Maximum Diameter Research Articles

Comparison of mitral valve apparatus anomalies between sarcomeric hypertrophic cardiomyopathy and Fabry disease cardiomyopathy

Abstract Background Despite different etiopathogenesis, Fabry disease (FD) cardiomyopathy and sarcomeric hypertrophic cardiomyopathy (HCM) share a similar hypertrophic phenotype. Cardiac magnetic resonance (CMR) plays a pivotal role in distinguishing between these two clinical conditions, thanks to the thorough morphological definition of the phenotype and non-invasive tissue characterization. A high prevalence of mitral apparatus anomalies has been previously described both in sarcomeric HCM and FD cardiomyopathy. Purpose This study systematically compares the morphology of the mitral apparatus in sarcomeric HCM and FD cardiomyopathy, to add new insights into differential diagnosis. Methods CMR images of 120 patients were retrospectively analyzed and divided as follows: healthy controls CTRL (n=40), HCM (n=40), and FD (n=40) with left ventricular hypertrophy (LVH). The analyses included the measurement of I) papillary muscles’ hypertrophy, expressed as the maximum diameter (D max) of the anterolateral (AL) and posteromedial (PM) papillary muscles (see Figure 1 A and B); II) the anteriorization of the anterolateral papillary muscle defined as the distance between the anterolateral papillary muscle and the anterior interventricular junction (Anteriorization of AL) (Fig. 1 C); III) the length of the anterior mitral leaflet (MVL length) (Fig. 1 D). All measurements were performed on cine-SSFP sequences in diastole. Results Compared to healthy controls, HCM and FD patients showed significant hypertrophy of both papillary muscles (p<0.001) and elongation of the anterior mitral leaflet (p<0.001). Both papillary muscles in FD patients showed greater hypertrophy compared to HCM patients (D max AL p=0.017 and D max PM p=0.039). No significant differences were observed between FD and HCM regarding MVL length (p=0.078). Compared to FD (p=0.028) and healthy controls (p<0.001), HCM patients showed greater anteriorization of the anterolateral papillary muscle. (Results are summarized in Table 1). Conclusions From the comparison of mitral valve apparatus anomalies between HCM and FD, it emerged that patients with FD cardiomyopathy show a higher degree of papillary muscle hypertrophy, while patients with sarcomeric HCM display a greater anterior displacement of the anterolateral papillary muscle. The systematic analysis of the morphology of mitral apparatus can be integrated in the differential diagnosis between these two pathologies.Fig.1 Representation of MeasurementsTable 1.Summary results table

Relationship between 3-dimensional aortic geometry and the risk of new-onset heart failure

Abstract Introduction Aortic geometric assessments to date have typically involved cross-sectional imaging of discrete aortic segments. However, the complex 3D geometry of the thoracic aorta, and its relationship to the risk of cardiovascular disease has not been assessed in large studies. Methods We segmented the thoracic aorta in SSFP axial MRI images from 49,282 UK Biobank participants using a deep convolutional neural network (U-Net). We then computed geometric measurements (centerline length, arch height, arch width, arch height-width ratio, arch unfolding index [inverse of tortuosity], curvature and mean, minimum and maximum diameters) in the overall thoracic aorta as well as in 6 subsegments. We quantified their relationship to the risk of cardiomyopathy and heart failure (HF) using multivariable Cox-proportional hazards models. All hazard ratios are standardized. Centerline length was allometrically indexed to body height. Results In models adjusted for age, sex, BMI kg/m2, low-density lipoprotein mg/dl, high-density lipoprotein mg/dl, triglycerides mg/dl, systolic blood pressure and diastolic blood pressure, the curvature of the aorta (HR=0.63; 95% CI=0.39, 0.99; P<0.05), particularly the aortic arch (HR=0.54; 95% CI= 0.35, 0.87; P<0.05) was strongly related to a lower risk of incident cardiomyopathy. A higher arch unfolding index (HR=1.46; 95% CI=1.03, 2.07; P<0.05), higher width-to-height ratio (HR=1.10; 95% CI= 1.02, 1.19; P<0.05) and lower aorta tortuosity (HR=1.20; 95% CI= 1.09, 1.32; P<0.05) were all associated with a higher risk of cardiomyopathy. This aortic geometric pattern was also associated with a greater risk of a new HF diagnosis (arch unfolding [HR=1.23; 95% CI= 1.07, 1.42; P<0.05], width to heigh ratio [HR=1.06; 95% CI= 1.01, 1.11; P0.05]). Conclusion We demonstrate that 3-D thoracic aortic geometric indices are strongly associated with incident cardiomyopathy and HF, independent of classic risk factors. This is likely related to abnormal afterload and ventricular-arterial interactions since adverse geometric remodeling affects left ventricular pulsatile load.Cardiomyopathy & Heart Failure Hazards

Genome wide association studies on three-dimensional aortic geometric indices measured with magnetic resonance imaging

Abstract Introduction To date, three-dimensional properties of the aorta have not been comprehensively quantified in a population level dataset, nor has there been a genome-wide association study (GWAS) to identify significant single nucleotide polymorphisms (SNPs) associated with geometric properties of the aorta. Methods We segmented the thoracic aorta of 48,045 subjects in the UK Biobank using a U-Net convolutional neural network. We then computed geometric measurements (centerline length, arch height, arch width, arch height-width ratio, curvature, and mean, minimum and maximum diameter) across six subsegments of the aorta. Centerline length was allometrically indexed to body height. Using generalized linear models, we performed GWAS on each geometric phenotype adjusted for the following covariates: (1) age, (2) sex, and (3) ten genetic principal components. SNPs with a minor allele frequency < 0.05 were excluded. We performed LD-based clumping with an r2 threshold of 0.001 to identify significant loci and used LDSC to compute the genetic heritability of each geometric phenotype. Results After performing LD clumping, we identified 457 significant(P<5e-8) SNPs across 36 aortic geometric parameters. GWAS-based heritability analyses showed a mean heritability of 13.8 (9.9) % across all aortic geometric parameters, with all intercepts being close to 1, suggesting minimal genomic inflation. Maximum aorta diameter exhibited the highest observed heritability of 34.5 (3.0) %. Allometric centerline length showed a heritability of 13.6 (1.5) %. Similarly, arch height and width showed heritability of 14.6 (1.5) %, and 13.64 (1.5) % respectively. Aortic curvature showed limited heritability at 8.54 (1.2) %, with arch curvature being further reduced to 7.6 (1.20) %. Conclusion To our knowledge, this was the first study that investigated the genetic architecture of aortic centerline length, aortic curvature, and aortic tortuosity. These results suggest that aortic remodeling associated with aging and pathological conditions has important genetic contributions. SNPs associated with aortic geometry may identify therapeutic targets to prevent aortic remodeling, which should be the focus of future work.significant_snpsheritability

Mitral annular dynamics after transcatheter edge-to-edge repair for functional mitral regurgitation: comparison with surgical annuloplasty

Abstract Background Transcatheter edge-to-edge repair (TEER) is a recently emerged therapeutic option for functional mitral regurgitation (FMR). Although the mitral annular shape and function may play an important role in the pathophysiology of FMR, few reports have evaluated the impact of TEER. We sought to investigate the impact of TEER on the mitral annulus and its motion in FMR compared with that of mitral annuloplasty (MAP). Methods Using three-dimensional transesophageal echocardiography, we evaluated the mitral annular morphology and dynamic motion in patients who underwent TEER or MAP before and after the procedures. Mitral annulus analysis was performed by a semi-automatic program to create a dynamic model of the three-dimensional structure, where the end-systolic annular structure was semi-automatically annotated and manually corrected, followed by automatic tracking of the annulus throughout the cardiac cycle . The mitral annular parameters such as mitral annular diameters, area, circumference, and height at all frames were automatically calculated from the model. In order to align the cardiac phase in each patient (i.e. to set the start and the end of diastole and systole at the same time for all patient), data were spline-interpolated to 100 systolic and 200 diastolic frames and then statistically analyzed. The dynamic changes of the parameters during the cardiac cycle were calculated as (maximum – minimum value) / maximum value after the interpolation. Results Patients who underwent TEER (n=20, 69±15 years, 40% female) and those who underwent MAP (n=16, 64±11 years, 6% female) had similar echocardiographic characteristics before the procedures. The maximum anteroposterior diameter and annulus area decreased after both TEER and MAP, while the intercommissural diameter decreased only after MAP but not after TEER. After TEER, the dynamic change in anteroposterior diameter throughout the cardiac cycle tended to decrease (p=0.055), while intercommissural change rather increased (p=0.049), resulting in preserved change in annulus area (p=0.74). After MAP, changes in both diameters and area decreased significantly (all p<0.05). MAP was associated with postoperative mitral annulus area immobility after adjustment (p=0.030). Conclusions The dynamic motion of the mitral annulus in patients with FMR was better preserved after TEER than after MAP. There was a decreasing trend in anteroposterior motion, which was compensated for by intercommissural motion after TEER. Future studies are needed to determine the association of these results with cardiac function and prognosis.

Numerical Simulation of Resistance and Flow Field for Submarines near Ice Surface

When a submarine operates in polar regions, the polar environment inevitably impacts its resistance and flow field characteristics, especially when the submarine navigates near the ice surface. This paper investigates the hydrodynamic characteristics of a submarine sailing near the free water surface and the ice surface using computational fluid dynamics (CFD) methods. In order to quantify the impact of ice on the resistance and flow field characteristics of the submarine, the resistance coefficients are calculated for both near ice surface and free surface. The resistance, velocity field, and pressure distribution around the submarine at different depths and speeds are analyzed. The results indicate that the total resistance of the submarine sailing near the ice surface is lower than the free water surface. When the submarine is sailing near the ice surface, its total resistance coefficient decreases with increased submergence depth at a constant Froude number. At a fixed depth, the resistance coefficient also decreases as the Froude number increases. Additionally, when the dimensionless depth relative to the maximum hull diameter (D) exceeds 3.5, it has little effect on the resistance coefficient.

Prognostic value of the right coronary venous anatomy in patients undergoing cardiac resynchronization therapy

Abstract Background The size and distribution of the coronary veins (CV) reflect both intracavitary pressure and myocardial blood flow, and therefore, in patients with cardiomyopathy, CV anatomy could potentially become a biomarker of disease severity. While the left coronary veins have been well described, there are few descriptions of the right CV system. Purpose Given these considerations, the aim of the study was to evaluate the anatomy of the right CV system and its potential prognostic significance in patients with advanced cardiomyopathy. Methods We analyzed CV angiograms from 121 patients (age 67±14 years) undergoing cardiac resynchronization therapy (CRT). The right ventricular (RV) veins were seen to fill during the injection of contrast through multiple connections with the left sided venous system. Patients were followed for a median of 43 [IQR 3-73] months, during which 12 patients expired. Results Anterior cardiac veins (ACV), which overlay the RV wall were observed in 85 (70%) patients and had a maximum ostial diameter of 2.04±0.8 mm. Multiple ACVs were seen in 62 patients. These veins were observed to empty directly into the venous sinus of right atrium (VSRA), into the RV, the right atrium (RA), or into the small cardiac vein (SCV) in 68, 9, 5, and 3 patients respectively. The right marginal vein (RMV) was visualized in 21 (17%) patients, had a diameter of 2.3±1.2 mm, and ran a course along the right border of the RV, emptying directly into RV, RA or into VSRA in 9, 4 and 8 patients respectively. The VSRA present in 91 (75%) patients, coursed parallel to the right coronary sulcus, collecting blood from the ACV’s and RMV’s and drained into the RA (Figure A); in 7 patients, 2 VSRA ostia were noted. VSRA lengths and diameters varied (11-119 mm, mean 41±25 mm) and (1.2-6.9mm, mean 2.7±1.2mm) respectively. The VSRA lengths correlated significantly with RV fractional area change, RV systolic pressure, tricuspid regurgitation severity evaluated by echocardiography, and P wave amplitude in ECG lead II (r=-0.65; p=0.041, r=0.88; p=0.019, r=0.52; p=0.030, and r=0.79; p=0.031 respectively). The VSRA diameters, which were significantly larger in patients with obstructive sleep apnea (3.6±1.5 vs. 2.3±1.2mm; p=0.021) correlated significantly with RV systolic pressure, and tricuspid regurgitation severity by echocardiography (r=0.77; p=0.009, and r=0.63; p=0.006 respectively). Patients who expired during follow-up had a significantly longer VSRA than patients who remained alive (Figure B). The VSRA length, RV fractional area change, and baseline QRS duration independently predicted survival in a Cox multivariate model that also included age and left ventricular ejection fraction. Conclusions RV venous system demonstrates a highly variable anatomy that has not been previously well described. The size of the VSRA correlated with parameters of RV function and predicted survival in patients undergoing CRT.Figure

Accuracy of right atrial pressure estimation by transthoracic echocardiography

Abstract Background/Introduction Transthoracic echocardiography provides an estimate of right atrial pressure (RAP) using the guideline-recommend method of measuring inferior vena cava (IVC) diameter and collapsibility. Despite being ubiquitously reported and necessary for the estimation pulmonary artery systolic pressure, the accuracy of this method for RAP estimation has not been rigorously validated. Purpose To evaluate the accuracy of the guideline-recommended method for the estimation of RAP by TTE. Methods A single center, retrospective chart review of patients who had a TTE and right heart catheterization (RHC) within 48 hours of each other from January 2018 to December 2020. Maximum and minimum IVC diameter were measured by trained study personnel. Accuracy was then stratified by the presence/absence of a history of two variables that could modify IVC diameter independent of RAP—syncope, which is associated with more dilated IVC in some studies and liver disease, which could result in compression (from parenchymal fibrosis surrounding the IVC) or dilation (from diversion of portal blood flow through the IVC among other mechanisms) of the IVC. Results The 117 patients who met inclusion criteria had a median age of 67 years old (interquartile range [IQR] 58 – 75) and median RAP of 13 mmHg (IQR 8 – 18) on RHC. The median time between TTE and RHC was 9.6 hours (IQR 3.8 – 24.5 hours) during which 24 (20.5%) patients received intravenous fluids (median 220 mL administered; IQR 145 – 320). Forty-three (35.9%) received diuretics between the studies with most patients receiving either 1 (26 patients, 61.9% of those who received diuretics) or 2 (13 patients, 31.0%) diuretic doses. In evaluating accuracy, only 26 patient’s (20.5%) RAP by RHC fell within estimated RAP range by TTE (Figure 1). After excluding the 60 patients who received fluids and/or diuretics between the TTE and RHC, the TTE estimate was still only accurate in 13 (22.8%) patients. When analyzing how each subcomponent of the TTE guidelines for RAP estimation correlated with RAP via RHC, maximum IVC diameter and percent collapsibility had Pearson’s correlation coefficients of 0.47 and 0.24 respectfully (Figure 2A and 2B). Past medical history was significant for syncope in 16 patients (13.7%) and liver disease in 8 patients (6.8%). Compared to those without each factor, the absolute accuracy of the TTE estimate was lower when stratified by a history of syncope (12.5% accurate vs 21.8%, p = 0.60) and liver disease (12.5% vs 21.2%, p = 0.90) though neither were statistically significant. Conclusion In this retrospective chart review, RAP estimation by TTE using the guideline-recommended method had limited accuracy. Prospective evaluation with minimal time between RHC and TTE is needed to validate the accuracy of the TTE guidelines.Accuracy of TTE for RAP estimationCorrelation between RAP & TTE Variables

Feasibility, accuracy, and reproducibility of device sizing in virtual reality for percutaneous left atrial appendage closure - a single center study

Abstract Background Left atrial appendage closure (LAAC) is a safe and effective procedure for stroke prevention in patient with non-valvular atrial fibrillation. Procedural planning and device sizing remains challenging due to the highly complex and variable three-dimensional (3D) anatomy of the left atrial appendage (LAA). Virtual reality (VR) is a innovative, recent technology allowing a superior spatial orientation visualization of 3D imaging datasets. Purpose Therefore, we aimed to evaluate feasibility and accuracy of LAA measurements in VR for device sizing in patients planned for LAAC. Methods Twenty-one patients (79±7 years, 62% male) with non-valvular atrial fibrillation scheduled for LAAC were randomly included in our study. Preprocedural a multi-slice computed tomography (MSCT) was performed for device sizing in all patients. MSCT-based 3D models were established and visualized in VR using a dedicated software (VMersive, Warsaw, Poland). LAA dimensions (Ostium, landing zone (LZ), and depth) were assessed directly in the virtual environment. Conventional measurements of LAA ostium, landing zone (LZ) and depth using commercially available software were compared to measurements in VR. Results 3D reconstruction of MSCT datasets and visualization in VR were successfully performed automatically in all patients within a few seconds. MSCT and VR demonstrated good correlations for ostium minimum (r = 0.93), maximum (r = 0.8) and mean (r = 0.88, all p<0.001) diameters. Additionally, LZ minimum (r=0.84), maximum (r=0.86) and mean (r=0.9) diameters showed good correlation (all p<0.001). Moderate correlation was observed for depth measurements (r=0.76, p<0.001). Furthermore, intraclass correlation coefficients ranging from 0.88 to 0.98 denoted high inter- and intraobserver agreement. Conclusion Immersive VR allows highly feasible, accurate and reproducible measurements of the LAA dimensions directly in the virtual environment, hence enabling accurate device sizing for LAAC.

Nomogram for the Pathological Complete Response After Neoadjuvant Chemotherapy in Muscle-Invasive Bladder Cancer Patients.

No validated instrument currently exists to predict neoadjuvant chemotherapy (NAC) response in muscle-invasive bladder cancer (MIBC) patients. We aim to develop and validate a nomogram based on clinicopathological factors for predicting who would benefit most from NAC. Between January 2016 and April 2023, 361 consecutive MIBC patients treated with NAC were enrolled in the study. Two hundred sixty patients at the Hu Nan institution comprised the development cohort. The validation cohort (91 patients) was from the Xiang Hua center. Patient clinicopathologic information was documented. Using regression coefficients, a predictive model was constructed using multivariate logistic regression. The likelihood ratio test with Akaike's information criterion was then used as the ending rule for backward stepwise selection. This predictive model's efficacy was evaluated for discrimination, calibration, and clinical utility. Predictors of this model included the origin of MIBC, pathological tumor type, clinical tumor stage, and tumor size. In the validation cohort, the model demonstrated good discrimination with an AUROC of 0.7221 (P < 0.001) and calibration (Unreliability test, P = 0.580). In addition, decision curve analysis revealed that the model was clinically beneficial. This study indicated that primary MIBC, pure UC pathological type, lower clinical tumor stage, and maximum tumor diameter <3 cm were significant predictors of ypCR in MIBC patients after NAC. This nomogram may contribute to the preciousadministration of NAC and the avoidance of chemotherapy toxicity and delayed RC.

Location-specific prognostic significance of plaque burden, stenosis, and plaque morphology in coronary artery disease

Abstract Background The prognostic significance of coronary plaque localization, percentage atheroma volume (PAV), stenosis, and plaque morphology has been underexplored. Purpose To investigate the prognostic significance of plaque localization beyond plaque burden, presence of stenosis and plaque morphology. Methods Patients with no cardiac history who underwent coronary CTA were included. PAV, maximum diameter stenosis, and plaque morphology were assessed and classified into proximal, mid, or distal segments of the coronary tree. Major adverse cardiac events (MACE) were defined as death or non-fatal myocardial infarction. Results Among 2819 patients 267 events (9.5%) occurred during a median follow-up of 6.9 years. PAV of the proximal segments was strongly correlated to PAV localized at of the mid (R= 0.76) and distal segments (R = 0.74, p &amp;lt; 0.01 for both). When adjusted for traditional risk factors and presence of plaque on other locations, only proximal PAV was independently associated with MACE (3rd quartile HR 2.08, 95% 1.17–3.71, p=0.01 and 4th quartile HR 2.29, 95% CI 1.21–4.34, p=0.01). Similar results were seen for presence of stenosis. Proximal, mid, and distal PAV as a solitary metric (unadjusted) had similar predictive value for MACE with an AUC of 0.73 (95% CI 0.69-0.76) for proximal PAV and 0.72 (95% CI 0.68-0.76) for both mid and distal localized plaque). Similar results were obtained using diameter stenosis instead of PAV. The presence of low-attenuation plaque (LAP) in the proximal segments had additional prognostic value. Calcified or noncalcified PAV did not provide additional value beyond total location-specific PAV and presence of low-attenuation plaque. Conclusions Proximal located PAV is an independent predictor of death and non-fatal MI, while there was no incremental prognostic value of plaque localized at the mid or distal coronary segments. The presence of LAP in the proximal segments provided additional prognostic value for prediction of MACE.

Deep learning and Diagnostic value of cardiac cine MRI for assessing patent foramen ovale in patients with cerebral disorders compared with cTCD

Abstract Purpose To investigate the clinical feasibility of cardiac MRI (CMRI) cine technology using deeplearning without contrast for diagnosis and classification of patent foramen ovales (PFOs) in patients with cerebral disorders. Materials and Methods Fourty-four patients (24 males and 20 females; mean age, 41.3 years; range, 21-64 years) with cerebral disorders underwent both contrast transcranial doppler sonography (cTCD) and non-enhanced CMRI examinations between October 2019 and March 2020. and datas from 335 patients were collected by 2023.CMRI was performed with a 3.0T MR scanner by using OBL FIESTA CINE 4CH sequence. The scanning direction was perpendicular to the interatrial septum (IAS) slice. The obtained MR images were analyzed by AW station 4.7 and the pseudo-color coding was also performed according to the different phases. The condition of the blood shunt was observed and recorded by using deep learning, including measuring the length and width of the PFO and observing whether it was complicated with IAS aneurysm or secondary septum thickening. Results Thirty-nine of 44 patients with cerebral disorders were confirmed with positive RLS by cTCD test, and 37 of the 39 patients were diagnosed with a PFO at CMRI. Two of 5 patients with negative cTCD test were also diagnosed with a PFO at CMRI. Compared with cTCD as a standard, CMRI had a sensitivity of 94.9%, specificity of 60.0%, accuracy of 90.9%, positive predictive value of 94.9%, negative predictive value of 60.0%, and AUC of 0.774. Based on the pseudo-color coding, the right-to-left color jet was observed in 34 patients, and the two-way shunting was found in 5 patients. The IAS aneurysm and secondary septum thickening were found in 5 and 3 patients (11.4% and 6.8%). The maximum diameters of PFOs ranged from 1.7 mm to 16.8 mm and the mean diameter was 5.4±3.4 mm. Conclusion By using deep learning,CMRI cine technology without contrast provided a noninvasive and excellent method for PFO identification, evaluation and classification, with both high sensibility (92.85%) and concordance (90.9%) when compared to cTCD.PFO types

The prognostic impact of maximal aortic diameter on acute type B aortic dissection progression in a Chinese population

Currently, evidence concerning the link between maximal aortic diameter and in-hospital mortality in cases of acute type B aortic dissection (ATBAD) is insufficient. Thus, this study aimed to explore the relationship between the maximal aortic diameter at the time of admission and the early prognosis of patients diagnosed with ATBAD. A total of 678 patients with ATBAD were included between January 2016 and December 2018, during which their clinical data was gathered. The independent variable analyzed was the maximal diameter of the aorta, while the dependent variable was mortality during hospitalization. Factors considered in this analysis included the patients’ age, gender, body mass index (BMI), medical history of hypertension, stroke, diabetes, atherosclerosis, smoking habits, chronic kidney insufficiency, time until presentation, systolic and diastolic blood pressures, ejection fraction, presence of aortic regurgitation, symptoms, involvement of abdominal vessels, laboratory findings, and treatment approaches. Of these patients collected, the mean age was 56.03 ± 12.22 years, and approximately 82.45% of them were male. After analysis, it was found that the maximal aortic diameter of patients with ATBAD was positively correlated with in-hospital mortality (OR = 1.06, 95% CI 1.03 to 1.10). Surprisingly, a J curve relationship was detected between maximal aortic diameter (point 31 mm) and in-hospital death for patients with ATBAD. The effect sizes and confidence intervals of the right (maximal aortic diameter > 31 mm) and left (maximal aortic diameter ≤ 31 mm) aspects of the inflection point were 1.06 (1.02–1.11) and 1.03 (0.83–1.28), respectively. In addition, the stratified analysis showed a stable relationship between maximal aortic diameter and in-hospital mortality, while there was no significant difference in the interaction between different subgroups. In patients with ATBAD, a J-curve relationship was identified between the maximal aortic diameter and in-hospital mortality. Specifically, when the maximal aortic diameter exceeds 31 mm, a positive correlation with in-hospital death was observed.

Interobserver variability of clinical target volume delineation in patients undergoing breast-conserving surgery without surgical clips: a pilot study on preoperative magnetic resonance simulation

BackgroundIn patients undergoing breast-conserving therapy without surgical clip implantation, the accuracy of tumor bed identification and the consistency of clinical target volume (CTV) delineation under computed tomography (CT) simulation remain suboptimal. This study aimed to investigate the feasibility of implementing preoperative magnetic resonance (MR) simulation on delineations by assessing interobserver variability (IOV).MethodsPreoperative MR and postoperative CT simulations were performed in patients who underwent breast-conserving surgery with no surgical clips implanted. Custom immobilization pads were used to ensure the same supine position. Three radiation oncologists independently delineated the CTV of tumor bed on the images acquired from MR and CT simulation registration and CT simulation alone. Cavity visualization score (CVS) was assigned to each patient based on the clarity of the tumor bed on CT simulation images. IOV was indicated by generalized conformity index (CIgen), denoted as CIgen−CT and CIgen−MR/CT, and the distance between the centroid of mass (dCOM), denoted as dCOMCT and dCOMMR/CT. The variation of IOV in different CVS subgroups was analyzed.ResultsA total of 10 patients were enrolled in this study. The median and interquartile range (IQR) of maximum pathological diameter of the tumors in all patients were 1.55 (0.80–1.92) cm. No statistical significance was found between the volumes of CTVs on CT simulation and on MR/CT simulation registration images (p = 0.387). CIgen−MR/CT was significantly larger than CIgen−CT (p = 0.005). dCOMMR/CT was significantly smaller than dCOMCT (p = 0.037). The median and IQR of CVS in all patients were 2.34 (2.00–3.08). The difference of CIgen between CIgen−MR/CT and CIgen−CT was larger in the low CVS group (p = 0.016). The difference of dCOM showed a decreasing trend when CVS was lower, although it did not reach statistical significance (p = 0.095).ConclusionsFor patients who underwent breast-conserving surgery without surgical clip implantation, the use of preoperative MR simulation in delineating the CTV of tumor bed decreased the IOV among observers. The consistency of tumor bed identification was improved especially in cases where the margins of tumor bed were challenging to visualize on CT simulation images. The study findings offer potential benefits in reducing local recurrence and minimizing tissue irritation in the surrounding areas. Future investigation in a larger patient cohort to validate our results is warranted.

Predictive factors for lymph node metastasis in papillary thyroid cancer patients undergoing neck dissection: insights from a large cohort study

BackgroundThis study aimed to investigate the risk factors and metastatic patterns in papillary thyroid cancer (PTC) patients undergoing lymph node dissection, offering guidance for clinical practice.MethodsA total of 924 PTC patients who underwent thyroidectomy with central neck dissection (CND) or lateral neck dissection (LND) between January 2021 and November 2022 were included in the analysis. The study investigated the relationships between clinicopathological characteristics, lymph node metastasis, and various risk factor.ResultsAmong the 924 PTC patients, the cervical lymph node metastasis rate was 59.1% (546 patients). Of these patients, 381 had central neck metastasis (CNM, 41.2%), while the remaining 165 patients had lateral neck metastasis (LNM, 17.9%). Factors associated with increased risk of CNM and LNM included larger tumor diameter, presence of multiple tumors, and capsular invasion (p&amp;lt;0.05). Male sex, age &amp;lt;55 years, larger tumor diameter (&amp;gt;0.85 cm), multiple tumors, capsular invasion, and absence of Hashimoto’s disease were identified as independent risk factors for CNM (p&amp;lt;0.05), with an AUC value of 0.722. CNM, maximum diameter &amp;gt;1.15 cm, and multiple tumors were independent risk factors for LNM (p&amp;lt;0.05), with an AUC of 0.699.ConclusionThese findings suggest that tailored neck dissection based on individual risk factors is crucial, particularly in cases of suspected LNM with larger tumors, CNM, multiple tumors, and capsular invasion.

Effect of Casing Mixtures along with Turmeric Powder on the Growth Parameters and Yield of White Button Mushroom [Agaricus bisporus (Lange) Imbach

Protein is one of the nutrients that is included in balance diet for proper growth and development of humankind. The amount of food that is needed for human consumption is insufficient. Agaricus bisporus (Lange) Imbach commonly known as white button mushroom, is the most widely accepted food globally with nutritional and medicinal properties. The present experiment was conducted during the Rabi season 2023 at Mushroom crop room, Department of Plant Pathology, SHUATS, Prayagraj, Uttar Pradesh to evaluate the effect of Turmeric powder at different concentrations (0.5%, 1%, 1.5%, 2% and 2.5%) incorporated into three different casing mixture viz., FYM + Cocopeat + Sawdust (1:1:1) with an objective to monitor the growth and yield aspects of white button mushroom. Turmeric at concentration 2% shows significant increase of weight of fruiting bodies, enhances stalk length, stalk diameter and pileus diameter. These results were also observed at 2.5% concentration but it also inhibited the growth of mold fungus as well as A. bisporus. Among all treatments used in the study, the results revealed that minimum average time taken for completion of spawn run (15.28 days) and pinhead initiation (17.29 days) as well as maximum pileus diameter (4.87 cm), stalk length (3.32 cm), stalk diameter (2.36 cm), yield (583.33 g) and biological efficiency (13.56) highest recorded in T4 [FYM + Cocopeat + Sawdust (1:1:1) + Turmeric powder @ 2%.

Solidification process of hollow metal droplets impacting a substrate

Recently, there has been a renewed interest in hollow droplet impact, as the internal bubble makes a difference in the spreading morphology during thermal spraying and three-dimensional printing. This paper is dedicated to the solidification process of a hollow metal droplet impacting a cold substrate. The influence of initial impact velocity and substrate temperature on the spreading process is numerically investigated by employing a phase-field method coupled with a solidification model. Solidification was shown to strongly alter droplet spreading and the flow state of the center liquid column. To describe the flow state of the center liquid column, three patterns, namely ‘no-jet’, ‘transition region’, and ‘counter-jet’ are defined. The simulation results show that the formation of the center counter-jet is inhibited by the solidification layer when Péclet number Pe<357, where Pe is the ratio of convection rate to diffusion rate. In addition, the critical Pe at which the phenomenon of counter-jet occurs gradually rises with the substrate temperature falling. Finally, a quantitative analysis of the maximum spreading diameter is proposed by establishing an energy conservation equation. The predicted diameters are in good agreement with the simulated results. It allows us to provide a general expression for the hollow droplets' maximum spreading diameter, using the impact and temperature parameters.

Mifepristone and rapamycin have non-additive benefits for life span in mated female Drosophila

ABSTRACT The drugs mifepristone and rapamycin were compared for their relative ability to increase the life span of mated female Drosophila melanogaster. Titration of rapamycin indicated an optimal concentration of approximately 50 μM, which increased median life span here by average +81%. Meta-analysis of previous mifepristone titrations indicated an optimal concentration of approximately 466 μM, which increased median life span here by average +114%. Combining mifepristone with various concentrations of rapamycin did not produce further increases in life span, and instead reduced life span relative to either drug alone. Assay of maximum midgut diameter indicated that rapamycin was equally efficacious as mifepristone in reducing mating-induced midgut hypertrophy. The mito-QC mitophagy reporter is a previously described green fluorescent protein (GFP)–mCherry fusion protein targeted to the outer mitochondrial membrane. Inhibition of GFP fluorescence by the acidic environment of the autophagolysosome yields an increased red/green fluorescence ratio indicative of increased mitophagy. Creation of a multi-copy mito-QC reporter strain facilitated assay in live adult flies, as well as in dissected midgut tissue. Mifepristone was equally efficacious as rapamycin in activating the mito-QC mitophagy reporter in the adult female fat-body and midgut. The data suggest that mifepristone and rapamycin act through a common pathway to increase mated female Drosophila life span, and implicate increased mitophagy and decreased midgut hypertrophy in that pathway.

Robot-assisted resection of renal tumor in children and comparison with laparoscopic surgery

BackgroundRobot-assisted surgery (RAS) is being performed with increasing frequency in pediatric oncology. We report our experience with RAS for renal tumors in children and compare the outcomes between RAS and laparoscopic surgery (LAS).MethodsA total of 23 patients with renal tumor who underwent minimally invasive surgery (MIS) between January 2020 and December 2023 were included in the study. The inclusion criteria enrolled in this study was unilateral tumors with maximum tumor diameter less than 10 cm. Patients who had enlarged lymph node, venous thrombosis, preoperative tumor rupture, bilateral renal tumor, or extrarenal extension on imaging were deemed contraindications and excluded. Patient demographics, operative details, postoperative outcomes and follow-up were recorded.ResultsAmong these patients, 17 underwent RAS and 6 underwent LAS. In the RAS group, the median age was 64 months (range, 9–156) with a median weight of 19.48 kg (range, 8.4–46.5); the maximum tumor diameter at operation was 55.65 mm (range, 22–88); the operation time was 188.8 min (range, 120–210), the intraoperative blood loss was 20 ml (range, 5–50), and the length of postoperative hospital stay was 4 days (range 1–9). There was no significant difference in patients’ age, weight, location, tumor size, histological pattern and operation time between the two groups (P > 0.05). The RAS group had a significantly less intraoperative blood loss (P = 0.026) and less length of postoperative stay (P = 0.01) than the LAS group.ConclusionOur initial experience suggested that RAS in pediatric renal tumor was feasible and safe, and it reduced surgical trauma and accelerate postoperative recovery for the patients. Due to the limitations of sample size and study quality, the clinical importance of these findings still needs to be further verified.

Overall Survival of Young Patients with Hepatocellular Carcinoma in Barcelona Clinic Liver Cancer Stage B in a Retrospective Study Based on a Multicenter Cohort.

Hepatocellular carcinoma (HCC) is usually diagnosed in patients at the age of > 45years. We aimed to determine the prognosis of patients with HCC at the age of 30-44years compared with that of patients at a more senior age. Based on the Sun Yat-sen University Cancer Center database, a total of 1745 patients with HCC were retrospectively enrolled and were assigned to three age groups (30-44, 45-59, and 60-70years). The primary endpoint was overall survival. Among baseline characteristics, five variables including sex, serum albumin level, total bilirubin level, the maximum tumor diameter, and the number of tumor nodules were adjusted using propensity score matching. Patients aged 30-44years presented a worse overall survival, a greater number of HCC nodules, a greater maximum tumor diameter, and higher serum alpha-fetoprotein (AFP) concentration than those aged 45-59years in a crude analysis (p < 0.05). Using propensity score matching, the difference in overall survival between the two cohorts was canceled (p > 0.05). The prognosis of patients with HCC at age 30-44years was equal to that of patients aged 45-59years.

Optimization of White Tea Flavanol Extraction Process by the Ultrasonic‐Assisted Deep Eutectic Solvent Method and Determination of the Antioxidant and Antibacterial Activity

ABSTRACTFlavanols have a variety of health benefits and biological activities and become the hotspot of the food development and research. In this research, flavanols were extracted from white tea by ultrasonic‐assisted deep eutectic solvent (DES) method. High‐performance liquid chromatography was used to determine the content of flavanols. The influence of four factors on the flavanol extraction yield was analyzed by single factor experiments, including deep eutectic solvent mole ratio (the mole of hydrogen bond acceptors: the mole of hydrogen bond donors), solid–liquid ratio (white tea sample weight/g: the volume of DES/mL), extraction time and extraction temperature. On the basis of single factor experiments, the factors which had significant effects on the flavanol extraction yield were further optimized by the response surface test. The results showed that the optimized extraction conditions were as follows: the mole ratio of DES 1: 4 (choline chloride: 1,2‐propanediol), the solid–liquid ratio 1:30, the extraction temperature 56°C, the extraction time 53 min, and the ultrasonic power 341 W. Under the above parameters, the extraction yield of white tea flavanols was 9.63 mg/g. After purification with macroporous resin, antioxidation and antibacterial experiments were carried out. The results showed that the antioxidant and antibacterial effects of white tea flavanols were remarkable. The antibacterial effects performed best on Escherichia coli, followed by Bacillus subtilis and Staphylococcus aureus. The maximum diameter of the antibacterial zone on Escherichia coli was 0.95 ± 0.11 mm. The best radical scavenging rates of OH, ABTS+ and DPPH were 97.1%, 97.5%, and 88.4%, respectively, when the flavanol concentration was 9.5 mg/mL. The conclusions of this research can provide theoretical foundation for the further study of white tea flavanols.