Normal Reference Research Articles

Evolution of Sagittal Spinal Alignment During Pubertal Growth: A Large-Scale Study in a Chinese Pediatric Population.

Previous studies have reported normative data for sagittal spinal alignment in asymptomatic adults. The sagittal spinal alignment change in European children was recently reported. However, there is a lack of studies on the normative reference values of sagittal spinal and pelvic alignment and how these parameters change at different growth stages in Chinese children. The aims of this study were to establish the normative reference values of sagittal spinopelvic parameters in Chinese children, to investigate their variation during growth, and to compare these parameters between Chinese and European populations. The radiographic data of 1,916 healthy Chinese children (female:male sex ratio, 1.02:1; mean age, 11.9 ± 4.3 years) were analyzed in a retrospective, single-center study. Full-spine radiographs were utilized to measure several sagittal parameters, including pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser sign, and triradiate cartilage status). During skeletal growth, pelvic incidence (PI) increased from 31.3° to 38.4° (p < 0.001), and pelvic tilt (PT) increased from 7.8° to 12.2° (p < 0.001). There were also increases in LL (from 45.0° to 46.3°; p = 0.020) and proximal LL (from 14.5° to 15.9°; p = 0.023). The peak of change in PI occurred between Groups 1 and 2 (from 31.3° to 35.8°; p = 0.011). The peak of change in LL was observed between Groups 1 and 3 (from 45.0° to 47.7°; p = 0.008). The peak of change in proximal LL (from 14.5° to 15.9°; p = 0.039) and distal TK (from 6.1° to 6.9°; p = 0.039) occurred between Groups 1 and 5. A subgroup comparison showed that age and TK were significantly higher in male patients than in female patients across the skeletal growth groups. This was a comprehensive study of sagittal alignment in a large cohort of Chinese children. These findings can serve as age, sex, and ethnicity-specific reference values for spine surgeons when assessing and planning correction surgery for pediatric patients. The sagittal alignment variations during skeletal growth were different from those in European children, representing a unique cascade effect occurring during skeletal maturation in the Chinese population. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Brain volume metric analysis is correlated with aging changes and sex differences in Thai older adults

Introduction: Normative data on structural brain volume changes with age and sex differences are required as a reference standard for future research and clinical use. Methods: We studied a two-center, metropolitan-based, prospective cohort of adults aged fifty-five years and older who were recruited from community-dwelling settings and outpatient clinics without cognitive impairment at baseline and who were followed up for 2 years. The clinical data, neuropsychological tests, and brain MRI obtained with FreeSurfer software were utilized for quantitative volumetric measurements. Results: A total of 296 participants were recruited at the beginning, with 17 participants (5.8%, excluding 2 subjects with claustrophobia) excluded due to abnormal MRI findings and 27 participants (9.1%) excluded due to MCI/dementia. Among the 250 remaining, 14 patients dropped out or were lost to follow-up, and 35 had MCI or AD converters (14.8%). The remaining 201 subjects with normal cognitive function aged 55-85 years were analyzed for structural brain volume. There were significant correlations between age and brain parameters, including the hippocampus, corpus callosum, thalamus and ventricular volume changes (p value &lt; 0.05). There were significant differences between males and females in total intracranial volume, caudate, temporal lobe, and ventricle volumes in subjects aged 65–74 years, and in total intracranial volume and ventricle volumes in subjects aged 55–64 years (p value &lt; 0.05). Conclusion: Age and sex contributed to differences in brain structure and ventricular volume. These data could be used as a normative reference for clinical interpretation in people up to 85 years old and for understanding the physiological aging-related changes in the brain.

P-52 ASYMPTOMATIC MIXED PITUITARY MACROADENOMA IN A YOUNG MALE PATIENT

Abstract Introduction Central hyperthyroidism due to a thyrotropin (TSH)-secreting pituitary adenoma is a rare cause of hyperthyroidism, representing 0.5-1.0% of all pituitary adenomas. The etiopathogenesis of TSH-secreting-adenomas is unknown and no definite role for various oncogenes has been proven. Plurihormonal pituitary adenomas reveal greater tumor recurrence and local invasion than do mono-secreting pituitary adenomas and therefore they need to be followed more closely. Clinical Case We present the case of a 19-year-old male who was admitted to the endocrinology clinic, was asymptomatic, and had abnormal thyroid tests during routine examinations. Laboratory tests revealed TSH 1.33 (normal RI), freeT4 2.5 (high), freeT3 6.78 (high), and the patient had tachycardia (pulse 120/min) on physical examination, but had no complaints. Thyroid antibody tests were negative, and ultrasonography revealed normal thyroid gland size and homogeneous parenchyma. Alpha subunit test was requested with suspicion of TSHoma and genetic test was requested considering thyroid hormone receptor resistance. In the pituitary panel tests, the patient's GH and IGF1 tests were found to be high for his age and gender, The lowest GH value in the GH-OGTT test was 3.95 ng/mL. LH was high but testosterone was within the normal reference range. The patient was found to have mandibular prognathism and his secondary sex characteristics were normal. Pituitary MRI revealed a nodular appearance on the left side of the pituitary gland, measuring 13x9 mm, hypointense on T1A, hyperintense on T2A, and showing contrast medium uptake. The infundibulum deviates to the right, and there is no pressure on the optic chiasm. Visual field test was normal. AlphaSubunit pituitary tumor marker value was found to be high at 1.9ng/mL (RIs ≤0.5). The genetic test for resistance to thyroid hormone, also came back normal. The patient underwent endoscopic transsphenoidal pituitary adenomectomy due to pituitary macroadenoma by an experienced neurosurgeon. No postoperative complications developed. In cytopathological evaluation, histochemical studies performed with silver stain showed that the reticulin roof was lost. In immunohistochemical studies, SF-1, PIT-1, LH (diffuse), GH (densely granular), TSH (rare) and LMWK (perinuclear cytoplasmic weighted) were positive. T-PIT and Prolactin were negative. Ki-67 proliferation index was 5%. Postoperative pituitary tests were normal and no deficiency was observed and no treatment was required. At the postoperative 3rd month follow-up, the lowest GH value in the GH-OGTT test was 0.16 ng/mL, and no residual mass was observed in the pituitary MRI. The patient, who had no postoperative complaints, is being followed up by the endocrinology clinic. Conclusion Mixed pituitary tumors are rare and can sometimes appear as silent tumors, but may be aggressive during follow-up, so better follow-up is necessary.Table 1:Pituitary panel biochemical results

(In)completing Accounting: Financial Managers and Quality Reforms in the Danish Health System

This study investigates the way that managers operating in the Danish health system encounter, make sense of, and enact a series of different reforms equipping and encouraging them to attend to and improve the quality of medical care. Our attention focuses on the conditions under which managers are enabled to perceive the incompleteness of the accounting systems and metrics, which shape and are shaped by how the reforms are enacted and what they ultimately mean in practice. On this basis we offer novel insights into the process we refer to as incompleting accounting, which we show involves and relates to managerial actions and intentions, and design characteristics of the accounting systems themselves. Illuminating the relationship between incompleting accounting at the level of practice, and completing quality at the level of policy, also allows us to provide a normative assessment of the different quality improvement regimes. Finally, we contribute to debates about the breaking down of distinctions between medical and managerial forms of knowledge and action, highlighting among other things a new direction of hybridization brought about as an indirect effect of accounting for quality.

Normative Values of Rhinology Questionnaires in Young Adults: A Tool to Identify Candidates for Rhinoplasty

Objective: Normative values of Rhinoplasty Outcome Evaluation (ROE) and Functional Rhinoplasty Outcome Inventory 17 (FROI-17) allow the monitoring of surgery outcomes. The objective of our study was to determine the reference norms of these disease-specific questionnaires in the age group that most often seeks rhinoplasty. Methods: The normative values of the ROE and FROI-17 questionnaires were calculated for 570 (459 women and 111 men) young adults at the mean age of 19.3 ± 1.3 years, range 18–25 years. Each participant underwent an ENT examination. All those who obtained a positive result were asked to complete two questionnaires: ROE and FROI-17. Results: The mean total ROE score was 13.4 ± 2.3, with a median of 13 and a range from 7 to 24. The mean overall FROI-17 score was 9.1 ± 13.3, with a median of 4 and a range from 4 to 72. For nasal symptoms, the mean was 4.0 ± 6.0, with a median of 1 and a range from 0 to 29. We observed a statistically significant difference between men and women only for the normative values of nasal symptoms (mean 4.0 ± 5.9 and median 2 (0–27) vs. mean 3.7 ± 6.5 and median 0 (0–29)). Additionally, there was a statistically significant correlation between the normative values of the ROE and FROI-17 scores (ρs = −0.413 for all participants, ρs = −0.314 for women, and ρs = −0.437 for men). Conclusions: The established normative values for the ROE and FROI-17 questionnaires among young, healthy individuals without nasal abnormalities can assist in the initial assessment of individuals seeking rhinoplasty. Deviations from these normative values in the ROE and FROI-17 questionnaires results may serve as indicators of potential concerns, such as body dysmorphic disorder (BDD).

Evaluating Biomechanical and Viscoelastic Properties of Masticatory Muscles in Temporomandibular Disorders: A Patient-Centric Approach Using MyotonPRO Measurements

The temporomandibular joint (TMJ) is essential for chewing and speaking functions, as well as for making facial expressions. However, this joint can be affected by disorders, known as temporomandibular disorders (TMDs), induced by complex causes that lead to limitations in daily activities. Building on the methodology and findings from our previous study on TMJ function, our research aims to apply the established criteria and norms to patients with TMDs. The primary goal is to evaluate the applicability and clinical relevance of these reference norms in predicting the severity and progression of TMJ disorders within a clinical population. Using non-invasive myotonic measurements, we evaluated 157 subjects, including both non-TMD-affected and TMD-affected individuals. To achieve optimal results, five primary parameters (frequency, stiffness, decrement, relaxation time, and creep) were analyzed using statistical–physical tools, providing quantitative functionality degrees across different previously examined clinical groups. The obtained results identified significant quantitative markers for early diagnosis and personalized treatment of TMJ disorders. This interdisciplinary approach leads to a deeper understanding of TMJ dysfunctions and makes a meaningful contribution to clinical practice, providing more precise tools for managing and treating this complex condition.

ЭЛЕМЕНТНЫЙ СТАТУС ЖИВОТНЫХ И ЕГО РАСПРЕДЕЛЕНИЕ В СРЕДЕ ТЕЛОК С РАЗЛИЧНЫМ АЛЛЕЛЬНЫМ НАБОРОМ ГЕНОВ, АССОЦИИРОВАННЫХ С КАЧЕСТВОМ ГОВЯДИНЫ

The purpose of the study is to determine the effect of polymorphism of the CAPN1 and TG5 genes on the elemental status of heifers in the conditions of the technogenic zone of the Southern Urals. The study was conducted at Sovkhoz Bredinsky LLC, Chelyabinsk Region, on 40 heads of Simmental Bredinsky meat-type heifers. Laboratory studies were carried out at the Center for Collective Use of the Federal State Budgetary Scientific Institution of the Federal Scientific Center of the BST RAS. According to the results of genotyping, biosubstrates in the form of wool were taken from animals of different genotypes and sent to Mikronutrienty LLC (Moscow), where their elemental composition was determined by mass spectrometry using a Nexion 300D quadrupole mass spectrometer (Perkin Elmer, USA). The results indicate a moderate heterogeneity of the genotyped population for the CAPN1 gene and a significant shift in heterozygosity for the TG5 gene. The elemental status of the animals is reflected in a graph that does not show any excess of toxic elements of the upper limits of the reference values for the Southern Urals zone, with the exception of the excess of the upper centiles of the reference norms for some essential elements, such as Mg (265.3 µg/g), K (2840.7) and Na (1571.6 µg/g), which is associated with the peculiarities of the geochemical conditions of the area. The results of the analysis of the distribution of the content of elements in the hair of 15–16-month-old heifers, depending on the polymorphism of the CAPN1 and TG5 genes, showed the lack of reliability of the dependence of the content of elements in the hair of animals on the genotype according to the polymorphic state of the above genes. At the same time, some peculiarities in the distribution of magnesium were observed for the TG5 gene, the amount of which in animals with the TT genotype was 2.1 times less than in analogues with the CC genotype, and for zinc, on the contrary, it was 33.2 % more (P &gt; 0.05). To obtain reliable values, it is necessary to repeat the studies on a larger sample.

Thirty years later: the lingering effects of adolescent idiopathic scoliosis surgery with third-generation implants on quality of life.

To determine patient-reported clinical status in a cohort of patients operated on during adolescence for adolescent idiopathic scoliosis (AIS) using Cotrel-Dubousset instrumentation after a minimum follow-up (FU) of 25years. Multicentric cross-sectional observational study. We assessed the clinical status of patients using the lumbar-pain numeric rating scale (NRS), ODI, SRS-22r, SF-36, and EQ-5D-5L. For NRS and SRS-22r, the reported "Patient Acceptable Symptom State" (PASS +) was used as a reference for normality. Further, normative data were used for SF-36 and EQ-5D-5L. Out of 226 eligible patients, 152 (67% of the total; 87% female) were included (mean FU = 29.6years). The mean age at FU was 45.1years (SD3.4; range 36-55). The PASS + status was achieved by 56.7% of patients on the SRS-22 subtotal score, 56% of patients in the NRS and 56.8% in the ODI questionnaire achieving PASS + state. Significant differences were found between the normative values for the SF-36 and EQ-5D-5L scores, but the magnitude of the differences was not clinically relevant. Clinically significant differences were found for SF-36 bodily pain (43.0 vs. 50.0; p < 0.001), SF-36 PCS (42.8 vs. 50.0; p = 0.0001) and EQ-5D-5L pain score, with the scoliotic population having 4.1 times more risk of severe/extreme pain than their peers. Thirty years after surgery, AIS patients have more pain and worse physical functioning than their peers. However, the differences are not clinically relevant except for pain and physical activity. Further, on average, the former are in good clinical condition, although surgery has not normalized their lives.

Retrospective analysis of hepatic copper concentrations in an internal feeding colony of dogs fed a broad range of foods.

To examine the effects of age, sex, year of death/sample collection, and liver histopathology on liver copper concentrations in dogs fed a wide variety of commercial dog foods throughout their lives. This study utilized all bioarchived liver samples collected during necropsy at time of death from 2006 to 2022 from dogs housed in a closed feeding colony. Liver samples were analyzed on a dry matter basis for copper concentration by inductively coupled plasma-optical emission spectrometry and did not require specific criteria for selection. The effects of animal age, year of death/collection, sex, and liver histopathology on liver copper concentrations were assessed. Liver samples were analyzed from 296 dogs. Age and sex had no effect on liver copper concentrations, which increased linearly over time by an average of 3.41 ppm per year but remained within the normal reference range. Quantile regression indicated that the lowest 5% and highest 5% of liver copper concentrations analyzed were not changing and only a slight increase (3.7 ppm per year) was observed in the lower 25th quantile. The mean copper concentration of abnormal liver histopathology samples was not different from the mean copper concentration of normal liver histopathology samples. Histopathologic findings or animal demographic did not impact liver copper concentrations over a 16-year period. Liver copper concentration increased linearly but remained within the normal reference range. Mean liver copper concentrations for each year remained within normal limits. Studies assessing the impact of specific nutrient profiles and sources in various populations are warranted.

Validity of the Alberta Infants Motor Scale in Norwegian infants aged 6-9 months through comparison with Canadian and Dutch scores.

The Alberta Infant Motor Scale (AIMS) is widely used to assess infant motor development but has shown limited cross-cultural validity in various populations. The distribution of the original AIMS scores has not been cross-culturally validated for Norwegian infants. This study aimed to evaluate the applicability of the Canadian AIMS norm reference for Norwegian infants aged 6-9 months and compare their percentile rankings with the Canadian and Dutch norms. In this cross-sectional study, AIMS scores from a sample of 189 Norwegian infants aged 6-9 months were compared to the Canadian and Dutch norms. Total raw scores from the Canadian norms were compared to those of the Norwegian sample, and the percentiles of the Canadian and Dutch sample were compared to tentative Norwegian percentiles. Norwegian infants aged 6-9 months consistently scored lower on the AIMS than their Canadian counterparts (p < 0.001), with 81% scoring at or below the 50th percentile and 18% falling at or below cut-off indicating possible motor delay. Using the Dutch norms, 20% of the Norwegian sample scored at or below the 50th percentile, while only 1% scored at or below the cut-off. A comparison of the percentile ranks showed that Canadian norms had the highest ranks for all age groups, followed by the Norwegian sample and subsequently the Dutch norms. The observed difference is considered clinically significant. Neither Canadian nor Dutch AIMS norms are valid for Norwegian infants due to the Canadian norms being too stringent and the Dutch norms being too lenient. A thorough cross-cultural validation for infants 0-18 months to establish Norwegian-specific AIMS norms is recommended.

Analysis of Dynamic Mandibular Movement of Patients With Condylar Hyperplasia Treated With Orthognathic Surgery and Condylectomy.

To assess the dynamic mandibular movement of patients with condylar hyperplasia before and after simultaneous orthognathic surgery and condylectomy through an intraoral approach. Two groups of patients diagnosed with unilateral condylar hyperplasia were studied: the preoperative group consisted of 23 patients and the postoperative group consisted of 13 patients who had undergone simultaneous orthognathic surgery and condylectomy through an intraoral approach with follow-up for more than 1 year. The normal reference value was obtained from 11 individuals without oral and maxillofacial diseases. Three-dimensional mandibular movement trajectories and electromyography of masticatory muscles were recorded. Patients showed no limitation in mandibular border movement before surgery, but the average amplitude of electromyography of the lower head of lateral pterygoid muscle on the affected side was lower than normal reference value. After condylectomy, the maximum mouth opening decreased [32.00 (26.55, 36.20) mm], mandibular movement deviated to the affected side, and the maximum distance in protrusive movement of the mandibular incisal point and the movement to the normal side were both significantly lowered. Amplitude of electromyography of the lateral pterygoid muscle on the normal side increased in the postoperative group compared with the preoperative group. Patients with condylar hyperplasia had a restriction in protrusive and to the normal side movement, and mandibular movement deflected to the affected side after condylectomy, which indicates the necessity of postoperative individualized rehabilitation training.

Vi-PLUS: Pioneering Plane-Wave Ultrasound to Assess Breast Glandular Tissue in Healthy Women-A Pilot Study.

This study pioneers the application of the ViPLUS module, utilizing plane-wave ultrasound to measure breast tissue viscosity and elasticity. The primary goal was to establish normal reference values for viscosity in healthy women. Secondary objectives included exploring correlations between breast tissue viscosity and breast density categories, hormonal influences, and menstrual cycle phases. A prospective study was conducted on 245 asymptomatic women. Viscosity and elasticity measurements were obtained using the ViPLUS module, ensuring high reliability with stringent quality control measures. Data were statistically analyzed to evaluate correlations and group differences. The median viscosity value for normal breast parenchyma was 1.7 Pa.s, with no significant variations based on breast density, menopausal status, or menstrual cycle phase. A strong correlation (rho = 0.866, p < 0.001) was observed between elasticity and viscosity values. The findings suggest that breast viscosity is consistent across diverse physiological states, indicating its potential as an independent diagnostic marker. This parameter could be pivotal in future breast cancer screening strategies, especially for younger women and those with dense breasts.

Clinical validation of artificial intelligence-based single-subject morphometry without normative reference database.

Single-subject voxel-based morphometry (VBM) is a powerful technique for reader-independent detection of brain atrophy in structural magnetic resonance imaging (MRI) to support the (differential) diagnosis and staging of neurodegenerative diseases in individual patients. However, VBM is sensitive to the MRI scanner platform and details of the acquisition sequence. To mitigate this limitation, we recently proposed and technically validated a convolutional neural network (CNN)-based VBM which does not rely on a normative reference database. Clinical validation of CNN-based VBM. CNN-based VBM was compared with conventional VBM based on a mixed-scanner normative database in 227 consecutive patients (66.0 ± 9.6 years, 53.3% female) with suspected dementing neurodegenerative disease. VBM maps were interpreted visually by two experienced readers, first with respect to the presence of any neurodegenerative disease, then for the differentiation between Alzheimer's disease (AD)-typical and non-AD atrophy patterns. A Likert 6-score was used for both tasks. Simultaneously acquired positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) served as reference standard. Repeated-measures ANOVA revealed a significant impact of the VBM method on the visual detection of any neurodegenerative disease (p < 0.001). Balanced accuracy/sensitivity/specificity were 80.4/86.3/74.5% for CNN-based VBM versus 75.7/79.5/71.8% for conventional VBM. Differentiation between AD and non-AD typical atrophy patterns did not differ between both VBM methods (p = 0.871). CNN-based VBM provides clinically useful accuracy for the detection of neurodegeneration-suspect atrophy with higher sensitivity than conventional VBM with a mixed-scanner normative reference database and without compromising specificity.

Role of Vitamin D Status and Alterations in Gut Microbiota Metabolism in Fibromyalgia-Associated Chronic Inflammatory Pain.

Background/Objectives: Several studies suggest gut microbiota metabolites as important immuno-modulators in inflammatory pain. We aimed to investigate the relationship between vitamin D status and gut dysbiosis markers in fibromyalgia (FM)-associated chronic inflammation. Methods: Blood samples were collected from sixty-eight female FM patients (49.9 ± 12.35 years). Pain intensity was assessed by FIQ-R. The serum levels of the pro-inflammatory cytokines TNF-α, IL-1β, IL-6, IL-17, IFN-γ, as well as those of vitamin D (25(OH)D3) and the kynurenine/tryptophan ratio (Kyn/Trp) were determined by ELISA and HPLC, respectively. The plasma levels of the SCFAs acetate, butyrate, and propionate were detected by GC-MS. Results: A mean FIQ-R score indicated that the patients could be classified as having moderate FM. The mean levels of all cytokines, but IL-6 and IL-1β, were higher than the normal reference values. The highest concentrations of cytokines were observed in patients showing the highest FIQ-R scores and the lowest 25(OH)D3 levels. Deficient levels of acetate were found paralleled by an increase in Kyn/Trp. The highest acetate concentrations were detected in patients with the lowest FIQ-R scores and 25(OH)D3 levels. Significantly negative correlations were found between 25(OH)D3 concentrations and FIQ-R scores (p = 0.007) as well as IL-17 levels (p = 0.002) and between acetate and TNF-α (p = 0.040) as well as FIQ-R scores (p = 0.028), while significantly positive correlations were observed between Kyn/Trp and IL-17 (p = 0.027) as well as IFN-γ (p = 0.003). Conclusions: Our preliminary data suggest that the vitamin D status along with altered gut microbiota metabolism plays a major role in FM-related inflammatory pain. Replication of these findings in a larger cohort is required to provide additional insights.

CT-Based Body Composition Measures and Systemic Disease: A Population-Level Analysis Using Artificial Intelligence Tools in Over 100,000 Patients.

Background: CT-based abdominal body composition measures have shown associations with important health outcomes. Artificial intelligence (AI) advances now allow deployment of tools that measure body composition in large patient populations. Objective: To assess associations of age, sex, and common systemic diseases on CT-based body composition measurements derived using a panel of fully automated AI tools in a population-level adult patient sample. Methods: This retrospective study included 140,606 adult patients (mean age 53.1±17.6 years; 67,613 male, 72,992 female) who underwent abdominal CT at a single academic institution between January 1, 2000, and February 28, 2021. CT examinations were not restricted based on patient setting, clinical indication, or IV contrast media utilization. Thirteen fully automated AI body composition tools quantifying liver, spleen, and kidney volume and attenuation, vertebral trabecular attenuation, skeletal muscle area and attenuation, and abdominal fat area and attenuation were applied to each patient's first available abdominal CT examination. EHR review was performed to identify common systemic diseases, including cancer, cardiovascular disease (CVD), diabetes mellitus (DM), and cirrhosis, based on relevant ICD-10 codes; 64,789 (46.1%) patients had a diagnosis of at least one systemic disease. Multiple linear regression models were performed in the 118,141 (84.0%) patients with no systemic disease or a single systemic disease, to assess age, sex, and presence of systemic disease as predictors of body composition measures; effect sizes were characterized using the unstandardized regression coefficient B. Results: Multiple linear regression models using age, sex, and systemic disease as predictors were overall significant for all 13 body composition measures (all p<.001) with variable goodness of fit (R2=0.03-0.43 across models). In the models, age was predictive of all 13 body composition measures, sex of 12 measures, cancer of nine measures, CVD of 11 measures, DM of 13 measures, and cirrhosis of 12 measures (all p<.05). Conclusion: Age, sex, and the presence of common systemic diseases were predictors of AI-derived CT-based body composition measures. Clinical Impact: An understanding of the identified associations with common systemic diseases will be critical for establishing normative reference ranges as CT-based AI body composition tools are developed for clinical use.

Determination of Urinary Neutrophil Gelatinase-Associated Lipocalin (uNGAL) Reference Intervals in Healthy Adult and Pediatric Individuals Using a Particle-Enhanced Turbidimetric Immunoassay.

Background: The current gold standards for diagnosing acute kidney injury (AKI) are an increase in serum creatinine and a decrease in urine output, which are inadequate for rapid diagnosis. Neutrophil gelatinase-associated lipocalin (NGAL) is a 25-kDa protein produced and secreted by injured kidney tubule epithelial cells, and can serve as an early urinary biomarker for AKI. ProNephro AKI (NGAL) is an immunoassay for the quantitative determination of NGAL in urine (uNGAL) that recently received FDA clearance. A multisite, cross-sectional study was conducted to establish reference intervals for uNGAL in apparently healthy individuals. Methods: Urine samples were collected from apparently healthy individuals aged ≥3 months who met all inclusion criteria and no exclusion criteria. Specimens were temporarily stored at room temperature or 2-8 °C, then transferred into urinalysis tubes before being frozen and shipped for testing. uNGAL testing was performed using the ProNephro AKI (NGAL) immunoassay on a Roche cobas c501 analyzer. Results: Of the 688 individuals screened, 677 were eligible, and 629 (91.4%) of those were deemed evaluable. The 95th and 97.5th percentile uNGAL values for all pediatric participants were below the clinical cutoff of 125 ng/mL. uNGAL values were statistically significantly higher for female vs. male participants in both adult (p = 0.003) and pediatric groups (p < 0.001), while differences were not statistically significant for age, site location, race, or ethnicity. Conclusions: This study provides normal reference intervals for uNGAL with the ProNephro AKI (NGAL) clinical chemistry immunoassay that may be useful for interpreting patient results.

Gait asymmetry assessment through Eigen-Gait components on dissimilarity maps

Motor impairments caused by neurological diseases have an important impact on gait, particularly on the coordination between left and right lower limbs. Deviation from normal gait is often measured to assess this impact on gross motor functions, and to monitor the progress of patients during rehabilitation. The concept of gait dissimilarity map is introduced to represent bilateral raw gait signals, while accounting for their respective spatiotemporal dynamics. A model of gait for the healthy population is constructed through Singular Value Decomposition, considering both lower limbs. The obtained eigenvectors synthesize the symmetry present in gait. Then, by projecting the dissimilarity maps of patients with gait disorders on the space formed by such eigenvectors, we compute their associated Eigen-Gait Asymmetry Index (EGAI) relatively to an average normal gait reference vector. For the knee joint in the sagittal plane, EGAI values of patients are higher (9.73 ±2.16) than those of healthy controls (3.86 ±0.9), reflecting the asymmetry induced by neurological diseases. Patients with hemiparesis show the highest EGAI (10.4 ±1.8), followed by patients with paraparesis (9.9 ±1.8) and patients with tetraparesis (8.6 ±2.5). Indeed, patients with hemiparesis show a more asymmetrical gait since only one side of the body is affected. EGAI for hip, ankle and pelvis joints in the sagittal plane show similar trends. Our innovative method characterizes bilateral gait, enriching traditional unilateral assessments. Our method yields a comprehensive score reflecting both asymmetry and gait deviations, aiming to provide clinicians with an effective and precise monitoring tool.

Breathlessness dimensions should be evaluated in relation to the level of exertion: a clinical study.

Exertional breathlessness is a dominating symptom in cardiorespiratory disease, limiting exercise capacity. Multidimensional measurement has been proposed to capture breathlessness, but it is unknown whether it is useful to differentiate people with abnormal vs normal exertional breathlessness intensity. This was a secondary analysis of a randomized controlled trial of outpatients aged ≥18 years performing a symptom-limited cycle incremental exercise test (IET). Breathlessness sensations at end of IET were identified using the multidimensional dyspnea profile (MDP) 30-min post-exercise and compared between people with abnormally high breathlessness (Borg 0-10 rating > upper limit of normal [ULN]) and people within normal ranges (≤ULN) in relation to the percentage of predicted peak power output defined by normative reference equations. Of 92 participants, 20 (22%) had abnormally high breathlessness. Compared with those with normal breathlessness (n=72 [78%]), the abnormal group reported higher symptom intensity at peak exercise (7.9 ± 1.7 vs 6.3 ± 1.4 Borg units; p<0.001) and had lower peak power output 129 ± 52W vs 167 ± 55W; p<0.001). Differences between those with normal, and abnormal exertional breathlessness regarding MDP ratings were not statistically significant (all p>0.05): overall unpleasantness, 4.1 ± 2.3 vs 4.7 ± 1.6; immediate perception, 10.9 ± 2.8 vs 11.5 ± 1.8; and emotional response, 4.1 ± 7.6 vs 3.2 ± 7.5. MDP ratings had no relation to peak power output. Breathlessness dimensions are similar at the peak of a standardized IET and cannot differentiate between people with normal and abnormally high exertional breathlessness.

Quantifying the Diagnostic Utility of Baseline Testing in Concussion Management: An Analysis of Collegiate Athletes From the NCAA-DoD CARE Consortium Dataset

Background: Although preseason baseline testing is a commonly recommended part of the concussion management process, its “value-added” contribution to the diagnosis of acute concussion compared with normative reference values remains in question. Purpose: This research aimed to evaluate the diagnostic benefits of baseline testing in acute concussion assessment compared with normative reference values and characterize the athletes who receive the most diagnostic utility from baseline testing. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: The investigators selected athletes from the National Collegiate Athletic Association—Department of Defense (NCAA-DoD) Concussion Assessment, Research, and Education (CARE) Consortium with at least 2 baseline assessments and 1 concussion. Two predictive models were developed that mimic acute concussion assessment using multivariate logistic regression based on a battery of postural control, neurocognitive status, and symptom assessments. The first predictive model gives a concussion status prediction based on change scores computed using individualized baseline testing information, whereas the second model uses normative reference values. The investigators defined and computed a novel metric called the Diagnostic Utility of Baseline Testing by comparing the concussion status predicted by each of these predictive models. The Diagnostic Utility of Baseline distribution was analyzed across athlete demographic characteristics and medical history. Results: The study included 1081 collegiate athletes (43.9% female) with 1279 acute concussion assessments (24- to 48-hour postinjury assessments) and 1551 reference assessments (baseline and 6-month assessments). Both the baseline and normative models exhibited notably high area under the curve values of .89 and .90, respectively. Most athletes (86.7%) did not gain additional diagnostic benefits from baseline testing versus normative values. Those with Hispanic ethnicity (P = .038) or a history of psychiatric disorders (P < .001) or depression (P = .002) were more likely to be correctly identified as having acute concussion when change scores were derived from normative values instead of individualized baseline values. Conclusion: This study highlights that the additional diagnostic benefit of preseason baseline testing over normative data is limited for most collegiate student-athletes. Thus, normative data can be used for most collegiate student-athletes in the absence of baseline testing. Moreover, these results can inform decisions on the allocation of baseline tests in resource-limited athletic settings, emphasizing the need for targeted concussion assessment strategies based on individual characteristics.

Gait Analysis after Anterior Cruciate Ligament Reconstruction: A Study in Morocco

Gait analysis is a valuable tool for understanding joint function, especially in knees with ligament defects. It allows for the identification and correction of deficits following ligament reconstruction. In this study, we analyze the knee kinematics of patients who have undergone anterior cruciate ligament (ACL) reconstruction and followed a rigorous rehabilitation protocol. Our goal is to evaluate the effectiveness of rehabilitation in these patients. We conducted a descriptive retrospective study on 20 patients at the Orthopedics and Traumatology Department B of Mohamed VI University Hospital in Marrakech, in collaboration with the Physical Medicine and Functional Rehabilitation Department and the Gait and Movement Analysis Laboratory. The study population had a mean age of 31.5 years, a mean height of 173 cm, and a mean body mass index of 24.14, with 85&amp;#37; of subjects being male (&lt;i&gt;n&lt;/i&gt; &amp;#61; 14). Gait analysis data revealed minimal deviations from normal reference values in spatio-temporal metrics, joint amplitudes, and ground reaction force. Our findings show that with adequate care and compliance to a comprehensive rehabilitation protocol, patients undergoing ACL reconstruction can regain a near-normal gait.