Echocardiographic probability of pulmonary hypertension: a validation study

BackgroundAccording to current guidelines, the diagnosis of pulmonary hypertension (PH) relies on echocardiographic probability followed by right heart catheterization. How echocardiography predicts PH recently re-defined by a mean pulmonary artery pressure (mPAP) >20 mmHg instead of ≥25 mmHg and pulmonary vascular disease defined by a pulmonary vascular resistance (PVR) >3 or >2 Wood units has not been established.MethodsA total of 278 patients referred for PH underwent a comprehensive echocardiography followed by a right heart catheterization. Fifteen patients (5.4%) were excluded because of insufficient quality echocardiography.ResultsWith PH defined by a mPAP >20 mmHg, 23 patients had no PH, 146 had pre-capillary and 94 post-capillary PH. At univariate analysis, maximum velocity of tricuspid regurgitation (TRV) ≥2.9 and ≤3.4 m s−1, left ventricle (LV) eccentricity index >1.1, right ventricle (RV) outflow tract (OT) notching or acceleration time <105 ms, RV-LV basal diameter >1 and PA diameter predicted PH, whereas inferior vena cava diameter and right atrial area did not. At multivariable analysis, only TRV ≥2.9 m s−1 independently predicted PH. Additional independent prediction of PVR >3 Wood units was offered by LV eccentricity index >1.1 and RVOT acceleration time <105 ms and/or notching, but with no improvement of optimal combination of specificity and sensibility or positive prediction.ConclusionsEchocardiography as recommended in current guidelines can be used to assess the probability of re-defined PH in a referral center. However, the added value of indirect signs is modest and sufficient quality echocardiographic signals may not be recovered in some patients.

Physiological Responses of Robinia pseudoacacia and Quercus acutissima Seedlings to Repeated Drought-Rewatering Under Different Planting Methods

Changing precipitation patterns have aggravated the existing uneven water distribution, leading to the alternation of drought and rewatering. Based on this variation, we studied species, namely, Robinia pseudoacacia and Quercus acutissima, with different root forms and water regulation strategy to determine physiological responses to repeated drought-rewatering under different planting methods. Growth, physiological, and hydraulic traits were measured using pure and mixed planting seedlings that were subjected to drought, repeated drought-rewatering (i.e., treatments), and well-irrigated seedlings (i.e., control). Drought had negative effects on plant functional traits, such as significantly decreased xylem water potential (Ψmd), net photosynthetic rate (AP), and then height and basal diameter growth were slowed down, while plant species could form stress imprint and adopt compensatory mechanism after repeated drought-rewatering. Mixed planting of the two tree species prolonged the desiccation time during drought, slowed down Ψmd and AP decreasing, and after rewatering, plant functional traits could recover faster than pure planting. Our results demonstrate that repeated drought-rewatering could make plant species form stress imprint and adopt compensatory mechanism, while mixed planting could weaken the inhibition of drought and finally improve the overall drought resistance; this mechanism may provide a theoretical basis for afforestation and vegetation restoration in the warm temperate zone under rising uneven spatiotemporal water distribution.

Histopathology-guided management of ocular surface squamous neoplasia with corneal stromal or scleral invasion using ruthenium-106 plaque brachytherapy

Background/aimTo evaluate the safety and efficacy of ruthenium-106 (Ru-106) plaque brachytherapy in managing invasive ocular surface squamous neoplasia (OSSN).MethodsThis is a retrospective, non-comparative, interventional case series of 42 eyes with OSSN with histopathologically-proven corneal stromal and/or scleral invasion that underwent Ru-106 plaque brachytherapy. Main outcome measures were tumour regression, eye salvage, final visual acuity, treatment complications and metastasis.ResultsAt presentation, the mean tumour basal diameter was 9.3 mm (range 5–26 mm) and thickness 3.1 mm (range 1.5–11 mm). Prior treatment included excision biopsy in two patients (5%), incision biopsy and topical interferon in one each (2%). Following excision with 4 mm clinically clear margins, corneal stromal and/or scleral invasion of OSSN was confirmed in all 42 cases, with the excised base showing invasive squamous cell carcinoma. A total dose of 5000 cGy over a mean duration of 19.7 hours (range 7–41 hours) was provided to an axial depth of 2 mm using Ru-106 surface plaque. Over a mean follow-up of 36.9 months (range 22.3–72 months), complete tumour regression was achieved in all eyes (100%). Two eyes (5%) showed conjunctival tumour growth remote from the site of prior treatment. Visual acuity was maintained at ≥20/200 in 35 eyes (83%), with a loss of >2 Snellen lines in 1 eye (2%). There was no evidence of regional lymph node or systemic metastasis.ConclusionHistopathology-guided use of Ru-106 surface plaque brachytherapy is a safe and an effective adjuvant therapy in the management of corneal stromal and/or scleral invasion of OSSN.

No differences in the long-term prognosis of iris and choroidal melanomas when adjusting for tumor thickness and diameter

Objective To assess the long-term prognosis for patients with iris melanomas and compare it with the prognosis for small choroidal melanomas. Design Retrospective observational case series. Methods All patients treated for iris melanomas at a single referral institution between January 1st 1986 and January 1st 2016 were included. Patients treated for small choroidal melanomas during the same period were included for comparison. The cumulative incidence of melanoma-related mortality was calculated. Patient and tumor characteristics and size-adjusted hazard ratio (HR) for melanoma-related mortality were compared between iris and small choroidal melanomas. Results Forty-five iris melanomas and 268 small choroidal melanomas were included. Twenty-four iris melanomas (53%) had been treated with local resection, 12 (27%) with Ruthenium-106 brachytherapy, 7 (16%) with enucleation and 2 (4%) with proton beam irradiation. Twenty-one (68%), 7 (16%) and 2 (4%) of the iris melanomas were of the spindle, mixed and epithelioid cell types, respectively. Twenty-three patients had deceased before the end of follow-up. Median follow-up for the 22 survivors was 13.3 years (SD 9.4). Patients with iris melanomas were more often asymptomatic at presentation and had a trend towards significantly lower age (59 versus 63 years, Student’s T-tests p = 0.057). Further, iris melanomas had significantly smaller basal diameter (5.8 versus 8.0 mm, p < 0.0001) and tumor volume (79 mm3 versus 93 mm mm3, p < 0.0001) but greater thickness (3.0 versus 2.5 mm, p < 0.0001). The cumulative incidence of iris melanoma-related mortality was 5% at 5 years after diagnosis, and 8% at 10, 15 and 20 years. The incidence was not significantly different to small choroidal melanomas (Wilcoxon p = 0.46). In multivariate Cox regression with tumor diameter and thickness as covariates, patients with choroidal melanomas did not have increased HR for melanoma-related mortality (HR 2.2, 95% CI 0.5–9.6, p = 0.29). Similarly, there were no significant survival differences in matched subgroups (Wilcoxon p = 0.82). Conclusions There are no survival differences between iris and choroidal melanomas when adjusting for tumor size. The reason for the relatively favorable prognosis of iris melanomas compared to melanomas of the choroid and ciliary body is likely that they are diagnosed at a smaller size.

Assessing the Contribution of Citrus Orchards in Climate Change Mitigation through Carbon Sequestration in Sargodha District, Pakistan

Adopting agroforestry practices in many developing countries is essential to combat climate change and diversify farm incomes. This study investigated the above and below-ground biomass and soil carbon of a citrus-based intercropping system in six sites (subdivisions: Bhalwal, Kot Momin, Sahiwal, Sargodha, Shahpur and Silanwali) of District Sargodha, Southeast Pakistan. Tree biomass production and carbon were assessed by allometric equations through a non-destructive approach whereas, soil carbon was estimated at 0–15 cm and 15–30 cm depths. Above and below-ground biomass differed significantly, and the maximum mean values (16.61 Mg ha−1 & 4.82 Mg ha−1) were computed in Shahpur due to greater tree basal diameter. Tree carbon stock fluctuated from 6.98 Mg C ha−1 to 10.28 Mg C ha−1 among selected study sites. The surface soil (0–15 cm) had greater bulk density, organic carbon, and soil carbon stock than the subsoil (15–30 cm) in the whole study area. The total carbon stock of the ecosystem ranged from 25.07 Mg C ha−1 to 34.50 Mg C ha−1 across all study sites, respectively. The above findings enable us to better understand and predict the carbon storage potential of fruit-based agroforestry systems like citrus. Moreover, measuring carbon with simple techniques can produce trustworthy outcomes that enhance the participation of underdeveloped nations in several payment initiatives such as REDD+.

Differences in Allometric Relationship of Two Dominant Woody Species Among Various Terrains in a Desert Region of Central Asia

The allometric relationship among different functional traits is an ecological strategy for plants to promote resource utilization, which indicates the ability of plants to adapt to environmental changes coordinately. In this study, we conducted a field survey on Haloxylon ammodendron and H. persicum among different terrains (dune crest, eastern slope, western slope and inter-dune) in the Gurbantunggut Desert, obtained their quantitative and morphological characteristics, and analyzed their allometric relationships between plant height and canopy radius, plant height and basal diameter by using standardized major axis estimation. We found that: (1) The dominated terrains of H. ammodendron and H. persicum were different; (2) The individual morphology of the two Haloxylon species changed significantly with the terrains (p &lt; 0.05), with the largest and smallest ones growing on the eastern slope and the inter-dune lowland, respectively; (3) Fixed allometric patterns were observed in the above-ground parts of the two Haloxylon species, as the growth of canopy and basal stem was preferentially to plant height; (4) These allometric relationships were significantly affected by the terrain, and exhibited discrepancy between two species, they both invested less in plant height in windy habitats, such as the dune crest and western slope, but H. ammodendron growing on the western slope and H. persicum growing on the eastern slope invested more in basal diameter for strengthening mechanical support and resources acquisition, respectively. These results indicated that both studied species adopted an ecological strategy that allocating more resources to horizontal expansion rather than vertical growth, the terrain has an important influence on the allometric relationship of their above-ground parts, and the trade-off mechanism of main components investing was different for these two species due to habitat heterogeneity and ecological adaptability.

MR imaging characteristics of uveal melanoma with histopathological validation

Purpose To evaluate the magnetic resonance imaging (MRI) characteristics of uveal melanoma (UM), to compare them with fundoscopy and ultrasound (US), and to validate them with histopathology. Methods MR images from 42 UM were compared with US and fundoscopy, and on 14 enucleated cases with histopathology. Results A significant relationship between the signal intensity on T1 and pigmentation on histopathology was found (p=0.024). T1 hyperintense UM were always moderately or strongly pigmented on histopathology, while T1-hypointense UM were either pigmented or non-pigmented. Mean apparent diffusion coefficient (ADC) of the UM was 1.16 ± 0.26 × 10−3 mm2/s. Two-thirds of the UM had a wash-out and the remaining a plateau perfusion time-intensity curve (TIC). MRI was limited in evaluating the basal diameter of flat tumors. US tends to show larger tumor prominence (0.5mm larger, p=0.008) and largest basal diameter (1.4mm larger, p<0.001). MRI was good in diagnosing ciliary body involvement, extrascleral extension, and optic nerve invasion, but limited on identifying scleral invasion. An increase of tumor prominence was associated with lower ADC values (p=0.030) and favored a wash-out TIC (p=0.028). An increase of tumor ADC correlated with a plateau TIC (p=0.011). Conclusions The anatomical and functional MRI characteristics of UM were comprehensively assessed. Knowing the MRI characteristics of UM is important in order to confirm the diagnosis and to differentiate UM from other intra-ocular lesions and because it has implications for treatment planning. MRI is a good technique to evaluate UM, being only limited in case of flat tumors or on identifying scleral invasion.

Prognostic Factor Utility of BAP1 Immunohistochemistry in Uveal Melanoma: A Single Center Study in Spain

Even today, the mortality rate for uveal melanoma (UM) remains very high. In our research, we sought to determine which pathological and clinical features were correlated with the prognosis of UM. BAP1 (BRCA1-Associated Protein 1) gene mutation has been analyzed as one of the strongest predictors for metastasis in UM. The BAP1 gene codifies the BAP1 protein which has a tumor suppressor function. The presence of this protein can be determined by BAP1 immunohistochemical staining. Eighty-four uveal melanoma patients and forty enucleated eyeballs were examined. Metastasis was present in 24 patients. Nuclear BAP1 staining was low in 23 patients. The presence of a higher large basal diameter tumor (p < 0.001), tumor infiltrating lymphocytes (p = 0.020), and a lack of nuclear BAP1 immunostaining (p = 0.001) ocurred significantly more often in the metastatic group. Metastasis-free survival was lower in patients with low nuclear BAP1 staining (p = 0.003). In conclusion, to the best of our knowledge, this is the first time that BAP1 staining has been studied in uveal melanoma in a Spanish community. We believe that this technique should become routine in the pathological examination of uveal melanoma in order to allow adequate classification of patients and to establish an individual follow-up plan.

Presumed incipient choroidal melanoma: proposed diagnostic criteria and management

AimsTo propose diagnostic criteria for a presumed incipient choroidal melanoma based on tumour growth rate and tumour doubling time (TDT) and to describe management of such tumours with transpupillary thermotherapy (TTT).MethodsRetrospective interventional case series of nine consecutive presumed incipient uveal melanomas diagnosed and treated with TTT in 2010–2017. Growth rate in mm/year and per cent/year in largest basal diameter (LBD) and TDT were compared with published data for uveal melanomas and growing naevi that did not transform to melanoma under long-term follow-up.ResultsThe median LBD and thickness were 1.6 mm (range 0.9–2.3) and 0.20 mm (range 0.15–0.29), respectively. The median age was 57 years (range 47–78). Seven tumours were classified as de novo melanomas and two as transformed naevi. The median time from first observation to diagnosis was 3.3 years (range 2.2–7.3), LBD growth rate 0.25 mm/year (range 0.11–0.72) and 34 per cent/year (range 10–1437), and TDT 609 days (range 97–1612). The estimates matched those reported for uveal melanoma (median TDT 521 days, 90th percentile 2192) and exceeded those for growing naevi (median growth rate 0.04 mm/year, 90th percentile 0.12; 1.1 per cent/year, 90th percentile 2.6). The predicted median age at de novo appearance was 51 years (range 32–63). No tumour grew after TTT during a median follow-up of 2.1 years (range 0.6–8.7).ConclusionsIn this series, relative growth rate and TDT best qualified as diagnostic criteria for an incipient choroidal melanoma. Too small for brachytherapy, they could be managed with TTT.

Correlations Between Visual Acuity, Presenting Symptoms and Histopathological Findings in Enucleated Eyes with Uveal Melanoma

Visual outcomes after treatment of uveal melanoma have been investigated repeatedly. In this paper, we evaluate the correlation between visual acuity (VA) prior to enucleation, presenting symptoms and findings upon histopathological examination of eyes and tumors. Sixty nine patients were included. Their mean best corrected visual acuity (BCVA) prior to enucleation was LogMAR 0.80 (SD 0.70). Patients that reported low VA or blurry vision did not have lower BCVA upon refraction (p=0.34). Patients with low BCVA had tumors with greater apical tumor thickness (p=0.027), basal diameter (p=0.012) and stage (p=0.014). The experience of a shadow in the visual field correlated with presence of vasculogenic mimicry in the tumor (p<0.001). In multivariate Cox regressions with tumor thickness and diameter as covariates, tumor cell type and infiltration of the optic nerve head were associated with increased hazard for melanoma-related mortality (3.2 and 3.6, respectively). We conclude that patients that report low VA do not necessarily have worse BCVA. The latter do however have tumors with larger dimensions, at more advanced stage. A shadow in the VF correlates with presence of vasculogenic mimicry, which is an independent predictor for poor prognosis along with tumor infiltration of the optic disc and tumor cell type.