Cavity Wall Thickness Research Articles

Significance of changes in cavity after treatment in Mycobacterium avium complex pulmonary disease

Cavities are characteristic radiological features related to increased mycobacterial burden and poor prognosis in Mycobacterium avium complex pulmonary disease (MAC-PD). However, cavity changes following treatment and their clinical implications remain unknown. We aimed to elucidate whether cavity obliteration or reduction in cavity size or wall thickness correlates with microbiological cure. In total, 136 adult patients with cavitary MAC-PD treated for ≥ 6 months between January 1st, 2009, and December 31st, 2021, in a tertiary referral centre in South Korea were enrolled. The cavity with the largest diameter at treatment initiation was tracked for size and thickness changes. Following median treatment of 20.0 months, 74 (54.4%) patients achieved microbiological cure. Cavity obliteration, achieved in 58 (42.6%) patients at treatment completion, was independently associated with microbiological cure. In patients with persistent cavities, size reduction of ≥ 10% was significantly associated with microbiological cure, whereas thickness reduction was not. Five-year mortality rates in patients with cavity obliteration, persistent but reduced cavity, and persistent cavity without shrinkage were 95.6%, 72.1%, and 65.3%, respectively (P < 0.001). In conclusion, cavity obliteration or shrinkage at treatment completion is associated with microbiological cure and reduced mortality in MAC-PD, suggesting that cavity changes could serve as a proxy indicator for treatment response.

Correlation between Gene polymorphism levels of serum matrix metalloproteinases with cavitary features and pulmonary fibrosis of the Patient tuberculosis multi-drug resistance using high-resolution computerized tomography of the Thorax

Matrix metalloproteinases (MMPs) are proteins that play a role in the inflammatory and remodeling processes caused by infections, including pulmonary tuberculosis (TB), especially multidrug resistance. This study aims to investigate the relationship between variations in MMP-1 and MMP-9 blood levels, cavity features such as number, diameter, and wall thickness, and the location of fibrosis in multidrug-resistant (MDR) and drug-sensitive (DS) tuberculosis patients. This study used a comparative cross-sectional study design. The subjects, who were outpatients at Abdoel Moelok Hospital, Lampung, Indonesia, had passed the ethical test. We divided the subjects into two groups: 34 in the MDR-TB group and 36 in the DS-TB group. An ELISA test determined the levels of MMP-1 and MMP-9, while the PCR-sequencing method determined the genotypes of MMP-1 and MMP-9. Additionally, we measured cavities and fibrosis using thoracic high-resolution computerized tomography (HRCT) imaging. In MDR-TB patients, there was a significant difference in the number of cavities larger than 6.6 mm in diameter, as well as cavity thickness, compared to DS-TB patients. The distribution of fibrosis in lung segments was also significantly different in MDR-TB compared to DS-TB. Although MMP-9 levels in the MDR-TB group were higher than in the DS-TB group, there was no statistically significant difference. Based on HRCT measurements, this study found a link between MDR-TB and DS-TB in terms of the number of cavities, the diameter of the cavities, the thickness of the cavity walls, and the location of fibrosis in the affected lung segments. There was no link between the MMP-1 (−1607G) and MMP-9 (C1562T) genotypes and the levels of MMP-1 and MMP-9 in the blood. The MMP-1 genotype in the two study groups was very different and was linked to twice as many cases of MDR-TB. In addition, there was a substantial difference in cavity wall thickness between the G/G MMP-1 1607 genotype and the T/T MMP-9 genotype in the two study groups.

Building a model for the differential diagnosis of non-tuberculous mycobacterial lung disease and pulmonary tuberculosis: A case-control study based on immunological and radiological features

BackgroundAlthough the incidence of non-tuberculous mycobacterial pulmonary disease (NTM-PD) is increasing annually, it is easily misdiagnosed as pulmonary tuberculosis (PTB). This study aimed to screen and identify the immunological and radiological characteristics that differentiate NTM-PD from PTB and to construct a discriminatory diagnostic model for NTM-PD, providing new tools for its differential diagnosis. MethodsHospitalised patients diagnosed with NTM-PD or PTB between January 2019 and June 2023 were included in the study. Immunological and radiological characteristics were compared between the two groups. Based on the selected differential features, a logistic regression algorithm was used to construct a discriminatory diagnostic model for NTM-PD, and its diagnostic performance was preliminarily analysed. ResultsPatients with NTM-PD were significantly older than those with PTB and the tuberculosis-specific interferon-gamma release assay (TB-IGRA) positivity rate was significantly lower in the NTM-PD group. Moreover, the absolute counts of total T lymphocytes, CD4+ T lymphocytes, CD8+ T lymphocytes, NK cells, and B lymphocytes were significantly lower in patients with NTM-PD and PTB than in healthy controls. Additionally, patients with NTM-PD had a significantly lower absolute count of B lymphocytes than the PTB group. Radiological analysis revealed significant differences between patients with NTM-PD and PTB in terms of cavity wall thickness, bronchial dilation, lung consolidation, pulmonary nodule size, pulmonary emphysema, lung bullae, lymph node calcification, pleural effusion, mediastinal and hilar lymphadenopathy, and the tree-in-bud sign. Bronchial dilation was identified as the predominant risk factor of NTM-PD, whereas TB-IGRA positivity, lymph node calcification, pleural effusion, and mediastinal and hilar lymphadenopathies were protective factors. Based on this, we constructed a discriminatory diagnostic model for NTM-PD. Its receiver operating characteristic curve demonstrated good diagnostic performance, with an area under the curve of 0.938. At the maximum Youden index of 0.746, the sensitivity and specificity were 0.835 and 0.911, respectively. ConclusionsPatients with NTM-PD and PTB exhibited impaired humoral and cellular immune functions as well as significant differences in radiological features. The constructed NTM-PD diagnostic model demonstrated good diagnostic performance. This study provides a new tool for the differential diagnosis of NTM-PD.

Numerical Investigation of Conjugate Natural Convection From a Vertical Cylindrical Open Cavity

AbstractAn extensive numerical analysis is performed on a vertical cylindrical open cavity made of aluminum with varying thicknesses to study conjugate natural convection. The key purpose of this study is to evaluate the effect of cylinder wall thickness on natural convection at the outer wall of the cylinder, which is coupled to the inner cylinder wall that has a constant temperature of 450 K and the ambient air which temperature is 300 K. The Navier–Stokes equations, continuity equation, and energy equations are solved numerically. The finite volume method is applied in the computational domain that includes the vertical cylindrical open cavity by using ansys-fluent 18 to specify the properties of flow and exchange of thermal energy. A couple of pertinent parameters are used for the numerical investigation like Rayleigh number within laminar regime (within range 104–108), aspect ratio (undefined proportion of length to diameter of the cylinder (L/D)) of the vertical cylindrical open cavity (2, 4, 6, 8, 10), and cylinder wall thickness (0, 1, 2, 3, 4 mm). This study presents the velocity vector field and thermal plume contours. An approximate Nusselt number to Rayleigh number equation is developed for the vertical cylindrical cavity within the range of Rayleigh numbers addressed by this work.

Design and research of soft-body cavity-type detonation drivers

According to the high-energy-density movement characteristics of animals during jumping, soft-body cavity-type detonation driver that combines the explosive chemical reaction mechanism of hydrogen and oxygen is designed, in order to control the robot in jump to achieve output optimization. Then, combined with the theoretical values of the detonation dynamic equation and experimental data for the performance parameters, the influences of the mixing ratio of hydrogen (H2) and oxygen (O2), the volume of mixed hydrogen and oxygen in the cavity, and the shape, wall thickness, and area ratio value of the soft-body cavity on the output performance of the detonation driver are analyzed. When gas volume is 20:10mL, the jump height reaches 2.5m. In addition, the upper and lower area ratio of cavity is optimized to 2:1, improving the output performance by 21.6% on average. Therefore, the above research results provide reference for the driver structure design of jumping robot.

On the fracture behavior of molar teeth with MOD cavity preparation

Mesial-occlusal-distal (MOD) cavity preparations are commonly used to restore damaged teeth. While numerous in vitro cavity designs have been devised and tested, no analytical frameworks for assessing their resistance to fracture seem to exist. This concern is addressed here by resorting to a 2D slice specimen cut from restored molar teeth with rectangular-base MOD cavity. The evolution of damage due to axial cylindrical indentation is followed in situ. The failure begins with a rapid debonding along the tooth/filler interface and continues with unstable cracking from the cavity corner. The debonding load qd is fairly fixed while the failure load qf is insensitive to the presence of filler, increasing with cavity wall thickness h and reducing with cavity depth D. The growth of the corner crack is studied using a 2D fracture analysis in conjunction with the FEM technique. The ratio h = h/D emerges as a viable system parameter. A simple expression for qf given in terms of h and dentin toughness KC is developed that predicts well the test data. In vitro studies on full-fledged molar teeth with MOD cavity preparation show that the fracture resistance of filled cavities often exceeds by a large margin that of unfilled ones. Indications are that this may reflect load sharing with the filler. Thus, the fracture resistance of the unfilled cavity provides a lower bound to a compromised MOD filling after long-term aging in the mouth. This bound is well predicted by the slice model. Finally, it is recommended that MOD cavities be prepared, if applicable, such that h > D regardless of the tooth size.

Chronic cavitary pulmonary aspergillosis: Serial clinical and CT findings correlated with antifungal treatment and patient response.

Chronic cavitary pulmonary aspergillosis (CCPA) is the most common form of chronic pulmonary aspergillosis. We hypothesise that by observing serial clinical and CT findings of CCPA patients with antifungal therapy, factors helping predict responses to antifungal therapy could be withdrawn. A total of 31 patients with CCPA who received antifungal therapy for greater than six months and who had serial CT studies were included. Clinical finding analyses were performed at initial and last follow-up CT acquisition dates. Clinical characteristics and CT features were compared between clinically improving or stable and deteriorating groups. With antifungal therapy, neutrophil-to-lymphocyte ratio (2.66 vs. 5.12, p= .038) and serum albumin (4.40 vs. 3.85 g/dl, p= .013) and CRP (1.10 vs. 42.80 mg/L, p= .007) were different between two groups. With antifungal therapy, meaningful CT change, regardless of clinical response grouping, was decrease in cavity wall thickness (from 13.70 mm to 8.28 mm, p< .001). But baseline (p= .668) and follow-up (p= .278) cavity wall thickness was not different between two groups. In univariate analysis, initial maximum diameter of cavity (p= .028; HR [0.983], 95% CI [0.967-0.998]) and concurrent NTM infection (p= .030; HR [0.20], 95% CI [0.05-0.86]) were related factors for poor clinical response. With antifungal therapy, cavities demonstrate wall thinning. Of all clinical and radiological findings and their changes, initial large cavity size and concurrent presence of NTM infection are related factors to poor response to antifungal therapy.

Use of advanced echocardiographic modalities to discriminate preclinical HCM mutation carriers from non-carriers

Abstract Background It is a challenging goal to identify which family members of patients with hypertrophic cardiomyopathy (HCM) will subsequently develop HCM. Previous studies evaluating the utility of two-dimensional conventional Doppler echocardiography in HCM families with a known pathogenic variant identified on genetic testing have been unable to reliably distinguish preclinical genotype-positive, phenotype-negative (G+P−) individuals from their healthy genotype-negative, phenotype-negative (G−P−) relatives. Purpose To determine if advanced echocardiographic modalities can discriminate preclinical HCM mutation carriers (G+P−) from non-carriers (G−P−). Methods A total of 199 participants who had undergone genetic testing from HCM families with a known pathogenic variant were included in the study: 39 G−P−; 58 G+P− and 102 overt HCM patients (G+P+). Speckle tracking echocardiography (STE) and colour M-mode were performed on all participants and longitudinal, circumferential and radial strain, and torsion were compared. Results Patients with overt HCM had the highest septal, posterior wall thickness, septum/posterior wall (Sep/PW) thickness ratio and left ventricular outflow tract (LVOT) gradient and lowest global longitudinal, circumferential and radial strain, and tissue Doppler-derived myocardial systolic and diastolic velocities. Comparing G−P− and G+P− individuals, there were no significant differences in LV cavity size, wall thickness, LVOT gradient, LVEF and tissue Doppler-derived myocardial systolic and diastolic velocities. However, G+P− individuals had significantly higher peak apical rotation, peak twist and colour M-mode flow propagation velocity (Vp). Multivariate linear regression identified two independent predictors (peak apical rotation and Vp), and a regression equation (using multivariate linear regression) {Mutation carrier prediction value = (0.210×peak apical rotation) − (0.002×Vp) + 0.156; r=0.655)} was derived which allowed reliable discrimination of G+P- individuals with a sensitivity of 95.2% and specificity of 94.1% at the optimal cut-off. Conclusion In HCM family members without overt HCM, peak apical rotation and Vp provide good sensitivity and specificity for identifying mutation carriers and may be a clinically useful early marker of HCM before the onset of hypertrophy. Future longitudinal studies involving larger cohorts are required to validate these findings. Funding Acknowledgement Type of funding sources: None.

Development of 1.3 GHz Medium-β (β = 0.634) Disk-Loaded Deflecting Cavity for 150 keV Electron Beam

A miniaturized 150 kV DC photocathode gun is developed at Peking University to generate electron beam which can be manipulated in temporal and spatial distribution as requirements freely. To measure the bunch length which is an important temporal parameter of the low energy electron beam from the DC photocathode gun, a 1.3 GHz medium-β disk-loaded deflecting cavity is adopted. In this paper we present the design of the deflecting cavity which involves the microwave design including the geometry optimization and the separation of the orthogonal dipole modes as well as the power coupling, the mechanical design including the determination of the cavity wall thickness and the tuning as well as brazing structure, and the thermodynamic analysis. Particle tracking simulation shows that the best resolution of 190 fs can be achieved for the 150 keV electron beam by using the deflecting cavity. Its fabrication is completed and the RF measurements are carried out with a vector network analyzer. It is shown the measured values of the RF physical parameters are in good agreement with the simulation design ones.

Effects of Cavity Conditions on Transcription Molding of Microscale Prism Patterns Using Ultra-High-Speed Injection Molding

Abstract Ultra-high-speed injection molding has been reported to be a very effective method for improving transcription molding. In this study, by using stampers with V-grooves having pitches of 25 μm and 100 μm, we investigated the effects of cavity conditions, including cavity thickness, groove layout, and groove pitch size, on transcription molding. These experiments were also conducted under various molding conditions such as injection rates, melt and mold temperatures, and holding pressure, etc. As a result, it was found that the groove layout of a stamper remarkably affects transcription fidelity and these effects do not disappear when the molding is performed with a cavity-vacuum process. This phenomenon was explained using the well-known molecular orientation by the extensional flow during injection molding. When transcription molding was performed with cavities of different thicknesses (0.5 mm, 1.0 mm, and 2.0 mm), the effect of holding pressure on transcription was inversely related to the cavity wall thickness. This result indicates that, in the molding with a thin cavity wall, the transcription mainly completed during the filling stage. In addition to the shortening of cavity filling time and decrease in viscosity by shear heating, an accelerated increase in cavity pressure during the cavity filling stage was also found to be important for explaining the improvement in transcription with ultrahigh-speed injection molding.

IDF21-0582 Cardiac structure and function prediabetes and diabetes without heart failure: A hospital based cross-sectional study

Background: Individuals with diabetes mellitus and pre-diabetes are at particularly high risk of incident heart failure (HF) or death, even after accounting for known confounders. Prior studies have shown that individuals with diabetes have increased left ventricular (LV) wall thickness and mass, and impaired diastolic function in the absence of overt LV systolic dysfunction; the alterations in cardiac structure and function in less impaired glycemic states without prevalent cardiovascular disease are less well described. Also most previous studies have only performed limited measures of cardiac structure and function, and none have comprehensively evaluated cardiac parameters, particularly diastolic function. Aim: This study was done with the aim of studying the cardiac structure and functions in normotensive patients with prediabetes and diabetes who don’t have symptoms of heart failure. Method: The study was an analytical cross sectional study with a comparison group. The study was conducted in department of Medicine which caters to more than 11000 in patients annually out of which at least 4-5% are suffering from diabetes mellitus. We estimated number of diabetic patients as 30, prediabetics as 130 and normal patients in the comparison group were estimated to be 130. All consecutive patients who was known case of diabetes mellitus or on anti-diabetic medication are followed up regularly in out-patient (OPD) of medicine department and worked up and managed according to American diabetes association (ADA) standards of care for patients with diabetes mellitus. All patients included in the study was subjected to 2D echocardiography. An echocardiography examination, including M-mode, two dimensional (2D) and Left ventricular mass and left ventricular mass indexed to body surface area estimated by LV cavity dimension and wall thickness at end-diastole. Results: We enrolled a total of 300 study participants out of which 40 diabetics, 130 prediabetes and 130 normal individuals which were used as a comparator group for both diabetic patients and prediabetes patients. The mean age of our study participants was 54.85 ± 13.65 in diabetes, 53.72 ± 12.18 in prediabetes and 49.49 ± 11.88 in the comparator group. The diabetic patients showed significantly increased LA volume in prediabetes (38.27 ± 8.74) and diabetes patients (34.26 ±10.82) as compared to the normal (27.47 ± 8.81). The dimensions of LV interventricular septum in systole and diastole were increased in diabetic and prediabetes patients as compared to normal individuals. Similarly, the EDV was significantly higher in diabetic and prediabetes patients. The LVEF was reduced significantly in the diabetic (50.26 ±5.41) and prediabetes (52.43 ±4.69) as compared to the normal individuals. The E/A ratio was increased in diabetic patients (0.78±0.10) and prediabetics (0.84±0.09) as compared to normal individuals. LV mass was also more in the diabetic and prediabetic patients. Discussion: We demonstrated several indices of LV systolic and diastolic dysfunction were increased in both diabetes and prediabetes, LV geometry differed significantly and decrease ejection fraction, increase LV mass in prediabetes and diabetes as compared to comparator group. We have performed robust characterization of cardiac structure and function beyond ejection fraction and LV mass and looked at LA volume indices.

Noninvasive Cardiac Imaging in Formerly Preeclamptic Women for Early Detection of Subclinical Myocardial Abnormalities: A 2022 Update.

Preeclampsia is a maternal hypertensive disease, complicating 2–8% of all pregnancies. It has been linked to a 2–7-fold increased risk for the development of cardiovascular disease, including heart failure, later in life. A total of 40% of formerly preeclamptic women develop preclinical heart failure, which may further deteriorate into clinical heart failure. Noninvasive cardiac imaging could assist in the early detection of myocardial abnormalities, especially in the preclinical stage, when these changes are likely to be reversible. Moreover, imaging studies can improve our insights into the relationship between preeclampsia and heart failure and can be used for monitoring. Cardiac ultrasound is used to assess quantitative changes, including the left ventricular cavity volume and wall thickness, myocardial mass, systolic and diastolic function, and strain. Cardiac magnetic resonance imaging may be of additional diagnostic value to assess diffuse and focal fibrosis and perfusion. After preeclampsia, sustained elevated myocardial mass along with reduced myocardial circumferential and longitudinal strain and decreased diastolic function is reported. These findings are consistent with the early phases of heart failure, referred to as preclinical (asymptomatic) or B-stage heart failure. In this review, we will provide an up-to-date overview of the potential of cardiac magnetic resonance imaging and echocardiography in identifying formerly preeclamptic women who are at high risk for developing heart failure. The potential contribution to early cardiac screening of women with a history of preeclampsia and the pros and cons of these imaging modalities are outlined. Finally, recommendations for future research are presented.

Aspergilloma Morphology on Computed Tomography Angiography and its Clinical Impact in Patients of Haemoptysis

Amongst various manifestations of pulmonary aspergillosis, chronic pulmonary aspergillosis (CPA) is the most common. We conducted this study to identify different morphological forms of CPA, on computed tomography angiography (CTA), and to correlate these with clinical presentation, as well as, associated imaging features. The study design was cross-sectional, with a final sample size of 65 patients, recruited over a period of 2years from January 2017 to October 2018. Patients with past history of tuberculosis (TB), presenting with haemoptysis and found to have aspergilloma on computed tomography and lab tests were included in the study. All patients underwent CTA for evaluation of haemoptysis. Three morphological types of intracavitary aspergilloma on imaging were identified: type 1-nodular soft tissue along the cavity-wall, type-2 soft tissue density with multiple air lucencies and type-3 homogenous soft tissue opacity with air-crescent sign. Aspergilloma types were correlated with grade and duration of haemoptysis, associated imaging findings and vascularity score on CTA. Mean age of the patients was 40.97 +/- 13.69 years. As the type of aspergilloma changed from 1 to 3, there was a decrease in cavity wall thickness, peri-cavitary inflammation and vascularity. It is the type 1 and 2 aspergillomas, which caused more inflammation in the lungs, and hence recruited more abnormal vasculature. No significant correlation was found between haemoptysis severity and type of aspergilloma; type 3 aspergilloma however had longer duration of haemoptysis.In conclusion, the initial stages of formation of aspergilloma (type 1 and 2) cause more parenchymal inflammation and symptoms. The classical Monod sign is observed in the late stage of aspergilloma, since the peri-cavitary inflammation is reduced by then and thus the symptoms.

Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes.

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes.Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%—higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (−18.7 ± 1.6 vs. −20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes.Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Greater glider (Petauroides volans) den tree and hollow characteristics

Hollow-bearing trees provide essential habitat for a range of threatened Australian wildlife species. Limited data exist for the hollow choice of greater gliders (Petauroides volans). This study aimed to provide the first comprehensive overview of the dimensions and characteristics of the den trees and hollows used by greater gliders, in the context of an endangered population. Through spotlighting and stag-watching, we identified 68 greater glider hollows in 54 den trees. When compared to reference hollows, greater gliders appeared to be preferentially choosing dens based on tree species, tree diameter at breast height (DBH), hollow type, hollow height and hollow depth. The aspect, entrance diameter, and cavity wall thickness of hollows did not appear to be influencing den choice, when compared to reference hollows. Greater gliders preferred to den in blackbutt (Eucalyptus pilularis) trees with a mean DBH of 114.1 cm (±4.3 cm). Hollows were most commonly a ‘branch end’ type of hollow. Mean depth of hollows was 252 cm (±12 cm). Mean hollow height was 15.4 m (±0.4 m). While not significant, hollows had a mean minimum hollow entrance of 18.1 cm (±0.6 cm) and a mean maximum cavity wall thickness of 8.0 cm (±0.7 cm). It is likely that hollow depth contributes to temperature buffering within dens, which is important for den choice as greater gliders are highly sensitive to hot temperatures. Our findings have important conservation implications for assessing den trees, and for improving designs of nest boxes and artificial cavities.

DOES THICKNESS REALLY MATTER? DIAGNOSTIC DILEMMAS IN CAVITARY LESIONS

TOPIC: Lung Cancer TYPE: Medical Student/Resident Case Reports INTRODUCTION: A pulmonary cavity is a gas-filled space seen as a lucency within a pulmonary consolidation, a mass, or a nodule. The differential for a solitary cavity of the lung includes anaerobic lung abscess, fungal infections, tuberculosis and malignancy. Wall thickness <4 mm has been shown to be caused by benign processes while thickness >15 mm are usually malignant. We describe the case of a former smoker in whom an infection was masking a cavitary squamous cell carcinoma of the lung. CASE PRESENTATION: A 75 year-old former smoker presented to the ER with hemoptysis for 1 week. He was afebrile with BP 90/50 and HR 124. WBC count was 17.8K/L. CT Chest revealed a 9.7 cm irregular cavitary mass in the right upper lobe of the lung with thick walls measuring 29 mm and evidence of invasion into the right hilum and chest wall causing rib fractures. Exam was significant for foul-smelling breath and poor dentition with gross aspiration while lying flat. Bronchoscopy demonstrated thick purulent secretions in the RUL and advancement into RUL takeoff with the bronchoscope led directly inside the cavity, revealing thick, friable walls. BAL and endobronchial brushings were obtained. Given patient's risk factors for aspiration and imaging findings, there was concern for possible anaerobic lung abscess. BAL cultures were polymicrobial. He received antibiotics and improved. However, BAL cytology and endobronchial brushing demonstrated malignant cells. Pathology from a CT-guided biopsy of the lesion confirmed squamous cell carcinoma of the lung. DISCUSSION: Several features of our patient's clinical presentation were suggestive of anaerobic lung abscess including aspiration, poor dentition, halitosis and leukocytosis. However, primary lung cancer remains the most frequent cause of a solitary cavitary lung lesion. Squamous cell carcinoma is the most common subtype to cavitate due to tumoral necrosis, in up-to 82% of patients. Features that can raise suspicion for malignancy as an etiology of a lung cavity include thickness of cavity wall >15 mm with irregular internal contours, upper lobe location and chest wall invasion, all of which were present in our patient. Our case highlights the importance of maintaining a high index of suspicion for underlying malignancy in smokers with cavitary lesions, despite an overwhelming clinical picture of infection. CONCLUSIONS: Cavitary lung lesions with high-risk radiological features such as wall thickness>15 mm should prompt accelerated work-up for malignancy to minimize high morbidity and mortality. REFERENCE #1: Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, Brown KK, Mehta A, Husta B, Ryu JH, Sarosi GA, Franquet T, Verschakelen J, Johkoh T, Travis W, Raoof S. Cavitary Lung Diseases: A Clinical-Radiologic Algorithmic Approach. Chest. 2018 Jun;153(6):1443-1465. doi: 10.1016/j.chest.2018.02.026. Epub 2018 Mar 6. PMID: 29518379. DISCLOSURES: No relevant relationships by Roxanne GarciaOrr, source=Web Response No relevant relationships by Sumit Patel, source=Web Response No relevant relationships by Nehan Sher, source=Web Response

Neural network-based left ventricle geometry prediction from CMR images with application in biomechanics

Combining biomechanical modelling of left ventricular (LV) function and dysfunction with cardiac magnetic resonance (CMR) imaging has the potential to improve the prognosis of patient-specific cardiovascular disease risks. Biomechanical studies of LV function in three dimensions usually rely on a computerized representation of the LV geometry based on finite element discretization, which is essential for numerically simulating in vivo cardiac dynamics. Detailed knowledge of the LV geometry is also relevant for various other clinical applications, such as assessing the LV cavity volume and wall thickness. Accurately and automatically reconstructing personalized LV geometries from conventional CMR images with minimal manual intervention is still a challenging task, which is a pre-requisite for any subsequent automated biomechanical analysis. We propose a deep learning-based automatic pipeline for predicting the three-dimensional LV geometry directly from routinely-available CMR cine images, without the need to manually annotate the ventricular wall. Our framework takes advantage of a low-dimensional representation of the high-dimensional LV geometry based on principal component analysis. We analyze how the inference of myocardial passive stiffness is affected by using our automatically generated LV geometries instead of manually generated ones. These insights will inform the development of statistical emulators of LV dynamics to avoid computationally expensive biomechanical simulations. Our proposed framework enables accurate LV geometry reconstruction, outperforming previous approaches by delivering a reconstruction error 50% lower than reported in the literature. We further demonstrate that for a nonlinear cardiac mechanics model, using our reconstructed LV geometries instead of manually extracted ones only moderately affects the inference of passive myocardial stiffness described by an anisotropic hyperelastic constitutive law. The developed methodological framework has the potential to make an important step towards personalized medicine by eliminating the need for time consuming and costly manual operations. In addition, our method automatically maps the CMR scan into a low-dimensional representation of the LV geometry, which constitutes an important stepping stone towards the development of an LV geometry-heterogeneous emulator.

The Multi-slice Spiral Computed Tomography (MSCT) Features of Thin-Walled Cystic Lung Cancer with Ground Glass Opacity

Background: Lung cancer is the leading cause of cancer-related mortality worldwide. Thin-walled cystic lung cancer with ground glas s opacity (GGO) is a type of lung carcinoma with specific computed tomography (CT) features. Objectives: To investigate the imaging features of multi-slice spiral computed tomography (MSCT) of GGO and to improve the imaging diagnosis of this type of lung cancer. Patients and Methods: The clinical data of 24 patients with pathologically confirmed thin-walled cystic lung cancer with GGO were retrospectively analyzed in this study. The imaging features of preoperative MSCT, including vascular convergence, burr signs, pleural depression signs, lobulation signs, thickness and uniformity of the cavity wall, partitive membranes, and position of the ground-glass cavity, were examined. The relationship between the imaging features and postoperative pathological findings of lung carcinoma were also explored. Results: Most of the lesions (75.0%) were located in the upper lobe of the lungs. The size range of the cavity was 5.8 - 28.1 mm, with a mean of 13.6 ± 7.2 mm. Fifteen patients (62.5%) had a cavity wall thickness &lt; 2 mm, 6 (25.0%) patients had a cavity wall thickness in the range of 2 - 3 mm, and 3 (12.5%) patients had a cavity wall thickness of about 3 - 4 mm. A uniform cavity wall was found in 10 (41.7%) cases, while a non-uniform cavity wall was observed in 14 (58.3%) cases. Eleven patients showed pure GGO (45.8%), while 13 patients showed mixed GGO (54.2%). Besides, nine patients (37.5%) showed lobular signs, 12 (50.0%) patients showed spicule signs, and 6 (28.6%) patients showed vascular convergence signs. Twelve patients (50.0%) had signs of pleural indentation, while 14 (66.7%) patients showed thick or thin small blood vessel opacity or fine partitive membranes. Twenty-three patients were diagnosed with lung adenocarcinoma, while one patients was diagnosed with mixed adenosquamous carcinoma. Conclusion: Thin-walled cystic lung cancer with GGO is a rare clinical phenomenon. The imaging features of this type of lung cancer on MSCT are consistent with the characteristics of lung cancers.

CT Follow-Up of Postoperative Bronchopleural Fistula: Risk Factors for Progression to Chronic Complicated Infection

PurposeWe evaluated the risk factors for progression to chronic complicated bronchopleural fistula (BPF) after pulmonary resection using follow-up CT.Materials and MethodsWe retrospectively reviewed 45 cases with BPF that had undergone pulmonary resection during 2010–2018. We compared the clinical and radiological characteristics of those with complicated BPF (n = 24) and those without complicated (sterilized) BPF (n = 21). The clinical and radiological risk factors for progression to chronic complicated BPF were examined by logistic regression analysis.ResultsThe thickness of the pleural cavity wall (p = 0.022), the size of the pleural cavity (p = 0.029), and the size increase of BPF on follow-up (p = 0.012) were significantly different between the two groups. The risk factors for progression to chronic complicated BPF were age > 70 years (odds ratio, 6.43; 95% confidence interval, 1.2–33.7), the thickness of the cavity wall > 5 mm (odds ratio, 52.5; 95% confidence interval, 5.1–545.4), and an increase in the size of the pleural cavity on follow-up CT (odds ratio, 12.5; 95% confidence interval, 2.1–73.5), only in the univariate analysis.ConclusionThe risk factors for progression to chronic complicated BPF can be evaluated using follow-up CT.

Design Optimization of a Mechanically Improved 499.8-MHz Single-Cell Superconducting Cavity for HEPS

Superconducting 499.8-MHz radio frequency (rf) cavities have been proposed for the High Energy Photon Source (HEPS), a 6-GeV diffraction-limited synchrotron light source currently under construction in Beijing. Being an active third-harmonic system, two cavities shall provide 3.5-MV rf voltage and 400 kW of beam power to enable a complex rf gymnastics required by a novel injection scheme. Adopting the veteran KEKB-type 500-MHz single-cell geometry, the cavity design has been focused on optimizing its mechanical properties. Various cavity wall thickness and external stiffening mechanisms were investigated to reinforce the cavity to ensure compliance to the pressure vessel codes under different working conditions from a bare cavity to a dressed cavity in the cryomodule. Small margins on operational pressure previously reported on this type of cavity have been largely improved with slightly reduced yet acceptable frequency tunability. Extensive design optimizations have been conducted aiming for lower stress, larger elastic buckling pressure, and higher frequencies of mechanical modes to cause microphonics, while the frequency tunability, pressure sensitivity, and Lorentz force detuning were being carefully monitored. In view of the HEPS’s lifetime, cavity fatigue was examined. This constitutes a comprehensive design optimization of the 499.8-MHz single-cell superconducting cavity with improved mechanical properties.