Magnitude Of Recovery Research Articles

Predictors of Stroke Outcomes in Conservatively Treated Patients With Moyamoya Disease: A Follow-up MRI Study.

Little is known about the association between stroke and imaging and clinical features in conservatively treated patients with moyamoya disease (MMD). To investigate independent risk factors for stroke in conservatively treated patients with MMD during a long-term follow-up. Prospective study. One hundred sixty conservatively managed patients with MMD (median age 46 years, 89 male). Time of flight, turbo inversion recovery magnitude T1WI, turbo spin echo (TSE) T2WI, echo-planar imaging DWI, T2-fluid attenuated inversion recovery, dynamic susceptibility contrast-magnetic resonance imaging, and pre- and post-contrast 3D TSE T1WI sequences at 3.0 Tesla. Patients were assessed at baseline and followed yearly. Ischemic and hemorrhagic stroke incidence rates were determined. Multiple demographic, clinical (modified Rankin score [mRS]), and cerebral imaging (cerebral blood volume [CBV] and concentric enhancement of arterial wall) factors at baseline were considered as potential predictors of stroke during the follow-up period. Univariable and multivariable Cox proportional hazards models to calculate the hazard ratios (HRs) and corresponding 95% confidence interval (CI) for stroke. Cumulative risk of stroke was estimated by the Kaplan-Meier product-limit method. A P value <0.05 was considered statistically significant. The median follow-up duration was 47 months. During the follow-up period, 18 (11.25%) patients experienced stroke events (13 [8.13%] ischemic, 5 [3.12%] hemorrhagic). Univariable analysis showed that 11 factors were significantly associated with stroke. After adjustment for clinical characteristics, multivariable analysis showed that mRS score ≥3 (HR, 1.99; 95% CI, 1.26-3.14), decreased CBV (HR, 5.31; 95% CI, 2.32-12.13), and concentric enhancement of the arterial wall (HR, 4.16; 95% CI, 1.55-11.15) were significantly associated with stroke. Decreased CBV, mRS score ≥ 3, and concentric enhancement of the arterial wall were significantly associated with increased incidence of stroke in conservatively treated MMD. 2 TECHNICAL EFFICACY: Stage 4.

Impact of The Covid 19 Pandemic: Is There Overreaction in LQ 45 Stock?

The Covid-19 pandemic has had an impact on various aspects of life, including the capital market which has caused a negative response on most stock exchanges around the world, including the Indonesia Stock Exchange. The Effecieny Market Hypothesis (EMH) explains that the price of a stock will always be reflected from the information available in the market or investors tend to be rational. However, dramatic events such as COVID-19 allow investors to overreact. The results showed that there was an overreaction in both winner and loser stocks in the LQ 45 group on the IDX in 3 months of observation since covid was announced as a pandemic. This overreaction is then followed by a price reversal even though it has not given a significant return after t+13 for both winner and losser stocks. The speed of price recovery (magnitude effect) after the price reversal on the loser stock is higher (faster) than the winner stock. The speed of this price recovery is significantly affected by the company's capital structure and share ownership of individual investors (local and foreign).

Five-year follow-up study on quantitative muscle magnetic resonance imaging in facioscapulohumeral muscular dystrophy: The link to clinical outcome.

It is unclear how changes in quantitative muscle magnetic resonance imaging (MRI) relate to changes in clinical outcome in facioscapulohumeral muscular dystrophy (FSHD), although this information is crucial for optimal use of MRI as imaging biomarker in trials. We therefore assessed muscle MRI and clinical outcome measures in a large longitudinal prospective cohort study. All patients were assessed by MRI at baseline and at 5-year follow-up, employing 2pt-Dixon and turbo inversion recovery magnitude (TIRM) sequences, after which fat fraction and TIRM positivity of 19 leg muscles were determined bilaterally. The MRI compound score (CoS) was defined as the mean fat fraction of all muscles weighted for cross-sectional area. Clinical outcome measures included the Ricci-score, FSHD clinical score (FSHD-CS), MRC sumscore (MRC-SS), and motor-function-measure (MFM). We included 105 FSHD patients [mean age 54±14years, median Ricci-score 7 (range 0-10)]. The median change over 5years' time in the MRI-CoS was 2.0% (range -4.6 to +12.1; P<0.001). The median change over 5years' time in clinical outcome measures was small in all measures, with z-scores ranging from 5.0 to 7.2 (P<0.001). The change in MRI-CoS correlated with change in FSHD-CS and Ricci-score (ρ=0.25, respectively; ρ=0.23, P<0.05). The largest median increase in MRI-CoS was seen in baseline subgroups with an MRI-CoS 20-40% (6.1%), with ≥2 TIRM positive muscles (3.5%) or with an FSHD-CS 5-10 (3.1%). This 5-year study showed significant changes in MRI and clinical outcome measures and a significant correlation between changes in MRI-CoS and changes in clinical outcome measures. In addition, we identified subgroups of patients that are most prone to radiological disease progression. This knowledge further establishes quantitative MRI parameters as prognostic biomarkers in FSHD and as efficacy biomarkers in upcoming clinical trials.

The magnitude and pace of photosynthetic recovery after wildfire in California ecosystems

Wildfire modifies the short- and long-term exchange of carbon between terrestrial ecosystems and the atmosphere, with impacts on ecosystem services such as carbon uptake. Dry western US forests historically experienced low-intensity, frequent fires, with patches across the landscape occupying different points in the fire-recovery trajectory. Contemporary perturbations, such as recent severe fires in California, could shift the historic stand-age distribution and impact the legacy of carbon uptake on the landscape. Here, we combine flux measurements of gross primary production (GPP) and chronosequence analysis using satellite remote sensing to investigate how the last century of fires in California impacted the dynamics of ecosystem carbon uptake on the fire-affected landscape. A GPP recovery trajectory curve of more than five thousand fires in forest ecosystems since 1919 indicated that fire reduced GPP by [Formula: see text] g C m[Formula: see text] y[Formula: see text]([Formula: see text]) in the first year after fire, with average recovery to prefire conditions after [Formula: see text] y. The largest fires in forested ecosystems reduced GPP by [Formula: see text] g C m[Formula: see text] y[Formula: see text] (n = 401) and took more than two decades to recover. Recent increases in fire severity and recovery time have led to nearly [Formula: see text] MMT CO[Formula: see text] (3-y rolling mean) in cumulative forgone carbon uptake due to the legacy of fires on the landscape, complicating the challenge of maintaining California's natural and working lands as a net carbon sink. Understanding these changes is paramount to weighing the costs and benefits associated with fuels management and ecosystem management for climate change mitigation.

Residency and Fine-scale Habitat Use of Juvenile Goliath Grouper (Epinephelus Itajara) in a Mangrove Nursery

The Atlantic goliath grouper (Epinephelus itajara) is the largest grouper species in the Atlantic and exhibits high site fidelity and limited range of movement. By 1990, the goliath grouper population in US waters had declined approximately 95% relative to unfished levels, leading to a harvest ban in 1990. Since then, the south Florida population has grown but the magnitude of recovery remains unknown due to uncertainties about life history characteristics. However, despite these unknowns, the state of Florida approved a limited recreational harvest of goliath grouper. In 2021, fine-scale habitat use of three juvenile goliath grouper was investigated using acoustic telemetry and a positioning solver. All three individuals exhibited high site fidelity as well as a diel habitat use pattern, utilizing seagrass habitat during the night and mangrove habitat during the day. Fine-scale acoustic telemetry provides insight into not only habitat use, but broader habitat preferences as well. This study illustrates the need to consider deep seagrass-dominated channels lined with red mangroves when protecting juvenile goliath grouper populations within Florida Bay, especially as the population is opened to harvest.

Simulating Hypoxia in a New England Estuary: WASP8 Advanced Eutrophication Module (Narragansett Bay, RI, USA).

Anthropogenic sources of nutrients cause eutrophication in coastal waters. Narraganset Bay (USA), the largest estuary in New England, has large seasonal zones of hypoxia. In response, management strategies have been implemented to reduce nutrient loadings. In this study, a mechanistic, mass balance fate and transport modeling framework was developed and applied to Narragansett Bay to improve our understanding of the processes governing hypoxia. Discrete and continuous observations were used for model comparison and evaluation. Simulations captured the general trends and patterns in dissolved oxygen (DO) with depth and space. Simulations were unable to capture the wide diurnal range of observed continuous DO and phytoplankton concentrations, potentially suggesting the need for improved understanding of processes at this time scale. Mechanistic modelling scenarios were performed to investigate how different sources of nutrients affect DO. Results suggest tributary sources of nitrogen affected upper layers of DO, while sediment oxygen demand and nutrient fluxes affected deeper waters. This work highlights the importance of understanding and simulating the legacy effects of historic nutrient loading to estuary systems to understand the magnitude and timing of long-term recovery due to reductions in nutrient loadings.

Evaluation of Classic and Quantitative Imaging Features in the Differentiation of Benign and Atypical Lipomatous Soft Tissue Tumors Using a Standardized Multiparametric MRI Protocol: A Prospective Single-Centre Study in 45 Patients

Discrimination between benign and atypical lipomatous tumors (ALT) is important due to potential local complications and recurrence of ALT but can be difficult due to the often-similar imaging appearance. Using a standardized MRI protocol, this study aimed to rank established and quantitative MRI features by diagnostic value in the differentiation of benign and atypical lipomatous tumors and to develop a robust scoring system. Patients with clinical or sonographic suspicion of a lipomatous tumor were prospectively and consecutively enrolled from 2015 to 2019 after ethic review board approval. Histology was confirmed for all ALT and 85% of the benign cases. Twenty-one demographic and morphologic and twenty-three quantitative features were extracted from a standardized MRI protocol (T1/T2-proton-density-weighting, turbo-inversion recovery magnitude, T2* multi-echo gradient-echo imaging, qDIXON-Vibe fat-quantification, T1 relaxometry, T1 mapping, diffusion-weighted and post-contrast sequences). A ranking of these features was generated through a Bayes network analysis with gain-ratio feature evaluation. Forty-five patients were included in the analysis (mean age, 61.2 ± 14.2 years, 27 women [60.0%]). The highest-ranked ALT predictors were septation thickness (gain ratio merit [GRM] 0.623 ± 0.025, p = 0.0055), intra- and peritumoral STIR signal discrepancy (GRM 0.458 ± 0.046, p < 0.0001), orthogonal diameter (GRM 0.554 ± 0.188, p = 0.0013), contrast enhancement (GRM 0.235 ± 0.015, p = 0.0010) and maximum diameter (GRM 0.221 ± 0.075, p = 0.0009). The quantitative features did not provide a significant discriminatory value. The highest-ranked predictors were used to generate a five-tiered score for the identification of ALTs (correct classification rate 95.7% at a cut-off of three positive items, sensitivity 100.0%, specificity 94.9%, likelihood ratio 19.5). Several single MRI features have a substantial diagnostic value in the identification of ALT, yet a multiparametric approach by a simple combination algorithm may support radiologists in the identification of lipomatous tumors in need for further histological assessment.

Novel regenerative drug, SPG302 promotes functional recovery of diaphragm muscle activity after cervical spinal cord injury.

Spinal cord hemisection at C2 (C2 SH), sparing the dorsal column is widely used to investigate the effects of reduced phrenic motor neuron (PhMN) activation on diaphragm muscle (DIAm) function, with reduced DIAm activity on the injured side during eupnoea. Following C2 SH, recovery of DIAm EMG activity may occur spontaneously over subsequent days/weeks. Various strategies have been effective at improving the incidence and magnitude of DIAm recovery during eupnoea, but little is known about the effects of C2 SH on transdiaphragmatic pressure (Pdi ) during other ventilatory and non-ventilatory behaviours. We employ SPG302, a novel type of pegylated benzothiazole derivative, to assess whether enhancing synaptogenesis (i.e., enhancing spared local connections) will improve the incidence and the magnitude of recovery of DIAm EMG activity and Pdi function 14 days post-C2 SH. In anaesthetised Sprague-Dawley rats, DIAm EMG and Pdi were assessed during eupnoea, hypoxia/hypercapnia and airway occlusion prior to surgery (C2 SH or sham), immediately post-surgery and at 14 days post-surgery. In C2 SH rats, 14 days of DMSO (vehicle) or SPG302 treatments (i.p. injection) occurred. At the terminal experiment, maximum Pdi was evoked by bilateral phrenic nerve stimulation. We show that significant EMG and Pdi deficits are apparent in C2 SH compared with sham rats immediately after surgery. In C2 SH rats treated with SPG302, recovery of eupneic, hypoxia/hypercapnia and occlusion DIAm EMG was enhanced compared with vehicle rats after 14 days. Treatment with SPG302 also ameliorated Pdi deficits following C2 SH. In summary, SPG302 is an exciting new therapy to explore for use in spinal cord injuries. KEY POINTS: Despite advances in our understanding of the effects of cervical hemisection (C2 SH) on diaphragm muscle (DIAm) EMG activity, very little is understood about the impact of C2 SH on the gamut of ventilatory and non-ventilatory transdiaphragmatic pressures (Pdi ). Recovery of DIAm activity following C2 SH is improved using a variety of approaches, but very few pharmaceuticals have been shown to be effective. One way of improving DIAm recovery is to enhance the amount of latent local spared connections onto phrenic motor neurons. A novel pegylated benzothiazole derivative enhances synaptogenesis in a variety of neurodegenerative conditions. Here, using a novel therapeutic SPG302, we show that 14 days of treatment with SPG302 ameliorated DIAm EMG and Pdi deficits compared with vehicle controls. Our results show that SPG302 is a compound with very promising potential for use in improving functional outcomes post-spinal cord injury.

The recovery of plant community composition following passive restoration across spatial scales

Abstract Human impacts have led to dramatic biodiversity change which can be highly scale‐dependent across space and time. A primary means to manage these changes is via passive (here, the removal of disturbance) or active (management interventions) ecological restoration. The recovery of biodiversity, following the removal of disturbance, is often incomplete relative to some kind of reference target. The magnitude of recovery of ecological systems following disturbance depends on the landscape matrix and many contingent factors. Inferences about recovery after disturbance and biodiversity change depend on the temporal and spatial scales at which biodiversity is measured. We measured the recovery of biodiversity and species composition over 33 years in 17 temperate grasslands abandoned after agriculture at different points in time, collectively forming a chronosequence since abandonment from 1 to 80 years. We compare these abandoned sites with known agricultural land‐use histories to never‐disturbed sites as relative benchmarks. We specifically measured aspects of diversity at the local plot‐scale (α‐scale, 0.5 m2) and site‐scale (γ‐scale, 10 m2), as well as the within‐site heterogeneity (β‐diversity) and among‐site variation in species composition (turnover and nestedness). At our α‐scale, sites recovering after agricultural abandonment only had 70% of the plant species richness (and ~30% of the evenness), compared to never‐ploughed sites. Within‐site β‐diversity recovered following agricultural abandonment to around 90% after 80 years. This effect, however, was not enough to lead to recovery at our γ‐scale. Richness in recovering sites was ~65% of that in remnant never‐ploughed sites. The presence of species characteristic of the never‐disturbed sites increased in the recovering sites through time. Forb and legume cover declines in years since abandonment, relative to graminoid cover across sites. Synthesis. We found that, during the 80 years after agricultural abandonment, old fields did not recover to the level of biodiversity in remnant never‐ploughed sites at any scale. β‐diversity recovered more than α‐scale or γ‐scale. Plant species composition recovered, but not completely, over time, and some species groups increased their cover more than others. Patterns of ecological recovery in degraded ecosystems across space and long time‐scales can inform targeted active restoration interventions and perhaps, lead to better outcomes.

136 A SHOCKING CASE OF MYOCARDITIS?

Abstract Background Cardiac involvement is common in systemic sclerosis (SSc), being a poor prognostic factor and the leading cause of mortality. Cardiac involvement ranges from a serendipitous diagnosis to relevant cardiac manifestations such as arrhythmias, pericardial effusion, myocardial dysfunction, and valvular diseases. Case report A 39-year-old female without remarkable medical history, on estroprogestinic therapy was admitted to our hospital in June 2020 after an out-of-hospital cardiovascular arrest due to ventricular fibrillation (VF). A coronary angiography ruled out coronary artery disease. Magnetic resonance imaging (MRI) showed a picture of acute myopericarditis characterized by late linear and nodular intramyocardial and subepicardial gadolinium enhancement of the septal and inferior segments of the left ventricle, with trivial oedema in the same location in turbo inversion recovery magnitude (TIRM) sequences. A subcutaneous-implantable cardiac defibrillator (S-ICD) was positioned for secondary prevention. At the 5 months ICD interrogation, 3 episodes of VF detected and treated by the device were documented. In December 2020 two more appropriate device interventions on polymorphic VT/VF occurred. A septal myocardial biopsy was then performed showing diffused replacement fibrosis in the absence of signs of acute inflammation or virus on the molecular investigation. In March 2021 the patient was referred to our institution after experiencing several ventricular arrhythmia episodes successfully treated by the ICD. A myocardial positron emission tomography (PET) scan documented the uptake of 18-fluorodeoxyglucose at middle and basal septum. A 'targeted' myocardial biopsy showed a substitutive fibroadiposis with sporadic inflammatory cells, in absence of cardiotropic viruses on the molecular investigation. We then initiated Anakinra, an anti-IL1 agent with an anti-inflammatory effect to prevent further development of "inflammation-driven fibrosis". Given the Raynaud's phenomenon reported by the patient, a capillaroscopy was performed, confirming isolated megacapillaries and apical haemorrhages, compatible with early pattern scleroderma. Immunologic examinations found homogeneous ANA 1:320 and anti-RNA polymerase III, while other autoantibodies, viral serologies and tubercular analysis were negative. In October 2021, the patient was readmitted to our hospital for recurrence of arrhythmic storm. A radiofrequency catheter-based ablation was performed. After a new episode of VT properly treated by the S-ICD in May 2022, the device was explanted, and a cardiac resynchronization therapy defibrillator was implanted. The genetic analysis identified a heterozygous deletion (c1262_1263del) of Lamin A (LMNA) classified as probably pathogenic in left ventricular arrhythmogenic cardiomyopathy or dilated cardiomyopathy. Conclusion A diagnosis of borderline myocarditis in anti-RNA-polymerase III+ systemic sclerosis with heterozygous deletion of LMNA was finally formulated, after having excluded pulmonary (PET, forced vital capacity, and CO lung diffusion in normal range), cutaneous, musculoskeletal and gastro-oesophageal involvement as well as a paraneoplastic nature (by total body PET) given the positivity for antiRNA-polymerase III.

The pattern and magnitude of T cell subsets reconstitution during ten years of ART with viral suppression in HIV-infected patients

The extent of immune reconstitution in human immunodeficiency virus (HIV) infected persons receiving long-term antiretroviral therapy (ART) with controlled viral load has been controversial. We studied the extent and speed of T cell subsets retrieval after long-term antiretroviral treatment. 662 HIV-infected patients followed at least 2 years whose plasma HIV-1 RNA load <50 copies/mL were evaluated for longitudinal and functional phenotypic indices of immune restoration. Determinants of change in magnitude and importance of recovery have been evaluated using mixed linear regression models. Almost all robust immune restorations achieved occurred after 2-3 years of ART. The median CD4 lymphocyte count increased 449 cells/μl (IQR 303-604) from 226 cells/μl (IQR 83-336) at baseline during the third year (P < 0.001); CD4+T lymphocyte rises during the sixth and tenth years were not significant. Naive and memory CD4+T cells'reconstitution occurred in the sixth and eighth years of ART but no significant change thereafter. The change of CD45RA+Naïve and CD45RA-memory CD4+T cell reconstitution is different in baseline CD4+T cell counts <100 cells/μl group and in baseline CD4+T cell counts >100 cells/μl group. Activation antigen expression (CD38 or HLA-DR) on CD8 lymphocytes declined mostly during the first till second year, and after 4 years, activation antigen expression on patient lymphocytes showed no significant change. The proportion of CD4 cells expressing CD28 climbed during the first years and reached normal levels in the second year. Immune restoration was dependent on the capacity of immune system during the first 2-3 year of ART. But the significant change of CD4 and compartments of CD4+T cells could persist until 6-8 years. The pattern of CD38+CD8+, HLA-DR+CD8+, CD28+CD4+ T cells could quickly return to normal level and no significant change after sufficient time of ART. In general, the immune response compared to the baseline status may be the overall effect from the age and time of antiretroviral treatment.

Investigating impacts of small dams and dam removal on dissolved oxygen in streams.

Small surface-release dams are prevalent across North American watersheds and can alter stream flow, thermal regimes, nutrient dynamics, and sediment transport. These dams are often implicated as a cause of negative water quality impacts-including reduced dissolved oxygen (DO)-and dam removal is increasingly employed to restore natural stream processes and improve DO. Published impacts of small dams on DO vary widely across sites, and even less is known about the extent and timescale of DO recovery following removal. Therefore, we sought to quantify the effects of small dams and dam removal on DO and determine the dam, stream, and watershed characteristics driving inter-site variation in responses. We deployed continuous data loggers for 3 weeks during summer months in upstream (reference), impoundment, and downstream reaches at each of 15 dammed sites and collected equivalent data at 10 of those sites following dam removal. Prior to dam removal, most sites (60%) experienced a decrease in DO (an average of 1.15 mg/L lower) within the impoundment relative to upstream, but no consistent impacts on diel ranges or on downstream reaches. Before dam removal, 5 impacted stream reaches experienced minimum DO levels below acceptable water quality standards (<5 mg/L); after dam removal, 4 of 5 of these reaches met DO standards. Sites with wider impoundments relative to upstream widths and sites located in watersheds with more cultivated land experienced the greatest decreases in impoundment DO relative to upstream. Within one year following dam removal, impoundment DO recovered to upstream reference conditions at 80% of sites, with the magnitude of recovery strongly related to the magnitude of pre-removal impacts. These data suggest that broadly, small dams negatively affect stream DO, and the extent of effects are modulated by impoundment geometry and watershed characteristics. These results may help practitioners to prioritize restoration efforts at those sites where small dams are having outsized impacts, and therefore where the greatest water quality benefits may occur.

Effects of mixture and management on growth dynamics and responses to climate of Quercus robur L. in a restored opencast lignite mine

Opencast mining is currently one of the most destructive economic activities of natural ecosystems. Many restoration techniques have been developed to promote the recovery of terrestrial ecosystems degraded by mining, and afforestation and reforestation are among the most important methods to this purpose. In this study, we evaluated the combined effect of tree species mixture and thinning intervention on growth dynamics and responses to the climate of a target native planted oak (pedunculate oak, Quercus robur L.) about 40 years after reforestation of an opencast lignite mining area in Central Italy. The species used for reforestation were a native tree species (Q. robur L.), two valuable broadleaved trees (Fraxinus angustifolia Vahl. and Prunus avium L.) and a nitrogen-fixing tree (Alnus cordata Loisel.) to improve timber quality and restore the ecological and environmental value of the degraded land. Climate-growth relationships for precipitation, the Standardised Precipitation-Evaporation Index (SPEI), and temperature (on a monthly and seasonal scale) were tested together with indices based on tree-ring responses to drought. Thinning improved the stem quality and promoted a significant long-term increase in basal area increment (BAI, +31.0%) only in the mixture with alder. The thinning effect slightly mitigated radial growth reductions of oak trees during drought (resistance) and produced a general improvement in the magnitude of resilience and post-drought growth recovery (+37% and +27% on average, respectively). This effect was most evident when oak trees were mixed with only the N-fixing alder species, both after shorter- and longer-term drought or rainfall reduction. In conclusion, the mixture with alder combined with thinning practices resulted in the best management option to produce good-quality stems, improve growth performances, and mitigate drought effects in the recovery of opencast lignite mines through reforestation.

Daily Assessment of On-Treatment Tumor Regression by Cone Beam CT as a Prognostic Dynamic Biomarker in Nasopharyngeal Cancer

<h3>Purpose/Objective(s)</h3> Despite advancements in radiotherapy, approximately 30% of nasopharyngeal cancer (NPC) patients develop treatment failure. Dynamic on-treatment biomarkers may provide early evidence of response and improve risk stratification and treatment selection. Using daily cone beam computed tomography (CBCT) scans, we measure air volume recovery, an automated surrogate of tumor regression, and report its association with outcomes. <h3>Materials/Methods</h3> Patients with NPC treated with curable intent were included. Primary gross target volume (GTVp) was propagated from planning CTs to daily CBCTs by rigid registration and a density threshold was applied to measure the air volume in a 5 mm uniform expansion of the GTVp. Air volume was expressed as percent of planning GTVp volume. Missing values were interpolated, air volume trajectories were smoothed by sliding window averaging, and area under the curve (AUC) was calculated to provide a summary metric capturing both magnitude and rapidity of air volume recovery. Primary endpoint was recurrence free survival (RFS). <h3>Results</h3> Between 2013 and 2015, 39 consecutive NPC patients (2 stage II, 26 stage III, 11 stage IVA-B), ECOG 0-1, underwent radical radiotherapy (n=5) or chemoradiotherapy (CRT) (n=34) to a planned dose of 70 Gy in 35 fractions (Fx). Median AUC of the air volume recovery curve was 2.8 (Range: 0.05-7.4). Patients with above-median AUC had longer RFS (HR=0.28, log-rank p=0.045, median follow-up: 83 mo). Exploration of clinical factors associated with air recovery showed that AUC was higher in CRT than RT alone (OR: 1.74±1.60, p=0.04), lower in large tumors with high GTVp volume (OR: -0.037±0.18, p<0.001), and was not correlated with disease stage. Current smokers had 26% lower median AUC than never/former smokers (p=0.132). AUC was lower in patients with detectable end-of-treatment Epstein-Barr virus (EBV) circulating tumor DNA (median AUC 0.99 vs. 2.8 in undetectable EBV, p=0.021). We performed exploratory <i>post-hoc</i> analysis on air volume velocity (slope of air volume curve) and identified two independent putative positive prognostic biomarkers: high mid-treatment slope and negative end-treatment slope. Patients without failure had higher mid-treatment air recovery velocity (Fx 15-22), with Fx 18 velocity yielding the maximal RFS difference (HR: 0.12, p = 0.007). Negative velocity at the end of treatment was associated with improved regional (p=0.033) and distant metastatic (p=0.013) control. <h3>Conclusion</h3> Greater and more rapid tumor regression, inferred by the CBCT surrogate measure of air volume recovery, was associated with improved RFS. This discovery cohort also allowed us to identify promising dynamic biomarkers which might guide treatment adaptation. Specifically, we observed strong clinical outcome associations with mid- and end-treatment air recovery velocities. Validation of these biomarkers is ongoing in a large cohort of NPC patients with mature follow up.

Species' attributes predict the relative magnitude of ecological and genetic recovery following mass mortality.

Theoretically, species' characteristics should allow estimation of dispersal potential and, in turn, explain levels of population genetic differentiation. However, a mismatch between traits and genetic patterns is often reported for marine species, and interpreted as evidence that life-history traits do not influence dispersal. Here, we couple ecological and genomic methods to test the hypothesis that species with attributes favouring greater dispersal potential-e.g., longer pelagic duration, higher fecundity and larger population size-have greater realized dispersal overall. We used a natural experiment created by a large-scale and multispecies mortality event which created a "clean slate" on which to study recruitment dynamics, thus simplifying a usually complex problem. We surveyed four species of differing dispersal potential to quantify the abundance and distribution of recruits and to genetically assign these recruits to probable parental sources. Species with higher dispersal potential recolonized a broader extent of the impacted range, did so more quickly and recovered more genetic diversity than species with lower dispersal potential. Moreover, populations of taxa with higher dispersal potential exhibited more immigration (71%-92% of recruits) than taxa with lower dispersal potential (17%-44% of recruits). By linking ecological with genomic perspectives, we demonstrate that a suite of interacting life-history and demographic attributes do influence species' realized dispersal and genetic neighbourhoods. To better understand species' resilience and recovery in this time of global change, integrative eco-evolutionary approaches are needed to more rigorously evaluate the effect of dispersal-linked attributes on realized dispersal and population genetic differentiation.

Stress–Deformation Response of Rigid–Soft Particulate Mixtures under Repetitive Ko Loading Conditions

Sand–rubber mixtures used in transportation infrastructure experience repetitive loading. Hence, in this study, the mixtures of rigid sand particles and soft tire chip particles with two different size ratios at varying tire chip fractions (TF) by weight were prepared, and repetitive loading tests were performed for 10,000 cycles at 100 kPa stress amplitude (Δσ). The results of this study demonstrate that significant volume contraction occurs for the tested rigid-soft mixtures during repetitive loading due to the continuous accumulation of plastic strain. Most notably, this study reveals that the magnitude of elastic strain recovery of the tested mixtures decreases with increasing cyclic loading number, reflecting the transition of the structural skeleton from the contacts between sand-to-rubber and/or rubber-to-rubber to those between sand-to-sand and/or rubber-to-sand under repetitive loading conditions with constant Δσ. The effects of TF and size ratio on the compressibility of the tested mixtures are also evaluated in this study.

Papillary Lesions of the Breast: Addition of DWI and TIRM Sequences to Routine Breast MRI Could Help in Differentiation Benign from Malignant.

We aimed to investigate the magnetic resonance imaging (MRI) features of benign, atypical, or malignant papillary breast lesions and to assess the additional value of diffusion-weighted imaging (DWI) and turbo inversion recovery magnitude (TIRM) sequences to routine breast MRI. Differentiation between benign and malignant papillary breast lesions is essential for patient management. However, morphologic features and enhancement patterns of malignant papillary lesions may overlap with those of benign papilloma. Seventy-two papillary breast lesions (50 benign, 22 atypical or malignant) were included in the current study, retrospectively. We divided the patients into two groups: benign papillary breast lesions and atypical or malignant papillary breast lesions. Morphologic, dynamic, turbo inversion recovery magnitude (TIRM) values and diffusion features of the papillary lesions were compared between two groups. Benign papillary lesions were smaller in size (p=0.006 and p=0.005, for radiologists 1 and 2 respectively), closer to the areola (p=0.045 and 0.049 for radiologist 1 and 2 respectively), and had higher ADC values (p=0.001 for two radiologists) than the atypical or malignant group. ROC curves showed diagnostic accuracy for ADC (AUC=0.770 and 0.762, p = 0.0001 for two radiologists), and showed a cut-off value of ≤ 957 x 10-6 mm2/s (radiologist 1) and ≤ 910 x 10-6 mm2/s (radiologist 2). MRI is a useful method for differentiation between benign and malignant papillary breast lesions. Centrally located, lesser in size, and higher ADC values should be considered benign, whereas peripherally located, larger in size, and lower ADC values should be considered malignant.

Cognitive-motor dissociation and time to functional recovery in patients with acute brain injury in the USA: a prospective observational cohort study

Recovery trajectories of clinically unresponsive patients with acute brain injury are largely uncertain. Brain activation in the absence of a behavioural response to spoken motor commands can be detected by EEG, also known as cognitive-motor dissociation. We aimed to explore the role of cognitive-motor dissociation in predicting time to recovery in patients with acute brain injury. In this observational cohort study, we prospectively studied two independent cohorts of clinically unresponsive patients (aged ≥18 years) with acute brain injury. Machine learning was applied to EEG recordings to diagnose cognitive-motor dissociation by detecting brain activation in response to verbal commands. Survival statistics and shift analyses were applied to the data to identify an association between cognitive-motor dissociation and time to and magnitude of recovery. The prediction accuracy of the model that was built using the derivation cohort was assessed using the validation cohort. Functional outcomes of all patients were assessed with the Glasgow Outcome Scale-Extended (GOS-E) at hospital discharge and at 3, 6, and 12 months after injury. Patients who underwent withdrawal of life-sustaining therapies were censored, and death was treated as a competing risk. Between July 1, 2014, and Sept 30, 2021, we screened 598 patients with acute brain injury and included 193 (32%) patients, of whom 100 were in the derivation cohort and 93 were in the validation cohort. At 12 months, 28 (15%) of 193 unresponsive patients had a GOS-E score of 4 or above. Cognitive-motor dissociation was seen in 27 (14%) patients and was an independent predictor of shorter time to good recovery (hazard ratio 5·6 [95% CI 2·5-12·5]), as was underlying traumatic brain injury or subdural haematoma (4·4 [1·4-14·0]), a Glasgow Coma Scale score on admission of greater than or equal to 8 (2·2 [1·0-4·7]), and younger age (1·0 [1·0-1·1]). Among patients discharged home or to a rehabilitation setting, those diagnosed with cognitive-motor dissociation consistently had higher scores on GOS-E indicating better functional recovery compared with those without cognitive-motor dissociation, which was seen as early as 3 months after the injury (odds ratio 4·5 [95% CI 2·0-33·6]). Recovery trajectories of clinically unresponsive patients diagnosed with cognitive-motor dissociation early after brain injury are distinctly different from those without cognitive-motor dissociation. A diagnosis of cognitive-motor dissociation could inform the counselling of families of clinically unresponsive patients, and it could help clinicians to identify patients who will benefit from rehabilitation. US National Institutes of Health.

Reduction in Acquisition Time and Improvement in Image Quality in T2-Weighted MR Imaging of Musculoskeletal Tumors of the Extremities Using a Novel Deep Learning-Based Reconstruction Technique in a Turbo Spin Echo (TSE) Sequence.

Background: The aim of this study was to assess the technical feasibility and the impact on image quality and acquisition time of a deep learning-accelerated fat-saturated T2-weighted turbo spin echo sequence in musculoskeletal imaging of the extremities. Methods: Twenty-three patients who underwent MRI of the extremities were prospectively included. Standard T2w turbo inversion recovery magnitude (TIRMStd) imaging was compared to a deep learning-accelerated T2w TSE (TSEDL) sequence. Image analysis of 23 patients with a mean age of 60 years (range 30–86) was performed regarding image quality, noise, sharpness, contrast, artifacts, lesion detectability and diagnostic confidence. Pathological findings were documented measuring the maximum diameter. Results: The analysis showed a significant improvement for the T2 TSEDL with regard to image quality, noise, contrast, sharpness, lesion detectability, and diagnostic confidence, as compared to T2 TIRMStd (each p < 0.001). There were no differences in the number of detected lesions. The time of acquisition (TA) could be reduced by 52–59%. Interrater agreement was almost perfect (κ = 0.886). Conclusion: Accelerated T2 TSEDL was technically feasible and superior to conventionally applied T2 TIRMStd. Concurrently, TA could be reduced by 52–59%. Therefore, deep learning-accelerated MR imaging is a promising and applicable method in musculoskeletal imaging.

Analysis of the physiological response in junior tennis players during short-term recovery: Understanding the magnitude of recovery until and after the 25 seconds rule

Literature lacks evidence about the physiological recovery of tennis players between points. This study aimed to: (i) verify the heart rate (HR) and oxygen uptake (V̇O2) recovery variance in young tennis players from the end of a tennis drill until the 25-s mark and onwards (65-s limit), performed at several intensities, and (ii) test the curve fitting that better characterizes the players’ HR and V̇O2 recovery, from the end of the drill until the 65-s mark. The sample was composed of 13 male tennis players (age: 16.80 ± 1.61 years) recruited from a National Tennis Association. Players were instructed to perform a drill test (“two-line drill wide mode”) based on an intensity increment protocol. Three levels of intensity were used based on the reserve HR and V̇O2. A significance level effect was observed on the HRreserve and V̇O2reserve ( P &lt; .001). At all three levels of intensity, the first 25 s were enough to significantly ( P &lt; .001) recover the HRreserve and V̇O2reserve. The same significance trend ( P &lt; .001) was maintained until the 65 s but with a lower magnitude over time. Overall, the HR and V̇O2 curve fitting indicated a cubic relationship at the three levels of intensity (except the V̇O2 at the first level). Considering the specific test performed, players significantly elicited their physiological profile for every additional 10 s (after the 25-s rule) in the three levels of intensity performed. Despite this being a drill test and not a competitive point, coaches, players, and tennis organizations should be aware of these findings.