Inferring ecological selection from multidimensional community trait distributions along environmental gradients.

Understanding the drivers of community assembly is critical for predicting the future of biodiversity and ecosystem services. Ecological selection ubiquitously shapes communities by selecting for individuals with the most suitable trait combinations. Detecting selection types on key traits across environmental gradients and over time has the potential to reveal the underlying abiotic and biotic drivers of community dynamics. Here, we present a model-based predictive framework to quantify the multidimensional trait distributions of communities (community trait spaces), which we use to identify ecological selection types shaping communities along environmental gradients. We apply the framework to over 3600 boreal forest understory plant communities with results indicating that directional, stabilizing, and divergent selection all modify community trait distributions and that the selection type acting on individual traits may change over time. Our results provide novel and rare empirical evidence for divergent selection within a natural system. Our approach provides a framework for identifying key traits under selection and facilitates the detection of processes underlying community dynamics.

The community of root fungi is associated with the growth rate of Norway spruce (Picea abies).

Our study delved into the relationship between root-associated fungi, gene expression and plant morphology in Norway spruce cuttings derived from both slow-and fast-growing trees. We found no clear link between the gene expression patterns of adventitious roots and the growth phenotype, suggesting no fundamental differences in the receptiveness to fungal symbionts between the phenotypes. Interestingly, saplings from slow-growing parental trees exhibited a higher richness of ectomycorrhizal species and larger roots. Some ectomycorrhizal species, typically found on mature spruces, were more prevalent on saplings from slow-growing spruces. The ericoid mycorrhizal fungus, Hyaloscypha hepaticola, showed a stronger association with saplings from fast-growing spruces. Moreover, saplings from slow-growing spruces had a greater number of Ascomycete taxa and free-living saprotrophic fungi. Aboveground sapling stems displayed some phenotypic variation; saplings from fast-growing phenotypes had longer branches but fewer whorls in their stems compared to those from the slow-growing group. In conclusion, the observed root-associated fungi and phenotypic characteristics in young Norway spruces may play a role in their long-term growth rate. This suggests that the early interactions between spruces and fungi could potentially influence their growth trajectory.

Efficacy of Biological and Chemical Control Agents against Heterobasidion Spore Infections of Norway Spruce and Scots Pine Stumps on Drained Peatland.

Treatment of conifer stumps with a control agent effectively prevents Heterobasidion spore infections in summer cuttings and protects the residual stand and the next tree generation from damage caused by Heterobasidion root rot. Thus far, stump treatment experiments have been carried out in mineral soils, and no information is available on the efficacy of stump treatment agents in boreal peatland conditions. In the present study, biological and chemical control agents (Phlebiopsis gigantea and urea, respectively) were tested in Scots pine and Norway spruce stands subjected to thinning, cap cutting, and clearcutting on drained peatland in Central Finland. The control efficacy of urea was high in both spruce and pine stumps (on average 99.5 and 85.3%, respectively), while the efficacy of P. gigantea was highly variable on both tree species and ranged from full protection down to negative control effect, i.e., there were more Heterobasidion infections on the treated than untreated half of the stumps. The moisture content of the stump wood or the thickness of the peat layer did not affect the control efficacy of either control agent. These results emphasize a need for further studies to determine the reasons for the unsteadiness of the biological control in peatland conditions.

Landscape context and substrate characteristics shape fungal communities of dead spruce in urban and semi-natural forests.

Urban green areas are becoming increasingly recognized for their biodiversity potential. However, little is known about how urbanization shapes cryptic species communities, such as those residing in deadwood. In this study, we investigated downed Norway spruce trunks at intermediate stages of decay, in urban and semi-natural forests in southern Finland. To understand the interconnections between landscape context, deadwood characteristics and wood-inhabiting fungal communities, we studied structural characteristics, surface epiphyte cover and internal moisture and temperature conditions of the tree trunks, and fungal communities residing in the wood. Our findings showed that urban tree trunks had less epiphyte cover and lower moisture than trunks in semi-natural forests. Overall, urban forests provide less favourable habitats for a majority of the dominant wood-inhabiting fungal species and for red-listed species as a group. Yet, 33% of urban trunks hosted at least one red-listed species. While these landscape-scale effects may be driven by local climatic conditions as well as contingencies related to available species pools, our results also highlight the significance of substrate-scale variability of deadwood in shaping wood-inhabiting fungal communities. We show that epiphyte cover is a significant driver or indicator of these small-scale dynamic processes in deadwood.

Radiation dose of fluoroscopy-guided versus ultralow-dose CT-fluoroscopy-guided lumbar spine epidural steroid injections.

OBJECTIVE: Compare radiation dose of lumbar spine epidural steroid injections (ESIs) performed under fluoroscopy guidance and ultralow-dose CT-fluoroscopy guidance. MATERIALS AND METHODS: Retrospective review of consecutive lumbar ESIs performed using fluoroscopy, between May 2017 and April 2019, and using ultralow-dose CT-fluoroscopy, between August 2019 and February 2021, was performed. Ultralow-dose CT-fluoroscopy technique omits a planning CT scan, utilizes CT-fluoroscopy, and minimizes radiation dose parameters. Patient characteristics (age, sex, height, weight, body mass index (BMI)), procedural characteristics (anatomic level, type of ESI, procedure time, pain reduction, complications, trainee participation), and radiation dose were compared. Chi-square tests and two-sample t-tests were performed for statistical analysis. RESULTS: One hundred and forty-seven patients (mean age 55.8 ± 16.7; 85 women) underwent ESIs using fluoroscopy. Sixty-six patients (mean age 60.9 ± 16.7; 33 women) underwent ESIs using ultralow-dose CT-fluoroscopy. The effective dose for the fluoroscopy group was 0.30 mSv ± 0.34, compared to 0.15 mSV ± 0.11 for ultralow-dose CT-fluoroscopy (p < 0.001). The average age in the CT-fluoroscopy group was older (p = 0.04), and there was more trainee participation in the fluoroscopy group (p < 0.001); otherwise there was no statistically significant difference in patient or procedural characteristics between the conventional fluoroscopy group and the ultralow-dose CT-fluoroscopy group. There was no statistically significant difference in immediate post-procedure pain reduction between the groups (p = 0.16). Four intrathecal injections occurred only in the fluoroscopy group, though this difference was not significant (p = 0.18). CONCLUSION: Ultralow-dose CT-fluoroscopy technique for image-guided lumbar spine ESIs can lower radiation dose compared to fluoroscopy-guided technique.

Role and function of Chondrostereum purpureum in biocontrol of trees.

A decay fungus, Chondrostereum purpureum (Pers. Ex Fr.) Pouzar, has been investigated in Europe, Northern America and New Zealand for its ability to decay hardwood stumps and thus prevent sprouting. The aim of these investigations has been to find an alternative to mechanical (cutting only) and chemical sprout control (cutting and applying chemicals to stumps in order to prevent sprouting). Mechanical sprout control is not an efficient option due to hardwood tree species' ability to re-sprout efficiently after cutting, and therefore management costs are high. Chemicals would be efficient but due to their harmful effects on the environment, alternatives are needed. The fungal treatment, i.e., cutting accompanied with C. purpureum inoculum is an environmentally friendly and efficient option for sprout control. This mini-review comprises the role and function of C. purpureum in biocontrol of trees: the ecology of C. purpureum, its sprout control efficacy, factors affecting sprout control efficacy, devices in biological sprout control, potential risks, and the future perspectives of biological sprout control. KEY POINTS: • A fungus Chondrostereum purpureum is efficient in preventing sprouting of hardwoods • C. purpureum is not sensitive to environmental conditions • Devices should be developed for cost-efficient biological sprout control.

Rainstorm effects on the biocontrol efficacy of the decay fungus Chondrostereum purpureum against birch sprouting in boreal forests.

In forest regeneration areas, alongside roads and railways, under electric power lines and above gas pipe lines, there is a need for regular sprout control. A biocontrol method against broadleaved sprouting with formulations including the decay fungus Chondrostereum purpureum (Pers. Ex Fr.) Pouzar has been shown to be effective. Yet, heavy rain during spreading of this fungal inoculum on freshly cut stumps may affect the efficacy of the treatment, i.e., stump mortality during the following years. Thus, we performed an experiment where freshly cut birch stump surfaces (Betula pendula Roth and Betula pubescens Ehrh.) were treated with fungal inoculum under heavy irrigation and without it. Furthermore, two different adjuvants which aimed to fix the fungal inoculum to freshly cut stumps during irrigation and to protect against solar radiation were tested. Our results revealed that the artificial rainstorm treatment caused a delay in the efficacy of C. purpureum, but after three growing seasons, there was no significant difference in the mortality of birch stumps treated under irrigation or without it (stump mortalities 74 and 86%, respectively). Adjuvants did not improve the efficacy in stumps treated under irrigation nor in those treated without irrigation. KEY POINTS: • Heavy rain delayed the sprout control efficacy of a fungus Chondrostereum purpureum. • Final efficacy of formulations was the same in wet and dry conditions. • No additional adjuvants are needed to improve formulations.

Impact of enzymatic hydrolysis on the nutrients, phytochemicals and sensory properties of oil hemp seed cake (Cannabis sativa L. FINOLA variety).

Enzymatic hydrolysis of the oil hemp seed (FINOLA variety) cake and defatted hemp seed cake by SC-CO2 was carried out using Flavorpro 750 MDP and Promod 439 L enzymes, and proximate composition, proanthocyanidins, phytic acid, lignanamides and cannabinoids were determined from the separated phases. CIELAB* color parameters were measured, while trained panelists evaluated taste, color, and smell in 1-9 Hedonic scale. Ten lignanamides, seven cannabisin-type and three grossamide-type, were found, from the cannabinoids, only cannabidiolic acid was detected. Protein, fat, ash, lignanamides and proanthocyanidins remained mostly in the sediments after the hydrolysis process in the Flavorpro treated samples, while dry matter, fat and ash was released mostly to liquids in Promod treated samples. The defatting process by SC-CO2 resulted in a higher lightness and the enzymatic processing did not have effect on the color attributes. Sediments from the enzymatic treatment were tastier, with better color and smell than liquids.

Adaptation of subpopulations of the Norway spruce needle endophyte Lophodermium piceae to the temperature regime.

Lophodermium piceae represents the most common Norway spruce needle endophyte. The aim of this study was to find out whether subpopulations of L. piceae in climatically different environments (in which Norway spruce occurs natively) are adapted to local thermal conditions. L. piceae's ability for thermal adaptation was investigated by determining growth rates of 163 isolates in vitro at four different temperatures: 2, 6, 20 and 25 °C. Isolates were obtained between 1995 and 2010 from apparently healthy needles sampled in Finland, Poland, Switzerland, Italy and southeastern Siberia. The sampling sites represent seven climatically distinct locations. Results were evaluated in relation to the age and geographic origin of the isolate, in addition to the highest and lowest average monthly temperature of the sampling location. We found a significant correlation between the growth rate and the age of the isolate at 25 °C. Variation in growth rates between subpopulations was low compared to within subpopulations. Only at 2 °C did statistically significant differences between the average growth rates of subpopulations emerge. These results suggest that L. piceae covers the whole distribution area of Norway spruce but that generally the thermal reaction norm of its subpopulations has not changed according to local temperature ranges, despite high contrast in thermal conditions across this vast area. Therefore, it would appear that the thermal environment is not a crucial factor in assessing the fitness of this fungal species within the native range of Norway spruce.

Interfertility and genetic variability among European and North American isolates of the basidiomycete fungus Chondrostereum purpureum.

The conspecificity of Finnish and western Canadian isolates of the decay fungus Chondrostereum purpureum was investigated by several approaches, including the assessment of genetic variability, mating and progeny analysis, and the analysis of selected phenotypic traits. Eight second-generation single spore strains per fungal isolate pairing were investigated with specific genetic markers developed for both Finnish and Canadian parental isolates. Tests of linkage disequilibrium were used to analyze whether these markers assorted independently among single spore strains. This procedure was similarly applied to the third-generation spore progeny. Finally, global non-metric multidimensional scaling was used to analyze independent random amplified microsatellite marker data to assess the genetic variability of the parental Finnish and Canadian isolates, and their second- and third-generation progeny. Our results revealed that the parental isolates from Finland and western Canada were genetically divergent, but no interfertility barriers were identified between these geographically distant fungi. Furthermore, parental genetic markers used in mating studies demonstrated that second- and third-generation spore progenies underwent normal meiosis and genetic recombination without linkage disequilibrium. Based on this work, the studied C. purpureum isolates from Finland and Canada can be considered as belonging to a single biological species, although genetic and limited phenotypic differentiation was observed.

Scots pine aminopropyltransferases shed new light on evolution of the polyamine biosynthesis pathway in seed plants.

Background and Aims: Polyamines are small metabolites present in all living cells and play fundamental roles in numerous physiological events in plants. The aminopropyltransferases (APTs), spermidine synthase (SPDS), spermine synthase (SPMS) and thermospermine synthase (ACL5), are essential enzymes in the polyamine biosynthesis pathway. In angiosperms, SPMS has evolved from SPDS via gene duplication, whereas in gymnosperms APTs are mostly unexplored and no SPMS gene has been reported. The present study aimed to investigate the functional properties of the SPDS and ACL5 proteins of Scots pine (Pinus sylvestris L.) in order to elucidate the role and evolution of APTs in higher plants. Methods: Germinating Scots pine seeds and seedlings were analysed for polyamines by high-performance liquid chromatography (HPLC) and the expression of PsSPDS and PsACL5 genes by in situ hybridization. Recombinant proteins of PsSPDS and PsACL5 were produced and investigated for functional properties. Also gene structures, promoter regions and phylogenetic relationships of PsSPDS and PsACL5 genes were analysed. Key Results: Scots pine tissues were found to contain spermidine, spermine and thermospermine. PsSPDS enzyme catalysed synthesis of both spermidine and spermine. PsACL5 was found to produce thermospermine, and PsACL5 gene expression was localized in the developing procambium in embryos and tracheary elements in seedlings. Conclusions: Contrary to previous views, our results demonstrate that SPMS activity is not a novel feature developed solely in the angiosperm lineage of seed plants but also exists as a secondary property in the Scots pine SPDS enzyme. The discovery of bifunctional SPDS from an evolutionarily old conifer reveals the missing link in the evolution of the polyamine biosynthesis pathway. The finding emphasizes the importance of pre-existing secondary functions in the evolution of new enzyme activities via gene duplication. Our results also associate PsACL5 with the development of vascular structures in Scots pine.

4D-CT is Superior to Ultrasound and Sestamibi for Localizing Recurrent Parathyroid Disease.

BACKGROUND: Recurrent primary hyperparathyroidism (PHPT) presents a diagnostic challenge in localizing a hyperfunctioning gland. Although several imaging modalities are available for preoperative localization, 4D-CT is increasingly utilized for its ability to locate both smaller and previously unlocalized lesions. Currently, there is a paucity of data evaluating the utility of 4D-CT in the reoperative setting compared with ultrasound (US) and sestamibi. We aimed to determine the sensitivity of 4D-CT in localizing parathyroid adenomas in recurrent or persistent PHPT. METHODS: We performed a retrospective review of prospectively collected data from a tertiary-care hospital, and identified 58 patients who received preoperative 4D-CT with US and/or sestamibi between May 2008 and March 2016. Data regarding the size, shape, and number of parathyroid lesions were collected for each patient. RESULTS: A total of 62 lesions were identified intraoperatively among the 58 patients (6 with multigland disease) included in this investigation. 4D-CT missed 13 lesions identified intraoperatively, compared with 32 and 22 lesions missed by US and sestamibi, respectively. Sensitivity for correct lateralization of culprit lesions was 77.4% for 4D-CT, 38.5% for US, and 46% for sestamibi. 4D-CT was superior in lateralizing adenomas (49/62) compared with US (20/52; p < 0.001) and sestamibi (18/47; p < 0.001). The overall cure rate (6-month postoperative calcium < 10.7 mg/dL) was 89.7%. All patients with lesions correctly lateralized by 4D-CT were cured at 6 months. CONCLUSION: 4D-CT localized parathyroid adenomas with higher sensitivity among patients with recurrent or persistent PHPT compared with sestamibi or US-based imaging.

Early root growth and architecture of fast- and slow-growing Norway spruce (Picea abies) families differ-potential for functional adaptation.

The relationship between the growth rate of aboveground parts of trees and fine root development is largely unknown. We investigated the early root development of fast- and slow-growing Norway spruce (Picea abies (L.) H. Karst.) families at a developmental stage when the difference in size is not yet observed. Seedling root architecture data, describing root branching, were collected with the WinRHIZO™ image analysis system, and mixed models were used to determine possible differences between the two growth phenotypes. A new approach was used to investigate the spatial extent of root properties along the whole sample root from the base of 1-year-old seedlings to the most distal part of a root. The root architecture of seedlings representing fast-growing phenotypes showed ~30% higher numbers of root branches and tips, which resulted in larger root extensions and potentially a better ability to acquire nutrients. Seedlings of fast-growing phenotypes oriented and allocated root tips and biomass further away from the base of the seedling than those growing slowly, a possible advantage in nutrient-limited and heterogeneous boreal forest soils. We conclude that a higher long-term growth rate of the aboveground parts in Norway spruce may relate to greater allocation of resources to explorative roots that confers a competitive edge during early growth phases in forest ecosystems.

The efficacy of six elite isolates of the fungus Chondrostereum purpureum against the sprouting of European aspen.

The sprouting of broad-leaved trees after cutting is problematic in forest regeneration areas, along roads and railways, under electric power and above gas pipe lines. In Finland, one of the most difficult species to control in these areas is the European aspen (Populus tremula), which produces both stump sprouts and root suckers after saplings have been cut. In this study, we investigated whether a decay fungus of broad-leaved trees, Chondrostereum purpureum, could be used as a biological control agent against aspen sprouting. The efficacy of six elite strains of C. purpureum (improved earlier in a breeding process) was investigated on aspen for three years. The most efficient C. purpureum strain, R53, tested earlier on birch (Betula pendula and B. pubescens), was efficient in causing mortality of aspen stumps and preventing the development of root suckers. With this strain, stump mortality was 78%, while significantly lower in control stumps which were cut only (47%). Aspen trees in the vicinity of the treatments (within a 10 m radius around each sapling) decreased the efficacy of C. purpureum. This study shows that the decay fungus C. purpureum can successfully be used in the sprout control of aspen saplings.

Breeding increases the efficacy of Chondrostereum purpureum in the sprout control of birch.

We tested whether the pairing of selected isolates could be used to increase the efficiency of a decay fungus Chondrostereum purpureum (Pers. Ex Fr.) Pouzar to control hardwood sprouting in Finland. We paired C. purpureum strains efficient in sprout control or highly active in laccase production, and tested the efficacy of their progeny in spout control experiments. This procedure resulted in a strain with an efficacy superior to that of the parental strains. The mortality of birch (Betula pendula Roth. and B. pubescens Ehrh.) 1 cm in stump diameter was 78%, 56% and 9% for the best progeny, the best parental strain and the control, respectively. Mortality was only slightly higher for B. pendula than for B. pubescens but no significant differences were found between the number or maximum height of stump sprouts. Our results showed that cross breeding of this decay fungus is a good alternative in attempts to produce efficient biocontrol agents against hardwood sprouting.

Tree species composition affects the abundance of rowan (Sorbus aucuparia L.) in urban forests in Finland.

Recent studies have shown a considerable increase in the abundance of rowan (Sorbus aucuparia) saplings in urban forests in Finland, yet the reasons for this increase are not well understood. Here we investigated whether canopy cover or tree species composition, i.e., the basal areas of different tree species in Norway spruce dominated urban forests, affects the abundances of rowan seedlings, saplings and trees. Altogether 24 urban forest patches were investigated. We sampled the number of rowan and other saplings, and calculated the basal areas of trees. We showed that rowan abundance was affected by tree species composition. The basal area of rowan trees (≥ 5 cm in diameter at breast height, dbh) decreased with increasing basal area of Norway spruce, while the cover of rowan seedlings increased with an increase in Norway spruce basal area. However, a decrease in the abundance of birch (Betula pendula) and an increase in the broad-leaved tree group (Acer platanoides, Alnus glutinosa, Alnus incana, Amelanchier spicata, Prunus padus, Quercus robur, Rhamnus frangula and Salix caprea) coincided with a decreasing number of rowans. Furthermore, rowan saplings were scarce in the vicinity of mature rowan trees. Although it seems that tree species composition has an effect on rowan, the relationship between rowan saplings and mature trees is complex, and therefore we conclude that regulating tree species composition is not an easy way to keep rowan thickets under control in urban forests in Finland.

Development of growth media for solid substrate propagation of ectomycorrhizal fungi for inoculation of Norway spruce (Picea abies) seedlings.

A silica-based propagation medium was developed for large-scale production of ectomycorrhizal (ECM) fungal inoculum by solid state fermentation. Development of the medium was started by screening for an optimal growth medium among six different semisynthetic agar media traditionally used in cultivation of ECM fungi. The majority (65 %) of the twenty tested ECM fungal strains that typically colonize Norway spruce (Picea abies) seedlings grew best on modified Melin-Norkrans (MMN) medium with reduced sugar content (½MMN). In order to develop a nutritionally similar medium for large-scale cultivation of the ECM fungi, we chose silica to form a solid matrix and light brewery malt extract to provide nutrients. The medium was supplemented with a commercial humic acid product that was shown to boost fungal growth. The optimal concentration of the constituents was screened for in two assays by determining the growth rates of seven potential inoculant ECM fungal strains (Amphinema sp., Cenococcum geophilum, Hebeloma sp., Meliniomyces bicolor, Paxillus involutus, Piloderma byssinum, and Tylospora asterophora). As a result, we composed a silica-based mass propagation medium (pH 5.8) containing 2.5 % brewery malt extract and 0.5 g/l humic acid product Lignohumate AM. This medium is easily produced and supported good growth of even the slowly growing and rarely studied Athelioid ECM strains. Furthermore, root systems of Norway spruce nursery seedlings were colonized by the tested ECM fungi by using solid inoculum formulated from the silica medium.

Diagnostic yield of delayed phase imaging in CT angiography of the head and neck: a retrospective study.

PURPOSE: To evaluate how often delayed images, obtained during neurovascular CTA, provide unique information relative to early phase imaging alone. MATERIALS AND METHODS: Informed consent was waived by the institutional review body for this study. Neurovascular CTAs from January through June 2009 were searched to identify those with delayed phase imaging. Reports were reviewed to identify cases where delayed images provided potentially unique information. The studies with potentially unique information were re-interpreted to determine if the information was indeed unique. RESULTS: 645 CTAs with delayed phase imaging were identified. There were 324 men and 310 women (median age 67 years; range 20-96 years). 59 studies (59/645: 9.1%) had findings on the delayed images. There were 13 cases with hemorrhage, with 4 showing progression on delayed views. Of the remaining 46 cases, 28 had occlusion of a vessel that did not reconstitute on the delayed images, 6 had occlusion of a vessel that did reconstitute on the delayed images, 7 had a string sign which was unchanged on the delayed views and 5 had no abnormal findings. Thus in 10 cases the findings were unique to the delayed images (10/645: 1.55%). Four showed active bleeding, three showed proximal occlusion with distal internal carotid filling from ophthalmic collaterals, two showed pial vessels filling distal to proximal MCA occlusion, and one showed retrograde vertebral artery filling due to subclavian steal. 95% confidence limits of the expected incidence of unique information from the delayed phase images are 0.6%-2.5%. CONCLUSION: Obtaining delayed phase imaging for neurovascular CTA should be an active decision and not the default protocol. This avoids imaging with little, if any value. If delayed images had not been obtained in our cohort, no detriment in patient management would have occurred.

Superior canal dehiscence length and location influences clinical presentation and audiometric and cervical vestibular-evoked myogenic potential testing.

Superior canal dehiscence (SCD) is caused by an absence of bony covering of the arcuate eminence or posteromedial aspect of the superior semicircular canal. However, the clinical presentation of SCD syndrome varies considerably, as some SCD patients are asymptomatic and others have auditory and/or vestibular complaints. In order to determine the basis for these observations, we examined the association between SCD length and location with: (1) auditory and vestibular signs and symptoms; (2) air conduction (AC) loss and air-bone gap (ABG) measured by pure-tone audiometric testing, and (3) cervical vestibular-evoked myogenic potential (cVEMP) thresholds. 104 patients (147 ears) underwent SCD length and location measurements using a novel method of measuring bone density along 0.2-mm radial CT sections. We found that patients with auditory symptoms have a larger dehiscence (median length: 4.5 vs. 2.7 mm) with a beginning closer to the ampulla (median location: 4.8 vs. 6.4 mm from ampulla) than patients with no auditory symptoms (only vestibular symptoms). An increase in AC threshold was found as the SCD length increased at 250 Hz (95% CI: 1.7-4.7), 500 Hz (95% CI: 0.7-3.5) and 1,000 Hz (95% CI: 0.0-2.5), and an increase in ABG as the SCD length increased at 250 Hz (95% CI: 2.0-5.3), 500 Hz (95% CI: 1.6-4.6) and 1,000 Hz (95% CI: 1.3-3.3) was also seen. Finally, a larger dehiscence was associated with lowered cVEMP thresholds at 250 Hz (95% CI: -4.4 to -0.3), 500 Hz (95% CI: -4.1 to -1.0), 750 Hz (95% CI: -4.2 to -0.7) and 1,000 Hz (95% CI: -3.6 to -0.5) and a starting location closer to the ampulla at 250 Hz (95% CI: 1.3-5.1), 750 Hz (95% CI: 0.2-3.3) and 1,000 Hz (95% CI: 0.6-3.5). These findings may help to explain the variation of signs and symptoms seen in patients with SCD syndrome.

Discriminating parathyroid adenoma from local mimics by using inherent tissue attenuation and vascular information obtained with four-dimensional CT: formulation of a multinomial logistic regression model.

PURPOSE: To identify a set of parameters, which are based on tissue enhancement and native iodine content obtained from a standardized triple-phase four-dimensional (4D) computed tomographic (CT) scan, that define a multinomial logistic regression model that discriminates between parathyroid adenoma (PTA) and thyroid nodules or lymph nodes. MATERIALS AND METHODS: Informed consent was waived by the institutional review board for this retrospective HIPAA-compliant study. Electronic medical records were reviewed for 102 patients with hyperparathyroidism who underwent triple-phase 4D CT and parathyroid surgery resulting in pathologically proved removal of adenoma from July 2010 through December 2011. Hounsfield units were measured in PTA, thyroid, lymph nodes, and aorta and were used to determine seven parameters characterizing tissue contrast enhancement. These were used as covariates in 10 multinomial logistic regression models. Three models with one covariate, four models with two covariates, and three models with three covariates were investigated. Receiver operating characteristic (ROC) analysis was performed to determine how well each model discriminated between adenoma and nonadenomatous tissues. Statistical differences between the areas under the ROC curves (AUCs) for each model pair were calculated, as well as sensitivity, specificity, accuracy, negative predictive value, and positive predictive value. RESULTS: A total of 120 lesions were found; 112 (93.3%) lesions were weighed, and mean and median weights were 589 and 335 mg, respectively. The three-covariate models were significantly identical (P > .65), with largest AUC of 0.9913 ± 0.0037 (standard error), accuracy of 96.9%, and sensitivity, specificity, negative predictive value, and positive predictive value of 94.3%, 98.3%, 97.1%, and 96.7%, respectively. The one- and two-covariate models were significantly less accurate (P < .043). CONCLUSION: A three-covariate multinomial logistic model derived from a triple-phase 4D CT scan can accurately provide the probability that tissue is PTA and performs significantly better than models using one or two covariates.