Median Thickness Research Articles

Gender difference in the relationship between epicardial adipose tissue and central obesity.

Body fat distribution is closely related to cardiovascular disease than the amount of total body fat itself. The epicardial adipose tissue (EAT) measured by transthoracic echocardiography represents central obesity. We hypothesized that the gender affected the link between EAT thickness and body fat distribution. We measured EAT thickness using transthoracic echocardiography and total body fat and regional body fat distribution using dual-energy X-ray absorptiometry (DXA) in 390 patients (250 males, 59 ± 11 year-old). The EAT thickness was measured on the free wall of the right ventricle at the end of the diastole on parasternal long-axis view of echocardiography. The median and mean EAT thickness of 390 patients were 4.0 mm and 4.2 ± 1.2 mm, respectively. The mean EAT thickness revealed positive correlation with truncal fat mass to total body fat mass ratio (FMtrunk/FMtotal, R = 0.291, P = .024). Subgroup analysis categorized by gender demonstrated the female group has stronger correlation of EAT thickness with fat distribution than the male group (male: R = 0.174, P = .006, female: R = 0.378, P < .001). EAT thickness is closely related to body fat distribution. Females showed a more significant correlation between EAT thickness and central fat accumulation than males. EAT thickness might be considered as a relevant parameter of central obesity, especially in females.

Oxidative stress drives endometrial fibrosis via TGF-β1/MAPK signaling pathway in breast cancer.

Breast cancer patients have high serum reactive oxygen species (ROS) levels, which exert toxicity on the ovary. However, it is still unclear whether tumor-derived ROS play a role in endometrial development and function in breast cancer. Breast cancer patients and healthy controls were recruited and endometrial thickness was measured by transvaginal ultrasound (TVUS). Xenograft tumors of the breast cancer cell line MDA-MB-231 in a female BALB/c nude mice model were established, and the therapeutic mechanism of vitamin C (VC) was investigated on uterine pathology invivo and the contribution of co-culture of breast cancer cell and endometrial epithelial cell on this process was examined invitro. Median thickness in endometria was lower in breast cancer patients and tumor-bearing mice compared to controls. A gene signature of uteri in tumor-bearing mice demonstrated differential expression of genes (DEGs) regulating extracellular matrix (ECM) and epithelial-mesenchymal transition (EMT), and activation of TGF-β and MAPK signaling pathways. In addition, ROS, EMT- and ECM-related protein levels were enhanced in uteri in tumor-bearing mice, as well as in Ishikawa cells which were co-cultured with MDA-MB-231 cells compared to controls. Supplementation with VC reduced endometrial damage, inhibited the EMT process and collagen deposition, and maintained better histologic architecture of uteri in tumor-bearing mice via inactivation of the TGF-β1/p38MAPK pathway. In women with breast cancer oxidative stress in the endometrium results in a fibrotic response as a consequence of EMT. VC could alleviate endometrial fibrosis via TGF-β1/p38MAPK pathway and provide new predictive and therapeutic targets for fertility preservation in younger breast cancer patients.

Abstract 4120821: Electrochemical Impedance Spectroscopy Unmasks High-Risk Atherosclerotic Features in Human Coronary Artery Disease

Background: Coronary plaque rupture remains the prominent mechanism of myocardial infarction. Accurate identification of rupture-prone plaque may improve clinical management. This study assessed the discriminatory performance of electrochemical impedance spectroscopy (EIS) in human cardiac explants to detect high-risk atherosclerotic features that portend rupture risk. Methods: In this single-center, prospective study, n=26 cardiac explants were collected for EIS interrogation of the three major coronary arteries. Vessels in which advancement of the EIS catheter without iatrogenic plaque disruption was rendered impossible were not assessed. N=61 vessels underwent EIS measurement and histological analyses. Plaques were dichotomized according to previously established high rupture-risk parameter thresholds. Diagnostic performance was determined via receiver operating characteristic areas-under-the-curve (AUC). Results: Necrotic cores were identified in n=19 vessels (median area 1.53 mm 2 ) with median fibrous cap thickness of 62 μm. Impedance was significantly greater in plaques with necrotic core area ≥1.75 mm 2 vs &lt;1.75 mm 2 (19.8±4.4 kΩ vs 7.2±1.0 kΩ, P =0.019), fibrous cap thickness ≤65 μm vs &gt;65 μm (19.1±3.5 kΩ vs 6.5±0.9 kΩ, P =0.004), and ≥20 macrophages per 0.3 mm-diameter high-power field (HPF) vs &lt;20 macrophages per HPF (19.8±4.1 kΩ vs 10.2±0.9 kΩ, P=0.002). Impedance identified necrotic core area ≥1.75 mm 2 , fibrous cap thickness ≤65 μm, and ≥20 macrophages per HPF with AUCs of 0.889 (95% CI: 0.716–1.000) ( P =0.013), 0.852 (0.646—1.000) ( P =0.025), and 0.835 (0.577—1.000) ( P =0.028), respectively. Further, phase delay discriminated severe stenosis (≥70%) with an AUC of 0.767 (0.573—0.962) ( P =0.035). Conclusions: EIS discriminates high-risk atherosclerotic features that portend plaque rupture in human coronary artery disease and may serve as a complementary modality for angiography-guided atherosclerosis evaluation.

Evaluation of the macula, retinal nerve fiber layer and choroid thickness in premature ovarian failure using spectral-domain optical coherence tomography.

The aim of our study is to describe the basal findings at the first diagnosis of the disease in patients with premature ovarian failure (POF) and to draw attention to the early changes in the macula, optic nerve head and choroid. In a prospective case-control study, 90 patients with POF and 90 control patients were evaluated. All participants underwent the same ophthalmic examination, including visual acuity, intraocular preasure measurement, anterior and posterior segment evaluation, macular and coroidal thickening, and retinal nerve fiber layer (RNFL) measurements with the same device (Spectral Domain OCT, software version 5.6.3.0, Heidelberg, Germany). The median age was 30.00 (28.00-31.00) in the control group and 29.00 (27.00-31.00) in the POF group (p = 0.249). The median thickness of the temporal outer macular region was statistically significantly thinner in the POF group (295.00 (289.00-303.25)) compared to the control group (306.00 (290.75-328.00)) (p < 0.001). There was a statistically significant decrease in all choroidal regions (p < 0.001), including the central, nasal 500, nasal 1500, temporal 500, and temporal 1500 regions in the POF group according to the control group. An increase in intraocular pressure in the postmenopausal period has been reported, suggesting a link between the postmenopausal decline in sex hormones and glaucoma. Our study is the first to monitor changes in choroidal, retinal thickness and RNFL in POF images showing early menopausal symptoms.

Bilateral middle meningeal artery embolization for the treatment of bilateral chronic subdural hematoma

ObjectiveMiddle meningeal artery embolization (MMAE) is a treatment strategy increasingly used in the management of chronic subdural hematoma (CSDH). While frequently performed for the treatment of bilateral chronic subdural hematoma (bCSDH), outcomes of bilateral MMAE (bMMAE) have not often been independently reported in the literature. In this study, we document the outcomes and utility of bMMAE for the treatment of bCSDH at our institution. MethodsThis is a retrospective cohort study of patients who underwent bMMAE at our institution between 2018 and 2024. Demographic, clinical, and outcome variables were compared using standard statistical approaches between reoperation and non-reoperation groups, and resolution and non-resolution groups. ResultsTwenty-eight patients underwent bMMAE for the treatment of CSDH. The median age was 75 years. Median radiographic follow-up was 8.0 months. At the time of last-follow-up, radiographic bilateral CSDH resolution was observed in 5 patients (17.9 %) and 10 patients (35.7 %) continued to have symptoms at last follow-up. Reoperation occurred in 5 patients (17.9 %). On univariate comparison between reoperation and non-reoperation cases, patients in the reoperation cohort were more likely to have persistent symptoms at last follow-up (80.0 % versus 26.1 %, p = 0.0410) and had a larger median pre-operative thickness (19.0 versus 13.0, p = 0.0498). There were no significant differences in outcome variables between resolution and non-resolution cases of bMMAE. ConclusionsbMMAE is a promising technique for the management of bCSDH with and without concomitant surgical evacuation. Further work is required for proper patient identification for bCSDH treatment options.

Biomechanical and Physical Characteristics of Dental Dam Sheets Used for Absolute Isolation.

This study aimed to evaluate the mechanical and physical properties of dental dam sheets used for absolute isolation and to correlate the mechanical parameters with cost. Twenty-one dental dam sheets were tested: ALLPRIME; Madeitex; Sanctuary non-latex, Sanctuary latex black, green, and blue; Nic Tone blue and black; Mk Life; Elastidam; Bassi; Pribanic; Care; OK; MDC Dental; Keystone; Dura Dam; Flexidam; Sanctuary blue; Nic Tone blue; Ehros; and USE. The thicknesses of the dental dam sheets were measured using a digital micrometer (Mitutoyo). The dental dam sheets (n=15) were prepared by cutting the samples with dimensions of 80 × 10 mm with a 1.7 mm hole made at the center of each specimen, following the ISO 9001 standard. The specimens were tested using a universal testing machine (Emic) at a speed of 500 mm/min until rupture to calculate rupture force (RF, N), elongation (%), and ultimate tensile strength (UTS, MPa), their thickness (mm) was measured using a digital micrometer, and scanning electron microscopy and X-ray energy dispersive spectroscopy were performed to analyze the structure and composition. The radiopacity was measured using digital radiography. Thickness, UTS, RF, and elongation data were analyzed by one-way ANOVA and Tukey's test (α=0.05). The Flexidam dental dam had the largest thickness (0.5 mm), while Nic Tone had a median thickness of 0.3 mm; the RF value (41.3 N) was higher for the thicker dental dams. The other dental dams had RF values ranging from 19 to 30 N. The highest elongation was obtained for the non-latex Sanctuary dental dam (600 mm). The Bassi dental dam had the highest UTS value (15 MPa), and medium and small particles were observed in most of the gums. A loss of continuity was detected in the structure of Sanctuary green and blue media. The predominant elements in the sheets were carbon, magnesium, sulfur, silicon, and calcium. The UTS, RF, and elongation varied substantially, indicating insufficient standardization of dental dam sheets. Nonetheless, most of the tested dental dams exhibited mechanical and physical properties suitable for clinical use. The correlation between the cost and mechanical properties of the dental dams was very low.

Evaluation of Eating Behavior in Children with Psoriasis: Retrospective Cross Sectional Study

Background. Patients with psoriasis have increased thickness of visceral fat, including epicardial adipose tissue (EAT) that has wide spectrum of biological effects. Its thickness can be affected by the presence of obesity and eating behavior (EB) changes. Studying the associations between EB and markers of adipose tissue functional activity in children with psoriasis may help to better understand this variables correlations in the scope of comorbidities. Objective. Aim of the study is to analyze the relationship between Psoriasis Area and Severity Index (PASI), Children’s Dermatology Life Quality Index (CDLQI), EAT thickness, and leptin levels in pediatric patients with psoriasis and EB disorders. Methods. Retrospective cross sectional single-center study was conducted. 72 medical records of children with psoriasis (with varying body mass index level) who were examined and treated in dermatology department in the period from December 2021 to January 2024. All included patients have underwent dietician consultation and survey with DEBQ and CEBQ questionnaires, as a result predominant EB type was determined. EAT thickness (via two-dimensional echocardiography) and leptin levels were also measured. Psoriasis severity was evaluated via PASI and CDLQI indices. Patients were divided into three groups: with external, emotiogenic, and restrictive EB. The medians of the obtained values were calculated with determination of the confidence interval, all results were compared with each other via Kruskall-Wallis test. Results. Group of patients with external EB has shown following results: median EAT thickness was 2.5 mm (Q1–Q3: 2.1–2.8), median leptin level — 17.3 ng/ml (Q1–Q3: 14.4–26.4), median of PASI — 17 points (Q1–Q3: 12.5–20.5), median of CDLQI — 7 points (Q1–Q3: 4–13.5). Group of patients with emotionogenic EB has median EAT thickness of 2.2 mm (Q1–Q3: 1.85–2.55), median leptin level — 20.1 ng/ml (Q1–Q3: 14.5–23.95), median of PASI — 14 points (Q1–Q3: 12–16.5), median of CDLQI — 6 points (Q1–Q3: 3–12). Group of patients with restrictive EB has median EAT thickness of 3.4 mm (Q1–Q3: 3.1–3.9), median leptin level — 28.2 ng/ml (Q1–Q3: 26.1–33.5), median of PASI — 24 points (Q1–Q3: 21–27), median of CDLQI — 13 points (Q1–Q3: 9–21). Statistically significant (p = 0.0014) increase in PASI and CDLQI points was observed at comparison of different groups via Kruskall-Wallis test. Patients from restrictive EB group have shown higher values of EAT thickness, leptin levels, PASI, and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing leptin levels and EAT thickness in the remaining groups. Conclusion. Patients with restrictive EB had higher PASI and CDLQI scores compared to patients with emotionogenic and external EB. No statistically significant differences were observed when comparing EAT thickness and leptin levels. Small study sample was the only research limitation.

Extracellular vesicles characterization in patients with hypertrophic cardiomyopathy

Abstract Background Hypertrophic cardiomyopathy (HCM) is a genetic disorder, diagnosed according to the presence of phenotypical traits of the myocardium. A specific biomarker which can associate with the severity of HCM is lacking. Extracellular Vesicles (EVs), nanoparticles released by cells into biological fluids, hold promise as accessible diagnostic tools, as their abundance and molecular composition can reflect the severity of cardiac diseases (Rizzuto 2024). We aim at characterising plasma-derived EVs isolated from 28 HCM patients and 18 healthy volunteers (CTR). Methods The whole cohort underwent transthoracic echocardiography, whereas magnetic resonance and exome sequencing was performed on HCM patients. EVs were isolated via ultracentrifugation from plasma of both groups. Quantitative and qualitative assessments of EVs were performed by nanoparticle tracking analysis, transmission electron microscopy, Western blot, targeted (Olink) and untargeted (nLC-MS/MS) proteomics and FACS analysis. Plasma-derived EV subpopulations were characterised according to their cellular origin. Data are expressed as median and interquartile range (25th, 75th). Results Most patients were male (68% HCM and 66% CTR) with a median age of 58 (49-69) years (HCM) and 47 (44-52) (CTR). Among HCM patients, missense mutations in the MYH7 gene were the most identified. The median maximum wall thickness (WTMax) in HCM was 16 mm (15-19) vs 8 mm (7-9) in CTR. The isolated EVs expressed tetraspanins (CD9, CD63 and CD81), Alix and β-integrin and showed an intact phospholipid bilayer of 100 nm in size. EV concentration was reduced in HCM vs CTRL, respectively 2.8*109 EV/ml/cell count (2*109-4*109) and 4.6*10⁹ EV/ml/cell count (3*109-6*109). Among 15 plasma-derived EV subpopulations studied, those released from platelets (CD41a) and activated platelets (CD62P and CD40L) were increased in HCM patients vs CTR by 1.7 fold. Negative associations were found between E/e’, parameter of diastolic function, and cardiomyocyte-derived EVs (r= -0.2658), and between left ventricle ejection fraction and platelet-derived EVs (r=-0.2189); a positive correlation was found between WTMax and EVs derived from activated endothelial cells (r=0.2330). The proteomic analysis of EVs shows an enrichment in proteins related to platelets adhesion and inflammation in HCM patients. Conclusions HCM patients present a peculiar phenotypic pattern of EVs that may associate with diagnostic clinical features of HCM.

Ice thickness control and measurement in the VitroJet for time-efficient single particle structure determination

Embedding biomolecules in vitreous ice of optimal thickness is critical for structure determination by cryo-electron microscopy. Ice thickness assessment and selection of suitable holes for data collection are currently part of time-consuming preparatory routines performed on expensive electron microscopes. To address this challenge, a routine has been developed to measure ice thickness during sample preparation using an optical camera integrated in the VitroJet. This method allows to estimate the ice thickness with an error below ±20 nm for ice layers in the range of 0–70 nm. Additionally, we characterized the influence of pin printing parameters and found that the median ice thickness can be reproduced with a standard deviation below ±11 nm for thicknesses up to 75 nm. Therefore, the ice thickness of buffer-suspended holes on an EM grid can be tuned and measured within the working range relevant for single particle cryo-EM. Single particle structures of apoferritin were determined at two distinct thicknesses of 30 nm and 70 nm. These reconstructions demonstrate the importance of ice thickness for time-efficient cryo-EM structure determination.

Satellite observations and modeling of the plasmapause structure and dynamics

We investigated the structure and dynamics of the plasmapause using electron density data from the Arase (ERG) satellite between 2017 and 2019. By fitting the electron density profile to a hyperbolic function using the least-squares method, 1891 plasmapause events were identified. The hyperbolic function’s fitting parameters were used to estimate the plasmapause’s location and thickness. The plasmapause location and thickness were mapped onto the geomagnetic equator plane. We examined the dependence of the plasmapause location and thickness on the geomagnetic disturbance. The median plasmapause location on the geomagnetic equator plane was 32,089 km from Earth’s center. Plasmapause locations depend on geomagnetic disturbances that vary between four and six radii of the Earth.In contrast, the median plasmapause thickness obtained by fitting a hyperbolic function on the geomagnetic equator plane was 2472 km. The thickness changed from ∼1500 km at night to ∼ 3000 km during the daytime. The thickness was several times larger than the ring current H+ Larmor radius, suggesting an association with plasma instability in the plasmapause due to the penetration of magnetospheric electric fields.Additionally, we developed a three-dimensional empirical electron density model with historical effects associated with refilling the plasmasphere, plasmapause, and magnetosphere. The International Reference Ionosphere (IRI) model can be enhanced to incorporate the electron density model of the plasmasphere and estimate the total electron content (TECp) in the plasmasphere using the empirical model. Our analysis provides valuable insights into plasmapause and contributes to a better understanding of the inner magnetosphere.

Electrochemical impedance spectroscopy unmasks high-risk atherosclerotic features in human coronary artery disease.

Coronary plaque rupture remains the prominent mechanism of myocardial infarction. Accurate identification of rupture-prone plaque may improve clinical management. This study assessed the discriminatory performance of electrochemical impedance spectroscopy (EIS) in human cardiac explants to detect high-risk atherosclerotic features that portend rupture risk. In this single-center, prospective study, n = 26 cardiac explants were collected for EIS interrogation of the three major coronary arteries. Vessels in which advancement of the EIS catheter without iatrogenic plaque disruption was rendered impossible were not assessed. N = 61 vessels underwent EIS measurement and histological analyses. Plaques were dichotomized according to previously established high rupture-risk parameter thresholds. Diagnostic performance was determined via receiver operating characteristic areas-under-the-curve (AUC). Necrotic cores were identified in n = 19 vessels (median area 1.53 mm2) with a median fibrous cap thickness of 62 μm. Impedance was significantly greater in plaques with necrotic core area ≥1.75 mm2 versus <1.75 mm2 (19.8 ± 4.4 kΩ vs. 7.2 ± 1.0 kΩ, p = .019), fibrous cap thickness ≤65 μm versus >65 μm (19.1 ± 3.5 kΩ vs. 6.5 ± 0.9 kΩ, p = .004), and ≥20 macrophages per 0.3 mm-diameter high-power field (HPF) versus <20 macrophages per HPF (19.8 ± 4.1 kΩ vs. 10.2 ± 0.9 kΩ, p = .002). Impedance identified necrotic core area ≥1.75 mm2, fibrous cap thickness ≤65 μm, and ≥20 macrophages per HPF with AUCs of 0.889 (95% CI: 0.716-1.000) (p = .013), 0.852 (0.646-1.000) (p = .025), and 0.835 (0.577-1.000) (p = .028), respectively. Further, phase delay discriminated severe stenosis (≥70%) with an AUC of 0.767 (0.573-0.962) (p = .035). EIS discriminates high-risk atherosclerotic features that portend plaque rupture in human coronary artery disease and may serve as a complementary modality for angiography-guided atherosclerosis evaluation.

Evaluating mechanical benefit of wedge osteotomies in endoscopic surgery for sagittal synostosis using patient-specific 3D-printed models.

Endoscopically assisted sagittal strip craniotomy with subsequent cranial orthosis is a frequently used surgical approach for non-syndromic sagittal synostosis. Originally, this technique involved a wide sagittal strip craniectomy with bilateral wedge osteotomies. More recent studies suggest omitting wedge osteotomies, achieving similar outcomes. The controversy surrounding wedge osteotomies and our efforts to refine our technique led us to create models and evaluate the mechanical impact of wedge osteotomies. We conducted a 3D-print study involving preoperative CT scans of non-syndromic scaphocephaly patients undergoing minimally invasive-assisted remodelation (MEAR) surgery. The sagittal strip collected during surgery underwent thickness measurement, along with a 3-point bending test. These results were used to determine printing parameters for accurately replicating the skull model. Model testing simulated gravitational forces during the postoperative course and assessed lateral expansion under various wedge osteotomy conditions. The median sagittal strip thickness was 2.00mm (range 1.35-3.46mm) and significantly positively correlated (p = 0.037) with the median force (21.05 N) of the 3-point bending test. Model testing involving 40 models demonstrated that biparietal wedge osteotomies significantly reduced the force required for lateral bone shift, with a trend up to 5-cm-long cuts (p = 0.007). Additional cuts beyond this length or adding the occipital cut did not provide further significant advantage (p = 0.1643; p = 9.6381). Biparietal wedge osteotomies reduce the force needed for lateral expansion, provide circumstances for accelerated head shape correction, and potentially reduce the duration of cranial orthosis therapy.

Comparison of clinicopathological features and treatment outcomes for cutaneous melanomas of the head and neck and melanomas arising at other sites: Implications for systemic therapy

Melanoma is increasingly recognized as a heterogeneous disease, with conflicting evidence regarding whether cutaneous head and neck melanoma (CHNM) represents a distinct entity. Comparison of clinicopathological features and treatment outcomes of CHNM and cutaneous melanomas of other sites (CMOS). Patients with CHNM and CMOS diagnosed between 2000 and 2018 were included. Locoregional control, distant metastasis-free survival, melanoma-specific survival (MSS), and overall survival (OS) were described using the Kaplan-Meier method. Cox regression analyses were performed to examine associations between prognostic factors and outcomes. Additional analyses of survival from time of stage IV disease diagnosis were undertaken, stratified by receipt of BRAF-targeted therapy and immune checkpoint inhibitor immunotherapy. Of 3007 CHNM and 10,637 CMOS patients, CHNM had more adverse pathological features (median age 65.9 vs 58.5, P<.001; median Breslow thickness 1.7mm vs 1.2mm, P<.001; and ulceration 21.2% vs 18.2%, P<.001). CHNM had worse locoregional control (hazard ratio (HR) 1.17, P<.001) and distant metastasis-free survival (HR 1.25, P<.001) but there were no significant differences in MSS or OS. Among stage IV patients who received immune checkpoint inhibitor, CHNM had better MSS (HR 0.56, P=.001) and OS (HR 0.57, P<.001) on multivariable analyses. Retrospective study, offset by prospective data collection. CHNM is associated with a distinct clinicopathological and prognostic profile.

Thiel cadaver eye as a training model for sub-Tenon’s blocks: a feasibility study

BackgroundRegional anaesthesia education, especially for ocular procedures, necessitates reliable surgical training models. While cadaveric models offer anatomical fidelity, conventional embalming methods may compromise tissue integrity. We aimed to assess the effectiveness of Thiel cadavers for training in sub-Tenon’s blocks by evaluating ocular tissues and measuring insertion forces.MethodsExperimental design, using twenty eyes from ten Thiel cadaver heads. These cadavers were specifically prepared to test the administration of sub-Tenon’s blocks. The research was conducted in a controlled laboratory setting appropriate for handling cadaveric materials and conducting precise measurements. Each cadaver eye underwent an initial ultrasound examination, and its axial length was noted. An intravitreal injection of heptastarch solution followed, to re-establish the eye’s sphericity. After this volume injection, the axial length and intraocular pressure were measured again. Mock sub-Tenon’s blocks were administered in 2 separate quadrants of the eye, with insertion forces measured using a pressure gauge. These were compared to a data set of insertion forces measured in a series of isolated pig’s eyes on which STBs had been performed. Main outcome measurements were macroscopic assessment of the ocular tissue layers and the insertion forces required for the sub-Tenon’s blocks. In a second set of 10 Thiel cadaver heads, 5 ml of sodium chloride were injected as sub-Tenon’s blocks and the emergence of a periocular “T-sign” ascertained and measured by ultrasound.ResultsFour of twenty eyes (20%) retained near-natural sphericity, with the remaining requiring volume injection to approximate physiological shape and pressure. The conjunctiva and Tenon’s layer were intact, and correct cannula placement was achieved in all cases. In 16 of 20 eyes where T-signs could be measured, the median thickness of the T-sign amounted to 2.72 mm (range 1.34 mm–5.28 mm). The average maximum cannula insertion force was 2.92 Newtons. Insertion forces in intact Thiel cadaver heads were consistently higher than in isolated pig’s eyes (3.6 N vs 2.0 N).ConclusionThese findings suggest that Thiel cadavers are a promising model for training in sub-Tenon’sblocks, despite the challenge of often desiccated and involuted eyes.

Targeting the Tie-2 Receptor With Faricimab in Central Serous Chorioretinopathy: A Case Series Motivated by a Genetic Finding

PurposeTo investigate the effects of faricimab, a bispecific antibody targeting VEGF and Ang-2 (thus increasing Tie-2 activity), in patients with CSC based on a recent genetic study that implicated Tie-2 signaling in CSC pathophysiology. DesignA retrospective interventional multicenter case series. MethodsWe included patients with chronic CSC (persistent or recurrent SRF for ≥6 months) who received at least one faricimab 6mg injection between January 1 2022 and April 1 2024. Study sites included Massachusetts Eye and Ear and University of California San Francisco. Patients with evidence of a choroidal neovascular membrane on color photos, optical coherence tomography (OCT) and/or fluorescein angiography were excluded. 16 eyes (15 patients) met the inclusion criteria. The median central macular thickness at each visit from 52 weeks before to 52 weeks after the first faricimab injection was calculated using automated Heidelberg Spectralis ETDRS subfield measurements. ResultsPrior to treatment with faricimab, CSC had been diagnosed a median of 4.1 years (range 0.9–8) earlier and SRF (and intraretinal fluid [IRF] in a subset) had been continuously present for a median of 30 weeks (range 9–257). Decreases in macular thickness were observed in 14/16 eyes after the first faricimab injection and in 14/16 eyes in the full follow-up period compared with prior, 10 of which experienced complete resolution of SRF following the start of the first series of injections at a median of 4 weeks (range 2—25). One eye worsened after the second injection. The median improvement in macular thickness was 40μm [range -3 to 89.5] (P=0.0007). Upon review of OCT images, reductions in macular thickness were consistent with reductions in SRF and/or IRF. Visual acuity improved by 2 lines or more in 6/16 eyes. ConclusionsIn a retrospective case series of patients with chronic CSC and longstanding SRF, we observed improvement in macular thickness after intravitreal faricimab. While the small number of patients and variable natural history of CSC preclude definitive conclusions, a randomized controlled trial seems warranted.

Lnsights into Adjuvant Systemic Treatment Selection for Patients with Stage III Melanoma: Data from the Dutch Cancer Registry.

Patient demographics and shared decision making might influence the choice of adjuvant therapy for stage III melanoma. To identify factors for treatment selection of patients diagnosed with stage III melanoma to better understand current treatment decisions and improve further treatment counseling. Data from 2007 patients diagnosed with stage III melanoma, between December 2018 and 2021, sourced from the Dutch Cancer Registry, were analyzed. Among the cohort, 48.7% received no therapy, 45.8% received checkpoint inhibition, and 5.5% received targeted therapy (TT). Patients foregoing therapy were significantly older [67.0 years (range 53.0-77.0) vs. 62.0 year (range 52.0-72.0)], had poorer performance scores (PS), and higher Charlson Comorbidity Index scores compared to those receiving therapy (p<0.001). Patients undergoing therapy had significantly higher median Breslow thickness (3.3mm vs. 2.2mm) and higher prevalence of ulceration (49.9% vs. 38.1%). Those with connective tissue disease and/or congestive heart disease were more likely to receive TT [odds ration (OR) 8.1; 95% confidence interval (CI) 1.7-37.6 and OR 9.3; 95% CI 1.2-72.2, respectively]. Median treatment time among strata for disease recurrence was 4.26months (3.69-4.82) for immunotherapy and 3.1months (0.85-5.36) for TT (p=0.298). Patients who developed recurrent disease were equal across treatment types (p=0.656). The number of patients with grade 3 complications was different for each treatment type [immunotherapy: 17.8% vs. TT: 37.3% (p<0.001)]. Age, PS, and Breslow thickness seem to influence adjuvant treatment decisions. Clinicians' preference for immunotherapy might play a role in counseling BRAF-positive patients for adjuvant therapy, this however, cannot be confirmed in this dataset. Overall, only a small proportion of patients completed adjuvant treatment.

Pseudo-myometrial thinning in placental site trophoblastic tumors: a case series with multiparametric MRI.

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic neoplasm with few previous imaging case reports. We report multiparametric MRI findings in four cases of PSTT with special emphasis on the "pseudo-myometrial thinning" underlying the tumor. We reviewed multiparametric MRI and pathologic findings in four cases of PSTT from four institutions. Signal intensity, enhancement pattern, margins, and location of the tumors were evaluated, and myometrial thickness underlying the tumor and normal myometrial thickness contralateral to the tumor were measured on MRI. The myometrial thickness underlying the tumor was also measured in the resected specimen and compared with the myometrial thickness measured on MRI using the Friedman test. All tumors showed heterogeneous signal intensity on T1-weighted imaging, T2-weighted imaging (T2WI), and diffusion-weighted imaging. Three of the four tumors had a hypervascular area on dynamic contrast-enhanced (DCE) MRI. A hypointense rim on T2WI and DCE-MRI was seen in all tumors. All tumors protruded into the uterine cavity to varying degrees and extended into the myometrium close to the serosa. The myometrial thickness underlying the tumor measured on MRI (median thickness, 1.2mm) was significantly thinner than that measured on pathology (median thickness, 9.5mm) and normal myometrial thickness contralateral to the tumor on MRI (median thickness, 10.3mm) (P = 0.02), and there was no significant difference between the latter two. The thickness of the myometrium underlying the tumor on MRI was approximately one tenth of the thickness on pathology. Thus, the tumors appeared to have almost transmural invasion even when pathologically located within the superficial myometrium. This "pseudo-thinning" of the underlying myometrium and the hypointense rim on MRI could be caused by focal compression of the myometrium by the tumor, possibly due to the fragility of the myometrium at the placental site.

Comprehensive Characterization of Surface-Bound Proteins and Measurement of Fibrin Fiber Thickness on Extracorporeal Membrane Oxygenation Circuits Collected From Patients.

To characterize surface-bound proteins and to measure the thickness of fibrin fibers bound to extracorporeal membrane oxygenation (ECMO) circuits used in children. Single-center observational prospective study, April to November 2021. PICU, Royal Children's Hospital, Melbourne, Australia. Patients aged less than 18 years on venoarterial ECMO and without preexisting disorder. None. ECMO circuits were collected from six patients. Circuit samples were collected from five different sites, and subsequently processed for proteomic and scanning electron microscopy (SEM) studies. The concentration of proteins bound to ECMO circuit samples was measured using a bicinchoninic acid protein assay, whereas characterization of the bound proteome was performed using data-independent acquisition mass spectrometry. The Reactome Over-representation Pathway Analyses tool was used to identify functional pathways related to bound proteins. For the SEM studies, ECMO circuit samples were prepared and imaged, and the thickness of bound fibrin fibers was measured using the Fiji ImageJ software, version 1.53c ( https://imagej.net/software/fiji/ ). Protein binding to ECMO circuit samples and fibrin networks showed significant intra-circuit and interpatient variation. The median (range) total protein concentration was 19.0 (0-76.9) μg/mL, and the median total number of proteins was 2011 (1435-2777). A total of 933 proteins were commonly bound to ECMO circuit samples from all patients and were functionally involved in 212 pathways, with signal transduction, cell cycle, and metabolism of proteins being the top three pathway categories. The median intra-circuit fibrin fiber thickness was 0.20 (0.15-0.24) μm, whereas the median interpatient fibrin fiber thickness was 0.18 (0.15-0.21) μm. In this report, we have characterized proteins and fiber fibrin thickness bound to ECMO circuits in six children. The techniques and approaches may be useful for investigating interactions between blood, coagulation, and the ECMO circuit and have the potential for circuit design.

Comparison of different methods used in the classification of maxillary gingival phenotype: A diagnostic accuracy study.

This study aimed to evaluate the reliability and applicability of novel methods for determining gingival phenotypes and compare them with currently recommended methods. Six maxillary anterior teeth from 50 systemically and periodontally healthy patients were evaluated using two conventional methods (periodontal probe translucency method [PP] and transgingival measurement with an endodontic file [EF]), and two novel methods (colored biotype probe translucency method [CBP] and transgingival measurement with a Florida probe [FP]). All data were statistically analyzed. Intra-examiner reproducibility and inter-examiner reproducibility for all methods were analyzed using 10 randomly selected patients who were re-evaluated for each analysis. Moderate agreement was found between EF and PP, with statistically significant differences between median gingival thickness (GT) values for thick 0.8 mm (0.5-1.1 mm) and thin 1 mm (0.6-1.7 mm) phenotypes, and a threshold GT value of ≤0.92 mm (p < .001). FP and PP also showed moderate agreement, with statistically significant differences between median GT values for thick and thin phenotypes (0.80 mm [0.40-1.60 mm] and 0.89 mm [0.40-1.60 mm], respectively), and a threshold GT value of ≤0.8 mm (p < .001). PP and CBP values showed a substantial agreement (p < .001). A statistically significant difference was found between median EF values and CBP categories (p < .001); however, paired comparisons showed that the distinction was applicable only between thin and other phenotypes. Although CBP was found to be successful in detecting the thin phenotype, it was not successful in distinguishing between medium, thick, and very thick phenotypes; moreover, it did not appear to offer any advantages over PP. Although FP may be preferable to EF in measuring gingival thickness, the cost of FP is a disadvantage.

A novel imaging biomarker for prediction of cerebrovascular ischemic events: Pericarotid fat density

BackgroundTo investigate the relationship between pericarotid fat density measured in carotid CTA and vulnerable carotid plaque. MethodsThis retrospective study included 374 participants who underwent carotid CTA between June 1, 2021, and December 1, 2021 (234 males, median age 68 years [interquartile range: 61–75]). Two groups, symptomatic and asymptomatic, were defined based on either diffusion-weighted MRI or a clinical history of acute ischemia or TIA within 6 months before or after CTA. The relationship between pericarotid fat density and cerebrovascular ischemic events was assessed using receiver operating characteristic analysis and binary logistic regression analysis. ResultsIn the symptomatic group (n = 135), mean pericarotid fat density (−63.3 ± 21.7 vs. -81.7 ± 16.9 HU, respectively; p < 0.001) and median maximum plaque thickness (4 [interquartile range: 3–6] vs. 3.7 [interquartile range: 2.6–4.7] mm, respectively; p = 0.002) were higher, while plaque density (42.1 ± 19.6 vs. 50.6 ± 20.4 HU, respectively; p = 0.001) was lower compared to the asymptomatic group. Pericarotid fat density (OR: 1.038, 95% CI: 1.023–1.053, p < 0.001) was identified as an independent predictor for symptomatic patients. The optimal cut-off value for pericarotid fat density predicting symptomatic patients was estimated as −74 HU (area under the curve: 0.753, 95% CI:0.699–0.808, p < 0.001). Inter-reader agreement for pericarotid fat density was found to be almost perfect (intraclass correlation coefficient: 0.818, 95% CI: 0.770–0.856, p < 0.001). ConclusionPericarotid fat density may serve as an imaging biomarker in predicting acute cerebrovascular ischemic events.