To establish parameters for congenital cervical stenosis (CCS) using computed tomography (CT), assessing influences of patient sex, race, and ethnicity. Measurements were collected of anteroposterior diameter (APD), interpedicular distance (IPD) and cervical intervertebral foramen dimensions (CIFD) from 1000 patients between 18 and 35 years of age without spinal pathology. CCS was determined as two standard deviations below the mean of the collected measurements. Irrespective of vertebral level, mean anatomic APD, CIFD and IPD measurements were as follows: 14.94 ± 1.99 mm for APD, 6.58 ± 1.45 mm and 6.68 ± 1.45 mm for left and right widths, of 9.30 ± 2.30 mm and 9.25 ± 2.80 mm for left and right heights, 57.0 ± 19.2 mm2 and 59.5 ± 20.3 mm2 for left and right areas, and 25.4 ± 1.78 mm for IPD. Irrespective of vertebral level, threshold values for CCS were 10.96 mm for APD, 3.68 mm and 3.78 mm for left and right widths, of 4.70 mm and 3.65 mm for left and right heights, 20.6 mm2 and 19 mm2 for left and right areas, and 21.8 mm for IPD. Males demonstrated larger CCS threshold values than females for left and right CIFD area and APD. African American patients had smaller CIFDs and APD, and subsequent CCS thresholds compared to White patients. This study reports measurements of CIFD, IPD, and APD to establish quantitative thresholds for diagnosis of CCS. CCS thresholds were significantly influenced by patient sex, race, and ethnicity.
RATIONALE:Dyspnea is a prominent symptom of fibrotic hypersensitivity pneumonitis (fHP), limiting patients' activity and impairing their quality of life. The University of California San Diego Shortness of Breath questionnaire (UCSD-SOBQ) is a 24-item instrument used to assess dyspnea severity in patients with various respiratory conditions. OBJECTIVES:This study aimed to examine the reliability and responsiveness of the UCSD-SOBQ score, its validity as a measure of dyspnea severity, and its prognostic value in a prospective cohort with fHP. METHODS:We conducted psychometric analyses on UCSD-SOBQ response data and assessed the association between score changes and survival in patients with fHP who completed the UCSD-SOBQ and other HP severity metrics at baseline, 6 and 12 months. We introduce the reliable change index (RCI) and the likely change index (LCI) to assess the statistical significance of within-individual change in UCSD scores. RESULTS:At baseline, internal consistency was high (Cronbach's alpha = 0.97). Significant moderately strong correlations were observed between UCSD-SOBQ scores and percent predicted forced vital capacity (FVC%), r = -0.46, percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%), r = -0.32, and Borg dyspnea scores r = 0.56. UCSD-SOBQ scores were significantly different between the lowest and highest strata of FVC% (64.9 ± 18.9 vs. 36.2 ± 22.9), DLCO% and Borg scores. The threshold for worsening within-individual change in the UCSD-SOBQ score at 95% confidence was 12 points. A 1-point higher baseline UCSD-SOBQ score was associated with a 2% increase in the risk of death or transplant (HR 1.02, 95% CI 1.00, 1.04). CONCLUSIONS:In fHP, the UCSD-SOBQ score is a reliable and valid measure of dyspnea severity, is responsive to change, discriminates patients with differing severities, and is associated with transplant free survival. Additional qualitative data and psychometric analyses could tailor the UCSD-SOBQ to fHP and may further improve its measurement properties.
BACKGROUND:Optimizing plastic surgeon distribution is essential to meeting rising consumer demand for aesthetic operations. OBJECTIVES:This study aimed to identify aesthetic surgery demand-supply mismatches across U.S. Designated Market Areas (DMAs) and quantify regional demand changes from pre- to post-COVID periods. METHODS:This cross-sectional ecological analysis used Google Trends (Google LLC, Mountain View, CA, USA) Relative Search Volume (RSV) averaged for nine aesthetic operations as a proxy for demand across 210 DMAs from August 2024-2025. Surgeon concentration was calculated as board-certified plastic surgeons per 10,000 residents. Demand-Supply Ratio (DSR) was defined as RSV divided by surgeon concentration. DMAs were grouped into quintiles (Tiers 1-5, highest to lowest DSR). RESULTS:Median RSV was 45.03 (Interquartile Range [IQR] 39.52-54.90) and median surgeon density was 0.10 (IQR 0.06-0.17). Seventeen DMAs (8.1%) were "plastic surgery deserts," with search activity but no surgeons, clustering in the South, Midwest, and West. Median DSR was 426.16 (IQR 307.35-565.08), with highest DSRs concentrated in Southern and rural/interior DMAs, whereas coastal hubs were saturated. While surgeon concentration increased across DSR Tiers 1-5, RSV did not significantly differ. Nationally, median RSV increased 22.54% (IQR 16.65%-32.34%) from 2018-2019 to 2024-2025, with rising RSV in 95.2% of DMAs and highest growth in the Midwest (+32.58%, IQR 24.90%-47.55%). CONCLUSIONS:Southern and rural DMAs are disproportionately represented among underserved aesthetic markets and plastic surgery deserts. Aesthetic demand is rising nationwide, particularly in the American interior, underscoring high-growth regions where strategic expansion of aesthetic services by board-certified plastic surgeons may improve patient access and safety.
Formal thought disorder (FTD), a prominent feature of schizophrenia, encompasses disruptions in thought, language, and communication. This study examines cortical thickness (CT) alterations in first-episode psychosis (FEP) patients (N=24), their siblings (SIB) (N=21), and healthy controls (CON) (N=21) to explore potential neural correlates of FTD. Using structural MRI, we analyzed whole-brain CT and its relationship with positive and negative FTD measured by Thought and Language Index. Out-of-sample spatial correlations of gene expression with regional CT were also performed using a transcriptomic dataset. FEP had significant CT reductions in right middle frontal gyrus (MFG) compared with SIB and CON and in superior frontal gyrus (SFG) compared to CON; but SIB did not differ from CON. GLM analyses demonstrated that negative FTD exerted a significant main effect on CT in the MFG and SFG. By contrast, positive FTD showed no significant associations with CT. Neuroimaging-transcriptomic association analysis identified key biological pathways linked to cortical morphology. These findings emphasize the specific association between negative FTD and CT alterations in frontal brain regions, confirming prior reports. Future research should examine larger cohorts and investigate additional FTD subtypes to further elucidate neural correlates and potential familial risks of schizophrenia.
BACKGROUND. Adrenal incidentalomas are common findings at contrast-enhanced CT, yet their management remains controversial. OBJECTIVE. The purpose of this study was to determine the prevalence of malignancy among incidental indeterminate adrenal nodules detected on contrast-enhanced CT in patients without known cancer. METHODS. We performed a 12-institution retrospective cohort study of adult patients without known cancer who underwent contrast-enhanced CT of the abdomen from January 1, 2010, to April 2, 2016. Consecutive reports from 10,646 cases were reviewed. CT images were reviewed for 2603 cases with reports describing an adrenal nodule measuring 1 cm or larger. Malignancy or benignancy was determined using the following reference standards: pathology, diagnostic imaging (attenuation on unenhanced CT < 10 HU or signal-intensity loss at chemical-shift MRI), imaging stability for at least 1 year, or clinical follow-up of at least 5 years. Descriptive statistics were performed using the binomial exact method and chi-square test. RESULTS. The final cohort included 1320 patients (813 women, 507 men; mean age, 63.1 ± 15.2 [SD] years) with 1506 adrenal nodules. Mean nodule size was 2.1 ± 0.7 (SD) cm (range, 1.0-10.7 cm; IQR, 1.6-2.5 cm). The prevalence of malignancy among all nodules, nodules measuring 1-2 cm, nodules measuring 2-4 cm, and nodules measuring more than 4 cm was 0.1% (1/1506; 95% CI, 0.0-0.4%), 0.0% (0/773; 95% CI, 0.0-0.4%), 0.1% (1/694; 95% CI, 0.0-0.8%), and 0.0% (0/39; 95% CI, 0.0-7.4%), respectively. The one malignant nodule was an adrenocortical carcinoma diagnosed 9 years after initial detection. A total of 940 nodules underwent unenhanced CT after the index CT examination; all were benign. Of these, 654 were less than 10 HU, 157 were 10-20 HU, and 129 were more than 20 HU. CONCLUSION. The prevalence of malignancy among incidental indeterminate adrenal nodules on contrast-enhanced CT in patients without known cancer was exceedingly low. CLINICAL IMPACT. Follow-up imaging is not warranted for small (1-2 cm) incidental indeterminate adrenal nodules detected on contrast-enhanced CT in patients without known cancer.
