Distal Research Articles

Experimental study on pore structure evolution of thermally treated shales: implications for CO2 storage in underground thermally treated shale horizons

Extracting gas from unconventional shale reservoirs with low permeability is challenging. To overcome this, hydraulic fracturing (HF) is employed. Despite enhancing shale gas production, HF has drawbacks like groundwater pollution and induced earthquakes. Such issues highlight the need for ongoing exploration of novel shale gas extraction methods such as in situ heating through combustion or pyrolysis to mitigate operational and environmental concerns. In this study, thermally immature shales of contrasting organic richness from Rajmahal Basin of India were heated to different temperatures (pyrolysis at 350, 500 and 650 °C) to assess the temperature protocols necessary for hydrocarbon liberation and investigate the evolution of pore structural facets with implications for CO2 sequestration in underground thermally treated shale horizons. Our results from low-pressure N2 adsorption reveal reduced adsorption capacity in the shale splits treated at 350 and 500 ºC, which can be attributed to structural reworking of the organic matter within the samples leading to formation of complex pore structures that limits the access of nitrogen at low experimental temperatures. Consequently, for both the studied samples BET SSA decreased by ∼58% and 72% at 350 °C, and ∼67% and 68% at 500 °C, whereas average pore diameter increased by ∼45% and 91% at 350 °C, and ∼100% and 94% at 500 °C compared to their untreated counterparts. CO2 adsorption results, unlike N2, revealed a pronounced rise in micropore properties (surface area and volume) at 500 and 650 ºC (∼30%–35% and ∼41%–63%, respectively for both samples), contradicting the N2 adsorption outcomes. Scanning electron microscope (SEM) images complemented the findings, showing pore structures evolving from microcracks to collapsed pores with increasing thermal treatment. Analysis of the SEM images of both samples revealed a notable increase in average pore width (short axis): by ∼4 and 10 times at 350 °C, ∼5 and 12 times at 500 °C, and ∼10 and 28 times at 650 °C compared to the untreated samples. Rock-Eval analysis demonstrated the liberation of almost all pyrolyzable kerogen components in the shales heated to 650 °C. Additionally, the maximum micropore capacity, identified from CO2 gas adsorption analysis, indicated 650 °C as the ideal temperature for in situ conversion and CO2 sequestration. Nevertheless, project viability hinges on assessing other relevant aspects of shale gas development such as geomechanical stability and supercritical CO2 interactions in addition to thermal treatment.

Changes in femoral anteversion after intramedullary nailing for pediatric femoral shaft fracture: a multicenter study

BackgroundThe rotational change after using a flexible intramedullary (IM) nail for femoral shaft fractures has been a concern for many surgeons. Recently, a statistical shape model (SSM) was developed for the three-dimensional reconstruction of the femur from two-dimensional plain radiographs. In this study, we measured postoperative femoral anteversion (FAV) in patients diagnosed with femoral shaft fractures who were treated with flexible IM nails and investigated age-related changes in FAV using the SSM.MethodsThis study used radiographic data collected from six regional tertiary centers specializing in pediatric trauma in South Korea. Patients diagnosed with femoral shaft fractures between September 2002 and June 2020 and patients aged < 18 years with at least two anteroposterior (AP) and lateral (LAT) femur plain radiographs obtained at least three months apart were included. A linear mixed model (LMM) was used for statistical analysis.ResultsOverall, 72 patients were included in the study. The average patient age was 7.6 years and the average follow-up duration was 6.8 years. The average FAV of immediate postoperative images was 27.5 ± 11.5°. Out of 72 patients, 52 patients (72.2%) showed immediate postoperative FAV greater than 20°. The average FAV in patients with initial FAV > 20° was 32.74°, and the LMM showed that FAV decreased by 2.5° (p = 0.0001) with each 1-year increase from the time of initial trauma.ConclusionsThis study explored changes in FAV after femoral shaft fracture using a newly developed technology that allows 3D reconstruction from uncalibrated 2D images. There was a pattern of change on the rotation of the femur after initial fixation, with a 2.5° decrease of FAV per year.

Risk factors for anteroposterior laxity increase over time in double-bundle anterior cruciate ligament reconstruction using hamstring autografts.

An anteroposterior (AP) laxity can increase over time after anterior cruciate ligament reconstruction (ACLR) using hamstring tendons; however, the associated risk factors remain unclear. This study aimed to investigate the risk factors of this phenomenon. Overall, 151 patients who underwent ACLR using hamstring autografts were recruited. AP laxity was evaluated using Knee Lax 3 arthrometer at 5 months, 1 and 2 years postsurgery. Patients were categorised into groups I (>1 mm increase) and C (<1 mm increase) based on whether they experienced an irreversible increase in AP laxity after 1 or 2 years compared with 5 months. Patient demographics and Knee injury and Osteoarthritis Outcome Score (KOOS) at 2 years postsurgery were compared between groups. Group I (n = 33, 21%) showed a side-to-side difference of 4.6 (3.0-7.2) mm in AP laxity preoperatively and 0.3 (-0.7 to 1.3), 1.1 (0.2-1.9) and 2.4 (1.7-3.2) mm at 5 months, 1 and 2 years postoperatively, while group C (n = 119, 79%) showed 4.3 (2.8-5.7) mm preoperatively and 1.3 (0-1.9), 0.9 (0.1-1.8) and 0.6 (-0.3 to 1.5) mm, respectively. No significant differences were observed in the overall KOOS at 2 years (n.s.). However, group I was older (36 [22-46] vs. 28 [19-39] years; p = 0.044), had longer surgical waiting periods (122 [69-341] vs. 81 [52-136] days; p = 0.041) and lower preoperative Tegner activity scale scores (6 [5-7] vs. 7 [6,7]; p = 0.002). While 33 patients (21%) experienced AP laxity increase over time, they had comparable clinical outcomes with group C. Level III.

Adaptive optics in an oblique plane microscope

Adaptive optics (AO) can restore diffraction-limited performance when imaging beyond superficial cell layers in vivo and in vitro, and as such, is of interest for advanced 3D microscopy methods such as light-sheet fluorescence microscopy (LSFM). In a typical LSFM system, the illumination and detection paths are separate and subject to different optical aberrations. To achieve optimal microscope performance, it is necessary to sense and correct these aberrations in both light paths, resulting in a complex microscope system. Here, we show that in an oblique plane microscope (OPM), a type of LSFM with a single primary objective lens, the same deformable mirror can correct both illumination and fluorescence detection. Besides reducing the complexity, we show that AO in OPM also restores the relative alignment of the light-sheet and focal plane, and that a projection imaging mode can stabilize and improve the wavefront correction in a sensorless AO format. We demonstrate OPM with AO on fluorescent nanospheres and by imaging the vasculature and cancer cells in zebrafish embryos embedded in a glass capillary, restoring diffraction limited resolution and improving the signal strength twofold.

Oblique subcostal transverse abdominis plane block for postoperative pain control in patients undergoing open sublay mesh hernia repair: a prospective double-blind randomized placebo-controlled clinical trial

BackgroundA bilateral oblique subcostal transverse abdominis plane block may help provide perioperative analgesia and reduce opioid use in patients undergoing sublay mesh hernia repair, but its clinical value is unclear.MethodsIn...

Assessment of Pelvic Tilt in Anteroposterior Radiographs by Area Ratio Based on Deep Learning.

Diagnostics. Based on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs. Pelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement. PT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases. We observed no disparity between males and females in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD±4.71°), with a correlation coefficient between them reaching 0.96. Additionally, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is -0.58° (SD±5.97°). We found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.

Can Highly Specific Ultrasound Criteria Obviate the Need for Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Lymph Node Metastasis

Background: Sentinel lymph node biopsy (SLNB) is primarily performed to detect axillary lymph node involvement and determine the need for surgical axillary lymph node dissection (ALND). However, the procedure is expensive and necessitates the use of radio-labelled colloids that are not readily available to a large number of patients. It also carries the risk of producing occasional false negative results. Objectives: This study aimed to define highly specific ultrasound parameters to ascertain axillary lymph node involvement as an alternative or complementary method to SLNB in selected patients who require ALND. Patients and Methods: In this prospective cross-sectional study, 256 patients with confirmed breast cancer and normal axillary clinical examination were selected through non-probability purposive sampling. The selected patients were referred to Omid Hospital, a tertiary educational oncology center in Mashhad, Iran, from 2018 to 2022. This study identified highly specific cut-off points for ultrasound parameters to determine lymph node involvement in comparison with the histological diagnosis post-SLNB or ALND. Measurements were taken of the tumor size, the cortical thickness of the axillary lymph node, the short axis diameter of the node, and the count of lymph nodes with a cortical thickness of ≥ 3 mm. Patients without visible lymph nodes in axillary ultrasound and those with a history of neo-adjuvant treatments were excluded from the study. Results: Among 256 patients with a mean age of 46.41 ± 10.77 years, 202 (87.9%) had histologically confirmed metastatic adenopathy. The ultrasound cut-off values identified to define metastasis with high certainty were as follows: A tumor size &gt; 50.5 mm (with 97% specificity), a difference in cortical thickness of ≥ 4.5 mm (with 100% specificity), a short axis diameter of the node &gt;12 mm (with 95% specificity), more than three lymph nodes with a cortical thickness of ≥ 3 mm (with 94.3% specificity), and a cortical thickness of ≥ 6 mm (with 95% specificity). Conclusions: Highly specific ultrasound findings can diagnose lymph node metastasis with a high degree of certainty. Patients exhibiting these abnormal findings should be managed with caution, even in cases where SLNB results are negative. Under certain conditions, these patients may be directly referred for ALND.

Hemi-diaphragm detection of chest X-ray images based on convolutional neural network and graphics.

Chest X-rays (CXR) are widely used to facilitate the diagnosis and treatment of critically ill and emergency patients in clinical practice. Accurate hemi-diaphragm detection based on postero-anterior (P-A) CXR images is crucial for the diaphragm function assessment of critically ill and emergency patients to provide precision healthcare for these vulnerable populations. Therefore, an effective and accurate hemi-diaphragm detection method for P-A CXR images is urgently developed to assess these vulnerable populations' diaphragm function. Based on the above, this paper proposes an effective hemi-diaphragm detection method for P-A CXR images based on the convolutional neural network (CNN) and graphics. First, we develop a robust and standard CNN model of pathological lungs trained by human P-A CXR images of normal and abnormal cases with multiple lung diseases to extract lung fields from P-A CXR images. Second, we propose a novel localization method of the cardiophrenic angle based on the two-dimensional projection morphology of the left and right lungs by graphics for detecting the hemi-diaphragm. The mean errors of the four key hemi-diaphragm points in the lung field mask images abstracted from static P-A CXR images based on five different segmentation models are 9.05, 7.19, 7.92, 7.27, and 6.73 pixels, respectively. Besides, the results also show that the mean errors of these four key hemi-diaphragm points in the lung field mask images abstracted from dynamic P-A CXR images based on these segmentation models are 5.50, 7.07, 4.43, 4.74, and 6.24 pixels,respectively. Our proposed hemi-diaphragm detection method can effectively perform hemi-diaphragm detection and may become an effective tool to assess these vulnerable populations' diaphragm function for precision healthcare.

Objective Parameters for Evaluating Internal Nasal Valve Compromise: Beyond the Angle Perspective.

Since nasal valve surgery for internal nasal valve (INV) compromise has gained popularity, controversies over its indications and insurance coverage disputes have emerged due to the absence of a gold-standard evaluation. Therefore, we aimed to identify the objective parameters for the INV compromise. We analyzed 186 INVs in 93 patients who underwent nasal valve surgery. The data included facial computed tomography images, acoustic rhinometry, modified Cottle test, and symptom scores. The patients were categorized based on their symptoms and modified Cottle's test results. We measured the INV angle, area, volume, lateral wall thickness, septal angle, and nasal bone area using computed tomography (CT). The compromised INV group (nasal obstruction with a positive modified Cottle test) was characterized by smaller INV areas on both the coronal and axial views, smaller INV volume on the axial view, and thinner lateral wall on the coronal view (all P < 0.05). Acoustic rhinometry revealed a smaller minimal cross-sectional area and volume in the compromised INV group (both P < .001). Regression analysis revealed significant associations between a compromised INV and the INV area on the axial view and the minimal cross-sectional area on acoustic rhinometry. Relying solely on the INV angle in CT scans has limitations in assessing compromised INV. Instead, the INV area on axial CT scans and the minimal crosssectional area on acoustic rhinometry hold potential as objective parameters for evaluating INV compromise.

Prickle2 regulates apical junction remodeling and tissue fluidity during vertebrate neurulation.

The process of folding the flat neuroectoderm into an elongated neural tube depends on tissue fluidity, a property that allows epithelial deformation while preserving tissue integrity. Neural tube folding also requires the planar cell polarity (PCP) pathway. Here, we report that Prickle2 (Pk2), a core PCP component, increases tissue fluidity by promoting the remodeling of apical junctions (AJs) in Xenopus embryos. This Pk2 activity is mediated by the unique evolutionarily conserved Ser-Thr-rich region (STR) in the carboxyterminal half of the protein. Mechanistically, the effects of Pk2 require Rac1 and are accompanied by increased cadherin dynamics and destabilization of tricellular junctions, the hotspots of AJ remodeling. Notably, Pk2 depletion leads to the accumulation of mediolaterally oriented cells in the neuroectoderm, whereas the overexpression of Pk2 or Pk1 containing the Pk2-derived STR promotes cell elongation along the anteroposterior axis. We propose that Pk2-dependent regulation of tissue fluidity contributes to anteroposterior tissue elongation in response to extrinsic cues.

A Comparative Study Between Ultrasound-Guided Ilioingunial/Iliohypogastric Nerve Block versus Transverse Abdominis Plane Block in Patients Undergoing Oblique Inguinal Hernia Repair

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress, respiratory complications, delirium, myocardial ischemia and prolonged hospital stay. Objective Regional anesthesia by (Ultrasound guided (US) Transversus abdominis plane block (TAP) or Ultrasound guided ilioinguinal and iliohypogastric nerves (IIN+IHN) block may be used as components of multimodal anesthesia with a comparable effect. In the present study, Bupivacaine is used to compare between them following inguinal hernia repair. Patients and Methods The study was conducted on 60 randomly chosen patients aged above 18 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective unilateral open inguinal hernia repair under general anesthesia, in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups. TAP block Group: received general anesthesia and (0.2 mL/kg of 0.25% bupivacaine per side), by midaxillary approach, under ultrasound guidance, the probe was placed transversely between the iliac crest and costal margin. Ilioinguinal/ iliohypogastric nerves block group: received general anesthesia, with (0.2 mL/kg of 0.25% bupivacaine per side). The inferior portion of linear ultrasound transducer will be placed over the anterior superior iliac spine with the superior margin of the transducer pointed directly in an oblique plane toward the umbilicus. The superior margin of the ultrasound transducer was slowly rotated superiorly and inferiorly until the fascial plane between the internal oblique and transverse abdominis muscle is identified. Results The results of the study revealed that patients received IIN+IHN block had significantly lower pain scores at 8, 12, 16, 20, and 24 hrs after operation, delayed time for rescue analgesia and decreased total need of analgesic in the first 24hrs post-operative compared to patients who received TAP nerves block. Conclusion IIN+IHN block was effective in reducing postoperative pain scores for 4-6 hours, lowering total 24-h postoperative opioid and analgesic consumption and delaying the need for rescue analgesia after inguinal hernia repair under general anesthesia, compared to TAP nerves block. It will be more useful to study in high-risk hypertensive and cardiac patients and to correlate with plasma catecholamine levels, which reflect the stress response and it is necessary to evaluate postoperative pain on movement in farther studies.

MRI in Postero-Lateral Corner Injuries of the Knee Joint: Clinical-Radiological Correlation

Abstract Background The posterolateral corner (PLC) was once regarded as the “dark side of the knee” owing to the complex and variable anatomy superimposed on the inconsistent terminology used in the literature to describe the structures in this region. Aim of the Work To describe the role of MRI in assessment of posteriolateral corner injury of knee joint. Patients and Methods This cross sectional study was conducted in department of Radiology in Ain Shams University, the data collected from database to reach sample size number and enrolled data of 20 patients in period was 18-24 months. Results We were able to show that the MRI procedure we gave accurately visualises the majority of the complex individual components of the posterolateral knee, as well as damage to these structures, in this investigation. When the diagnosis of grade III injuries to the posterolateral knee is in doubt, we believe that MRI of the posterolateral knee is a useful complement to the surgeon. In our capacity to correctly diagnose damaged structures on MRI, there were no clear differences between acute and chronic knee injuries. On MRI, avulsions or tears of the direct arm or anterior arm insertion off the fibular styloid show focal discontinuity, nonvisualization, increased signal intensity, or proximal retraction, often with a contemporaneous bone avulsion. The damage pattern can also be seen in axial and sagittal views. Conclusion When posterolateral rotatory instability is suspected, the MRI approaches that described for visualizing particular injuries to the posterolateral knee will almost always reveal the bulk of the affected structures. When a posterolateral knee injury is assessed on MRI, using a special MRI protocol that covers the full fibular head and styloid on all imaging sequences will help in identifying these structures.

IMPROVING APPROACHES TO DETERMINING THE LEVEL OF FILLING OF THE PIPE BODY WITH PUMPED PRODUCT

As of 2015, there were more than 200 permanent and variable gravity sections of crude oil and petroleum product pipelines in the pipeline system of PJSC Transneft, the natural monopoly for pipeline transportation of crude oil and petroleum products in the Russian Federation. The operation of gravity sections in oil pipelines in Russia is a very important safety and environmental issue, and Russian oil transportation companies are constantly working on improving approaches to monitor and control pipeline operation modes. When these sections occur, special attention is given to determining the geometric capacity of the pipeline section, as pumping is done in batches and commercial pumping product remains in the gravity section during periodic shutdowns. Due to the limited technical equipment of these sections and the likely illegal unrecorded product withdrawals in these pipeline sections, the most demanding approach is to determine the fill factor of the pipe body. The fill factor is influenced by many factors, including the presence of gas phase and water accumulations, correct geometry of the pipe body and other factors. Given the given initial data, it can be seen that the solution to the problem of determining the filling level of a stopped oil pipeline is reduced to the construction of a multifactor model. For accurate determination, in addition to the model, there is a need for relevant software, an algorithm for solving the problem ofcalculating the filling factor. Correspondingly, operating organisations need a system for accounting and control of the product filling level at these sections at the level of improvement of the state system for ensuring unity of measurements and metrological support of accounting for the long-distance pipeline transport of oil and oil products - a strategic resource, the revenues from the sale of which account for about 23 % of the budgetary system of the Russian Federation.The calculation created and proposed by the authors is divided into stages in which the initial data is sequentially collected, the voltages on the capacitors are calculated, the data is processed using the interpolation method, an image is constructed using the Newton-Gauss method, and the filling factor is calculated with various multiphase pumping products. The calculation is made based on voltage readings from sensors located orthogonally to the axis of the pipe body. Using the approximation method and the Newton-Gauss method, you can get rid of the «noise» and level the phase boundary. When tested and implemented at pipeline pumping facilities, it will be possible to clarify the existing dependences of the influence of gas phase friction on the fluid flow rate, and, therefore, evaluate the effect on the filling factor. This calculation can become a tool in the fight against illegal tappings.

Topographic Organization of Glutamatergic and GABAergic Parvalbumin Positive Neurons in the Lateral Habenula.

Parvalbumin-expressing (PV) neurons, classified by their expression of the calcium-binding protein parvalbumin, play crucial roles in the function and plasticity of the lateral habenular nucleus (LHb). This study aimed to deepen our understanding of the LHb by collecting information about the heterogeneity of LHb PV neurons in mice. To achieve this, we investigated the proportions of the transmitter machinery in LHb PV neurons, including GABAergic, glutamatergic, serotonergic, cholinergic, and dopaminergic neurotransmitter markers, using transcriptome analysis, mRNA in situ hybridization chain reaction, and immunohistochemistry. LHb PV neurons comprise three subsets: glutamatergic, GABAergic, and double-positive for glutamatergic and GABAergic machinery. By comparing the percentages of the subsets, we found that the LHb was topographically organized anteroposteriorly; the GABAergic and glutamatergic PV neurons were preferentially distributed in the anterior and posterior LHb, respectively, uncovering the anteroposterior topography of the LHb. In addition, we confirmed the mediolateral topography of lateral GABAergic PV neurons. These findings suggest that PV neurons play distinct roles in different parts of the LHb along the anteroposterior and mediolateral axes, facilitating the topographic function of the LHb. It would be interesting to determine whether their topography is differentially involved in various cognitive and motivational processes associated with the LHb, particularly the involvement of posterior glutamatergic PV neurons.Significance statement The parvalbumin-expressing (PV) neurons are key in the understanding of the neural circuits in the lateral habenula (LHb). There are three subsets of LHb PV neurons in mice: glutamatergic, GABAergic, and double-positive for both glutamatergic and GABAergic machinery, with the majority being glutamatergic. Herein, we demonstrate that these subsets of the LHb PV neurons were topographically organized anteroposteriorly, suggesting topographic function in the LHb.

P-038 Sperm head morphometric reference values of 1856 sperms in fertile Asian males

Abstract Study question To explore comprehensive normal sperm morphometric reference values by measuring 1856 sperms in fertile males using artificial intelligence (AI) technique. Summary answer Four novel describing parameters of sperm head (size, shape, area, and uniformity) and 14 other features for normal sperm head were extracted and characterized. What is known already Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. The human spermatozoon is one of the most diverse cell types known. However, most assessment criteria have only 3 morphometric parameters (Length, width, and length/width ratio) for sperm head morphometric measurement. We detailed the features of sperm head by defining and characterizing 14 parameters based on AI. Study design, size, duration This is a prospective observational study. The study included 1856 normal sperm images from 23152 stained sperm acquired by an Automated Sperm Morphology Analysis (ASMA) system. The measured sperm morphometry data were acquired from May 2020 to December 2021. Participants/materials, setting, methods All participants (54 fertile males) had fathered a child naturally during the past year. The measured sperm morphometry data were acquired from candidate donors of the Sichuan Province Human Sperm Bank (SPHSB, Chengdu, China). Images of 23,152 stained sperm captured by ASMA. All sperm images were assessed by three experienced technicians. Finally, we concluded 14 morphometric data from normal sperm by measuring sizes in pixels. Main results and the role of chance (1) Characteristics of sperm head size and shape: We present eight sperm head size and shape parameters for the 1856 visually normal spermatozoa. The median head size parameters included head length of 4.02 (95% CI: 4.01–4.05) μm, head width of 2.52 (95% CI: 2.52–2.54) μm, length to width ratio of 1.59 (95% CI: 1.59–1.62), and head girth of 11.18 (95% CI: 11.17–11.25) μm. The median head symmetry parameters included short axis symmetry (SAS) of 92.1% (95% CI: 88.3%–89.2%) and the long axis symmetry (LAS) of 94.3% (95% CI: 91.6%–92.3%). The median head shape parameters included median of ellipse intersection over union (EIoU) of 88.9% (95% CI: 85.4%–86.3%) and girth intersection over union (GIoU) of 102.4% (95% CI: 102.4%–102.5%). (2) Characteristics of sperm head area and acrosome uniformity: Descriptive analysis of the sperm head area characteristics included a median sperm head area of 7.72 (95% CI: 7.74–7.85) μm2, acrosome area of 3.67 (95% CI: 3.77–3.88) μm2, acrosome area ratio of 48.2% (95% CI: 47.8%–48.6%), post-acrosomal area of 3.95 (95% CI: 3.95–4.00) μm2, acrosome uniformity of 88.6% (95% CI: 88.6%–89.1%), and nuclear uniformity of 100.0% (95% CI: 99.8%–99.9%). Limitations, reasons for caution This study had several limitations that should be noted. The use of samples from a single center, covering relatively young participants from only seven provinces in China, could limit the usage of our findings. The use of only three technicians to assess the samples may have introduced a subjective bias. Wider implications of the findings The measurement technique was accurate, objective, and highly informative by AI. The data provide extremely detailed information for reference studies and comparison of sperm head parameters among different male groups. These new parameters can be applied in routine semen analysis when assessing sperm morphology and male fertility potential. Trial registration number not applicable

A comparative cohort study of surgical approaches for adult spinal deformity at a minimum 2-year follow-up.

This study was a retrospective multi-center comparative cohort study. A retrospective institutional database of operative adult spinal deformity patients was utilized. All fusions > 5 vertebral levels and including the sacrum/pelvis were eligible for inclusion. Revisions, 3 column osteotomies, and patients with < 2-year clinical follow-up were excluded. Patients were separated into 3 groups based on surgical approach: 1) posterior spinal fusion without interbody (PSF), 2) PSF with interbody (PSF-IB), and 3) anteroposterior (AP) fusion (anterior lumbar interbody fusion or lateral lumbar interbody fusion with posterior screw fixation). Intraoperative, radiographic, and clinical outcomes, as well as complications, were compared between groups with ANOVA and χ2 tests. One-hundred and thirty-eight patients were included for study (PSF, n = 37; PSF-IB, n = 44; AP, n = 57). Intraoperatively, estimated blood loss was similar between groups (p = 0.171). However, the AP group had longer operative times (547.5min) compared to PSF (385.1) and PSF-IB (370.7) (p < 0.001). Additionally, fusion length was shorter in PSF-IB (11.4) compared to AP (13.6) and PSF (12.9) (p = 0.004). There were no differences between the groups in terms of change in alignment from preoperative to 2years postoperative. There were no differences in clinical outcomes. While postoperative complications were largely similar between groups, operative complications were higher in the AP group (31.6%) compared to the PSF (5.4%) and PSF-IB (9.1) groups (p < 0.001). While there were differences in intraoperative outcomes (operative time and fusion length), there were no differences in postoperative clinical or radiographic outcomes. AP fusion was associated with a higher rate of operative complications.

Influence of Impaired Upper Extremity Motor Function on Static Balance in People with Chronic Stroke.

Stroke is a leading cause of disability, especially due to an increased fall risk and postural instability. The objective of this study was to analyze the impact of motor impairment in the hemiparetic UE on static balance in standing, in subject with chronic stroke. Seventy adults with chronic stroke, capable of independent standing and walking, participated in this cross-sectional study. The exclusion criteria included vestibular, cerebellar, or posterior cord lesions. The participants were classified based on their UE impairment using the Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA-UE). A posturographic evaluation (mCTSIB) was performed in the standing position to analyze the center of pressure (COP) displacement in the mediolateral (ML) and anteroposterior (AP) axes and its mean speed with eyes open (OE) and closed (EC) on stable and unstable surfaces. A strong and significant correlation (r = -0.53; p < 0.001) was observed between the mediolateral (ML) center of pressure (COP) oscillation and the FMA-UE, which was particularly strong with eyes closed [r(EO) = 0.5; r(EC) = 0.54]. The results of the multiple linear regression analysis indicated that the ML oscillation is influenced significantly by the FMA-Motor, and specifically by the sections on UE, wrist, coordination/speed, and sensation. The hemiparetic UE motor capacity is strongly related to the ML COP oscillation during standing in individuals with chronic stroke, with a lower motor capacity associated with a greater instability. Understanding these relationships underpins the interventions to improve balance and reduce falls in people who have had a stroke.

Predictors of lateral lymph node metastasis and skip metastasis in patients with papillary thyroid microcarcinoma

BackgroundPapillary thyroid microcarcinoma (PTMC) is characterized by its favorable prognosis and potential for active surveillance (AS) as a management option. However, the presence of cervical lymph node (LN) metastasis, especially lateral LN metastasis, significantly impacts management and prognosis. Previous studies have focused on post-surgery risk factors for cervical LN metastasis. This study aims to identify predictors of lateral LN metastasis by analyzing pre-operative ultrasonographic findings alongside clinicopathological factors.MethodsA retrospective review of medical records was conducted for patients with PTMC who underwent surgery at Chonnam National University Hwasun Hospital between 2004 and 2013. This is a case–control study that compares patients with lateral LN metastasis (N1b) to age- and sex-matched patients without LN metastasis (N0). Subgroup analysis was performed to evaluate risk factors of skip metastasis.ResultsThe study included 90 patients with PTMC with lateral LN metastasis (N1b) and 268 age- and sex-matched patients without LN metastasis (N0). The mean age was 49.3 years, and female patients were dominant in both groups. Structural recurrences of 4.4% (4/90) were observed only in the N1b group. The N1b group exhibited a higher frequency of upper lobe tumor location compared to the N0 group (38.9% vs. 16.0%, p &amp;lt; 0.001). There was no significant difference in the locations with the presence of invasion to adjacent organs. A higher proportion of non-parallel shape was observed in the N1b group than the N0 group (80.0% vs. 66.0%, p = 0.013). There were no differences in echogenicity, sonographic feature, margin, and AP diameter of the thyroid gland between the two groups. In multivariate analysis, independent risk factors for lateral LN metastasis included extrathyroidal extension, multiplicity, upper lobe tumor location, and non-parallel shape. Skip metastasis in patients with PTMC was associated with upper lobe tumor location.ConclusionDetailed ultrasound examinations, evaluating tumor location, number, orientation, and the presence of ETE, are crucial in accurately predicting lateral LN metastasis especially when primary tumor was in the upper lobe to avoid missing skip metastasis. These evaluations can help guide the decision between AS and immediate surgery in patients with PTMC.

Comparison of postoperative clinical outcomes and knee stability of cruciate-retaining total knee arthroplasty using the tibia-first gap navigation technique with a computer-aided system and measured-resection technique: A retrospective analysis of a propensity-matched cohort.

This study aimed to clarify whether the range of motion (ROM), anterior and posterior (AP) stabilityand other clinical measures changed in patients who underwent tibia-first total knee arthroplasty (TF-TKA) using navigation with a computer-aided system after surgery. This is a retrospective study and we conducted a matched cohort analysis of 60 measured resection (MR)-TKAs and 52 TF-TKAs performed by a single surgeon. All the surgeries used the same implant and approach. Baseline differences between the groups were adjusted using propensity score matching. We compared each patient's measured ROM and Oxford Knee Score (OKS) and performed knee AP laxity measurements by using a device during routine follow-ups. A total of 40 MR-TKAs with a mean age of 73.5 ± 5.6 years and sex (male 10, female 30) were compared to 40 TF-TKAs with a mean age of 74.0 ± 5.7 years and sex (male 13, female 27) at 2-year follow-ups. Two years postoperatively, there was a significant difference in the AP laxity at 30° of knee flexion between both groups (7.0 ± 3.4 mm vs. 5.2 ± 2.3 mm, p < 0.01). In contrast, no differences were found between both groups for knee flexion (120.8 ± 9°vs. 116.7 ± 9.8°, p = 0.07) and OKS score (41.8 ± 6.9 vs. 41.0 ± 5.9, p = 0.61). The AP stability in the midflexion obtained using the tibia-first technique remained consistent even after 2 years. However, OKS and ROM were not significantly different from those of the MR-TKA group. Retrospective comparative LEVEL III study.

Reporting average glandular dose and its associations with age and exposure parameters

PurposeTo report average glandular dose (AGD) values for the Saudi breast cancer screening program and to examine the relationship between AGD with age and exposure parameters. MethodsScreening mammography of 187,788 exposures were collected. The AGD was calculated per exposure and considering each view (craniocaudal (CC) and mediolateral oblique (MLO)) separately. Spearman correlation, Mann–Whitney U test, and Kruskal-Wallis tests were to test the difference existence in AGD across various age groups and inter- and intra-views (MLO and CC) in acquisition parameters. ResultsThe mean AGD per projection was 1.45 mGy and most AGD falls between 1.3 and 1.5 mGy for both projections which are close in value to those reported to other countries. The participants have a mean age of 49 years. The mean values for the used exposure parameters were 135 N for compression force (CF), 58 mm for compressed breast thickness (CBT), 29 kVp, and 74 mAs. An inverse relation between AGD and age (r = −0.131, p < 0.001) was found. Additionally, AGD was also correlated with CBT (0.39, p < 0.001), and CF (−0.11, p < 0.001). ADG, CBT, CF, mAs, and kVp, were found to have statistically significant differences between CC and MLO (p = 0.001). The CF was the only parameter that had a significant difference between left and right MLOs (p = 0.016). ConclusionWe observed a trend of decreasing AGD with aging in the women of our population. We also noticed that AGD decreases with higher CFs and lower CBTs. A potential explanation for this is that the composition of the breast is changing (glandular tissue reduces) with aging, allowing more CF and thinner CBT leading to less absorbed AGD.