T2 Level Research Articles

Deep learning radiomics under multimodality explore association between muscle/fat and metastasis and survival in breast cancer patients.

Sarcopenia is correlated with poor clinical outcomes in breast cancer (BC) patients. However, there is no precise quantitative study on the correlation between body composition changes and BC metastasis and survival. The present study proposed a deep learning radiomics (DLR) approach to investigate the effects of muscle and fat on distant metastasis and death outcomes in BC patients. Image feature extraction was performed on 4th thoracic vertebra (T4) and 11th thoracic vertebra (T11) on computed tomography (CT) image levels by DLR, and image features were combined with clinical information to predict distant metastasis in BC patients. Clinical information combined with DLR significantly predicted distant metastasis in BC patients. In the test cohort, the area under the curve of model performance on clinical information combined with DLR was 0.960 (95% CI: 0.942-0.979, P < 0.001). The patients with distant metastases had a lower pectoral muscle index in T4 (PMI/T4) than in patients without metastases. PMI/T4 and visceral fat tissue area in T11 (VFA/T11) were independent prognostic factors for the overall survival in BC patients. The pectoralis muscle area in T4 (PMA/T4) and PMI/T4 is an independent prognostic factor for distant metastasis-free survival in BC patients. The current study further confirmed that muscle/fat of T4 and T11 levels have a significant effect on the distant metastasis of BC. Appending the network features of T4 and T11 to the model significantly enhances the prediction performance of distant metastasis of BC, providing a valuable biomarker for the early treatment of BC patients.

ABCL-286 Abrupt Obstruction of the Central Airway by a Relapse of Thyroid Gland Diffuse Large B-Cell Lymphoma: An Unusual Presentation

Primary thyroid lymphoma is a rare neoplasm comprising 1%-5% of all thyroid malignancies and 1%-7% of all extra-nodal lymphomas. Most thyroid lymphomas are of B-cell origin. Sharing a rare case of relapsed primary thyroid gland diffuse large B-cell lymphoma (DLBCL) and its diagnostic and therapeutic outcome, emphasizing the airway obstruction event. A case report. In March 2019, a 69-year-old man was admitted to our hospital with the following results of the thyroid gland biopsy-HP/Dg. High-grade DLBCL of the thyroid gland (CD20+, CD23+, Ki67=95%) was led by the endocrinologist because of the swelling symptoms around the neck and the changes in the thyroid gland ultrasound. The patient had no family history of any chronic or malignant disorders. Since the patient's laboratory tests and physical examination findings were normal, we decided to immediately start treating him with RCHOP protocol. After 8 rounds of chemotherapy, the patient was stable, and we planned to continue with maintenance therapy. Unfortunately, the patient came back before suggested with severe dyspnea, and the neck CT revealed a paravertebral/retrotracheal mass of 10.4×9.7×8.0 cm that was dislocating the trachea in the anterior plan and compromising the trachea and esophagus in T2 level. In the following days, there was an exacerbation of the dyspnea leading to total airway obstruction with SpO2 decreasing below 65%, and we needed to intubate the patient. Immediately after that, a tracheostomy was performed by an otorhinolaryngologist. When the patient's condition stabilized, we decided to treat his relapse with 4 cycles of salvage therapy-R-ESHAP-because of the lack of a transplant procedure in our country. After salvage chemotherapy, a PET-CT revealed no pathological FDG absorption, and a repeated neck CT showed a total reduction of the retrotracheal mass. The patient is still being followed every 6 months and has been in complete remission ever since. Seventeen months after completing the R-ESHAP treatment protocol, the patient is still in remission with no signs of disease and a normal CT scan. Despite the rare presentation of DLBCL, optimal early management and a multidisciplinary approach had a great impact on the patient's prognosis.

S2321 Esophageal Button Battery Retrieval: Time-In May Not Be Everything

Introduction: Management of ingested foreign bodies is a challenging task given differences in type and presentation. Ingested button batteries cause injury via electrical discharge, corrosive contents, and toxicity. The European Society of Gastrointestinal Endoscopy recommends endoscopic retrieval within 12-24 hours for objects longer than 6 cm. Conservative monitoring can be instituted for blunt objects less than 6 cm in length and 2.5 cm in diameter, or post pyloric. Due to risks of fistulas, perforation, and vocal cord paralysis, ingested button battery cases are handled emergently. However, we present an unusual case that demonstrated significantly delayed endoscopic removal of an ingested button battery without complication. Case Description/Methods: A 45-year-old male with no medical history presented 4 days after ingestion of ‘2 magnets’. He had dysphagia and difficulty eating solid foods, but remaining review of systems was negative. He denied tobacco or alcohol use, and no family history of gastrointestinal cancers. Vitals were normal. His abdomen was benign. Visualization of his oropharynx was unremarkable. Labs did not demonstrate leukocytosis or anemia. Imaging revealed one radiopaque body in the esophagus at T1 level and one in the rectum. Endoscopic removal of the object was delayed until day 6 given patient’s initial refusal. A 20mm button battery was found in the esophagus and removed with a roth net (Figure panel 1). Mild localized mucosal necrosis was noted underlying the object (Figure panel 2). He tolerated oral intake later that evening. Discussion: The management of foreign bodies is a challenge due to technical difficulties of endoscopic retrieval and unpredictable outcomes. As seen in this case, the excessive duration of time post button battery ingestion did not correlate to severity and complications expected. Despite its larger diameter of 20 mm, the button battery only caused mild mucosal necrosis. This case demonstrates that esophageal dwell time alone is not an independent risk factor and may not correlate with severity of injury. There are risks associated with performing emergent endoscopic procedures including availability of staff, abbreviated time for full preoperative evaluation, and logistic challenges. It is important to identify when procedures can be performed under controlled circumstances. Our case contributes to the fund of knowledge regarding delayed endoscopic foreign body removal of a button battery but should not be used to guide current management without additional data.Figure 1.: 1: Identification of a 20mm button battery in the upper esophagus. 2: Mild localized necrosis of the esophageal mucosa directly underlying the object.

P.62 Increased skeletal muscle extracellular volume fraction in patients with Becker muscular dystrophy assessed by quantitative magnetic resonance imaging

Quantitative magnetic resonance imaging (MRI) is increasingly proposed in clinical trials related to dystrophinopathies, including Becker muscular dystrophy (BMD). Extracellular volume fraction (ECV) is a candidate variable to characterize muscle tissues microstructure. Previous studies have demonstrated that the myocardium of BMD patients presented increased ECV. Given that cardiac muscle shares important structural features with skeletal muscles, we hypothesize that ECV could also be a sensitive biomarker to monitor pathological alterations of the skeletal muscle structure in BMD patients. We established the sensitivity of ECV quantification using magnetic resonance fingerprinting with water and fat separation (MRF T1-FF) as an imaging biomarker of skeletal muscle tissue alterations in BMD, by comparison with fat fraction (FF) and water relaxation time quantification. Data from the thighs of 28 BMD patients and 8 healthy volunteers were acquired. The MRI exam comprised FF mapping, water T2 mapping and water T1 mapping before and after an intravenous injection of a gadolinium-based contrast agent using MRF T1-FF from which ECV was calculated. Mann-Whitney tests, Kruskal-Wallis tests, ROC curves analysis and Spearman-rank correlation tests were performed. ECV was higher in dystrophic patients than in controls (0.20 [0.16 – 0.28] vs 0.07 [0.06 – 0.07], p<.001). In muscles of BMD patients with normal FF, ECV was also higher than in muscles of healthy controls (0.11 [0.10 – 0.13] vs 0.07 [0.06 – 0.09], p<.001). ECV classified dystrophic muscles with high sensitivity and specificity (AUC, 0.98; 95%CI: 0.96-0.99, p <.001), and correlated significantly with FF (ρ = .62, p < .001), water T2 (ρ = .56, p = .002), Walton score (ρ = .58, p = .001) and serum cardiac troponin-T level (ρ = .63, p < .001). In conclusion, muscle ECV measured with MRF represents a promising imaging biomarker for the early detection of skeletal muscle involvement in patients with Becker muscular dystrophy.

Tunable Optical Molecular Thermometers Based on Metallacrowns.

The effect of ligands' energy levels on thermal dependence of lanthanide emission was examined to create new molecular nanothermometers. A series of Ln2Ga8L8'L8″ metallacrowns (shorthand Ln2L8'), where Ln = Gd3+, Tb3+, or Sm3+ (H3L' = salicylhydroxamic acid (H3shi), 5-methylsalicylhydroxamic acid (H3mshi), 5-methoxysalicylhydroxamic acid (H3moshi), and 3-hydroxy-2-naphthohydroxamic acid (H3nha)) and H2L″ = isophthalic acid (H2iph), was synthesized and characterized. Within the series, ligand-centered singlet state (S1) energy levels ranged from 23,300 to 27,800 cm-1, while triplet (T1) energy levels ranged from 18,150 to 21,980 cm-1. We demonstrated that the difference between T1 levels and relevant energies of the excited 4G5/2 level of Sm3+ (17,800 cm-1) and 5D4 level of Tb3+ (20,400 cm-1) is the major parameter controlling thermal dependence of the emission intensity via the back energy transfer mechanism. However, when the energy difference between S1 and T1 levels is small (below 3760 cm-1), the S1 → T1 intersystem crossing (and its reverse, S1 ← T1) mechanism contributes to the thermal behavior of metallacrowns. Both mechanisms affect Ln3+-centered room-temperature quantum yields with values ranging from 2.07(6)% to 31.2(2)% for Tb2L8' and from 0.0267(7)% to 2.27(5)% for Sm2L8'. The maximal thermal dependence varies over a wide thermal range (ca. 150-350 K) based on energy gaps between relevant ligand-based and lanthanide-based electronic states. By mixing Tb2moshi8' with Sm2moshi8' in a 1:1 ratio, an optical thermometer with a relative thermal sensitivity larger than 3%/K at 225 K was created. Other temperature ranges are also accessible with this approach.

Trehalose–Carnosine Prevents the Effects of Spinal Cord Injury Through Regulating Acute Inflammation and Zinc(II) Ion Homeostasis

Spinal cord injury (SCI) leads to long-term and permanent motor dysfunctions, and nervous system abnormalities. Injury to the spinal cord triggers a signaling cascade that results in activation of the inflammatory cascade, apoptosis, and Zn(II) ion homeostasis. Trehalose (Tre), a nonreducing disaccharide, and l-carnosine (Car), (β-alanyl-l-histidine), one of the endogenous histidine dipeptides have been recognized to suppress early inflammatory effects, oxidative stress and to possess neuroprotective effects. We report on the effects of the conjugation of Tre with Car (Tre–car) in reducing inflammation in in vitro and in vivo models. The in vitro study was performed using rat pheochromocytoma cells (PC12 cell line). After 24 h, Tre–car, Car, Tre, and Tre + Car mixture treatments, cells were collected and used to investigate Zn2+ homeostasis. The in vivo model of SCI was induced by extradural compression of the spinal cord at the T6–T8 levels. After treatments with Tre, Car and Tre–Car conjugate 1 and 6 h after SCI, spinal cord tissue was collected for analysis. In vitro results demonstrated the ionophore effect and chelating features of l-carnosine and its conjugate. In vivo, the Tre–car conjugate treatment counteracted the activation of the early inflammatory cascade, oxidative stress and apoptosis after SCI. The Tre–car conjugate stimulated neurotrophic factors release, and influenced Zn2+ homeostasis. We demonstrated that Tre–car, Tre and Car treatments improved tissue recovery after SCI. Tre–car decreased proinflammatory, oxidative stress mediators release, upregulated neurotrophic factors and restored Zn2+ homeostasis, suggesting that Tre–car may represent a promising therapeutic agent for counteracting the consequences of SCI.

Measurement of hair thyroid and steroid hormone concentrations in the rat evidence endocrine disrupting potential of a low dose mixture of polycyclic aromatic hydrocarbons

Polycyclic aromatic hydrocarbons (PAHs) have been shown to influence endogenous hormones levels in animal models, but little is known about the effects of their mixtures. For hormone measurements, hair analysis is a promising approach to provide information on long-term status of hormones. Herein we used hair analysis to assess the combined effects of 13 PAHs on steroid and thyroid hormones levels in a rat model. The PAH mixture was administered orally three times per week to female rats at doses of 0, 10, 20, 40, 80, 200, 400 and 800 μg/kg of body weight for each compound over a 90-day exposure period. Fourteen out of 36 analyzed hormones were detected in rat hair, including pregnenolone (P5), 17α-hydroxyprogesterone (17-OHP4), corticosterone (CORT), dehydroepiandrosterone (DHEA), androstenedione (AD), 3,3′-diiodo-L-thyronine (T2), 3,3′,5-triiodo-L-thyronine (T3), and 3,5,3′,5′-triiodo-L-thyronine (T4). The PAH mixture significantly elevated P5 and DHEA levels at the doses of 200 and 400 μg/kg but reduced T2 and T3 levels at the highest dose as compared to the control. While P5, DHEA, 17-OHP4 and AD concentrations exhibited inverted U-shaped dose responses, T2, T3 and T4 concentrations exhibited inverse linear dose responses, which are further confirmed by their relationships with hair hydroxylated PAHs (OH-PAHs) concentrations. Likewise, there were significant nonmonotonic relationships of hormone molar ratios (e.g., AD/17-OHP4 and DHEA/CORT ratios) with exposure intensity and OH-PAHs. Overall, our results demonstrate the capability of PAH mixtures to interfere with steroid and thyroid hormones in female rats.

Multiple Clay Shoveler's Fractures of the Thoracic Spine.

Typically, a clay shoveler’s fracture is a stress-type avulsion fracture involving the spinous processes of the lower cervical or upper thoracic vertebrae. Even though C7 and T1 are the most commonly involved spinal levels, these avulsion fractures can occur at any lower cervical or upper thoracic level, either as solitary or multiple fractures. This fracture used to be common in workers who shovel heavy loads of clay for long periods, hence its name. It does not cause any structural, functional, or neurological impairments and is therefore considered a stable fracture. Management is mostly conservative, involving rest, analgesics, and activity modification for a period of 4–6 weeks. Here, we present a 35-year-old male who sustained a motor vehicle accident. Except for midline tenderness in the back, there were no other positive findings. Plain radiographs showed a T11 vertebral compression fracture and absent or deviated spinous process shadows for most of the upper thoracic vertebrae. Computed tomography (CT) imaging clearly revealed multiple spinous process fractures extending from T2 to T8 levels. Considering the stability of these fractures, the patient was managed conservatively with rest, bracing, and analgesics. The recovery was quick, and he was back to his full functional status by six weeks.

Phrenic-to-intercostal reflex activity in response to high frequency spinal cord stimulation (HF-SCS)

ObjectiveHF-SCS is a novel technique of inspiratory muscle activation which results in coincident activation of the diaphragm and inspiratory intercostal muscles via spinal cord pathways and has the potential to provide respiratory support in ventilator dependent persons with spinal cord injury. The purpose of the present study was to examine the phrenic-to-intercostal reflex during HF-SCS. MethodsIn 5 anesthetized and C2 spinalized dogs, electrical stimulation was applied via a stimulating electrode located on the ventral surface of the upper thoracic spinal cord at the T2 level. Fine wire recording electrodes were used to assess single motor unit (SMU) activity of the left and right external intercostal muscles (EI) in the 3rd interspace before and after sequential left and right phrenicotomy. ResultsMean control peak firing frequency of the right EI and left EI was 11.4 ± 0.3 Hz and 10.6 ± 0.3 Hz respectively. Following unilateral right phrenic nerve section, mean SMU peak firing frequency of right EI (ipsilateral to the section) was significantly greater when compared to control (15.9 ± 0.5 Hz vs 11.4 ± 0.3 Hz; p = 0.01). Mean SMU peak firing frequency of the contralateral left EI remained unchanged (10.2 ± 0.3 Hz vs 10.6 ± 0.3 Hz, p = 0.40). Subsequent, section of the left phrenic nerve resulted in significantly higher mean SMU peak firing frequency of the left EI (16.2 ± 0.5 Hz vs 10.2 ± 0.3 Hz) when compared to before section p = 0.01). Contralateral, right EI peak firing frequency was not different if compared to before left phrenic nerve section (16.9 ± 0.4 Hz vs. 15.9 ± 0.5 Hz; p = 0.14). ConclusionThis study demonstrates that during HF-SCS: 1) unilateral diaphragmatic afferents reflexly inhibit motor activity to the ipsilateral EI muscles, 2) the neural circuitry mediating the phrenic-to-intercostal reflex is preserved at a spinal level and does not require supraspinal input and 3) unilateral compensatory increases were observed in EI muscle activation following ipsilateral diaphragm paralysis.

Acute Transverse Myelitis after Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case Report

Herpes zoster is caused by reactivated varicella-zoster virus (VZV) and characterized by a painful skin rash with vesicles that affects the adjacent dermatomes. Transverse myelitis is a rare complication of VZV infection that may even occur in immunocompetent patients. Here, we report a 60-year-old male patient admitted with right lower-extremity weakness and hypesthesia. Spine magnetic resonance imaging (MRI) revealed transverse myelitis at the C3–C4 and T6 levels. A month prior to admission, the patient was diagnosed with herpes zoster involving the right T2-T4 dermatome. Considering his history of VZV infection, he was treated with intravenous steroids and acyclovir. Eleven days after hospitalization, paraplegia developed to Medical Research Council grade 0/5 despite performing plasmapheresis. MRI confirmed the aggravation of the cord lesion between T4 and T7. Acute transverse myelitis after VZV infection is a rare disease that can cause serious sequelae in immunocompetent patients. Therefore, clinicians should be cautious of this situation.

Perioperative analgesic efficacy and safety of erector spinae plane block in posterior cervical spine surgery: a double-blinded, randomized controlled study

<h3>BACKGROUND CONTEXT</h3> Posterior cervical spine surgeries (PCSS) are typically open surgeries and entail significant postoperative pain. Current perioperative pain management in PCSS is reliant on multimodal analgesia. While perioperative epidural anesthetic infusion can be used in lumbar surgeries, this is not an option in the cervical spine. Pre-emptive regional analgesia through erector spinae plane block (ESPB) has shown significant perioperative analgesic benefits in lumbar spine surgeries. There are no such clinical studies in PCSS. <h3>PURPOSE</h3> To assess the safety and efficacy of ultrasound-guided ESPB for perioperative analgesia in PCSS. <h3>STUDY DESIGN</h3> Prospective, randomized controlled, double-blinded study. <h3>PATIENT SAMPLE</h3> This study included 86 patients requiring sub-axial PCSS with or without instrumentation randomized into two groups, those who underwent ESPB with multimodal analgesia (case) and those with only multimodal analgesia (control). <h3>OUTCOME MEASURES</h3> Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization and complications were recorded. <h3>METHODS</h3> After anesthesia and prone position, case patients received ultrasound-guided ESPB at the T1 level using 15ml of 0.25% bupivacaine and 8mg dexamethasone bilaterally while the control patients received only standard postoperative multimodal analgesia. <h3>RESULTS</h3> Each group included 43 patients; the two groups were identical in demographic and surgical profile. The intraoperative opioid consumption (119.53±40.35 vs 308.6±189.78; p<0.001) in mcg), muscle relaxant usage (50.00±0.00 mg vs 59.53±3.75 mg, p<0.001), surgical duration (124.77±26.63/ 156.74±37.01 mins; p<0.01) and intraoperative blood loss (310.47±130.73 ml vs 429.77±148.50 ml; p<0.05) were significantly less in the ESPB group. In the postoperative period, the control group's pain score was significantly higher (p<0.001). The Modified Observer Alertness/Sedation Score (MOASS) score and satisfaction scores also showed significant differences between the case and control groups (p<0.001). The mean time required to ambulate (sitting/walking) was statistically less in cases (15.81±6.15/20.72±4.02 hours) when compared to controls (16.86±6.18/ 23.05±8.88 hours) (p<0.001). <h3>CONCLUSION</h3> In patients undergoing PCSS, ESPB is a safe and effective technique with better outcomes than standard multi-modal analgesia alone, in terms of reduced intraoperative opioid requirements and blood loss, better postoperative analgesia and early mobilization. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

The effect of opioid-sparing anesthesia regimen on short-term cognitive function after thoracoscopic surgery: a prospective cohort study

BackgroundAs type of surgery and opioids are suggested risk factors for the development of cognitive decline after surgery, we evaluated the effect of an opioid-sparing anesthesia regimen involving preoperative erector spinae block and continuous infusion of flurbiprofen on the incidence of cognitive decline after video-assisted thoracoscopic surgery.MethodsIn this observational study, patients over 18 years old presenting for elective video-assisted thoracoscopic surgery were divided into two groups, the erector spinae plane block group (ESPB group, who received preoperative single shot of bi-level ESPB at T4 and T6 levels) and the control group who received intercostal nerve blocks through T5 to T7 intercostal spaces along mid-axillary line after surgery. Continuous infusion of flurbiprofen (8 mg/h) and intravenous oxycodone rescue (1 mg/bolus, lockout time 10 minutes) were provided as postoperative analgesics. Cognitive function was measured one day before and 48 h after surgery with brief Cogstate computerized battery (CCB).ResultsThere were 60 patients included with 30 in each group. Perioperative sufentanil dose was significantly reduced in ESPB group. Nine (30%) and 15 (50%) patients had delayed neurocognitive recovery in the ESPB group and the control group respectively. Psychomotor speed and visual attention tests were the two tests that patients showed cognitive decline. The results of multivariate regression revealed that patients who were more than 53.5 years of age (OR 9.213, 95% CI 1.789, 47.437, P = 0.008) and low levels of education (less than 9 years of complimentary education) (OR 6.829, 95% CI 1.068, 43.677, P = 0.042) were independent risk factors for postoperative delayed neurocognitive recovery. For subgroup analysis, ESPB could reduce the occurrence of delayed neurocognitive recovery in patients with both risk factors (6/10 (60%) vs. 11/11 (100%), P = 0.004) compared to the control group.ConclusionsMiddle-aged people and low levels of education are independent risk factors for delayed neurocognitive recovery after thoracoscopic surgery. ESPB has the potential to prevent cognitive decline in high-risk patients.Trial registrationChiCTR1800014508 (www.chictr.org.cn, January 17, 2018; Hong Zhao, M.D.). URL: http://www.chictr.org.cn/showproj.aspx?proj=24778. The date of the enrolment of the first participant to the trial was January 22, 2018.

Cardiac Assessment in Children with MIS-C: Late Magnetic Resonance Imaging Features.

Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2–4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2–6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients’ MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2–6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.

Luminescence chronology of the Sankosh river terraces in the Assam- Bhutan foothills of the Himalayas: Implications to climate and tectonics

Himalaya is an active fold and thrust belt formed due to continent-continent collision between the Eurasian and Indian plates. It comprises a 3000 km long chain of mountains that span ∼1000 km across, with major boundary thrusts viz., Main Central Thrust (MCT), Main Boundary Thrust (MBT) and the Main Frontal Thrust (MFT). MFT is marked as mountain front and is the most active thrust; however, evidence of tectonic activity along MCT and MBT also exists. Tectonic activity along MFT created uplifted terraces which now serve as geomorphic archives of past tectonic events. The present study focussed on a glacial-fed river Sankosh that originates in northern Bhutan, and crosses MCT, MBT and MFT before joining the Brahmaputra River in Assam. Due to tectonic uplift, the river shows a deflection at MFT, incising and thus forming four levels of strath terraces. Luminescence chronology, geomorphic studies and analysis of satellite images suggest four levels of terraces T4 (highest level, 195 m asl), T3, T2 and T1 (lowest level, 120 m asl). The quartz was found insensitive for luminescence dating, and thus fading corrected Infra-Red Stimulated Luminescence (IRSL) ages on feldspar minerals were measured that provided ages of 143-77 ka (T4), 65-36 ka (T2) and 35-14 ka (T1), respectively. The T3 terrace was present only on the right bank of the river and could not be accessed. These ages accord with other studies at the Chalsa and Malbazar, North Bengal (west of the study area) and this regional disposition of similar ages suggest that these formed during glacial-interglacial periods. The strath terraces indicate a time-averaged tectonic uplift with a 0.5 mm/year rate over the past 150 ka.

Effects of Muscle Energy Technique and Joint Manipulation on Pulmonary Functions, Mobility, Disease Exacerbations, and Health-Related Quality of Life in Chronic Obstructive Pulmonary Disease Patients: A Quasiexperimental Study.

Chronic obstructive pulmonary disease (COPD) is primarily a disease of the lungs; however, extrapulmonary comorbidities like rib cage stiffness, decreased thoracic spine mobility, postural changes, and skeletal muscle dysfunctions also coexist. Muscle energy technique (MET) and joint manipulation (JM) may help alleviate these musculoskeletal problems. This study was aimed at evaluating the effectiveness of MET and JM on pulmonary functions, dyspnea, chest wall mobility, disease exacerbations, and health-related quality of life in COPD patients. A total of 16 patients (7 women and 9 men) suffering from COPD between the ages of 35 and 65 years participated in the study. Pretest-posttest quasiexperimental design was used. MET was applied to the sternocleidomastoid, anterior scalene, pectoralis major muscles, and at the C4-C6 level of the cervical spine. Maitland JM was performed in the thoracic region at the intervertebral, costovertebral, and costotransverse joints. The treatment intervention lasted for 3 weeks. FEV1/FVC, maximum inspiratory pressure (MIP), SpO2, modified Borg dyspnea scale (MBDS), COPD assessment test (CAT), mMRC dyspnea scale, BODE index, right and left hemidiaphragm excursion, and chest wall expansion at T4 and T10 levels were the outcome measures. Significant improvement (p < 0.05) was observed in FEV1/FVC, MIP, SpO2, MBDS, CAT, mMRC dyspnea scale, BODE index, and chest expansion at T4 and T10 levels. Only for the hemidiaphragm excursion, no significant (p > 0.05) improvement was observed. Combined application of MET to accessory respiratory muscles and cervical spine and JM to thoracic spine improved pulmonary functions, chest wall mobility, and health-related quality of life and reduced dyspnea and disease exacerbations in patients with mild to moderate COPD.

Extradural Contralateral Ventral Root Transfer to Treat Lower Limb Motor Dysfunction in Paraplegia.

Eight cadavers were included in this anatomical study. This study aimed to confirm the anatomical feasibility of extradural transfer of the contralateral T11 ventral root (VR) to the ipsilateral L2 level and the contralateral L1 VR to the ipsilateral L3 level to restore lower limb function in cases of paraplegia. Motor dysfunction due to hemiplegia significantly affects the daily life of patients. To date, unlike in cases of upper limb dysfunction, there are few studies on the surgical management of lower limb movement dysfunction. Eight cadavers were included in this study to confirm the feasibility of the nerve transfer. After separating the VR and dorsal root at each level, the VRs at the T11 and L1 levels were anastomosed with the VRs of L2 and L3, respectively. The length of the VRs of donor roots and the distance between the donor and recipient nerves were measured. H&E staining was performed to verify the number of axons and the cross-sectional area of the VRs. Lumbar x-rays of 60 healthy adults were used to measure the distance between the donor and recipient nerves. After exposing the bilateral extradural each root, the VRs could be easily isolated from the whole root. The distance between the VRs of T11 and L2, L1, and L3 was significantly longer than the length of the donor nerve. Therefore, the sural nerve was used for grafting. The measurements performed on the lumbar x-rays of the 60 healthy adults confirmed the results. The number of axons and cross-sectional area of the VRs were measured. Our study confirmed the anatomical feasibility of transferring the VRs of T11 to L2 and that of L1 to L3 to restore lower limb function in cases of hemiplegia. 5.

How does tree mortality caused by bark beetle (Trypophloeus klimeschi) outbreaks affect changes in soil fungal communities?

Forest disturbances such as fires, windthrows, and insect outbreaks have a serious influence on how these ecosystems function. In recent years, an outbreak of an endemic bark beetle species (Trypophloeus klimeschi Eggers) has caused a major disturbance in the Populus alba var. pyramidalis northwest shelter forest in China. The rapid and widespread death of P. alba var. pyramidalis caused by this beetle has cascading effects on the soil properties and fungal communities’ diversity that remain uncertain. We evaluated the mortality of P. alba var. pyramidalis forest attacked by T. klimeschi in this area and set four different levels of tree mortality: T1 level (0–10%), T2 level (11–40%), T3 level (41–70%) and T4 level (71–100%). We simultaneously measured rhizosphere soil properties and fungal community composition (using high-throughput sequencing) at different tree mortality levels. The increase in tree mortality resulted in a steep increase in the soil concentrations of ammonium nitrogen (NH4+), nitrate nitrogen (NO3–) and available phosphorus, as well as a reduction in soil pH. Meanwhile, the fungal communities showed profound changes, the relative abundance of ectomycorrhizal fungi decreased significantly by 71%, and the relative abundance of pathogenic fungi increased significantly by 73%. The combined effects of the changes in the soil fungal communities’ composition and available nitrogen content resulted in a significant 26% reduction in the richness of soil fungi. Our findings suggest that the mortality of poplar species due to the rapid range expansion of T. klimeschi will have significant impacts on crucial soil fungal communities, which may have sustained and potentially important implications for the future restoration of forest ecology in this area. The composition and changes of soil fungal communities should be considered in the subsequent forest ecological restoration process in this area.

Utility of Noncancerous Chest CT Features for Predicting Overall Survival and Noncancer Death in Patients With Stage I Lung Cancer Treated With Stereotactic Body Radiotherapy.

BACKGROUND. Noncancerous imaging markers can be readily derived from pre-treatment diagnostic and radiotherapy planning chest CT examinations. OBJECTIVE. The purpose of this article was to explore the ability of noncancerous features on chest CT to predict overall survival (OS) and noncancer-related death in patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT). METHODS. This retrospective study included 282 patients (168 female, 114 male; median age, 75 years) with stage I lung cancer treated with SBRT between January 2009 and June 2017. Pretreatment chest CT was used to quantify coronary artery calcium (CAC) score, pulmonary artery (PA)-to-aorta ratio, emphysema, and body composition in terms of the cross-sectional area and attenuation of skeletal muscle and subcutaneous adipose tissue at the T5, T8, and T10 vertebral levels. Associations of clinical and imaging features with OS were quantified using a multivariable Cox proportional hazards (PH) model. Penalized multivariable Cox PH models to predict OS were constructed using clinical features only and using both clinical and imaging features. The models' discriminatory ability was assessed by constructing time-varying ROC curves and computing AUC at prespecified times. RESULTS. After a median OS of 60.8 months (95% CI, 55.8-68.0), 148 (52.5%) patients had died, including 83 (56.1%) with noncancer deaths. Higher CAC score (11-399: hazard ratio [HR], 1.83 [95% CI, 1.15-2.91], p = .01; ≥ 400: HR, 1.63 [95% CI, 1.01-2.63], p = .04), higher PA-to-aorta ratio (HR, 1.33 [95% CI, 1.16-1.52], p < .001, per 0.1-unit increase), and lower thoracic skeletal muscle index (HR, 0.88 [95% CI, 0.79-0.98], p = .02, per 10-cm2/m2 increase) were independently associated with shorter OS. Discriminatory ability for 5-year OS was greater for the model including clinical and imaging features than for the model including clinical features only (AUC, 0.75 [95% CI, 0.68-0.83] vs 0.61 [95% CI, 0.53-0.70]; p < .01). The model's most important clinical or imaging feature according to mean standardized regression coefficients was the PA-to-aorta ratio. CONCLUSION. In patients undergoing SBRT for stage I lung cancer, higher CAC score, higher PA-to-aorta ratio, and lower thoracic skeletal muscle index independently predicted worse OS. CLINICAL IMPACT. Noncancerous imaging features on chest CT performed before SBRT improve survival prediction compared with clinical features alone.

Neuroorthopedic approach to treating a patient with schwannoma and aggressive hemangioma at a single spinal motion segment: a case study

A clinical case of surgical treatment of a female patient with dumbbell schwannoma growing from the T4 nerve root and aggressive hemangioma of the T4 vertebral body and arch is presented. The open kyphoplasty through posterior approach was performed and followed by T4 laminectomy, costotransversectomy at the T4–T5 level on the left, total microsurgical resection of the tumor through right extrapleural approach, and transpedicular fixation of the T3–T5 vertebrae. There were no postoperative complications. The control computer tomography confirmed the complete removal of the tumor and the spine stability at the level of surgery.

The effect of nitrogen fertilisation on yield and quality of maize (Zea mays L.)

Abstract Nitrogen (N) is one of the most essential nutrients affecting the yield and quality of maize (Zea mays L.). A field experiment was conducted at the experimental plot of the Department of Agronomy, The Hungarian University of Agriculture and Life Sciences, Hungary, to investigate the effect of nitrogen fertilisation on the yield and quality of maize. The experimental site included four observation plots with a net of 2 × 5 m size. Four N levels of T1, T2, T3, and T4 were sprayed at indicated plants in four replications according to treatment viz. 0, 50, 100, and 150 kg N ha−1. Nitrogen application in general does not significantly affect maize yield, its components, or grain quality. However, out of the four N treatments, the optimal N application between 50–100 kg N ha−1 potentially increased the yield, also the total expression of protein and starch contents in maize can be achieved with the right amount of N fertiliser, indicating that the treatment could produce a high grain yield as well as high protein and starch contents. Good N fertilising practice will boost the maize's nutritional value and make it more significant in the agriculture in the future. In addition, more research and assessment are essential to acquire the most benefit from the effect of optimal N application on maize yield and quality, and the findings could be beneficial to researchers and growers.