Low Volume Research Articles

Abstract PS01-01: Feasibility and oncological safety of targeted axillary dissection or sentinel lymph node biopsy in patients with clinically node-positive disease after neoadjuvant chemotherapy in the prospective MF-1803 NEOSENTITURK-study

Abstract Background: Previous prospective studies reported decreased false negative rates in patients presenting with T1-3/cN1 disease, with the removal of 2 or more sentinel lymph nodes (SLNs), using combined technique for SLN biopsy (SLNB), and by targeted axillary dissection (TAD) in initially clinically node-positive patients after neoadjuvant chemotherapy (NAC). The aim of this prospective study is to compare the feasibility and the oncological safety of TAD with SLNB in patients with cN-positive/ycN0 breast cancer following NAC in a prospective study. Methods: This study included patients with a cT1-4N1-3M0 disease from the prospective multicenter MF1803 NEOSENTITURK registry study who were treated either SLNB- or TAD-alone without ALND. TAD included removing the biopsy-proven positive LN marked mostly with a clip as SLN or non-SLN. All patients had nodal and regional irradiation. Results: Between 2019 to 2021, 976 patients with cT1-4N1-3M0 disease from 37 centers underwent either SLNB-alone (n=620) or TAD-alone (n=356). Patients with TAD (median age: 46, range: 24-76) and SLNB (median age:46, range: 21-80) have shown a similar age distribution. The median number (range, 25%-75%) of SLNs and total LNs and total metastatic LNs removed were 3 (2-4), 4(3-6), and 1 (1-2), respectively. Patients with TAD were more likely to have cT1-2 disease (91.9% vs 78.7%, p< 0.001), cN1 disease (85.7% vs 78.5%, p< 0.006), a breast conservative surgery (66.0% vs 51.3%, p< 0.001), the combined technique for mapping (44.1% vs 22.3%, p< 0.0001), and a decreased median (IQR) lymph node ratio as calculated by the total positive lymph node number to the total lymph node number (0.29:0.20-0.40 vs 0.33: 0.20-0.50; p=0.033). Of note, there was a trend for the decreased non-sentinel lymph node positivity in the TAD-group compared to the SLNB-group that did not reach the statistical significance (TAD: 10% vs SLNB: 19%, p=0.07). However, no significant difference could be found in pathological characteristics including tumor type, breast pCR, non-luminal disease such as HER2-positivity or triple negative disease or presence of low volume metastatic disease (ITC or micrometastasis), and extracapsular extension (Table 1). Of note, patients with ypN-positive disease (n=351) were more likely to have SLNs (ypN+, 3.7±1.7 vs ypN0, 3.4±1.7, p=0.008) or total LNs (ypN+, 4.7±1.9 vs ypN0, 3.4±1.9, p=0.001) removed compared to those with ypN0 (n=635). Among those with ypN0 disease, patients with TAD were more likely to have LNs removed compared to those with SLNB (TAD, 4.2±1.9 vs 3.9±1.9, p=0.034) (Table 2). Of those with ypN+, patients with TAD were more likely to have SLNs compared to those with SLNB (TAD, 3.9±1.7 vs 3.5±1.7, p=0.062), whereas patients with SLNB were more likely to have non-SLNs removed compared to those with TAD (TAD, 2.3±1.4 vs 2.9±1.5, p=0.028). At a mean follow-up of 28.8 months (±12.1), the ipsilateral axillary and locoregional recurrence rates were 0.2% (n=2) and 0.4% (n=4) in the TAD-group and SLNB_group, respectively. Of note, no significant difference could be found in ipsilateral axillary, locoregional, and systemic recurrences between cohorts treated with TAD-alone vs SLNB-alone (Table 3). Conclusion: Our findings suggest that TAD might be more feasible in ypN+ patients which resulted in a decreased lymph node ratio and decreased non-SLN positivity. In ypN0 patients, TAD may contrary cause unnecessary lymph node removal that might be important in arm function and lymphedema development. Furthermore, our findings with short-term follow-up indicate that axillary and locoregional recurrences were observed at very low rates in a selected group of ycN0 patients treated with SLN- or TAD without ALND. Therefore, omission of ALND could be safely considered for patients with limited nodal involvement ( <2 LNs) as long as <3 LNs removed and nodal radiotherapy provided. Table 1. Clinicopathologic Characteristics According to the Axillary Surgery: Targeted Axillary Dissection (=TAD) versus Sentinel Lymph Node Biopsy (=SLNB) Table 2. Clinicopathologic Characteristics According to the Pathological Nodal Status Table 3. Locoregional and systemic recurrences in cT1-4N1-3 patients treated with Targeted Axillary Dissection (=TAD) or Sentinel Lymph Node Biopsy (=SLNB) (Nf976) Citation Format: Neslihan Cabıoğlu, Hasan Karanlik, Mehmet Ali Gulcelik, Havva Belma Kocer, Mahmut Muslumanoglu, Abdullah İgci, Mustafa Tukenmez, Cihan Uras, Enver Ozkurt, Gokhan Giray Akgul, Selman Emiroglu, Süleyman Bademler, Ahmet Dağ, Didem Can Trabulus, Nilufer Yıldirim, Guldeniz Karadeniz Cakmak, Ebru Sen Oran, Halil Kara, Gul Basaran, Ayse Altinok, M. Umit Ugurlu, Kazim Senol, Baha Zengel, Niyazi Karaman, Ecenur Varol, Ece Dilege, Yasemin Bolukbasi, Alper Akcan, Yeliz Emine Ersoy, Aykut Soyder, Serdar Ozbas, Mehmet Velidedeoglu, Beyza Ozcinar, N. Zafer Utkan, Bulent Citgez, Burak Celik, Leyla Zer, Gurhan Sakman, Levent Yeniay, Lutfi Dogan, Mutlu Dogan, Fazilet Erozgen, BERK GOKTEPE, Orhan Agcaoglu, Taner Kivilcim, Fatih Levent Balci, Bahadir M. Gulluoglu, Ayfer Kamali Polat, Kamuran Ibis, Vahit Ozmen. Feasibility and oncological safety of targeted axillary dissection or sentinel lymph node biopsy in patients with clinically node-positive disease after neoadjuvant chemotherapy in the prospective MF-1803 NEOSENTITURK-study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PS01-01.

High stiffness 3D-printed continuous pitch carbon fiber reinforced polymer composites

This study presents a method for 3D printing very high stiffness pitch-based carbon fiber (CF) reinforced polylactic acid (PLA) composites using a modified open-source 3D printer. The fused filament fabrication (FFF) technique was used to fabricate the samples with alternating layers of PLA and PLA-coated pitch CF. The tensile Young’s modulus of the 3D-printed composite samples was measured to characterize the effect of different grades and volume fractions of pitch CF on the behaviour of the printed composites. Three grades of pitch CF which have different Young’s modulus were used with volume fractions ranging from 2.4 to 8.4%. Tensile tests showed that the K1392U CF reinforced composite with a 7.3% volume fraction demonstrated the highest improvement in Young’s modulus of 850% compared to neat 3D-printed PLA. This improvement is notably higher than any previous 3D-printed carbon-based composites at a relatively low volume fraction of CF. Statistical analysis showed increased Young’s modulus in all of 3D-printed composite samples tested. The experimental values were compared to the Halpin-Tsai model and suggest that some degree of fibre breakage occurred during the 3D printing process owing to the relative stiffness of the pitch-based fibers. Future directions and suggestions for process improvements are discussed.

Relationships between snowpack, low flows and stream temperature in mountain watersheds of the US west coast

AbstractWater temperatures in mountain streams are likely to rise under future climate change, with negative impacts on ecosystems and water quality. However, it is difficult to predict which streams are most vulnerable due to sparse historical records of mountain stream temperatures as well as complex interactions between snowpack, groundwater, streamflow and water temperature. Minimum flow volumes are a potentially useful proxy for stream temperature, since daily streamflow records are much more common. We confirmed that there is a strong inverse relationship between annual low flows and peak water temperature using observed data from unimpaired streams throughout the montane regions of the United States' west coast. We then used linear models to explore the relationships between snowpack, potential evapotranspiration and other climate‐related variables with annual low flow volumes and peak water temperatures. We also incorporated previous years' flow volumes into these models to account for groundwater carryover from year to year. We found that annual peak snowpack water storage is a strong predictor of summer low flows in the more arid watersheds studied. This relationship is mediated by atmospheric water demand and carryover subsurface water storage from previous years, such that multi‐year droughts with high evapotranspiration lead to especially low flow volumes. We conclude that watershed management to help retain snow and increase baseflows may help counteract some of the streamflow temperature rises expected from a warming climate, especially in arid watersheds.

Limitations in design and applications of ultra-small mode volume photonic crystals

Ultra-small mode volume nanophotonic crystal cavities have been proposed as powerful tools for increasing coupling rates in cavity quantum electrodynamics systems. However, their adoption in quantum information applications remains elusive. In this work, we investigate possible reasons why, and analyze the impact of different low mode volume resonator design choices on their utility in quantum optics experiments. We analyze band structure features and loss rates of low mode volume bowtie cavities in diamond and demonstrate independent design control over cavity-emitter coupling strength and loss rates. Further, using silicon vacancy centers in diamond as exemplary emitters, we investigate the influence of placement imprecision. We find that the benefit on photon collection efficiency and indistinguishability is limited, while the fabrication complexity of ultra-small cavity designs increases substantially compared to conventional photonic crystals. We conclude that ultra-small mode volume designs are primarily of interest for dispersive spin-photon interactions, which are of great interest for future quantum networks.

Fewer Operators, Lower Volumes in View for the Prolific Permian

The $100-billion-plus wave of oil industry consolidation that swept through the Permian Basin of west Texas and southeast New Mexico in the second half of 2023 may have crested but is still showing momentum that will likely result in more deals over the remainder of this year. Need evidence? Look to February’s $50-billion combination of Diamondback Energy and rival Endeavor Energy Resources. Endeavor began as a green-shoot sole-proprietorship in 1979 to drill its first well in Midland County, Texas. By 2016, the private company had transitioned into one of the region’s top horizontal well operators—completing over 1,100 gross operated horizontal wells and producing more than 400,000 gross operated barrels of oil equivalent per day at the time of the Diamondback deal. The Diamondback/Endeavor marriage was the side salad in an otherwise grand buffet of deals that ran roughshod through the region over the past several months. Last October, ExxonMobil cut a deal to acquire Pioneer Natural Resources for around $60 billion. Chevron followed suit with its $53-billion deal to acquire rival Hess. Other smaller, but notable deals included Permian Resources’ $4.5-billion bid for Earthstone Energy, Canada’s Ovintiv’s $4.3-billion offering on a trio of regional deals, and Civitas Resources snapping up private-equity-led Tap Rock Resources and Hibernia Energy III for a combined $4.7 billion. The lion’s share of the larger deals is characterized by players with more-predominant international footprints snapping up more-focused producers in an area of established crude oil production. When deals like this occur, not only are you taking two potential drilling programs and making them one, but you are also bringing these assets into a situation of heightened competition for budget dollars due to the acquiring company’s other financial requirements. This is expected to result in less drilling and, as a result, less production coming from the prolific Permian over the course of the next several months. “We do have production growth from the Permian slowing to about 400,000 B/D in 2024 from 500,000 in 2023 and 600,000 in 2022,” said Andrew Dittmar, analyst with Enverus. “It’s hard to draw a direct correlation to the consolidation of private E&Ps, but in my view that is playing a role. There has been over $100 billion in private sales in the Permian since 2021. Privates are far more likely to target double-digit production growth versus publics managing for flat production or low single-digit growth. Privates are especially likely to ramp up production immediately before going to market to garner a higher sales price, so the wave of privates gearing up to sell then transacting was a tailwind for Permian volumes,” Dittmar said. He noted that moving forward, this will have a diminished effect since there are limited large private entities left to merge in the Permian region. The likelihood of public-public mergers, such as ExxonMobil acquiring Pioneer or APA purchasing Callon Petroleum, having a significant impact is lower, as these companies were already operating with a focus on minimal growth in their assets.

Increased adiposity to muscle ratio and severity of sinusitis affect quality of life in asthma—Computed tomographic analysis—

BackgroundDeteriorated sinusitis and increased adiposity relative to muscle mass may affect the quality of life(QoL) in patients with asthma. However, whether these effects are observed regardless of intra-pulmonary pathology is unknown. ObjectivesTo evaluate the correlation of the cross-sectional ratio of abdominal visceral fat (VF) to erector spinae muscle (ESM) and sinus findings based on Lund-Mackey scoring system (LMS) on computed tomography (CT) with the impaired score of the Asthma Quality of Life Questionnaire (AQLQ), regardless of airway and parenchymal disease, in patients with asthma. MethodsParticipants from the Hokkaido-based severe asthma cohort who had completed AQLQ and CT examination at the entry. The participants were divided into high (highest) and low (other quartiles) groups based on the extra-pulmonary indices. The multivariate analysis examined the association of VF/ESM for the adiposity-to-muscle ratio, LMS with AQLQ, after adjusting for the airway fractal dimension for airway index, %low attenuation volume for parenchymal index. ResultsNo significant differences were observed in VF/ESM and LMS in terms of sex. The AQLQ score in the high VF/ESM group and high LMS group was lower than those in low VF/ESM group and low LMS group (N:Male/Female, 63/100). High VF/ESM (estimate [95% confidence interval], (-0.43[-0.61,-0.25]) and high LMS scores (-0.22(-0.41, -0.03)) were associated with low AQLQ scores, adjusted for age, body mass index, smoking status, blood eosinophil counts, and intra pulmonary CT indices. ConclusionsIncreased VF relative to ESM mass and high LMS may deteriorate asthma related QoL, regardless of intra-pulmonary disease.

Importance of computed tomography perfusion on assessing collateral circulation and prognosis of patients with acute anterior circulation large vessel occlusion after endovascular therapy

This study probed the importance of computed tomography perfusion (CTP) on assessing collateral circulation and prognosis in patients with acute anterior circulation large vessel occlusion (AAC-LVO) after endovascular therapy (EVT). Retrospective analysis was performed on the case data of 124 AAC-LVO patients who achieved EVT in the First People's Hospital of Lianyungang. All patients received computed tomography (CT) examination. Based on the multi-phase computed tomography angiography (mCTA) score, patients were separated into poor collateral circulation group and good collateral circulation group. Based on modified Rankin scale (mRS) score, patients were separated into good prognosis group and poor prognosis group. The receiver operating characteristic (ROC) curve was used to measure the efficacy of CTP parameters in predicting good collateral circulation or good prognosis. Correlation between CTP parameters with mCTA collateral and 90-day mRS circulation score was analyzed using the Spearman correlation analysis. The age and admission national Institutes of Health stroke scale (NIHSS) scores of the good collateral circulation group were lower than the poor collateral circulation group, and low perfusion area volume with Tmax > 6 s (VTmax>6s), infarct core area volume (VCBF<30%)and hypoperfusion intensity ratio (HIR) were also lower. The mCTA collateral cycle score was negatively related to VTmax>6 s, VCBF<30% and HIR. The area under the curve (AUC) values of VTmax>6 s and VCBF<30% and HIR for predicting good collateral circulation were 0.763, 0.884 and 0.842, respectively, which suggested that perfusion parameters VTmax>6 s, VCBF<30% and HIR could effectively indicate the status of patients’ collateral circulation. Relative to the poor prognosis group, patients in the good prognosis group possessed lower admission NIHSS score, younger age, smaller final infarct volume, lower HIR, VCBF<30%, VTmax>6s, Alberta Stroke Program Early CT(ASPECT) score, and higher mCTA score. Spearman correlation analysis unveiled that ASPECT score, mCTA score and 90-day mRS were negatively correlated. The final infarct volume, perfusion parameters HIR and VCBF<30% were positively correlated with 90-day mRS. ROC analysis showed that all variates had good prognostic value for acute anterior circulation great vessel occlusion patients, while VCBF<30% and HIR had high diagnostic value for prognosis. To sum up, CTP can provide a comprehensive imaging assessment of the collateral circulation of patients with AAC-LVO and has a higher predictive value for the prognosis assessment of patients with EVT in terms of VCBF<30%, HIR score and mCTA collateral circulation score.

409. Cortico-Thalamic Structural Co-Variation Networks are Related to Familial Risk for Schizophrenia in the Context of Lower Nuclei Volume Estimates in Patients: An ENIGMA Study

409. Cortico-Thalamic Structural Co-Variation Networks are Related to Familial Risk for Schizophrenia in the Context of Lower Nuclei Volume Estimates in Patients: An ENIGMA Study

Structural neuroimaging changes associated with subjective cognitive decline from a clinical sample

BackgroundAlzheimer’s disease (AD) is characterized by progressive deterioration of cognitive functions. Some individuals with subjective cognitive decline (SCD) are in the early phase of the disease and subsequently progress through the AD continuum. Although neuroimaging biomarkers could be used for the accurate and early diagnosis of preclinical AD, the findings in SCD samples have been heterogeneous. This study established the morphological differences in brain magnetic resonance imaging (MRI) findings between individuals with SCD and those without cognitive impairment based on a clinical sample of patients defined according to SCD-Initiative recommendations. Moreover, we investigated baseline structural changes in the brains of participants who remained stable or progressed to mild cognitive impairment or dementia. MethodsThis study included 309 participants with SCD and 43 healthy controls (HCs) with high-quality brain MRI at baseline. Among the 99 subjects in the SCD group who were followed clinically, 32 progressed (SCDp) and 67 remained stable (SCDnp). A voxel-wise statistical comparison of gray and white matter (WM) volume was performed between the HC and SCD groups and between the HC, SCDp, and SCDnp groups. XTRACT ATLAS was used to define the anatomical location of WM tract damage. Region-of-interest (ROI) analyses were performed to determine brain volumetric differences. White matter lesion (WML) burden was established in each group. ResultsVoxel-based morphometry (VBM) analysis revealed that the SCD group exhibited gray matter atrophy in the middle frontal gyri, superior orbital gyri, superior frontal gyri, right rectal gyrus, whole occipital lobule, and both thalami and precunei. Meanwhile, ROI analysis revealed decreased volume in the left rectal gyrus, bilateral medial orbital gyri, middle frontal gyri, superior frontal gyri, calcarine fissure, and left thalamus. The SCDp group exhibited greater hippocampal atrophy (p < 0.001) than the SCDnp and HC groups on ROI analyses. On VBM analysis, however, the SCDp group exhibited increased hippocampal atrophy only when compared to the SCDnp group (p < 0.001). The SCD group demonstrated lower WM volume in the uncinate fasciculus, cingulum, inferior fronto-occipital fasciculus, anterior thalamic radiation, and callosum forceps than the HC group. However, no significant differences in WML number (p = 0.345) or volume (p = 0.156) were observed between the SCD and HC groups. ConclusionsThe SCD group showed brain atrophy mainly in the frontal and occipital lobes. However, only the SCDp group demonstrated atrophy in the medial temporal lobe at baseline. Structural damage in the brain regions was anatomically connected, which may contribute to early memory decline.

Environmental DNA storage and extraction method affects detectability for multiple aquatic invasive species

AbstractEnvironmental DNA (eDNA) refers to genetic material released by organisms into their surrounding environment. Collecting and identifying eDNA has gained popularity for monitoring and surveillance of aquatic invasive species. Invasive species management is most successful when an invasion is identified early while population size is likely to be low, highlighting the importance of eDNA detection sensitivity. Various factors influence DNA yield recovered from environmental samples. Environmental DNA storage and extraction methods, for example, can be adjusted to maximize DNA yield, thereby improving detectability. In this study, we compared the performance of two eDNA storage and extraction methods in detecting three common aquatic invasive species (Bythotrephes longimanus, Dreissena polymorpha, and Faxonius rusticus) across five natural ecosystems of Minnesota, United States. One method involved storing filters in 95% ethanol (EtOH) and extracting DNA using a DNeasy PowerSoil Pro Kit (Qiagen, Hilden, Germany), whereas the other method used cetyl trimethylammonium bromide (CTAB) for storage and a phenol–chloroform–isoamyl (PCI) procedure for DNA extraction. We also investigated the effect of DNA extract volume (1 μL relative to 3 μL) in qPCR reactions on eDNA detections for the commercial kit method. The CTAB‐PCI method yielded significantly more positive detections, across all three species, compared to the EtOH‐Qiagen method. Moreover, we found that using 1 μL of DNA extract in qPCR reactions was equally effective as using 3 μL. To improve detections of aquatic invasive species, we recommend that researchers store eDNA sample filters in CTAB or a similar lysis buffer such as Longmire's solution and extract with PCI when feasible, but note that lower extract volumes might be used without negative effect when either increasing technical replicates or repurposing samples for the detection of multiple species.

Determination of interparticle radiative heat transfer and radiation absorption for ellipsoidal particle beds using Monte Carlo ray tracing

The calculation of radiative heat transfer between particles in particle-based solar systems presents significant challenges in terms of computational cost and accuracy. This study addresses these challenges by employing the discrete element method to generate random particle packings and the Monte Carlo ray tracing method to investigate the influence of particle shape and volume fraction (ϕ) on interparticle radiation transfer and the absorption of incident radiation. The results reveal that, at low volume fractions, the shape and orientation of ellipsoidal particles have a pronounced impact on direct radiative transfer. Oblate particles exhibit the highest average radiation distribution factor (RDF), and the dispersion of RDF data is more prominent for oblate and elongated prolate particles compared to spheres. As ϕ increases to 0.35, the contribution of indirect transfer from neighboring particles becomes significant for oblate particles, resulting in a reduction in the dispersion of RDF data. Furthermore, when ϕ reaches 0.55, the decisive factor in determining RDF becomes the shielding effect of particles positioned between the emitting and receiving particles. The average RDF tends to converge among particles of different shapes, although oblate and elongated prolate particles still exhibit considerably larger RDF dispersion compared to spherical and near-spherical particles. Additionally, the effective absorptivity of the particle bed for incident radiation decreases as the aspect ratio of particles increases at all volume fractions. Moreover, the transmitted fraction demonstrates an exponential relationship with the depth, and beds composed of spherical particles exhibit better radiation transmittance compared to beds containing non-spherical particles.

Quantifying Bone Loss and Lateralization with Standardized Baseplate vs Augmented Baseplates

IntroductionReverse shoulder arthroplasty continues to be utilized for the treatment of cuff tear arthropathy, glenohumeral degenerative joint disease, and irreparable rotator cuff tears. With advancement in component designs, glenoid retroversion and inclination are now correctable with augmented baseplates. However, quantifying bone loss and lateralization compared to standard baseplates has not been studied. The purpose of the current study is to determine the volume of bone reamed and net lateralization with a standardized baseplate vs augmented baseplate when glenoid inclination was corrected to neutral. Materials and MethodsA series of 21 CT scans of patients presenting for shoulder arthroplasty were chosen based on a range of increasing native positive inclination. CT scans were uploaded into a segmentation software and processed. Four fellowship trained shoulder surgeons were then blinded from each other and virtually placed a neutral baseplate and an augmented baseplate for each specimen. Baseplate position was standardized. Additionally, baseplate backside seating of a minimum of 80% was also standardized and glenosphere (non-lateralized) size was selected to eliminate variation in baseplate contact and position. Glenoid inclination was corrected to a minimal of neutral in each specimen as well as glenoid retroversion corrected to < 10o. Net lateralization from the center of the glenoid to the most lateral aspect of the baseplate was calculated in millimeters. ResultsThe mean glenoid retroversion was 8.1o and superior inclination was 10.6o for all specimens. Across all specimens and surgeons, use of a 10-degree augment resulted in similar baseplate backside seating area (219.2 mm3 vs 226.2 mm3, p > 0.05). There was substantially lower volume of bone reamed in the augmented baseplate patients (619mm3 vs 1102mm3, p < 0.001). Larger standard deviation seen in the augmented baseplate columns are attributed to differences in surgeon preference for percent backside seating, which was standardized at a minimum of 80%. Use of a 10-degree full wedge augment resulted in 2.4 mm additional glenoid lateralization than a neutral baseplate on average across all included scapulae. ConclusionThe current study demonstrates approximately 50% less bone removal and 2.4 mm of true lateralization with a 10-degree augmented baseplate when compared to standard baseplates.

The burden of periprosthetic femoral fractures in England and Wales: insights from the first two years of data collection in the National Hip Fracture Database and regional variation in care

IntroductionPeriprosthetic femoral fractures (PPFFs) represent an important healthcare problem, with a rising incidence noted due to an increase in the number of arthroplasty surgeries being performed. There is a current lack of national consensus as to how these complex, often frail patients are managed. AimsOur primary aim was to present the epidemiology of PPFFs in England and Wales over the first two years of data collection by the National Hip Fracture Database (NHFD). Secondary aims included how well the NHFD Key Performance Indicators (KPIs) are met for PPFF patients, whether centres reporting a higher burden of PPFF patients are more likely to meet KPIs compared to lower volume centres, and to also identify if regional variation in care for these patients exist. MethodsPatients aged 60 years or over, admitted to any acute hospital in England or Wales with a PPFF within the period 1st January 2020 to 31st December 2021 were included. Fractures were classified using the Vancouver system. The primary outcome of interest was the incidence of PPFF in England and Wales. Secondary outcomes included i) geographical distribution, ii) pattern of injury, iii) treatment received, iv) KPI performance nationally, v) KPI performance by top 5 highest volume hospitals vs the rest, vi) KPI performance by region and vii) KPI performance compared with native hip fracture patients. ResultsA total of 5,566 PPFFs were reported during our study period. A 31% increase in cases was seen between 2020 and 2021 (2,405 to 3,161). The South-West of England reported the highest burden of PPFFs (14% of all cases reported in 2021). Vancouver B subtypes were most common around hip replacements (62%) and C subtype around knee replacements (55%). A total of 4,598 patients (82.6%) underwent operative management. There was regional variation in KPI attainment. When compared to KPI attainment for native hip fractures PPFF care under performed in most regions and domains. High volume PPFF centres were not associated with improved attainment of KPIs. ConclusionWe have described the incidence, nature, and management of PPFF at national and regional levels using routinely collected NHFD data. Both numerically and due to case complexity, PPFF are a considerable challenge to patients and health services alike. This epidemiology is not captured by other existing datasets and increased case contribution to the NHFD is encouraged to improve understanding and enable prioritisation and delivery of further care and research.

Influence of Solute Carrier Family 22 Member 1 (SLC22A1) Gene Polymorphism on Metformin Pharmacokinetics and HbA1c Levels: A Systematic Review.

Solute Carrier Family 22 Member 1 (SLC22A1, also known as OCT1) protein has a vital role in the metabolism of metformin, a first-line anti-diabetes medication. Genetic polymorphism in SLC22A1 influences individual response to metformin. This review aims to compile the current knowledge about the effects of SLC22A1 genetic polymorphism on metformin pharmacokinetics and HbA1c levels. We followed the PRISMA 2020 standards to conduct a systematic review. We searched the publications for all appropriate evidence on the effects of SLC22A1 genetic polymorphism on metformin pharmacokinetics and HbA1c from January 2002 to December 2022. Initial database searches identified 7,171 relevant studies. We reviewed 155 titles and abstracts after deleting duplicates. After applying inclusion and exclusion criteria, 23 studies remained. Three studies found that rs12208357, rs34059508, and G465R had a considerable impact (p < 0.05) on metformin pharmacokinetics, resulting in increased metformin plasma (Cmax), a higher active amount of drug in the blood (AUC), and lower volume of distribution (Vd) (p<0.05). SLC22A1 polymorphisms with effects on HbA1c include rs628031 (four of seven studies), rs622342 (four of six studies), rs594709 (one study), rs2297374, and rs1867351 (one of two studies), rs34130495 (one study), and rs11212617 (one study) (p < 0.05).

Performance of a solar parabolic trough concentrator using vacuum linear V-shaped cavity receiver

The popularity of renewable energy is on the rise as fossil fuel resources continue to deplete and environmental pollution levels increase. Consequently, enhancing the performance of renewable energy systems has become a compelling subject of research. This study introduces an innovative structure, the Linear Cavity Receiver (LCR), as a receiver for solar Parabolic Trough Concentrators (PTCs). Notably, this novel structure incorporates a vacuum V-shaped LCR, marking a pioneering achievement worldwide. By adopting this configuration, the solar system’s thermal efficiency is enhanced through the reduction of heat losses. The results confirmed the superiority of the vacuum V-shaped LCR over a non-vacuum receiver in optimizing the performance of the solar PTC system. It was found that the vacuum linear V-shaped cavity receiver exhibited superior efficiency for larger cavity tube diameters, higher inlet temperatures, and lower volume flow rates. Moreover, this study showed that decreasing the cavity tube diameter, increasing solar radiation, reducing the working fluid (WF)’s inlet temperature, and raising the volume flow rate contribute to an increase in both cavity heat gain and the solar system’s thermal efficiency. It can be concluded that the thermal efficiency of the solar system was about 72.24 %, 71.6 %, and 69.9 % for cavity tube diameters 5 mm, 10 mm, and 25 mm, respectively. These findings hold great significance in the design of power-generating PTC systems, ensuring their optimal efficiency. Also, the results of this study can be used to improve energy governance by using more efficient thermal power systems.

Gray matter volume in women with the BRCA mutation with and without ovarian removal: evidence for increased risk of late-life Alzheimer's disease or dementia.

Ovarian removal prior to spontaneous/natural menopause (SM) is associated with increased risk of late life dementias including Alzheimer's disease. This increased risk may be related to the sudden and early loss of endogenous estradiol. Women with breast cancer gene mutations (BRCAm) are counseled to undergo oophorectomy prior to SM to significantly reduce their risk of developing breast, ovarian, and cervical cancers. There is limited evidence of the neurological effects of ovarian removal prior to the age of SM showing women without the BRCAm had cortical thinning in medial temporal lobe structures. A second study in women with BRCAm and bilateral salpingo-oophorectomy (BSO) noted changes in cognition. The present, cross-sectional study examined whole-brain differences in gray matter (GM) volume using high-resolution, quantitative magnetic resonance imaging in women with BRCAm and intact ovaries (BRCA-preBSO [study cohort with BRCA mutation prior to oophorectomy]; n = 9) and after surgery with (BSO + estradiol-based therapy [ERT]; n = 10) and without (BSO; n = 10) postsurgical estradiol hormone therapy compared with age-matched women (age-matched controls; n = 10) with their ovaries. The BRCA-preBSO and BSO groups showed significantly lower GM volume in the left medial temporal and frontal lobe structures. BSO + ERT exhibited few areas of lower GM volume compared with age-matched controls. Novel to this study, we also observed that all three BRCAm groups exhibited significantly higher GM volume compared with age-matched controls, suggesting continued plasticity. The present study provides evidence, through lower GM volume, to support both the possibility that the BRCAm, alone, and early life BSO may play a role in increasing the risk for late-life dementia. At least for BRCAm with BSO, postsurgical ERT seems to ameliorate GM losses.

Association of Basal Forebrain Volume with Amyloid, Tau, and Cognition in Alzheimer's Disease.

Degeneration of cholinergic basal forebrain (BF) neurons characterizes Alzheimer's disease (AD). However, what role the BF plays in the dynamics of AD pathophysiology has not been investigated precisely. To investigate the baseline and longitudinal roles of BF along with core neuropathologies in AD. In this retrospective cohort study, we enrolled 113 subjects (38 amyloid [Aβ]-negative cognitively unimpaired, 6 Aβ-positive cognitively unimpaired, 39 with prodromal AD, and 30 with AD dementia) who performed brain MRI for BF volume and cortical thickness, 18F-florbetaben PET for Aβ, 18F-flortaucipir PET for tau, and detailed cognitive testing longitudinally. We investigated the baseline and longitudinal association of BF volume with Aβ and tau standardized uptake value ratio and cognition. Cross-sectionally, lower BF volume was not independently associated with higher cortical Aβ, but it was associated with tau burden. Tau burden in the orbitofrontal, insular, lateral temporal, inferior temporo-occipital, and anterior cingulate cortices were associated with progressive BF atrophy. Lower BF volume was associated with faster Aβ accumulation, mainly in the prefrontal, anterior temporal, cingulate, and medial occipital cortices. BF volume was associated with progressive decline in language and memory functions regardless of baseline Aβ and tau burden. Tau deposition affected progressive BF atrophy, which in turn accelerated amyloid deposition, leading to a vicious cycle. Also, lower baseline BF volume independently predicted deterioration in cognitive function.

Assessment of Ventilation Using Adult and Pediatric Manual Resuscitators in a Simulated Adult Patient.

The bag-valve-mask (BVM) or manual resuscitator bag is used as a first-line technique to ventilate patients with respiratory failure. Volume-restricted manual resuscitator bags (eg, pediatric bags) have been suggested to minimize overventilation and associated complications. There are studies that both support and caution against the use of a pediatric resuscitator bag to ventilate an adult patient. In this study, we evaluated the ability of pre-hospital clinicians to adequately ventilate an adult manikin with both an adult- and pediatric-size manual resuscitator bag without the assistance of an advanced airway or airway adjunct device. This study was conducted at an international conference in 2022. Conference attendees with pre-hospital health care experience were recruited to ventilate an adult manikin using a BVM for 1 min with both an adult and pediatric resuscitator bag, without the use of adjunct airway devices, while 6 ventilatory variables were collected or calculated: tidal volume (VT), breathing frequency, adequate breaths (VT > 150 mL), proportion of adequate breaths, peak inspiratory pressure (PIP), and estimated alveolar ventilation (EAV). A total of 208 participants completed the study. Ventilation with the adult-sized BVM delivered an average VT of 290.4 mL compared to 197.1 mL (P < .001) when using the pediatric BVM. PIP with the adult BVM was higher than with the pediatric BVM (10.6 cm H2O vs 8.6 cm H2O, P < .001). The median EAV with the adult bag (1,138.1 [interquartile range [IQR] 194.0-2,869.9] mL/min) was markedly greater than with the pediatric BVM (67.7 [IQR 0-467.3] mL/min, P < .001). Both pediatric- and adult-sized BVM provided lower ventilation volumes than those recommended by professional guidelines for an adult. Ventilation with the pediatric BVM was significantly worse than with the adult bag when ventilating a simulated adult subject.

Fiber Optic Assisted Optofluidic Viscometer for Biomedical Applications

AbstractOptical fiber technology is gaining increasing importance in all those fields requiring reliable, miniaturized, compact, and plug‐and‐play devices, with a special relevance in life science applications. Here, optical fibers are adopted to measure the fluids viscosity, by detecting the transit time (related to viscosity) of a steel bead moving through the tested fluid in a microfluidic channel under constant pressure. The proposed optofluidic system is designed by defining a theoretical model, here experimentally validated in the viscosity range of 5–110 cP, well resembling main blood flow features. The achieved results demonstrate the capability to work in multi‐point and single‐point detection modalities with a trade‐off between resolution (minimum of 10−1 and 1 cP respectively) and measurement time (tens of seconds and milliseconds range, respectively). An optimum accuracy close to 1.5% has been achieved, with room for further optimization by reducing bead size uncertainty. The proposed platform features simple, low‐cost, reliable, and fast measurements and ensures the integration with microfluidics chip in a miniaturized and disposable system. The low volumes required (scalable down to µL range) and the ease of use enable the translation of the proposed platform in clinical scenarios involving real‐time blood and plasma viscosity measurements under physiological conditions.

Whole blood versus balanced resuscitation in massive hemorrhage: six of one or half dozen of the other?

Whole blood (WB) resuscitation is increasingly used at trauma centers. Prior studies investigating outcomes in WB versus component-only (CO) resuscitation have been limited by small cohorts, low volumes of WB resuscitation, and unbalanced CO resuscitation. This study aimed to address these limitations using data from a high-volume Level I trauma center, which adopted a WB-first resuscitation paradigm in 2018. We hypothesized that the resuscitation method, WB or balanced CO, would have no impact on patient mortality. A single-center, retrospective cohort study of adults presenting as a trauma activation from July 2016 through July 2021 was performed. Receipt of 3 or more units of WB or packed red blood cells (RBC) within the first hour of resuscitation was required for inclusion. Patients were grouped into WB versus CO resuscitation and important clinical outcomes were compared. Mortality was evaluated with Kaplan-Meier analysis, log-rank testing, and multivariable Cox proportional hazards modeling. There were 180 patients in the WB group and 170 patients in the CO group. Of the 180 WB patients, 110 (61%) received only WB during the first 24 hours. The WB group received a median of 5.0 units (IQR 4.0-8.0) of WB and CO group received a median of 6.0 units (IQR 4.0-11.8) of RBCs during the first 24 hours of resuscitation. In the CO group, median RBC/plasma and RBC/platelet ratios approximated 1:1:1. Groups were similar in clinicopathologic characteristics including age, injury severity score, mechanism of injury, and requirement for hemorrhage control interventions (WB 55% vs CO 59%, p = 0.60). Unadjusted survival was equivalent at 24 hours (p = 0.52) and 30 days (p = 0.70) between both groups on Kaplan-Meier analysis with log-rank testing. On multivariable Cox regression, WB resuscitation was not independently associated with improved survival after accounting for age, ISS, mechanism of injury, and receipt of hemorrhage control procedure (HR 0.85, 95% CI 0.61-1.19, p = 0.34). Balanced CO resuscitation is associated with similar mortality outcomes to that of WB based resuscitation. Level IV; Therapeutic/Care Management.