Median Thickness Research Articles

Application of digital image correlation to study the influence of the water/cement ratio on the interfacial transition zone in cement-based materials

The interfacial transition zone (ITZ) has long been considered the weakest region in cement-based materials. In this paper, digital image correlation (DIC) technology was applied to measure the thickness and elastic modulus of the ITZ, and the influence of the water/cement (w/c) ratio on the ITZ is discussed. An axial compression loading test was conducted using specimens prepared with three w/c ratios. Based on the differences in the mechanical properties of each phase, the characteristics of the ITZ were calculated with DIC technology. The ITZ thickness was determined from the abrupt interval observed in the displacement curve, and the elastic modulus was calculated by fitting the slope of the stress–strain curve in the elastic stage. The results showed that DIC technology was feasible for measuring the properties of the ITZ. Specifically, the median ITZ thickness and median elastic modulus were determined to be approximately 65.78–83.19 μm and 1.73–3.92 GPa, respectively, which were in agreement with previous studies. Statistical analysis indicated that the ITZ thickness slightly increased with increasing w/c ratio, while its elastic modulus gradually decreased. When the w/c ratio exceeds a certain threshold, the properties of the ITZ tend to be consistent.

Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors

Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). Data from 2577 LLDs who underwent living donor hepatectomy (n=2511) or aborted living donor hepatectomy (n=66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n=446; 17.9%), adenomyomatosis (n=9), and papillary hyperplasia (n=6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n=207; 0.4%), cholelithiasis (n=53), cholesterol polyp (n=31), and noncholesterol polyp (n=19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P=.001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P=.015). The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.

Topography and Choroidal Thickness Measurement in Healthy Asian Indian Subjects using RTVue XR 100 Optical Coherence Tomography.

The purpose was to study the choroidal thickness and its profile, derived from different point locations in healthy Asian Indian subjects using RTVue XR 100 optical coherence tomography (OCT) and to determine its correlation with age, refractive error, and axial length. In this cross-sectional study, 300 eyes of 150 healthy subjects, with no ocular pathology, were scanned in a single session, using a line scan protocol of RTVue XR 100 OCT. Choroidal thickness was measured at the subfoveal region, and six measurements were obtained on either side of the fovea (temporal and nasal) at 500 μm interval apart, up to 3000 μm. The correlation between subfoveal choroidal thickness and age, refractive error, and axial length was assessed. Three hundred eyes of 150 healthy subjects were included in the analysis. Median age of the study participants was 55 years (interquartile range [IQR]: 44-61). The median subfoveal choroidal thickness was 235 μm (IQR: 210-263). The choroidal thickness was minimum at nasal 3000 μm from the fovea, while it was maximum in the subfoveal region. The point zones which were near the fovea showed thicker choroidal thickness than the outer zones, both nasally and temporally (P < 0.00001 at all locations), and at all point locations the choroid were thicker temporally than nasally (All P < 0.00001). Subfoveal choroidal thickness showed negative correlation with age (coefficient = -0.62, P = 0.03) and axial length (correlation = -8.52, P = 0.02). A decrease in subfoveal choroidal thickness of 0.62 μm/year was found by regression analysis. Our study provides normative database and topographic profile of choroidal thickness in the normal Asian Indian eyes using RTVue XR 100 OCT.

CHOROIDAL VASCULAR ALTERATIONS IN AGE-RELATED MACULAR DEGENERATION AND POLYPOIDAL CHOROIDAL VASCULOPATHY.

To evaluate morphologic alterations in choroidal veins in eyes with typical neovascular age-related macular degeneration (nAMD) and polypoidal choroidal vasculopathy (PCV). A retrospective review of baseline indocyanine green angiography in eyes with typical nAMD and PCV. We evaluated Haller layer veins in the early-phase indocyanine green angiography (before 2 minutes) for 1) macular anastomosis, 2) dilated Haller veins, and 3) focal variation in vessel caliber by at least 50% from the narrowest to largest diameters. We included 70 patients with gradable indocyanine green angiography for the prespecified features in the study eye (36 typical nAMD and 34 PCV) and 59 fellow eyes. The median subfoveal choroidal thickness was 167 µm versus 219 µm, P = 0.08, in the presenting eyes in typical nAMD and PCV, respectively. Macular anastomosis was common in both typical nAMD and PCV (presenting eyes 58.3% vs. 58.8%. P = 0.97; fellow eyes 65.5% vs. 63.3%, P = 0.86). Dilated Haller veins were numerically less common in typical nAMD than PCV (presenting eyes 52.8% vs. 67.6%, P = 0.21; fellow eyes 65.5% vs. 70.0%, P = 0.71), while vascular caliber variation was numerically more common in typical nAMD than PCV (presenting eyes 72.2% vs. 63.8%, P = 0.45; fellow eyes 69.0% vs. 56.7%, P = 0.33). The presence of all three features was more common in the presenting eyes with PCV compared with typical nAMD (35.3% vs. 13.9%, P = 0.03). In a multivariable analysis, every increase of 100 µm of CT conferred a 2.75 risk of having all three features present. Choroidal vascular remodeling is common in both tAMD and PCV but may be driven by different stimuli.

Risk of Harm in Needle Decompression for Tension Pneumothorax.

Tension pneumothorax (TPX) is the third most common cause of preventable death in trauma. Needle decompression at the fifth intercostal space at anterior axillary line (5th ICS AAL) is recommended by Tactical Combat Casualty Care (TCCC) with an 83-mm needle catheter unit (NCU). We sought to determine the risk of cardiac injury at this site. Institutional data sets from two trauma centers were queried for 200 patients with CT chest. Inclusion criteria include body mass index of =30 and age 18-40 years. Measurements were taken at 2nd ICS mid clavicular line (MCL), 5th ICS AAL and distance from the skin to pericardium at 5th ICS AAL. Groups were compared using Mann-Whitney U and chi-squared tests. The median age was 27 years with median BMI of 23.8 kg/m2. The cohort was 69.5% male. Mean chest wall thickness at 2nd ICS MCL was 38-mm (interquartile range (IQR) 32-45). At 5th ICS AAL, the median chest wall thickness was 30-mm (IQR 21-40) and the distance from skin to pericardium was 66-mm (IQR 54-79). The distance from skin to pericardium for 75% of patients falls within the length of the recommended needle catheter unit (83-mm). The current TCCC recommendation to "hub" the 83mm needle catheter unit has potential risk of cardiac injury.

New ultrasonographic risk assessment of uterine scar dehiscence in pregnancy after cesarean section

PurposeWe performed a new ultrasonographic risk assessment of uterine scar dehiscence, which is a potential risk factor for uterine rupture, in pregnancy after cesarean section. We attempted to shed light on the natural course of the change in the lower uterine segment by means of a longitudinal investigation through quantitative and qualitative evaluations.MethodsThis retrospective single-center study involved 31 women with a normal singleton pregnancy delivered by elective cesarean section between 2020 and 2021, with all women showing a “niche” in the lower uterine segments. The lower uterine segments were assessed qualitatively and quantitatively using transvaginal ultrasonography at 16–21, 22–27, and 28–33 weeks of gestation, and subjects were divided into two groups: those with uterine dehiscence (12 women) and those without uterine dehiscence (19 women), depending on the gross findings of the lower uterine segments at cesarean section. Analyses were performed using Wilcoxon’s rank-sum and Mann–Whitney U test with a significance level of P < 0.05.ResultsThe lower uterine segments changed from V-shaped to U-shaped to thin as gestation progressed and was more prominent in the uterine dehiscence group, occurring mostly at 22–27 weeks. At 22–27 weeks, the median myometrial thickness in the uterine dehiscence group was lower than in the group without uterine dehiscence (P = 0.0030). Thinning of the lower uterine segments had moved the cephalad at 22–27 and 28–33 weeks in cases with and without uterine dehiscence.ConclusionA model of morphological changes in the niche was constructed based on qualitative and quantitative assessments. The morphological changes and actual thinning of the lower uterine segments were prominent in the second trimester in women considered to have uterine scar dehiscence.

Elasticity evaluation of the plantar fascia: A shear wave elastography study involving 33 early-stage plantar fasciopathy subjects.

Background: Plantar fasciopathy, the most common foot condition seen in elderly and athletic populations, can be diagnosed and differentially diagnosed with imaging modalities such as ultrasound shear wave elastography (SWE). However, standard guidelines for ultrasound elastography of the plantar fascia are lacking. The purpose of this study was to determine the impact of the region of interest (ROI) on the evaluation of the plantar fascia elasticity and confirm the screening accuracy of SWE in the early-stage of plantar fasciopathy. Methods: This was an observational case‒control study involving 50 feet of 33 early-stage plantar fasciopathy subjects (the plantar fasciopathy group) and 96 asymptomatic feet of 48 healthy volunteers (the non-pain group). Clinical information, including age, gender, height, weight, visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Scale score (AOFAS), and the symptom duration, were recorded. All participants underwent both conventional ultrasound and SWE evaluation. The plantar fascia elastic parameters included SWEsingle-point, calculated with a single-point ROI set at the greatest thickness of the plantar fascia, and SWEmulti-point, calculated by multipoint ROIs set continuously from the origin at the calcaneus to about 2cm from the calcaneal origin. Results: The plantar fasciopathy group presented a higher VAS score (median [IQR), 4.00 (3.00) vs. 0.00 (0.00), p < 0.001] and lower AOFAS score [median (IQR), 79.50 (3.00) vs. 100.00 (10.00), p < 0.001] than the non-pain group. The median plantar fascia thickness of the plantar fasciopathy group was significantly greater than that of the non-pain group [median (IQR), 3.95 (1.37)mm vs 2.40 (0.60)mm, p < 0.001]. Abnormal ultrasound features, including echogenicity, border irregularities, and blood flow signals, were more prominent in the plantar fasciopathy group than in the non-pain group (29% vs. 0%, p < 0.001; 26% vs. 1%, p < 0.001; 12% vs. 0%, p < 0.001, respectively). Quantitative analysis of the plantar fascia elasticity revealed that the difference between the value of SWEsingle-point and SWEmultipoint was significant [median (IQR), 65.76 (58.58) vs. 57.42 (35.52)kPa, p = 0.02). There was a moderate and significant correlation between the value of SWEsingle-point and heel pain. However, there was no correlation between the value of SWEmultipoint and heel pain. Finally, we utilized the results of SWEsingle-point as the best elastic parameter reflecting clinical heel pain and found that SWEsingle-point could provide additional value in screening early-stage plantar fasciopathy, with an increase in sensitivity from 76% to 92% over conventional ultrasound alone. Additionally, compared with conventional ultrasound and SWE, the use of both improved the accuracy of screening for plantar fasciopathy. Although there were no significant differences in the negative predictive value of conventional ultrasound, SWE, and their combination, the positive predictive value when using both (90.20%) was significantly greater than that when using conventional ultrasound (74.50%) or SWE alone (76.50%). Conclusion: The plantar fascia elastic parameter calculated with single-point ROIs set at the greatest thickness of the plantar fascia is positively correlated with fascia feel pain. Single-point analysis is sufficient for the screening of the early-stage plantar fasciopathy using SWE. SWEsingle-point may provide additional valuable information for assessing the severity of plantar fasciopathy.

Pulmonary Vascular Remodeling and Prognosis in Patients Evaluated for Heart Transplantation: Insights from the OCTOPUS-CHF Study.

In patients with advanced heart failure, the intravascular optical coherence tomography (OCT) of subsegmental pulmonary artery measurements is correlated with right heart catheterization parameters. Our aim was to study the prognostic value of pulmonary OCT, right heart catheterization data, and the echocardiographic estimation of pulmonary pressure in patients studied for elective heart transplants. This research is an observational, prospective, multicenter study involving 90 adults with a one-year follow-up. A total of 10 patients (11.1%) died due to worsening heart failure before heart transplantation, 50 underwent a heart transplant (55.6%), and 9 died in the first year after the transplant. The patients with and without events (mortality or heart failure-induced hospitalization) had similar data regarding echocardiography, right heart catheterization, and pulmonary OCT (with a median estimated pulmonary artery systolic pressure of 42.0 mmHg, interquartile range (IQR) of 30.3-50.0 vs. 47.0 mmHg, IQR 34.6-59.5 and p = 0.79, median pulmonary vascular resistance of 2.2 Wood units, IQR 1.3-3.7 vs. 2.0 Wood units, IQR 1.4-3.2 and p = 0.99, and a median pulmonary artery wall thickness of 0.2 ± 0.5 mm vs. 0.2 ± 0.6 mm and p = 0.87). Pulmonary vascular remodeling (evaluated with echocardiography, right heart catheterization, and pulmonary OCT) was not associated with prognosis in a selected sample of adults evaluated for elective heart transplants. Pulmonary OCT is safe and feasible for the evaluation of these patients.

Accuracy and precision when deriving sea-ice thickness from thermistor strings: a comparison of methods

A precise knowledge of landfast sea-ice (fast-ice) thickness is relevant to many different disciplines. Sea Ice Monitoring Stations (SIMS) are used to measure time series of fast-ice thickness at a location. SIMS measure ice and ocean temperature via thermistor strings with many different methods for extracting sea-ice thickness from temperature existing. This study investigates: if thickness results from temperature recorded by SIMS of different designs, and analysed with different methods are comparable; which methods are recommended for their robustness, precision and accuracy and how they compare to independent thickness measurements; how otherwise unuseable data can be salvaged through specific SIMS designs. We present an analysis of fast-ice thickness calculated from SIMS deployed in McMurdo Sound, Antarctica and in the Chukchi Sea near Utqiaġvik, Alaska, over two decades. We find that median thicknesses derived by different methods agree within 1 ± 1.5 cm for McMurdo Sound and 2 ± 3 cm for Utqiaġvik. Thus, it is possible to confidently compare data collected from different stations and analysed with different methods. The vertical gradient of sea-ice temperature gives the best results for fast-ice thickness during the growth season and including standard resistors in a thermistor string can reduce potential data loss due to noise.

Hippocampal subregional thinning related to tau pathology in early stages of Alzheimer’s disease

AbstractBackgroundSubregions in the medial temporal lobe (MTL) are affected early by Alzheimer’s disease (AD) pathology and subject to grey matter atrophy. Measuring the earliest AD‐related atrophy in the hippocampus is challenging as region‐of‐interest (ROI) analyses of hippocampal subregional volumes collapse across voxels within anatomical subregions. PET imaging studies, however, report accumulation of tau pathology between anatomical subregions in the earliest disease stages (Berron et al., 2021) fitting reports from the neuropathological literature (Lace et al., 2019; Ravikumar et al., 2021). Thus, sensitive in vivo methods of point‐wise structural measures are needed in order to detect the earliest hippocampal thinning in AD along the anterior‐posterior as well as the medial‐lateral hippocampal axis.MethodHere we analyzed data from 76 amyloid‐beta negative (Ab‐) cognitively normal (CN), 46 Ab+ CN individuals and 25 Ab+ patients with mild cognitive impairment (MCI) from the BioFINDER‐2 study, who underwent 7 Tesla T2‐weighted structural magnetic resonance imaging, tau positron emission tomography imaging (using 18F‐RO‐948) and cognitive assessments. First, we segmented hippocampal subfields and extrahippocampal subregions. Second, we calculated point‐wise hippocampal thickness estimates (Diers et al.) of hippocampal subfields subiculum, cornu ammonis (CA)1, CA2 and CA3 on the level of the hippocampal body. Thirdly, we extracted local tau‐PET SUVR from Area 35 (A35), entorhinal cortex and amygdala. Finally, we assessed relationships between hippocampal local thickness and tau accumulation as well as cognitive performance.ResultOur analyses revealed earliest hippocampal thinning associated with tau accumulation in an area spanning the boundary of subiculum and CA1 at the level of the anterior hippocampal body. Ab+ MCI patients showed more posterior thinning in comparison to Ab‐ CU participants. Median thickness in an ROI comprising vertices with A35 tau‐related thinning (A35‐TauThinning‐ROI) was significantly lower in MCI Ab+ and tended to be lower in CU Ab+ compared to CU Ab‐. Higher median thickness in the hippocampal A35‐TauThinning‐ROI, but not whole CA1 nor subiculum thickness, was associated with better 10‐Word‐Delayed‐Recall and higher PACC scores.ConclusionOur results suggest that tau‐related thinning of hippocampal subregions can be observed already in early disease stages. Tau‐related point‐wise thickness measures were more sensitive compared to volumetric measures of anatomical subregions.

Hippocampal subregional thinning related to tau pathology in early stages of Alzheimer’s disease

AbstractBackgroundSubregions in the medial temporal lobe (MTL) are affected early by Alzheimer’s disease (AD) pathology and subject to grey matter atrophy. Measuring the earliest AD‐related atrophy in the hippocampus is challenging as region‐of‐interest (ROI) analyses of hippocampal subregional volumes collapse across voxels within anatomical subregions. PET imaging studies, however, report accumulation of tau pathology between anatomical subregions in the earliest disease stages (Berron et al., 2021) fitting reports from the neuropathological literature (Lace et al., 2019; Ravikumar et al., 2021). Thus, sensitive in vivo methods of point‐wise structural measures are needed in order to detect the earliest hippocampal thinning in AD along the anterior‐posterior as well as the medial‐lateral hippocampal axis.MethodHere we analyzed data from 76 amyloid‐beta negative (Ab‐) cognitively normal (CN), 46 Ab+ CN individuals and 25 Ab+ patients with mild cognitive impairment (MCI) from the BioFINDER‐2 study, who underwent 7 Tesla T2‐weighted structural magnetic resonance imaging, tau positron emission tomography imaging (using 18F‐RO‐948) and cognitive assessments. First, we segmented hippocampal subfields and extrahippocampal subregions. Second, we calculated point‐wise hippocampal thickness estimates (Diers et al.) of hippocampal subfields subiculum, cornu ammonis (CA)1, CA2 and CA3 on the level of the hippocampal body. Thirdly, we extracted local tau‐PET SUVR from Area 35 (A35), entorhinal cortex and amygdala. Finally, we assessed relationships between hippocampal local thickness and tau accumulation as well as cognitive performance.ResultOur analyses revealed earliest hippocampal thinning associated with tau accumulation in an area spanning the boundary of subiculum and CA1 at the level of the anterior hippocampal body. Ab+ MCI patients showed more posterior thinning in comparison to Ab‐ CU participants. Median thickness in an ROI comprising vertices with A35 tau‐related thinning (A35‐TauThinning‐ROI) was significantly lower in MCI Ab+ and tended to be lower in CU Ab+ compared to CU Ab‐. Higher median thickness in the hippocampal A35‐TauThinning‐ROI, but not whole CA1 nor subiculum thickness, was associated with better 10‐Word‐Delayed‐Recall and higher PACC scores.ConclusionOur results suggest that tau‐related thinning of hippocampal subregions can be observed already in early disease stages. Tau‐related point‐wise thickness measures were more sensitive compared to volumetric measures of anatomical subregions.

Ultrasonographic features of the endometrium following successful medical termination of early pregnancy

ObjectiveUltrasonographic features of the endometrium are often assessed when deciding the necessity of surgical intervention following early medical abortion. Knowledge is therefore needed on the ultrasonographic appearance of the endometrium following successful medical abortion in order to avoid unnecessary surgical interventions. We aimed to assess endometrial thickness and echogenicity at multiple time points following successful early medical abortion. Study designWe conducted a retrospective study in the largest office-based abortion providing clinic in Denmark. Using archived ultrasonographic images, we assessed endometrial thickness and echogenicity following all early medical abortions that did not need surgical intervention or repeated medication for completion during the years 2014–2017. ResultsUltrasonographic endometrial features were assessed 1854 times following 1074 early medical abortions. Median endometrial thickness in the 1st week from induction was 13 milimeters (mm; lower-upper quartile 11–17 mm). For the 2nd, 3rd, 4th, and >4th week, the median endometrial thickness was found to be 11 mm (9–15 mm), 11 mm (8–14 mm), 12 mm (9–16 mm), and 11 mm (8–14 mm), respectively.Of the ultrasonographic examinations performed in the 1st week from medical induction, 24.7 % showed a heterogenous endometrium. For 2nd, 3rd, 4th, >4th week, the frequency of heterogeneity was 23.9 %, 16.3 %, 21.3 %, 18.9 %, respectively.A total of 151 abortions (14.1 %) were each examined three times, median time of examination being day 7, 15, and 26 following induction. Among these abortions, the three most common patterns of change in endometrial thickness were “decreasing” (37.7 %), “increasing-decreasing” (23.2 %), and “decreasing-increasing” (21.9 %). Further, 49.7 % of the 151 abortions showed a homogenous endometrium at all three examinations, 17.2 % showed a heterogenous endometrium at first examination and a homogenous endometrium the following two examinations, and 9.9 % showed a heterogenous endometrium at the first two examinations followed by a homogenous endometrium. ConclusionIn early medical abortions completed without secondary intervention, endometrial thickness and echogenicity varied clinically significantly for weeks following the medical induction. Every possible pattern of change in endometrial thickness and echogenicity was observed.

Minimally invasive fibrinolytic treatment and drainage in patients with acute subdural hemorrhage and underlying comorbidities.

The incidence of acute subdural hemorrhage (ASDH), which is often caused by head trauma, is steadily increasing due to an increase in the elderly population and the use of anticoagulants. Urgent surgical treatment is recommended if the patient has impaired consciousness, worsening neurological symptoms, or brain midline shift (MLS) due to large hematomas on brain computed tomography (CT). Although large craniotomy is traditionally recommended for ASDH removal, old age, comorbidities, and antiplatelet drugs are considered risk factors for surgical complications, many neurosurgeons hesitate to perform aggressive surgical procedures in these patients. In this study, we introduced a method that can quickly and effectively remove ASDH without general anesthesia. We retrospectively reviewed 11 cases of patients with ASDH who underwent hematoma drainage between June 2019 and December 2020. We measured the maximum subdural hematoma thickness and MLS on brain CT of patients and recorded the Glasgow Coma Scale scores before and after the surgical procedure. All patients had multiple comorbidities, and seven patients received anticoagulant or antiplatelet therapy. On initial brain CT, the median subdural hemorrhage thickness was 21.36 mm, median MLS was 10.09 mm, and mean volume of the subdural hematoma was 163.64 mL. The mean evacuation rate of the subdural hematoma after drainage was 83.57%. There was no rebleeding or operation-related infection during the aspiration procedure, and the median MLS correction after the procedure was 7.0 mm. Our treatment strategies can be a reliable, less invasive, and alternative treatment option for patients at high risk of complications due to general anesthesia or patients who are reluctant to undergo a large craniotomy due to a high bleeding tendency.

Abstract 13069: Left Atrial Mechanics in Patients With Hypertrophic Cardiomyopathy

Background: Patients with hypertrophic cardiomyopathy (HCM) frequently have diastolic dysfunction (DD) characterized by elevated filling pressures. Speckle-tracking analysis of the left atrium (LA) is an imaging tool for quantifying DD, however, its value in HCM is not well established. Methods. Transthoracic echocardiographic images of consecutive HCM patients with a septal thickness ≥15 mm and no aberrant loading conditions at an academic tertiary care center were evaluated. Peak atrial longitudinal strain (PALS) was determined by averaging the atrial strain over all segments in the 4- and 2-chamber views ( Figure ). Results. Among 205 HCM patients, 108 patients (52 years, 40% female) had sinus rhythm and sufficient image quality to be included. The median interventricular wall thickness was 20 mm (IQR 17-23), the relative wall thickness ratio was 0.65 mm (IQR 0.46-0.87), and the LV mass index was 164.0 g/m 2 (IQR 131.5-188.5). The mean PALS was 18.5% (± 8.8%) and did not differ between men and women. PALS significantly (all p &lt;0.05) correlated with septal thickness (r=-0.31), LA volume index (r=-0.60), E/A ratio (r=-0.25), E/E’ (r=-0.63), systolic pulmonary pressure (r=-0.31), and high sensitivity troponin-T levels (r=-0.43). Moreover, PALS correlated with resting gradients in patients with relevant LV outflow tract obstruction (n=53 [49%]; r=-0.29). Among patients who underwent cardiac magnetic resonance imaging (81%), PALS was significantly correlated with LA ejection fraction (r=0.59) and late gadolinium enhancement of the total LV mass (r=-0.42). In addition, PALS was the only echocardiographic parameter reflecting DD that was significantly associated with the presence of LGE (Odds Ratio 0.93, 95%CI 0.88-0.99). Conclusion. PALS is a useful tool for quantifying DD in HCM patients and is associated with the presence of LGE. Future research will need to evaluate its significance in early identification of HCM patients at risk of sudden cardiac death.

Pararenalfat Tissue: Rate of Pararenal Obesity and Relation with Anthropometric Indices of Obesity

Aim. To study a rate of excessive pararenal fat tissue (PRFT) thickness and its relationship with anthropometric obesity indices.Material and methods. 372 patients (152 men and 220 women) were included in the study, the average age was 63.5±13.3 years. There were measured: height, weight, waist circumference (WC), hip circumference (HC), body mass index (BMI), WC/height ratio, sagittal abdominal diameter (SAD), body fat percentage (BFP), body surface area (BSA), body adiposity index (BAI) and visceral obesity index (VAI). All subjects underwent abdominal multispiral computed tomography. PRFT thickness was detected on a single slice at the level of the left renal vein.Results. 27% of the examined group had BMI&lt;25 kg/m2, 28% – excessive body mass, 45% – obesity. The median PRFT thickness was 1.61 (1.03; 2.46) cm. There were correlations between PRFT thickness and glucose (r=0,64, p&lt;0,05) and uric acid (r=0,46, p&lt;0,05) levels. The threshold of referential PRFT thickness was 1,91cm. The rate of pararenal obesity was 9,9% among those with normal body mass, 29,3% in excessive body mass, 66,1% – in 1 class obesity, 67,7% – in 2 class, and 90,1% – in 3 class. The correlation analysis revealed a significant positive correlation between the PRFT thickness and obesity indices with exception of VAI and BAI: with BMI (r=0.43, p&lt;0.05), WC (r=0.57, p&lt;0.05), SAD (r=0.58, p&lt;0.05), BFP (r=0.48, p&lt;0.05), WC/height ratio (r=0.46, p&lt;0.05), and BSA (r=0.58, p&lt;0.05).Conclusion. Excessive PRFT may be detected isolated without any external anthropometric signs of obesity, wherein it is an active component of metabolic disorders typical for obesity. The most significant indices for the detection of pararenal obesity may be WC, SAD, and BSA.

OPTICAL COHERENCE TOMOGRAPHY FEATURES IN IDIOPATHIC NONINFECTIOUS INTERMEDIATE, POSTERIOR, OR PANUVEITIS.

To characterize optical coherence tomography features in patients with idiopathic intermediate, posterior, or panuveitis. This is a retrospective case series of all consecutive cases of idiopathic intermediate, posterior, or panuveitis at four tertiary care centres between 2010 and 2021. A total of 94 eyes (55 patients) were followed for an average duration of 29.8 (SD 21) months. The median central macular thickness was 284 µ m at baseline and 267 µ m at last follow-up. At baseline and last follow-up, respectively, 24% and 20% of uveitic eyes had intraretinal fluid, 12% and 1% subretinal fluid, and 43% and 54% epiretinal membrane. In addition, ellipsoid zone abnormalities on en-face were noted in 34% and 19% of cases at baseline and last follow-up, respectively. The baseline median visual acuity was significantly lower among cases with ellipsoid zone en-face slab abnormalities compared with those without (0.2 logarithm of minimum angle of resolution [interquartile range: 0-0.6] vs. 0.1 logarithm of minimum angle of resolution [interquartile range: 0-0.3], P = 0.0051). With initiation of treatment, the central macular thickness, intraretinal fluid, subretinal fluid, and ellipsoid zone en-face abnormalities improved over time, whereas the number of cases with epiretinal membrane increased among eyes with idiopathic intermediate, posterior, and panuveitis. Presence of ellipsoid zone en-face abnormalities at presentation may be associated with worse visual acuity.

Soft tissue augmentation with a volume-stable collagen matrix or an autogenous connective tissue graft at implant sites: Five-year results of a randomized controlled trial post implant loading.

Interventions to augment the mucosal thickness around dental implants are indicated to optimize esthetics and maintain peri-implant health. However, there is a lack of clinical data on the long-term performance of soft tissue substitutes, such as volume-stable collagen matrix (VCMX), compared to autogenous grafts, such as subepithelial connective tissue grafts (SCTGs). This randomized controlled trial aimed to assess 5-year data on clinical and radiographic outcomes at implant sites previously augmented with VCMX or SCTG. Twenty patients were randomly assigned for soft tissue augmentation with VCMX or SCTG at single implant sites. Following abutment connection, final restorations were inserted (baseline; BL) and patients were reexamined up to 5 years (FU-5). Measurements included clinical data, marginal bone levels, mucosal thickness, and ridge contour changes. Nonparametric tests and estimates were applied for the statistical analysis. The median buccal mucosal thickness increased by 0.3mm (Q1: -0.8; Q3: 1.0) in the VCMX group (P=0.656) and 0.3mm (Q1: 0.0; Q3: 1.0) in the SCTG group (P=0.188) between BL and FU-5 (intergroup P=0.752), while the ridge contour decreased by a median of -0.3mm (-0.9; -0.1) (P=0.078) for VCMX and -0.3mm (-0.4; -0.2) (P=0.039) for SCTG (intergroup P=0.817). Peri-implant health was maintained in both groups with stable clinical and radiographic outcomes and without significant differences between the treatments. Despite the limited power and considerable dropout rate in the present study, soft tissue augmentation at implant sites with either VCMX or SCTG resulted in similar stable peri-implant tissues, favorable esthetics, and clinically negligible contour changes at 5 years post loading.

Predictors of Lymph Node Involvement in Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy

<h3>Purpose/Objective(s)</h3> Following neoadjuvant chemoradiotherapy (NART), some rectal cancer patients may have pathologic lymph node involvement (ypN+) despite complete response in the primary tumor, and should not be candidates for non-operative management. The aim of this study was to determine risk factors for ypN+ in rectal cancer patients treated with NART. <h3>Materials/Methods</h3> Data of rectal cancer patients treated with NART followed by surgery were evaluated. Patients with synchronous colon cancer, radiotherapy to surgery interval longer than 13 weeks, and those without lymph node (LN) dissection were excluded from the analysis. 92 patients were included. Median age was 59 (30-83). Female/male ratio was 35/57. Tumor location was proximal, mid- and distal rectum in 3, 45 and 44 patients, respectively. Tumor histology was adenocarcinoma in 79 patients, signet ring cell in 6 and mucinous carcinoma in 7. Clinical T stage was T2, T3 and T4 in 3, 81 and 8 patients, respectively. 90 patients had clinical LNs larger than 4 mm (10-34 mm: n=46). Median tumor and LNs SUV_max were 15 (3.9-46) and 2 (0.5-17.6), respectively. Median tumor GTV was 73 (28.9-370) ml. Median tumor length and thickness were 6 (3-14) cm and 16.5 (7-30) mm, respectively. All patients received 56 Gy to the primary tumor and 50.4 Gy to the lymph node regions, simultaneously in 28 fractions, and concurrent capecitabine. 27 patients had ypN+. Clinical and radiological features at initial presentation were analyzed to predict ypN+ using Chi-square or Mann-Whitney U tests. Logistic regression analysis was performed to determine the factors affecting ypN+. ROC analysis was performed to determine the cutoff values. <h3>Results</h3> Age (p=0.027), tumor SUV_max (p=0.001), largest clinical LN size (p=0.007) and number of LNs ≥10 mm in diameter (p=0.033) were significantly different between ypN0 and ypN+ patients in univariate analysis (Table). Only tumor SUV_max (HR (%95 CI): 0.828 (0.731-0.937), p=0.003) and largest clinical LN size (HR (%95 CI): 1.338 (1.023-1.750), p=0.033) were significant in multivariate analysis. Area under the ROC analysis curve (AUC) to determine ypN+ was 68.8% for LN size and 79.3% for tumor SUV_max. Cutoff values of LN size and tumor SUV_max for ypN+ were 10.5 mm (p=0.005) and 12.57 (p<0.001), respectively. Although ypN+ rates were higher in patients with signet ring cell (83%) and mucinous (43%) histology compared to adeno carcinoma (24%), it was not statistically significant. <h3>Conclusion</h3> Rectal cancer patients with lower tumor SUV_max and larger clinical lymph nodes at initial presentation are more likely to have pathologic lymph node involvement following neoadjuvant chemoradiotherapy.

Gynecologic Melanoma: A 25-Year Institutional Experience

<h3>Purpose/Objective(s)</h3> Melanoma of the gynecologic tract is a rare malignancy with poor outcomes. We sought to describe clinicopathological features, patterns of care, and outcomes in a large cohort of patients (pts) with this diagnosis treated at our institution. <h3>Materials/Methods</h3> Using an institutional pathology database we identified 141 pts with gynecologic melanoma treated 1995-2021. Clinicopathologic variables were described and time to outcome was calculated by the Kaplan-Meier method. <h3>Results</h3> Median age was 62 years (IQR 54-70). Primary tumors were located at the vulva (n=97, 69%), vagina (n=34, 24%) or cervix (n=10, 7%). Of the 123 pts with known primary tumor pathology, median tumor thickness was 5.0 mm (IQR 1.8-7.1 mm), 72% had ulceration (n=88), 21% had PNI (n=26), 28% had LVI (n=35), 6% had microsatellitosis (n=7) and 42% had a component of melanoma-in-situ (MIS, n=52) with 15% (n=21) having multifocal disease at presentation. Most pts had locally confined disease at diagnosis (n=110, 78%). Nine percent (n=13) had clinically involved nodes without distant metastasis (DM) and 13% had DM (n=18). At presentation 29 pts (21%) had unresectable disease, 2 of whom had surgery after response to neoadjuvant systemic therapy. Of the 112 pts with resectable disease, 77% (n=86) had nodal sampling with 40% of those (n=34) having pathologically positive nodes. Of the 105 pts with known margins: 47% R0 (n=49), 29% MIS+ (n=30), 21% R1 (n=22) and 4% R2 (n=4). Twenty-seven pts (23% resected) received neoadjuvant systemic therapy (11 pts at diagnosis and 16 pts at recurrence). Immune checkpoint inhibitors (ICI) were the most common class (67%, n=18). Ten pts (37%) had imaging or pathologic evidence of response to neoadjuvant therapy (6 ICI, 2 chemotherapy and 2 targeted therapy). Forty-three pts (37% resected) received adjuvant systemic therapy at the time of initial resection. Thirty-nine pts (28%) received pelvic RT during their treatment course. The primary tumor bed was the target for all except 2 pts who received RT to unilateral inguinal nodes and 1 pt who received RT to a pelvic sidewall mass. The timing of RT was: 1 neoadjuvant (3%), 15 adjuvant (38%), 14 to gross disease without DM (36%) and 9 to gross disease with DM (23%). The most common adjuvant regimens were 30 Gy in 5 fractions (n=6) or 48 Gy in 20 fractions (n=3). Of 141 pts, 79 (56%) were diagnosed after 2014, the era during which ICI were used. Median follow-up of those diagnosed pre-2014 was 98 months (mo, IQR 54-111 mo) and post-2014 was 39 mo (IQR 26-50 mo). Pre- vs. post-2014 3-year actuarial event rates were not significantly different with 59% vs. 49% local control (p=0.52); 56% vs. 60% nodal control (p=0.78); 45% vs. 34% DM-free survival (p=0.11); 25% vs. 20% disease-free survival; and 55% vs. 56% melanoma-specific survival (p=0.55). <h3>Conclusion</h3> Gynecologic tract melanoma outcomes continue to be poor with a significant need for improved treatment options, both in terms of pelvic and distant disease control.

Evaluating Anatomic Conformity of 3D Printer-Assisted Thermoplastic Bolus: A Novel Approach to Patient-Specific Bolus Generation

<h3>Purpose/Objective(s)</h3> To assess the anatomic conformity of custom thermoplastic boluses generated based on patient-specific 3D-printed molds. <h3>Materials/Methods</h3> A retrospective review of consecutive cases of 3D printer-assisted custom thermoplastic bolus was performed. For each case, target volume-specific contours (molds) were generated using computed tomography-based (CT) simulation scans in a treatment planning system. Molds were exported into a standard tessellation language (STL) file for rapid manufacturing on a 3D Printer using polylactic acid (PLA) filament. STL files were converted into G-code script and printed on slicer settings of 220°C nozzle temperature, 0.3 mm layer height, and 20% infill. The thickness of the thermoplastic bolus utilized was based on the treating radiation oncologist's prescription and ranged between 5.0 and 10.0 mm. Once heated, thermoplastic boluses were shaped using the 3D printed target volume-specific PLA molds. The quality of 3D printer-assisted thermoplastic boluses was confirmed on CT scanners before clinical use. Anatomic conformity of the boluses was quantified as mean/standard deviation (SD) of bolus-to-body air gap measured at five points equidistant from the center of the target volume. These isocentric points were assessed on first-fraction cone-beam CT scans. <h3>Results</h3> From September 2018 to January 2022, 13 3D printer-assisted thermoplastic boluses were generated for treatment to the scalp (4), nose (6), anus (2), and vulva (1) with a median dose of 50.0 Gy (range 24-70) and median of 20.0 fx prescribed (range 5-35). All treatments were 6MV/MeV with a median bolus thickness of 5.0 mm (range 5.0-10.0). The mean air gap visualized was 2.0 mm (range 0.0-6.8) ± 0.16 SD. Based on Malone Bolus Fit Classification System (excellent: no gap; good: <5 mm; tolerable: 5-10mm; poor: >10 mm), 12 cases were considered "good fit" with one case categorized as "excellent fit" with no notable air gaps. <h3>Conclusion</h3> This novel approach in generating 3D printer-assisted thermoplastic boluses allows for rapid offline manufacturing of patient-specific boluses without sacrificing quality in anatomic conformity.