Automated temporalis muscle quantification and growth charts for children through adulthood.

Lean muscle mass (LMM) is an important aspect of human health. Temporalis muscle thickness is a promising LMM marker but has had limited utility due to its unknown normal growth trajectory and reference ranges and lack of standardized measurement. Here, we develop an automated deep learning pipeline to accurately measure temporalis muscle thickness (iTMT) from routine brain magnetic resonance imaging (MRI). We apply iTMT to 23,876 MRIs of healthy subjects, ages 4 through 35, and generate sex-specific iTMT normal growth charts with percentiles. We find that iTMT was associated with specific physiologic traits, including caloric intake, physical activity, sex hormone levels, and presence of malignancy. We validate iTMT across multiple demographic groups and in children with brain tumors and demonstrate feasibility for individualized longitudinal monitoring. The iTMT pipeline provides unprecedented insights into temporalis muscle growth during human development and enables the use of LMM tracking to inform clinical decision-making.

Engineered silver nanoparticle (Ag-NP) behaviour in domestic on-site wastewater treatment plants and in sewage sludge amended-soils.

Untreated sludge from small-scale on-site domestic wastewater treatment systems (septic tanks) was spiked with 20, 60 and 100 nm silver nanoparticles (Ag-NPs) to investigate Ag-NP behaviour in these systems that are widely distributed in rural areas. In addition, the release of Ag-NPs from a previously spiked clay-rich loam reference soil (LUFA 2.4) was evaluated, in the presence and absence of untreated sludge, to simulate the common practice of sludge disposal by spreading on agricultural land. Single particle ICP-MS was used to determine Ag-NP size distribution and the results were compared with total Ag (Ag-NP and ionic) measured in acid digested samples. As documented previously for large municipal scale wastewater treatment plants, Ag-NPs are found to be overwhelmingly (~98%) retained in the sludge in these small-scale systems. The Ag-NP retention efficiency on the LUFA reference soil amended with sludge is approximately 10 times greater than that of LUFA soil alone (in the absence of sludge). For soil spiked with 60 nm Ag-NPs, the calculated average diameter of Ag-NPs in the supernatant, after 24 h was 45 ±â€¯3 nm (dissolution rate 7.2E-06 mol/m2·h for 60 nm Ag-NP), smaller than that of supernatant from the combined sludge/soil system (52 ±â€¯2 nm), indicating lower Ag-NP dissolution rates in the sludge-amended soil. This study provides new information about the leachability of Ag-NPs from septic tank sludge and suggests that the effluent and sludge from septic tanks are potential sources of both nano- and dissolved ionic-Ag to environmental waters.

Brain tumors and epileptic spasms: Natural history and outcomes.

While brain tumors are a frequent cause of seizures, they rarely cause epileptic spasms (ES). The objective of this study was to investigate features of tumor-associated ES. We conducted a retrospective review of patients with ES and a brain tumor. Demographics; pathologic, radiologic, and EEG data; treatment response; and long-term outcome were collected. Twenty four patients were identified; 11 met inclusion criteria. Epileptic spasm (ES) onset occurred prior to tumor diagnosis in seven patients (63%), and after tumor resection in 4 patients (36%). Spasms and ictal EEG often had focal features (45%). Gross total tumor resection resulted in ES freedom in 3/7 patients. There was poor response to first-line therapy (ACTH/vigabatrin; 1/5 with ES freedom). Low grade tumors predominated (8/11) with dual pathology (associated cortical malformation) in 2 patients. All tumors involved cortex; half involved subcortical regions and/or brainstem. Ten patients developed other seizure types; eight experienced refractory epilepsy, and nine had a Modified Rankin Scale of >3. In summary, EEG in tumor-associated ES often has focal features of either the semiology or EEG. Complete tumor resection yielded ES freedom in only a subset of patients. Most patients developed refractory epilepsy and adverse developmental outcomes.

Postoperative Radiotherapy Patterns of Care and Survival Implications for Medulloblastoma in Young Children.

IMPORTANCE: Postoperative radiotherapy to the craniospinal axis is standard-of-care for pediatric medulloblastoma but is associated with long-term morbidity, particularly in young children. With the advent of modern adjuvant chemotherapy strategies, postoperative radiotherapy deferral has gained acceptance in children younger than 3 years, although it remains controversial in older children. OBJECTIVE: To analyze recent postoperative radiotherapy national treatment patterns and implications for overall survival in patients with medulloblastoma ages 3 to 8 years. DESIGN, SETTING, AND EXPOSURES: Using the National Cancer Data Base, patients ages 3 to 8 years diagnosed as having histologically confirmed medulloblastoma in 2004 to 2012, without distant metastases, who underwent surgery and adjuvant chemotherapy with or without postoperative radiotherapy at facilities nationwide accredited by the Commission on Cancer were identified. Patients were designated as having "postoperative radiotherapy upfront" if they received radiotherapy within 90 days of surgery or "postoperative radiotherapy deferred" otherwise. Factors associated with postoperative radiotherapy deferral were identified using multivariable logistic regression. Overall survival (OS) was compared using Kaplan-Meier analysis with log-rank tests and multivariable Cox regression. Statistical tests were 2-sided. MAIN OUTCOMES AND MEASURES: Postoperative radiotherapy utilization and overall survival. RESULTS: Among 816 patients, 123 (15.1%) had postoperative radiotherapy deferred, and 693 (84.9%) had postoperative radiotherapy upfront; 36.8% of 3-year-olds and 4.1% of 8-year-olds had postoperative radiotherapy deferred (P < .001). On multivariable logistic regression, variables associated with postoperative radiotherapy deferral were age (odds ratio [OR], 0.57 per year; 95% CI, 0.49-0.67 per year) and year of diagnosis (OR, 1.18 per year; 95% CI, 1.08-1.29 per year). On survival analysis, with median follow-up of 4.8 years, OS was improved for those receiving postoperative radiotherapy upfront vs postoperative radiotherapy deferred (5-year OS: 82.0% vs 63.4%; P < .001). On multivariable analysis, variables associated with poorer OS were postoperative radiotherapy deferral (hazards ratio [HR], 1.95; 95% CI, 1.15-3.31); stage M1-3 disease (HR, 1.86; 95% CI, 1.10-3.16), and low facility volume (HR, 1.75; 95% CI, 1.04-2.94). CONCLUSIONS AND RELEVANCE: Our national database analysis reveals a higher-than-expected and increasing rate of postoperative radiotherapy deferral in children with medulloblastoma ages 3 to 8 years. The analysis suggests that postoperative radiotherapy deferral is associated with worse survival in this age group, even in the modern era of chemotherapy.

Resultados clínicos y funcionales de la cecoproctoplastia con rotación anti horaria - Experiencia preliminar / Clinical and functional results of the ceco proctoplasty with anti clockwise rotation - Preliminary experience

Introducción: la colectomía subtotal con anastomosis cecorrectal o cecoproctoplastia, es una alternativa a la colectomía total con anastomosis ileorrectal; permite conservar el íleon distal, válvula ileocecal y el ciego preservando las importantes funciones de absorción. El objetivo del trabajo es observar los resultados clínicos y funcionales post operatorios de la cecoproctoplastia. Materiales y Métodos: los pacientes seleccionados con promedio de 57 años de edad, fueron 3 (tres) casos de diverticulosis colónica complicada, 2 (dos) casos con hemorragia y 1 (uno) con diverticulitis, 1 (uno) caso de angiodisplasias múltiples y 1 (uno) caso de cáncer de colon sigmoides, adenocarcinoma bien diferenciado T2 N0 M0, todos fueron sometidos a colonoscopia y en cuatro de ellos se efectuó enema opaco y todos presentaban válvula ileocecal continente. La técnica, sigue la propuesta de Zinzidohoue. Resultados: no se registraron mortalidad ni complicaciones mayores. Los resultados funcionales en relación a la cantidad y característica de las deposiciones diarias al año del postoperatorio, todos los pacientes presentaron 2 a 3 deposiciones diarias. Discusión: en 1998, Zinzidohoue propuso una modificación a la técnica de Deloyers en la colectomía subtotal con conservación de la unión ileocecal, que preserva la continuidad anastomosando el ciego al muñón rectal. Esta técnica, representa actualmente una alternativa a la colectomía total con anastomosis ileorrectal considerado a menudo como insatisfactorio debido a la alta frecuencia de diarrea y alto índice obstrucción del intestino delgado. Conclusión: nuestra experiencia preliminar, nos permite afirmar que la cecoproctoplastia es una técnica aconsejable en seleccionados casos, representa una alternativa a la ileoproctoanastomosis por sus resultados clínicos y funcionales satisfactorio.

Background: subtotal colectomy with cecorrectal anastomosis or cecoproctoplasty is an alternative to total colectomy with ileorectal anastomosis. It allows keeping the distal ileon, the ileocaecal valve and the cecum, preserving important absorption functions. This work is aimed to evaluate the postoperative clinical and functional outcomes from cecoproctoplasty technique. Materials and methods: five patients with a mean age of 57 years old were selected. Three of them were suffering from complicated colonic diverticulitis, 2 with hemorrhage and 1 with diverticulitis; 1 case of multiple angiodysplasia and 1 with sigmoid colon cancer, well-differentiated adenocarcinoma T2N0M0. All of them undergone colonoscopy, in 4 of them were performed x ray with barium enema. All patients presented good continence of the ileocaecal valve. The technique is based on the proposal of Zinzidohoue. Results: there was no mortality and no postoperative complication. Functional outcomes regarding the number and characteristics of mean daily stool frequency over a year was 2-3. Discussion: by 1998, Zinzidohoue proposed a Deloyers’ technique modification in subtotal colectomy with ileocaecal junction conservation, which keeps the continuity, joining the cecum to the rectal stump. This technique represents an alternative to total colectomy with ileorectal anastomosis. It is often considered as unsatisfactory because of the high rate of diarrhea and small intestine obstruction. Conclusion: our preliminary experience allows us to state that cecoproctoplasty is a recommended technique in selected cases. It represents an alternative to ileorectal anastomosis because of its satisfactory clinical and functional results.