DLT) is 28 days post infusion. Part 2 will independently evaluate 186RNL in 3 different cohorts: Cohort A: up to 12 subjects with a diagnosis of recurrent, refractory, or progressive ependymoma; Cohort B: up to 12 subjects with a diagnosis of recurrent, refractory, or progressive HGG; Cohort C: up to 15 subjects with newly diagnosed DIPG. The primary endpoint is overall response rate (ORR) by Radiographic Assessment in Pediatric Neuro-Oncology (RAPNO) criteria. Secondary endpoints are PFS-24 and OS-24 in Cohort A and PFS-12 and OS-12 in Cohorts B and C. Planned enrollment will begin in H2 2021.

Ultrasound-Guided Long-Axis Versus Short-Axis Femoral Artery Catheterization in Neonates and Infants Undergoing Cardiac Surgery: A Randomized Controlled Study

The objective of the present study was to compare ultrasound-guided long-axis (LAX) and short-axis (SAX) femoral artery catheterization in neonates and infants undergoing cardiac surgery. A single-center, prospective, randomized, single-blinded, controlled study. This study was conducted in the operating room and intensive care unit of the division of cardiac surgery, Mansoura University Children's Hospital, Egypt. Ninety neonates and infants undergoing elective cardiac surgery were enrolled in this study and randomly allocated to ultrasound-guided LAX and SAX groups. Ultrasound-guided femoral artery catheterization was done using either LAX (in-plane) or SAX (out-of-plane) technique. The primary outcome measure was the rate of a successful first puncture. The secondary outcome measures were the rates of mechanical complications, failure rate, time to a successful first, second, and third puncture, total time of catheterization, and imaging time. The first puncture success rate was significantly higher (p=0.048) in the LAX group (34 of 41, 82.9%) than in the SAX group (25 of 41, 60.9%). The mean time to a successful first puncture was significantly shorter (p < 0.001) in the LAX group (153.1 ± 30.1 seconds) than in the SAX group (227.2 ± 48.8 seconds). The total catheterization time was significantly shorter in the LAX group than in the SAX group. There was no significant difference in the rate of complication. With a single experienced operator performing the ultrasound-guided femoral artery cannulation, the LAX technique resulted in a higher first puncture success rate and shorter time to cannulation than the SAX technique.

The IMMULAB trial: A phase II trial of immunotherapy with pembrolizumab in combination with local ablation for patients with early stage hepatocellular carcinoma (HCC).

TPS4159 Background: The investigator-initiated IMMULAB study investigates the clinical activity of peri-interventional treatment with the anti-PD1 antibody pembrolizumab in HCC patients who are candidates for local ablation via either radiofrequency ablation (RFA), microwave ablation (MWA) or brachytherapy, or - as recommended for tumor larger than 3 cm – by combination with TACE. Patients with extrahepatic disease are excluded. Local ablation is known to induce tumor destruction with subsequent antigen release resulting in host adaptive immune responses. However, tumors could quickly overcome the immune responses by upregulating PD-L1/PD-1 expression and inhibiting the function of CD8+ and CD4+ T cells. Thus, combination of local ablation with an anti-PD1 antibody might display interesting effects by activating immune cells and disabling immune inhibitory mechanisms at the same time. Methods: This is a prospective investigator initiated single-arm multicenter phase II trial investigating immunotherapy with the PD-1 inhibitor pembrolizumab in combination with local ablation in early stage hepatocellular carcinoma (HCC). Patients with a child-pugh classification score ≤ 6, including high risk candidates for local ablation (defined as patients having ≤ 5 tumor nodules with diameters ≤ 7cm [longest axis] each OR patients with vascular infiltration) receive 200mg pembrolizumab i.v. q3w for 2 cycles. Thereafter, radiologic imaging is followed by local ablation on day 1 of cycle 3. Further pembrolizumab (200mg) is applied 2 days after ablation and thereafter every 3 weeks (q3w) for a total treatment duration of up to 12 months. It is planned to enroll 30 pts. Primary efficacy endpoint is the overall response rate (RECIST 1.1) after 2 cycles of pembrolizumab and before performing local ablation aiming in the conversion / downstaging of borderline candidates by pre-interventional treatment with pembrolizumab. Overall recruitment has started; currently (Feb 2021) 18 of 30 planned patients have been enrolled. Clinical trial information: NCT03753659.

Coincidence? - Graves’ Disease &amp; Thyroid Cancer

Abstract Background: DG coincidently with thyroid carcinoma has been reported as a rare phenomenon. It was thought that DG would be a protective condition in the development of cancer. However, published studies indicate the opposite, reporting an increased prevalence of differentiated thyroid cancer in DG compared to the general population. Some authors even report greater aggressiveness of this type of cancer in the presence of DG, with higher rates of, multifocality, metastatic disease and with a higher risk of recurrence. Clinical Case: Female, 46 years old, smoker 10 U.M.A., sent to the Endocrinology consultation due to symptomatic hyperthyroidism. No history of exposure to cervical radiotherapy, contact with iodinated products or cervical pain. Analytically, TSH &amp;lt;0.008 uUI / mL (0.27-4.2), free T4 4.09 ng/dL(0.93-1.70), free T3&amp;gt;20 pg/mL(2.57-4, 43), high levels of anti-thyroid and anti-TSH receptors 11.4IU/L (N &amp;lt;1.75), diagnosing with Graves’ disease. The thyroid ultrasound revealed a globose and hypervascularized thyroid. In the right hemithyroid, an echogenic nodular area of ​​ill-defined limits of about 12mm was identified, associated with some hyperechogenic elements. Bilateral cervical and submandibular lymph nodes were visualized with a short 8 mm axis, highlighting a ganglion in the right jugular chain, questioning the presence of millimeter echogenic foci. She started metibasol, with improved thyroid function and opted for ultrasound surveillance. Four months later, she repeated the ultrasound of the thyroid, maintaining a hypercogenic area, with ill-defined limits in the right lobe, with a 13mm longest axis. She also maintained adenopathies in the right jugulo-carotid chain, rounded, without hilum, the largest one with 13x9x17mm, and it was performed a fine needle aspiration of the ganglion. There was no measurement of thyroglobulin in the wash. The morphological changes were compatible with ganglion metastasis due to papillary thyroid carcinoma with a predominantly follicular pattern. She started 5% lugol solute, 7 drops every 8 hours for 8 days before surgery and underwent total thyroidectomy and central and lateral lymphadenectomy, with the identification of a mixed, multifocal papillary carcinoma. in the right lobe and isthmus, the microscopic size of the largest focus was 40mm, without invasion of the capsule or vascular invasion, with ganglion metastases in the lateral (9/46) and central district (6/6) (pT2N1b). She underwent treatment with I131 at a dose of 120mCi. Conclusion: This clinical case stands out for its uniqueness, given the simultaneity of Graves’ disease and thyroid cancer. The presence of cervical adenomegaly, which is rare in DG, increased clinical suspicion. Due to the increase of the adenopathy in a short period of time, we decided to perform a biopsy, which in this case was essential for the diagnosis and subsequent treatment.

Volumineuse adénopathie cervicale kystique métastatique d´un microcarcinome papillaire de la thyroïde

Cervical cystic lymph node metastasis may be confused with a branchial cyst or a cystic lymphangioma. It may be the only tell-tale sign of a papillary carcinoma of the thyroid gland. We here report the case of a 50-year-old patient presenting with a swelling in the right lower region of the jugular vein and carotid artery which had grown over the preceeding three years. Clinical examination showed renitent swelling. There was no palpable thyroid nodule. Cervical ultrasound showed a fluid cystic lesion measuring 10 cm and containing some septa. It didn’t show any thyroid nodule. Cervical computed tomography (CT) scan showed right laterocervical cystic mass containing peripheral calcifications and pressing the internal jugular vein and the sternocleidomastoid muscle. The patient underwent cervicotomy. Extemporaneal anatomopathological examination showed metastasis from papillary microcarcinoma of the thyroid gland. The patient underwent total thyroidectomy associated with bilateral central compartment and right lateral side compartment dissection. Anatomopathological examination showed nonencapsulated papillary thyroid microcarcinoma measuring 3 mm along its longer axis. The patient had lymph node metastases in the left and right sectors VI and in the right sector IV. The patient underwent two cycles of radioiodine therapy with excellent outcome.

Fracture Shape and Orientation Contributions to P-Wave Velocity and Anisotropy of Alpine Fault Mylonites

P-wave anisotropy is significant in the mylonitic Alpine Fault shear zone. Mineral- and texture-induced anisotropy are dominant in these rocks but further complicated by the presence of fractures. Electron back-scattered diffraction and synchrotron X-ray microtomography (micro-CT) data are acquired on exhumed schist, protomylonite, mylonite, and ultramylonite samples to quantify mineral phases, crystal preferred orientations, microfractures, and porosity. The samples are composed of quartz, plagioclase, mica and accessory garnet, and contain 3–5% porosity. Based on the micro-CT data, the representative pore shape has an aspect ratio of 5:2:1. Two numerical models are compared to calculate the velocity of fractured rocks: a 2D wave propagation model, and a differential effective medium model (3D). The results from both models have comparable pore-free fast and slow velocities of 6.5 and 5.5 km/s, respectively. Introducing 5% fractures with 5:2:1 aspect ratio, oriented with the longest axes parallel to foliation decreases these velocities to 6.3 and 5.0 km/s, respectively. Adding both randomly oriented and foliation-parallel fractures hinders the anisotropy increase with fracture volume. The anisotropy becomes independent of porosity when 80% of fractures are randomly oriented. Modeled anisotropy in 2D and 3D are different for similar fracture aspect ratios, being 30 and 15%, respectively. This discrepancy is the result of the underlying assumptions and limitations. Our numerical results explain the effects that fracture orientations and shapes have on previously published field- and laboratory-based studies. Through this numerical study, we show how mica-dominated, pore-free P-wave anisotropy compares to that of fracture volume, shape and orientation for protolith and shear zone rocks of the Alpine Fault.

Nutcracker Esophagus: Investigation In A Female Patient With Dysphagia And Odinophagy

Introduction: Odinophagia and dysphagia are important symptoms related to the upper gastrointestinal tract, specifically at the level of the oropharynx and esophagus. Objective: to investigate the possible cause of these symptoms through clinical history and complementary exams, thus outlining a more specific approach. Methodology: anamnesis was performed followed by neck ultrasound, fine needle aspiration (FNAP), videolaryngoscopy, computed tomography of the neck, ultrasound with thyroid dopller, esophagogastroduodenal seriography, esophageal manometry, hormone and thyroid antibodies dosage, and evaluation of thyroid antibodies. speech therapy. Results: neck ultrasound with topical thyroid gland, diffusible to swallow, diffusely heterogeneous, mixed nodule in upper / middle and anterior third of the left lobe measuring about 2.2cm x 1.6cm x 1.0 cm, in addition to sparse colloidal cysts by the glandular parenchyma, no larger than 0.6 cm, cervical lymph nodes increased in number and dimensions, some coalescent, the largest being located in the left submandibular region, measuring 1.8 cm in its longest axis. US-guided FNAB: Oncotic Cytology- Benign nodule (Category II of the Bethesda system) consistent with benign follicular nodule (Colloid goiter). Paraffin inclusion- Some follicular epithelial ceslls, in addition to leukocytes, amidst eosinophilic background (system I category) Bethesda). High digestive endoscopy without changes. Videolaryngoscopy without alterations. Computed tomography of the neck showing homogeneous prominent palatine tonsils. Heterogeneous thyroid lobes. Submandibular prominent lymph node on the right (IIA) measuring 1.1 cm. Ultrasonography with thyroid doppler confirms the p revious findings. Manometry showed hypertonia of the lower esophageal sphincter, compatible with nutcracker esophagus. Final Considerations: A patient admitted to investigate dysphagia with two months of evolution associated with odynophagia reaches a final diagnosis of nutcracker esophagus, in addition to a benign thyroid nodule. Thus, the investigation should be supplemented on an outpatient basis with high-resolution manometry. He is discharged with a medical prescription and guidance to start monitoring with a gastroenterologist.

The influence of biophysical parameters in a biomechanical model of cortical folding patterns

Abnormal cortical folding patterns, such as lissencephaly, pachygyria and polymicrogyria malformations, may be related to neurodevelopmental disorders. In this context, computational modeling is a powerful tool to provide a better understanding of the early brain folding process. Recent studies based on biomechanical modeling have shown that mechanical forces play a crucial role in the formation of cortical convolutions. However, the effect of biophysical parameters in these models remain unclear. In this paper, we investigate the effect of the cortical growth, the initial geometry and the initial cortical thickness on folding patterns. In addition, we not only use several descriptors of the folds such as the dimensionless mean curvature, the surface-based three-dimensional gyrification index and the sulcal depth, but also propose a new metric to quantify the folds orientation. The results demonstrate that the cortical growth mode does almost not affect the complexity degree of surface morphology; the variation in the initial geometry changes the folds orientation and depth, and in particular, the slenderer the shape is, the more folds along its longest axis could be seen and the deeper the sulci become. Moreover, the thinner the initial cortical thickness is, the higher the spatial frequency of the folds is, but the shallower the sulci become, which is in agreement with the previously reported effects of cortical thickness.

Particle Size-Frequency Distributions of the OSIRIS-REx Candidate Sample Sites on Asteroid (101955) Bennu

We manually mapped particles ranging in longest axis from 0.3 cm to 95 m on (101955) Bennu for the Origins, Spectral Interpretation, Resource Identification, and Security–Regolith Explorer (OSIRIS-REx) asteroid sample return mission. This enabled the mission to identify candidate sample collection sites and shed light on the processes that have shaped the surface of this rubble-pile asteroid. Building on a global survey of particles, we used higher-resolution data from regional observations to calculate particle size-frequency distributions (PSFDs) and assess the viability of four candidate sites for sample collection (presence of unobstructed particles ≤ 2 cm). The four candidate sites have common characteristics: each is situated within a crater with a relative abundance of sampleable material. Their PSFDs, however, indicate that each site has experienced different geologic processing. The PSFD power-law slopes range from −3.0 ± 0.2 to −2.3 ± 0.1 across the four sites, based on images with a 0.01-m pixel scale. These values are consistent with, or shallower than, the global survey measurements. At one site, Osprey, the particle packing density appears to reach geometric saturation. We evaluate the uncertainty in these measurements and discuss their implications for other remotely sensed and mapped particles, and their importance to OSIRIS-REx sampling operations.

CMR feature tracking strain patterns and their association with circulating cardiac biomarkers in patients with hypertrophic cardiomyopathy

AimsCMR feature tracking strain (CMR-FT) provides prognostic information. However, there is a paucity of data in hypertrophic cardiomyopathy (HCM). We sought to analyze global CMR-FT parameters in all four cardiac chambers and to assess associations with NT-proBNP and cardiac troponin T (hsTnT) in patients with HCM.MethodsThis retrospective study included 144 HCM patients and 16 healthy controls with CMR at 1.5 T. Analyses were performed on standard steady-state free precession cine (SSFP) CMR data using a commercially available software. Global left ventricular (LV) strain was assessed as longitudinal (LVLAX-GLS), circumferential (LVLAX-GCS) and radial strain (LVLAX-GRS) on long -axis (LAX) and as LVSAX-GCS and LVSAX-GRS on short- axis (SAX). Right ventricular (RV-GLS), left atrial (LA-GLS) and right atrial (RA-GLS) strain were assessed on LAX.ResultsWe found LVLAX-GLS [− 18.9 (− 22.0, − 16.0), − 23.5 (− 25.5, − 22.0) %, p = 0.0001), LVSAX-GRS [86.8 (65.9–115.5), 119.6 (91.3–143.7) %, p = 0.001] and LALAX-GLS [LA2CH-GLS 29.2 (19.1–37.7), LA2CH-GLS 38.2 (34.3–47.1) %, p = 0.0036; LA4CH-GLS 22.4 (14.6–30.7) vs. LA4CH-GLS 33.4 (28.4–37.3) %, p = 0.0033] to be impaired in HCM compared to healthy controls despite normal LVEF. Furthermore, LV and LA strain parameters were impaired in HCM with elevated NT-proBNP and/or hsTnT, despite preserved LVEF compared to HCM with normal biomarker levels. There was a moderate correlation of LV and LA CMR-FT with levels of NT-proBNP and hsTnT.ConclusionCMR-FT reveals LV and LA dysfunction in HCM despite normal LVEF. The association between impaired LV strain and elevated NT-proBNP and hsTnT indicates a link between unapparent functional abnormalities and disease severity in HCM.Graphic abstractTypical CMR-FT findings in patients with hypertrophic cardiomyopathy

Effects of Chain Length on the Structure and Dynamics of Semidilute Nanoparticle–Polymer Composites

We use molecular dynamics simulations to study how the chain length affects the structure and segmental dynamics of polymer–nanoparticle (NP) composites at semidilute NP concentrations. For NPs having relatively strong interactions with the polymer, we can approximate the system as an ideal NP dispersion, which isolates the effect of direct interactions among the NPs. By varying both the chain length N and NP concentration, we examine regimes where the chain size (i.e., chain radius of gyration Rg) is small compared to the NP separation d (d/Rg > 1), as well as cases where d/Rg < 1, so that chains readily “bridge” between the NPs. We find that the fraction of such bridging chains in our simulations can be expressed as a universal function of d/Rg. Structurally, the polymers slightly elongate near the NP interface and the chains tend to align their longest axis with the NP interface. We show that the effect of NPs on the chain structure is nearly chain length-independent, whereas the effect on chain alignment extends farther from the NP surface as the chain length increases. Chains that bridge between NPs must significantly elongate when the NP separation is large compared to the chain dimensions (d/Rg > 1). Although these bridging chains have a longer relaxation time than nonbridging chains, they do not make a substantial contribution to the overall nanocomposite segmental relaxation time for the conditions studied because the bridging chains represent only a small fraction of the system. Note that relaxation at the scale of chains may differ for bridging chains. When NP separation is comparable or smaller than the chain size (d/Rg < 1), bridging chains are more prevalent, but their properties are more similar to nonbridging chains than when d/Rg > 1. Accordingly, the variation of the computational glass transition temperature Tg with chain length essentially mirrors the trend for the reference pure polymer melt, where Tg increases with chain length and roughly saturates at large polymer mass. Overall, for the conditions studied, bridging chains are found to have a small impact on the segmental dynamics of nanocomposites.