Midsagittal Research Articles

Free Vibration Analysis of Trapezoidal Bi-Stable Laminates Supported at the Elastic Midpoint of the Median Line

This study investigates the natural vibration of trapezoidal bi-stable laminates (TBL) with elastic supports at the midpoints of the median lines. Configuration of the midplane of the TBL is expressed by a polynomial with 17 parameters. Then, the first order shear deformation theory, curing temperature, and nonlinear strain displacement relations combining energy principles are applied to obtain the bi-stable shapes numerically. Three translational springs and two rotational springs are added at the midpoint of the median line in the trapezoidal bi-stable laminate to acquire elastic point supports. And, by varying the stiffness of the springs, arbitrary elastic point support boundary conditions can be achieved. Chebyshev polynomials are applied to characterize the mode shape function of the TBL. The vibration mode functions of the TBL are mapped to a square area under the new coordinate system by using the coordinate mapping method. Furthermore, the effects of geometry, layup sequence, and spring stiffness on the natural vibrations of the TBL are analyzed, which provides a reference for research in this field. The innovation and highlights lie in the following: (1) the natural frequencies and modes of trapezoidal bi-stable plates are solved; (2) arbitrary elastic support is achieved by a set of artificial springs; (3) the influences of spring stiffness, layer sequence, and trapezoidal base angle on the natural vibration of a trapezoidal bi-stable plate are studied.

The axial and sagittal CT values of the 7th thoracic vertebrae in screening for osteoporosis and osteopenia

To evaluate the difference in computed tomography (CT) attenuation value of different planes of the 7th thoracic vertebra and investigate the efficacy of axial and sagittal vertebral CT measurements in predicting osteoporosis. Patients who underwent routine chest CT and dual-energy X-ray absorptiometry (DXA) within 1 month were included in this retrospective study. The CT attenuation values of different planes were compared. Logistic regression and receiver operating characteristic (ROC) were used to analyse the difference of each plane in the diagnosis of osteoporosis. The study included 1,338 patients (mean age of 61.9±11.9; 54% female). The CT attenuation values decreased successively in the normal group, osteopenia group, and osteoporosis group. The paired t-test results showed that the mid-axial measurements were greater than mid-sagittal measurements, with a mean difference of 9 HU, the difference was statistically significant (p<0.001, 95% confidence interval [CI]=7.8-10.1). For each one-unit reduction in mid-sagittal CT attenuation value, the risk of osteopenia or osteoporosis increased by 3.6%. To distinguish osteoporosis from non-osteoporosis (osteopenia+normal), the sensitivity was 90% and the specificity was 52.4% at the mid-sagittal threshold of 113.7 HU. The CT attenuation values of mid-sagittal plane have higher diagnostic efficacy than axial planes in predicting osteoporosis. For patients with a sagittal CT attenuation value of <113.7 HU in the T7, further DXA examination is warranted.

A valuable subarachnoid space named the occipito-atlantal cistern

The cisterna magna has been defined as the space between the inferior margin of the cerebellar vermis to the level of the foramen magnum, while an enlarged dorsal subarachnoid space at the occipito-cervical junction extending from the foramen magnum to the upper border of the axis (C2) is still ignored. Recently, the myodural bridge complex is proved to drive the cerebral spinal fluid flowing via this region, we therefore introduce the “occipito-atlantal cistern (OAC)” to better describe the subarachnoid space and provide a detailed rationale. The present study utilized several methods, including MRI, gross anatomical dissection, P45 sheet plastination, and three-dimensional visualization. OAC was observed to be an enlarge subarachnoid space, extending from the foramen magnum to the level of the C2. In the median sagittal plane, OAC was a funnel shape and its anteroposterior dimensions were 15.92 ± 4.20 mm at the level of the C0, 4.49 ± 1.25 mm at the level of the posterior arch of the C1, and 2.88 ± 0.77 mm at the level of the arch of the C2, respectively. In the median sagittal plane, the spino-dural angle of the OAC was calculated to be 35.10 ± 6.91°, and the area of OAC was calculated to be 232.28 ± 71.02 mm2. The present study provides OAC is a subarachnoid space independent from the cisterna magna. Because of its distinctive anatomy, as well as theoretical and clinical significance, OAC deserves its own name.

Corpus callosum area and sectioning: a radioanatomical study correlated with MRI and cadaver morphometry.

The corpus callosum (CC) is the primary interhemispheric connection between the two cerebral hemispheres. Besides their similar morphological characters, there are differences in their measurements. This study aimed to divide the CC into groups using planes based on the anterior commissure (AC) and posterior commissure (PC) and to detect differences in CC magnetic resonance imaging (MRI) and cadaver samples between these groups. The study included 80 patients (40 male and 40 female patients) who underwent normal MRI in the midsagittal plane, and 38 cerebral hemispheres from 40 adult cadaver brains, with each hemisected in the midsagittal plane. The medial surface of the CC was divided vertically into three parts (the anterior, middle, and posterior zones) according to the AC and PC. Areas and parameters were measured in both the cadaveric hemispheres and patient MRI images. The total CC area and CC areas between, anterior, and posterior to the AC-PC vertical lines were the same in both the MRI and cadaver samples. In addition, morphometric measurements like the CC length, AC-PC length, and CC height at the AC and PC vertical lines, and their correlations were also found to be similar between the MRI and cadaver samples. This study proposes three areas according to AC and PC classification (anterior, middle, and posterior). This new proposed classification is suitable for stereotactic interventions and is useful for obtaining data from MRI images. However, it should be kept in mind that there may be changes and variations.

Description of Standardized Planes and Angles for Percutaneous Supra-acetabular Screw Placement.

Percutaneous screw fixation for pelvic fractures has become a minimally invasive alternative to an open operation. The complex anatomy of the pelvis renders this procedure challenging. The objective of this study was to assess standardized angles and dimensions of safety zones within a 3D computed tomography model for optimal supra-acetabular screw placement. Computed tomography scans of 107 patients that suffered major trauma without showing any bone injury of the pelvis were collected. Using a software-based analysis, raw computed tomography data were transformed into 3D models to set standardized landmarks and determine the possible insertion corridor. Screws not exceeding a length of 97mm in females and 106.4mm in males were, in 95% of the evaluated cases, insertable without cortical bone penetration. The safety zone was 6.6mm for females and 7.9mm for males. Screws not exceeding these diameters were safely insertable in 95% of the cases. For the midsagittal plane, the angle was 36.4±5.1 on the left and 34.7±2.9 on the right (p=0.008). For the anterior pelvic plane, the angle was 31.3±4.5° on the left and 34.0±4.8° on the right (p=0.008). Percutaneous fixation using supra-acetabular screws is a promising method to treat simple supra-acetabular fractures. These results may improve its safe utilization and could facilitate its broader clinical application.

Efficacy and safety of crizotinib in ALK-positive systemic anaplastic large-cell lymphoma in children, adolescents, and adult patients: results of the French AcSé-crizotinib trial

BackgroundThe French phase II AcSé-crizotinib trial aimed to evaluate the safety and efficacy of crizotinib in patients with ALK, ROS1, and MET-driven malignancies, including ALK-positive anaplastic large-cell lymphoma (ALK+ ALCL). MethodsALK+ ALCL patients 12 months or older with measurable disease and no standard care options available received crizotinib twice daily at 165 mg/m2 in children and adolescents and 250 mg in adults. The primary end-point was the response rate at 8 weeks. ResultsTwenty-eight patients were enroled between February 2014 and March 2018. Three patients who were not treated were excluded from the analysis. The median age was 19 years. The median previous line of chemotherapy was two. In the 24 patients with an evaluable response, the response rate at 8 weeks was 67% (95% CI: 47–82%). All patients discontinued crizotinib after a median treatment duration of 3.7 months: eight for progression, two for adverse events (AEs) related to prior treatments, and 15 by choice, including six for allogeneic stem-cell transplantation. The median follow-up was 45 months. Nine patients experienced an event: eight relapses (seven after crizotinib discontinuation and one after dose reduction), and one died in complete remission. The median duration of response was 43.3 months (95% CI: 8.3–not reached). The 3-year progression-free and overall survival rates were 40% (95% CI: 23–59%) and 63% (95% CI: 43–79%). Grade 3 or 4 treatment-related AEs occurred in 32% of patients. ConclusionCrizotinib shows efficacy and an acceptable safety profile in ALK+ ALCL relapsed/refractory patients. However, a large proportion of patients experience a relapse after crizotinib discontinuation. Future studies will assess if prolonged ALK inhibitor exposure has curative potential without consolidation.

Understanding the Effect of Prescription Isodose in Single-Fraction Stereotactic Radiosurgery on Plan Quality and Clinical Outcomes for Solid Brain Metastases.

There is wide variation in treatment planning strategy for central nervous system (CNS) stereotactic radiosurgery. We sought to understand what relationships exist between intratumor maximum dose and local control (LC) or CNS toxicity, and dosimetric effects of constraining hotspots on plan quality of multiple metastases volumetric modulated arc therapy radiosurgery plans. We captured brain metastases from 2015 to 2017 treated with single-isocenter volumetric modulated arc therapy radiosurgery. Included tumors received single-fraction stereotactic radiosurgery, had no previous surgery or radiation, and available follow-up imaging. Our criterion for local failure was 25% increase in tumor diameter on follow-up MRI or pathologic confirmation of tumor recurrence. We defined significant CNS toxicity as Radiation Therapy Oncology Group irreversible Grade 3 or higher. We performed univariate and multivariate analyses evaluating factors affecting LC. We examined 10 stereotactic radiosurgery plans with prescriptions of 18 Gy to all targets originally planned without constraints on the maximum dose within the tumor. We replanned each with a constraint of Dmax 120%. We compared V50%, mean brain dose, and Dmax between plans. Five hundred and thirty tumors in 116 patients were available for analysis. Median prescription dose was 18 Gy, and median prescription isodose line (IDL) was 73%. Kaplan-Meier estimate of 12-month LC only tumor volume (HR 1.43 [1.22-1.68] P < .001) was predictive of local failure on univariate analysis; prescription IDL and histology were not. In multivariate analysis, tumor volume impacted local failure (HR 1.43 [1.22-1.69] P < .001) but prescription IDL did not (HR 0.95 [0.86-1.05] P = .288). Only a single grade 3 and 2 grade 4 toxicities were observed; tumor volume was predictive of CNS toxicity (HR 1.58 [1.25-2.00]; P < .001), whereas prescription IDL was not (HR 1.01 [0.87-1.17] P = .940). The prescription isodose line had no impact on local tumor control or CNS toxicity. Penalizing radiosurgery hotspots resulted in worse radiosurgery plans with poorer gradient. Limiting maximum dose in gross tumor causes increased collateral exposure to surrounding tissue and should be avoided.

Evaluating feasibility of functional near-infrared spectroscopy in dolphins.

Using functional near-infrared spectroscopy (fNIRS) in bottlenose dolphins (Tursiops truncatus) could help to understand how echolocating animals perceive their environment and how they focus on specific auditory objects, such as fish, in noisy marine settings. To test the feasibility of near-infrared spectroscopy (NIRS) in medium-sized marine mammals, such as dolphins, we modeled the light propagation with computational tools to determine the wavelengths, optode locations, and separation distances that maximize sensitivity to brain tissue. Using frequency-domain NIRS, we measured the absorption and reduced scattering coefficient of dolphin sculp. We assigned muscle, bone, and brain optical properties from the literature and modeled light propagation in a spatially accurate and biologically relevant model of a dolphin head, using finite-element modeling. We assessed tissue sensitivities for a range of wavelengths (600 to 1700nm), source-detector distances (50 to 120mm), and animal sizes (juvenile model 25% smaller than adult). We found that the wavelengths most suitable for imaging the brain fell into two ranges: 700 to 900nm and 1100 to 1150nm. The optimal location for brain sensing positioned the center point between source and detector 30 to 50mm caudal of the blowhole and at an angle 45deg to 90deg lateral off the midsagittal plane. Brain tissue sensitivity comparable to human measurements appears achievable only for smaller animals, such as juvenile bottlenose dolphins or smaller species of cetaceans, such as porpoises, or with source-detector separations in adult dolphins. Brain measurements in juvenile or subadult dolphins, or smaller dolphin species, may be possible using specialized fNIRS devices that support optode separations of . We speculate that many measurement repetitions will be required to overcome hemodynamic signals originating predominantly from the muscle layer above the skull. NIRS measurements of muscle tissue are feasible today with source-detector separations of 50mm, or even less.

Measurement of brainstem diameter in small-breed dogs using magnetic resonance imaging.

Measurement of brainstem diameters (midbrain, pons, and medulla oblongata)is of potential clinical significance, as changes in brainstem size may decrease or increase due to age, neurodegenerative disorders, or neoplasms. In human medicine, numerous studies have reported the normal reference range of brainstem size, which is hitherto unexplored in veterinary medicine, particularly for small-breed dogs. Therefore, this study aims to investigate the reference range of brainstem diameters in small-breed dogs and to correlate the measurements with age, body weight (BW), and body condition score (BCS). Herein, magnetic resonance (MR) images of 544 small-breed dogs were evaluated. Based on the exclusion criteria, 193 dogs were included in the midbrain and pons evaluation, and of these, 119 dogs were included in the medulla oblongata evaluation. Using MR images, the height and width of the midbrain, pons, and medulla oblongata were measured on the median and transverse plane on the T1-weighted image. For the medulla oblongata, two points were measured for each height and width. The mean values of midbrain height (MH), midbrain width (MW), pons height (PH), pons width (PW), medulla oblongata height at the fourth ventricle level (MOHV), medulla oblongata height at the cervicomedullary (CM) junction level (MOHC), rostral medulla oblongata width (RMOW), and caudal medulla oblongata width (CMOW) were 7.18 ± 0.56 mm, 17.42 ± 1.21 mm, 9.73 ± 0.64 mm, 17.23 ± 1.21 mm, 6.06 ± 0.53 mm, 5.77 ± 0.40 mm, 18.93 ± 1.25 mm, and 10.12 ± 1.08 mm, respectively. No significant differences were found between male and female dogs for all the measurements. A negative correlation was found between age and midbrain diameter, including MH (p < 0.001) and MW (p = 0.002). All brainstem diameters were correlated positively with BW (p < 0.05). No significant correlation was found between BCS and all brainstem diameters. Brainstem diameters differed significantly between breeds (p < 0.05), except for MW (p = 0.137). This study assessed linear measurements of the brainstem diameter in small-breed dogs. We suggest that these results could be useful in assessing abnormal conditions of the brainstem in small-breed dogs.

Study on short-term clinical observation of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area.

To analyse the short-term clinical results of the effect of apically repositioned flap combined with free gingival graft to widen keratinized tissue in implant area, so as to provide a basis for its clinical application. Fifteen patients with intraoral single or multiple missing teeth, who did not undergo implant restoration or who re-examined after implant restoration completed were included, along with KW less than 1-2 mm on the buccal side of the median line of the alveolar ridge crest in the implant area, or KW less than 1-2 mm on the buccal side of the abutments and dental crown margins. All underwent apically repositioned flap combined with free gingival graft, which were reviewed. Fifteen patients with missing keratinized gingivae underwent free gingival flap graft, survived with all grafted gingival flaps. Compared with before implantation, significant keratinized tissue widening and area gain were obtained at 1 and 3 months postoperatively. The free gingival flap graft can significantly widen the buccal keratinized mucosa of the implant, and to some extent maintains the health status of the implant, which is worthy of clinical promotion and application.

Anatomical morphometry for Cricothyrotomy puncture and incision

PurposeEmergency surgical airway securing techniques include cricothyrotomy, puncture, and incision. While the instruments used for these methods vary in size, no index of laryngeal morphology exists to guide instrument selection. Therefore, we measured the morphology of the cricothyroid ligament in Japanese individuals and assessed its correlations with height.MethodsThis retrospective study used 61 anatomical practice specimens. The cricothyroid ligament of the laryngeal area was dissected, and a frontal image was recorded. Next, images of the midsagittal sections of the larynx and trachea were recorded. The width and height of the cricothyroid ligament were measured from the frontal images, and the depth of the larynx and the angle to the lower edge of the cricothyroid plate were measured from the mid-sagittal cross-sectional images. The height was estimated from the tibial lengths of the specimens and statistically analyzed for correlations. ResultsThe width and depth were significantly greater in males. Overall, there was a slight correlation between the results of each laryngeal measurement and estimated height for all items.ConclusionThe morphology of cricothyrotomy revealed that the width and depth of the laryngeal area varied according to sex. Moreover, the results also showed a correlation with the estimated height. Thus, it is important to predict the morphology of the laryngeal area and cricothyroid ligament by considering factors such as patient sex, weight, and height.

A cross-sectional study on three-dimensional compensatory characteristics of maxillary teeth in patients with different types of skeletal Class III malocclusion with mandibular asymmetry.

The purpose of this study was to analyze three-dimensional dental compensation in patients with different types of skeletal Class III malocclusion with mandibular asymmetry, using cone-beam computed tomography (CBCT) and three-dimensional reconstruction measurement technology, thereby providing clinical guidance and reference for combined orthodontic and orthognathic treatment. 81 patients with skeletal Class III malocclusion with mandibular asymmetry were selected in accordance with the inclusion criteria. According to a new classification method based on the direction and amount of menton deviation relative to ramus deviation, patients were divided into three groups called Type 1, Type 2, and Type 3. In Type 1, the direction of menton deviation was consistent with that of ramus deviation and the amount of menton deviation was greater than that of ramus deviation. In Type 2, the direction of menton deviation was consistent with that of ramus deviation and the amount of menton deviation was smaller than that of ramus deviation. In Type 3, the direction of menton deviation was inconsistent with that of ramus deviation. The maxillary occlusal plane (OP), anterior occlusal plane (AOP), and posterior occlusal plane (POP) were measured on reconstructed CBCT images. The vertical, transverse, and anteroposterior distances from maxillary teeth to reference planes and the 3D angles between the long axis of these teeth and reference planes were measured. These dental variables measured from the deviated and non-deviated sides were compared within each group, as well as among each other. Of the 81 patients with asymmetrical Class III malocclusion, 52 patients were categorized in Type 1, 12 patients in Type 2, and 17 patients in Type 3. There were significant differences between deviated and non-deviated sides in Type 1 and Type 3 (p < 0.05). In Type 1, the vertical distances of maxillary teeth on the deviated side were lower than those on the non-deviated side, and AOP, OP, and POP on the deviated side were larger than those on the non-deviated side (p < 0.05). In Type 3, the vertical distances of the maxillary teeth on the deviated side were lower (p < 0.05), and the AOP and OP on the deviated side were larger than those on the non-deviated side. In all three groups, the transverse distances of the maxillary teeth from the mid-sagittal plane on the deviated side were larger than those on the non-deviated side (p < 0.05), and the angles between the long axis of maxillary teeth and the mid-sagittal plane on the deviated side were larger, respectively (p < 0.05). The maxillary teeth on the deviated side were observed to have smaller eruption heights in Type 1 and Type 3. In Type 1, AOP, POP, and OP were greater on the deviated side, while in Type 3, only AOP and OP were greater on the deviated side. The maxillary teeth of patients in all three groups on the deviated side were buccal and buccally inclined. Larger sample observations are still needed to further verify these findings.

Cyclic mechanical stretch pre-stimulated bone marrow mesenchymal stem cells promote the healing of infected bone defect in a mouse model.

Cyclic mechanical stretch (CMS) is an effective method to accelerate mesenchymal stem cells (MSCs) differentiation. Here, we investigated CMS pre-stimulated bone marrow MSCs (CMS-BMSCs), characterized and evaluated the therapeutic potential of CMS-BMSCs on the treatment of infected bone defect in mouse model. BMSCs were obtained from C57BL/6J mice and then subjected to CMS. The osteogenic differentiation capacity of BMSCs was evaluated by alkaline phosphatase (ALP) assay, Alizarin Red staining, qRT-PCR and Western blot. The pre-stimulated BMSCs were transplanted into infected bone defect mice, osteogenesis, antibacterial effects, and inflammatory responses were examined. CMS significantly increased ALP activity and the expression of osteoblastic genes (col1a1, runx2, and bmp7) and enhanced osteogenic differentiation and nrf2 expression of BMSCs. Transplantation of CMS pre-stimulated BMSCs promoted the healing of infected bone defect in mice, enhanced antibacterial effects, and reduced inflammatory responses in the mid-sagittal section of the fracture callus. CMS pre-stimulated BMSCs enhance the healing of infected bone defects in a mouse model, suggesting a potential therapeutic strategy for treating infected bone defects. This article is protected by copyright. All rights reserved.

Comparison of infrazygomatic crest bone screw position using a postero-anterior cephalogram versus cone-beam computed tomography: a cross sectional study

Abstract Background The position of infrazygomatic crest bone screws is an important consideration in determining the success of orthodontic treatment. The aim of this study was to compare the position of infrazygomatic crest (IZC) bone screws in relation to skeletal and dental parameters using postero-anterior (PA) cephalograms and cone beam computed tomography (CBCT). Methods A CBCT scan and a PA cephalogram were taken of 19 patients (8 males; 11 females) after IZC bone screw placement. Each CBCT image was reconstructed and oriented using the CS 3D CBCT software (Carestream Dental LLC, Atlanta, USA) and was subsequently analysed. The landmarks were traced on the PA cephalogram. The angulation of the IZC bone screw was measured with respect to three skeletal and two dental landmarks and compared between the two imaging modalities. A paired t-test was applied to compare the means of different variables between the PA cephalogram and CBCT scan. Results The results showed no statistically significant difference between the two imaging modalities with respect to four landmarks, i.e., the inter-jugale plane, the mid sagittal plane, the zygomatic arch and the perpendicular long axis to the 1st molar but a small statistically significant difference was seen with respect to measurements from the facial surface of the 1st molar (P ≤ 0.05). Conclusion The angulation and position of an IZC bone screw are consistent between the two imaging modalities. A PA cephalogram may be used as a substitute for a CBCT scan to reduce the radiation exposure to patients.

3-dimensional analysis of hard- and soft-tissue symmetry in a Chinese population

BackgroundFacial symmetry severely affects appearance and function. Large numbers of patients seek orthodontic treatment to improve facial symmetry. However, the correlation between hard- and soft-tissue symmetry is still unclear. Our aim was to investigate the hard- and soft-tissue symmetry in subjects with different levels of menton deviation and sagittal skeletal classes with 3D digital analysis and to investigate the relationship between the entire and individual hard- and soft-tissues.MethodsA total of 270 adults (135 males and 135 females) consisting of 45 subjects of each sex in each sagittal skeletal classification group. All subjects were further classified into relative symmetry (RS), moderate asymmetry (MA) and severe asymmetry (SA) groups based on the degree of menton deviation from the mid-sagittal plane (MSP). The 3D images were segmented into anatomical structures and mirrored across the MSP after establishing a coordinate system. Original and mirrored images were registered by a best-fit algorithm, and the corresponding root mean square (RMS) values and colormap were obtained. The Mann‒Whitney U test and Spearman correlation were conducted for statistical analysis.ResultsThe RMS increased with greater deviations with regard to the deviation of the menton in most of anatomical structures. Asymmetry was represented in the same way regardless of sagittal skeletal pattern. The soft-tissue asymmetry had a significant correlation with dentition in the RS group (0.409), while in the SA group, it was related to the ramus (0.526) and corpus (0.417) in males and was related to the ramus in the MA (0.332) and SA (0.359) groups in females.ConclusionsThe mirroring method combining CBCT and 3dMD provides a new approach for symmetry analysis. Asymmetry might not be influenced by sagittal skeletal patterns. Soft-tissue asymmetry might be reduced by improving the dentition in individuals with RS group, while among those with MA or SA, whose menton deviation was larger than 2 mm, orthognathic treatment should be considered.

O-267 Uterine contractility in women with adenomyosis differs significantly from healthy control women - the waves study

Abstract Study question Description of uterine contractility characteristics in adenomyosis patients compared to healthy controls and according to degree of dysmenorrhoea measured by quantitative 2D transvaginal ultrasound (TVUS). Summary answer Women with adenomyosis show differences in uterine contraction patterns (frequency, amplitude, velocity, and contraction coordination) compared to healthy controls and depending on degree of dysmenorrhoea. What is known already The natural contraction pattern of the uterus changes throughout the menstrual cycle in response to cyclic changes in hormones. In abnormal uteri, such as adenomyotic uteri, this response may be different. Adenomyosis can cause dysmenorrhoea, menorrhagia, dyspareunia, and subfertility. These symptoms could be explained by different contraction patterns of the uterus, however, this has not yet been objectively quantified due to the absence of a suitable measurement tool. Recently, speckle-tracking and strain analysis of 2D TVUS was used to assess differences in contraction coordination, frequency, velocity, and direction, depending on the phase of the menstrual cycle in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating uterine contractility in TVUS recordings. Our study includes the TVUS recordings of 31 women with adenomyosis and 106 women with healthy uteri. Patients were included in 3 centres from 2017 to 2023 (Netherlands, Greece, Italy). Participants/materials, setting, methods 31 women with sonographic suspicion of adenomyosis and 106 women with healthy uteri with natural menstrual cycles were included. Uterine contraction frequency, amplitude, velocity, and coordination were assessed by applying a dedicated speckle tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. Degree of dysmenorrhoea was measured according to visual analogue score (VAS). Women with suspicion of adenomyosis were compared to women with healthy uteri according to the phase of their menstrual cycle. Main results and the role of chance Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p &amp;lt; 0.05). Uterine contractility differed between women with adenomyosis and healthy controls during the periovulatory phase, revealing lower frequency (1.50±0.25 vs. 1.75±0.35, p = 0.031), higher amplitude (0.076±0.039 vs. 0.046±0.018, p = 0.001), and lower velocity (0.64±0.18 vs. 0.84±0.22, p = 0.020) of uterine contractions in the group with adenomyosis patients. In the late luteal phase, women with adenomyosis showed higher amplitude (0.050±0.02 vs. 0.035±0.01, p = 0.039) and lower velocity (0.51±0.11 vs. 0.72±0.16, p = 0.032) than the healthy controls. During menstruation, women with adenomyosis showed a trend towards higher contraction amplitude (0.044± 0.01 vs. 0.037±0.01, p = 0.051) compared to healthy controls. During the menstrual, periovulatory and late luteal phase, women with adenomyosis showed reduced contraction coordination (p = 0.047, p = 0.015 and p = 0.011, respectively) compared to healthy controls. Increased dysmenorrhoea (VAS score) in overall adenomyosis patients was associated with lower contraction velocity (p = 0.043) and a tendency towards lower frequency (p = 0.160) and higher amplitude (p = 0.154). Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis characteristics (i.e. adenomyosis severity, adenomyosis type, adenomyosis location). Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound images. Women with adenomyosis were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings Uterine contractility differs between patients with adenomyosis versus healthy women throughout the menstrual cycle. More dysmenorrhoea in adenomyosis patients was also associated with a different contractility pattern. This suggests an aetiological mechanism for the clinical presentation of adenomyosis (i.e. dysmenorrhoea and subfertility) and presents potential therapeutic markers. Trial registration number NL52466.100.15

P-342 Uterine contractile patterns in adenomyosis patients normalize under hormonal contraception use: the WAVES study

Abstract Study question Comparison of uterine contractility (UC) in adenomyosis patients (AP) with and without hormonal contraception (HC) compared to controls with HC, measured by transvaginal ultrasound (TVUS). Summary answer AP with HC show better contraction coordination compared to untreated AP. AP with HC show comparable UC compared to controls with HC. What is known already Adenomyosis is a disease of the uterus that can cause dysmenorrhoea, menorrhagia, dyspareunia and subfertility. These symptoms could be explained by the different contraction patterns in women with adenomyosis compared to healthy controls. Therapeutic use of hormonal contraception reduces the symptoms experienced by women with adenomyosis. This could be explained by the normalization of contraction patterns, which has not yet been objectively quantified due to the absence of a suitable measurement tool. A novel speckle-tracking and strain analysis by 2D TVUS recordings has recently been used to assess differences in contraction coordination, contraction frequency, velocity and direction in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating UC on TVUS. Our study includes the TVUS recordings of 23 women with adenomyosis without hormonal contraception treatment, 15 women with adenomyosis undergoing hormonal contraception treatment, and 17 women with healthy uteri undergoing hormonal contraception treatment. Patients were included in 3 centres from 2017 to 2023 (Catharina Hospital Eindhoven, Fertility Clinic Thessaloniki and University Federico Napels). Participants/materials, setting, methods 23 women with sonographic suspicion of adenomyosis without HC, 15 women with adenomyosis undergoing HC treatment and 17 women with healthy uteri with HC were included. HC included oral combined HC, progesterone only pill and hormonal IUD. UC frequency, amplitude, velocity and coordination were assessed by applying a dedicated speckle-tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. AP with HC were compared to AP without contraception and to healthy controls with HC. Main results and the role of chance Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p &amp;lt; 0.05). The adenomyosis group with contraception showed more contraction coordination compared to the adenomyosis group without hormonal contraception treatment (0.23 ±0.10 vs. 0.29 ±0.11, p = 0.041). There was a tendency towards higher contraction frequency (1.53 ±0.21 vs. 1.42, p = 0.153) and lower amplitude (0.56 ±0.04 vs. 0.65 ±0.04, p = 0.159) in the adenomyosis group with hormonal contraception treatment compared to the adenomyosis group without hormonal contraception treatment. There were no significant differences in uterine contractility between the adenomyosis group with hormonal contraception treatment compared to the healthy group with hormonal contraception treatment. Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis and contraception characteristics due to this being an ongoing study. Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound recordings. AP were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings The normalization of UC under therapeutic use of HC compared to untreated AP and the lack of differences in UC between AP and healthy controls with HC, confirms the therapeutic effect on adenomyotic symptoms. This presents a new therapeutic efficacy marker for adenomyosis. Trial registration number NL52466.100.15 Study funding Yes Funding source Funding by commercial/corporate company(ies)

P-342 Uterine contractile patterns in adenomyosis patients normalize under hormonal contraception use: the WAVES study

Abstract Study question Comparison of uterine contractility (UC) in adenomyosis patients (AP) with and without hormonal contraception (HC) compared to controls with HC, measured by transvaginal ultrasound (TVUS). Summary answer AP with HC show better contraction coordination compared to untreated AP. AP with HC show comparable UC compared to controls with HC. What is known already Adenomyosis is a disease of the uterus that can cause dysmenorrhoea, menorrhagia, dyspareunia and subfertility. These symptoms could be explained by the different contraction patterns in women with adenomyosis compared to healthy controls. Therapeutic use of hormonal contraception reduces the symptoms experienced by women with adenomyosis. This could be explained by the normalization of contraction patterns, which has not yet been objectively quantified due to the absence of a suitable measurement tool. A novel speckle-tracking and strain analysis by 2D TVUS recordings has recently been used to assess differences in contraction coordination, contraction frequency, velocity and direction in healthy women. Study design, size, duration This study is part of an ongoing multi-centre prospective observational cohort study investigating UC on TVUS. Our study includes the TVUS recordings of 23 women with adenomyosis without hormonal contraception treatment, 15 women with adenomyosis undergoing hormonal contraception treatment, and 17 women with healthy uteri undergoing hormonal contraception treatment. Patients were included in 3 centres from 2017 to 2023 (Catharina Hospital Eindhoven, Fertility Clinic Thessaloniki and University Federico Napels). Participants/materials, setting, methods 23 women with sonographic suspicion of adenomyosis without HC, 15 women with adenomyosis undergoing HC treatment and 17 women with healthy uteri with HC were included. HC included oral combined HC, progesterone only pill and hormonal IUD. UC frequency, amplitude, velocity and coordination were assessed by applying a dedicated speckle-tracking and strain analysis to 2-4-minute TVUS recordings in midsagittal section. AP with HC were compared to AP without contraception and to healthy controls with HC. Main results and the role of chance Age, BMI, parity and uterus volume were significantly higher in the women with adenomyosis compared to the healthy controls (p &amp;lt; 0.05). The adenomyosis group with contraception showed more contraction coordination compared to the adenomyosis group without hormonal contraception treatment (0.23 ± 0.10 vs. 0.29 ± 0.11, p = 0.041). There was a tendency towards higher contraction frequency (1.53 ± 0.21 vs. 1.42, p = 0.153) and lower amplitude (0.56 ± 0.04 vs. 0.65 ± 0.04, p = 0.159) in the adenomyosis group with hormonal contraception treatment compared to the adenomyosis group without hormonal contraception treatment. There were no significant differences in uterine contractility between the adenomyosis group with hormonal contraception treatment compared to the healthy group with hormonal contraception treatment. Limitations, reasons for caution No sub-analysis was done to assess effects of additional adenomyosis and contraception characteristics due to this being an ongoing study. Women with extensive adenomyosis were not included due to impossibility to perform analysis of ultrasound recordings. AP were older, had higher BMI and larger uterus volumes than healthy controls. Wider implications of the findings The normalization of UC under therapeutic use of HC compared to untreated AP and the lack of differences in UC between AP and healthy controls with HC, confirms the therapeutic effect on adenomyotic symptoms. This presents a new therapeutic efficacy marker for adenomyosis. Trial registration number NL52466.100.15

Actionable molecular alterations in newly diagnosed and recurrent IDH1/2 wild-type glioblastoma patients and therapeutic implications: a large mono-institutional experience using extensive next-generation sequencing analysis

BackgroundNext-generation sequencing (NGS) panels enable the identification of alterations in cancer-related genes. This may guide a molecularly targeted strategy for the treatment of glioblastoma (GBM). Material and methodsWe retrospectively analysed data obtained using FoundationOne®CDx in a large cohort of IDH1/2 wild-type GBM. We aimed to 1) identify potentially actionable molecular alterations at diagnosis and/or recurrence based on ESMO Scale for Clinical Actionability of Molecular Targets (ESCAT) defined categories of targetability, 2) understand the clinical implications of NGS in terms of access to and activity of targeted therapies. ResultsIn 442 samples, an NGS profile was available in 98.2%. The median time from diagnosis to NGS profiling was 7.4 months (interquartile range (IQR): 3.4–13.2). Although about half of the patients had at least one actionable molecular alteration, only 3.4% of them were classified as ESCAT IB–IC and 6.7% as ESCAT IIB. Only 36 patients (10.5%) received personalised treatment in clinical trials or as off-label/compassionate use from second-line (median line 3). Most patients did not receive targeted therapy due to clinical deterioration/death (49.6%). Patients treated with dabrafenib/trametinib (9 patients) had the highest disease control rate of 77% and an objective response rate of 22%, with a median progression-free survival (PFS) of 5.2 months. No complete/partial responses were seen with the other regimens. 4/9 (44.4%) patients on anti-BRAF/anti-MEK, 2/4 patients (50%) on erdafitinib and 1/1 patient on capmatinib had a PFS ratio > 1.3. One recurrent GBM patient with ROS1-GOCP fusion maintained a complete response for 11.3 months on entrectinib. ConclusionsOur study demonstrated the feasibility of NGS in GBM samples. As the number of clinically relevant targets was limited and only a small group of GBM patients were treated with targeted therapy, NGS testing should be performed in the context of clinical trials. Our results support the activity of anti-BRAF/anti-MEK, while for the other agents prospective study results are needed to draw solid conclusions.

Differences in positions of cone-beam computed tomography landmarks in patients with skeletal Class III facial asymmetry according to midsagittal planes.

This study aimed to clarify differences in the positions of cone-beam computed tomography (CBCT) landmarks according to different midsagittal planes (MSPs) in patients with skeletal Class III facial asymmetry. Pre-treatment CBCT data from 60 patients with skeletal Class III were used. The patients were classified into symmetric (menton deviations of < 2 mm) or asymmetric (menton deviations of > 4 mm) groups. Six MSPs were established based on previous studies, and three-dimensional analyses were performed for the planes in both the groups. The measurement outcomes were compared statistically. A statistically significant interaction (p < 0.01) was observed between MSPs and facial asymmetry. No significant differences were observed among MSPs in the symmetric group. However, significant differences in linear measurements were identified among MSPs in the asymmetric group. Specifically, the upper facial MSP revealed both maxillary and mandibular transverse asymmetries. On the other hand, anterior nasal spine (ANS)-associated MSP could not identify maxillary asymmetry. Furthermore, the menton deviation was approximately 3 mm lower when estimated using the ANS-associated MSP than that using upper facial MSP. The choice of MSP can significantly affect treatment outcomes while diagnosing patients with asymmetry. Therefore, care should be taken when selecting MSP in clinical practice.