Low T2 Research Articles

CORRELATION BETWEEN CHANGES IN RADIOGRAPHIC JOINT SPACE WIDTH AND MRI CARTILAGE THICKNESS IN THE APPROACH COHORT

In knee OA, JSW measured on weight-bearing radiographs is often used as a surrogate measure for cartilage thickness, although it represents multiple factors. Changes in JSW often show a weak correlation with changes in cartilage thickness as measured on non-weight-bearing MRI. A previous study suggested that the difference in weight-bearing between the two techniques (partly) causes this weak correlation. To 1) investigate the correlation between changes in radiographic JSW and MRI cartilage thickness using the APPROACH cohort, and 2) to explore the influence of different parameters that could contribute to weight-bearing related differences in JSW and cartilage thickness changes. 297 patients were included at five European centers. In the current study, only medial OA patients were included. Radiographs and 1.5T or 3T MRI scans, including 3D SPGR MRI, were acquired at baseline, 6 months, 1 year and 2 years. The medial JSW and minimum JSW were measured from radiographs. Medial FT cartilage thickness (MFTC) was measured from MRIs. Only patients with both measurements at ≥3 time points, including baseline and 2 years, were included. Linear regression was used to determine 2-year change. Pearson correlations were calculated between the changes in MFTC and JSW. The influence of 4 parameters on the correlations was investigated: cartilage quality (T2 mapping, 3 evenly sized groups; high, medium, low), meniscal extrusion (2 groups; MOAKS score 0 or ≥1), and potential pain-induced unloading (2 groups; >2 higher NRS pain in index knee than other knee or not) and increased BMI-induced loading (3 groups; healthy (BMI<25), overweight (25<BMI<30), obese (BMI≥30)). Modification of the slope of the correlation between changes in MFTC and JSW by the 4 parameters was investigated using interaction terms in linear regression models. These models (using standardized variables) were also used to compare Pearson correlations between JSW and MFTC changes. If there was a statistically significant difference between groups in correlation or slope (interaction term p<0.05), correlations were analyzed separately per group. The current analysis included 178 patients with medial knee OA. An average decrease in medial JSW (-0.06 mm; SD 0.49), minimum JSW (-0.07 mm; SD 0.56) and cartilage thickness (-0.09 mm; SD 0.14) was seen. Correlations between changes in cartilage thickness and medial (R=0.34; p<0.001) and minimum (R=0.22; p=0.003) JSW were weak. There was a difference in correlation of changes in MFTC with minimum JSW between T2 time categories (p<0.05), and in correlation and slope with medial JSW for meniscal extrusion (both p<0.05), but not for pain and BMI (all p>0.2). Only patients with the lowest T2 times and with meniscal extrusion showed significant moderate correlations. Potential pain-induced unloading and BMI-induced extra loading during weight-bearing radiograph acquisition do not seem to contribute to differences in the relation between JSW and MFTC. Patients with lower T2 times showed a stronger correlation, indicating that healthier cartilage is potentially less influenced by compression during weight-bearing. The relation between JSW and cartilage thickness changes was also influenced by meniscal extrusion. Future research should include a combination of factors to detect how weight-bearing JSW represents cartilage thickness, quality, meniscal extrusion, and other possible factors (e.g. radiographic positioning). Loaded MRI studies would be of value as well. EU/EFPIA Innovative Medicines Initiative Joint Undertaking (grant n° 115770). WW: Chondrometrics GmbH; FWR: Boston Imaging Core Lab. IMI-APPROACH (NCT03883568) participants and investigators. CORRESPONDENCE ADDRESS: [email protected].

Developing formalin-based fixative agents for post mortem brain MRI at 9.4T.

To develop fixative agents for high-field MRI with suitable dielectric properties and measure MR properties in immersion-fixed brain tissue. Dielectric properties of formalin-based agents were assessed (100MHz-4.5GHz), and four candidate fixatives with/without polyvinylpyrrolidone (PVP) and different salt concentrations were formulated. B1 field and MR properties (T1 , , R2 , , and magnetic susceptibility [QSM]) were observed in white and gray matter of pig brain samples during 0.5-35days of immersion fixation. The kinetics were fitted using exponential functions. The immersion time required to reach maximum values at different tissue depths was used to estimate the Medawar coefficient for fixative penetration. The effect of replacing the fixatives with Fluoroinert and phosphate-buffered saline as embedding media was also evaluated. The dielectric properties of formalin were nonlinearly modified by increasing amounts of additives. With 5% PVP and 0.04% NaCl, the dielectric properties and B1 field reflected in vivo conditions. The highest B1 values were found in white matter with PVP and varied significantly with tissue depth and embedding media, but not with immersion time. The MR properties depended on PVP yielding lower T1 , higher , more paramagnetic QSM values, and a lower Medawar coefficient (0.9 ; without PVP: 1.5). Regardless of fixative, switching to phosphate-buffered saline as embedder caused a paramagnetic shift in QSM and decreased that progressed during 1 month of storage, whereas no differences were found with Fluorinert. In vivo-like B1 fields can be achieved in formalin fixatives using PVP and a low salt concentration, yielding lower T1 , higher , and more paramagnetic QSM than without additives. The kinetics of allowed estimation of fixative tissue penetration.

Implementation of transanal minimally invasive surgery (TAMIS) for rectal neoplasms: results from a single centre

BackgroundLocal excisions are important in a tailored approach to treatment of rectal neoplasms. In cases of low risk T1 local excision facilitates rectal-preserving treatment. Transanal minimally invasive surgery (TAMIS) is the most recent alternative developed for local excision. In this study we evaluate the results after implementing TAMIS as the routine procedure for local excision of rectal neoplasms.MethodsAll patients who underwent TAMIS from January 2016 to January 2020 at St. Olav’s University Hospital were included, and clinical, pathological and oncological data were prospectively registered. The primary endpoint was local recurrence, and the secondary endpoint was complications.ResultsThere were 76 patients (42 men, mean age was 69 years [range 26–88 years]), The mean tumour level was 82 mm (range 20–140 mm) from the anal verge measured on rigid proctoscopy, and mean tumour size was 32 mm (range 8–73 mm). Three patients experienced complications needing intervention (Clavien–Dindo > 3A). Seventeen patients had rectal adenocarcinoma, 9 of whom underwent R0 completion total mesorectal excision (cTME). Fifty-five patients had an adenoma, 3 of whom developed recurrence (5.4%) within 12 months. All recurrences were treated successfully with a new TAMIS procedure. In addition, TAMIS was used in treatment of 2 patients with a neuroendocrine tumour, 1 patient with a haemangioma and 1 patient with a solitary rectal ulcer.ConclusionsTAMIS surgery is associated with a low risk of complications and a low recurrence rate in rectal neoplasms. In cases of adenocarcinoma, R0 cTME surgery is feasible in the sub-group with high risk T1 and T2 tumours.

Myocardial fibrosis assessed by magnetic resonance imaging in asymptomatic heterozygous familial hypercholesterolemia: the cholcoeur study.

BackgroundFamilial Hypercholesterolemia (FH) is an underdiagnosed condition with an increased cardiovascular risk. It is unknown whether lipid accumulation plays a role in structural myocardial changes. Cardiovascular Magnetic Resonance (CMR) is the reference technique for the morpho-functional evaluation of heart chambers through cine sequences and for myocardial tissue characterization through late gadolinium enhancement (LGE) and T1 mapping images. We aimed to assess the prevalence of myocardial fibrosis in FH patients.MethodsSeventy-two asymptomatic subjects with genetically confirmed FH (mean age 49·24, range 40 to 60 years) were prospectively recruited along with 31 controls without dyslipidaemia matched for age, sex, BMI, and other cardiovascular risk factors. All underwent CMR including cine, LGE, pre- and post-contrast T1 mapping. Extracellular volume (ECV) and enhancement rate of the myocardium (ERM = difference between pre- and post-contrast myocardial T1, normalized by pre-contrast myocardial T1) were calculated.FindingsFive FH patients and none of the controls had intramyocardial LGE (p= 0·188). While no changes in Native T1 and ECV were found, post-contrast T1 was significantly lower (430·6 ± 55ms vs. 476·1 ± 43ms, p<0·001) and ERM was higher (57·44± 5·99 % vs 53·04±4·88, p=0·005) in HeFH patients compared to controls. Moreover, low post-contrast T1 was independently associated with the presence of xanthoma (HR 5·221 [1·04-26·28], p= 0·045). A composite score combining the presence of LGE, high native T1 and high ERM (defined as ≥ mean ± 1·5 SD) was found in 20·8% of the HeFH patients vs. 0% in controls (p<0·000, after adjustment for main confounders).InterpretationCMR revealed early changes in myocardial tissue characteristics in HeFH patients, that should foster further work to better understand and prevent the underlying pathophysiological processes.

A pragmatic guide to choosing biologic therapies in severe asthma.

There are now several monoclonal antibody (mAb) therapies (“biologics”) available to treat severe asthma. Omalizumab is an anti-IgE mAb and is licensed in severe allergic asthma. Current evidence suggests it may decrease exacerbations by augmenting deficient antiviral immune responses in asthma. Like all other biologics, clinical efficacy is greatest in those with elevated T2 biomarkers. Three biologics target the interleukin (IL)-5–eosinophil pathway, including mepolizumab and reslizumab that target IL-5 itself, and benralizumab that targets the IL-5 receptor (IL-5R-α). These drugs all reduce the exacerbation rate in those with raised blood eosinophil counts. Mepolizumab and benralizumab have also demonstrated steroid-sparing efficacy. Reslizumab is the only biologic that is given intravenously rather than by the subcutaneous route. Dupilumab targets the IL-4 receptor and like mepolizumab and benralizumab is effective at reducing exacerbation rate as well as oral corticosteroid requirements. It is also effective for the treatment of nasal polyposis and atopic dermatitis. Tezepelumab is an anti-TSLP (thymic stromal lymphopoietin) mAb that has recently completed phase 3 trials demonstrating significant reductions in exacerbation rate even at lower T2 biomarker thresholds.Many patients with severe asthma qualify for more than one biologic. To date, there are no head-to-head trials to aid physicians in this choice. However, post-hoc analyses have identified certain clinical characteristics that are associated with superior responses to some therapies. The presence of allergic and/or eosinophilic comorbidities, such as atopic dermatitis, nasal polyposis or eosinophilic granulomatosis with polyangiitis, that may additionally benefit by the choice of biologic should also be taken into consideration, as should patient preferences which may include dosing frequency. To date, all biologics have been shown to have excellent safety profiles.

Very small effects of an imagery-based randomised trial to promote adherence to wearing face coverings during the COVID-19 pandemic and identification of future intervention targets

Objective: Mental imagery interventions are a cost-effective way of promoting health behaviour change. We tested a mental imagery intervention designed to promote adherence to wearing face coverings during the COVID-19 pandemic.Design: A four-arm randomised controlled trial to explore potential mechanisms of action. Main outcome measures: Measures of behaviour (frequency of self-reported face covering adherence), theory of planned behaviour constructs (i.e. intention, attitudes, subjective norms, and perceived behavioural control), personality traits, imagery ability and barrier self-efficacy were measured at baseline (T1). Behaviour was also assessed at four-week follow-up (T2).Results: Of 297 participants, a majority always wore face coverings (N = 216, 73% overall sample). Logistic regression analyses revealed no intervention effects on changes in adherence to wearing face coverings, though T1 wearing of face coverings and being male predicted T2 behaviour. Subgroup analysis of participants self-reporting ‘suboptimal T1 adherence, revealed that T2 non-adherence was predicted by being a non-student and by subjective norms and lower T1 intention to wear face coverings.Conclusion: Imagery-based interventions to increase face covering wearing adherence may exert significant public health effects but only when conducted on a very large scale. Our findings suggest that interventions should target men and disrupt habitual past behaviour.

Abstract 9370: Myocardial Tissue Characterization of Pediatric Patients With Duchenne Muscular Dystrophy

Introduction: Cardiomyopathy (CM) is the leading cause of death in Duchenne muscular dystrophy (DMD). Cardiac magnetic resonance (CMR) parametric mapping sequences, Native T1, T2, and extracellular volume (ECV), can offer insights into disease pathophysiology. The objective of this abstract was to leverage parametric mapping sequences to define the tissue characteristics of DMD CM progression. We hypothesized DMD subjects could be categorized based on fibrosis, myocardial edema, and fat infiltration. Methods: DMD patients (n=52; median 12.1 years) underwent CMR including T1, T2, and ECV at the base, mid, and apex. Categories were defined as normal, early fibrosis (normal ECV, high T1, normal T2), fibrosis (high ECV, normal or high T1, normal T2), edema (normal or high ECV, normal or high T1, high T2), fat (normal ECV, low T1, high T2) or fibrofatty (high ECV, normal or low T1, high T2). Statistical analysis included Chi-square, Wilcoxon rank sum, Wilcoxon signed rank, and Spearman’s rho. Results: Median left ventricular ejection fraction (LVEF) was 59% and 15 (29%) had LVEF &lt; 55%; 18 subjects (35%) had normal LVEF and no late gadolinium enhancement. These subjects were younger (10.2 years [8.4,11.6] vs 14.7 [11.5,17.8], p&lt;0.001). Native T1 was elevated in at least one slice in 42 (81%). Patients with high T2 at any slice (n=13) were older (p=0.009) and had lower LVEF (p=0.009) compared with normal T2 (n=39). The most common stratifications (Figure 1) were early fibrosis (n=14) and fibrosis (n=21). Of the 13 with high T2, 9 were categorized as edema, 2 as fibrofatty, and 2 as fat. T2 at the base, mid, and apex increased from first to second CMR (all p&lt;0.05) and T2 at mid and apex correlated with age (rho=0.2 and rho=0.38, p&lt;0.05). Conclusion: Myocardial fibrosis is common in DMD. CM progresses with age and higher T2 suggesting fatty/fibrofatty infiltration. CMR parametric mapping sequences offer insights into disease pathophysiology, which should drive therapeutic innovation.

Abstract 14232: Performance Of Cardiac Magnetic Resonance Fingerprinting Mapping - Evaluation By Comparison With Standard Techniques In A Large Patient Population

Background: Parametric mapping is now widely used as a part of cardiac MRI protocols. Cardiac Magnetic Resonance Fingerprinting (cMRF) techniques for parametric mapping allow for simultaneous evaluation of T1 and T2 within a single acquisition. In this study, we evaluate the performance of cMRF through comparison with clinically utilized pulse sequences for T1 and T2 in a large heterogeneous population. Hypothesis: cMRF T1 and T2 measurements agree with clinically available mapping sequences in a heterogeneous patient cohort. Methods: We obtained myocardial T1 and T2 values across the whole mid short axis slice of the left ventricle in 175 patients using cMRF (T1/T2), Modified Look-Locker Inversion Recovery (MOLLI, T1), and T 2 -prepared balanced steady-state free precession (bSSFP). Patients were classified into the groups “Ischemic cardiomyopathy (ICM)”, “Nonischemic Cardiomyopathy (NICM)”, “Normal”, and “Other”. The group classified as “Other” was not analyzed separately. Results: cMRF had similar T1 compared with MOLLI (1036 vs 1046 ms, p=0.06, r=0.76) and slightly lower T2 compared with bSSFP (46.1 vs 49.6 ms, p&lt;0.01, r=0.5) in the entire cohort. Mean T1 was higher in ICM compared to Normal when measured by both MRF (1074 vs 997, p&lt;0.01) and MOLLI (1073 vs 1015, p&lt;0.01). The same was true when comparing NICM and Normal for both MRF and MOLLI (p&lt;0.01). T1 was more concordant in NICM (r=0.82) vs ICM (r=0.46) and Normal (r=0.54) while T2 had similar concordance across the spectrum of pathologies. Bland-Altman plots showed good agreement between cMRF and MOLLI (Bias: -9.86, 95% CI: -98.58, 78.86)/bSSFP (Bias: -3.55, 95% CI: -11.68, 4.57). The concordance was stable across a range of heart rates. Conclusions: cMRF is an emerging technique for simultaneous T1/T2 mapping in the myocardium. In a large heterogeneous population, cMRF T1 and T2 values showed good agreement with clinically-utilized pulse sequences. Further work is needed to identify sources of discrepancies.

Machine learning in the classification of lithology using downhole NMR data of the NGHP-02 expedition in the Krishna-Godavari offshore Basin, India

We apply machine learning techniques to classify the lithology using downhole nuclear magnetic resonance (NMR) data of gas hydrate reservoirs in the Krishna-Godavari (KG) Basin, eastern Indian offshore. We choose two sites of the second expedition of the Indian National Gas Hydrate Program (NGHP-02) for our study, one with clay dominated site NGHP-02-01 from Area E and another with silt/sand dominated site NGHP-02-05 from Area C. We obtain five distinct classes in NMR signals at two sites using unsupervised techniques such as Davies-Bouldin index, silhouette, self-organizing map, k-means clustering and emergent self-organizing map. Obtained classes are interpreted using the NMR T2 distribution pattern with time in terms of clay, silt, sand and pebble/gravels with depth and reconciled with gamma-ray, density, porosity, resistivity, velocity and photoelectric factor. Our results demonstrate the lithology as silty-clay with minor sand at Hole NGHP-02-01A, and silt, sand with less clay and minor pebble/gravel at Hole NGHP-02-05A. The presence of gas hydrate is identified by observing an overall low amplitude T2 distribution curve, which is due to the reduction of pore space by solid gas hydrate. The maximum concentration of gas hydrate of about 43% of pore space estimated using NMR- and density-porosity are distributed mainly in silty-clay at Hole 01A and of about 75% in clayey-silt and silty-sand at Hole 05A. Low amplitude NMR T2 signals observed in clay-dominated sediments at higher relaxation time may be due to the fracture-filled gas hydrates at both holes. Interestingly, high porosity (90–95%), high permeability (4 mD), low bulk-density (1.2 gm/cm3) and low photoelectric factor (0.8 b/electron) are found in sandy layers within the gas hydrate-stability zone at Hole 05A, which possibly comprising buried channels. Comparison of the lithology obtained from other log data with that from NMR data and core samples illustrates that the NMR data are most effective for characterization of reservoirs, except for a high concentration of gas hydrate in a sandy/coarse-grained reservoir, which needs further studies.

Association of Cerebral Blood Flow and Brain Tissue Relaxation Time With Neurodevelopmental Outcomes of Preterm Neonates: Multidelay Arterial Spin Labeling and Synthetic MRI Study.

Both cerebral blood flow (CBF) and brain tissue relaxation times are known to reflect maturation in the neonatal brain. However, we do not yet know if these factors are associated with neurodevelopmental outcomes. The objective of this study was to acquire CBF and relaxation time in preterm neonates, using multidelay arterial spin labeling and synthetic magnetic resonance imaging (MRI), and show their association with later neurodevelopmental outcomes. In this prospective study, preterm neonates were recruited, and multidelay arterial spin labeling and synthetic MRI were performed between September 2017 and December 2018. These neonates underwent the Bayley Scales of Infant Development test at 18 months of age, and both cognitive and motor outcome scores were measured. Transit time-corrected CBF and T1 and T2 relaxation time values were measured for different brain regions. The measured values were correlated with gestational age (GA) at birth and corrected GA at the MRI scan. Simple and multiple linear regression analyses were performed for the measured values and neurodevelopmental outcome scores. Forty-nine neonates (median [interquartile range] GA, 30 [2] weeks, 209 [17] days; 28 boys) underwent MRI scans at or near term-equivalent age (median [interquartile range] corrected GA, 37 [2] weeks, 258 [14] days). Transit time-corrected CBF (coefficient, 0.31-0.59) and relaxation time (coefficient, -0.39 to -0.86) values showed significant correlation with corrected GA but not with GA. After controlling for GA, the frontal white matter CBF in preterm neonates showed a negative relationship with cognitive outcome scores (β = -0.97; P = 0.029). Frontal white matter T1 relaxation times showed a positive relationship with cognitive outcome scores (β = 0.03; P = 0.025) after controlling for GA. Higher CBF values and lower T1 relaxation times in frontal white matter were associated with poorer cognitive outcomes. As quantitative neuroimaging markers, CBF and relaxation times may help predict neurodevelopmental outcomes in preterm neonates.

Prospective effects of PTSD and attachment on subjective age among veterans and their wives.

The goal of the present study was to assess the trauma-induced experience of subjective aging for trauma survivors and their spouses in relation to the bidirectional effects of posttraumatic stress disorder (PTSD) and attachment insecurities. One hundred and seventy Israeli combat veterans from the 1973 Yom Kippur War and their wives reported their subjective age (SA), 35 and 42 years after the war (T1, T2). We conducted actor-partner interdependence cross-lagged models between spouses' SA and examined the associations between T1 PTSD, T1 attachment anxiety and avoidance, and spouses' T2 SA, while controlling for chronological age. The results indicated that the wives' T1 SA positively contributed to the veterans' T2 SA and the veterans' T1 SA positively contributed to the wives' T2 SA. Veterans' T1 attachment avoidance prospectively contributed to their higher T2 SA. Wives' PTSD severity and attachment anxiety at T1 prospectively contributed to their higher T2 SA. Wives' T1 attachment avoidance contributed to their lower T2 SA. Wives' attachment anxiety and health problems at T1 prospectively contributed to veterans' reports of higher T2 SA. This study emphasizes the dyadic processes that underly trauma-related aging. The impact of dyadic processes should not be overlooked in research and clinical interventions. Specifically, effective trauma interventions during old age should take into account the impact that spouses have on trauma survivors' mental states and aging processes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Compositional evaluation of lesion and parent bone in patients with juvenile osteochondritis dissecans of the knee using T2 * mapping.

Juvenile osteochondritis dissecans (JOCD) lesions contain cartilaginous, fibrous and osseous tissues which are difficult to distinguish with clinical, morphological magnetic resonance imaging (MRI). Quantitative T2 * mapping has earlier been used to evaluate microstructure and composition of all aforementioned tissues as well as bone mineral density. However, the ability of T2 * mapping to detect changes in tissue composition between different JOCD lesion regions, different disease stages, and between stable and unstable lesions has not been demonstrated. This study analyzed morphological and T2 * MRI data from 25 patients (median age, 12.1 years) with 34 JOCD-affected and 13 healthy knees. Each lesion was assigned a stage reflecting the natural history of JOCD, with stages I and IV representing early and healed lesion, respectively. T2 * values were evaluated within the progeny lesion, interface and parent bone of each lesion and in the control bone region. T2 * was negatively correlated with JOCD stage in progeny lesion (ρ = -0.871; p < 0.001) and interface regions (ρ = -0.649; p < 0.001). Stage IV progeny showed significantly lower T2 * than control bone (p = 0.028). T2 * was significantly lower in parent bone than in control bone of patients with stable lesions (p = 0.009), but not in patients with unstable lesions (p = 0.14). Clinical significance: T2 * mapping enables differentiation between different stages of JOCD and quantitative measurement of the ossification degree in progeny lesion and interface. The observed T2 * decrease in healed and stable lesions may indicate increased bone density as a result of the active repair process. T2 * mapping provides quantitative information about JOCD lesion composition.

Robotic Trachelectomy for Cervical Myoma after Partial Hysterectomy

<h3>Study Objective</h3> To present a rare case of cervical leiomyoma in a post partial hysterectomy patient. <h3>Design</h3> Case report illustrated with video. <h3>Setting</h3> Under general anesthesia, the patient was placed in dorsolithotomy position, arms alongside the body and legs 80°abducted in adjustable stirrups. Two robotic portals were positioned in both iliac fossae, in addition to the umbilical, and a conventional laparoscopic portal was placed on the right flank. The cervix was manipulated and delineated with a 60cc syringe. <h3>Patients or Participants</h3> We present a case of a 43-year-old woman who had undergone partial hysterectomy 8 years ago due to intense menstrual bleeding and multiple uterine fibroids. She went to the gynecologist with a complaint of deep dyspareunia and chronic pelvic pain in the left lower quadrant. These complaints started after 3 years of hysterectomy and were now more intense. Physical examination revealed the presence of a partially mobile nodule of 5cm in left iliac fossa, slightly sore to the touch. During the investigation, her pelvic MRI showed signs of partial hysterectomy, the uterine cervix with multiple retention cysts and a well-defined nodule with low T2 signal in the left lateral region vascularized by branches from the left internal iliac vessels measuring 5.3 × 4.2 × 4.7 cm. Cervical cytology was negative. <h3>Interventions</h3> Patient was eligible for a robotic-assisted simple trachelectomy. <h3>Measurements and Main Results</h3> Surgery duration time was 2 hours with minimal blood loss. She was discharged after 15 hours with mild soreness. After 2 weeks she had complete remission of symptoms and the final pathological report confirmed leiomyoma of the uterine cervix. <h3>Conclusion</h3> Partial hysterectomy may not be enough for uterine fibroid treatment once the uterine cervix can be a site of fibroid growth. In addition, surgery afterwards may be hampered by the presence of pelvic adhesions and anatomical distortion.

T2* reduction in patients with acute post-traumatic headache.

Although iron accumulation in pain-processing brain regions has been associated with repeated migraine attacks, brain structural changes associated with post-traumatic headache have yet to be elucidated. To determine whether iron accumulation is associated with acute post-traumatic headache, magnetic resonance transverse relaxation rates (T2*) associated with iron accumulation were investigated between individuals with acute post-traumatic headache attributed to mild traumatic brain injury and healthy controls. Twenty individuals with acute post-traumatic headache and 20 age-matched healthy controls underwent 3T brain magnetic resonance imaging including quantitative T2* maps. T2* differences between individuals with post-traumatic headache versus healthy controls were compared using age-matched paired t-tests. Associations of T2* values with headache frequency and number of mild traumatic brain injuries were investigated using multiple linear regression in individuals with post-traumatic headache. Significance was determined using uncorrected p-value and cluster size threshold. Individuals with post-traumatic headache had lower T2* values compared to healthy controls in cortical (bilateral frontal, bilateral anterior and posterior cingulate, right postcentral, bilateral temporal, right supramarginal, right rolandic, left insula, left occipital, right parahippocampal), subcortical (left putamen, bilateral hippocampal) and brainstem regions (pons). Within post-traumatic headache subjects, multiple linear regression showed a negative association between T2* in the right inferior parietal/supramarginal regions and number of mild traumatic brain injuries and a negative association between T2* in bilateral cingulate, bilateral precuneus, bilateral supplementary motor areas, bilateral insula, right middle temporal and right lingual areas and headache frequency. Acute post-traumatic headache is associated with iron accumulation in multiple brain regions. Correlations with headache frequency and number of lifetime mild traumatic brain injuries suggest that iron accumulation is part of the pathophysiology or a marker of mild traumatic brain injury and post-traumatic headache.

T2* weighted placental MRI in relation to placental histology and birth weight.

Placental dysfunction may be found among normal birth weight (BW) pregnancies, as indicated by abnormal histological findings in postnatal placental examination in some of these pregnancies. T2* weighted placental MRI provides non-invasive information on placental oxygenation and thereby placental function. The aim of this study was to investigate the correlation between placental T2*, BW and placental histology. A total of 63 pregnant women underwent T2* weighted placental MRI at 15-40 week's gestation and a standardized placental histological examination (PHE). Abnormal PHE was defined by vascular malperfusion according to the Amsterdam workshop consensus. The correlation between PHE, BW z-score and T2* z-score was analyzed by logistic regression. Abnormal PHE was revealed in 28 pregnancies. Multiple logistic regression revealed a significant correlation between abnormal PHE and T2* z-score (OR=0.34, p=0.008), whereas BW z-score did not add significantly to the correlation of placental histology (OR=0.52, p=0.115). In BW z-score≥0, PHE was normal in 100% of pregnancies. In BW z-score≤-2, PHE was abnormal in 89% of pregnancies. In intermediate BW (z-score between -2 and 0), PPE was abnormal in 35% of pregnancies. In this intermediate group, placental T2* z-score was reduced (-1.52±1.22 (mean SD)) when compared to normal PHE pregnancies (-0.28±1.17), p=0.006. This study demonstrates a correlation between abnormal placental histology and low placental T2* value regardless of fetal size. This indicates that T2* provides information of placental function in vivo even when fetal size is normal. This finding highlights that fetal size alone is not a valid marker of placental dysfunction.

Placental MRI: Longitudinal relaxation time (T1) in appropriate and small for gestational age pregnancies.

The antenatal detection of small for gestational age (SGA) pregnancies is a challenge, which may be improved by placental MRI. The longitudinal relaxation time (T1) is a tissue constant related to tissue morphology and tissue oxygenation, thereby placental T1 may be related to placental function. The aim of this study is to investigate placental T1 in appropriate for gestational age (AGA) and SGA pregnancies. A total of 132 singleton pregnancies were retrieved from our MRI research database. MRI and ultrasound estimated fetal weight (EFW) was performed at gestational week 20.6-41.7 in a 1.5T system. SGA was defined as BW≤-15% of the expected for gestational age (≤10th centile). A subgroup of SGA pregnancies underwent postnatal placental histological examination (PHE) and abnormal PHE was defined as vascular malperfusion. The placental T1 values were converted into Z-scores adjusted for gestational age at MRI. The predictive performance of placental T1 and EFW was compared by receiver operating curves (ROC). In AGA pregnancies, placental T1 showed a negative linear correlation with gestational age (r=-0.36, p=0.004) Placental T1 was significantly reduced in SGA pregnancies (mean Z-score=-0.34) when compared to AGA pregnancies, p=0.03. Among SGA pregnancies placental T1 was not reduced in cases with abnormal PHE, p=0.84. The predictive performance of EFW (AUC=0.84, 95% CI, 0.77-0.91) was significantly stronger than placental T1 (AUC=0.62, 95% CI, 0.52-0.72) (p=0.002). A low placental T1 relaxation time is associated with SGA at birth. However, the predictive performance of placental T1 is not as strong as EFW.

The use of functional placental magnetic resonance imaging for assessment of the placenta after prolonged preterm rupture of the membranes in vivo: A pilot study.

Preterm prelabor rupture of membranes (PPROM) complicates 3% of pregnancies in the UK. Where delivery does not occur spontaneously, expectant management until 37weeks of gestation is advocated, unless signs of maternal infection develop. However, clinical presentation of maternal infection can be a late sign and injurious fetal inflammatory responses may already have been activated. There is therefore a need for more sensitive markers to aid optimal timing of interventions. At present there is no non-invasive test in clinical practice to assess for infection in the fetal compartment and definitive diagnosis of chorioamnionitis is by histological assessment of the placenta after delivery. This study presents comprehensive functional placental magnetic resonance imaging (MRI) quantification, already used in other organ systems, to assess for infection/inflammation, in women with and without PPROM aiming to explore its use as a biomarker for inflammation within the feto-placental compartment in vivo. Placental MRI scans were performed in a cohort of 12 women (with one having two scans) with PPROM before 34weeks of gestation (selected because of their high risk of infection), and in a control group of 87 women. Functional placental assessment was performed with magnetic resonance techniques sensitive to changes in the microstructure (diffusion) and tissue composition (relaxometry), with quantification performed both over the entire organ and in regions of interest between the basal and chorionic plate. Placental histology was analyzed after delivery where available. Normative evolution of functional magnetic resonance biomarkers over gestation was studied. Cases of inflammation, as assessed by histological presence of chorioamnionitis, and umbilical cord vasculitis with or without funisitis, were associated with lower T2* (mean T2* at 30weeks 50ms compared with 58ms in controls) and higher fractional anisotropy (mean at 30weeks 0.55 compared with 0.45 in controls). These differences did not reach significance and there was substantial heterogeneity both in T2* and Apparent Diffusivitiy across the cohort. This first exploration of functional placental assessment in a cohort of women with PPROM demonstrates that functional placental MRI can reveal a range of placental changes associated with inflammatory processes. It is a promising tool to gain information and in the future to identify inflammation in vivo, and could therefore assist in improving optimal timing for interventions designed to prevent fetal injury.

Investigation on the Interactive Effects between Temperature and Chemical Composition of Organic Wastes on Anaerobic Co-Digestion Performance

Synergistic effects among different chemical components under the anaerobic co-digestion (AcoD) process played an important role in improving its performance, which might be affected by the digesting temperature. The results showed that the actual methane production (AMP) and gasification rate (GR) of 50% lipid content were the highest, and the carbohydrate and protein content should be adjusted according to the temperature. Under mesophilic conditions, the M1 reactor with high protein content (carbohydrate–lipid–protein ratio, CLP = 20:50:30) had the highest AMP of 552.02 mL/g VS and GR of 74.72%. However, as the temperature increased, the high protein content produced high levels of ammonia nitrogen (AN) and free ammonia (FA), which formed a certain degree of ammonia inhibition, resulting in lower AMP and GR. Under thermophilic conditions, the low protein T2 reactor (CLP = 40:50:10) had the highest AMP and GR at 485.45 mL/g VS and 67.18%. In addition, the M1 and T2 reactors had the highest microbial diversity, which promoted substrate degradation and methane production. In the M1 reactor, acetoclastic metabolism is the main methanogenic pathway, while in the T2 reactor changes to hydrogenotrophic metabolism. Therefore, understanding the synergistic effect between temperature and chemical compositions was an effective way to improve the AcoD effect.

Bidirectional relationships between intuitive eating and shape and weight overvaluation, dissatisfaction, preoccupation, and fear of weight gain: A prospective study

Using a prospective design, we investigated possible bi-directional relationships between intuitive eating and four empirically distinct components of negative body image: overvaluation (judgements of self-worth contingent upon weight/shape), dissatisfaction (general discontent with weight/shape), preoccupation (ruminative thinking about weight/shape), and fear of weight gain. We assessed adult women at baseline (T1) and four-month follow-up (T2), as prior work has demonstrated that this time lag is sufficient to detect change in intuitive eating scores. After adjusting for T1 intuitive eating scores and demographic confounds, higher T1 dissatisfaction was the only body image component to significantly predict lower T2 intuitive eating scores in both univariate and multivariate models. Higher T1 intuitive eating scores also significantly predicted lower scores on each of the four negative body image components at T2. Findings suggest that general body discontent may be one of the more important body image variables that lead to decreases in intuitive eating principles. Present findings also add to a growing body of evidence demonstrating the potentially adaptive role of intuitive eating on psychological health indices.

PROXIMAL FIBULAR AUTOGRAFT RECONSTRUCTION AFTER RESECTION GCT DISTAL FIBULA

Background: Giant cell tumor (GCT) is a destructive bone tumor. The predilection of the GCT is mostly on the epiphysial of long bones. GCT of the distal fibula is a very rare case that becomes challenging in surgical management. The chosen surgical management is crucial and still under debate.Case Report: A 38-years-old male complaint of a painful lump in the lateral side of his left ankle for three months. Plain radiographs demonstrate a lytic lesion involving distal fibula, appropriate with 2nd-grade Campanacci. MRI showed a mass centered on the distal fibula with intermediate to high T2 signal, low T1 signal, and homogenous contrast enhancement. The patient underwent a wide excision and reconstruction of the distal fibula with a fibular head graft from the ipsilateral side. After fifteen months of evaluation, the result was excellent. The patient can full-wight-bearing with a full range of ankle joint movement, return to daily activities without pain, and no signs of recurrence. Functional status measured by the MSTS and CAIT showed good results, with total scores was 28 and 27.Discussion: Ten centimeters distal fibula is a crucial component to form stability of the ankle. Reconstruction of the distal fibula after wide excision requires the bone graft and is considered to maintain ankle stability. It can be achieved using autograft from fibula or iliac crest.Conclusion: Reconstruction of distal fibula GCT with proximal fibular autograft showed a great result. This method is a viable option as it provides good pain relief and functional improvement.