Normal Axis Research Articles

Identification of in vivo Hox13-binding sites reveals an essential locus controlling zebrafish brachyury expression.

During early embryogenesis, the vertebrate embryo extends from anterior to posterior because of the progressive addition of cells from a posteriorly localized neuromesodermal progenitor (NMp) population. An autoregulatory loop between Wnt and Brachyury/Tbxt is required for NMps to retain mesodermal potential and, hence, normal axis development. We recently showed that Hox13 genes help to support body axis formation and to maintain the autoregulatory loop, although the direct Hox13 target genes were unknown. Here, using a new method for identifying in vivo transcription factor-binding sites, we identified more than 500 potential Hox13 target genes in zebrafish. Importantly, we found two highly conserved Hox13-binding elements far from the tbxta transcription start site that also contain a conserved Tcf7/Lef1 (Wnt response) site. We show that the proximal of the two elements is sufficient to confer somitogenesis-stage expression to a tbxta promoter that, on its own, only drives NMp expression during gastrulation. Importantly, elimination of this proximal element produces shortened embryos due to aberrant formation of the most posterior somites. Our study provides a potential direct connection between Hox13 and regulation of the Wnt/Brachyury loop.

Spontaneous Resolution of Primary Hyperparathyroidism Following COVID-19 Infection

Background: Spontaneous resolution of primary hyperparathyroidism (PHPT) is extremely rare, and has previously been reported exclusively in the setting of apoplexy (auto-infarction) of a large parathyroid adenoma outgrowing its blood supply. We report an unusual case of spontaneous PHPT resolution after Covid-19 infection. Clinical Case: A 38-year-old Hispanic woman was seen in clinic for evaluation of hypercalcemia first noted on routine bloodwork in 2018. She had a history of nephrolithiasis (1 episode) but no other symptom associated with hypercalcemia. She was not on medications associated with hypercalcemia, and had no family history of Ca disorder. Serum biochemistry was notable for hypercalcemia (Ca: 10.9, 10.5, and 10.8 mg/dL, nl 8.4–10.2), normal albumin and Cr, elevated PTH (106 and 70 pg/mL, nl 15–65), with low phosphate (2.3 mg/dL, nl 2.4–4.5) and 25-OH-Vit. D (14 ng/mL, nl 20–80). 24-hr urinary studies showed elevated urine Ca (285 and 375 mg/day, nl 100–250), with urine Cr of 1.3 and 1.5 g/day, respectively. Findings of hypercalcemia, hypercalciuria, and elevated serum PTH, led to the diagnosis of PHPT. Neck ultrasound and sestamibi scan of the parathyroids with SPECT-CT did not localize any abnormal parathyroid gland. A month after PHPT diagnosis, and prior to surgical evaluation, patient presented with a 9-day history of fever, cough, and shortness of breath. She tested positive for Covid-19 infection by SARS-CoV-2 PCR on nasal swab, and was quarantined at home with symptomatic treatment. No glucocorticoids were given. Serum Ca was normal (9.5 mg/dL) at the time of Covid-19 diagnosis. All Covid-19 symptoms subsided 14 days after onset. Repeat labs 1 and 3 months after Covid-19 infection showed persistently normal serum Ca (10.0 and 9.8 mg/dL), with low then normal PTH (13 and 43 pg/mL), compatible with spontaneous resolution of PHPT. Patient denied any neck discomfort before, during, or after Covid-19 infection. Spontaneous resolution of PHPT is rare and follows apoplexy of a large parathyroid adenoma. In our patient, imaging failed to localize a large parathyroid adenoma, making it less likely that resolution of her PHPT was caused by apoplexy. Resolution of PHPT temporally coincided with Covid-19 infection, although the link between the two conditions is unclear at this time. Hypothesized mechanisms include an imbalance in the normal PTH-Ca axis caused by SARS-CoV-2 mediated release of inflammatory cytokines (e.g. interferon, previously reported to lower serum calcium), or development of antibodies against the parathyroid or CaSR. RNA and protein expression of ACE2, the SARS-CoV-2 cell receptor gene, is not detected in normal parathyroid tissue. Conclusion: To our knowledge, this is the first reported case of spontaneous resolution of PHPT after Covid-19 infection. Further studies are needed to understand the frequency of this occurrence, and the underlying mechanism.

Relative pelvic version displays persistent compensatory measures with normalised sagittal vertical axis after deformity correction.

A normal sagittal vertical axis (SVA) after spinal deformity correction can yield mechanical complications of up to 30%. Post-operative compensatory pelvic orientation can produce a normal SVA. We assess relative pelvic version (RPV), an individualised measure, for persistent post-operative compensatory measures. Adult spinal deformity (ASD) patients who were treated operatively, with a normal SVA (< ± 50mm) at 6-week follow-up were included, who were then followed-up after 2years. These only included patients with fusion of > 4 vertebrae extending to L5 or below. Six-week subgroups were made regarding pelvis orientation, relative pelvic version (RPV: anteversion, aligned, moderate or severe retroversion) with analysis of patient-related outcome measures (PROMs), complications and spino-pelvic sagittal parameters. At 6weeks, 140 patients met the inclusion criteria, 5 (3.6%) patients had anteversion, 59 (42.1%) were aligned, 60 (42.9%) had moderate retroversion and 16 (11.4%) patients had severe retroversion. Follow-up after 2years demonstrated increased RPV in all groups except the severe RPV group who were more likely to develop SVA > 50mm. Complications occurred in all groups. Significant 2-year differences were observed between moderate and severe RPV for back pain and PROMs but not between other RPV groups. Adult spinal deformity patients with a normal SVA after spino-pelvic instrumentation carry a significant risk of retroversion progression post-operatively, followed by increased positive sagittal balance. Relative pelvic version (RPV) measurements when categorised into anteversion, aligned, moderate retroversion and severe retroversion at 6weeks were predictive of PROMs at 2years.

Clinical impact of left and right axis deviations with narrow QRS complex on 3-year outcomes in a hospital-based population in Japan

While the prognostic impact of QRS axis deviation has been assessed, it has never been investigated in patients without conduction block. Thus, we evaluated the prognostic impact of QRS-axis deviation in patients without conduction block. We retrospectively analyzed 3353 patients who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a hospital-based population, after excluding patients with a QRS duration of ≥ 110 ms, pacemaker placement, and an QRS-axis − 90° to − 180° (northwest axis). The study population was categorized into three groups depending on the mean frontal plane QRS axis as follows: patients with left axis deviation (N = 171), those with right axis deviation (N = 94), and those with normal axis (N = 3088). The primary outcome was a composite of all-cause death and major adverse cardiovascular events. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the left axis deviation group (26.4% in the left axis deviation, 22.7% in the right axis deviation, and 18.4% in the normal axis groups, log-rank P = 0.004). After adjusting for confounders, the excess risk of primary outcome measure remained significant in the left axis deviation group (hazard ratio [HR] 1.44; 95% confidence interval [CI] 1.07–1.95; P = 0.02), while the excess risk of primary outcome measure was not significant in the right axis deviation group (HR 1.22; 95% CI 0.76–1.96; P = 0.41). Left axis deviation was associated with a higher risk of a composite of all-cause death and major adverse cardiovascular events in hospital-based patients without conduction block in Japan.

Hypertrophic cardiomyopathy with paroxysmal atrial fibrillation misdiagnosed as WPW syndrome

Hypertrophic cardiomyopathy (HCM) is associated with an increased incidence of Wolff–Parkinson–White (WPW) syndrome and atrial fibrillation. However, a delta-like wide QRS can be observed in the hypertrophied myocardium. When considering the rarity of the paraseptal bypass tract (BT), the normal QRS axis suggests a higher possibility of HCM origin. Otherwise, there is no known electrocardiographic clue indicating a wide QRS differentiation between HCM and WPW syndrome. Moreover, the atriofascicular, nodofascicular/ventricular or fasciculoventricular BT should be differentiated. In this case, atrioventricular conduction system incidental injury revealed a wide QRS origin from the HCM, but this method should be avoided except in some selected cases.

Structure and single particle dynamics of the vapour-liquid interface of acetone-CO2 mixtures

Molecular dynamics computer simulations of the liquid-vapour interface of acetone-CO2 mixtures are performed in the canonical (N,V,T) ensemble at 30 thermodynamic state points, ranging from 280 to 460 K and from about 10 to 116 bar, covering the entire composition range from neat CO2 to neat acetone. The molecules forming the first layer at the molecularly rough liquid surface as well as those of the next three subsurface molecular layers have been identified by the ITIM method, and the surface properties of the liquid phase are analyzed in a layer-wise manner. The arrangement of the molecules both within the macroscopic plane of the interface and along its normal axis, as well as their surface orientation and single particle dynamics at the liquid surface are analyzed in detail. It is found that, in accordance with their higher affinity to the vapour phase, CO2 molecules are enriched at the liquid surface, moreover, even within the surface layer they prefer to occupy positions that are more exposed to the bulk vapour phase than those preferred by acetone. In other words, within the molecularly wavy surface layer, CO2 molecules prefer to stay at the crests, while acetone molecules prefer to stay in the troughs. On the other hand, the lateral arrangement of the surface molecules is found to be more or less random. Both molecules prefer to stay perpendicular to the liquid surface, but this preference only involves the first molecular layer, and this preference is governed by the electrostatic interaction of the surface molecules. Both molecules perform considerable lateral diffusion at the liquid surface during their stay there, this diffusion being faster for the CO2 than for the acetone molecules, but not as much faster than in the bulk liquid phase.

Left-axis deviation in patients with nonischemic heart failure and left bundle branch block is a purely electrical phenomenon

Possible mechanisms of left-axis deviation (LAD) in the setting of left bundle branch block (LBBB) include differences in cardiac electrophysiology, structure, or anatomic axis. The purpose of this study was to clarify the mechanism(s) responsible for LAD in patients with LBBB. Twenty-nine patients with nonischemic cardiomyopathies and LBBB underwent noninvasive electrocardiographic imaging (ECGi), cardiac computed tomography, and magnetic resonance imaging in order to define ventricular electrical activation, characterize cardiac structure, and determine the cardiac anatomic axis. Sixteen patients had a normal QRS axis (NA) (mean axis 8° ± 23°), whereas 13 patients had LAD (mean axis -48° ± 13°; P <.001). Total activation times were longer in the LAD group (112 ± 25 ms vs 91 ± 14 ms; P = .01) due to delayed activation of the basal anterolateral region (107 ± 10 ms vs 81 ± 17 ms; P<.001). Left ventricular (LV) activation in patients with LAD was from apex to base, in contrast to a circumferential pattern of activation in patients with NA. Apex-to-base delay was longer in the LA group (95 ± 13 ms vs 64 ± 21 ms; P <.001) and correlated with QRS frontal axis (R2 = 0.67; P <.001). Both groups were comparable with regard to LV end-diastolic volume (295 ± 84 mL vs LAD 310 ± 91 mL; P = .69), LV mass (177 ± 33 g vs LAD 180 ± 37 g; P= .83), and anatomic axis. LAD in LBBB appears to be due to electrophysiological abnormalities rather than structural factors or cardiac anatomic axis.

Thyroid axis activity and dopamine function in depression

BackgroundSeveral lines of evidence suggest alterations in both hypothalamic-pituitary-thyroid (HPT) axis and dopamine (DA) function in depressed patients. However, the functional relationships between HPT and DA systems have not been well defined. MethodsWe examined thyrotropin (TSH) response to 0800 h and 2300 h protirelin (TRH) challenges, and adrenocorticotropic hormone (ACTH), cortisol and growth hormone (GH) responses to apomorphine (APO, a DA receptor agonist), in 58 drug-free DSM-IV major depressed inpatients without a suicidal behavior, and 22 healthy hospitalized controls. ResultsCompared with controls, patients showed 1) lower basal serum 2300 h-TSH, 2300 h-∆TSH, and ∆∆TSH (difference between 2300 h-∆TSH and 0800 h-∆TSH) levels, and 2) lower cortisol response to APO (∆COR). A negative relationship between ∆∆TSH values and hormonal responses to APO was observed in the depressed group, but not in the control group. When patients were classified on the basis of their ∆∆TSH status, patients with reduced ∆∆TSH values (< 2.5 mU/L) showed hormonal APO responses comparable to those of controls. Patients with normal ∆∆TSH values exhibited lower ∆ACTH, ∆COR, and ∆GH values than patients with reduced ∆∆TSH values and controls. ConclusionTaken together, these results suggest that hypothalamic DA function is unaltered in depressed patients with HPT dysregulation (i.e., increased hypothalamic TRH drive leading to altered TRH receptor chronesthesy on pituitary thyrotrophs). Conversely, hypothalamic DA-receptor function is decreased in patients with normal HPT axis activity. These findings are discussed in the context of the role of TRH as a homeostatic neuromodulator in depression.

COVID-19 and the Risk of Pulmonary Embolism: ECG Findings Can Help

We appreciate the kind invitation to provide an update on an aspect of our study published before [1]. Therefore, we decided to further discuss the Pulmonary Embolism (PE) in patients with COVID-19. COVID-19 pandemic has affected many countries and their health-care system. COVID-19 also imposes significant diagnostic challenges because of its wide range of complications [2]. Evidence shows that COVID-19 can cause a hypercoagulable state and increases the risk of thromboembolism [3]. The radiological appearance of PE in patients with COVID-19 might differ from COVID-19 (-) patients, and the clots are dominantly seen in peripheral zones [4,5]. This fact supports the idea that COVID-19 can cause PE by in-situ immune thrombosis, and the clots might originate from lung vessels rather than deep veins [6]. There is an overlap between signs and symptoms of COVID-19 infection and pulmonary embolism, making the diagnosis of pulmonary embolism challenging [7]. Elevated D-dimer levels may come to our help and increase our suspect for PE, but it is still not specific to the diagnosis of Venous Thromboembolism (VTE) [8]. Anticoagulant therapy may increase the patients’ survival rate [9]. Dyspnea, chest pain, and tachypnea are common in both PTE and COVID-19 infection. Hemoptysis has also been described as a rare COVID clinical symptom (0-5 %) [10], while this number is 13% for patients with PE [11]. In the case reported by Casey et al. [7], a 42 years old COVID-19 positive male presented with pleuritic chest pain, dyspnea, and hemoptysis. In the physical exam, he was tachypneic, and auscultation revealed bibasilar rhonchi. Electrocardiography demonstrated right axis deviation and an S1Q3T3 pattern with flattening of the T-waves in the II, III, aVL and aVF. These findings increased the probability of PE. Also, Laboratory evaluation showed a D-dimer of 4.8μg/dl. So a Computerized Tomography Angiography (CTA) of the chest was obtained. CTA demonstrated bilateral segmental pulmonary emboli and peripheral ground-glass opacities caused by COVID-19 pneumonia. However, sometimes everything becomes more complicated. In the case reported by Ioan et al. [12], a 61 years old male with a history of hypertension treated with Angiotensin-Converting Enzyme Inhibitor (ACEI) presented with dyspnea and cough. His blood pressure was normal, his heart and respiratory rates were 136 and 30, and oxygen saturation was &lt;85% on room air. His Electrocardiogram (ECG) showed sinus tachycardia, ST depression in I, aVL, and V2-V4, and ST-segment elevation in II, III, aVF. An Echocardiography was obtained, which showed RV dilatation, interventricular septal shift, RV lateral wall akinesia, and a pulmonary arterial systolic pressure of &gt;60mmHg. His hypoxemia was refractory to invasive mechanical ventilation, so he was intubated and underwent invasive mechanical ventilation without response. For this patient thrombolytic treatment was started due to suspicion of PE. The patient started improving. CTA confirmed PE with a finding of diffuse bilateral ground-glass opacities consistent with COVID-19 pneumonia. A coronary angiogram showed no significant coronary stenosis. In this case, no obvious sign or symptom, such as pleuritic chest pain or hemoptysis, could lead to PE diagnosis at first. In ECG, there was no flattening of the T-waves or S1Q3T3 pattern, and the patient had a normal axis. Although PE can present with an ST-segment elevation in anteroseptal leads (V1-V4) [13], it is a rare finding that can be mistaken for ST-elevation myocardial infarction. However, in the discussed patient, RV overload and severe pulmonary hypertension with refractory hypoxemia could lead us to PE diagnosis [12]. Conclusion In conclusion, diagnosing COVID-19 complications such as PE can be challenging as COVID-19 can mask their sign and symptoms. We should be aware of any signs or symptoms that can lead us to diagnose these complications. ECG is a low-cost and widely available tool that may give valuable clues to help us diagnose PE. Some ECG signs raise suspicions for PE, such as right axis deviation, S1Q3T3 pattern, or the flattening of T waves. As we saw in an above-discussed case, even an ST-segment elevation in anteroseptal leads can lead us to PE diagnosis.

Texture evolutions in aluminum and Al-3%Mg alloy subjected to shear deformation and subsequent annealing

Shear deformation is imposed on materials by several advanced techniques for microstructural and textural control. Shear texture evolved during deformation tends to remain after subsequent annealing. Texture evolutions with shear deformation and subsequent annealing in aluminum and Al-3mass%Mg alloy rolled sheets have been investigated by neutron diffraction technique. N-shaped specimen was prepared from the alloy sheet to impose shear strain in compression. The central objective part of the N-shaped specimen was sheared with slight rotation about the normal axis so as to develop preferred orientations of {111} parallel to the original shear plane and <110> parallel to the original shear direction before deformation. In-situ neutron diffraction analysis during step heating revealed that the preferred orientations formed by shear deformation remain and evolve as recrystallization texture during subsequent annealing in both materials. Evolutions of shear and recrystallization textures were compared after shear deformations with strains of 0.5 and 0.7 in two samples sheared parallel to rolling and transverse directions.

Treatment of lumbar canal stenosis in patients with compensated sagittal balance

IntroductionThe need to combine fusion with decompression in patients with lumbar canal stenosis is still controversial. The aim of this study was to show that isolated decompression leads to the same outcomes as decompression plus fusion in patients who have preserved global sagittal balance. Materials and MethodsA single-center retrospective cohort of 110 patients who were operated for a single-level lumbar stenosis was divided into two groups based on the treatment: isolated decompression or fusion-decompression. These patients had a normal odontoid-hip axis angle (ODHA) (−5° to +2°) and had no spondylolisthesis or frontal deformity. We compared the clinical outcome scores and spinal-pelvic parameters preoperatively and at 1 year of follow-up. We evaluated the minimal clinically important difference (MCID) corresponding to a 12.8-point difference in the Owestry Disability Index (ODI). The analysis in each group was based on the MCID. ResultsThe clinical outcome scores improved significantly in both groups. There was a 77% decrease in the ODI>12.8 points with no significant difference between groups. The analysis based on the MCID showed that patients with a poor clinical result at 1 year in the isolated decompression group were more likely to have lumbar pain, while the ones in the fusion-decompression group were more likely to have radicular pain. ConclusionThe clinical and radiological results of fusion-decompression are not superior at 1 year relative to isolated decompression for treating single-level lumbar canal stenosis in patients with compensated sagittal balance. Full-spine weight bearing radiographs are key to determining the patient's sagittal balance and to ensuring there are no radiological instability factors that may require a stabilizing procedure. Level of evidenceIV Retrospective study of data collected prospectively.

Controllable liquid crystal diffractive sail and its potential applications

This paper introduces a new type of diffractive solar sail composed of liquid crystal optical phased arrays, which control the thrust through electric modulation. The main feature of the proposed liquid crystal diffractive sail is its capability of generating a continuously variable and actively controllable tangential radiation pressure at the sun-facing attitude. The principles governing the generation of radiation pressure by electric modulation of the liquid crystal optical phased array under a broad spectrum of solar radiation are derived by considering a periodical voltage distribution analogous to a reflection step-shaped binary phase grating. Then the reliability of the theoretical model of radiation pressure is verified through comparison with finite-difference time-domain (FDTD) simulation results. A sun-facing liquid crystal diffractive sail may be utilized to replace the reflective sail in space missions by taking the advantage that no active attitude control of the sail surface towards sunlight is required. We also study the attitude control strategy of the proposed diffractive sail along its normal axis, allowing for the direction of tangential radiation pressure to be varied without changing its sun-facing attitude.

ОСОБЕННОСТИ ВНЕШНЕГО ПРОЯВЛЕНИЯ ПАТОЛОГИЙ НА МЯГКОЛИСТВЕННЫХ ПОРОДАХ

This paper analyzes the patterns of weakening of soft-wooded broadleaved species, provides the frequency of occurrence of the most common external signs of pathologies and their relationship with the general condition of trees. It was found that the most common pathological sign in soft-wooded broadleaved species is drying out of branches (58.2% of the surveyed trees), followed by breakage of skeletal branches (14.9%) and the presence of thick skeletal branches in the crown (14.4% ). Further, as the occurrence of signs decreases, we see trunk inclination of varying degrees (13.9%), where inclination of up to 30° prevails, various pathologies of the trunk shape (12.9%), the most frequent among which was the bifurcation of the trunk, bending of the trunk relative to the normal axis of the tree (7%) and fruiting bodies of wood-destroying fungi (4.1%). Small-leaved linden (Tilia cordata Mill.) was the most stable species in the surveyed plantation, on which the least number of pathological signs was recorded. The revealed features of the external manifestation of pathologies will make it possible to determine the category of the tree state more accurately and increase objectivity and reliability of forest pathological examinations

Electrocardiographic findings in Coronavirus Disease-19 and its correlation with clinical severity of disease

Background and Aims: Most data on electrocardiographic (ECG) changes in patients with coronavirus disease-19 (COVID-19) have been presented without comparison to patients with other acute respiratory illnesses. The correlation of ECG changes with disease severity has also not been studied. Subjects and Methods: We compared forty COVID-19-positive and forty COVID-19-negative patients in terms of clinical presentation, ECG at admission, and cardiac biomarkers. Statistical analysis was presented as frequency (percentage) and continuous as mean ± standard deviation. Chi-square test/Fischer's exact test was used. Results: Mean age overall in the study was 52.4 ± 16 years, 67.5% data were males. About 87.5% of the COVID-positive patients and 70% of the COVID-negative patients had ECG changes at baseline. Sinus tachycardia was seen in 45% (18/40) of COVID-positive patients. About 95% (38/40) of COVID-19 positive patients had normal axis, 5% (2/40) had supraventricular tachycardia, 2.5% (1/40) had premature atrial contractions (PACs), and 7.5% (3/40) had premature ventricular contractions. One patient had ventricular bigeminy. About 7.5% (3/40) of COVID-positive cases had complete right bundle branch block (RBBB), one had complete left bundle branch block (LBBB), whereas one had incomplete LBBB. About 7.5% (3/40) of COVID-positive cases had ST-segment elevation, one of whom also developed postmyocardial infarction left ventricular thrombus. About 15% (6/40) had nonST-segment elevation acute coronary syndrome. Conclusions: COVID-19 patients have ECG changes of left-sided heart disease (PACs and LBBB) and right-sided disease (RBBB, right axis deviation, and right ventricular strain pattern) at presentation, however, right heart changes predominate. COVID-19 patients had a higher occurrence and a wider variety of ECG changes at presentation than other acute respiratory illnesses and these changes correlate well with clinical disease severity as does troponin I level.

Poland's syndrome with dextroposition and paradoxical breathing.

An asymptomatic 60-year-old woman presented to our outpatient clinic for a routine health screening as part of a government welfare program. Her medical history was unremarkable, however physical examination revealed hypoplasia of the left chest wall muscles, breast tissue, nipple, absence of axillary hair, absence of the costal cartilages of upper ribs on the left side of the chest and brachydactyly in the left hand. There was also paradoxical breathing at the levels of the 2nd, 3rd and 4th rib of the left chest. The rest of the examination was unremarkable. The chest radiograph revealed reduced upper left hemithorax volume with partial rib agenesis of the 2nd, 3rd and 4th rib, bilateral cervical ribs, dextroposition of the heart and mid thoracic scoliosis with convexity to the left. A 12-lead electrocardiogram revealed a sinus rhythm with a normal axis, lead 1 has upright P, QRS, and T waves and aVR is globally negative. The precordial leads show normal R Waves in V1-4, deep S waves in V1-2, small S waves in V3-4 and no S waves in V5-6. There is diminution of the precordial complexes in V3, 4, 5 and 6. These findings are consistent with a dextroposition of the heart. The blood investigations were unremarkable. The findings from physical examination, chest radiograph and 12 lead electrocardiogram are consistent with Poland's Syndrome. As the patient was otherwise well and not bothered by her condition, no treatment was initiated for her.

Clinical Significance of Celiac Trunk and Superior Mesenteric Artery Diameter Following Computed Tomography

Introduction: The celiac trunk and superior mesenteric arteries are the first and second anterior branches of the abdominal aorta. Knowledge of the anatomy and dimensions of these vessels is mandatory for interventional radiologists and vascular surgeons. There are a number of anatomical variations of the celiac trunk. Aim: To evaluate whether there is an alteration in the dimension of the celiac trunk and the distance between celiac trunk and Superior Mesenteric Artery (SMA) in the presence of anatomical variants. Materials and Methods: This cross-sectional study was conducted on 150 patients who were referred to the Radiology Department for Contrast Enhanced Computed Tomography (CECT) of the abdomen between September 2019 to February 2020. The diameter of the celiac trunk, SMA and the distance between celiac trunk and SMA were measured. Those who had previous history of any abdominal surgeries or mass lesions were excluded from the study. Results: Celiac trunk variants were observed in 39 patients in our study. The mean diameter was 6.57±1.35 mm in those with normal celiac axis anatomy as compared to a mean of 6.82±1.53 mm in patients with variants (p=0.33). The mean diameter of the SMA was 14.28±7.07 mm in females whereas in males it was 11.88±5.21 mm. The distance between the celiac trunk and SMA was 21.92±7.96 mm in those with normal celiac trunk anatomy and 22.29±5.95 mm in those with a variant anatomy (p=0.79). Conclusion: There is no difference in the dimension of the celiac trunk and distance between celiac trunk and SMA in the presence of anatomical variants. This is important for planning interventional procedures involving cannulation, stenting and anastomosis of the vessel.

Characterization of Birefringent Titanium-Oxide Thin Films Deposited by DC Sputtering

This work presents the characterization of birefringent properties of titanium-oxide thin films using spectrophotometry and double-cavity Fabry-Perot structures. All films were deposited by DC sputtering over tilted substrates and the birefringence was characterized as a function of the deposition angle by the numerical difference between the refractive indexes for s- and p-polarized light beams. As a result, the highest value of birefringence (0.03) was obtained for samples tilted at 21º (having the normal axis as reference). A polarizing narrow-band Fabry-Perot filter centered at 400 and 700nm was designed by means of numerical simulations of the multilayer structures using a MATLAB© toolbox to solve the classical optical equations. Using this designed double-cavity Fabry-Perot structure [Ag(40nm) / TiO2(160nm) / Ag(40nm) / TiO2(164nm) / Ag(40nm)], transmittance ratios (Tp/Ts) for p- and s-polarized light beams resulted 1.70 at a wavelength of 699nm and 1.36 at another wavelength of 393nm (centers of the two narrow-band peaks), which corroborated the birefringent characteristics of the nearly-stoichiometric titania (TiO2) thin films.

Normal values of cardiac axis (CA) measurements in healthy fetuses during the first trimester screening ultrasound.

To report the normal fetal cardiac axis (CA) values at the time of the first trimester screening ultrasound. Standardized images and measurement of the CA were obtained from 100 healthy fetuses between 11+0and 13+6weeks of gestation along with the nucal thichkness (NT), Crown-rump length (CRL) and other measurements. We excluded cases with abnormal NT, later diagnosis of abnormalities, and suspected fetal cardiopathy during the pregnancy follow-up. Data analysis was performed after all the patients delivered and cardiopathy was excluded. CA was measurable in all the cases. Higher CRL was associated with a decrease in the CA. The mean±SD embryonic/fetal CA was 48±5,2°, ranging from 39 to 60°, The 2.5 percentile was defined at 40° and the 97.5 percentile at 59°. The Pearson test resulted in a significant correlation between CA and CRL with a coefficient R of 70% and p-value <0.01. CA tends to decrease at the 11 to 13+6 gestational ages. We defined 2.5 and 97.5% curves for the normal values of CA in our Middle Eastern population. Alarger study will be required to differentiate normal andabnormal values for the early detection of heart abnormalities.

Prediction of Mortality Associated with Cardiac and Radiological Findings in Patients with Pulmonary Embolism

Abstract Background: In this study, we aimed to compare echocardiography, electrocardiography (ECG) abnormalities, Doppler ultrasonography (USG), and computed tomography pulmonary angiography (CTPA) results in predicting 3-month mortality in patients with acute pulmonary embolism (PE). Methods: This retrospective cohort study included 124 patients (72 females, 52 males) with acute PE. Demographics, symptoms, clinical signs, comorbidities, history of surgery, arterial blood gas, liver-renal functions, complete blood count, echocardiography, ECG, Doppler USG, and CTPA results, as well as 3-month mortality were recorded. Results: pH (z = –2.623; p &lt;0.01), hemoglobin (z = –3.112; p &lt;0.01), and oxygen saturation (z = –2.165; p &lt;0. 01) were significantly higher in survivors. White blood cell (z = –2.703; p &lt;0.01), blood urea nitrogen (z = –3.840; p &lt;0.01), creatinine (z = –3.200; p &lt;0.01), respiratory rate (z = –2.759; p &lt;0.01), and heart rate (z = –2.313; p &lt;0.01) were significantly higher in non-survivors. Nonspecific ST changes (AUC 0.52, 95% CI 0.43–0.61), p pulmonale (AUC 0.52, 95% CI 0.43–0.61), normal axis (AUC 0.61), right axis deviation (AUC 0.56), right ventricle strain pattern (AUC 0.59), and right pulmonary artery embolism (AUC 0.54) on CTPA showed the highest mortality prediction. Conclusions: Nonspecific ST changes, p pulmonale, normal axis and right axis deviation in ECG, RV strain in echocardiography, and right pulmonary artery embolism on CTPA are associated with a higher mortality in patients with PE.

Should 15° of valgus coronal-plane deformity be the upper limit for a total ankle arthroplasty?

Preoperative talar valgus deformity ≥ 15° is considered a contraindication for total ankle arthroplasty (TAA). We compared operative procedures and clinical outcomes of TAA in patients with talar valgus deformity ≥ 15° and < 15°. A matched cohort of patients similar for demographics and components used but differing in preoperative coronal-plane tibiotalar valgus deformity ≥ 15° (valgus, n = 50; 52% male, mean age 65.8 years (SD 10.3), mean body mass index (BMI) 29.4 (SD 5.2)) or < 15° (control, n = 50; 58% male, mean age 65.6 years (SD 9.8), mean BMI 28.7 (SD 4.2)), underwent TAA by one surgeon. Preoperative and postoperative radiographs, Ankle Osteoarthritis Scale (AOS) pain and disability and 36-item Short Form Health Survey (SF-36) version 2 scores were collected prospectively. Ancillary procedures, secondary procedures, and complications were recorded. At mean 5.1 years follow-up (SD 2.6) (valgus) and 6.6 years (SD 3.3) (controls), mean AOS scores decreased and SF-36 scores increased significantly in both groups. Improvements in scores were similar for both groups - AOS pain: valgus, mean 26.2 points (SD 24.2), controls, mean 22.3 points (SD 26.4); AOS disability: valgus, mean 41.2 points (SD 25.6); controls, mean 34.6 points (SD 24.3); and SF-36 PCS: valgus, mean 9.1 points (SD 14.1), controls, mean 7.4 points (SD 9.8). Valgus ankles underwent more ancillary procedures during TAA (40 (80%) vs 13 (26%)) and more secondary procedures postoperatively (18 (36%) vs 7 (14%)) than controls. Tibiotalar deformity improved significantly (p < 0.001) towards a normal weightbearing axis in valgus ankles. Three valgus and four control ankles required subsequent fusion, including two for deep infections (one in each group). Satisfactory mid-term results were achieved in patients with preoperative valgus malalignment ≥ 15°, but they required more adjunctive procedures during and after TAA. Valgus coronal-plane deformity ≥ 15° is not an absolute contraindication for TAA if associated deformities are addressed. Cite this article: Bone Joint J 2020;102-B(12):1689-1696.