Longitudinal View Research Articles

Abstract 4421: Development of a clinical-genomic database to study tumor evolution and molecular biomarkers of drug resistance in a real-world setting

Abstract Background: Real-world evidence (RWE), specifically the integration of clinical and molecular data, plays an increasingly important role in elucidating the molecular landscape of advanced solid tumors, at diagnosis and at progression, and furthering precision oncology research. However, reliance on tissue genomic testing results within these RWE databases significantly limits our understanding of tumor evolution as tissue profiles are typically limited to a single time point, generally at diagnosis, and biopsies are not routinely completed at progression. Circulating tumor DNA (ctDNA) analysis at diagnosis and progression is an alternative to serial tissue testing. Studying the real-world data derived from ctDNA testing results can provide additional information, specifically around tumor evolution and mechanisms of innate and acquired resistance in response to intervening therapies (targeted and non-targeted). Methods: Anonymized results from patients consecutively tested with Guardant360®, a CLIA-certified, CAP-accredited, NYSDOH-approved ctDNA test indicated for patients with advanced and metastatic solid tumor cancers (Guardant Health, Redwood City, California) were analyzed. Using a secure and HIPAA-compliant methodology, these results were then linked to a de-identified encounters database containing medical and pharmacy claims to provide a longitudinal view of patients' journeys, including diagnosis, treatments, and real-world outcomes. Results: Of 85,874 patients, the disease groups most highly represented were lung, breast, colorectal, prostate, and pancreas cancers. 48,317 patients (56.3%) had a record of treatment with an antineoplastic treatment (i.e. chemo, hormonal, small molecule, or immuno-therapy). Of patients with a record of therapy, 14,608 (30.2%) had a record of therapy following, but none prior to, the Guardant360 test date, 14,493 (30.0%) had a record of therapy prior to, but not following theGuardant360 test date, and 19,216 (39.8%) had a record of therapy both before and after Guardant360 test date. Conclusions: In a cohort of patients who underwent ctDNA testing and for whom treatment information was available, post-therapy molecular results were available in 69.8%. The availability of genomic information following systemic therapy suggest that this dataset is a viable resource to study drug resistance and tumor evolution in the real-world setting. Citation Format: Naveen Kumar, Rajesh Kucharlapati, Aaron Hardin, Victoria M. Raymond, Stephen Fairclough, Kathryn Lang. Development of a clinical-genomic database to study tumor evolution and molecular biomarkers of drug resistance in a real-world setting [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 4421.

Reconstruction of Panoramic Dental Images Through Bézier Function Optimization.

Computed tomography (CT) and X-ray images have been extensively used as a valuable diagnostic tool in dentistry for surgical planning and treatment. Nowadays, dental cone beam CT has been extensively used in dental clinics. Therefore, it is possible to employ three-dimensional (3D) data from the CT to reconstruct a two-dimensional (2D) panoramic dental image that provides a longitudinal view of the mandibular region of the patient, avoiding an additional exposure to X-ray. In this work, we developed a new automatic method for reconstructing 2D panoramic images of the dental arch based on 3D CT images, using Bézier curves and optimization techniques. The proposed method was applied to five patients, some of them with missing teeth, and smooth panoramic images with good contrast were obtained.

Oblique versus longitudinal axis/in-plane approaches for ultrasound-guided radial arterial cannulation: A randomised controlled trial.

Oblique versus longitudinal axis/in-plane approaches for ultrasound-guided radial arterial cannulation: A randomised controlled trial.

Sonoanatomy of female reproductive organ of Sunda porcupine (Hystrix javanica).

The conventional anatomical study of specimens requires cutting processes which destruct the limited specimens. A non-destructive method, namely an ultrasonography, can be used to assess the anatomical organ information of those specimens. The aim of this research is to analyse the macroanatomy of the female reproductive organ in the Sunda porcupine (Hystrix javanica), using ultrasonographical imaging. In this study, four formaldehyde-fixed reproductive organ specimens of the Sunda porcupine were used. A 10-12MHz linear ultrasound transducer was utilized to provide an imaging format of both longitudinal and transversal views. Photographic images were then used as comparison with a sonographic image. The results show that the ultrasound image of the Sunda porcupine reproductive organ soft tissue was hypoechoic, the lumen and antrum follicles were anechoic, while atretic follicles and the mons pubis were hyperechoic. Generally, the size of the organ was not significantly different between photographical and ultrasonographical imaging (p>.05). In conclusion, ultrasound images can be utilized for anatomical studies of the Sunda porcupine reproductive organs without destructing the specimen.

Strain Curve Classification Using Supervised Machine Learning Algorithm with Physiologic Constraints

Speckle tracking echocardiography (STE) enables quantification of myocardial deformation by a generation of spatiotemporal strain curves or time–strain curves (TSCs). Currently, only assessment of peak global longitudinal strain is employed in clinical practice because of the uncertainty in the accuracy of STE. We describe a supervised machine learning, physiologically constrained, fully automatic algorithm, trained with labeled data, for classification of TSCs into physiologic or artifactual classes. The data set of 415 healthy patients, with three cine loops per patient, corresponding to the three standard 2-D longitudinal views, was processed using a previously published, in-house STE software termed K-SAD. We report an accuracy of 86.4% for classifying TSCs as physiologic, artifactual and undetermined curves. The positive predictive value for a physiologic strain curve is 89%. This is as a necessary step for a similar separation of pathologic conditions, to allow full utilization of the temporal information concealed in layer-specific segmental TSCs.

Maternal Anaemia in Pregnancy: A Significantly Greater Risk Factor for Anaemia in Australian Aboriginal Children than Low Birth Weight or Prematurity.

To identify maternal and perinatal risk factors associated with childhood anaemia. A retrospective cohort studywas conducted in three remote Katherine East Aboriginal communities in Northern Territory, Australia. Children born 2004-2014 in Community A and 2010-2014 in Community B and C, and their respective motherswere recruited into the study.Maternal and child datawere linked to providea longitudinal view of each child for the first 1000 days from conception to 2-years of age. Descriptive analyses were used to calculate mean maternal age, and proportions were used to describe other antenatal and perinatal characteristics of the mother/child dyads. The main outcome was theprevalence of maternal anaemia in pregnancy and risk factors associated with childhood anaemia at age 6months. Prevalence of maternal anaemia in pregnancy was higher in the third trimester (62%) compared to the first (46%) and second trimesters (48%). There was a strong positive linear association (R2 = 0.46, p < 0.001) between maternal haemoglobin (Hb) in third trimester pregnancy and child Hb at age 6months. Maternal anaemia in pregnancy (OR 4.42 95% CI 2.08-9.36) and low birth weight (LBW, OR 2.62, 95% CI 1.21-5.70) were associated with an increased risk of childhood anaemia at 6months of age. This is the first study to identify the association of maternal anaemia with childhood anaemia in the Australian Aboriginal population. A review of current policies and practices for anaemia screening, prevention and treatment during pregnancy and early childhood would be beneficial to both mother and child. Our findings indicate that administering prophylactic iron supplementation only to children who are born LBW or premature would be of greater benefit if expanded to include children born to anaemic mothers.

Using a bi-directional digital health platform for cancer care coordination and monitoring to enhance the cancer care continuum between patients, clinicians and caregivers.

e14105 Background: It has been recognized that current electronic medical record (EMR) systems detract from the patient-provider relationship and that an innovative technology is needed to re-center medical encounters on the patient-provider engagement. This is especially important in oncology during new patient onboarding, care coordination in between medical visits and survivorship planning. Methods: We built a HIPAA compliant role-based digital health platform to support providers in patient engagement and care coordination. In this pilot at a non-profit oncology center in India, nurse navigators onboarded the patients using the mobile application. The technology was used to digitize past medical records and parse the clinical history. In addition, self-reported patient past medical history, family history, as well as social, reproductive and surgical history was collected as needed. The system collated the information into an easy to consume case summary for the oncologists. The system was tested with 3 clinicians and consented cancer patients. Results: Nearly 200 cancer patients participated in the pilot study. Patients’ medical records were digitized by oncology nurse navigators. The summarized longitudinal view of the patient’s medical history was used by oncologists for diagnosis and treatment planning. Participating clinicians noted that the digital case summary saved time and effort in treatment planning. In addition, it was noted that collaboration between nursing staff, medical oncologist, surgical oncologist and radiation oncologist was substantially improved. Conclusions: We demonstrate the value of using digital health technology to support the care coordination of cancer patients in a low-resource, non-profit clinical center in India.

Comparison of the Predictive Value of Transvaginal Cervical Length at 11-14 Weeks and at 20-22 Weeks of Gestation in Preterm Labour

Background: Preterm labour is defined as the onset of labour before 37 weeks of gestation, in pregnancy beyond 20 weeks of gestation, and is responsible for nearly 75% of all neonatal mortality and neurological morbidity. Cervical length (CL) is one of the major determinants of preterm delivery. Several studies have been able to conclude that transvaginal CL assessment may be a useful tool for the prediction of preterm delivery. The risk of preterm birth varies inversely with CL measured by ultrasound in low-risk women. Objective: To evaluate and compare the predictive value of transvaginal cervical length between 11-14 weeks and 20-22 weeks of gestation in preterm labour. Material and Methods: A total of 264 pregnant women who were primigravida, singleton pregnancy, and women at gestational age 11-14 weeks and 20-22 weeks were included in the study. They were subjected for CL measurement at 11-14 and 20-22 weeks of gestation using transvaginal ultrasonography with the standard longitudinal view of the cervix while the patient’s bladder was empty. GEL VOLUSON 730 PRO Trans Vaginal Ultrasound (TVS) probe IC 5-9 H instrument with 5-9 MHz was used to measure CL. Results: The variables analyzed were the mean cervical length at 11-14 weeks and 20-22 weeks, the rate of shortening of cervical length in those who deliver at term and preterm and the cervical length at 11-14 weeks 20-22 weeks was correlated with gestational age at delivery and the predictive value of the same was determined. Cut-off of cervical length at 11-14 and 20-22 weeks of gestation was 3.73 cm and 2.89 and was statistically significant for the prediction of pre-term labour. Reduction in cervical length from 11-14 weeks to 20-22 weeks of gestation of more than 0.7 cm is predictive of preterm labour with statistical significance (p<0.001). Conclusion: Routine mid-pregnancy cervical length assessment in low-risk women can be a cost-effective method of preterm birth reduction but the implementation of such a policy is highly dependent upon local factors. If it is to be undertaken, cervical length assessment should be performed according to a standardized technique.

دراسة تقنیة ولغویة لأحد الأکفان الکتانیة الأوزیریة المحفوظة بمتحف کلیة الآداب - جامعة الإسکندریة Technical and Linguistic Study of a Linen Osirian Shroud Preserved in the Museum of the Faculty of Arts, Alexandria University.

تم تناول الکفن الکتاني موضع الدراسة على امتداد مسارين متوازيين، أحدهما خاص بتکنولوجيا الصناعة، وبه تم دراسة کافة الجوانب التقنية التي استخدمت في صناعة الکفن ، والتي شملت الألياف وفحصها بالميکروسکوب الإلکتروني الماسح ، حيث تم فحص اتجاه برم الألياف واتضح أنها برمت جهة اليسار على هيئة حرف S وکذلک تم فحص المظهر الطولي للألياف واتضح أنها ألياف کتانية بما يميز ألياف الکتان من فواصل عرضية ، وبالنسبة للتراکيب النسجية المستخدمة بالقطعة فقد اتضح أنها نسيج سادة1/1 ومشتقاته کالسادة المضلع وشبه السلة والسلة. وقد تمت الاستعانة بوحدة التحليل العنصري المزود بها الميکروسکوب الإلکتروني الماسح لتحليل ترکيب الحبر المستخدم والتي اتضح أنه أحمر الهيماتيت. وبالنسبة للمسار الأخر فهو محور الدراسة اللغوية للقطعة النسجية للکفن الأوزيرى على المحاور الفرعية التالية متمثلة في التالي : أولا وصف عام للقطعة لتوضيح الزخارف التي يحويها الکفن ، ثانيا : ترجمة النص لتيسير مرحلة التعرف على هوية صاحب الکفن والعصر الذى ينتمى إليها ، والتعرف على نوع الخط الذى کتب به النص ، وسمات الخط في تلک الفترة، ثالثا الدراسة الخطية واللغوية والتي تتمثل في عرض الصور الکتابية المختلفة لکلمات النص للتعرف على أشکال کتابتها خلال مراحل العصور اللغوية المختلفة ، ثم توضيح عملية الاشتقاق اللغوي والاختصار التي مرت بها بعض کلمات النص. Abstract: The linen shroud was studied in two parallel tracks, one of which is concerned with the industrial technology, where all the technical aspects used in the shroud industry were studied. That included fibers examination by scanning electron microscopy, where the direction of the spinning of the fibers was examined. It was found out that the spinning takes the left direction in the form of the letter S. The longitudinal view of the fibers was examined as well, and it turned out to be linen fibers, as the linen fibers are distinguished by the presence of nods. The textile structures used in the piece turned out to be 1/1 plain weave and its derivatives, such as polygon plain weave, semi-basket weave, and basket weave. The elemental analysis unit equipped with the scanning electron microscope was used to analyze the composition of the ink used, which turned out to be hematite. The other aspect focuses on the linguistic study of the textile piece of the Osirian shroud. It is divided into sub-aspects represented in the following: First, a general description of the piece to explain the motifs contained in the shroud. Second, translation of the text to facilitate identification of the shroud owner and the era to which they belong, as well as recognizing the written text and the features of calligraphy in that period. Third, the calligraphic and linguistic study, which is represented in presenting the various written images of the words of the text to identify the forms of writing during the different linguistic ages, then clarifying the process of linguistic derivation and abbreviation through which some of the words of Text had undergone.

Quantitative assessment of carotid artery atherosclerosis by three-dimensional magnetic resonance and two-dimensional ultrasound imaging: a comparison study.

It has been proven that magnetic resonance (MR) and ultrasound imaging are useful tools in the quantification of carotid atherosclerotic plaques. However, there are only a few pieces of evidence to illustrate the links of quantitative measurements of carotid plaques between MR and ultrasound imaging. This study looked to compare the quantitative measurements of carotid plaques and investigate their relationship between three-dimensional (3D) MR vessel wall imaging and two-dimensional (2D) ultrasound imaging. Seventy-five asymptomatic elderly subjects (mean age: 73.3±5.7 years; 45 males) with carotid atherosclerotic plaques diagnosed by both ultrasound and MR imaging were included in this study. The plaque size, including the maximum wall thickness (Max WT), plaque length, and plaque area, was measured by 3D MR and ultrasound imaging on longitudinal and cross-sectional views. The quantitative assessments of carotid plaque size were compared and correlated between 3D MR and 2D ultrasound imaging. In total, the quantitative measurements of 101 plaques on longitudinal views or 44 plaques on cross-sectional views of both MR and ultrasound imaging were compared. The Max WT of the plaques (longitudinal: 2.9±0.8 vs. 2.4±0.9 mm; cross-sectional: 3.2±1.1 vs. 2.6±0.7 mm) and plaque areas (longitudinal: 24.3±13.4 vs. 17.0±12.7 mm2; cross-sectional: 24.9±24.6 vs. 16.8±13.3 mm2) measured by MR imaging were found to be significantly higher than those measured by ultrasound imaging (all P<0.001). Moderate to strong correlations were found in Max WT, plaque area, plaque length between 3D MR and ultrasound imaging. The quantitative measurements of carotid plaques using 3D MR and 2D ultrasound are significantly correlated. The plaque area and Max WT measured by 3D MR imaging are more significant than these parameters measured by 2D ultrasound imaging, which might be explained by the resolution of MR imaging and the workflow of measurements.

The Implementation of Eating Healthy Program in Early Childhood

&#x0D; &#x0D; &#x0D; Eating habits develop during the first years of a child's life, children learn what, when, and how much to eat through direct experience with food and by observing the eating habits of others. The aim of this study is to get a clear picture of the Eating program Healthy, starting from the planning, implementation, supervision, and evaluation as a case study of nutrition education; to get information about the advantages, disadvantages and effects of implementing a healthy eating program for children. This research was conducted through a case study with qualitative data analysed using Miles and Huberman techniques. Sample of children in Ananda Islāmic School Kindergarten. The results showed the Healthy Eating program could be implemented well, the diet was quite varied and could be considered a healthy and nutritious food. The visible impact is the emotion of pleasure experienced by children, children become fond of eating vegetables, and make children disciplined and responsible. Inadequate results were found due to the limitations of an adequate kitchen for cooking healthy food, such as cooking activities still carried out by the cook himself at the Foundation's house which is located not far from the school place; use of melamine and plastic cutlery for food; the spoon and fork used already uses aluminium material but still does not match its size; does not involve nutritionists.&#x0D; Keywords: Early Childhood, Eating Healthy Program&#x0D;

A Career Eulogy Reflective Exercise: A View into Early Professional Identity Formation

Beginning medical students have a very early idea of what their physician identity will be. Providing a brief structured opportunity to reflect on the end of their career can be an important first step in identity formation. A reflective exercise was used in the summer prior to beginning medical school as each class of students at a regional rural medical school began a summer prematriculation program from 2015-2019. Students wrote what they wished to be said about them at the end of their career using a “Career Eulogy.” Identifiers were removed and narratives were coded into recurring text clusters by the authors. The students, on an anonymous evaluation, strongly agreed that the exercise facilitated the accomplishment of the program goals. Reflections from 42 entering medical students indicated a preference to be remembered for compassion, passion, quality, and patient relationships. Men more frequently mentioned family and enjoying life, and women more frequently mentioned patient relationships. Rural students included quality and being a teacher of medical students more frequently, and those with a physician parent included passion and community more frequently. Those who later chose family medicine as a specialty more often included references to enjoying life and family. This reflective exercise provided useful insight into early professional identity formation among these medical students and served to encourage group discussion. It could be used with larger, more diverse groups to determine its value and clarify true differences among the demographic and specialty choice patterns. This exercise could also be used annually for each student, providing a longitudinal view of identity formation.

EP31 Musculoskeletal ultrasound of rheumatoid arthritis pregnancy: a single centre experience

Abstract Background The utility of musculoskeletal ultrasound (MSK-US) in the measurement of disease activity of rheumatoid arthritis (RA) is well established. However, it has not been formally studied in pregnancy, with the literature limited to a single case report. Standard disease activity assessment in RA pregnancy comprises measurement of the DAS28(3) CRP score, which removes the visual analogue score (VAS) and replaces ESR with CRP, as both of these components may be confounded by pregnancy. Use of this modified score remains problematic as the tender joint count may be affected by non-specific musculoskeletal pain in pregnancy, and the swollen joint count may be obscured by peripheral oedema, especially late in pregnancy. No study of RA in pregnancy has used MSK-US to measure disease activity. Our objective was to conduct a pilot study of MSK-US in RA pregnancy, and compare findings with clinical assessment using the DAS28(3)CRP score. Methods We offered MSK-US to pregnant RA patients attending the UCLH obstetric rheumatology clinic from September 2018 to September 2019. Patients were assessed longitudinally through pregnancy/post-partum where possible. Examination was undertaken using a Logiq S8 US machine. The standard protocol comprised 22-joint assessment of hands (dorsal longitudinal and transverse views of wrists, metacarpophalangeal and proximal interphalangeal joints). In the feet, bilateral MTP joints were scanned with longitudinal views. Quantification of Power Doppler (PD) signal and grey scale (GS) synovitis was made as per the Outcome Measures in Rheumatoid Arthritis Clinical Trials (OMERACT) US definitions. PD and GS scores were calculated as mean scores of all joints scanned. Results To date, 17 pregnant RA patients have undergone a total of 35 MSK-US studies. Disease activity assessments showed 10/17 patients with persistent low activity through pregnancy, 5/17 with moderate or good response, 1/17 with no response and 1/17 with a moderate flare. Overall, PD scores correlated well with DAS28(3) CRP assessment (R2 = 0.68). All patients at moderate or high disease activity by DAS28(3) CRP had ≥1 joint with detectable PD signal, but 2/21 patients clinically in ‘remission’ and 3/7 patients in ‘low disease activity’ had detectable PD. One patient with only 2 tender and 1 swollen joints (and normal CRP; DAS28 3.17) had very extensive PD signal and contributed to the decision to recommence anti-TNF treatment in the 3rd trimester. It was noted that increased vascularity in pregnancy can complicate the assessment of synovial PD signal. MSK-US was particularly helpful in distinguishing true joint synovitis from subcutaneous oedema in the feet. Conclusion This is the first series of MSK-US in pregnant RA patients. The detection of active joint synovitis (by PD signal) in clinical remission/low disease activity states suggests a potential role for MSK-US in confirming apparent low disease activity in pregnancy, and thus guiding stratification of treatment. Disclosures C. Raine None. J. Manson None. C. Ciurtin None. I. Giles None.

Inferior Vena Cava Ultrasound in Children: Comparing Two Common Assessment Methods*

Inferior vena cava ultrasound has been used as a predictor of fluid responsiveness in children. Two ultrasonographic modes can be used to measure the respiratory variation of inferior vena cava diameter: M-mode and B-mode. Inconsistencies in measurements between the modes can result in inaccuracies in commonly used indices that assess fluid responsiveness. Our primary objective was to determine whether there are differences in the ultrasound-based measurements between these two modes of evaluation, which would impact respiratory variation of inferior vena cava diameter calculation. Our secondary objective was to assess inferior vena cava displacements during the respiratory cycle as a possible mechanism for measurement differences between the modes. Prospective observational study. PICU of a tertiary care teaching hospital. Seventy-three children under controlled ventilation (median age of 16 mo and weight of 10 kg). The inferior vena cava diameters were measured using a longitudinal view using B- and M-mode ultrasound. Two respiratory variation of inferior vena cava diameter indices were evaluated: distensibility and respiratory variation. Maximum craniocaudal and mediolateral displacements of the inferior vena cava were measured using the B-mode ultrasound. Maximum diameters of the inferior vena cava were similar between the B- and M-modes (7.90 vs 7.90 mm, respectively; p = 0.326), but minimum diameters were smaller when measured by M-mode (6.36 vs 5.00 mm; p = 0.003). When calculated by data obtained from M-mode, respiratory variation of inferior vena cava diameter indices presented significantly higher values compared to B-mode measures (p ≤ 0.001, for both). Median inferior vena cava displacements were 5.00 mm (interquartile range, 3.68-6.26 mm) in the craniocaudal and 0.80 mm (interquartile range, 0.12-1.23 mm) in the mediolateral directions. There is a significant difference between measurements of the minimum inferior vena cava diameter observed in M- and B-mode ultrasound during the respiratory cycle in children under controlled ventilation. This results in imprecise respiratory variation of inferior vena cava diameter indices. Displacements of the inferior vena cava during the respiratory cycle may influence the reliability of ultrasonographic measurements, particularly in M-mode.

Five Years at the Edge: Watching Internet From the ISP Network

The Internet and the way people use it are constantly changing. Knowing traffic is crucial for operating the network, understanding users’ needs, and ultimately improving applications. Here, we provide an in-depth longitudinal view of Internet traffic during 5 years (from 2013 to 2017). We take the point of the view of a national-wide ISP and analyze rich flow-level measurements to pinpoint and quantify changes. We observe the traffic, both from a point of view of users and services. We show that an ordinary broadband subscriber downloaded in 2017 more than twice as much as they used to do 5 years before. Bandwidth hungry video services drove this change at the beginning, while recently social messaging applications contribute to increase of data consumption. We study how protocols and service infrastructures evolve over time, highlighting events that may challenge traffic management policies. In the rush to bring servers closer and closer to users, we witness the birth of the sub-millisecond Internet, with caches located directly at ISP edges. The picture we take shows a lively Internet that always evolves and suddenly changes. To support new analyses, we make anonymized data available at https://smartdata.polito.it/five-years-at-the-edge/ .

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of Duplex Sonography of Native Renal Vessels

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

AIUM Practice Parameter for the Performance of an Ultrasound Examination of Solid-Organ Transplants.

A search for apatite crystals in the gap zone of collagen fibrils in bone using dark-field illumination.

Bright-field transmission electron microscope (TEM) images of ion milled or focused ion beam (FIB) sections of cortical bone sectioned parallel to the long axis of collagen fibrils display an electron-dense phase in the gap zones of the fibrils, as well as elongated plates (termed mineral lamellae) comprised of apatite crystals, which surround and lie between the fibrils. Energy dispersive X-ray spectroscopy (EDS) and electron energy loss spectroscopy (EELS) studies by others have shown that the material in the gap zones is calcium phosphate. Dark-field (DF) images are capable of revealing the projected position of crystals of apatite in a section of bone. We obtained bright field (BF) images of ion milled sections of bovine femoral cortical bone cut parallel to fibril axes (longitudinal view), and compared them with DF images obtained using the (002) apatite reflection to test a widely held theory that most of the mineral in bone resides in the gap zones. Most apatite crystals which were illuminated in DF images and which projected onto gap zones were extensions of crystals that also project onto adjacent overlap zones. However, in BF images, overlap zones do not appear to contain significant amounts of mineral, implying that the crystals imaged in DF are actually in the interfibrillar matrix but projected onto images of fibrils. However a small number of "free" illuminated crystals did not extend into the overlap zones; these could be physically located inside the gap zones. We note that projections of gap zones cover 60% of the area of any longitudinal field of view; thus these "free" crystals have a high random probability of appearing to lie on a gap zone, wherever they physically lie in the section. The evidence of this study does not support the notion that most of the mineral of bone consists of crystals in the gap zone. This study leaves uncertain what is the Ca-P containing material present in gap zones; a possible candidate material is amorphous calcium phosphate.

Thin Fluttering Bands: New Findings in the Carotid Evaluation

The aim of this study was to investigate the prevalence, characteristics, and possible clinical impact of the thin fluttering bands detected by carotid ultrasound. This is a prospective, observational study carried out in a single center between 2016 and 2018. A thin fluttering band was defined as a hyperechoic fluttering band detected by ultrasound in the carotid lumen in absence of findings compatible with pattern of dissection. Intraobserver and interobserver variability were carried out. A total of 3440 patients (p) were evaluated by carotid ultrasound, and thin fluttering bands were detected in 118 p (prevalence of 3.43%). The mean age was 58.9 ± 8.5 years and 48 p (40.7%) were male. In total, 97.5% of patients had no symptoms or neurological history. A total of 134 thin fluttering bands were identified (1.13 TFB/p; 104 p with 1 thin fluttering band, 12 p with 2 thin fluttering bands, and 2 p with 3 thin fluttering bands), and 83% of them were visualized from both longitudinal and transversal ultrasound views. Seventy-seven (57.5%) thin fluttering bands were localized on the right side, with the carotid bifurcation as the most common location (127 thin fluttering bands, 94.8%). The mean length of the bands was 5.6 ± 2.6 mm, with no significant differences in size according to the location, intima media thickness, or presence of carotid plaques. No significant interobserver and intraobserver variability was found. In conclusion, we have presented patients with thin fluttering bands, observing a significant prevalence in our population and ruling out a visual artifact. Their relationship with the genesis of atheroma plaques or its possible neurologic impact remains unclear.

Kindergarten Teachers’ Perspectives on Young Children’s Bullying Roles in Relation to Dominance and Peer Relationships: A Short-Term Longitudinal Approach in South Korea

There are several studies on young children’s bullying roles in relation to dominance or peer relationships. Although those are closely related, few studies examined this from longitudinal view and the influence of bullying role change on dominance and peer relationships. This study aimed to examine (1) the relationship between bullying roles and dominance, (2) the relationship between bullying roles and peer relationships, (3) the percentage of bullying role change over time, and (4) the changes in bullying roles in relation to changes in dominance and peer relationships. Sixty-three South Korean kindergarten teachers completed questionnaires regarding bullying roles, dominance, and peer relationships about 1312 children aged 3–5. The data were collected in mid-October 2017 and January 2018. The results showed that bullies had the highest dominance. No-role children had the most positive peer relationships, followed by bullies. About 10% of all sampled children remained involved in bullying over time. Their role changes related to changes in dominance rather than to changes in peer relationships. The findings imply that dominance should be considered to prevent young children’s bullying, in which peer relationships are interrelated. Intervention should be implemented as soon as possible to stop repeated victimization or bullying in early childhood.