Multiple Lobes Research Articles

Combined [18F]FDG-PET with MRI structural patterns in predicting post-surgical seizure outcomes in temporal lobe epilepsy patients.

To integrate the glucose metabolism measured using [18F]FDG PET/CT and anatomical features measured using MRI to forecast the post-surgical seizure outcomes of intractable temporal lobe epilepsy. This retrospective study enrolled 63 patients with drug-resistant temporal lobe epilepsy. Z-transform of the patients' PET images based on comparison with a database of healthy controls, cortical thickness, and quantitative anisotropy (QA) of the diffusion spectrum imaging concordant/non-concordant with cortical resection was adopted to quantify their predictive values for the post-surgical seizure outcomes. The PET hypometabolism region was concordant with the surgical field in 47 of the 63 patients. Forty-two patients were seizure-free post-surgery. The sensitivity and specificity of PET in predicting seizure freedom were 89.4% and 68.8%, respectively. Complete resection of foci with overlapped PET, cortical thickness, and QA abnormalities resulted in Engel I in 27 patients, which was a good predictor of seizure freedom with an odds ratio (OR) of 19.57 (95% CI 2.38-161.25, p = 0.006). Hypometabolism involved in multiple lobes (OR = 7.18, 95% CI 1.02-50.75, p = 0.048) and foci of hypometabolism with QA/cortical thickness abnormalities outside surgical field (OR = 14.72, 95% CI 2.13-101.56, p = 0.006) were two major predictors of Engel III/IV outcomes. ORs of QA to predict Engel I and seizure recurrence were 14.64 (95% CI 2.90-73.80, p = 0.001) and 12.01 (95% CI 2.91-49.65, p = 0.001), respectively. Combined PET and structural pattern is helpful to predict the post-surgical seizure outcomes and worse outcomes of Engel III/IV. This might decrease unnecessary surgical injuries to patients who are potentially not amenable to surgery. • A combined metabolic and structural pattern is helpful to predict the post-surgical seizure outcomes. • Favorable post-surgical seizure outcome was most likely reached in patients whose hypometabolism overlapped with the structural changes. • Hypometabolism in multiple lobes and QA or cortical thickness abnormalities outside the surgical field were predictors of worse seizure outcomes of Engel III/IV.

Clinical characteristics of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing: A case series.

Introduction:The objective of this study was to explore the clinical, laboratory, and imaging features of severe Chlamydia psittaci pneumonia in order to improve early diagnosis and treatment success rates.Methods:We conducted a retrospective record review of 14 cases of severe Chlamydia psittaci pneumonia diagnosed by metagenomic next-generation sequencing technology in our hospital. We extracted and analyzed data on the clinical symptoms and signs, contact history, laboratory investigations, chest computed tomography, treatment, and clinical outcomes.Results:Of the 14 patients, 12 (86%) were male and two (14%) were female, with a mean age of 57 years (SD: 7 years). Eleven patients (79%) had a history of poultry contact. The main clinical manifestations were fever (n = 14, 100%), flu-like symptoms (n = 10, 71%), cough, sputum (n = 9, 64%), and dyspnea (n = 5, 36%). Blood tests revealed marked elevation of neutrophil percentage, C-reactive protein, procalcitonin, brain natriuretic peptide, and creatine kinase levels; slight elevation of aspartate aminotransferase, creatinine, urea, fibrinogen, and D-dimer levels; and decreased albumin, sodium, and calcium levels. Chest computed tomography showed bilateral lesions (n = 7, 50%), middle-lower lobe lesions (n = 10, 71%), lesions in multiple lobes (n = 9, 64%), consolidation shadows (n = 11, 79%), and pleural effusions (n = 11, 79%). The median time from disease onset to hospital admission was 4.5 days (interquartile range: 1–17 days); the mean length of hospital stay was 20.9 ± 8.5 days, and the mean time from admission to diagnosis was 5.1 ± 2.6 days. After diagnosis, patients were either treated with doxycycline alone or doxycycline combined with quinolones. All 14 patients developed respiratory failure and received invasive mechanical ventilation; two (14%) received veno-venous extracorporeal membrane oxygenation, four (29%) received continuous renal replacement therapy, and three (21%) died.Discussion and conclusion:A poultry contact history and typical flu-like symptoms are early indicators of Chlamydia psittaci pneumonia. Substantial elevations in procalcitonin, creatine kinase, and brain natriuretic peptide indicate severe disease. Metagenomic next-generation sequencing is useful for diagnosis. Early empirical antibiotic therapy with quinolones can reduce the mortality in critically ill patients.

Music, Math, and Working Memory: Magnetoencephalography Mapping of Brain Activation in Musicians.

Musical transposing is highly demanding of working memory, as it involves mentally converting notes from one musical key (i.e., pitch scale) to another key for singing or instrumental performance. Because musical transposing involves mental adjustment of notes up or down by a specific amount, it may share cognitive elements with arithmetical operations of addition and subtraction. We compared brain activity during high and low working memory load conditions of musical transposing versus math calculations in classically trained musicians. Magnetoencephalography (MEG) was sensitive to differences of task and working memory load. Frontal-occipital connections were highly active during transposing, but not during math calculations. Right motor and premotor regions were highly active in the more difficult condition of the transposing task. Multiple frontal lobe regions were highly active across tasks, including the left medial frontal area during both transposing and calculation tasks but the right medial frontal area only during calculations. In the more difficult calculation condition, right temporal regions were highly active. In coherence analyses and neural synchrony analyses, several similarities were seen across calculation tasks; however, latency analyses were sensitive to differences in task complexity across the calculation tasks due to the high temporal resolution of MEG. MEG can be used to examine musical cognition and the neural consequences of music training. Further systematic study of brain activity during high versus low memory load conditions of music and other cognitive tasks is needed to illuminate the neural bases of enhanced working memory ability in musicians as compared to non-musicians.

Comparative analysis of clinical features between severe coronavirus disease 2019 and severe community acquired pneumonia

To compare and analyze the clinical features of patients with severe coronavirus disease 2019 (sCOVID-19) and severe community acquired pneumonia (sCAP) who meet the diagnostic criteria for severe pneumonia of the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS). A retrospective comparative analysis of the clinical records of 116 patients with sCOVID-19 admitted to the department of critical care medicine of Wuhan Third Hospital from January 1, 2020 to March 31, 2020 and 135 patients with sCAP admitted to the department of critical care medicine of Shanghai First People's Hospital from January 1, 2010 to December 31, 2017 was conducted. The basic information, diagnosis and comorbidities, laboratory data, etiology and imaging results, treatment, prognosis and outcome of the patients were collected. The differences in clinical data between sCOVID-19 and sCAP patients were compared, and the risk factors of death were analyzed. The 28-day mortality of sCOVID-19 and sCAP patients were 50.9% (59/116) and 37.0% (50/135), respectively. The proportion of arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) ≤ 250 mmHg (1 mmHg ≈ 0.133 kPa) in sCOVID-19 patients was significantly higher than that of sCAP [62.1% (72/116) vs. 34.8% (47/135), P < 0.01]. The possible reason was that the proportion of multiple lung lobe infiltration in sCOVID-19 was significantly higher than that caused by sCAP [94.0% (109/116) vs. 40.0% (54/135), P < 0.01], but the proportion of sCOVID-19 patients requiring mechanical ventilation was significantly lower than that of sCAP [45.7% (53/116) vs. 60.0% (81/135), P < 0.05]. Further analysis of clinical indicators related to patient death found that for sCOVID-19 patients PaO2/FiO2, white blood cell count (WBC), neutrophils (NEU), neutrophil percentage (NEU%), neutrophil/lymphocyte ratio (NLR), total bilirubin (TBil), blood urea nitrogen (BUN), albumin (ALB), Ca2+, prothrombin time (PT), D-dimer, C-reactive protein (CRP) and other indicators were significantly different between the death group and the survival group, in addition, the proportion of receiving mechanical ventilation, gamma globulin, steroid hormones and fluid resuscitation in death group were higher than survival group. Logistic regression analysis showed that the need for mechanical ventilation, NLR > 10, TBil > 10 μmol/L, lactate dehydrogenase (LDH) > 250 U/L were risk factors for death at 28 days. For sCAP patients, there were significant differences in age, BUN, ALB, blood glucose (GLU), Ca2+ and D-dimer between the death group and the survival group, but there was no significant difference in treatment. Logistic regression analysis showed that BUN > 7.14 mmol/L and ALB < 30 g/L were risk factors for 28-day death of sCAP patients. The sCOVID-19 patients in this cohort have worse oxygen condition and symptoms than sCAP patients, which may be due to the high proportion of lesions involving the lungs. The indicators of the difference between the death group and the survival group were similar in sCOVID-19 and sCAP patients. It is suggested that the two diseases have similar effects on renal function, nutritional status and coagulation function. But there were still differences in risk factors affecting survival. It may be that sCOVID-19 has a greater impact on lung oxygenation function, inflammatory cascade response, and liver function, while sCAP has a greater impact on renal function and nutritional status.

Mechanisms of corneal intrastromal laser dissection for refractive surgery: ultra-high-speed photographic investigation at up to 50 million frames per second.

Every year, more than a million refractive eye surgeries using femtosecond lasers are performed but the intrastromal cutting process remains an area of development. We investigated the mechanisms of laser dissection in cornea by ultra-high-speed photography. We found that the intrastromal bubble forms multiple lobes along the elongated laser plasma and the overlying lobes expand along the corneal lamellae. Videography demonstrated that the cutting process relies on crack propagation in the stroma along the bubble lobes with the crack originating from the pre-existing bubble layer. These insights are important for further improvement of the cutting mechanisms in refractive surgery.

Unilateral vs Bilateral Lower Lobe Surveillance Transbronchial Biopsies in Patients with Bilateral Lung Transplant Patients

<h3>Purpose</h3> Transbronchial biopsies are routinely performed in surveillance of subclinical rejection after lung transplantation. Sensitivity of transbronchial biopsies can be increased by sampling lower lobes and multiple lobes. Due to the inherent risks of the procedure, biopsies are usually limited to one lung. It is not known if sampling bilateral lower lobes improves diagnostic sensitivity for ACR or affects the outcomes. At our institution, one of the transplant pulmonologist routinely biopsies both the lower lobes hence, this provided us with an opportunity to study and compare the diagnostic yield of biopsies of unilateral vs bilateral lower lobes. <h3>Methods</h3> Retrospective analysis of charts was performed on 83 patients transplanted with lungs bilaterally over 3.5 years. Details of surveillance transbronchial biopsies at 1, 3, 6, 9 (Optional) and 12 months after transplantation were collected for analysis. <h3>Results</h3> 83 lung transplant recipients studied over 3.5 years with a total of 427 transbronchial biopsies. Out of these, 116 procedures were performed bilaterally and 195 procedures were performed unilaterally. Among the 116 patients biopsied bilaterally, 2 samples were inadequate and 25 patients (21.73%) had evidence of ACR including minimal (A1) in 31 samples and A2 rejection in 1 sample. Only 6 out of 25 patients had evidence of ACR in both the lower lobes and 4 out of those procedures were performed in the same patient at different times. Only one of these patient with A2 rejection and another with persistent A1 rejection were treated with pulsed dose steroids for ACR. Among the 195 samples obtained unilaterally, 1 sample was inadequate and 30 biopsy specimens had evidence of ACR (15.38%) including minimal (A1) ACR in 24 samples and mild (A2) rejection in 6 samples. All patients with A2 rejection were treated with pulsed dose steroids for ACR. There were no reported episodes of life threatening hemoptysis or pneumothorax associated any of the above procedures. <h3>Conclusion</h3> In bilateral lung transplant recipients, bilateral lower lobe surveillance transbronchial biopsies may increase the yield for detection of ACR. Detection of ACR simultaneously in both the lower lobes is rare. Unilateral ACR was minimal in most of the biopsies and did not alter the management. Bilateral lower lobe biopsies was not associated with increased risk of pneumothorax

Long-term neurodevelopmental outcome of neonates born at term with perinatal haemorrhagic stroke: A population-based study.

AimTo assess the long‐term neurodevelopmental outcome of neonates born at term diagnosed with perinatal haemorrhagic stroke (PHS) and investigate the associations among brain territorial involvement, clinical risk factors, and neurodevelopmental outcomes.MethodWe conducted a population‐based study enrolling 55 neonates born at term with PHS confirmed by magnetic resonance imaging born between 2007 and 2017. Long‐term neurodevelopmental outcome was assessed using the Bayley Scales of Infant Development, Second Edition, the Brunet–Lézine test, and the Stanford–Binet Intelligence Scales, Fifth Edition.ResultsFollow‐up was available in 50 (91%) of the infants, at a median age of 60 months (interquartile range 35–88). Forty per cent of the infants developed according to population norms, and developmental disabilities were diagnosed less frequently among neonates with frontal lobe PHS. In a multivariable model, parietal lobe PHS increased the risk for cerebral palsy (odds ratio [OR] 6.7; 95% confidence interval [CI] 1.1–41.4) and cognitive impairment (OR: 23.6; 95% CI: 2.9–194.9), while the involvement of the thalamus and/or basal ganglia was associated with epilepsy (OR: 7.0; 95% CI: 1.3–37.7). Seizures on admission were associated with epilepsy (OR: 10.8; 95% CI: 1.8–64.3). Patients with PHS affecting multiple lobes had poor prognosis.InterpretationParietal lobe haemorrhage, the involvement of the thalamus/basal ganglia, PHS affecting multiple lobes, and seizures were independent predictors of chronic neurodevelopmental sequelae, suggesting that the stroke territorial involvement and clinical risk factors influence the outcome of PHS.

CLINICAL CHARACTERISTICS AND CHEST X-RAY AND COMPUTED TOMOGRAPHY FINDINGS IN DIFFERENT CLINICAL SEVERITY GRADING OF COVID-19 PATIENTS

Background: Clinical assessment, chest X-ray (CXR) and high-resolution computed tomography (HRCT) are used in the Corona virus disease-19 (COVID-19) management. The aim of the study was to determine the clinical characteristics and CXR and HRCT findings in COVID-19 patients with different clinical severity. Methods: This was a hospital-based cross-sectional study conducted at Chitwan Medical College, Department of Pulmonary and Critical Care Medicine from September to December 2020. Data from sixty adult patients with moderate (non-severe), severe, and critical COVID 19 disease having both CXR and HRCT were collected and were analyzed using SPSS version 16. Results: Median age of patients in our hospital-based study was 59.9 years and 76.7% were male, 30% had diabetes, and 35% had hypertension. Respiratory rate (p=0.001) and shortness of breath (p= 0.011) significantly increased and oxygen saturation (SpO2) (p&lt;0.001) decreased with increase in clinical severity of COVID-19 disease. Among the moderate, severe and critical clinical severity groups, there was significant difference in the HRCT findings like ground-glass opacity (GGO), consolidation, septal thickening, crazy paving pattern, bronchiectasis and fibrosis (p&lt;0.05). GGO was the most common finding. Bilateral consolidation in CXR and multiple lobes in both lungs involvement in HRCT were similar across the moderate, severe and critical clinical severity (p&gt;0.05). Conclusions: There was no difference in CXR and HRCT findings across moderate, severe and critical clinical severities of COVID-19; future study performing CXR whenever HRCT is done for any indication may similarly indicate the situation in mild COVID-19 disease.

Underlying causes of persistent pneumonia in children at the Intensive Care Unit,Vietnam National Children’s Hospital

The study describes underlying causes of children with severe persistent pneumonia (sPP) admitted to the Intensive Care Unit (ICU), Vietnam National Children’s Hospital. In the prospective and descriptive study, all patients classified as sPP (pneumonia persisting for 30 days or more, despite receiving antibiotics for a minimum period of 10 days), admitted to ICU, Vietnam National Children’s Hospital from November 2019 to August 2020 were recruited. Patients were divided into groups based on having a recurrent lesion in the same lobe or lesion in multiple lobes before undergoing several investigational tests to identify the underlying causes. 82 patients with sPP accounted for 21.9% of children admitted to ICU due to pneumonia and 10.6% of total patients at ICU. Underlying causes were diagnosed in 82.9% of sPP children, with the most common causes are abnormalities in respiratory (19.5%), immune disorders (18.3%), congenital heart diseases (17.1%). Underlying causes couldn’t be identified in 17.1% of the patients, among whom necrotizing pneumonia or lung abscess account for 50%, ARDS 21.4%, and tuberculosis 14.3%. Local and recurrent x-ray lesions in one lung lobe accounted for 22%.

High Efficiency Beam Alignment Based on Multi-Modal Beam Patterns for Massive MIMO Antenna Systems

Multiple-input multiple-output (MIMO) is considered as the key technology for 5G wireless communications networks. In the millimeter-wave (mmWave) frequency bands, directional beamforming is essential to the establishment of an efficient radio link for signal transmission. However, in wireless mobile environments, the effective beam direction is generally unavailable in the initial access phase. Hence, beam alignment (BA) is crucial for link establishment in initial access. In this work, we propose an efficient BA technique, referred to as the multi-modal pattern BA scheme, to improve the performance and efficiency of initial access in massive MIMO systems. Unlike the conventional sequential search scheme using single-modal patterns, the transmission of synchronization signals in the proposed scheme is based on the use of multi-modal patterns, each of which specifies multiple main lobes with distinguishable directions. Incomparison with the conventional scheme, our scheme can greatly enhance the achieved angular resolution after BA under the use of a fixed number of synchronization signals. As a result, the signal-to-noise ratio (SNR) of the established link is significantly improved. By contrast, if the same angular resolution is desired, the proposed scheme can greatly reduce the number of required synchronization signals to conserve the radio resources, including transmission power and bandwidth, and to decrease the searching delay in the BA procedure. In addition, considering multi-modal pattern construction for the transmission using a single radio-frequency (RF) chain, we propose an effective approach to generate the desired beamforming vectors fulfilling the essential constant amplitude constraint.

Clinical Characteristics and CT Imaging Features of COVID-19 on Admission: A Retrospective Study.

Coronavirus Disease 2019 (COVID-19) pandemic has become a global health issue. This study aimed to explore the clinical characteristics and CT imaging features of patients with COVID-19 on admission. Consecutive patients with laboratory-confirmed COVID-19 were retrospectively recruited to this study from January 2020 to March 2020. According to the disease severity status on admission, patients were divided into two groups, the common group, and the severe group. Forty-four patients (F/M 20/24) who were COVID-19 positive were enrolled in this study. The most common onset symptom was fever (90.9%), followed by cough (43.2%). As for the laboratory tests, common findings included increased C reactive protein (47.7%) and erythrocyte sedimentation rate (43.2%) and decreased lymphocyte (34.1%). The frequency of decreased lymphocyte count and increased lactate dehydrogenasewas higher in the severe group (n=14) than in the common group (n=30). About 86% of patients showed typical imaging findings of COVID-19 infection, including ground-glass opacity with ill-defined margins, air bronchogram, interlobular septal thickening, and consolidation. Lesions were mainly located in the peripheral and subpleural regions with diffused distribution and multiple lung lobes were found to be affected. Fever and cough were the most common onset symptoms of COVID-19. Increased C reactive protein and erythrocyte sedimentation rate were the most common laboratory findings. Typical signs of chest CT imaging of COVID-19 included ground-glass opacity with ill-defined margins, air bronchogram, interlobular septal thickening, and consolidation.

The Nuclear Function of IL-33 in Desensitization to DNA Damaging Agent and Change of Glioma Nuclear Structure.

Glioma, the most common subtype of primary brain tumor, is an aggressive and highly invasive neurologically tumor among human cancers. Interleukin-33 (IL-33) is considered as a dual functional cytokine, an alarmin upon tissue damage and a nuclear chromatin-associated protein. Despite that, IL-33 is known to foster the formation of the inflammatory tumor microenvironment and facilitate glioma progression, evidence showing nuclear IL-33 function is still poor. In this study using lentivirus-mediated IL-33 gene knockdown (IL33KD) and IL-33 overexpression (IL33oe) in rat C6 glioma cells and human glioma cell lines (U251MG and U87MG), we found that IL33oe-glioma cells had resistance to the insults of the alkylating agent, temozolomide (TMZ), possibly because of the increased expression of DNA repair genes (i.e., BRCA1, BRCA2, Rad51, FANCB, and FANCD) in IL33oe-glioma cells. Alternatively, examination of glioma nuclear shape from transmission electron microscopy (TEM) imaging analysis and immunofluorescence for histone protein H2A staining showed that IL33KD attenuated the abnormal cancerous nuclear characteristic, such as indentation, long clefts, and multiple nucleoids. Yet, IL33oe promoted the changes in glioma nuclear shapes, such as the formation of multiple lobes. We further found that histone proteins, H2A and H3, were reduced in IL33KD glioma cells. The non-histone DNA-binding nucleoproteins, the high mobility group A1 (HMGA1) and HMGA2, were also downregulated by IL33KD. In contrast, IL33oe increased H2A and H3 proteins and HMGA1 and HMGA2 in glioma cells. Altogether, the upregulation of nuclear IL-33 expression was along with an increase in the expression of DNA repair genes, contributing to the desensitization of glioma cells to DNA damaging agents. Moreover, nuclear IL-33 proteins in cooperation with chromatin-associated proteins regulate glioma nuclear structure, which might be crucial for glioma progression and malignancy.

Left appendage morphology as risk factors for cardio-embolism in patients with stroke of undetermined source

Abstract Background Left atrium (LA) volume and function and certain left atrial appendage (LAA) morphologies are known to be strongly associated with the risk of thrombus formation and thromboembolism in patients with atrial fibrillation (AF). Little is known about the role of LA parameters and LAA morphology in patients with Embolic Stroke of Undetermined Source (ESUS). Purpose To assess LA volume and function and LAA morphologies in ESUS patients and the potential association with cardioembolic risk. Methods Twenty consecutive patients with ESUS who underwent contrast enhanced electrocardiogram-gated computed tomography (CT) as part of stroke etiology evaluation were matched by age and gender to patients with and without history of AF (twenty in each group) who had CT as part of standard evaluation before transcatheter aortic valve implantation. LA maximum (LAVmax) and minimum (LAVmin) volumes and function, measured as total emptying volume (LAEV) and total emptying fraction (LAEF) were assessed, and three- dimensional structures of the LA and LAA were constructed using the volume-rendered post-processing technique. Results The mean age of patients was 75.9±8.61, 76.1±8.52, 77.8±7.72) in the ESUS, AF and non-AF groups, respectively, with 11 (55%) females in each group. Compared to patients with ESUS, patients with AF showed significantly greater LAVmax (100.59±31.59 ml vs.155.78±63.15 ml, respectively, p=0.001) and LAVmin (71.38±30.69 ml vs. 140.73±64.60 ml; respectively, p&amp;lt;0.001), while LAV max and LAVmin were similar, in patients with ESUS and non-AF. The distribution of LAA morphologies significantly differed between patients with ESUS and patients with AF and non-AF: 1 (5%) vs. 9 (45%) chicken-wing; 14 (70%) vs. 8 (40%) cauliflower; and 5 (25%) vs. 3 (15%) Cactus; respectively. Conclusion LA appendage morphology, but not LA volume, seems to be associated with ESUS. LAA morphologies with multiple lobes, cauliflower and cactus, seems to be associated with ESUS. Larger studies are needed to confirm these associations. Funding Acknowledgement Type of funding sources: None.

Spatiospectral lobe characteristics for F404 engine noise

Spatiospectral lobes are a currently unexplained phenomenon seen in noise radiation from tactical aircraft. These lobes can be seen as either multiple peaks in the noise spectra at a given field location or multiple local maxima in the directivity when observing the radiated noise field at a particular frequency. Using hybrid beamforming of a 120-microphone near-field array, the characteristics of these lobes are studied for a GE F404 engine installed on a T-7A aircraft and at different engine conditions. Both the measured field and field reconstructions show multiple spatiospectral lobes. While the overall directivity of the noise shifts forward with increase in frequency, individual lobes appear, shift aft, and then disappear as frequency is increased. Individual lobes were also raytraced back to the jet centerline to determine an apparent acoustic source location. For frequencies where multiple lobes are present, they generally radiate from an overlapping maximum source region that moves upstream with frequency. This corroborates the characteristics of spatiospectral lobes observed in other aircraft. [Work supported by ONR.]

TENSION PNEUMOTHROAX AS INITIAL MANIFESTATION OF LUNG INVOLVEMENT IN CUTANEOUS SARCOIDOSIS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Bullae formation resulting in pneumothorax typically occurs in the late stages of pulmonary sarcoidosis. CASE PRESENTATION: A 56-year-old female with past medical history of hypertension and cutaneous sarcoidosis diagnosed two years ago via skin biopsy. The patient presented with symptoms of heaviness on the right side on the chest, cough, and shortness of breath which started the day before. On examination, the patient was tachypneic, tachycardiac with decreased breath sounds on the right upper and middle lung fields. Chest x-ray showed a right-sided pneumothorax (Figure #1). Computed tomography of the chest (CT) showed a large right pneumothorax measuring approximately 7.5 cm between the visceral and parietal pleura. There were also multiple right upper lobe pulmonary micronodules and biapical bullae, worse on the right lung (figure #2). A Chest tube thoracostomy was performed and patient monitored in the ICU till pneumothorax resolved. Following resolution, a video-assisted thoracoscopic surgery (VATS) with right apical wedge resection of blebs, mechanical and chemical pleurodesis, and chest tube placement was performed. Histology of the right lung apex confirmed non-necrotizing granulomatous reaction from sarcoidosis. The patient improved following surgery and discharged with outpatient follow-up. DISCUSSION: Bullae formation typically presents in advanced pulmonary sarcoidosis with fibrotic changes. In rare cases, bullous disease and subsequent pneumothorax have been reported in the early stage of pulmonary sarcoidosis [1]. Several mechanisms have been proposed for the formation of such bullae; these include bronchial obstruction by sarcoid lesions, causing peripheral air trapping and alveolar distension and rupture, retraction and collapse of surrounding disease lung, and the presence of inflammatory alveolitis causing tissue destruction [2]. Pneumothorax is caused by rupture of these subpleural bullae or necrotic granulomas. Management is by chest tube drainage, bullectomy by thoracoscopic surgery may be required in cases of recurrent pneumothorax [3]. A high index of suspicion should be maintained as pneumothorax can be the presenting feature of early or advanced pulmonary sarcoidosis and predisposes to increased morbidity and mortality. CONCLUSIONS: Bullous disease and pneumothorax are rare presentations of sarcoidosis. Pneumothorax should be suspected in all stages of sarcoidosis in patients with pulmonary symptoms due to high mortality associated with late detection and management. REFERENCE #1: Froudarakis, Marios E., et al. "Pneumothorax as a first manifestation of sarcoidosis." Chest 112.1 (1997): 278-280. REFERENCE #2: Manika, Katerina, et al. "Pneumothorax in sarcoidosis." Journal of thoracic disease 6.Suppl 4 (2014): S466. REFERENCE #3: Keller, Cesar A., et al. "Histopathologic diagnosis made in lung tissue resected from patients with severe emphysema undergoing lung volume reduction surgery." Chest 111.4 (1997): 941-947. DISCLOSURES: No relevant relationships by Ramez Alyacoub, source=Web Response No relevant relationships by Ifunanya Ejikeme, source=Web Response No relevant relationships by CHIDINMA EJIKEME, source=Web Response

MULTIFOCAL PULMONARY GRANULAR CELL TUMOR

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: Granular cell tumors, also known as Abrikossoff tumors, are a rare group of Schwannian neoplasms typically found in the skin and tongue, but also occur in the lung. Granularity of the cells is due to accumulation of secondary lysosomes in the cytoplasm. Only 0.5-2% of pulmonary granular cell tumors (pGCT) are malignant, but some benign cases show similar behavior. Here, we describe a diagnostically challenging case of multifocal pGCT. CASE PRESENTATION: A 48-year old male with history of asthma, chronic obstructive pulmonary disease, hypertension, and alcoholic steatohepatitis presented for evaluation of a right lung mass found on chest X-ray 5 years ago. He endorsed progressive dyspnea poorly controlled with beclomethasone and albuterol inhalers. He had history of tobacco smoking with 31 pack-years, as well as alcohol abuse. He worked in a shipyard for 3 years with exposure to asbestos and welding fumes. Computed tomography of the chest showed a 4.1-cm solid mass in the right lower lobe, as well as a 1.1-cm endobronchial lesion in the right bronchus intermedius, multiple left lower lobe lesions, and mediastinal lymphadenopathy. Spirometry showed moderate obstructive disease with bronchodilator response. Biopsies of lower lobe and tracheal mucosal lesions obtained by bronchoscopy revealed sheets of epithelioid cells with abundant eosinophilic granular cytoplasm and small uniform nuclei consistent with pGCT. There was no evidence of necrosis or increased mitotic figures to suggest malignancy. Immunostaining was positive for S100, CD68, SOX10, inhibin, and PAS. He was referred to Interventional Pulmonology for laser debulking and endobronchial stenting. DISCUSSION: Determining whether pGCTs are malignant or benign can be challenging. Both types occur in all age groups. Both can cause dyspnea, cough, and pleuritic chest pain. Large tumor size is not predictive, as many malignant pGCT's are <4 cm at time of diagnosis. Additionally, 20% of benign pGCTs have multiple lung lesions. However, the presence of extrapulmonary metastases is diagnostic of malignancy. Malignant pGCTs also show 3 or more histologic features of the Fanburg-Smith criteria, including necrosis, spindling, pleomorphism, vesicular nuclei with large nucleoli, high nuclear/cytoplasmic ratio, and increased mitotic activity. Positive p53 or Ki67 immunostaining can indicate malignancy in indeterminate cases. Management of benign pGCTs is surgical. Small tumors <1.0 cm may be removed by bronchoscopic extirpation, laser therapy, or sleeve resection. Larger tumors are resected surgically. Prognosis for benign pGCT is good (2-8% recurrence) if complete margin-free removal is achieved. CONCLUSIONS: Malignant and benign pGCTs share many features that make them difficult to differentiate. Absence of extrapulmonary metastases, Fanburg-Smith criteria, and specific immunostaining helps rule out malignancy in cases with multifocal lung lesions. REFERENCE #1: Jiang M, Anderson T, Nwogu C, Tan D. Pulmonary malignant granular cell tumor. World J Surg Oncol. 2003;1(1):22. Published 2003 Oct 21. doi:10.1186/1477-7819-1-22. REFERENCE #2: Fanburg-Smith JC, Meis-Kindblom JM, Fante R, Kindblom LG. Malignant granular cell tumor of soft tissue. Diagnostic criteria and clinicopathologic correlation. Am J Surg Pathol. 1998;22:779–794. doi: 10.1097/00000478-199807000-00001. REFERENCE #3: Khansur T, Balducci L, Tavassoli M. Granular cell tumor: clinical spectrum of the benign and malignant entity. Cancer. 1987;60:220–222. DISCLOSURES: No relevant relationships by Ramiz Fargo, source=Web Response No relevant relationships by Joseph Mak, source=Admin input No relevant relationships by Bryce Mikel, source=Web Response

Seizure in Patient with Neurofibromatosis and Amygdala Low-Grade Glioma

A 31-year-old male with history of bipolar disorder, suicidal attempts requiring inpatient hospitalization, and seizures on antiepileptic medications presented with increasing seizure frequency. He was neurologically intact yet had multiple facial, axillary, and inguinal flat pigmented macules (cafe au lait spots) and ophthalmologic examination with iris hamartomas (Lisch nodules) consistent with neurofibromatosis type1. Electroencephalogram was notable for multiple right temporal lobe seizures with anterior temporal interictal epileptiform discharges. Magnetic resonance imaging revealed a T2 hyperintense mass centered in the right amygdala, contiguous with the cystic area. Preoperative intracarotid sodium amobarbital testing showed left-sided language and memory dominance. The patient was operated on for right amygdalohippocampectomy, and initial pathology was consistent with a low-grade neuroepithelial neoplastic process. Further pathologic examination found hypercellular proliferation of predominantly bland, spindled cells with scattered, embedded neurocytic elements with dysplastic appearance, consistent with low-grade glioma. The patient was clinically diagnosed with neurofibromatosis type1.

GNSS Signal Availability Analysis in SSV for Geostationary Satellites Utilizing multi-GNSS with First Side Lobe Signal over the Korean Region

This paper verifies the applicability of multiple Global Navigation Satellite Systems (GNSSs) and side lobe signal utilization in Space Service Volume (SSV), especially for Geostationary Earth Orbit (GEO) missions over the Korean region. Unlike the ground or terrestrial systems, various constraints of space exploration in SSV cause a problem when estimating position using GNSS. This is mainly due to the limit of GNSS signal availability where its dominant variables include altitude, side lobe issues, as well as longitude because of different constellations of several GNSS. The numerical simulation shows the effectiveness of additional side lobe signals from multi-GNSS. In addition, the effect of non-MEO satellites’ signals in SSV for different longitudes is presented.

Computed tomography features of COVID-19 in children: A systematic review and meta-analysis.

Background:There are few reports on the chest computed tomography (CT) imaging features of children with coronavirus disease 2019 (COVID-19), and most reports involve small sample sizes.Objectives:To systematically analyze the chest CT imaging features of children with COVID-19 and provide references for clinical practice.Data sources:We searched PubMed, Web of Science, and Embase; data published by Johns Hopkins University; and Chinese databases CNKI, Wanfang, and Chongqing Weipu.Methods:Reports on chest CT imaging features of children with COVID-19 from January 1, 2020 to August 10, 2020, were analyzed retrospectively and a meta-analysis carried out using Stata12.0 software.Results:Thirty-seven articles (1747 children) were included in this study. The heterogeneity of meta-analysis results ranged from 0% to 90.5%. The overall rate of abnormal lung CT findings was 63.2% (95% confidence interval [CI]: 55.8%–70.6%), with a rate of 61.0% (95% CI: 50.8%–71.2%) in China and 67.8% (95% CI: 57.1%–78.4%) in the rest of the world in the subgroup analysis. The incidence of ground-glass opacities was 39.5% (95% CI: 30.7%–48.3%), multiple lung lobe lesions was 65.1% (95% CI: 55.1%–67.9%), and bilateral lung lesions was 61.5% (95% CI: 58.8%–72.2%). Other imaging features included nodules (25.7%), patchy shadows (36.8%), halo sign (24.8%), consolidation (24.1%), air bronchogram signs (11.2%), cord-like shadows (9.7%), crazy-paving pattern (6.1%), and pleural effusion (9.1%). Two articles reported 3 cases of white lung, another reported 2 cases of pneumothorax, and another 1 case of bullae.Conclusions:The lung CT results of children with COVID-19 are usually normal or slightly atypical. The lung lesions of COVID-19 pediatric patients mostly involve both lungs or multiple lobes, and the common manifestations are patchy shadows, ground-glass opacities, consolidation, partial air bronchogram signs, nodules, and halo signs; white lung, pleural effusion, and paving stone signs are rare. Therefore, chest CT has limited value as a screening tool for children with COVID-19 and can only be used as an auxiliary assessment tool.

P07.02 Robot-assisted stereotactic brain biopsy combined with cortical mapping using navigated transcranial magnetic stimulation

Abstract BACKGROUND Frame-based stereotactic biopsy has been for decades the gold-standard method for taking samples of brain tumors for the histopathological diagnostic in cases when surgery was contraindicated. However, novel frameless techniques have been developed in order to facilitate the procedure for the neurosurgeon, and for the patient as well. Preoperative cortical mapping techniques enable the planning of the trajectory with the sparing of eloquent areas. MATERIAL AND METHODS A preoperative cortical mapping using navigated transcranial magnetic stimulation was performed in the case of a 37-year-old male that presented with headache. The MRI scan revealed multiple lesions located frontal lobe and temporal lobe on the right hemisphere and frontal and occipital lobes on the left hemisphere. The results of the preoperative cortical mapping were integrated into the neuronavigation system and used for the planning of the frameless based stereotactic brain biopsy. A biopsy procedure was performed using a robotic arm according to the planned trajectory. RESULTS The targeted lesion was the right frontal one. The planned trajectory took into account the results from the cortical mapping using nTMS, and the eloquent areas were avoided. The robotic arm guided the procedure and aligned to the entry point and trajectory. According to the histopathological result the lesion was a grade II diffuse astrocytoma. There were no perioperative complications. CONCLUSION To our knowledge, this is the first report that describes the use of a robot-guided frameless brain biopsy system combined with the preoperative mapping of the eloquent cortical areas using navigated transcranial magnetic stimulation. This approach is a safe one and carries less burden for the patient as well as for the surgeon.