Proximal Level Research Articles

Management of Proximal Femoral Metastasis “Systematic Review/Meta-Analysis”

Abstract Background Adequate treatment of patients with proximal femur metastases demands higher level of attention due to the increasing life expectancy, and the need of maintaining good functional integrity and quality of life. In the presence of impending or actual pathologic fracture, treatment requires a reconstruction which provides pain control, stable and secure fixation and allows for immediate weight-bearing. Objective to evaluate management of proximal femoral metastasis as regards: functional outcome, oncological outcome and complications. Material and Methods This systematic review was conducted on human subjects in different literatures collected from different medical websites before 2022 in which we compared osteosynthesis including IMN (group 1) and reconstruction whether endoprosthesis replacement, total hip arthroplasty or hip hemiarthroplasty (group 2) in treatment of proximal femoral metastasis. Results Osteosynthesis results in a high recurrence, failure rate and non-union, while Dislocation rates and infections were common in reconstruction. the survival rate was prolonged in reconstruction than in osteosynthesis by IMN.

Adolescent idiopathic scoliosis: a prospective randomised trial protocol comparing clinical and radiological outcomes in minimally invasive surgery versus standard posterior spinal fusion in a single-centre, the Rizzoli Orthopaedic Institute, Bologna, Italy

IntroductionMinimally invasive spine surgery (MISS) has been shown to be safe and effective in adolescent idiopathic scoliosis (AIS) correction, even though there is no consensus on which treatment provides the...

“Thanks to my activists Friends”: a qualitative study of perspectives of young adults and professionals on the factors related to seeking support among victims of sexual violence in Spain

BackgroundSexual violence (SV) is a public health problem with high prevalence among the young population. The use of formal resources for SV care (e.g. institutional services) is low in this age group. This study applies a framework of health assets to identify the factors that positively influence the search for support for SV among young people, the functions of that support and the level of proximity as articulated by both young people and professionals.MethodsA qualitative study was conducted through 38 semi-structured interviews with young people and professionals from SV resource centers and/or care services for the young population in Spain. A thematic theoretical analysis was conducted, embedded in inductive insights emerging from the data, following a particular adaptation of the constant comparative method, under the grounded theory approach. This analysis was carried out by coding the interview transcripts with the support of Atlas.ti.ResultsYoung women identified assets, categorized as feminist, that they believe they are essential in the search for formal support services for SV. However, unlike young men, they considered the police and judicial system to be barriers and not assets. There were also differences between the young people and professionals in identifying assets. Young people also considered their partner and traditional media as health assets, in contrast to professionals who did not identify these as such valuable resources in the help-seeking process. Informal assets, such as family, friends and the internet are considered close resources. In contrast, specialized care services for gender-based violence/SV and the judicial and police systems were perceived as more distant resources among the young interviewees.ConclusionsThis study shows similarities and discrepancies among young women and men and SV response professionals in identifying assets for seeking SV support among youth. The study shows an inverse relationship between perceptions of proximity and the level of formality of the asset. This study also contributes to map the relationships and information exchanges between assets. It is advisable to inform professionals about the assets that professionals do not acknowledge, and about actions that allow young people to access formal resources.

Spatiotemporal mobility network of global scientists, 1970–2020

The mobility of scientists, manifested by movements to new academic institutions, grows with globalization and plays a crucial role in individual careers, institutional productivity, and knowledge dissemination. Current research on scientists’ mobility focuses on aggregated levels such as inter-country mobility, with little attention paid to fine-grained institutional level, leading to a simplified spatial portrayal of the mobility. To fill the gap, we take scientists in geography as examples, and reconstructed their dynamic mobility network among institutions from 1970 to 2020 based on massive literature metadata. Our findings reveal the spatial mobility pattern that is now dominated by North America, Western and Northern Europe, East Asia, and Oceania, with the trend of intensification, multipolarity, and inequality over time. Specifically, the mobility network exhibits clear community structure largely constrained by spatial proximity and national borders. We also uncovered a universal downward mobility pattern embedded in the hierarchical structure. Our quantitative analysis further suggest that mobility is facilitated by multiple realities, including spatial, cultural, and scientific proximity, institutional rankings and national economic levels, cooperation, and visa-free policies, with varying dynamics. These results contribute to spatiotemporal insights into the mechanisms of scientific development in theory, and the basis for talent policymaking in practice.

The preservation of cervical flexibility helps maintain cervical sagittal alignment after laminoplasty

BACKGROUND CONTEXTCervical spine range of motion (ROM) is a critical factor in changes in cervical sagittal alignment (CSA) and clinical outcomes after cervical laminoplasty (LMP). However, the impact of postoperative cervical ROM on CSA after cervical LMP is still unclear. PURPOSEEvaluating the imaging and symptomatic data from patients with cervical spondylotic myelopathy (CSM) to identify the influence of postoperative cervical ROM on post-LMP CSA and surgical outcomes. STUDY DESIGNRetrospective study. PATIENT SAMPLEEighty-six patients undergoing LMP due to multilevel CSM OUTCOME MEASURESRadiographic parameters were measured before surgery and at follow-up: cervical lordosis (CL), T1 slope (T1S), cervical sagittal vertical axis (cSVA), CL in flexion (Flex CL), CL in extension (Ext CL), total cervical spine range of motion (ROM), cervical spine range of flexion (Flex ROM), and cervical spine range of extension (Ext ROM). Japanese Orthopedic Association (JOA) and visual analog score (VAS) were used to assessed clinical outcomes. Other parameters included age, gender, body mass index (BMI), follow-up time, number of surgical segments, proximal level, distalis level, and collar wear time. METHODSWe divided patients according to the changes in CSA (loss of cervical lordosis (LCL)>10°, or ≤10°; an increase in cervical sagittal vertical axis (I-cSVA) >10mm, or ≤10mm). A receiver-operating characteristic curve (ROC) analysis was constructed to identify the optimal cut-off value to discriminate the patients with and without postoperative deterioration of CSA. RESULTSThe postoperative total and Flex ROM were significantly lower in the LCL>10° and I-cSVA>10mm groups. Multivariate logistic regression analysis showed that low post-Flex ROM was significant risk factor for postoperative deterioration of CSA. ROC showed that the cut-off value for postoperative Flex ROM was 15.60°. Improvements in JOA recovery rate and neck pain were more significant in the flexibility group (post-Flex ROM ≥15.6°) after surgery. Patients in the stiffness group (post-Flex ROM <15.6°) wore a collar longer. CONCLUSIONSThe preservation of cervical flexibility can maintain CSA after cervical LMP. Postoperative cervical stiffness is related to poor surgical outcomes because significant cervical kyphotic change and sagittal imbalance are likely to occur after surgery. Prolonged wearing of cervical collar is correlated with cervical stiffness following cervical LMP.

Proximal Bilateral Arm Transplantation with Left Shoulder Reconstruction: Outcomes at 24 Months.

Arm transplantation has been proposed as a valid therapeutic option for arm amputees. A bilateral arm transplantation including reconstruction of the left shoulder was performed on January 13, 2021 in Lyon (France). The recipient was a 48-year-old man with bilateral amputation at proximal arm level on both sides following an electric shock in 1998. He had received a liver transplant in 2002. The donor was a 35-year-old man. On the right side, the donor humerus was fixed on the remaining 9-cm-long proximal stump, and was reinforced with the donor fibula in an intramedullary fashion. On the left side, the whole donor humerus (including the humeral head) was transplanted with reconstruction of the gleno-humeral joint, including a suspension ligamentoplasty. The immunosuppressive protocol was based on antithymocyte globulins as induction therapy, and tacrolimus, steroids and mycophenolate mofetil as maintenance therapy. Good bone healing and a well-positioned ligamentoplasty on the left side were achieved. At 2 years, the recipient was able to flex both elbows, and wrist extension, finger flexion, and extension were appreciated on both sides. Intrinsic muscle activity was detectable by electromyography during the eighth posttransplant month, and sensitivity was recovered. The patient is satisfied with his autonomy in some daily activities, but his greatest satisfaction is the recovery of his body image. These results confirm that it is possible to propose this transplantation to proximal-level arm amputees. The patients' information about risks and limits as well as their compliance and determination remain important prerequisites.

Moss-produced human complement factor H with modified glycans has an extended half-life and improved biological activity.

Most drugs that target the complement system are designed to inhibit the complement pathway at either the proximal or terminal levels. The use of a natural complement regulator such as factor H (FH) could provide a superior treatment option by restoring the balance of an overactive complement system while preserving its normal physiological functions. Until now, the systemic treatment of complement-associated disorders with FH has been deemed unfeasible, primarily due to high production costs, risks related to FH purified from donors' blood, and the challenging expression of recombinant FH in different host systems. We recently demonstrated that a moss-based expression system can produce high yields of properly folded, fully functional, recombinant FH. However, the half-life of the initial variant (CPV-101) was relatively short. Here we show that the same polypeptide with modified glycosylation (CPV-104) achieves a pharmacokinetic profile comparable to that of native FH derived from human serum. The treatment of FH-deficient mice with CPV-104 significantly improved important efficacy parameters such as the normalization of serum C3 levels and the rapid degradation of C3 deposits in the kidney compared to treatment with CPV-101. Furthermore, CPV-104 showed comparable functionality to serum-derived FH in vitro, as well as similar performance in ex vivo assays involving samples from patients with atypical hemolytic uremic syndrome, C3 glomerulopathy and paroxysomal nocturnal hematuria. CPV-104 - the human FH analog expressed in moss - will therefore allow the treatment of complement-associated human diseases by rebalancing instead of inhibiting the complement cascade.

Predictors of leech therapy failure in revascularized and replanted digits

IntroductionVenous congestion is a common phenomenon following digital revascularization and replantation. Leech therapy allows for venous outflow while angiogenesis and neovascularization take place. The aim of this study is to evaluate the efficacy of leech therapy in the revascularized and replanted digits and determine risk factors for unsuccessful salvage. Materials and methodsA retrospective review was performed to identify all patients with complete or incomplete digital amputations at an academic Level 1 Trauma Center who underwent digital replantation or revascularization from January 2005 to December 2020. Amputations proximal to the palmar arch as well as revascularizations that showed any degree of perfusion on preoperative assessment were excluded. Leech therapy was initiated as soon as any signs of venous congestion appeared and was titrated to clinical effect. Patient demographics, medical history, injury mechanism, extent and level, operative details, leech therapy details, number of blood transfusions, hospitalization length, as well as the digit's ultimate survival data were collected. ResultsOf the 159 patients who underwent 213 digital revascularizations (n ​= ​135) and replantations (n ​= ​78), venous congestion requiring leech therapy developed in 27 digits in the revascularization group and in 26 in the replantation group. Of the digits that were leeched, 15 failed in the revascularization group (56 ​% failure rate) and 17 failed in the replantation group (65 ​% failure rate). Avulsion mechanism of injury and presence of a circumferential laceration were significantly associated with rate of failure in the revascularization cohort (p ​< ​0.01). Proximal level of injury was significantly associated with rate of failure in the replantation group (p ​< ​0.01). ConclusionLeech therapy has limited efficacy in avulsed or more proximally injured digits. These data can aid in determining the prognosis of a digit with venous congestion after revascularization and replantation.

Incidental pulmonary embolism in abdominal CT: detection rate and characteristics with artificial intelligence

Abstract Background Abdominal CT is a mainstay in the evaluation of abdominal infections, trauma, oncology, and postoperative complications. Pulmonary embolism is a common complication, but there is a risk that these ancillary findings are overlooked. In addition, data on detection rate and characteristics of incidental pulmonary embolism (iPE) on abdominal CT are lacking. Purpose The current study compared the period before and after implementing an artificial intelligence (AI) algorithm for iPE detection regarding detection rate and characteristics. Material and Methods A retrospective cross-sectional study was performed on abdominal CTs between August 1, 2019, and January 31, 2021 (before AI implementation, 8026 studies) and August 1, 2021, and January 31, 2023 (after AI implementation, 8765 studies). iPE cases were identified through text search and manually confirmed. Study indication and urgency were recorded for iPE patients, and the most proximal iPE level was assessed. A total of 1000 cases after AI implementation were randomly selected and manually reviewed for AI accuracy analysis. Results A total of 5876 patients with a mean age of 63.6 ± 17.7 years were included before AI implementation, and 6310 patients with a mean age of 63.2 ± 18.3 years after AI implementation. The iPE detection rate was higher after AI implementation, 0.57% (50/8765 studies) vs 0.12% (10/8026), P &amp;lt; .001. The most common study indications were abdominal pain (25%, 15/60 cases) and infection (30%, 18/60 cases). There were no differences in CT pulmonary angiography usage or the most proximal extent of the iPE between the periods before or after AI implementation, P &amp;gt; .05. AI identified 46/50 of the reported iPE with 7 AI false-positive cases for a positive predictive value of 87% (95% confidence interval: 75-93%). In the manually reviewed randomly selected subset, iPE prevalence was 1.7% (15/874, 95% confidence interval: 1.0-2.8%) with AI having 40% sensitivity (95% CI, 16-68) and 100% specificity (95% CI, 99.5-100). Conclusion Implementing AI for iPE detection and triage increased the iPE detection rate in abdominal CT. The AI sensitivity was moderate, with very few AI false positives.

Prototype design of an IoT-based dryer and temperature monitoring device and test its utilization on the dryness and proximate levels of seaweed

Seaweed has potential as a commodity for small and medium-scale businesses, but its quality is low due to conventional drying which experiences contamination and dries slowly. This research aims to produce a prototype IoT-based seaweed dryer to improve the quality of seaweed. The stages of this research are designing a prototype drying device, drying seaweed tests, and proximate analysis of seaweed. This research resulted in a 300W prototype using IoT components, including a solid state relay, Arduino Uno R3, potentiometer, thermocouple, 12C LCD, and SIM 800L V2 GSM GPRS module, with temperature control via an Android application. Optimal drying occurs at 60 oC, producing dried seaweed weighing 470.90 g from 1000 g. Water content decreases as temperature increases to 60 oC (18.85%), 50 oC (23.11%), 40 oC (32.30%), and conventional (34.50%). The highest protein, fat and carbohydrate content was at 60 oC, indicating drying efficiency at that temperature. Based on these results, it was concluded that using a dryer with a temperature of 60 oC was the best and most efficient.Keywords: Dryer; IoT; production; proximate; seaweed

Differences in Indicators of Socio-Psychological Integration Between Refugees from Syria and Receiving Community in Croatia

Abstract Socio-psychological integration is a dimension of integration affecting refugees and receiving community members alike, and is related to those integration goals which promote positive intergroup attitudes, close social proximity, interrelation of social networks, low levels of perceived intergroup threat, positive intergroup contact, etc. The goal of this study was to explore the differences in the levels of indicators of socio-psychological integration in both groups. Six hundred receiving community members in Croatia, and 149 refugees from Syria in Croatia participated in the field study. The results generally show that the refugees have more positive attitudes towards receiving community members, a closer social proximity and lower levels of perception of symbolic and realistic intergroup threat than vice-versa. Intergroup contact in Croatia is very rare, posing an interesting setting for the integration process. Potential implications of these findings are discussed.

Prevalence and risk factors of wound complications after transtibial amputation in patients with diabetic foot

BACKGROUND Diabetic foot (DMF) complications are common and are increasing in incidence. Risk factors related to wound complications are yet to be established after trans-tibial amputation under the diagnosis of DMF infection. AIM To analyze the prognosis and risk factors related to wound complications after transtibial amputation in patients with diabetes. METHODS This retrospective cohort study included seventy-two patients with DMF complications who underwent transtibial amputation between April 2014 and March 2023. The groups were categorized based on the occurrence of wound complications, and we compared demographic data between the complication group and the non-complication group to analyze risk factors. Moreover, a multivariate logistic regression analysis was performed to identify risk factors. RESULTS The average follow-up period was 36.2 months. Among the 72 cases, 31 (43.1%) had wound complications. Of these, 12 cases (16.7%) received further treatment, such as debridement, soft tissue stump revision, and re-amputation at the proximal level. In a group that required further management due to wound complications after transtibial amputation, the hemoglobin A1c (HbA1c) level was 9.32, while the other group that did not require any treatment had a 7.54 HbA1c level. The prevalence of a history of kidney transplantation with wound complications after transtibial amputation surgery in DMF patients was significantly greater than in cases without wound complications (P = 0.02). Other factors did not show significant differences. CONCLUSION Approximately 43.1% of the patients with transtibial amputation surgery experienced wound complications, and 16.7% required additional surgical treatment. High HbA1c levels and kidney transplant history are risk factors for postoperative wound complications.

Setting hinge position distal to the proximal margin of the distal lateral femur reduces the maximum principal strains of the hinge area and risk of hinge fractures.

The optimal hinge position to prevent hinge fractures in medial closing wedge distal femoral osteotomy (MCWDFO) based on the biomechanical background has not yet been well examined. This study aimed to examine the appropriate hinge position in MCWDFO using finite element (FE) analysis to prevent hinge fractures. Computer-aided design (CAD) models were created using composite replicate femurs. FE models of the MCWDFO with a 5° wedge were created with three different hinge positions: (A) 5 mm proximal to the proximal margin of the lateral epicondylar region, (B) proximal margin level and (C) 5 mm distal to the proximal margin level. The maximum and minimum principal strains in the cortical bone were calculated for each model. To validate the FE analysis, biomechanical tests were performed using composite replicate femurs with the same hinge position models as those in the FE analysis. In the FE analysis, the maximum principal strains were in the order of Models A > B > C. The highest value of maximum principal strain was observed in the area proximal to the hinge. In the biomechanical test, hinge fractures occurred in the area proximal to the hinge in Models A and B, whereas the gap closed completely without hinge fractures in Model C. Fractures occurred in an area similar to where the highest maximal principal strain was observed in the FE analysis. Distal to the proximal margin of the lateral epicondylar region is an appropriate hinge position in MCWDFO to prevent hinge fractures. Level V.

Risk factors of revision operation and early revision for adjacent segment degeneration after lumbar fusion surgery: a case-control study

Background contextAdjacent segment degeneration (ASD) following lumbar fusion operation is common and can occur at varying timepoints after index surgery. An early revision operation for ASD, however, signifies a short symptom-free period and might increase the risk of successive surgeries. PurposeWe aimed to elucidate the overall risk factors associated with revision surgeries for ASD with distinct attention to early revisions. Study design/SettingRetrospective, case-control study. Patient SampleThe study included 86 patients who underwent revision operations for ASD after lumbar fusion in the revision group and 166 patients who did not for at least 5 years after index surgery. Outcome measuresSagittal parameters, Pfirrmann grading, facet degeneration grading, and disc space height (DSH) of adjacent segments were assessed. MethodsRevision operations within 5 years postsurgery were defined as early revision. We compared the revision and no-revision groups as well as the early- and late-revision groups. ResultsThe revision group demonstrated a significantly greater preoperative C7–S1 sagittal vertical axis (SVA) (p=.001), postoperative C7–S1 SVA (p<.001), and postoperative pelvic incidence (PI)–lumbar lordosis (LL) (p<.001) than those in the no-revision group. Preoperative DSH of the proximal adjunct segment (p=.001), postoperative PI–LL (p=.014), and postoperative C7–S1 SVA (p=.037) exhibited significant association with ASD in logistic regression analysis. The early-revision group had a significantly higher patient age (p=.001) and a greater number of levels fused (p=.030) than those in the late-revision group. Multivariate Cox regression analysis demonstrated that old age (p=.045), a significant number of levels fused (p=.047), and a narrow preoperative DSH of the proximal adjacent level (p=.011) were risk factors for early revision. ConclusionsPostoperative sagittal imbalance, including significant PI–LL and C7–S1 SVA were risk factors for revision operation for ASD but not for early revision. These factors are likely to affect the long-term risk of revision operation due to ASD and thus are not considered risk factors for early revision. Narrow DSH of the proximal adjacent level increased the risks of both revision and early revision surgeries. Moreover, old age and a significant number of levels fused further increased the risk for early revision for ASD.

Self-induced Hot Water Finger Burn Trying to Get Feeling Back after Ropivacaine Block

Summary: This case report is about a patient with self-induced hot water burns several hours after an infraclavicular block with ropivacaine for a scaphoid fracture operation. This patient was honest about what happened. However, some patients are too embarrassed to admit what they did to themselves. The injury may be misdiagnosed by the emergency department physician or by the surgeon because the history is incomplete. The resulting burn, which can lead to fingertip loss when severe, can be erroneously misdiagnosed as an ischemic injury after lidocaine with epinephrine local anesthesia. Most hand surgeons have seen ischemic finger injuries the morning after failed finger replantation. Acutely ischemic fingers from arterial insufficiency do not have parallel hot water burn lines, reactive hyperemia at the base of the burn, or burn blisters at the fingertips. The purpose of this article and its video is to help physicians and nurses recognize the three signs of self-induced hot water finger burns after local anesthesia: (1) a parallel hot water line in the fingers at the proximal burn level; (2) reactive hyperemia just proximal to the burn line; (3) burn blisters in the submerged fingertips. When seeing postoperative patients with these signs, the examining clinician may tactfully ask: “Did you try to get the feeling back in your fingers by warming them?” It is hoped that the patient may then reveal that he tried warming the finger in water, and that may lead to the truth that the water was indeed too hot.

474 Comparing the Reciprocal Changes of Single Level Transforaminal Interbody Fusions Versus Lateral Interbody Fusions: A Radiographic Analysis for Sagittal Alignment and Spinopelvic Parameters

INTRODUCTION: Transforaminal lumbar interbody fusion (TLIF) and lateral lumbar interbody fusion (LLIF) are two techniques that are widely used to treat single-level pathology at L4-5. To date, no studies have compared the two techniques in terms of their ability to address disc space pathology, such as loss of height and spondylolisthesis, and achieve spinopelvic alignment goals. METHODS: After IRB approval, this study retrospectively reviewed the records of 203 patients who underwent single-level L4-L5 TLIFs and single-level L4-L5 LLIFs between 2017 to 2022. Preoperative and postoperative scoliosis films were collected and analyzed using an automated calibrated radiographic tool to measure pre-postoperative SA and SPs. Two blinded readers measured the pre-postoperative variables. Independent Sample T-tests were used to analyze the radiographic outcomes between the two groups. RESULTS: This study evaluated the results of 203 single-level TLIFs and LLIFs (109 L4-L5 TLIFs, and 94 L4-L5 LLIFs). Among the surgeries analyzed, 90 were MIS TLIFs, 19 open TLIFs, 16 standalone LLIs, and 78 LLIFs with posterior instrumentation. Postoperative scoliosis films were taken at a median of 0.28 (± 0.4) months. The analysis focused on comparing the reciprocal changes between both procedures. Significant statistical differences was found for ΔGTilt (p = 0.036), ΔLPA (p = 0.12), ΔADH (p = 0.03), ΔPDH (p = 0.04), ΔFH (p = 0.001), and ΔS% (p = 0.01) in the LLIF group, among all the variables included in the analysis. CONCLUSIONS: L4-5 LLIF and TLIF resulted in statistically similar amounts of lordosis restoration and reciprocal change at proximal and distal lumbar levels. LLIF was found to be superior in restoration of anterior disc height, posterior disc height, and foraminal height compared to TLIF. LLIF was also superior in percentage reduction of spondylolisthesis.

Abstract 2396: Tumor treating fields (TTFields) for spinal metastasis: Clinical trial concept for use of conductive implants as waveguides to enhance TTFields strength

Abstract Tumor treating fields (TTFields) is a FDA-approved electric fields-based therapy for glioblastoma (GBM) and malignant pleural mesothelioma. We describe a novel approach to increase the strength and therapeutic effect of TTFields at vertebral tumor targets, using spinal implants as electrically-conductive waveguides. In vivo anti-cancer efficacy is achieved with TTFields strength &amp;gt;1 V/cm. If the tumor is surrounded by tissues of lower conductivity (e.g., the skull in the case of GBM), then the TTFields strength reaching the tumor is decreased. Surgical treatment of radiation-refractory spinal metastases is difficult and provides a short-term benefit at the expense of a lengthy recovery. Such resections require bone removal that disrupts the spinal stability, necessitating reconstruction with titanium (Ti) pedicle screw constructs that are electrically conductive. We theorize that astute placement of Ti hardware in the proximate spinal levels post-resection would have a waveguiding effect of electrical current from the surrounding muscle towards the tumor. This would in turn boost TTFields strength achieved around the resection cavity, decreasing the chances of tumor recurrence. Bomzon et al. described a computational model of the distribution of TTFields in a realistic human torso. The simulation demonstrated that a TTFields strength of 3 V/cm can be achieved, which is approximately 3-fold greater than what is achieved in the brain parenchyma in the context of TTFields for GBM. In a more generic simulation using a 0.5 × 100 mm waveguide targeting a tumor deeper in the torso (480 mA), we found 21.8 vs. 61.2 cm3 volumes achieving ≥ the 1.0 V/cm efficacy floor, without and with the waveguide, respectively, a 2.8-fold increase. At a higher amplitude (550 mA) and stronger TTFields strength threshold of ≥1.5 V/cm, a negligible volume was attained with no waveguide (0.1 cm3), whereas a volume of 17.6 cm3 was attained around the tip of the waveguide when present. Based on compelling pre-clinical data, a prospective clinical trial is being designed in which patients with radiation-refractory spinal metastasis from any number of primary sites will undergo resection. Next, primary cultures of their tumor cells will be made and evaluated for the TTFields frequency that maximizes cell death on a per-patient basis. Patients will then undergo postoperative local TTFields therapy ± systemic therapy. The primary endpoint will be safety and efficacy of such an approach, with future aims focusing on local control rates. The application of TTFields as an adjunct to surgery may offer a new therapeutic option for patients with spinal metastasis who would otherwise not be considered surgical candidates. Similarly, waveguides may be used throughout the head and body to increase TTFields efficacy. Citation Format: Claudio E. Tatsui, Kristen W. Carlson, Chirag B. Patel. Tumor treating fields (TTFields) for spinal metastasis: Clinical trial concept for use of conductive implants as waveguides to enhance TTFields strength [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2396.

Steaming Maintains Fatty Acids, Antioxidants, and Proximate Content in Snack Bar Products from Cocoa Beans.

Chocolate products on the market are generally in the form of chocolate bars as snacks made from cocoa powder. Fat and powder are separated first through a pressing process to obtain the cocoa powder. Cocoa powder loses most of its fat content during processing. Therefore, the study aimed to determine the effect of steaming time on the cocoa bean content of fatty acids, free fatty acids, proximate levels, and antioxidant activity of snack bar products made from steamed cocoa beans. Seven steaming time intervals for cocoa beans were studied. The results showed that a longer steaming time affects the fatty acids, saturated fatty acids, antioxidants, and proximate in cocoa beans. Steaming time treatment at 45 minutes increased oleic acid, palmitic acid, and antioxidant activity. In addition, reducing free fatty acids represents a quality improvement that meets international Codex Alimentarius standards, offering a competitive advantage in the market. The food industry can adopt this steaming technique to develop snack bars and new products that are healthier and more sustainable by using steaming as an effective processing method in maintaining and increasing the nutritional value of products.

Detection of acute pulmonary embolism using native repeated magnetic resonance imaging acquisitions under free-breathing and without respiratory or cardiac gating. A diagnostic accuracy study

ObjectivesComputed tomography pulmonary angiography (CTPA) is the gold standard diagnostic method for patients with suspected pulmonary embolism (PE), but it has its drawbacks, including exposure to ionizing radiation and iodinated contrast agent. The present study aims to evaluate the diagnostic performance of our in-house developed non-contrast MRI protocol for PE diagnosis in reference to CTPA. Methods107 patients were included, all of whom underwent MRI immediately before or within 36 hours after CTPA. Additional cases examined only with MRI and a negative result were added to reach a PE prevalence of approximately 20%. The protocol was a non-contrast 2D steady-state free precession (SSFP) sequence under free-breathing, without respiratory or cardiac gating, and repeated five times to capture the vessels at different breathing/cardiac phases. The MRIs were blinded and read by two radiologists and the results were compared to CTPA. ResultsOf the 243 patients included, 47 were positive for PE. Readers 1 and 2 demonstrated 89% and 87% sensitivity, 100% specificity, 98% accuracy and Cohen’s kappa of 0.88 on patient level. In the per embolus comparison, readers 1 and 2 detected, 60 and 59/61 (98, 97%) proximal, 101 and 94/113 (89, 83%) segmental, and 5 and 2/32 (16, 6%) subsegmental emboli, resulting in 81 and 75% sensitivity respectively. ConclusionThe repeated 2D SSFP can reliably be used for the diagnosis of acute PE at the proximal and segmental artery levels.

Geographical and cognitive proximity effects on innovation performance: Which types of proximity for which types of innovation?

AbstractThe purpose of the paper is to explore the multi‐dimensional and intersecting nature of proximity to drive innovation performance. Applying a multi‐dimensional proximity framework, the study provides a deeper understanding of the importance of substitution and overlap mechanisms in the relation between geographical and cognitive proximity dimensions in innovation performance. The paper further analyses the moderation effect of organisational innovation in this relationship. Multivariate analysis proves the interaction effects between geographical and cognitive proximity, where cognitive proximity both substitutes and complements geographical proximity. However, external knowledge search for innovation along proximity dimensions differs depending on the type of innovation. Our findings corroborate the proximity paradox caused by lock‐in effects with the optimal level of proximity influenced by the interdependencies between proximity dimensions. This inverse U‐shaped relationship is flatter for firms that have adopted organisational innovation. External knowledge linkages should be tailored to the favourable characteristic of proximity to enhance firm innovation performance.