Body Surface Research Articles

Energy Flux Method for Wave Energy Converters

Hydrodynamic tools reveal information as to the behaviour of a device in the presence of waves but provide little information on how to improve or optimise the device. With no recent work on the transfer of power (energy flux) from a wave field through the body surface of a wave energy converter (WEC), we introduce the energy flux method to map the flow of power. The method is used to develop an open-source tool to visualise the energy flux density on a WEC body surface. This energy flux surface can also be used to compute the total power capture by integrating over the surface. We apply the tool to three WEC classes: a heaving cylinder, a twin-hulled hinged barge, and pitching surge devices. Using the flux surfaces, we investigate power efficiency in terms of power absorbed to power radiated. We visualise the hydrodynamic consequence of sub-optimal damping. Then, for two pitching surge devices with similar resonant peaks, we reveal why one device has a reduced power performance in a wave spectrum compared to the other. The results show the effectiveness of the energy flux method to predict power capture compared to motion-based methods and highlight the importance of assessing the flux of energy in WECs subjected to different damping strategies. Importantly, the tool can be adopted for a wide range of applications, from geometry optimisation and hydrodynamic efficiency assessment to structural design.

8205 Within day Symptoms Of Adrenal Insufficiency Predict Reduced Quality Of Life And Adrenal Crises In 712 MyAI Registry Participants

Abstract Disclosure: J.G. Kallet: None. W. Hover: None. A. Krein: None. M. Lowe: None. M.F. Slovick: None. G. Kinney: None. S. Majka: None. K. Warren: None. S. Watts: None. M.T. McDermott: None. E.A. Regan: None. Multiple studies have shown reduced quality of life in people with adrenal insufficiency based on 1- 4 week recall of symptoms. However, “within-day” symptoms are commonly reported to treating physicians, and there is no clear understanding of what these symptoms represent for quality of life or adequate disease management. Lack of adequate cortisol has been postulated as a factor for both persistent symptoms and reduced quality of life but dose adjustment is not typically prescribed. Within-day symptoms are similar to those reported prior to treatment, and include lack of energy, nausea, vomiting, anorexia, headache, dizziness, shakiness, muscle cramps, and cognitive impairments. Addressing the relationship between “within-day” symptoms and replacement dosing could improve disease management. Further, understanding the association of within-day symptoms to outcomes (quality of life and adrenal crises) provides an impetus to change the standard of care. Individuals enrolled in the MyAI registry provided information about “within-day” symptoms. These included energy to accomplish tasks, cognitive symptoms, and overall symptoms. The questions were scored with increased values representing greater and more frequent symptoms and were summed to create a severity score. Patients also reported adrenal crisis within the past year and completed the AddiQoL as quality of life over the past 4 weeks.Responses were obtained from 712 adult registry participants - 84% female, age range 23-89, mean 51.2 (15.2) years - and 47% reported an adrenal crisis within the past year. Within-day symptom score range was 3-15 points with mean 7.9 and SD of 2.96. Higher “within-day” symptom scores were associated with stepwise reductions in the AddiQoL (worse quality of life). Individuals who reported an adrenal crisis within the past year had significantly increased symptom scores [8.8 (2.9) vs 6.7 (2.5), p<0.0001]. Regression model for the AddiQoL total score (R2 = 0.8) found after adjusting for group, age and sex, that BMI (p = 0.0002) and symptom score (p<0.0001) were highly significant predictors of worse AddiQoL score. ConclusionAdrenal crisis is reported frequently by patients who are being treated for adrenal insufficiency. We found a strong association of “within-day” symptoms to both risk of adrenal crisis and reduced quality of life. Addressing persistent disease-related symptoms in adrenal insufficiency would be an appropriate disease management response to improve care. The initial choice of replacement dosing based on body surface area or other metric may be a starting point for care but should be informed by studies that show large variation in absorption and metabolism between individuals. Adjusting doses of replacement hormones and careful management of adrenal insufficiency symptoms could improve outcomes. Presentation: 6/1/2024

7302 Efficacy And Hepatotoxicity Of Ketoconazole In Cushing’s Syndrome

Abstract Disclosure: H. Elenius: None. R. McGlotten: None. S.T. Sharma: None. L.K. Nieman: None. Medical therapy (Rx) of Cushing’s Syndrome (CS) is complicated by variable efficacy, delays to treatment goal and adverse reactions. Ketoconazole (KTZ) use is limited by hepatotoxicity. We retrospectively reviewed records of 65 inpatients receiving KTZ for CS between 2004-2023 to assess efficacy and hepatotoxicity. 24-hour urinary free cortisol (UFC), AM serum cortisol (F), liver function tests (LFTs: alanine transaminase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP)) and daily doses of KTZ were noted. Patients were excluded if they received other medical Rx for CS or strong CYP3A4 inducers/inhibitors; baseline (base) or endpoint F/LFTs were unavailable; or if they received KTZ within 4 days prior to base labs. 35 patients (pts) were evaluated for efficacy. Treatment success was defined as F ≤12 mcg/dL. 17 pts (49%) achieved goal F at a median of 3 days (1-11, IQR 2.5-5.5). Compared to uncontrolled pts, there was no difference in Rx duration, base UFC or F, or initial or final KTZ doses, including when adjusted for base UFC, F, weight or body surface area. The absolute and percent dose increases and the F level prompting an increase did not differ between groups. Pts who reached goal had fewer days (d) between dose increases than uncontrolled pts (median 2 vs 4 d, p=0.025). Of 19 pts on a stable KTZ dose for ≥3 d after an increase, mean F decreased from d 0 to d +1 (-19%, p=0.01), +3 (-38%, p=0.0001) and +4 (-25%, p=0.04). D +3 F decreased from d +1 (-14%, p=0.03) and +2 (-13%, p=0.03). After d+3 no further reduction was seen (but likely biased by subsequent dose changes or discharge after d +3). 37 pts were evaluated for toxicity during KTZ Rx. Of 3 pts with a base LFT ≥3 times upper limit of normal (3ULN), LFTs rose ≥30% in 1, improved to <3ULN in 1 and did not change in the last pt. Of 34 pts with base LFTs <3ULN, a ≥30% rise of ≥1 LFT was seen in 27. Of these, 10/27 had ≥1 LFT rise to ≥3ULN after a minimum cumulative dose of 3400 mg and at least 4 days of Rx. Compared to the other 24, these 10 pts had higher means of base AST (75 vs 54% of ULN, p=0.046), cumulative KTZ doses (10080 vs 4071 mg, p=0.0015), and daily KTZ doses (927 vs 650 mg, p=0.004). AST and ALT increased by ≥30% before ALP (AST vs ALP: 4 vs 6 d, p=0.08). After KTZ was stopped or reduced, LFTs reached <3ULN at a median of 3 days (1-10, IQR 1.5-8.5) in 9 pts; pt 10 improved by discharge. 15/27 with an LFT rise ≥30% continued the same KTZ dose; LFTs stayed ≤ULN in 8, rose to >ULN in 5 and improved from base >ULN to ≤ULN in 2. By the end of inpt KTZ Rx (median 6 d, range 1-27, IQR 4-9), 13 pts (35%) had ≥1 LFT rise from ≤ULN to >ULN, 4 (11%) had ≥1 LFT improve from >ULN to ≤ULN. 12 stayed >ULN (32%); 8 (22%) stayed ≤ULN. Our data supports raising KTZ doses every 72 hours for rapid control. Base AST correlates with liver toxicity risk and tends to rise before ALP. An LFT rise ≥30% is seen in most pts and should not prompt Rx cessation if <3ULN. KTZ improves LFTs in a minority of pts, likely from cortisol reduction. Presentation: 6/3/2024

Evaluation of a National Sample of 16,671 Pediatric Burn Admissions: Identifying Predictors of Non-accidental Pediatric Burns

BackgroundBurn injuries remain one of the leading causes of injury and death in children. Studies have demonstrated a higher mortality for pediatric burns associated with non-accidental injury. Using data from a burn registry, our study aimed to discern potential factors associated with non-accidental burn injuries. MethodsWe utilized the American Burn Association database from 2016 to 2018, which collects data from over one hundred burn centers across the United States, to evaluate a large pediatric burn population. Patients aged ≤14 years were analyzed. The population was then divided into suspected non-accidental versus accidental burn injuries. A multivariable logistic regression model was utilized to evaluate for predictors of burn injuries. Additional models were used to assess the relationship between suspected non-accidental burn injury and mortality, intensive care unit (ICU) stay, and hospital length of stay. Results16,671 pediatric patients were included. Of those, 1228 (7.4%) patients suffered non-accidental burn injury. A majority of children who sustained non-accidental burn injury were younger, non-white, and sustained scald burns. The regression model demonstrated predictors for non-accidental burn injuries included younger age, Black race, chemical/corrosion burns, government insurance, and increased total body surface area (TBSA) burn. Overall mortality for the population was 0.5%. ConclusionThis evaluation of a national burn registry reveals differences in pediatric patients sustaining non-accidental burns compared to accidental burns. The findings in this study identify pediatric populations at risk for suspected non-accidental burn injuries which may assist in preparing the families for expectations after admission for a burn injury. Level of EvidenceIII.

12324 Clinical Features And PHEX Variants Of Adults With X-Linked Hypophosphatemia

Abstract Disclosure: L.P. Valadares: None. D.R. Carvalho: None. F.S. Lopes: None. R.S. Oliveira: None. L.G. Castro: None. X-linked hypophosphatemia (XLH), caused by loss-of-function PHEX mutations, is a lifelong renal phosphate-wasting disorder and the main cause of inherited hypophosphatemia. In adults, chronic hypophosphatemia leads to impaired bone mineralization and persistent osteomalacia. Short stature, lower limb deformities and musculoskeletal chronic pain can significantly impact the daily lives of affected individuals. This study aimed to describe the clinical and molecular profiles of 23 adults with genetically proven XLH who are being followed at a tertiary medical center in Brazil. We conducted a retrospective analysis of their medical records. The median age at diagnosis was 3.0 years (IQR 2.0-8.0) and the mean age at first visit at the adult care unit was 30.5 years (±12.7). Their mean final height was 144.2 cm (±10.5), with a mean body mass index (BMI) of 28.1 kg/m2 (±4.9). Nine patients were overweight, and seven were obese. Sixteen patients had a positive family history of rickets, and nine had offspring with XLH. Among the 14 different PHEX mutations that were identified, six had not been previously reported. Hypophosphatemia was observed in 21 patients at presentation at the adult care unit, increased serum alkaline phosphatase levels in 19, and 12 showed increased PTH levels. Chronic bone and muscular pain were reported by sixteen patients, eighteen had lower limb deformities, and six had a history of fractures and/or pseudofractures. Seventeen patients underwent orthopedic surgeries, with an average of 3.8 surgical interventions per patient. Nephrolithiasis and/or nephrocalcinosis were observed in nine patients, but none had glomerular filtration rate below 60 mL/min adjusted to 1.73 m2 of body surface. Three patients were on conventional treatment (phosphate and calcitriol) upon presentation at the adult care unit, five patients had never received XLH-specific treatment, and fifteen discontinued conventional therapy after completing skeletal growth, with a mean therapy duration of 12.1 years (±3.5). Out of the 20 patients without treatment, 16 were initiated on pharmacological therapy based on symptoms and signs of persistent osteomalacia. Eleven started combined phosphate and calcitriol supplementation, while five received calcitriol monotherapy. This cohort underscores that adults with XLH experience significant musculoskeletal morbidity throughout their lives, and require long-term follow-up, including assessment of energy metabolism. Importantly, most of them benefits from maintaining pharmacological treatment in adulthood. Presentation: 6/2/2024

REAÇÕES CUTÂNEAS GRAVES: UMA VISÃO ABRANGENTE SOBRE A SÍNDROME DE STEVENS-JOHNSON, SUA ETIOLOGIA, FISIOPATOLOGIA E ABORDAGENS TERAPÊUTICAS

Stevens-Johnson Syndrome (SJS) is a rare and severe condition characterized by epidermal detachment and mucosal lesions, primarily affecting the mouth, eyes, and genitals. Often triggered by adverse drug reactions, such as antibiotics and anticonvulsants, SJS can also be caused by viral infections and, rarely, neoplasms. SJS forms a spectrum with Toxic Epidermal Necrolysis (TEN), differing in the extent of skin involvement: in SJS, less than 10% of the body surface is affected, while in TEN, the involvement exceeds 30%. Although rare, with an incidence of 1.2 to 6 cases per million people, SJS carries high morbidity and mortality, leading to complications such as severe infections and permanent damage to the skin and mucous membranes. Early diagnosis is crucial, based on characteristic lesions and a recent history of medication use. In some cases, a biopsy is necessary to confirm the diagnosis. Treatment involves a multidisciplinary approach, including intensive care, immediate discontinuation of the causative drug, and immune modulation with corticosteroids or intravenous immunoglobulin. While new therapies, such as cyclosporine and special wound dressings, are being explored, there is still a need for consensus on the ideal treatment protocol, as well as advances in personalized diagnosis and treatment.

The Impact of Disease Severity on the Serum Levels of Significant Neutrophil Extracellular Trap (NET) Proteins in Patients with Psoriasis.

Psoriasis is an inflammatory skin disease with various symptoms of differing severities and with the reported prominent involvement of neutrophil extracellular traps (NETs). The excitation of neutrophils, e.g., by interleukin 8 (IL-8) or lipopolysaccharide (LPS), leads to the citrullination of histones and the release of protein-DNA complexes into the extracellular space, where they are digested by DNases. Our aim was to explore data on the levels of protein-complexed DNAs neutrophil elastase-DNA (NE-DNA) and myeloperoxidase-DNA (MPO-DNA), citrullinated histones (citH2, citH3, citH4), and NET-degrading enzyme DNase I in the serum of psoriatic patients with varying severities of clinical symptoms assessed with the Psoriasis Area Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores. The levels of factors were detected in 52 patients with psoriasis and 22 healthy volunteers by the enzyme-linked immunosorbent assay (ELISA). The results showed the elevated levels of NE-DNA, MPO-DNA, citH3, and DNase I in the patients with psoriasis compared to healthy volunteers (p < 0.05). Additionally, changes were noticed in the levels of NE-DNA, citH3, and DNase I, depending on the severity of symptoms (p < 0.05). In mild psoriasis (PASI < 10, BSA < 10, DLQI < 10), the suppressing activity of the enzyme caused the impaired ability to remove the physiological level of NETs, whereas in moderate to severe psoriasis (PASI ≥ 10, BSA ≥ 10, DLQI ≥ 10), the enhanced activity of DNase I failed to remove NETs due to the observed overexpression. It may, thus, be concluded that the mechanism of action of NETs, which play an undeniable role in psoriatic diseases, seem to follow two different paths depending on the severity of disease, which may be crucial in selecting potential anti-NET treatment methods.

Anatomical compatibility of a novel total artificial heart-An in-silico study.

ShuttlePump is a novel total artificial heart (TAH) recently introduced to potentially overcome the limitations associated with the current state-of-the-art mechanical circulatory support devices intended for adults. In this study, we adapted the outflow cannulation of the previously established ShuttlePump TAH and evaluated the anatomical compatibility using the virtual implantation technique. We retrospectively assessed the anatomical compatibility of the ShuttlePump using virtual implantation techniques within 3D-reconstructed anatomies of adult heart failure patients. Additionally, we examined the impact of outflow cannula modification on the hemocompatibility of the ShuttlePump through computational fluid dynamic simulations. A successful virtual implantation in 9/11 patients was achieved. However, in 2 patients, pump interaction with the thoracic cage was observed and considered unsuccessful virtual implantation. A strong correlation (r <-0.78) observed between the measured anatomical parameters and the ShuttlePump volume exceeding pericardium highlights the importance of these measurements apart from body surface area. The numerical simulation revealed that the angled outflow cannulation resulted in a maximum pressure drop of 1.8 mmHg higher than that of the straight outflow cannulation. With comparable hemolysis index, the shear stress thresholds of angled outflow differ marginally (<5%) from the established pump model. Similar washout behavior between the pump models indicate that the curvature did not introduce stagnation zone. This study demonstrates the anatomic compatibility of the ShuttlePump in patients with biventricular failure, which was achieved by optimizing the outflow cannulation without compromising hemocompatibility. Nevertheless, clinical validation is critical to ensure the clinical applicability of these findings.

Short-term (24 weeks) treatment efficacy and safety of ruxolitinib cream in participants with vitiligo: a systematic review and meta-analysis

ImportanceVitiligo is a chronic skin disorder causing depigmentation. There is a lack of evidence-based medical evidence regarding ruxolitinib efficacy and safety for vitiligo.ObjectiveTo assess the efficacy and safety of ruxolitinib cream in the treatment of vitiligo.MethodsThe databases of PubMed, Embase, and Cochrane Library were searched. The literature screening was independently conducted by two reviewers.Data extraction and synthesisFor continuous variables, weighted mean difference (WMD) along with a 95% confidence interval (CI) was performed. For dichotomous outcomes, we calculated the odds ratios (ORs) or risk ratios (RRs), and their corresponding 95% CIs. The certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Main outcomes and measuresSymptoms, quality of life, and safety were evaluated using various measures, including the Facial Vitiligo Area Scoring Index (F-VASI), Total Vitiligo Area Scoring Index (T-VASI), Facial Body Surface Area (F-BAS), Total Body Surface Area (T-BAS) and Treatment-emergent Adverse Events (TEAEs).ResultsThree trials, involving a total of 830 participants from nine countries were included (female 388, 46.7%, male 442, 53.3%). The meta-analysis demonstrated a significant increase in the likelihood of participants achieving F-VASI75 (OR, 4.34 [95% CI 2.67–7.06]; high), F-VASI50 (OR 4.71 [95% CI 3.24–6.84]; high), T-VASI75 (OR 2.78 [95% CI 1.10–7.00]; moderate), and T-VASI50 (OR 4.47 [95% CI 2.52–7.92]; high) when compared ruxolitinib to vehicle. Ruxolitinib was associated with more lowered percentage change of F-VASI scores (MD − 32.79 [95% CI − 36.37 to − 29.21]; moderate), and T-VASI scores (MD − 20.22 [95% CI − 23.11 to − 17.33]; moderate) from baseline compared to vehicle. There may not be a significant difference in the occurrence of TEAEs between ruxolitinib and vehicle (RR 1.46 [95% CI 0.85–2.49]; high).ConclusionsThe findings suggest that ruxolitinib cream holds promise as a treatment option for vitiligo. Further long-term studies are needed to assess its sustained efficacy and safety profile.Systematic review registrationPROSPERO CRD42023431112.

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries.

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns. A multi-centre prospective cohort study across six burn services. Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected. Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns. Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

On-site burn severity assessment using smartphone-captured color burn wound images

Accurate assessment of burn severity is crucial for the management of burn injuries. Currently, clinicians mainly rely on visual inspection to assess burns, characterized by notable inter-observer discrepancies. In this study, we introduce an innovative analysis platform using color burn wound images for automatic burn severity assessment. To do this, we propose a novel joint-task deep learning model, which is capable of simultaneously segmenting both burn regions and body parts, the two crucial components in calculating the percentage of total body surface area (%TBSA). Asymmetric attention mechanism is introduced, allowing attention guidance from the body part segmentation task to the burn region segmentation task. A user-friendly mobile application is developed to facilitate a fast assessment of burn severity at clinical settings. The proposed framework was evaluated on a dataset comprising 1340 color burn wound images captured on-site at clinical settings. The average Dice coefficients for burn depth segmentation and body part segmentation are 85.12 % and 85.36 %, respectively. The R2 for %TBSA assessment is 0.9136. The source codes for the joint-task framework and the application are released on Github (https://github.com/xjtu-mia/BurnAnalysis). The proposed platform holds the potential to be widely used at clinical settings to facilitate a fast and precise burn assessment.

PRELIMINARY DATA ON COAT COVERAGE AND GROOMING INTERFERING WITH THE THERMAL COMFORT OF LHASA APSO AND SHIH TZU DOGS

The objective of this report was to investigate the effects of grooming on thermal comfort in Lhasa Apso and Shih Tzu dogs exposed to different ambient temperatures. A randomized block design in a 3 x 2 factorial scheme was used, with 3 different temperatures associated with whether the animal was groomed or not. Six adult dogs, consisting of two Lhasa Apsos and four Shih Tzus, were used. The dogs were exposed to temperatures of 17°C, 25°C, and 33°C both before and after grooming. Physiological parameters (blood pressure, heart rate, respiratory rate, rectal temperature, ambient temperature, ITU, and body surface temperature) were measured using infrared thermography with a portable IRT camera. The images were analyzed using FLIR Tools™ software with an emissivity of 0.97. Variance analysis was performed to evaluate the isolated effects and interactions between the factors of coat coverage and ambient temperature at the 5% significance level. No interaction was found between the treatments, nor were there isolated effects of the factors on the physiological parameters evaluated. A temperature of 33°C was associated with a higher rectal temperature (p&lt;0.05) in the animals. Ungroomed dogs exposed to temperatures of 25°C and 33°C had ITU values above the thermal comfort limit. In terms of body temperature, there was a significant interaction effect between coat coverage and the environment under different climatic conditions (p&lt;0.05). The surveyed grooming dogs exhibited greater body temperatures at all temperatures tested, namely, 17°C, 25°C, and 33°C. Grooming did not reduce the effects of thermal stress caused by different climatic conditions, indicating that grooming is not advisable for these animals

Epidermal distribution of tetrodotoxin-rich cells in newly hatched larvae of Takifugu spp.

Pufferfish of the genus Takifugu possess tetrodotoxin (TTX), known as "pufferfish toxin" and it is believed that pufferfish eggs and newly hatched larvae utilize TTX as a defensive substance against predators. However, the mechanism for the placement of TTX to specific cells on the larval body surface during the developmental process remains unknown. In this study, we clarify the distribution and characteristics of TTX-rich cells. We performed whole-mount immunohistochemistry (IHC) using anti-TTX monoclonal antibody on larvae of two pufferfish species, Takifugu rubripes and Takifugu alboplumbeus, just after hatching. This allowed observation of the TTX location and compared it with those of wheat germ agglutinin (WGA)-positive (periodic acid-Schiff (PAS)-positive) cells for mucous cells and IHC using anti-Na+/K+-ATPase (NKA) monoclonal antibody for ionocytes. As a result, uniformly scattered localization of TTX-rich cells was commonly observed in the epidermis of the larvae of the two Takifugu species. TTX-rich cells were WGA-negative (PAS-negative) and structurally distinct from NKA-positive cells, suggesting that TTX-rich cells are unreported small cells unique to pufferfish skin, but not mucous cells nor ionocytes.

Size and Function of the Right Atrium in Healthy Children by Three-Dimensional Echocardiography.

Right atrial volume (RAV) and function have proven prognostic value in the assessment of cardiac disease and may be more accurately assessed using three-dimensional echocardiography (3DE). Normal 3DE reference values for the right atrial (RA) volume and function in healthy children have not yet been published. Furthermore, current methods of indexing cardiac measurements to body surface area (BSA) alone may be insufficient. We aimed to develop reference values for 3DE-derived RAV and function in the pediatric population, to provide a comparison of regression methods using BSA, height, weight, and sex, and to compare 3DE values to two-dimensional echocardiography (2DE) derived volumes. We retrospectively analyzed 187 3DE datasets acquired for a multi-center study on healthy children at two international centers. 3DE volumes were measured with vendor-agnostic software (Tomtec), and 2DE endo-diastolic volume (EDV) using the area-length single-plane approach. Regression curve-fitting of height (Ht), weight (Wt), BSA, and sex were explored to optimize Pearson coefficient and homoscedasticity. The relationship of 3DE RAVs to BSA alone was heteroscedastic, with a residual positive relationship on indexing (R2 = 0.2506). Optimal regression of Ln (Volume) = b0 + x*Ln (Ht) + y*Ln (Wt) + z*Sex was homoscedastic. Total RA emptying fraction (EF) did not vary across age or sex, however active and passive emptying was best fit by a spline curve with a knot at approximately BSA = 1 m2. Strong agreement with 2DE-derived EDV was present (r2 = 0.83). We provide reference values for RA size and function in the pediatric population and provide a comparison of methods for indexing these values.

Efficacy of a new customized navigation template for placement of transpedicular screws for unilateral access in children with congenital spinal deformity and thoracic malformation

BACKGROUND: Surgical treatment of congenital spinal deformities combined with thoracic development anomalies in children is an urgent and a complex problem in surgical practice. The surgical method of correcting congenital deformities caused by segmentation disorder of the lateral surfaces of vertebral bodies and unilateral rib synostosis is aimed at correcting the existing deformity using a transpedicular system. This technique is effective for treating this group of patients. However, it requires precise and accurate installation of the supporting elements of the metal structure owing to the high risk of damage to the neurovascular structures in the area of surgical intervention. A solution to this problem is the use of an individualized guide template with rib support for unilateral access in children with congenital deformities of the thorax and spine. AIM: To perform a comparative analysis of the results of using an individual rib-supported guide template for transpedicular screw placement and the “free hand” method in children during surgical correction of congenital spinal deformities accompanied by thoracic development anomalies. MATERIALS AND METHODS: The study included 14 patients who underwent surgical treatment for congenital deformity of the thoracic spine against the background of segmentation disorder of the lateral surfaces of the vertebral bodies in combination with thoracic anomalies. The patients were divided into two groups. Group 1 included six patients operated on using a new navigation template guide, and group 2 consisted of eight patients who underwent installation of support elements using the “free hand” method. The following parameters were compared: time spent at the stage of formation of bone canals for the support elements of the metal structure and accuracy and correctness of support element installation. Clinical data included demographic information and the size of the scoliotic arch, number of support elements, and presence of complications. Statistical analysis using Student’s t-test for unpaired samples or Mann–Whitney test was used to compare results. RESULTS: Data obtained in the course of the study confirmed the high efficiency and accuracy and showed that the use of the template reduces the time of bone canal formation, increases the accuracy, and provides greater correctness of the position of the supporting elements compared to the “free hand” method, which increases the efficiency and safety of surgical treatment. CONCLUSIONS: The developed template guide with support on the rib for the installation of the supporting elements of the metal structure in the surgical treatment of children with congenital deformity of the thoracic spine in combination with thoracic development anomaly showed better results compared to the use of the “free hand” method.

A Young Female’s Battle with Toxic Epidermal Necrolysis Induced by NSAIDs: A Case Report

Introduction: Stevens-Johnson Syndrome (SJS) is a rare but severe mucocutaneous reaction often triggered by medications or infections, characterized by extensive epidermal detachment and mucosal involvement. This condition poses a high risk of morbidity and mortality, requiring prompt recognition and treatment. Case Presentation: An 18-year-old Asian female from eastern Nepal presented with non-itchy red spots, high fever, and significant discomfort following the administration of ibuprofen for minor sores. She developed extensive skin involvement covering 25% of her body surface area and severe mucosal lesions. Laboratory investigations revealed anemia, leukocytosis, and coagulopathy. She was admitted to the ICU, where she received broad-spectrum antibiotics, corticosteroids, and supportive care. The patient also developed acute kidney injury during treatment but eventually recovered and was discharged after a week. Clinical Discussion: The rapid onset of SJS in this patient reveals the unpredictable nature of drug-induced reactions. Early intervention with a multidisciplinary approach involving dermatology, intensive care, and infectious disease specialists was crucial in managing her condition. Despite the controversy surrounding corticosteroid use in SJS, their administration likely contributed to the rapid improvement in inflammation and skin healing. The case highlights the importance of early recognition, prompt management, and careful monitoring for adverse drug reactions, especially when prescribing medications known to cause SJS. Conclusion: The successful outcome achieved through a multidisciplinary approach provides valuable insights into the effective strategies for handling severe drug reactions, emphasizing that early diagnosis and comprehensive management in patients with SJS is critical.

Assessment of the influence of body fat indices on antihypertensive drug responses.

Less than 50% of patients treated for hypertension reach a target office systolic blood pressure (SBP). We aimed to evaluate the role of adiposity on antihypertensive drug responses in newly diagnosed hypertensive patients. Estimated glomerular filtration rates, body mass index (BMI), skinfold thickness (SFT), body surface areas and waist circumferences of 150 hypertensive patients naïve to treatment were measured. Treatment protocols were started as combination of angiotensin converting enzyme inhibitor (ACE-I) plus calcium channel blocker (CCB), angiotensin receptor blocker plus CCB or ACE-I plus diuretic. Pre-treatment and change in blood pressure (ΔBP) after 4weeks treatment were determined. Multiple linear regression analysis was used to find independent predictors of Δblood pressure changes, and multivariable binary logistic regression analysis to find independent predictors of target SBP < 140 mmHg at 4weeks. A total of 104 patients reached the target systolic pressure of <140 mmHg at 4weeks. Triceps, mid-abdomen and subscapular SFT were significantly thicker in the uncontrolled blood pressure group (P = .011, P = .006 and P = .016, respectively). Pretreatment SBP (r = 0.644), pretreatment diastolic blood pressure (DBP) (r = 0.188), subscapular SFT (r = -0.318), suprailiac SFT (r = -0.211) and ΔDBP (r = 0.433) were correlated with ΔSBP in correlation analysis. Pretreatment SBP (β = 0.644, 95% CI = 0.697-0.993, P < .001), subscapular SFT (β = -0.253, 95% CI = -0.886--0.329, P < .001), pretreatment DBP (β = -0.380, 95% CI = -0.1001- -0.453, P = .001) and ΔDBP (β = 0.401, 95% CI = 0.377-0.796, P < .001) were independent predictors of ΔSBP in multivariable linear regression analysis. Subscapular SFT was an independent predictor of target SBP < 140 mmHg in multivariable logistic regression analysis (OR = 0.895, 95% CI = 0.832-0.963, P = .003). Subscapular SFT may be a valuable marker for prediction of response to antihypertensive drugs.

Clinical Features of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Induced by Immune Checkpoint Inhibitor versus Non-Immune Checkpoint Inhibitor Drugs in China: A Cross-Sectional Study and Literature Review.

Immune checkpoint inhibitors (ICIs) can cause life-threatening Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Large-scale original research on ICI-induced SJS/TEN is limited. This study aimed to explore the unique clinical characteristics and potential pathophysiological mechanisms of SJS/TEN induced by ICIs. This cross-sectional study compared the clinical features of SJS/TEN induced by ICIs and non-ICIs, and reviewed the case characteristics of ICI-induced SJS/TEN. Clinical features were analyzed using independent t-tests, Mann-Whitney U-tests, and multivariable regression models. This study enrolled 41 cases of ICI-induced SJS/TEN and 107 non-ICI-induced cases from January 22, 2015, to May 28, 2024. ICI-induced SJS/TEN patients exhibited a trend towards a longer latency period (β: 17, 95% CI: -1.49 to 35.48), a smaller affected body surface area (BSA) (β: -40.68, 95% CI: -71.59 to -9.77), and milder oral and ocular mucositis than non-ICI-induced cases. A literature review identified PD-1 inhibitors as the primary ICIs involved and systemic corticosteroids as the most frequent intervention. No statistically significant difference in mortality rate was observed between patients treated with systemic corticosteroids alone and those receiving combination therapies (P= 0.85). The mortality rate for ICI-induced SJS/TEN was 24.5%. This study offered the largest comparative analysis to date, highlighting the unique clinical features of ICI-induced SJS/TEN, including a smaller affected BSA, a prolonged latency period trend, and milder oral and ocular mucositis. We described the epidemiology, clinical presentation, and therapeutic strategies for ICI-induced SJS/TEN. These findings not only contribute to a deeper understanding of the complex immune-inflammatory pathways in severe immune-related cutaneous adverse events (ircAEs) but also may inform the development of more targeted and effective treatments.

Influence of gap ratios on wake dynamics of two rectangular 5:1 cylinders placed inline

The present study explores the impact of gap ratio (G) on the wake dynamics of two rectangular 5:1 cylinders placed inline at a fixed Reynolds number (Re) = 250. The lattice Boltzmann method is used for numerical simulations, and the gap ratio is varied in the range of 0.25–10. After validating the code for flow around a single square cylinder, the simulations are further carried out to explore the impact of gap ratio on the fluid flow past two inline cylinders with a similar aspect ratio = 5:1. Both the cylinders are found to face the reattachment of detached shear layers from front edges on to the side surfaces before the final separation. These reattached shear layers generate vortices on the upper and lower surface of cylinders exhibiting the reverse flow. For G &amp;lt; 4.5, the surface vortices appear on the first cylinder only, while for G ≥ 4.5, the surface vortices appear at both cylinders upper and lower sides. The reattachment point on the surface of the first cylinder is found to move downstream till G = 3, but after that, reverse phenomena occur with an increase in the gap ratio. The enhancement of flow induced lift results due to such separating and reattaching flow. Four distinct flow patterns appear at different gap ratios range: (a) single slender body, (b) non-fully developed duplex shedding, (c) fully developed duplex shedding, and (d) unpredictable vortex shedding. The root mean square value of drag coefficient for the first cylinder is mostly found less as compared to the second cylinder for all G. Negative pressure is observed at the upper, lower, and wake region of both bodies. However, the pressure appears to be positive at the foremost surface of second body when the flow pattern changed from fully developed duplex shedding to unpredictable vortex shedding. Strouhal of both cylinders shows distinct values corresponding to dual frequency at small gap ratios but becomes consistent at higher ones.

Composition of Gases in the Interporous Space of Technogenic Bodies

Abstract —We present results of studies of inclusions in secondary sulfates (antlerite and a mixture of copiapite and coquimbite) and arsenates (erythrite and picropharmacolite) formed on the surface of technogenic bodies, such as stored waste from the enrichment of sulfide (Belovo and Ursk waste heaps) and arsenide (disposal maps of the Tuvakobalt plant) ores. A wide range of components were identified in the gas–liquid inclusions, the main ones being water and carbon dioxide. Hydrocarbons, oxygen-containing organic compounds, and nitrogen- and sulfur-containing gases were found in smaller but measurable amounts. Arsine H3As was also detected in inclusions in picropharmacolite (calcium and magnesium arsenate–arsenite). The gas–liquid inclusions in secondary minerals reflect the composition of the interporous space in the waste body, filled with particular atmospheric gases entering the body in free form and with seasonal precipitation. The combination of in situ generated and penetrating gases determines the diversity of inorganic and biotic interactions in technogenic bodies. The presence of hydrocarbons and oxygen-containing organic compounds is, most likely, associated with bacterial transformations of organic matter (residual vegetation, wood, microalgae, and fungi). At the same time, carbon disulfide and sulfur dioxide are indicators of active inorganic reactions of decomposition of the sulfide matrix.