Multiple Lobes Research Articles

7762 A Unique Case Of Sepsis-Driven Bilateral Adrenal Hemorrhages In A Patient With HIT

Abstract Disclosure: A. Siddiqui: None. B. Shalit: None. H. Nadeem: None. Z. Khan: None. D. Pinkhasova: None. Introduction: Bilateral adrenal hemorrhages, commonly seen in the setting of sepsis as Waterhouse Friderichsen syndrome, is a rare life-threatening condition. This process is driven by the release of bacterial endotoxins leading to the activation of coagulation, fibrinolysis, and proinflammatory pathways. It is by a similar process that now non-septic hypercoagulable states, including heparin-induced thrombocytopenia (HIT), factor V Leiden and protein C resistance are also being recognized as etiologic for bilateral adrenal hemorrhaging. The following case demonstrates a combination of the two etiologies leading to adrenal insufficiency from bilateral adrenal hemorrhages. Clinical Case: A 48-year-old male presented to the emergency department with right upper quadrant pain, dyspnea, and a low-grade fever. Laboratory results indicated leukocytosis with a predominance of neutrophils. Initial computed tomography imaging revealed a 4 x 3.5 cm right lower lobe multi-loculated lung abscess and multiple right lower lobe segmental/subsegmental pulmonary emboli. The patient was started on a heparin drip and empiric antibiotics. Infectious disease was consulted to help determine the etiology of the lung abscess. Extensive workup including sputum, blood, fungal cultures, and acid-fast bacillus smear testing were negative. The patient improved on routine broad-spectrum antibiotics and was planned to be transitioned to a direct oral anticoagulant until serial imaging revealed incidental bilateral 4 cm adrenal hemorrhages. Endocrinology was emergently consulted; a random cortisol level was drawn and found to be low at 2.7 (3-17 µg/dL) with an elevated Adrenocorticotropic hormone (ACTH) level of 114 (6 - 50 pg/mL) indicative of primary adrenal insufficiency. The patient subsequently became hypotensive and was started on stress-dose steroids. Upon further investigation, the patient was found to be thrombocytopenic, and hematology was involved. Based on his 4T score of 5, concern was raised for HIT and argatroban was initiated. Moreover, the patient was eventually stabilized for discharge with close follow-ups with endocrinology, infectious disease, and hematology as an outpatient. Conclusion: There have been 17 reported cases of bilateral adrenal hemorrhaging in the setting of HIT uniformly presenting with complete hemodynamic collapse. This case serves as even more unique given the added component of sepsis. Both sepsis and HIT respectively have been well established to pose individual risk for developing bilateral adrenal hemorrhages. Hence, we hope to highlight the importance of exploring all potential causes of adrenal insufficiency in the setting of bilateral adrenal hemorrhaging and emphasize the harms of anchoring to a single etiology. Presentation: 6/3/2024

Effect of Airfoil thickness on low-frequency gust-airfoil interaction noise

Interaction between turbulence and an airfoil is a significant aerodynamic noise source for many engineering applications when turbulence in the wake of upstream blades interacts with the leading edge of downstream blades. Modeling the oncoming turbulence as harmonic gusts is a common approach to studying the noise generated by turbulence-airfoil interaction. The airfoil can be considered a compact noise source, resulting in a dipole-like sound directivity pattern when the acoustic wavelength of gust-airfoil interaction is much larger than the airfoil chord length. However, the interaction becomes more complex when the acoustic wavelength is comparable to or smaller than the airfoil chord, as the airfoil cannot be treated as a compact source anymore and multiple lobes appear in the radiated sound directivity. This paper studies airfoil thickness effects using a computational aeroacoustics approach based on the spectral/hp element method for low-reduced frequency gusts. It is found that the sound pressure decreases with the increase of thickness for low reduced frequency gusts. To reveal its mechanism, a semi-analytical method and the convective FW-H equation are used for low reduced frequency to analyze the radiated noise. The interaction between sound sources on the airfoil surface is crucial for the thickness effect.

Metastatic prostate adenocarcinoma to the brain – a clinicopathologic analysis of 21 cases

BackgroundBrain metastasis from prostate adenocarcinoma (PCa) is rare, often leading to death within a year. Its infrequent occurrence and atypical histopathologic features contribute to lower consideration in the differential diagnosis of tumor brain metastasis. This study aims to assess the clinical characteristics and distinctive histopathologic features of metastatic PCa in the brain for timely and enhanced diagnostic accuracy.DesignA retrospective search spanning 20 years (2003–2022) was conducted on our archives and identified 21 cases diagnosed as “metastatic prostate adenocarcinoma (mPCa)” in brain biopsies and resections. All existing slides were thoroughly reviewed to evaluate the histopathology of the mPCa.ResultThe mean age at presentation for brain metastasis was 70 years. Of 21 cases, 5 were dural-based lesions, 16 were true intraparenchymal metastases, including 2 sellar/suprasellar masses, 3 frontal, 3 temporal, 3 occipital, 1 cerebellum, and 4 involving multiple brain lobes. The average interval between initial diagnosis and brain metastasis was 90.75 months. Notably, brain metastasis was the initial presentation for one patient, while another patient, initially diagnosed with prognostic grade group (GG) 2 PCa in 1/12 cores, presented with isolated brain metastasis two years later. Architecturally, tumor cells were arranged in sheets or nests in most cases; however, four cases showed histologic cribriform patterns, and five displayed papillary architecture. Cytohistology varied from uniform monomorphic to highly pleomorphic cells with prominent nucleoli (8/19) and high mitotic activity. Interestingly, 1 case showed small round blue cell morphology, another had focal areas of rhabdoid and spindle cell differentiation, and 6 had cytoplasmic clearing. Almost half of the cases (47%) showed necrosis.ConclusionmPCa to the brain can present with variable histomorphology. Therefore, consideration of mPCa in the differential diagnosis of metastatic brain lesions, even with non-suggestive imaging, is imperative in male patients with or without a history of primary disease. Accurate and prompt diagnosis is crucial, given the recent advancements in treatment that have improved survival rates.

Successful treatment of mixed pulmonary Aspergillus and Mucor infection using intrabronchial amphotericin B infusion: a case report and literature review

BackgroundReports of pulmonary aspergillosis and mucormycosis co-infections are rare; thus, limited guidance is available on early diagnosis and treatment. We present a case of mixed pulmonary Aspergillus and Mucor infection and review the literature regarding this co-infection. The diagnosis and treatment methods are summarized to improve clinicians’ understanding of the disease and to facilitate early diagnosis and treatment.Case presentationA 60-year-old male farmer with poorly controlled diabetes mellitus was admitted to hospital with a fever of unknown origin that had been present for 15 days and pulmonary aspergillosis complicated by Mucor spp. infection. Because multiple lobes were involved, the infection worsened despite surgical resection and antifungal therapy. Finally, we treated this patient with a bronchoscopic infusion of amphotericin B. After four courses of bronchoscopic amphotericin B infusion, we observed rapid clinical improvement and subsequent resolution of pulmonary infiltrates.ConclusionOur case highlights the use of bronchoscopy in the successful clinical treatment of invasive fungal diseases of the lung.

Clinical features and treatment of apoplectic intratumoral hemorrhage of glioma

ObjectiveThe primary objective of this study was to explore the clinical characteristics of apoplectic intratumoral hemorrhage in gliomas and offer insights for improving the diagnosis and treatment of this disease.MethodsWe analyzed the clinical data of 35 patients with glioma and hemorrhage. There were eight cases of multiple cerebral lobe involvement, and 22 cases involved a single lobe. Twenty-one patients had a preoperative Glasgow Coma Scale (GCS) score of ≥ 9 and had a craniotomy with tumor resection and hematoma evacuation after undergoing preoperative preparation. A total of 14 patients with GCS < 9, including one with thalamic hemorrhage breaking into the ventricles and acute obstructive hydrocephalus, underwent craniotomy for tumor resection after external ventricular drainage (EVD). One patient had combined thrombocytopenia, which was surgically treated after platelet levels were normalized through transfusion. The remaining 12 patients received immediate intervention in the form of craniotomy hematoma evacuation and tumor resection.ResultsWe performed subtotal resection on three tumors of thalamic origin and two tumors of corpus callosum origin, but we were able to successfully resect all the tumors in other locations that were gross total resection Pathology results showed that 71.43% of cases accounted for WHO-grade 4 tumors. Among the 21 patients with a GCS score of ≥ 9, two died perioperatively. Fourteen patients had a GCS score < 9, of which eight patients died perioperatively.ConclusionsPatients with a preoperative GCS score ≥ 9 who underwent subemergency surgery and received aggressive treatment showed a reasonable prognosis. We found their long-term outcomes to be correlated with the pathology findings. On the other hand, patients with a preoperative GCS score < 9 required emergency treatment and had a high perioperative mortality rate.

An International Registry Study of Early-Stage NSCLC treatment variations (LUCAEUROPE) in Europe and the USA highlighting variations

ObjectiveHarmonized European NSCLC incidence, treatment approach, and survival based on national tumor registries are unclear. Summary background dataSurgery has the potential to cure NSCLC and significantly prolong survival. This large-scale international study aimed to investigate treatment variations in Europe and the USA, as well as the determinants for its utilization. MethodsThe retrospective cohort study analyzed data from six European national population-based cancer registries (Belgium, Denmark, Estonia, Germany, the Netherlands, and Slovenia) and the US SEER database from 2010–2015. ResultsThe study computed cancer incidence, survival, and age-standardized proportions of the use of various therapies. Multivariable logistic regression models were used to assess associations between resection and demographic and clinical parameters. A total of 428,107 records were analyzed. Among all countries, Estonia had the highest surgical resection rate (79.3 %) and the lowest radiation rate (7.3 %) for stage I patients. The Netherlands had the highest rate of radiotherapy across all years of investigation and the lowest surgery rate between 2012 and 2015. The primary treatment for early-stage NSCLC showed significant international variation, with the USA having a decrease in surgical rates from 67.6 % to 59.5 %. Resection was less frequently performed as tumor stage increased, patients aged, other lung cancer besides adenocarcinoma was present, and when the tumor site overlapped multiple lobes. ConclusionsResection rates have declined in some studied European countries and the USA and resection rates vary substantially among countries. Interpretation of current scientific lung cancer evidence and international guidelines results in wide variations in patient treatment.

Diversity of visual inputs to Kenyon cells of the Drosophila mushroom body

The arthropod mushroom body is well-studied as an expansion layer representing olfactory stimuli and linking them to contingent events. However, 8% of mushroom body Kenyon cells in Drosophila melanogaster receive predominantly visual input, and their function remains unclear. Here, we identify inputs to visual Kenyon cells using the FlyWire adult whole-brain connectome. Input repertoires are similar across hemispheres and connectomes with certain inputs highly overrepresented. Many visual neurons presynaptic to Kenyon cells have large receptive fields, while interneuron inputs receive spatially restricted signals that may be tuned to specific visual features. Individual visual Kenyon cells randomly sample sparse inputs from combinations of visual channels, including multiple optic lobe neuropils. These connectivity patterns suggest that visual coding in the mushroom body, like olfactory coding, is sparse, distributed, and combinatorial. However, the specific input repertoire to the smaller population of visual Kenyon cells suggests a constrained encoding of visual stimuli.

Cortical Face-Selective Responses Emerge Early in Human Infancy.

In human adults, multiple cortical regions respond robustly to faces, including the occipital face area (OFA) and fusiform face area (FFA), implicated in face perception, and the superior temporal sulcus (STS) and medial prefrontal cortex (MPFC), implicated in higher-level social functions. When in development, does face selectivity arise in each of these regions? Here, we combined two awake infant functional magnetic resonance imaging (fMRI) datasets to create a sample size twice the size of previous reports (n = 65 infants; 2.6-9.6 months). Infants watched movies of faces, bodies, objects, and scenes, while fMRI data were collected. Despite variable amounts of data from each infant, individual subject whole-brain activation maps revealed responses to faces compared to nonface visual categories in the approximate location of OFA, FFA, STS, and MPFC. To determine the strength and nature of face selectivity in these regions, we used cross-validated functional region of interest analyses. Across this larger sample size, face responses in OFA, FFA, STS, and MPFC were significantly greater than responses to bodies, objects, and scenes. Even the youngest infants (2-5 months) showed significantly face-selective responses in FFA, STS, and MPFC, but not OFA. These results demonstrate that face selectivity is present in multiple cortical regions within months of birth, providing powerful constraints on theories of cortical development.

MODL-05. UNDERSTANDING THE METABOLIC VULNERABILITIES IN INFILTRATING GLIOMATOSIS CEREBRI CELLS

Abstract BACKGROUND Gliomatosis cerebri (GC), a rare form of high-grade glioma, is characterized by a particularly invasive phenotype within multiple lobes of the brain and a dismal prognosis. This entity was removed in 2016 of the WHO brain tumor classification because of an absence of specific GC driving molecular signature. Its diffusive aspect on MRI is defined by an absence of cohesive tumor mass, a mild contrast enhancement and a rare neoangiogenesis. Based on those observations, our objectives were to understand how these cells are adapting to their brain environment without a physiological nutritive efflux associated to a reduced oxygen concentration and determine a metabolic signature of GC. METHODS Preliminary results in a large cohort of HGGs bearing several drivers (H3.3 G34V, NMYC amplified, BCOR positive) or a more “wildtype” phenotype with new entities (pedRTK 1 and 2) were underlining glucose and glutamine as major nutrients in cell metabolic suppliance. Therefore, epigenetic assessments, bulk metabolomics, and Seahorse technology, as well as labeled glucose and glutamine metabolites study, helped us in pediatric GC-derived cell lines (BT97 and BT139, PEDIAMODECAN program) to understand the role of both nutrients and their central role in GC in hypoxic microenvironment. RESULTS Both glucose and glutamine are involved in carbon fueling biosynthesis in those cells. Glutamine is much more involved in supplying nitrogen to fuel several specific amino acids and mitochondrial metabolisms. Meanwhile, we developed drug testing using Matrigel invasion aspects. The tested drugs were able to reduce invasiveness of GC cells and modify the intratumoral metabolism. CONCLUSION All those observations seem to explain GC cell adaptation into the hypoxic microenvironment, their plasticity and resistance through metabolic reprogramming based on glutaminolysis and glycolysis.

Clinicopathologic and molecular landscape of invasive mucinous adenocarcinoma of the lung.

8037 Background: Invasive mucinous adenocarcinoma (IMA), accounting for 2–10% of lung adenocarcinomas, often mimics pneumonia with multicentric opacities in multiple lobes and both lungs. Notable for its microscopic skip lesions leading to tumor spread through air spaces (STAS), IMA is still under-researched in terms of its comprehensive clinical and genetic characteristics in large, multicenter studies. Methods: Primary lung cancer cases were obtained from the Tempus database, categorized into either IMA or non-IMA, and compared by patient, clinical, biopsy, and molecular characteristics. The normalization of RNA-seq data involved computing transcripts per million (TPM), performing log2 transformations, and adjusting for assay and batch effects. Significantly up- and down-regulated genes were defined as false discovery rate q-values &lt; 0.05 and |log2(fold change)| &gt; 0.5. Results: The study analyzed 18,857 cases, with 655 (3.5%) in the IMA group and 18,202 (96.5%) in the non-IMA group. The IMA group predominantly consisted of older individuals (median age 70 vs. 68; p&lt;0.001), had fewer smokers (63% vs. 73%; p&lt;0.001), and included more individuals of Hispanic or Latino ethnicity (4.3% vs. 2.7%; p=0.007). This group was more likely to be diagnosed with early-stage cancer and less likely to have stage 4 cancer at diagnosis (stage 1: 23% vs. 14%, stage 2: 18% vs. 7.3%, stage 3: 23% vs. 17%, stage 4: 36% vs. 62%; p&lt;0.001). They exhibited significantly lower tumor mutational and neoantigen burdens (median 3.1 vs. 4.6 mutations/Mb and 6 vs. 9 neoantigens/Mb, respectively; both p&lt;0.001), fewer positive PD-L1 statuses (27% vs. 58%; p&lt;0.001), and different immune cell infiltration patterns (Table). Gene expression analysis revealed 416 upregulated and 258 downregulated genes in the IMA group compared to the non-IMA group. Conclusions: This analysis underscores the unique clinicopathologic and molecular characteristics of IMAs. An improved understanding of IMA’s biological behavior could lead to the development of more effective, personalized treatment strategies. [Table: see text]

Predicting the potentially exacerbation of severe viral pneumonia in hospital by MuLBSTA score joint CD4 + and CD8 +T cell counts: construction and verification of risk warning model

PurposeThis study mainly focuses on the immune function and introduces CD4+, CD8+ T cells and their ratios based on the MuLBSTA score, a previous viral pneumonia mortality risk warning model, to construct an early warning model of severe viral pneumonia risk.MethodsA retrospective single-center observational study was operated from January 2021 to December 2022 at the People's Hospital of Liangjiang New Area, Chongqing, China. A total of 138 patients who met the criteria for viral pneumonia in hospital were selected and their data, including demographic data, comorbidities, laboratory results, CT scans, immunologic and pathogenic tests, treatment regimens, and clinical outcomes, were collected and statistically analyzed.ResultsForty-one patients (29.7%) developed severe or critical illness. A viral pneumonia severe risk warning model was successfully constructed, including eight parameters: age, bacterial coinfection, CD4+, CD4+/CD8+, multiple lung lobe infiltrations, smoking, hypertension, and hospital admission days. The risk score for severe illness in patients was set at 600 points. The model had good predictive performance (AUROC = 0.94397), better than the original MuLBSTA score (AUROC = 0.8241).ConclusionA warning system constructed based on immune function has a good warning effect on the risk of severe conversion in patients with viral pneumonia.

A Multiobjective Array Beamforming Method for Arrays of Flexible Shape

High-performance beamforming incorporating multiple objectives for large-scale antenna arrays becomes increasingly important to improve the capacity and efficiency of wireless communication systems. The speed of synthesizing a desired beam pattern is critical in wireless communications systems to adapt to highly dynamic wireless channels. A modified particle swarm optimization (PSO) algorithm for synthesizing array beam patterns is proposed in this study. The initial positions of particles in PSO are designated following a Taylor distribution instead of being given uniformly distributed random values as in the classical PSO algorithm. The fitness functions are defined to include multiple objectives represented by producing multiple main lobes with customized deep and broadened nulls. Several scenarios have been established to examine the feasibility of the proposed algorithm. Moreover, the performance of the proposed algorithm is compared with those of the ones based on the classical PSO. A significant performance improvement for obtaining beamforming coefficients has been achieved. The robustness of the proposed algorithm is demonstrated further by applying it to a finite array on a curved surface for beamforming.

The communication of artificial intelligence and deep learning in computer tomography image recognition of epidemic pulmonary infectious diseases.

The objectives are to improve the diagnostic efficiency and accuracy of epidemic pulmonary infectious diseases and to study the application of artificial intelligence (AI) in pulmonary infectious disease diagnosis and public health management. The computer tomography (CT) images of 200 patients with pulmonary infectious disease are collected and input into the AI-assisted diagnosis software based on the deep learning (DL) model, "UAI, pulmonary infectious disease intelligent auxiliary analysis system", for lesion detection. By analyzing the principles of convolutional neural networks (CNN) in deep learning (DL), the study selects the AlexNet model for the recognition and classification of pulmonary infection CT images. The software automatically detects the pneumonia lesions, marks them in batches, and calculates the lesion volume. The result shows that the CT manifestations of the patients are mainly involved in multiple lobes and density, the most common shadow is the ground-glass opacity. The detection rate of the manual method is 95.30%, the misdetection rate is 0.20% and missed diagnosis rate is 4.50%; the detection rate of the DL-based AI-assisted lesion method is 99.76%, the misdetection rate is 0.08%, and the missed diagnosis rate is 0.08%. Therefore, the proposed model can effectively identify pulmonary infectious disease lesions and provide relevant data information to objectively diagnose pulmonary infectious disease and manage public health.

Morphological transitions between lobate resurfacing and distal breakout lava flows in flood basalts: insights from analog experiments

Continental flood basalts (CFBs) are dominated by two characteristic lava morphologies. The first type, referred to as ‘compound’ or ‘hummocky pāhoehoe,’ exhibits pillow-like lava flow lobes with cross-sections of ~ 0.5–2 m and thin chilled margins. The second type, referred to as ‘simple’ or ‘sheet lobes’ preserves more massive, inflated flow interiors that are laterally continuous on scales of 100s of meters to kilometers. Previous hypotheses suggest that two factors may contribute to stratigraphic changes in morphology from ‘compound’ to ‘simple’: 1) increased eruption duration or 2) increased extrusion rate. We test the hypothesis that a large increase in extrusion rate would result in flow morphology transitioning from multiple small lobes to inflated sheet lobes due to a shift in flow propagation from intraflow resurfacing-dominated to marginal breakout-dominated. Using polyethylene glycol (PEG) wax extruded into a circular water-filled tank 130 cm in diameter, we produced larger, more complex experiments than previous studies. Our efforts simulated more complex lava fields which change flow morphology with distance from the eruptive vent, characteristic of CFBs. Whereas previous PEG studies linked extrusion rate to near-source surface morphologies, our experiments evaluated how flow propagation mechanisms change with variable extrusion rate and distance from the source. Two flow propagation styles were identified: 1) resurfacing, in which molten material breaks through the surface of a flow and covers the older crust and 2) marginal breakouts, in which molten material extends beyond the crust at the active distal margin of the flow. Flows that propagated via marginal breakouts were found to have lower proportions of resurfaced area and vice versa. We show that significant resurfacing is needed to preserve internal chilled boundaries within a flow and a low-extrusion-rate surface morphology, whereas marginal breakout-dominated flows tend to inflate the pillow-like surface morphology preserving a massive interior at great distances from the vent. Higher and more steady extrusion rates tend to decrease the extent of resurfacing and increase the distance between the source and preserved low-extrusion-rate surface morphologies. We find that an extrusion rate increase equivalent to a jump in the extrusion rate scaling factor, Ψ value, from < 1 to > 5 would be necessary to ensure a switch from resurfacing-dominated lobate morphologies to marginal breakout-dominated propagation style. This amounts to a factor of 125 increase in effusion rate for fissure eruptions and a factor of 625 for point source eruptions, assuming no change in vent geometry. This would be equivalent to an effusion rate of 0.2 m3/s, as documented in 1987–1990 Kīlauea eruptions, increasing to 125 m3/s, which was commonly measured during the 2014 Holuhraun eruption in Iceland and the 2018 eruption at Leilani Estates in Hawai‘i. Thus, we propose that continental flood basalts do not require unusually large effusion rates, but instead were active for a longer and more consistent time period than smaller-volume eruptions.

Dynamics of 2D fluid in bounded domain via conformal variables

AbstractIn the present work, we compute numerical solutions of an integro‐differential equation for traveling waves on the boundary of a 2D blob of an ideal fluid in the presence of surface tension. We find that solutions with multiple lobes tend to approach Crapper capillary waves in the limit of many lobes. Solutions with a few lobes become elongated as they become more nonlinear. It is unclear whether there is a limiting solution for small number of lobes, and what are its properties. Solutions are found from solving a nonlinear pseudodifferential equation by means of the Newton conjugate‐residual method. We use Fourier basis to approximate the solution with the number of Fourier modes up to .

Plasma TDP‐43 Levels are Associated with Neuroimaging Measures of Temporal Lobe Structure

AbstractBackgroundTar DNA binding protein of 43kDa (TDP‐43) proteinopathy is a pathological hallmark of limbic‐predominant age‐related TDP‐43 encephalopathy (LATE), with or without comorbid Alzheimer’s disease neuropathologic change (AD‐NC). At present, the diagnosis of LATE neuropathologic change (LATE‐NC) can only be made at autopsy. There is thus an urgent need for a clinical biomarker for LATE and a blood‐based method would be optimal for clinical and economic reasons. Here, we assessed the relationship between plasma TDP‐43 levels with imaging measures of neurodegeneration (volume and cortical thickness).MethodParticipants were 72 nondemented older adults (47 women, age range 60‐94 years). Immunoassays for TDP‐43, phosphorylated threonine‐181 tau (p‐tau181), total tau (t‐tau), amyloid beta‐42 (Aß42), and amyloid beta‐40 (Aß40) were quantified (pg/mL) in duplicate for each participant using the Quanterix Simoa HD‐X instrument. Neuroimaging was conducted using a 3 Tesla MRI Siemens Prisma scanner with a 64‐channel head coil. A T1‐weighted MPRAGE sequence with 1 cubic mm voxels covering the entire brain was acquired. FreeSurfer software was used to estimate intracranial volume (ICV) and volumes of the entorhinal cortex (ERC), amygdala, and subiculum of the hippocampus, regions known to harbor TDP‐43 pathology in early stages of LATE‐NC. Multivariate linear regression models controlling for age, sex, and ICV were conducted in SPSS using plasma TDP‐43 as the predictor and volumetric or cortical thickness measurements as dependent variables.ResultThere was a negative association between plasma TDP‐43 concentration and ERC volume, a relationship that remained significant after controlling for plasma markers of AD‐NC (the Aß42/Aß40 ratio, p‐tau181/Aß40 ratio or t‐tau/Aß40 ratio). Results from subsequent exploratory analyses indicated a negative association between TDP‐43 and cortical thickness in the inferior temporal lobe, a finding which also remained significant after controlling for AD‐NC plasma biomarkers.ConclusionHigh plasma TDP‐43 levels were associated with in vivo imaging measures of neurodegeneration in multiple temporal lobe structures. Plasma TDP‐43 assays may prove useful in clinical trials seeking to enroll individuals at risk for LATE‐NC.

Predictors of reoperation after lung volume reduction surgery

ObjectivesLung volume reduction surgery (LVRS) has proven an effective treatment for emphysema, by decreasing hyperinflation and improving lung function, activity level and reducing dyspnoea. However, postoperative air leak is an important complication, often leading to reoperation.Our aim was to analyse reoperations after LVRS and identify potential predictors.MethodsConsecutive single-centre unilateral VATS LVRS performed from 2017 to 2022 were included. Typically, 3–5 minor resections were made using vascular magazines without buttressing. Data were obtained from an institutional database and analysed. Multivariable logistic regression was used to identify predictors of reoperation. Number and location of injuries were registered.ResultsIn total, 191 patients were included, 25 were reoperated (13%). In 21 patients, the indication for reoperation was substantial air leak, 3 patients bleeding and 1 patient empyema. Length of stay (LOS) was 21 (11–33) vs. 5 days (3–11), respectively. Only 3 injuries were in the stapler line, 13 within < 2cm and 15 injuries were in another site. Multivariable logistic regression analysis showed that decreasing DLCO increased risk of reoperation, OR 1.1 (1.03, 1.18, P = 0.005). Resections in only one lobe, compared to resections in multiple lobes, were also a risk factor OR 3.10 (1.17, 9.32, P = 0.03). Patients undergoing reoperation had significantly increased 30-day mortality, OR 5.52 (1.03, 26.69, P = 0.02).ConclusionsOur incidence of reoperation after LVRS was 13% leading to prolonged LOS and increased 30-day mortality. Low DLCO and resections in a single lobe were significant predictors of reoperation. The air leak was usually not localized in the stapler line.Graphical abstractKey question: What characterizes reoperations after lung volume reduction surgeries?Key findings: Lung injuries were predominantly located away from the original surgical site.Take home message: Lung injuries remote from the stapler line is frequent during reoperation after lung volume reduction surgery.Location of lung injuries found during reoperation after lung volume reduction surgery

Real-World Data of Outcome of Patients with Newly Diagnosed Bronchial-Associated Lymphoid Tissue Lymphoma: A Multi-Center Retrospective Analysis with Long-Term Survivors

Introduction Extranodal marginal-zone lymphoma (MZL) of mucosa-associated lymphoid tissue (MALT) is an indolent type of non-Hodgkin's lymphoma. Although the lung is the second most common site, it accounts for less than 1% of all lymphomas. Extranodal MZL of MALT type of the lungs originates from bronchial-associated lymphoid tissue (BALT) and is clinically referred to as “BALT lymphoma” or “BALToma”. The indolent nature of BALTomas results in none or mild symptoms and their slow growth pattern allows for various treatment approaches. Depending on the case, active surveillance may be considered, while others may benefit from surgery, radiotherapy or chemotherapy. Despite some existing reviews on this lymphoma, comprehensive characterization of optimal management and prognostic factors remains inadequately defined. Limited case reports and small-scale retrospective data analyses have been conducted, but the number of patients included in these studies was highly restricted. In this study, we conducted a retrospective analysis of clinical data from 67 BALToma patients in South Korea. Methods 67 patients were included in our analysis, all of whom were diagnosed with BALToma between September 1996 and January 2023 at three institutions in South Korea. The criteria for case inclusion was histologically confirmed diagnosis of extranodal MZL of pulmonary origin in accordance with WHO classifications, and availability of clinical data. Extranodal MZL was diagnosed based on WHO classifications, along with the findings from immunohistochemical staining for CD20 and CD3. If needed, CD5, CD10, CD23, cyclin D1, BCL6, and Ki-67 was also stained. Gene rearrangement studies targeting the IgH gene were conducted using PCR analysis. Patients were treated according to the stage and location of the disease. The patients were analyzed into two groups; observation or localized treatment and systemic chemotherapy. Localized treatment included surgery or radiotherapy. Systemic chemotherapy regimens used were mainly (R)-CVP and (R)-CHOP. Baseline characteristics was analyzed with Fisher's exact test. Overall survival (OS) and Progression Free Survival (PFS) were estimated using the Kaplan-Meier method. PFS was calculated from the date of diagnosis to the date on which progression was noted, the date of the last follow-up, or the date of death. OS was measured from the date of diagnosis to the date of death or the last follow-up visit. Survival rates were compared for statistical differences via Generalized Wilcoxon analyses. Prognostic factor analysis and hazard ratio was calculated using univariate and multivariate Cox Regression method. All statistical tests were two-sided, and p &amp;lt; 0.05 was considered statistically significant. All data was analyzed using SPSS Statistics for Windows, Version 27.0. Results The clinical characteristics of patients according to treatment modality was analyzed (Table 1). Gender, age, performance status was not significantly different between each group. Notably, involvement of single or multiple lobe (p=0.045), involvement of bilateral lung (p&amp;lt;0.001), nodal involvement (p=0.033), and involvement of extrapulmonary organ (p=0.010) was significantly different between each group. The PFS and OS according to treatment method are provided in Figure 1 and 2. 10-year PFS for observation or localized treatment was 78.7% whereas chemotherapy was 56.9% (p=0.044). 10-year OS for observation or localized treatment was 100%, whereas chemotherapy was 71.7% (p=0.016). The prognostic factors for progression of disease were significant only for the involvement of extrapulmonary organ in both univariate and multivariate (hazard ratio 3.615, p=0.023) analysis (Table 2). Prognostic factor analysis for overall survival did not yield any significant result. Conclusion This study concludes that the most important prognostic factor for the progression of disease is the involvement of extrapulmonary organ. This study implies that the feasibility of simply monitoring patients whose disease is confined exclusively to the lung is a viable strategy. However, in the case of extrapulmonary involvement, the implementation of systemic chemotherapy ought to be deliberated. Given the heightened potential for disease progression, this underscores the necessity for meticulous consideration during the development of therapeutic plans.

Vimentin regulates nuclear segmentation in neutrophils.

Granulocytes are indispensable for various immune responses. Unlike other cell types in the body, the nuclei of granulocytes, particularly neutrophils, are heavily segmented into multiple lobes. Although this distinct morphological feature has long been observed, the underlying mechanism remains incompletely characterized. In this study, we utilize cryo-electron tomography to examine the nuclei of mouse neutrophils, revealing the cytoplasmic enrichment of intermediate filaments on the concave regions of the nuclear envelope. Aided by expression profiling and immuno-electron microscopy, we then elucidate that the intermediate-filament protein vimentin is responsible for such perinuclear structures. Of importance, exogenously expressed vimentin in nonimmune cells is sufficient to form cytoplasmic filaments wrapping on the concave nuclear surface. Moreover, genetic deletion of the protein causes a significant reduction of the number of nuclear lobes in neutrophils and eosinophils, mimicking the hematological condition of the Pelger-Huët anomaly. These results have uncovered a new component establishing the nuclear segmentation of granulocytes.

Environmental evolution of western Tierra del Fuego (∼54°S) since ice-free conditions and its zonal/hemispheric implications

By virtue of its position adjacent to the Drake Passage, Tierra del Fuego in South America allows examining the vegetation and environmental history of the southernmost continental landmass outside Antarctica, and the evolution of the Southern Westerly Winds-Southern Ocean (SWW–SO) coupled system since the Last Glacial Maximum (LGM). For that purpose, we studied sediment cores from Lago Charquito, a small closed-basin lake in central-west Tierra del Fuego with a continuous lacustrine record since ∼17.3 ka. Ice-free conditions at the site imply a ∼70 km retreat of the Bahía Inútil glacier lobe from its LGM position during a ∼800-year interval, a trend that continued until its disappearance ∼100 km upstream from L. Charquito, ∼800 years later. Our palynological data show an open landscape dominated by cold-tolerant shrubs and herbs between ∼17.3–12.9 ka, with increases in precipitation of SWW origin at ∼16.3 ka, ∼14.7 ka, between ∼8.7–7.6 ka, and after ∼6.8 ka. Warming at ∼12.9 ka initiated an abrupt afforestation trend that stalled during the early Holocene (∼12–8.7 ka) owing to a precipitation decline and wildfires, and later resumed in response to invigorated SWW. We hypothesize that sparse Nothofagus tree populations inhabited the periphery of the Patagonian Ice Sheet (PIS) during the LGM and migrated toward the Andes contemporaneous with glacier recession as temperature rose during the Last Glacial Termination (T1). We posit that besides establishing topographic and climatic barriers for land biota, the PIS enabled the connectivity of cold-tolerant hygrophilous plant populations along a humid fringe adjacent to its land-based perimeter, despite the presumably dry conditions downwind from the eastern PIS margin. Our results suggest that southward shifts or expansion of the SWW toward or beyond Tierra del Fuego enhanced upwelling and ventilation of deep waters in the SO, northward shifts or weakening had the opposite effect. We observe that the time evolution of atmospheric CO2 concentrations, high-latitude air and sea-surface temperatures, and sea level during T1 fall short in explaining the timing and abruptness of the Bahía Inútil glacier lobe collapse, and quite possibly multiple other glacier lobes from the PIS.