Aflibercept monotherapy versus aflibercept with targeted retinal laser to peripheral retinal ischemia for diabetic macular oedema (LADAMO)

OBJECTIVE

We tested the hypothesis that targeted retinal laser photocoagulation (TPRP) to peripheral retinal ischaemia reduces the overall burden of aflibercept injections when treating diabetic macular oedema (DMO) over a 24-month period.

METHODS

Prospective, double-masked, multicentre, randomised controlled trial in Australia comparing aflibercept monotherapy, following a treat-and-extend protocol, or combination therapy of aflibercept and TPRP for DMO. The aflibercept monotherapy group received placebo laser. The primary outcome measure was the mean number of intravitreal aflibercept injections for each group at 24 months. Secondary outcome included: mean change in central macular thickness (CMT) and vision at trial completion, the proportion of eyes whose DMO resolved and the mean injection treatment interval. Ocular and systemic adverse events were recorded.

RESULTS

We enrolled 48 eyes of 47 patients; 27 eyes were randomised to combination therapy (aflibercept and TPRP) and 21 to aflibercept monotherapy. Thirty-two eyes (67%) completed the 2-year study. The number of intravitreal treatments given were similar for combination therapy (10.5 (SD 5.8) and monotherapy (11.8 (SD5.6)) (P = 0.44). The mean visual improvement (+4.0 (-1.8, 9.8) and +7.8 (2.6, 12.9) letters, P = 0.32), mean decrease in CMT (-154 (-222,-87) µm and -152 (-218,-86) µm, P = 0.96), proportion of eyes with CMT < 300 µm (48% and 67%; P = 0.50) and safety outcomes were similar in both the combination and monotherapy treatment groups (respectively).

CONCLUSIONS

Laser to areas of ischaemic peripheral retina does not reduce the burden of intravitreal aflibercept injections when treating diabetic macular oedema.

The evolution of pituitary cysts in growth hormone-treated children

OBJECTIVES

We have previously shown that pituitary cysts may affect growth hormone secretion. This study sought to determine cyst evolution during growth hormone treatment in children.

METHODS

Forty-nine patients with short stature, a pituitary cyst, and at least two brain MRI scans were included. The percent of the pituitary gland occupied by the cyst (POGO) was calculated, and a cyst with a POGO of ≤15% was considered small, while a POGO >15% was considered large.

RESULTS

Thirty-five cysts were small, and 14 were large. Five of the 35 small cysts grew into large cysts, while 6 of the 14 large cysts shrunk into small cysts. Of 4 cysts that fluctuated between large and small, 3 presented as large and 1 as small. Small cysts experienced greater change in cyst volume (CV) (mean=61.5%) than large cysts (mean=-0.4%). However, large cysts had a greater net change in CV (mean=44.2 mm³) than small cysts (mean=21.0 mm³). Older patients had significantly larger mean pituitary volume than younger patients (435.4 mm³ vs. 317.9 mm³) and significantly larger mean CV than younger patients (77.4 mm³ vs. 45.2 mm³), but there was no significant difference in POGO between groups.

CONCLUSIONS

Pituitary cyst size can vary greatly over time. Determination of POGO over time is a useful marker for determining the possibility of a pathologic effect on pituitary function since it factors both cyst and gland volume. Large cysts should be monitored closely, given their extreme, erratic behavior.

PMON330 The Relationship between Pituitary Volume and Chiari Malformation in Growth Hormone Deficiency and Idiopathic Short Stature

Patients with a small posterior cranial fossa may present with cerebellar tonsillar herniation through the foramen magnum, known as Chiari malformation (CM). The relationship between CM, pituitary volume (PV), and growth hormone deficiency (GHD) has not yet been explored and is the subject of this abstract. This study seeks to compare the differences in PV in short patients with CM with a diagnosis of either GHD or idiopathic short stature (ISS), to normal controls (NCs). The database of a Peds Endo Center between 2013-21 was queried for patients with CM and who had undergone MRI evaluation. Patients were separated into 4 groups: CM and GHD, CM and ISS, GHD without CM, and ISS without CM. These groups’ PV results were compared with NCs who we previously reported. The ages of short patients with CM (n=29) were compared to the ages of NCs (n=170); no significant difference was found (p = 0.12). The MN and MD PV for patients with GHD alone were 230.8 ± 89.64 and 217.62mm3, respectively. The MN and MD PV for patients with GHD and CM (n=23) were 246.55 ± 128.0 and 200.5mm3, respectively. The MN and MD PV for CM and ISS (n=6) were 671.54 ± 350.25 and 619.55mm3, respectively. The MN and MD PV for NCs were 364.0 ± 145.2 and 346.0mm3, respectively. The PV of patients with GHD alone were compared to the PV of patients with both GHD and CM; there was no significant difference found (p=1.0). Next, the PV of patients with GHD alone were compared to the PV of patients with both ISS and CM which showed that patients with GHD alone had significantly smaller PV compared to patients with both ISS and CM (p<0.05). Lastly, we compared the PV of patients with both GHD and CM versus patients with both ISS and CM, which showed that patients with both GHD and CM had significantly smaller PVs compared to patients with both ISS and CM (p<0.05). The PV of short patients with CM (n=29) were compared to the PV of NCs (n=170) and there was no significant difference found (p = 0.58). Our study demonstrates that PV is smaller in patients with GHD regardless of whether they have CM or not. We speculate that CM appears to be a radiological finding with no significant impact on PV, whereas GHD appears to have a significant impact on PV. Therefore we speculate the small PV exhibited in patients with CM and GHD appear to be related to GHD. A larger sample size will be needed to further elaborate on this concept.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

PSAT104 Predicting Response to Growth Hormone Therapy with Pituitary Volume and The Growth Hormone Stimulation Test

Background

Patients with diminished growth hormone (GH) secretion are candidates for GH therapy (GHT). The GH stimulation test (GHST) is considered the gold standard for the diagnosis of GH deficiency (GHD), yet its efficacy has been questioned. In this study we explore the GHST and PV's ability to define GHD and determine their individual ability to predict GHT outcomes.

Subjects and Methods

A database at a Pediatric Endocrinology center was queried for patients aged 6-18 yrs who underwent a GHST, MRI, and GHT between 1/2018 - 1/2021. Patients with a first follow up (FU) between 3 and 9 months were included; of these patients, second FUs were included if they occurred between 9 and 15 months. Patients with relevant comorbidities, those with GHST peak ≥ 10.0 ng/mL, and nonadherent patients were excluded. MRIs were acquired on a Philips 1.5 or 3.0 T scanner (2mm slices) and PV was calculated using the ellipsoid formula (LxWxH/2).

PV and height were converted to SDS. Response to treatment was defined as change in height SDS over the assessed time interval. A multiple linear regression was utilized to analyze the response to GHT relative to peak GH and PV, with initial height and age at stimulation included as covariates. The relationship between peak GH and PV SDS was analyzed with a Pearson correlation

Results

The first FU ranged between 3.1 and 8.9 months, and the second FU ranged between 9.0 and 14.9 months. 145 patients had one FU, and 83 patients had two FUs. Peak GH and PV SDS were not correlated (r=0.03). Patients who were relatively shorter for their age and gender at stimulation had higher growth rates in the first interval, but not in the second interval. Both PV and peak GH provided information about response to GHT. PV SDS negatively predicted the relative growth response to treatment in the first interval (slope=-0.03, p=0.048). However, PV only explained 3.7% of variation in growth. PV SDS was not a useful predictor of response in the second interval (slope=-0.01, p=0.693). Peak GH was a predictor of response to GHT in the first interval only after accounting for age at stimulation and initial height (slope=-0.01, p=0.032; r2=0.01). Peak GH was a predictor of response in the second interval (slope=-0.02, p=0.040), explaining 5.1% of the variation in growth.

Conclusion

Since peak GH and PV were not correlated, they likely reflect different physiological processes. PV and peak GH both provide information about response to GHT, so they should both be utilized to determine eligibility for GHT.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

RF26 | PSAT109 The Prevalence of Abnormalities in Cranial MRIs in Children with Short Stature Prior to Growth Hormone Therapy

Background

MRIs of the brain in patients with short stature have shown a number of abnormalities. Some of these radiological findings can have clinical significance. Here we have looked at MRI results in such a population.

Objective

To review the value and significance of the prevalence of all abnormal MRI findings of children with short stature who are to undergo growth hormone therapy (GHT).

Materials and methods

This study involved a retrospective review of MRI findings in all children prescribed GHT within a pediatric health network's database from Jan 2020 to Aug 2021. Post-gadolinium contrast enhanced brain and pituitary MRIs utilizing 2 mm slices were used to calculate pituitary volume. Pituitary volume was calculated using the ellipsoid formula (LxWxH/2). Pediatric patients diagnosed with non-acquired GHD or ISS, with MRIs having been performed between Jan 2020 and Aug 2021 and having been prescribed GHT by Aug 2021 were included in this study. Patients who experienced other endocrine abnormalities such as SGA, Turner Syndrome, and Noonan Syndrome were excluded. Patients with obstruction of sellar and parasellar religion due to movement artifacts or magnetic interference on their MRIs were also excluded.

Results

Of one hundred and twelve patients found, eighty one met criteria for inclusion in this study. Of the eighty one MRIs reviewed, twenty eight children, 34.6%, had normal pituitary anatomy and fifty three, 65.4%, had a pituitary abnormality. Out of the fifty three with a pituitary abnormality, forty three subjects, 81.1%, were determined to have a small pituitary volume, including significant pituitary hypoplasia. Ten subjects (18.9%) had an enlarged pituitary volume (pituitary hyperplasia). Of these ten patients who had an enlarged pituitary volume, eight were pubertal (80%). Nine children with a pituitary abnormality (16.9%) had additional structural anomalies on their MRIs. One had a small left frontal developmental venous anomaly. Two had Rathke's cleft cysts. Two had pars intermedia cysts. One had a small right parietal developmental venous anomaly. One had a small left parietal developmental venous anomaly. One had a left cerebellar tonsillar ectopia bordering on chiari malformation (.5 mm away on the coronal plane). One had a small lobulation (semi-bulbous projection) of the anterior pituitary gland, superior and anterior to the infundibular stalk.

Conclusion

Prevalence of brain abnormalities in children with short stature who are to undergo GHT is significant and warrants MRI evaluations in these subjects.

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Monday, June 13, 2022 12:58 p.m. - 1:03 p.m.

PSAT107 Evaluating Pituitary Volume and the Growth Hormone Stimulation Test in Siblings. Both Together Better Define the Etiology of Short Stature

We have shown that short children have significantly reduced pituitary volume (PV)s and have speculated PV as a cause for diminished chronic growth hormone (GH) secretion and poor growth. In this study, we further elucidate the role of PV in the etiology of short stature (SS) in a larger cohort of siblings (SBs).The database of a Peds Endo Center between 2013-21 was queried for siblings with SS who underwent a GH Stimulation test (GHST) and MRI evaluation. Their results were compared with normal controls (NCs) as previously reported. 129 SBs of 60 families were compared to 170 NCs. SBs were divided into 3 groups (GPs). GP1 (n=79) consisted of families with only GHD. GP2 (n=12) contained families with only ISS SBs. GP3 (n=38) comprised families with mixed GHD and ISS. SBs &lt;11 yrs and &gt;11 yrs were considered prepubertal (prePB) and pubertal (PB), RSP. The mean (MN) and median (MD) age for both prePB and PB SBs were significantly different (p 0.05). The 32 PB patients in GP3 had a mean PV of 316.17± 197.53 mm3, which was significantly different from that of the PB NCs of 424.6 ± 138.4 mm3 (p&lt;0.001). Out of 38 children in GP3, 18 passed the GHST and 11 of those children who passed demonstrated a small pituitary gland (61%). 78% of prePB SBs had small PVs, while 88% were GHD. 66% of PB SBs had small PVs, while 70% of PB SBs were GHD. 71% of all SBs had small PVs, while 77% were GHD. When combined, GHST and PV identify the etiology for SS in 92% of subjects. The GHST and PV together identify more patients of SS who should qualify and benefit from GH therapy than the GHST alone. Since ages were significantly different and present as a limitation to this study, future studies should strive for age match control

Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

PMON331 The Natural History of Pituitary Cysts in Patients with Growth Hormone Deficiency and Idiopathic Short Stature

Background

Pituitary cysts may be implicated in short stature and affect growth hormone secretion. The natural history of cysts is not known in patients with GHD and ISS.

Objective

To characterize the progression of cyst volume (CV) and percentage of the gland occupied by the cyst (POGO) over time in GHD and ISS patients.

Subjects and Methods

A pediatric health system's database was queried for patients diagnosed with short stature and a cyst with at least one follow up MRI between 2007-21. Data up to 7 years after first follow up was included in this study. The mean and median follow up time were 1.32±1.24 and 1.00. Cysts with a POGO≤15% were considered small, while a POGO>15% were considered large.

Results

The mean and median %ΔCV for all patients for all their follow up MRIs were 38.27%±179.14 and 0%. The mean and median %ΔPOGO for all patients were 38.32%±219.85 and -5.79%. The mean and median %ΔCV for patients with a small cyst (SC) (n=34) were 61.49%±215.60 and 0%. The mean and median %ΔPOGO for patients with a SC were 61.62%±267.25 and -2.89%. The mean and median %ΔCV for patients with a large cyst(LC)(n=14) were -0.4% ±-79.25 and 0%. The mean and median %ΔPOGO for patients with a LC were -1.08%±90.50 and -15.67%. 5 of the 35(14.3%) SCs grew into LCs and stayed large while 6 of the 14 LCs shrunk into SCs. 4 cysts fluctuated between large and small: 3 started large and 1 started small. CV of patients with LCs has a significant negative correlation with time (-0.37, p=0.01). The slope of the regression line is -0.01 mm3/month. The CV of patients with SCs does not show any change in time (-0.02, p=0.84). There is no significant difference in POGO (p=0.86) or in CV (p=0.96) in GHD and ISS patients. In GHD and ISS patients, the difference in POGO is different in each group at each MRI date (p=0.02), but not in CV (p=0.38). GHD patients had an average ΔPOGO of -1.05, while ISS patients had an average ΔPOGO of 1.26.

Conclusion

POGO can change greatly over time. LCs tend to take up less of the gland over time. SCs tend not to change significantly over time, but a minority can still enlarge and need to be monitored. So far, there have been no significant clinical consequences related to these cysts.

Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Distribution of soil carbon fractions under different bamboo species in northwest Himalayan foothills, India

Soil carbon and its fractions are important in understanding the mechanism of soil carbon sequestration. The present study evaluated the impact of seven commercial bamboo species, viz., Bambusa balcooa, B. bambos, B. vulgaris, B. nutans, Dendrocalamus hamiltonii, D. stocksii, and D. strictus, on labile and non-labile carbon fractions. In the 0-15-cm layer, B. nutans had the highest very labile C (7.65 g kg^-1) followed by B. vulgaris > B. balcooa > D. stocksii > D. hamiltonii > B. bambos > D. strictus > open. The active carbon pool was significantly low under the control plot (i.e. the open) indicating the positive influence of bamboo in soil C build-up in the top 0-15 cm soil layer. Amongst the different species of bamboo evaluated in this study, D. strictus accumulated the highest active C pool in 0-30-cm soil layer followed by B. vulgaris. Of the total organic C in the 0-30 cm soil depth, majority (55-60%) was contributed by the passive C pool comprising the less labile and the non-labile fraction of SOC. A high value of carbon stratification ratio (> 2) was observed for D. strictus, B. bambos, and D. hamiltonii which proves their potential for restoration of the degraded lands. The majority of bamboo species except for B. balcooa and D. stocksii showed a higher carbon management index than open systems, thereby indicating higher rates of soil C rehabilitation. Of the seven bamboo species, B. vulgaris, D. strictus, and B. nutans can be adopted for cultivation in the northwest Himalayas given their ability to positively impact the SOC and its fractions in both surface and sub-surface soil.

Brain MRI findings in COVID-19 patients with PRES: A systematic review

Background

Numerous case reports and case series have described brain Magnetic Resonance Imaging (MRI) findings in Coronavirus disease 2019 (COVID-19) patients with concurrent posterior reversible encephalopathy syndrome (PRES).

Purpose

We aim to compile and analyze brain MRI findings in patients with COVID-19 disease and PRES.

Methods

PubMed and Embase were searched on April 5th, 2021 using the terms “COVID-19”, “PRES”, “SARS-CoV-2” for peer-reviewed publications describing brain MRI findings in patients 21 years of age or older with evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and PRES.

Results

Twenty manuscripts were included in the analysis, which included descriptions of 30 patients. The average age was 57 years old. Twenty-four patients (80%) required mechanical ventilation. On brain MRI examinations, 15 (50%) and 7 (23%) of patients exhibited superimposed foci of hemorrhage and restricted diffusion respectively.

Conclusions

PRES is a potential neurological complication of COVID-19 related disease. COVID-19 patients with PRES may exhibit similar to mildly greater rates of superimposed hemorrhage compared to non-COVID-19 PRES patients.

In hospital outcomes of orbital/rotational coronary atherectomy in diabetic vs non-diabetic population: insights from the nationwide inpatient sample

Background

Atherectomy (AT) using an orbital/rotational system is useful in altering calcified plaque thereby facilitating stent placement and optimal stent expansion. Patients with diabetes mellitus (DM) are known to have a higher rate of complications after percutaneous coronary intervention. We aimed to assess the incidence of major adverse cardiovascular events after atherectomy in the diabetic population using a nationwide inpatient sample (NIS).

Methods

NIS-HCUP database from 2015–2017 was used to identify patients who underwent atherectomy. A cohort of patients with and without diabetes was identified. Demographics, in-hospital outcomes, complications in both groups were compared. Statistical significance was assigned at p&lt;0.05.

Results

Out of 6184 patients who underwent AT, 3134 (50.6%) patients had DM. Baseline characteristics have been outlined in the table below. Complications were comparable between the two groups except for higher incidence of post-procedure VTE in Diabetic patients. In-hospital mortality was lower among patients with DM (2.24% vs 3.29%, p-0.27), while the mean length of stay (5.92 vs 4.91 days, p-0.002) and the hospitalization charges ($165118.4 vs 151226, p-0.04) were higher, but this difference in length of stay and hospitalization charges were nullified on multivariate regression.

Conclusion

Our study suggests that an AT for severely calcified plaque in the coronary artery is a safe option in patients with DM with comparable in-hospital complications and outcomes to non-DM patients.

Funding Acknowledgement

Type of funding sources: None. Demographics and Outcomes of Atherectomy

Assessment of eco-hydrological parameters for important sympodial bamboo species in Himalayan foothills

Bamboos due to high soil water conservation potential are gaining increased attention in plantation programs across the globe. Large-scale plantation of fast-growing bamboo, however, can have important hydrological consequences. The study aims to quantify the eco-hydrological parameters, viz., throughfall (TF), stemflow (SF), and interception (I) in seven important sympodial bamboo species in north western Himalayan foothills of India. The species selected include Bambusa balcooa, Bambusa bambos, Bambusa vulgaris., Bambusa nutans, Dendrocalamus hamiltonii, Dendrocalamus stocksii, and Dendrocalamus strictus. Throughfall versus gross rainfall (GR) relationship in different species indicated high throughfall production during high rainfall events with r² > 0.90. Average throughfall was lowest (62.1%) in D. hamiltonii and highest in B. vulgaris (74.6%). SF ranged from 1.32% in B. nutans to 3.39% in D. hamiltonii. The correlation coefficient (r) between leaf area index (LAI), number of culms, and crown area with the interception were 0.746, 0.691, and 0.585, respectively. The funneling ratio (F) was highest (27.0) in D. hamiltonii and least in B. nutans. Canopy storage capacity was highest in D. strictus (3.57 mm) and least in D. hamiltonii (1.09 mm). Interception loss was highest (34.4%) in D. hamiltonii and lowest in B. vulgaris (23.5%) and D. strictus (23.6%). Higher interception in bamboos make them suitable for soil conservation, but careful selection of species is required in low rainfall areas.

Vessel Wall Enhancement and Focal Cerebral Arteriopathy in a Pediatric Patient with Acute Infarct and COVID-19 Infection

Herein, we report the findings of intracranial arterial wall enhancement, consistent with focal cerebral arteriopathy-inflammatory type, in a child presenting with acute infarct in the setting of coronavirus disease 2019 (COVID-19) infection. To our knowledge, this report provides the first description of vessel wall imaging findings in COVID-19-associated acute stroke.

Outcomes of transcatheter mitral valve repair from the latest nationwide inpatient sample database 2016–2017

Background

Transcatheter mitral valve repair (TMVR) is an alternative treatment option for severe mitral regurgitation (severe MR) in patients with high surgical risk. Previous studies have demonstrated safety and efficacy of TMVR. The aim of our study was to assess comorbid and patient outcome data in a nationwide sample.

Methods

From the Nationwide Inpatient Sample (NIS) 2016–2017, all adult patients with mitral valve regurgitation were identified. Patients were divided into two group- TMVR and SMVR (surgical mitral valve repair). Patients requiring surgical valve replacement were excluded. Primary outcomes were inpatient mortality and length of stay. Multivariate analysis was performed to adjust for comorbidities.

Results

A total of 6211 TMVR were performed, while 3789 SMVR were performed. TMVR patients were older (78.34 vs 62.26 years) and had more females (48.86 vs 36.18%). Comorbidities were higher in the TMVR group [heart failure (81.02 vs 46.02%, p&lt;0.001), diabetes mellitus (27.13 vs 15.81%, p&lt;0.001), chronic kidney disease (39.3 vs 13.7%, p&lt;0.001), chronic lung disease (27.13 vs 16.65%, p&lt;0.001). Complications were higher in the SMVR [Cardiogenic shock (3.8 vs 6%, p=0.007), blood transfusion requirement (19.44 vs 4.85%, p=0.001), respiratory failure (10.99 vs 7.37, p=0.012)]. Mean length of stay was higher with SMVR [8.60±0.22 (4.139–5.17) days] compared to TMVR [4.65±0.26 (8.167–9.03) days]. In-patient mortality was lower in TMVR (2.01 vs 2.45%, p-0.02). After adjusting for comorbidities on multivariate analysis, there was no difference in mortality between the groups (adjusted OR=1.081±0.419 (0.506–2.311).

Conclusion

From nationwide data, we report TMVR as a relatively safe treatment modality for severe MR, with comparable inpatient mortality and fewer complications than SMVR, despite having a significantly higher burden of comorbidities.

Funding Acknowledgement

Type of funding source: None

MRI Brain Findings in 126 Patients with COVID-19: Initial Observations from a Descriptive Literature Review

BACKGROUND AND PURPOSE

Recently, numerous investigational studies, case series, and case reports have been published describing various MR imaging brain findings in patients with COVID-19. The purpose of this literature review was to compile and analyze brain MR imaging findings in patients with COVID-19-related illness.

MATERIALS AND METHODS

Literature searches of PubMed, publicly available Internet search engines, and medical journal Web sites were performed to identify articles published before May 30, 2020 that described MR imaging brain findings in patients with COVID-19.

RESULTS

Twenty-two articles were included in the analysis: 5 investigational studies, 6 case series, and 11 case reports, encompassing MR imaging of the brain in 126 patients. The articles originated from 7 different countries and were published in 14 medical journals. MR imaging brain findings included specific diagnoses (such as acute infarct, posterior reversible encephalopathy syndrome) or specific imaging features (such as cortical FLAIR signal abnormality, microhemorrhages).

CONCLUSIONS

The most frequent diagnoses made on brain MR imaging in patients with COVID-19 were acute and subacute infarcts. Other common findings included a constellation of leukoencephalopathy and microhemorrhages, leptomeningeal contrast enhancement, and cortical FLAIR signal abnormality.

Rooting behaviour and soil properties in different bamboo species of Western Himalayan Foothills, India

Due to extensive root system, connected rhizome bamboos are considered suitable for improving soil properties within a short period, though most of the claims are anecdotal and need to be supported with quantified data. The study evaluates seven bamboo species viz., Bambusa balcooa, Bambusa bambos, Bambusa vulgaris, Bambusa nutans, Dendrocalamus hamiltonii, Dendrocalamus stocksii and Dendrocalamus strictus for their rooting pattern and impact on soil health properties. Coarse and fine root intensity was maximum in B. vulgaris. Coarse root biomass ranged from 0.6 kg m⁻³ in B. nutans to 2.0 kg m⁻³ in B. vulgaris and B. bambos. Fine root biomass ranged from 1.1 kg m⁻³ in B. nutans to 4.5 kg m⁻³ in D. hamiltonii. Contribution of fine roots in terms of intensity and biomass was much higher than coarse roots. Fine root biomass showed declining trend with increase in soil depth in all the species. During sixth year, the litter fall ranged from 8.1 Mg ha⁻¹ in D. stocksii to 12.4 Mg ha⁻¹ in D. hamiltonii. Among soil physical properties significant improvement were recorded in hydraulic conductivity, water stable aggregates and mean weight diameter. Soil pH, organic carbon and available phosphorus under different species did not reveal any significant changes, while significant reduction was observed in total nitrogen and potassium. Significant positive correlation was observed between WSA and iron content. Soil microbial population and enzyme activities were higher in control plot. Considering root distribution, biomass, soil hydraulic conductivity and water stable aggregates, B. bambos, B. vulgaris and D. hamiltonii are recommended for rehabilitation of degraded lands prone to soil erosion.

A Retrospective Study of Administrative Data to Identify Factors Associated with Future Disability Status among Older Colorectal Cancer Survivors

Disability is associated with loss of independence and early mortality. Currently, only 1–2% of cancer survivors who reported physical limitations received rehabilitation services. It is critical to identify factors associated with the development of disability to guide clinical practice given treatment changes. We aimed to 1) identify demographic and cancer-related characteristics associated with future disability status among older colorectal cancer survivors, and 2) compared the future disability status among cancer and matched non-cancer cohorts. Methods: We conducted a retrospective cohort study using the Texas Cancer Registry-national Medicare linked database. The cancer cohort included Medicare beneficiaries with a primary colorectal cancer diagnosis between 2005 and 2013 (n = 13,229). The non-cancer cohort was identified from a 5% sample of Medicare beneficiaries (n = 11,416). Diagnosis dates from the cancer cohort were used as the index date for the non-cancer cohort. Cohorts were matched 1:1 based on index date, age, and gender. Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals. Disability status was defined according to Davidoff and colleagues using inpatient, outpatient and durable medical equipment claims files, and assessed monthly, beginning 1 month after cancer diagnosis (or index date), continuing until disability, death, end of Medicare continuous enrollment, or end of study. Results: Factors that were significantly associated with disability status in the cancer cohort were age (HR = 3.50 for &gt;80 years old), female gender (HR = 1.50), race/ethnicity (HR = 1.34 for Hispanic and 1.21 for Black), stage (HR = 2.26 for distant stage), comorbidity (HR = 2.18 for &gt;1), and radiation (HR = 1.21). When compared to the non-cancer cohort, having a cancer diagnosis (HR = 1.07) and comorbidity (HR = 2.09 for &gt;1) were associated with developing disability. Conclusions: Colorectal diagnosis is an independent risk for disability status. Beyond well-known risk factors “age and mortality” subsets of survivors (Hispanic and Black survivors and those with comorbidity) are found to be at higher risk for developing disability. This warrants further investigation and may indicate targeted intervention to prevent future disability.

Minimizing Radiation Exposure in Evaluation of Pediatric Head Trauma: Use of Rapid MR Imaging

BACKGROUND AND PURPOSE

With >473,000 annual emergency department visits for children with traumatic brain injuries in the United States, the risk of ionizing radiation exposure during CT examinations is a real concern. The purpose of this study was to assess the validity of rapid MR imaging to replace CT in the follow-up imaging of patients with head trauma.

MATERIALS AND METHODS

A retrospective review of 103 pediatric patients who underwent initial head CT and subsequent follow-up rapid MR imaging between January 2010 and July 2013 was performed. Patients had minor head injuries (Glasgow Coma Scale, >13) that required imaging. Initial head CT was performed, with follow-up rapid MR imaging completed within 48 hours. A board-certified neuroradiologist, blinded to patient information and scan parameters, then independently interpreted the randomized cases.

RESULTS

There was almost perfect agreement in the ability to detect extra-axial hemorrhage on rapid MR imaging and CT (κ = 0.84, P < .001). Evaluation of hemorrhagic contusion/intraparenchymal hemorrhage demonstrated a moderate level of agreement between MR imaging and CT (κ = 0.61, P < .001). The ability of MR imaging to detect a skull fracture also showed a substantial level of agreement with CT (κ = 0.71, P < .001). Detection of diffuse axonal injury demonstrated a slight level of agreement between MR imaging and CT (κ = 0.154, P = .04). However, the overall predictive agreement for the detection of an axonal injury was 91%.

CONCLUSIONS

Rapid MR imaging is a valid technique for detecting traumatic cranial injuries and an adequate examination for follow-up imaging in lieu of repeat CT.

Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

AIM

The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT).

METHODS

Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software.

RESULTS

The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA <0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04).

CONCLUSION

A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.

Retrograde cysto-myelogram: Case Report

BACKGROUND

In the scenario of blunt trauma with suspected bladder injury, conventional retrograde cystography is the gold standard for accurate diagnosis.

CASE DESCRIPTION

The authors report the case of a 54-year-old patient who presented with pelvic and sacral fractures and a ruptured bladder after being hit by a vehicle. A retrograde computed tomography cystogram demonstrated extraperitoneal extravasation of the contrast agent, which traversed violated sacral nerve roots, resulting in contrast entering the subarachnoid space at the left sacral ala predominantly through the left L5 and S1 nerve roots.

CONCLUSIONS

This is the first known report of an accidental myelogram imaging performed through a retrograde cystogram.

Observation and quantification of nanoscale processes in lithium batteries by operando electrochemical (S)TEM

An operando electrochemical stage for the transmission electron microscope has been configured to form a "Li battery" that is used to quantify the electrochemical processes that occur at the anode during charge/discharge cycling. Of particular importance for these observations is the identification of an image contrast reversal that originates from solid Li being less dense than the surrounding liquid electrolyte and electrode surface. This contrast allows Li to be identified from Li-containing compounds that make up the solid-electrolyte interphase (SEI) layer. By correlating images showing the sequence of Li electrodeposition and the evolution of the SEI layer with simultaneously acquired and calibrated cyclic voltammograms, electrodeposition, and electrolyte breakdown processes can be quantified directly on the nanoscale. This approach opens up intriguing new possibilities to rapidly visualize and test the electrochemical performance of a wide range of electrode/electrolyte combinations for next generation battery systems.

Vibration platform for mice to deliver precise, low intensity mechanical signals to the musculoskeleton

OBJECTIVE

Low intensity vibration as a therapeutic and training modality has received increased attention despite the lack of clear mechanistic pathways. Thus, to determine mechanisms underpinning vibration-induced musculoskeletal adaptations, a vibration platform for mice was designed, constructed, and validated.

METHODS

Critical aspects of the platform include use of off-the-shelf components to (1) tailor individual parameter selection (acceleration and frequency), (2) produce low error across the plate's surface and throughout the range of vibration parameters, and (3) utilize accelerometer feedback to ensure fidelity within and between bouts of vibration. The vibration device is controlled by a centrally-mounted linear actuator on the underside of the platform that is modulated by accelerometer feedback.

RESULTS

Triaxial accelerometers confirmed that vibrations were purely vertical and acceleration responses were within 5% of target stimuli for all accelerations (0.2-1.0 g) and frequencies (25-90 Hz). The platform produced acceleration responses with ≤4% error between 25-90 Hz. Vibration modes were not detected indicating that the circular plate produced uniform stimuli across the platform (error ≤1.1%, P≥0.23) and mouse body mass did not affect the platform's performance (P≥0.43).

CONCLUSIONS

Our vibration device for mice improves upon existing devices and enables precise, low intensity mechanical signals to be applied with confidence.

Altered Fractional Anisotropy in Early Huntington's Disease

Huntington's disease (HD) is a dominantly inherited neurodegenerative disease best known for chorea. The disorder includes numerous other clinical features including mood disorder, eye movement abnormalities, cognitive disturbance, pendular knee reflexes, motor impersistence, and postural instability. We describe a mild case of HD early in the disease course with depression and subtle neurological manifestations. In addition, we review MRI and diffusion tensor imaging features in this patient. The bicaudate ratio, a measure of caudate atrophy, was increased. Fractional anisotropy values of the bilateral caudate and putamen were increased, signifying neurodegeneration of these structures in HD.

Late-onset neurodegeneration with brain iron accumulation with diffusion tensor magnetic resonance imaging

INTRODUCTION

Neuroferritinopathy is an autosomal dominant neurodegenerative disorder that includes a movement disorder, cognitive decline, and characteristic findings on brain magnetic resonance imaging (MRI) due to abnormal iron deposition. Here, we present a late-onset case, along with diffusion tensor imaging (DTI).

CASE PRESENTATION

We report the case of a 74-year-old Caucasian female with no significant past medical history who presented for evaluation of orofacial dyskinesia, suspected to be edentulous dyskinesia given her history of ill-fitting dentures. She had also developed slowly progressive dysarthria, dysphagia, visual hallucinations as well as stereotypic movements of her hands and feet.

RESULTS

The eye-of-the-tiger sign was demonstrated on T2 MRI. Increased fractional anisotropy and T2 hypointensity were observed in the periphery of the globus pallidus, putamen, substantia nigra, and dentate nucleus. T2 hyperintensity was present in the medial dentate nucleus and central globus pallidus.

DISCUSSION

The pallidal MRI findings were more typical of pantothenate kinase-associated neurodegeneration (PKAN), but given additional dentate and putamenal involvement, lack of retinopathy, and advanced age of onset, PKAN was less likely. Although the patient's ferritin levels were within low normal range, her clinical and imaging features led to a diagnosis of neuroferritinopathy.

CONCLUSION

Neurodegeneration with brain iron accumulation (NBIA) is a rare cause of orofacial dyskinesia. DTI MRI can confirm abnormal iron deposition. The location of abnormal iron deposits helps in differentiating NBIA subtypes. Degeneration of the dentate and globus pallidus may occur via an analogous process given their similar T2 and DTI MRI appearance.

Biomechanical analysis of pedicle screw thread differential design in an osteoporotic cadaver model

BACKGROUND

Pedicle screw fixation, the standard surgical care for posterior stabilization in the thoraco-lumbar spine has a high rate of failure in osteoporotic individuals. Screw design factors and insertion techniques have been shown to influence the biomechanical performance of pedicle screws. Our objective was to investigate the biomechanical characteristics of pedicle screw fixation in osteoporotic bone by comparing standard screws with newly designed differential crest thickness dual lead screws.

METHODS

An in-vitro spinal-level paired factorial study design was used to examine thoraco-lumbar spine biomechanical outcomes for differential pedicle screw thread designs. Six cadaveric human spines (T8-L5) were tested for six groups (n=20) consisting of 2 different crest thickness and 3 different insertion techniques. Bone mineral density was assessed and peak insertion torque measured while placing one screw of new design and control on the contralateral side. Screw pullout properties were measured from classical American Society for Testing and Materials protocols.

FINDINGS

The screws designed specifically for osteoporotic bone showed significantly larger insertion torque compared with the standard screw design irrespective of insertion technique. Much of the variability in pullout failure and stiffness was explained by bone mineral density. The osteoporotic screws of different crest thickness were statistically similar to each other in all outcome measures.

INTERPRETATION

Compared with standard pedicle screws, the dual lead osteoporotic-specific pedicle screws demonstrated significantly larger insertion torques and similar pullout properties. Non-significant increased biomechanical strength was observed for thin crest compared to thick crest dual lead pedicle screws indicating their enhanced purchase in osteoporotic bone.

Skeletal muscle MRI magnetisation transfer ratio reflects clinical severity in peripheral neuropathies

MRI may provide treatment outcome measures in neuromuscular conditions. The authors assessed MRI magnetisation transfer ratios (MTRs) in lower-limb musculature as markers of pathology in peripheral neuropathies and compared the findings with associated clinical data. Ten patients with Charcot-Marie-Tooth disease type 1A (CMT1A) and nine patients with chronic inflammatory demyelinating polyneuropathy (CIDP) were compared with 10 healthy subjects. The MTR in the calf muscles was significantly lower than controls in the two patient groups (both p<0.001). The median MTRs (IQR) were 50.5(1.6) percentage units (p.u.) (control), 41.5(10.6) p.u. (CMT1A) and 39.3(8.7) p.u. (CIDP). Moreover, anterior lower leg MTR correlated strongly with strength of ankle dorsiflexion, measured with the Medical Research Council scale, in CIDP (ρ=0.88, p<0.001) and also in CMT1A (ρ=0.50, p<0.05), where MTR also showed an association with disease duration (ρ=-0.86, p<0.001). Short tau inversion recovery MRI of the same muscles showed abnormalities associated with regions of reduced MTR (p<0.001), and MTR was also reduced in other muscles otherwise deemed normal appearing (p<0.001), indicating that MTR may be more sensitive to muscle damaged by denervation than conventional MRI. The significant reductions in muscle MTR in peripheral neuropathies and the associated correlations with clinical measures indicate that MTR has potential as an imaging outcome measure in future therapeutic trials.

MRI shows increased sciatic nerve cross sectional area in inherited and inflammatory neuropathies

Measurements of the cross sectional area of the sciatic nerve are described in a group of 10 patients with genetically confirmed Charcot-Marie-Tooth disease type 1A (CMT1A), nine patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and 10 healthy controls using MRI. One mid-thigh of each individual was imaged using a short tau inversion recovery sequence and the nerve appearance evaluated radiologically with respect to the signal intensity and visibility of the internal neural structure. The cross sectional area of the sciatic nerve of each individual was measured by defining irregular enclosing regions of interest on the MRI images. The sciatic nerve area was enlarged in both CMT1A (p<0.001) and CIDP (p=0.008) compared with controls and in CMT1A compared with CIDP (p<0.001). Median (interquartile range) areas were 67.6 (16.2) mm(2) for the CIDP group, 135.9 (46.5) mm(2) for the CMT1A group and 43.3 (19.9) mm(2) for the control group. The critical upper value for discriminating pathologically enlarged nerves from normal controls with p<0.05 was 64.4 mm(2). Quantification of sciatic nerve hypertrophy on MRI may be of assistance in cases where the diagnosis is still in doubt, providing an objective pathological marker complimenting other clinical investigations.

Cytoplasmic polyadenylation element binding protein is a conserved target of tumor suppressor HRPT2/CDC73

Parafibromin, a tumor suppressor protein encoded by HRPT2/CDC73 and implicated in parathyroid cancer and the hyperparathyroidism-jaw tumor (HPT-JT) familial cancer syndrome, is part of the PAF1 transcriptional regulatory complex. Parafibromin has been implicated in apoptosis and growth arrest, but the mechanism by which its loss of function promotes neoplasia is poorly understood. In this study we report that a hypomorphic allele of hyrax (hyx), the Drosophila homolog of HRPT2/CDC73, rescues the loss-of-ventral-eye phenotype of lobe (Akt1s1). Such rescue is consistent with previous reports that hyx/parafibromin is required for the nuclear transduction of Wingless (Wg)/Wnt signals and that Wg signaling antagonizes lobe function. A screen using double hyx/lobe heterozygotes identified an additional interaction with orb and orb2, the homologs of mammalian cytoplasmic polyadenylation element binding protein (CPEB), a translational regulatory protein. Hyx and orb2 heterozygotes lived longer and were more resistant to starvation than controls. In mammalian cells, knockdown of parafibromin expression reduced levels of CPEB1. Chromatin immunoprecipitation (ChIP) showed occupancy of CPEB1 by endogenous parafibromin. Bioinformatic analysis revealed a significant overlap between human transcripts potentially regulated by parafibromin and CPEB. These results show that parafibromin may exert both transcriptional and, through CPEB, translational control over a subset of target genes and that loss of parafibromin (and CPEB) function may promote tumorigenesis in part by conferring resistance to nutritional stress.