Asymptomatic infection poses a significant risk for children undergoing hematopoietic stem cell transplantation (HSCT). Pre-transplant surveillance computed tomography (CT) is commonly used to identify occult infection, though its diagnostic yield remains uncertain. We retrospectively reviewed pre-HSCT CT examinations from 635 first-time allogeneic transplant recipients to assess the frequency of occult pulmonary and abdominal infection. Potentially infectious findings were reported in 22% (110/494) of chest CTs but were uncommon in abdomen/pelvis CTs (2%; 7/449). These findings suggest that chest-only surveillance imaging may be more efficient and could reduce unnecessary radiation and contrast exposure in pediatric HSCT candidates.

For people with achondroplasia, the ability to walk pain-free and longer distances is essential for maintaining independence and quality of life. However, due to shorter extremities and misalignments in the lower limbs, the walking pattern of this cohort is often affected. One possible contributing factor is an imbalanced foot-to-leg ratio. Although these structural differences are well documented, research on their specific impact on gait mechanics remains limited. In particular, no studies have investigated how an imbalanced foot-to-leg ratio, among other potential factors, may influence kinematic and kinetic parameters throughout the gait cycle. Therefore, this study examined gait differences between children with achondroplasia (N = 15) and an age-matched (6-12 y) control group (N = 15). Using a 3D motion capture system (Vicon, 13 cameras) and a modified Plug-in-Gait model, spatio-temporal, kinematic, and kinetic parameters were analyzed. Statistical parametric mapping was applied to identify key moments in the gait cycle where significant deviations occurred between the two cohorts. Results showed that all spatio-temporal parameters, except cadence, differed significantly between the groups (p < 0.05). Most kinematic and kinetic parameters also showed significant differences, particularly around initial contact and toe-off. Notably, kinematic deviations were found at the pelvis, hip, and ankle during initial contact. Around toe-off, ankle kinematics were significantly different (p = 0.006). Kinetic differences at the hip and knee in both planes were also evident around toe-off. These findings suggest that an imbalanced foot-to-leg ratio may influence gait patterns, particularly during initial contact and toe-off phases. However, additional factors contributing to these deviations remain to be identified. Further research is necessary to elucidate these influences, which could support the development of more targeted and individualized therapeutic interventions for individuals with ACH.

The primary objective of urolithiasis therapy is complete stone removal and highest stone-clearance rates possible to minimize recurrence. A novel approach that employs a magnetic suspension and a magnetic probe for the passive collection and removal of small residual fragments was developed. This study assessed the feasibility of this system in porcine models. Five female domestic pigs underwent retrograde intrarenal surgery under general anaesthesia to assess the new magnetic system. Pre-analysed human calculi were endoscopically inserted and comminuted using lithotripsy. The magnetic suspension was applied, and the magnetic-stone fragment complex was extracted. After nephrectomy, independent blinded pathologists evaluated all the kidneys. Safety and tolerance assessments revealed no adverse events (i.e. no complications on the Clavien-Dindo scale > 1) or complications associated with treatment. This study revealed superficial urothelial damage in all animals, characterized by desquamation and inflammation, caused primarily by the insertion of access sheaths and laser lithotripsy. Residual magnetic particles were observed in the renal pelvis but did not show signs of toxicity even though this study is limited to the acute treatment. No pathological indicators were observed in the hemogram and urinalysis. Overall, the treatment did not cause any significant pathological changes. Preclinical in vivo evaluation of magnetic extraction of small rest fragments in porcine kidneys presents a promising, atraumatic approach for fragments removal. It demonstrated safety, tolerance, and feasibility that warrants clinical investigation. This method has the potential to increase stone-clearance rates with shorter extraction times, offering a possibility for addressing the challenge of urolithiasis in clinical practice.

Background Gadopiclenol is a macrocyclic gadolinium-based contrast agent (GBCA) with higher relaxivity compared with standard GBCAs, potentially allowing gadolinium dose reduction without decreasing efficacy. Purpose To investigate whether gadopiclenol at 0.05 mmol/kg is noninferior to gadobutrol at 0.1 mmol/kg for lesion visualization in body MRI. Materials and Methods A randomized, double-blind, crossover, phase 3 study was conducted between August 2019 and December 2020 at 33 centers in 11 countries. Adults with at least one suspected focal lesion in one of three different body regions (head and neck; breast, thorax, abdomen, or pelvis; or musculoskeletal system) underwent two contrast-enhanced MRI examinations, randomized to start with either gadopiclenol or gadobutrol. MRI examinations were read by three blinded expert readers for each respective body region. Readers rated border delineation, internal morphologic characteristics, and visual contrast enhancement. Three additional blinded readers assessed reader preference. For safety analysis, adverse events were recorded. The differences between gadopiclenol- and gadobutrol-enhanced MRI in terms of lesion visualization were analyzed with a generalized linear mixed model using a two-sided paired t test. Results Among 273 participants (mean age, 57 years ± 13 [SD]; 162 women) who underwent both gadopiclenol- and gadobutrol-enhanced MRI and had at least one correlating lesion, 260 participants without major protocol deviations were analyzed for noninferiority. Gadopiclenol was noninferior to gadobutrol for all qualitative visualization parameters and for all readers (lower limit 95% CI of the difference of at least -0.10, which was above the noninferiority margin [-0.35]; P < .001). For most participants (75%-83% [206-228 of 276]), readers reported no preference between gadopiclenol- and gadobutrol-enhanced images. Adverse events did not differ in frequency, intensity, type, or association with GBCA injection (12 of 288 participants receiving gadopiclenol and 16 of 290 receiving gadobutrol). Conclusion Gadopiclenol at 0.05 mmol/kg was comparable with gadobutrol at 0.1 mmol/kg for lesion evaluation at contrast-enhanced body MRI and had a similar safety profile. Clinical trial registration no. NCT03986138 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Bashir and Thomas in this issue.

A prerequisite for nerve-sparing pelvic surgery is a thorough understanding of the topographic anatomy of the fine and intricate pelvic nerve networks, and their connections to the central nervous system. Insights into the functions of pelvic nerves will help to interpret disease symptoms correctly and improve treatment. In this article, we review the anatomy and physiology of autonomic pelvic nerves, including their topography and putative functions. The aim is to achieve a better understanding of the mechanisms of pelvic pain and functional disorders, as well as improve their diagnosis and treatment. The information will also serve as a basis for counseling patients with chronic illnesses. A profound understanding of pelvic neuroanatomy will permit complex surgery in the pelvis without relevant nerve injury.

Disaster search dogs traverse diverse and unstable surfaces found in collapsed buildings. It is unknown if the physical conditioning on a treadmill involves the same muscle groups that are involved in rubble search. This 14-week prospective cohort study was conducted to investigate changes within the thermal gradients of specific dog muscles following treadmill compared to rubble search. Nine dogs, ranging in age from 6 months to 4 years, were randomly assigned to one of two groups. Each week the two groups would participate in either 20 min of treadmill or rubble searches. Prior to exercise, the dogs were weighed and then kenneled in a temperature-controlled study room for 20 min at 21°C. Pre-exercise thermal images were then captured of the standing dog from the dorsal, left and right lateral, and caudal perspectives, and of the sitting dog from the rostral perspective. Following a 10-min warm-up period of stretches, dogs proceeded to either treadmill or search. Upon completion, dogs were kenneled in the study room for 20 min prior to post-exercise thermal images. Images were sectioned into 22 muscle regions, the pre-exercise images were subtracted from the post-exercise images to determine the temperature difference (ΔT) for that dog, on that day, for that activity. Thermography measures radiant energy, temperature, and converts this information into an image. This study looked at ΔT within a region pre and post-exercise. The study failed to find a statistically significant difference in the ΔT within each muscle group between treadmill and search activities. There was a decrease in ΔT within all muscle regions over the of the study except for the right cranial shoulder, right caudal shoulder, and right hamstring for the treadmill activity only. The decrease was significant in the pelvis, left longissimus, right cranial shoulder for the search activity, left oblique, left caudal shoulder, and left quadricep muscular regions. These findings suggest that ΔT in muscle groups are similar between treadmill exercise and rubble search. Regardless of the exercise type, 14 weeks of structured Search and Rescue training and treadmill exercise resulted in less ΔT associated with a structured weekly exercise.

In young children, growth-friendly spinal implants with bilateral rib to pelvis fixation are used to control progressive spinal deformity. Whereas curve progression, complications and side-effects have been extensively studied in this patient population, no data are available on gait pattern changes and postural body adjustments. Our study evaluates whether gait pattern changed for ambulatory children treated with bilateral rib to pelvis implants compared to age-matched healthy children. In this small cohort study, gait analysis was performed using spatiotemporal and kinematic parameters of four ambulatory children with severe scoliosis and growth-friendly spinal implants using the bilateral rib to pelvis fixation. Data were statistically analyzed and compared to seven healthy age-matched children. Between both groups, no differences were seen in walking speed, cadence and stride length. The treated patients showed a lower range of motion of the pelvic obliquity and of the trunk obliquity and rotation, but a higher knee flexion. Growth-friendly spinal implants with bilateral rib to pelvis fixation are commonly used in wheelchair children and rarely indicated in ambulatory patients. The presented data show reduced trunk and pelvis motion using this implant construct. These findings help to understand body postural adjustments and add valuable information for families and care providers when considering this surgery. Level of evidence: Therapeutic level IV.

The objective of this study was to determine the response of the lumbar spinal motor control in different gravitational conditions. This was accomplished by measuring indicators of lumbar motor control, specifically lumbar spinal stiffness, activity of lumbar extensor and flexor muscles and lumbar curvature, in hypergravity and microgravity during parabolic flights. Three female and five male subjects participated in this study. The mean age was 35.5 years (standard deviation: 8.5 years). Spinal stiffness of the L3 vertebra was measured using impulse response; activity of the erector spinae, multifidi, transversus abdominis, and psoas muscles was recorded using surface electromyography; and lumbar curvature was measured using distance sensors mounted on the back-plate of a full-body harness. An effect of gravity condition on spinal stiffness, activity of all muscles assessed and lumbar curvature (p's < 0.007) was observed (Friedman tests). Post hoc analysis showed a significant reduction in stiffness during hypergravity (p < 0.001) and an increase in stiffness during microgravity (p < 0.001). Activity in all muscles significantly increased during hypergravity (p's < 0.001). During microgravity, the multifidi (p < 0.002) and transversus abdominis (p < 0.001) increased significantly in muscle activity while no significant difference was found for the psoas (p = 0.850) and erector spinae muscles (p = 0.813). Lumbar curvature flattened in hypergravity as well as microgravity, albeit in different ways: during hypergravity, the distance to the skin decreased for the upper (p = 0.016) and the lower sensor (p = 0.036). During microgravity, the upper sensor showed a significant increase (p = 0.016), and the lower showed a decrease (p = 0.005) in distance. This study emphasizes the role of spinal motor control adaptations in changing gravity conditions. Both hypergravity and microgravity lead to changes in spinal motor control. The decrease in spinal stiffness during hypergravity is interpreted as a shift of the axial load from the spine to the pelvis and thoracic cage. In microgravity, activity of the multifidi and of the psoas muscles seems to ensure the integrity of the spine. Swiss (BASEC-NR: 2018-00051)/French "EST-III" (Nr-ID-RCB: 2018-A011294-51/Nr-CPP: 18.06.09).