Diprosopus: a review of the aetiology and case report of early surgery in a 7-week-old infant with partial facial duplication

Abstract

Diprosopus is a rare craniofacial anomaly and is considered a subgroup of conjoined twinning. It encompasses a broad spectrum of duplications from single structure doubling to two completely formed heads on one neck. The aetiology of diprosopus remains a controversial topic, and many hypotheses exist. A multifactorial causal relationship is feasible because of the coexistence of other internal system anomalies of cardiac, gastrointestinal, neurological and respiratory origin. Ovid and PubMed databases were searched, using the key words: "diprosopus", "craniofacial duplication" and "duplicated mandible". The identified literature and key referenced articles therein were examined. The purpose was to consolidate the existing body of knowledge on the aetiology and management of diprosopus in order to improve our understanding of this rare condition. Our case report is relatively unique in that it represents a complete duplication of the mandible. Other tissues that were duplicated include the tongue, floor of mouth and the lower lip. It was hypothesised that associated growth abnormalities of the facial skeleton could undergo spontaneous correction if the duplicated mandible and associated tissues were excised early. On review, surgery is the only treatment that can offer functional, aesthetic and psychological improvement. Most patients who were offered surgery (in the reviewed literature) had a partial facial duplication. Surgery is usually deferred until the patient is older when more soft tissue is available to perform the reconstruction and when there would possibly be less growth restriction due to growth centre manipulation. This finding on the timing of surgery was in direct conflict with our hypothesis.

Level of Evidence: Level V, therapeutic study.

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Diprosopus: a review of the aetiology and case report of early surgery in a 7-week-old infant with partial facial duplication

Abstract

Diprosopus is a rare craniofacial anomaly and is considered a subgroup of conjoined twinning. It encompasses a broad spectrum of duplications from single structure doubling to two completely formed heads on one neck. The aetiology of diprosopus remains a controversial topic, and many hypotheses exist. A multifactorial causal relationship is feasible because of the coexistence of other internal system anomalies of cardiac, gastrointestinal, neurological and respiratory origin. Ovid and PubMed databases were searched, using the key words: "diprosopus", "craniofacial duplication" and "duplicated mandible". The identified literature and key referenced articles therein were examined. The purpose was to consolidate the existing body of knowledge on the aetiology and management of diprosopus in order to improve our understanding of this rare condition. Our case report is relatively unique in that it represents a complete duplication of the mandible. Other tissues that were duplicated include the tongue, floor of mouth and the lower lip. It was hypothesised that associated growth abnormalities of the facial skeleton could undergo spontaneous correction if the duplicated mandible and associated tissues were excised early. On review, surgery is the only treatment that can offer functional, aesthetic and psychological improvement. Most patients who were offered surgery (in the reviewed literature) had a partial facial duplication. Surgery is usually deferred until the patient is older when more soft tissue is available to perform the reconstruction and when there would possibly be less growth restriction due to growth centre manipulation. This finding on the timing of surgery was in direct conflict with our hypothesis.

Level of Evidence: Level V, therapeutic study.

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Atrophy of the ipsilateral mammillary body in unilateral hippocampal sclerosis shown by thin-slice-reconstructed volumetric analysis

Abstract

Purpose

Conventional volumetric analysis could not detect ipsilateral atrophy of the mammillary body in patients with unilateral hippocampal sclerosis. By using thin-slice-reconstructed volumetric analysis, we investigated whether the mammillary body volume is smaller on the hippocampal sclerosis side than in healthy subjects or the non-hippocampal sclerosis side.

Methods

This retrospective study included 45 patients with unilateral hippocampal sclerosis and 30 healthy subjects. Three-dimensional T1WI of 1 mm thicknesses were oversampled to a thickness of 0.2 mm (thin-slice-reconstructed images), and the mammillary bodies were segmented manually to determine mammillary body volume on each side. Mammillary body volumes on the hippocampal sclerosis side were compared with those in healthy subjects or the non-hippocampal sclerosis side.

Results

In patients with right hippocampal sclerosis, right mammillary body volume was both significantly smaller than that in healthy subjects (30.3 ± 10.3 vs. 43.3 ± 8.07 mm³, P < 0.001) and significantly smaller than the left mammillary body volume in each patient (30.3 ± 10.3 vs. 41.4 ± 10.1 mm³, P < 0.001). Similarly, in patients with left hippocampal sclerosis, left mammillary body volume was both significantly smaller than that in healthy subjects (37.7 ± 11.2 vs. 47.0 ± 8.65 mm³, P < 0.001) and significantly smaller than right mammillary body volume in each patient (37.7 ± 11.2 vs. 42.5 ± 7.78 mm³, P = 0.044).

Conclusions

In this study, thin-slice-reconstructed volumetric analysis showed that, in patients with unilateral hippocampal sclerosis, mammillary body volume on the hippocampal sclerosis side is smaller than that in healthy subjects and the non-hippocampal sclerosis side.

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Atrophy of the ipsilateral mammillary body in unilateral hippocampal sclerosis shown by thin-slice-reconstructed volumetric analysis

Abstract

Purpose

Conventional volumetric analysis could not detect ipsilateral atrophy of the mammillary body in patients with unilateral hippocampal sclerosis. By using thin-slice-reconstructed volumetric analysis, we investigated whether the mammillary body volume is smaller on the hippocampal sclerosis side than in healthy subjects or the non-hippocampal sclerosis side.

Methods

This retrospective study included 45 patients with unilateral hippocampal sclerosis and 30 healthy subjects. Three-dimensional T1WI of 1 mm thicknesses were oversampled to a thickness of 0.2 mm (thin-slice-reconstructed images), and the mammillary bodies were segmented manually to determine mammillary body volume on each side. Mammillary body volumes on the hippocampal sclerosis side were compared with those in healthy subjects or the non-hippocampal sclerosis side.

Results

In patients with right hippocampal sclerosis, right mammillary body volume was both significantly smaller than that in healthy subjects (30.3 ± 10.3 vs. 43.3 ± 8.07 mm³, P < 0.001) and significantly smaller than the left mammillary body volume in each patient (30.3 ± 10.3 vs. 41.4 ± 10.1 mm³, P < 0.001). Similarly, in patients with left hippocampal sclerosis, left mammillary body volume was both significantly smaller than that in healthy subjects (37.7 ± 11.2 vs. 47.0 ± 8.65 mm³, P < 0.001) and significantly smaller than right mammillary body volume in each patient (37.7 ± 11.2 vs. 42.5 ± 7.78 mm³, P = 0.044).

Conclusions

In this study, thin-slice-reconstructed volumetric analysis showed that, in patients with unilateral hippocampal sclerosis, mammillary body volume on the hippocampal sclerosis side is smaller than that in healthy subjects and the non-hippocampal sclerosis side.

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Low‐field MRI: An MR physics perspective

Historically, clinical MRI started with main magnetic field strengths in the ∼0.05–0.35T range. In the past 40 years there have been considerable developments in MRI hardware, with one of the primary ones being the trend to higher magnetic fields. While resulting in large improvements in data quality and diagnostic value, such developments have meant that conventional systems at 1.5 and 3T remain relatively expensive pieces of medical imaging equipment, and are out of the financial reach for much of the world. In this review we describe the current state‐of‐the‐art of low‐field systems (defined as 0.25–1T), both with respect to its low cost, low foot‐print, and subject accessibility. Furthermore, we discuss how low field could potentially benefit from many of the developments that have occurred in higher‐field MRI.

In the first section, the signal‐to‐noise ratio (SNR) dependence on the static magnetic field and its impact on the achievable contrast, resolution, and acquisition times are discussed from a theoretical perspective. In the second section, developments in hardware (eg, magnet, gradient, and RF coils) used both in experimental low‐field scanners and also those that are currently in the market are reviewed. In the final section the potential roles of new acquisition readouts, motion tracking, and image reconstruction strategies, currently being developed primarily at higher fields, are presented.

Level of Evidence: 5

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

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Advanced pulmonary MRI to quantify alveolar and acinar duct abnormalities: Current status and future clinical applications

There are serious clinical gaps in our understanding of chronic lung disease that require novel, sensitive, and noninvasive in vivo measurements of the lung parenchyma to measure disease pathogenesis and progressive changes over time as well as response to treatment. Until recently, our knowledge and appreciation of the tissue changes that accompany lung disease has depended on ex vivo biopsy and concomitant histological and stereological measurements. These measurements have revealed the underlying pathologies that drive lung disease and have provided important observations about airway occlusion, obliteration of the terminal bronchioles and airspace enlargement, or fibrosis and their roles in disease initiation and progression. ex vivo tissue stereology and histology are the established gold standards and, more recently, micro‐computed tomography (CT) measurements of ex vivo tissue samples has also been employed to reveal new mechanistic findings about the progression of obstructive lung disease in patients. While these approaches have provided important understandings using ex vivo analysis of excised samples, recently developed hyperpolarized noble gas MRI methods provide an opportunity to noninvasively measure acinar duct and terminal airway dimensions and geometry in vivo, and, without radiation burden. Therefore, in this review we summarize emerging pulmonary MRI morphometry methods that provide noninvasive in vivo measurements of the lung in patients with bronchopulmonary dysplasia and chronic obstructive pulmonary disease, among others. We discuss new findings, future research directions, as well as clinical opportunities to address current gaps in patient care and for testing of new therapies.

Level of Evidence: 5

Technical Efficacy: Stage 5

J. Magn. Reson. Imaging 2019.

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Targeted rapid knee MRI exam using T2 shuffling

Background

MRI is commonly used to evaluate pediatric musculoskeletal pathologies, but same‐day/near‐term scheduling and short exams remain challenges.

Purpose

To investigate the feasibility of a targeted rapid pediatric knee MRI exam, with the goal of reducing cost and enabling same‐day MRI access.

Study Type

A cost effectiveness study done prospectively.

Subjects

Forty‐seven pediatric patients.

Field Strength/Sequence

3T. The 10‐minute protocol was based on T₂ Shuffling, a four‐dimensional acquisition and reconstruction of images with variable T₂ contrast, and a T₁ 2D fast spin‐echo (FSE) sequence. A distributed, compressed sensing‐based reconstruction was implemented on a four‐node high‐performance compute cluster and integrated into the clinical workflow.

Assessment

In an Institutional Review Board‐approved study with informed consent/assent, we implemented a targeted pediatric knee MRI exam for assessing pediatric knee pain. Pediatric patients were subselected for the exam based on insurance plan and clinical indication. Over a 2‐year period, 47 subjects were recruited for the study and 49 MRIs were ordered. Date and time information was recorded for MRI referral, registration, and completion. Image quality was assessed from 0 (nondiagnostic) to 5 (outstanding) by two readers, and consensus was subsequently reached.

Statistical Tests

A Wilcoxon rank‐sum test assessed the null hypothesis that the targeted exam times compared with conventional knee exam times were unchanged.

Results

Of the 49 cases, 20 were completed on the same day as exam referral. Median time from registration to exam completion was 18.7 minutes. Median reconstruction time for T₂ Shuffling was reduced from 18.9 minutes to 95 seconds using the distributed implementation. Technical fees charged for the targeted exam were one‐third that of the routine clinical knee exam. No subject had to return for additional imaging.

Data Conclusion

The targeted knee MRI exam is feasible and reduces the imaging time, cost, and barrier to same‐day MRI access for pediatric patients.

Level of Evidence: 2

Technical Efficacy: Stage 6

J. Magn. Reson. Imaging 2019.

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State of the art: Evaluation and prognostication of myocarditis using cardiac MRI

Myocarditis encompasses both primary and secondary processes causing inflammation of the myocardium. Viral infections are a common secondary cause of myocarditis with important clinical relevance. Viral myocarditis has a varied clinical presentation, potentially resulting in significant morbidity and mortality. Acutely, systolic dysfunction and sudden cardiac death may ensue; chronically, myocarditis may result in a dilated cardiomyopathy requiring heart transplantation. Myocarditis is thought to be one of the most common causes of myocardial infarction with nonobstructive coronary arteries (MINOCA), with important consequences for cardiovascular outcomes. Patients with myocarditis are currently underdiagnosed. Cardiac MRI has evolved as the noninvasive test of choice, with cardiac MRI‐specific diagnostic requirements defined in the Lake Louise Criteria (LLC). Detecting the presence of tissue edema, hyperemia, and necrosis in both acute and chronic stages form the foundation of the LLC. Cardiac MR for chronic myocarditis (greater than 8 weeks from symptom onset) has decreased sensitivity for diagnosis. Emerging sequences such as T₁ and T₂ parametric maps provide tissue characterization regarding inflammation without reliance on reference tissue, overcoming limitations of the LLC. Beyond diagnostic criteria, these imaging techniques have proven useful in further characterizing the diseased tissue, prognostication, and clinical decision‐making. This review describes the utility and evolving use of cardiac MRI in clinical practice.

Level of Evidence: 1

Technical Efficacy Stage: 5

J. Magn. Reson. Imaging 2018;47:1061–1071.

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Primary care referral for knee MRI in the United Kingdom: Association with demography and subsequent surgical intervention

Background

Since 2008 primary care physicians (GPs) in our region have been allowed open access to knee MRI scans. There are questions about whether this changes referral practice and if it is an effective use of resources.

Purpose

To describe the change in demographics of patients referred for knee MRI following implementation of a new referral pathway.

Study Type

Retrospective observational study.

Population

All primary care referrals between 2008 and 2015 for knee MRI from a population of 900,000.

Field Strength/Sequence

Not applicable.

Assessment

Demographic profile and number of knee MRI referrals and subsequent arthroscopies.

Statistical Tests

Comparisons between urban and rural populations used the t‐test. Test for normality used Shapiro–Wilks. Comparison between abnormal MRI proportions used a chi‐squared test.

Results

There were 23,928 knee MRI referrals (10,695 from GPs) between 2000 and 2015. MRI knee referrals rose from 210 in 2008 to 2379 in 2015. The average age of the patient decreased from 46.8 (SD = 14.9) in 2008 to 41.3 (SD = 14.7) in 2015. Conversion to arthroscopy declined from 15.4% to 10.2%, but there was no significant change in abnormal scan proportion. Conversion rates showed no significant difference between rural (9.6%) and urban populations (10.5%). Referral rates were significantly higher in low socioeconomic status areas (47.3% vs. 34.6%). The median referral rate per 1000 patients was 13.8 (interquartile range = 8.4). Referral rates varied widely between practices.

Data Conclusion

Despite a large rise in knee MRI referrals from primary care, there has been no substantial change in the age profile, suggesting that there has been no increase in inappropriate referral of elderly patients in whom MRI is unlikely to influence management. A modest decrease in the conversion rate to arthroscopy may be reasonably offset against a decrease in secondary care referrals. Socioeconomic status of the target population must be considered when planning primary care knee MRI services.

Level of Evidence: 4

Technical Efficacy Stage: 6

J. Magn. Reson. Imaging 2019.

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Low‐field MRI: An MR physics perspective

Historically, clinical MRI started with main magnetic field strengths in the ∼0.05–0.35T range. In the past 40 years there have been considerable developments in MRI hardware, with one of the primary ones being the trend to higher magnetic fields. While resulting in large improvements in data quality and diagnostic value, such developments have meant that conventional systems at 1.5 and 3T remain relatively expensive pieces of medical imaging equipment, and are out of the financial reach for much of the world. In this review we describe the current state‐of‐the‐art of low‐field systems (defined as 0.25–1T), both with respect to its low cost, low foot‐print, and subject accessibility. Furthermore, we discuss how low field could potentially benefit from many of the developments that have occurred in higher‐field MRI.

In the first section, the signal‐to‐noise ratio (SNR) dependence on the static magnetic field and its impact on the achievable contrast, resolution, and acquisition times are discussed from a theoretical perspective. In the second section, developments in hardware (eg, magnet, gradient, and RF coils) used both in experimental low‐field scanners and also those that are currently in the market are reviewed. In the final section the potential roles of new acquisition readouts, motion tracking, and image reconstruction strategies, currently being developed primarily at higher fields, are presented.

Level of Evidence: 5

Technical Efficacy Stage: 1

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SSBbGF

Advanced pulmonary MRI to quantify alveolar and acinar duct abnormalities: Current status and future clinical applications

There are serious clinical gaps in our understanding of chronic lung disease that require novel, sensitive, and noninvasive in vivo measurements of the lung parenchyma to measure disease pathogenesis and progressive changes over time as well as response to treatment. Until recently, our knowledge and appreciation of the tissue changes that accompany lung disease has depended on ex vivo biopsy and concomitant histological and stereological measurements. These measurements have revealed the underlying pathologies that drive lung disease and have provided important observations about airway occlusion, obliteration of the terminal bronchioles and airspace enlargement, or fibrosis and their roles in disease initiation and progression. ex vivo tissue stereology and histology are the established gold standards and, more recently, micro‐computed tomography (CT) measurements of ex vivo tissue samples has also been employed to reveal new mechanistic findings about the progression of obstructive lung disease in patients. While these approaches have provided important understandings using ex vivo analysis of excised samples, recently developed hyperpolarized noble gas MRI methods provide an opportunity to noninvasively measure acinar duct and terminal airway dimensions and geometry in vivo, and, without radiation burden. Therefore, in this review we summarize emerging pulmonary MRI morphometry methods that provide noninvasive in vivo measurements of the lung in patients with bronchopulmonary dysplasia and chronic obstructive pulmonary disease, among others. We discuss new findings, future research directions, as well as clinical opportunities to address current gaps in patient care and for testing of new therapies.

Level of Evidence: 5

Technical Efficacy: Stage 5

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AJ5LLy

Targeted rapid knee MRI exam using T2 shuffling

Background

MRI is commonly used to evaluate pediatric musculoskeletal pathologies, but same‐day/near‐term scheduling and short exams remain challenges.

Purpose

To investigate the feasibility of a targeted rapid pediatric knee MRI exam, with the goal of reducing cost and enabling same‐day MRI access.

Study Type

A cost effectiveness study done prospectively.

Subjects

Forty‐seven pediatric patients.

Field Strength/Sequence

3T. The 10‐minute protocol was based on T₂ Shuffling, a four‐dimensional acquisition and reconstruction of images with variable T₂ contrast, and a T₁ 2D fast spin‐echo (FSE) sequence. A distributed, compressed sensing‐based reconstruction was implemented on a four‐node high‐performance compute cluster and integrated into the clinical workflow.

Assessment

In an Institutional Review Board‐approved study with informed consent/assent, we implemented a targeted pediatric knee MRI exam for assessing pediatric knee pain. Pediatric patients were subselected for the exam based on insurance plan and clinical indication. Over a 2‐year period, 47 subjects were recruited for the study and 49 MRIs were ordered. Date and time information was recorded for MRI referral, registration, and completion. Image quality was assessed from 0 (nondiagnostic) to 5 (outstanding) by two readers, and consensus was subsequently reached.

Statistical Tests

A Wilcoxon rank‐sum test assessed the null hypothesis that the targeted exam times compared with conventional knee exam times were unchanged.

Results

Of the 49 cases, 20 were completed on the same day as exam referral. Median time from registration to exam completion was 18.7 minutes. Median reconstruction time for T₂ Shuffling was reduced from 18.9 minutes to 95 seconds using the distributed implementation. Technical fees charged for the targeted exam were one‐third that of the routine clinical knee exam. No subject had to return for additional imaging.

Data Conclusion

The targeted knee MRI exam is feasible and reduces the imaging time, cost, and barrier to same‐day MRI access for pediatric patients.

Level of Evidence: 2

Technical Efficacy: Stage 6

J. Magn. Reson. Imaging 2019.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SSB6Tn

State of the art: Evaluation and prognostication of myocarditis using cardiac MRI

Myocarditis encompasses both primary and secondary processes causing inflammation of the myocardium. Viral infections are a common secondary cause of myocarditis with important clinical relevance. Viral myocarditis has a varied clinical presentation, potentially resulting in significant morbidity and mortality. Acutely, systolic dysfunction and sudden cardiac death may ensue; chronically, myocarditis may result in a dilated cardiomyopathy requiring heart transplantation. Myocarditis is thought to be one of the most common causes of myocardial infarction with nonobstructive coronary arteries (MINOCA), with important consequences for cardiovascular outcomes. Patients with myocarditis are currently underdiagnosed. Cardiac MRI has evolved as the noninvasive test of choice, with cardiac MRI‐specific diagnostic requirements defined in the Lake Louise Criteria (LLC). Detecting the presence of tissue edema, hyperemia, and necrosis in both acute and chronic stages form the foundation of the LLC. Cardiac MR for chronic myocarditis (greater than 8 weeks from symptom onset) has decreased sensitivity for diagnosis. Emerging sequences such as T₁ and T₂ parametric maps provide tissue characterization regarding inflammation without reliance on reference tissue, overcoming limitations of the LLC. Beyond diagnostic criteria, these imaging techniques have proven useful in further characterizing the diseased tissue, prognostication, and clinical decision‐making. This review describes the utility and evolving use of cardiac MRI in clinical practice.

Level of Evidence: 1

Technical Efficacy Stage: 5

J. Magn. Reson. Imaging 2018;47:1061–1071.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AJZaAN

Primary care referral for knee MRI in the United Kingdom: Association with demography and subsequent surgical intervention

Background

Since 2008 primary care physicians (GPs) in our region have been allowed open access to knee MRI scans. There are questions about whether this changes referral practice and if it is an effective use of resources.

Purpose

To describe the change in demographics of patients referred for knee MRI following implementation of a new referral pathway.

Study Type

Retrospective observational study.

Population

All primary care referrals between 2008 and 2015 for knee MRI from a population of 900,000.

Field Strength/Sequence

Not applicable.

Assessment

Demographic profile and number of knee MRI referrals and subsequent arthroscopies.

Statistical Tests

Comparisons between urban and rural populations used the t‐test. Test for normality used Shapiro–Wilks. Comparison between abnormal MRI proportions used a chi‐squared test.

Results

There were 23,928 knee MRI referrals (10,695 from GPs) between 2000 and 2015. MRI knee referrals rose from 210 in 2008 to 2379 in 2015. The average age of the patient decreased from 46.8 (SD = 14.9) in 2008 to 41.3 (SD = 14.7) in 2015. Conversion to arthroscopy declined from 15.4% to 10.2%, but there was no significant change in abnormal scan proportion. Conversion rates showed no significant difference between rural (9.6%) and urban populations (10.5%). Referral rates were significantly higher in low socioeconomic status areas (47.3% vs. 34.6%). The median referral rate per 1000 patients was 13.8 (interquartile range = 8.4). Referral rates varied widely between practices.

Data Conclusion

Despite a large rise in knee MRI referrals from primary care, there has been no substantial change in the age profile, suggesting that there has been no increase in inappropriate referral of elderly patients in whom MRI is unlikely to influence management. A modest decrease in the conversion rate to arthroscopy may be reasonably offset against a decrease in secondary care referrals. Socioeconomic status of the target population must be considered when planning primary care knee MRI services.

Level of Evidence: 4

Technical Efficacy Stage: 6

J. Magn. Reson. Imaging 2019.

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The frequency and predictors of persistent amenorrhea in premenopausal women with colorectal cancer who received adjuvant chemotherapy

The purpose of this study was to identify the frequency of chemotherapy-induced amenorrhea and associated factors thereof in premenopausal female patients diagnosed with colon cancer. Premenopausal female patients under the age of 50 years who were diagnosed with stages I, II, and III colon cancer were included. A questionnaire surveying personal history including menarche, comorbidities, drugs, other clinical features, and menstrual history during and after completion of chemotherapy was filled by the patients during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. A total of 60 patients were included in the study. Eleven patients had been treated with surgery alone, and 49 patients had received adjuvant chemotherapy with either fluorouracil (5-FU) alone (n=22) or 5-FU+oxaliplatin (n=27). The frequency of persistent amenorrhea 1 year after receiving chemotherapy was 20% in the whole group, 18% in patients who had received adjuvant chemotherapy with 5-FU alone, and 22% in patients who had received chemotherapy with 5-FU+oxaliplatin. Frequency of persistent amenorrhea was 3.5% in patients under the age of 44 years and 42.8% in patients aged 44 years and older. Multivariate analysis showed that age of 44 years and older (hazard ratio: 29.3; 95% confidence interval: 2.8–309.2, P=0.005) and menarche age of 14 years and older (hazard ratio: 7.6; 95% confidence interval: 1.2–49, P=0.076) were significantly associated with increased risk of persistent amenorrhea. In this study, we found that the frequency of persistent amenorrhea was 20% in patients who received 5-FU monotherapy or oxaliplatin-based adjuvant chemotherapy protocols in colon cancer treatment. Older age and later menarche were the factors that increased the risk of persistent amenorrhea 1 year after chemotherapy. Correspondence to Metin Demir, MD, Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey Tel: +90 312 305 2929; fax: +90 312 309 2905; e-mail: dr_metindemir@hotmail.com Received September 11, 2018 Accepted November 12, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Long-term therapy with bevacizumab in a young patient affected by NF-2: a case report and review of the literature

Neurofibromatosis type 2 (NF-2) is an autosomal dominant inherited disease caused by heterozygous mutations in the NF-2 tumor suppressor gene. It is characterized by the development of multiple benign tumors in the central nervous system. A majority of these tumors can be treated with surgery or radiotherapy in the case of the symptomatic disease. Cytotoxic chemotherapy has no established role in the treatment of NF-2. Vascular endothelial growth factor (VEGF) is a critical mediator of tumor angiogenesis and vessel permeability. VEGF and its receptor VEGFR-1 have been detected in schwannomas, and increased levels of these factors correlate with increased rates of tumor growth. The use of bevacizumab has made many progresses in recent years in NF-2 patients. We report a case of a young patient treated with more than 100 administration of bevacizumab, with clinical and instrumental benefits. Correspondence to Olga Nigro, MD, Department of Oncology, Circolo's Hospital, Varese 21100, Italy Tel: +39 033 239 3437; e-mail: nigro.olga3@gmail.com Received September 11, 2018 Accepted November 21, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Cardamonin inhibits the proliferation and metastasis of non-small-cell lung cancer cells by suppressing the PI3K/Akt/mTOR pathway

Cardamonin, a natural chalcone compound, has been reported to exert anticancer effects in several cancers. However, the specific pharmacological actions of cardamonin on human non-small-cell lung cancer (NSCLC) and the potential mechanisms still remain obscure. Here, we investigated the antineoplastic role of cardamonin in NSCLC both in vitro and in vivo. The proliferation of five NSCLC cell lines was inhibited in a dose-dependent and time-dependent manner with cardamonin treatment. In A549 and H460 cells, cardamonin induced apoptosis by activating caspase-3, upregulating Bax, and downregulating Bcl-2. In addition, cardamonin arrested cells in the G2/M phase and inhibited the expression levels of cyclin D1/CDK4. Moreover, cell migration and invasion were suppressed by reversing epithelial–mesenchymal transition with cardamonin treatment. Further study showed that cardamonin reduced the phosphorylation levels of the downstream effectors of phosphoinositide 3-kinase (PI3K), including protein kinase-B (Akt/PKB) and mammalian target of rapamycin (mTOR). Moreover, in the H460 xenograft model, cardamonin significantly retarded tumor growth. Also, in tumor tissues, we found that cardamonin treatment decreased the expression rates of Ki-67, p-Akt, and p-mTOR. These data suggest that cardamonin suppressed NSCLC cell proliferation and inhibited metastasis partly by restraining the PI3K/Akt/mTOR pathway and it might be an effective therapeutic compound for NSCLC in the future. *Zhenyu Li and Gang Wu contributed equally to the writing of this article. Correspondence to Gang Wu, MD, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China Tel/fax: +86 027 65659931; e-mail: xhzlwg@163.com Received May 15, 2018 Accepted October 7, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Cotreatment with sorafenib and oleanolic acid induces reactive oxygen species-dependent and mitochondrial-mediated apoptotic cell death in hepatocellular carcinoma cells

Hepatocellular carcinoma (HCC) is the most common liver malignancy, and the lack of effective chemotherapies underlines the need for novel therapeutic approaches for this disease. Recently, we discovered a novel synergistic induction of cell death by combining sorafenib, the only routinely used palliative chemotherapeutic agent, and the triterpenoid oleanolic acid (OA). However, the underlying mechanisms of action have remained obscure. Here, we report that sorafenib and OA acted in concert to trigger mitochondria-mediated apoptotic cell death, which is dependent on reactive oxygen species (ROS). Sorafenib/OA cotreatment significantly increased ROS production, which was prevented by the ROS scavengers α-tocopherol and MnTBAP. Importantly, rescue experiments showed that ROS were required for sorafenib/OA-induced apoptosis as ROS scavengers protected HCC cells against cell death. In addition, sorafenib and OA cotreatment cooperated to decrease myeloid cell leukaemia-1 expression and to activate Bak, two events that were prevented by ROS scavengers. Bak activation was accompanied by the loss of mitochondrial membrane potential, followed by PARP cleavage, DNA fragmentation and, finally, apoptotic cell death in HCC cells. By providing new insights into the molecular regulation of sorafenib/OA-mediated and ROS-dependent cell death, our study contributes toward the development of novel treatment strategies to overcome sorafenib resistance in HCC. Correspondence to Juliane Liese, MD, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany Tel: +49 641 9854 4701; fax: +49 641 9854 4709; e-mail: juliane.liese@chiru.med.uni-giessen.de Received October 10, 2018 Accepted January 1, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Rectovaginal fistula during treatment with axitinib in a patient with renal cell carcinoma: a case report and review of the literature

Renal cell carcinoma (RCC) is one of the most frequent malignancies of the adults. Its incidence has been increasing steadily by 2–4% each year. Up to 30% of patients present with metastases at diagnosis. It is a highly vascularized cancer because of the hypoxia-induced factor stabilization as a consequence of von Hippel-Lindau inactivation. Hypoxia-induced factor accumulation leads to transactivation of molecules involved in angiogenesis including vascular endothelial growth factor (VEGF) and platelet-derived growth factor. Sunitinib is an oral tyrosine kinase inhibitor that interacts with several angiogenesis receptors including platelet-derived growth factor receptors and VEGF receptors, and is approved for the first-line treatment in metastatic RCC. In terms of tolerability, patients treated with sunitinib showed a higher incidence of diarrhea, vomiting, hypertension, hand–foot syndrome, and neutropenia, a safety profile consistent with what had been observed in earlier phase studies. Axitnib is a potent and selective tyrosine kinase inhibitor of VEGF receptors 1, 2, and 3, and is approved in the second-line setting for patients with metastatic RCC. The tolerability profile of axitinib is favorable. The most commonly reported treatment-related adverse events are diarrhea, hypertension, fatigue, nausea, and dysphonia. Bowel toxicity, especially pneumatosis intestinalis and bowel perforation, is very uncommon. In particular, the incidence of intestinal perforation or fistulae is not well known for sunitinib or axitinib. Here, for the first time, we report the incidence of rectovaginal fistula in a 57-year-old White woman, with RCC, following treatment with sunitinib and axitinib. Correspondence to Olga Nigro, MD, ASST-Settelaghi, Circolo Hospital, Viale Borri 57, 21100 Varese, Varese, Italy Received September 24, 2018 Accepted December 14, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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The frequency and predictors of persistent amenorrhea in premenopausal women with colorectal cancer who received adjuvant chemotherapy

The purpose of this study was to identify the frequency of chemotherapy-induced amenorrhea and associated factors thereof in premenopausal female patients diagnosed with colon cancer. Premenopausal female patients under the age of 50 years who were diagnosed with stages I, II, and III colon cancer were included. A questionnaire surveying personal history including menarche, comorbidities, drugs, other clinical features, and menstrual history during and after completion of chemotherapy was filled by the patients during outpatient visits. Patients who received pelvic radiotherapy were excluded from the study. A total of 60 patients were included in the study. Eleven patients had been treated with surgery alone, and 49 patients had received adjuvant chemotherapy with either fluorouracil (5-FU) alone (n=22) or 5-FU+oxaliplatin (n=27). The frequency of persistent amenorrhea 1 year after receiving chemotherapy was 20% in the whole group, 18% in patients who had received adjuvant chemotherapy with 5-FU alone, and 22% in patients who had received chemotherapy with 5-FU+oxaliplatin. Frequency of persistent amenorrhea was 3.5% in patients under the age of 44 years and 42.8% in patients aged 44 years and older. Multivariate analysis showed that age of 44 years and older (hazard ratio: 29.3; 95% confidence interval: 2.8–309.2, P=0.005) and menarche age of 14 years and older (hazard ratio: 7.6; 95% confidence interval: 1.2–49, P=0.076) were significantly associated with increased risk of persistent amenorrhea. In this study, we found that the frequency of persistent amenorrhea was 20% in patients who received 5-FU monotherapy or oxaliplatin-based adjuvant chemotherapy protocols in colon cancer treatment. Older age and later menarche were the factors that increased the risk of persistent amenorrhea 1 year after chemotherapy. Correspondence to Metin Demir, MD, Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara 06100, Turkey Tel: +90 312 305 2929; fax: +90 312 309 2905; e-mail: dr_metindemir@hotmail.com Received September 11, 2018 Accepted November 12, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Long-term therapy with bevacizumab in a young patient affected by NF-2: a case report and review of the literature

Neurofibromatosis type 2 (NF-2) is an autosomal dominant inherited disease caused by heterozygous mutations in the NF-2 tumor suppressor gene. It is characterized by the development of multiple benign tumors in the central nervous system. A majority of these tumors can be treated with surgery or radiotherapy in the case of the symptomatic disease. Cytotoxic chemotherapy has no established role in the treatment of NF-2. Vascular endothelial growth factor (VEGF) is a critical mediator of tumor angiogenesis and vessel permeability. VEGF and its receptor VEGFR-1 have been detected in schwannomas, and increased levels of these factors correlate with increased rates of tumor growth. The use of bevacizumab has made many progresses in recent years in NF-2 patients. We report a case of a young patient treated with more than 100 administration of bevacizumab, with clinical and instrumental benefits. Correspondence to Olga Nigro, MD, Department of Oncology, Circolo's Hospital, Varese 21100, Italy Tel: +39 033 239 3437; e-mail: nigro.olga3@gmail.com Received September 11, 2018 Accepted November 21, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Cardamonin inhibits the proliferation and metastasis of non-small-cell lung cancer cells by suppressing the PI3K/Akt/mTOR pathway

Cardamonin, a natural chalcone compound, has been reported to exert anticancer effects in several cancers. However, the specific pharmacological actions of cardamonin on human non-small-cell lung cancer (NSCLC) and the potential mechanisms still remain obscure. Here, we investigated the antineoplastic role of cardamonin in NSCLC both in vitro and in vivo. The proliferation of five NSCLC cell lines was inhibited in a dose-dependent and time-dependent manner with cardamonin treatment. In A549 and H460 cells, cardamonin induced apoptosis by activating caspase-3, upregulating Bax, and downregulating Bcl-2. In addition, cardamonin arrested cells in the G2/M phase and inhibited the expression levels of cyclin D1/CDK4. Moreover, cell migration and invasion were suppressed by reversing epithelial–mesenchymal transition with cardamonin treatment. Further study showed that cardamonin reduced the phosphorylation levels of the downstream effectors of phosphoinositide 3-kinase (PI3K), including protein kinase-B (Akt/PKB) and mammalian target of rapamycin (mTOR). Moreover, in the H460 xenograft model, cardamonin significantly retarded tumor growth. Also, in tumor tissues, we found that cardamonin treatment decreased the expression rates of Ki-67, p-Akt, and p-mTOR. These data suggest that cardamonin suppressed NSCLC cell proliferation and inhibited metastasis partly by restraining the PI3K/Akt/mTOR pathway and it might be an effective therapeutic compound for NSCLC in the future. *Zhenyu Li and Gang Wu contributed equally to the writing of this article. Correspondence to Gang Wu, MD, Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China Tel/fax: +86 027 65659931; e-mail: xhzlwg@163.com Received May 15, 2018 Accepted October 7, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Cotreatment with sorafenib and oleanolic acid induces reactive oxygen species-dependent and mitochondrial-mediated apoptotic cell death in hepatocellular carcinoma cells

Hepatocellular carcinoma (HCC) is the most common liver malignancy, and the lack of effective chemotherapies underlines the need for novel therapeutic approaches for this disease. Recently, we discovered a novel synergistic induction of cell death by combining sorafenib, the only routinely used palliative chemotherapeutic agent, and the triterpenoid oleanolic acid (OA). However, the underlying mechanisms of action have remained obscure. Here, we report that sorafenib and OA acted in concert to trigger mitochondria-mediated apoptotic cell death, which is dependent on reactive oxygen species (ROS). Sorafenib/OA cotreatment significantly increased ROS production, which was prevented by the ROS scavengers α-tocopherol and MnTBAP. Importantly, rescue experiments showed that ROS were required for sorafenib/OA-induced apoptosis as ROS scavengers protected HCC cells against cell death. In addition, sorafenib and OA cotreatment cooperated to decrease myeloid cell leukaemia-1 expression and to activate Bak, two events that were prevented by ROS scavengers. Bak activation was accompanied by the loss of mitochondrial membrane potential, followed by PARP cleavage, DNA fragmentation and, finally, apoptotic cell death in HCC cells. By providing new insights into the molecular regulation of sorafenib/OA-mediated and ROS-dependent cell death, our study contributes toward the development of novel treatment strategies to overcome sorafenib resistance in HCC. Correspondence to Juliane Liese, MD, Department of General and Thoracic Surgery, Justus-Liebig-University Giessen, Rudolf-Buchheim-Str. 7, 35385 Giessen, Germany Tel: +49 641 9854 4701; fax: +49 641 9854 4709; e-mail: juliane.liese@chiru.med.uni-giessen.de Received October 10, 2018 Accepted January 1, 2019 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Rectovaginal fistula during treatment with axitinib in a patient with renal cell carcinoma: a case report and review of the literature

Renal cell carcinoma (RCC) is one of the most frequent malignancies of the adults. Its incidence has been increasing steadily by 2–4% each year. Up to 30% of patients present with metastases at diagnosis. It is a highly vascularized cancer because of the hypoxia-induced factor stabilization as a consequence of von Hippel-Lindau inactivation. Hypoxia-induced factor accumulation leads to transactivation of molecules involved in angiogenesis including vascular endothelial growth factor (VEGF) and platelet-derived growth factor. Sunitinib is an oral tyrosine kinase inhibitor that interacts with several angiogenesis receptors including platelet-derived growth factor receptors and VEGF receptors, and is approved for the first-line treatment in metastatic RCC. In terms of tolerability, patients treated with sunitinib showed a higher incidence of diarrhea, vomiting, hypertension, hand–foot syndrome, and neutropenia, a safety profile consistent with what had been observed in earlier phase studies. Axitnib is a potent and selective tyrosine kinase inhibitor of VEGF receptors 1, 2, and 3, and is approved in the second-line setting for patients with metastatic RCC. The tolerability profile of axitinib is favorable. The most commonly reported treatment-related adverse events are diarrhea, hypertension, fatigue, nausea, and dysphonia. Bowel toxicity, especially pneumatosis intestinalis and bowel perforation, is very uncommon. In particular, the incidence of intestinal perforation or fistulae is not well known for sunitinib or axitinib. Here, for the first time, we report the incidence of rectovaginal fistula in a 57-year-old White woman, with RCC, following treatment with sunitinib and axitinib. Correspondence to Olga Nigro, MD, ASST-Settelaghi, Circolo Hospital, Viale Borri 57, 21100 Varese, Varese, Italy Received September 24, 2018 Accepted December 14, 2018 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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< b > < i > Dermatophagoides farinae < /i > < /b > Upregulates the Effector Functions of Eosinophils through αMβ < sub > 2 < /sub > -Integrin and Protease-Activated Receptor-2

Conclusions: These findings suggested that Df extract and Der f 1 directly activate eosinophil functions through αMβ2-integrin and PAR-2. Eosinophil activation by HDM may play roles in the aggravation of allergic symptoms, not only in HDM-sensitized patients, but also in nonsensitized patients.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Role of < b > < i > Aspergillus fumigatus- < /i > < /b > Specific IgE in the Diagnosis of Allergic Bronchopulmonary Aspergillosis

Conclusions: RoutineA. fumigatus-sIgE screening for asthma patients can significantly improve the diagnostic rate of ABPA.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Mastocytosis and the Fig Wasp ( < b > < i > Blastophaga psenes < /i > < /b > )

Conclusions: We cannot exclude the possibility that the ingestion of fig withBlastophaga antigens may have triggered anaphylaxis in our patient.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Early-Life Environmental Factors, IFN- γ Methylation Patterns, and Childhood Allergic Rhinitis

Conclusions: This study suggests that early-life environments affect AR, and this is supported by the finding ofIFN- γY methylation as a mediator of the effect of an individual 's season of birth on AR.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Elevated Periostin Concentrations in the Bronchoalveolar Lavage Fluid of Patients with Eosinophilic Pneumonia

Conclusions: Although some blood leakage may be involved in the elevation of periostin in the BALF of EP, periostin can be induced locally, at least in part. Therefore, periostin may play a role in the development of EP.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome Drugs Derived From Pigs Could Be Risky in People With Alpha-Gal Syndrome

People with alpha-gal syndrome may develop allergic reactions to drugs that contain ingredients derived from pigs, researchers in Europe report.Reuters Health Information (Source: Medscape Allergy Headlines)

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< b > < i > Dermatophagoides farinae < /i > < /b > Upregulates the Effector Functions of Eosinophils through αMβ < sub > 2 < /sub > -Integrin and Protease-Activated Receptor-2

Conclusions: These findings suggested that Df extract and Der f 1 directly activate eosinophil functions through αMβ2-integrin and PAR-2. Eosinophil activation by HDM may play roles in the aggravation of allergic symptoms, not only in HDM-sensitized patients, but also in nonsensitized patients.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Role of < b > < i > Aspergillus fumigatus- < /i > < /b > Specific IgE in the Diagnosis of Allergic Bronchopulmonary Aspergillosis

Conclusions: RoutineA. fumigatus-sIgE screening for asthma patients can significantly improve the diagnostic rate of ABPA.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Mastocytosis and the Fig Wasp ( < b > < i > Blastophaga psenes < /i > < /b > )

Conclusions: We cannot exclude the possibility that the ingestion of fig withBlastophaga antigens may have triggered anaphylaxis in our patient.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Early-Life Environmental Factors, IFN- γ Methylation Patterns, and Childhood Allergic Rhinitis

Conclusions: This study suggests that early-life environments affect AR, and this is supported by the finding ofIFN- γY methylation as a mediator of the effect of an individual 's season of birth on AR.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Elevated Periostin Concentrations in the Bronchoalveolar Lavage Fluid of Patients with Eosinophilic Pneumonia

Conclusions: Although some blood leakage may be involved in the elevation of periostin in the BALF of EP, periostin can be induced locally, at least in part. Therefore, periostin may play a role in the development of EP.Int Arch Allergy Immunol (Source: International Archives of Allergy and Immunology)

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Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss

Conclusion: Round window niche drilling increases the contact area and time of methylprednisolone. It is an effective and safe salvage therapy of idiopathic SSNHL and its induced tinnitus.Audiol Neurotol 2018;23:309 –315 (Source: Audiology and Neurotology)

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Cannabinoid drugs: will they relieve or exacerbate tinnitus?

Purpose of review Recent enthusiasm for cannabinoid drugs for the treatment of chronic pain and some forms of epilepsy, raises the question of whether they could be useful for other disorders associated with abnormal neuronal activity in the brain, such as subjective tinnitus. Indeed, there is evidence to indicate that some tinnitus sufferers self-medicate using Cannabis. The aim of this review is to critically evaluate the available evidence relating to the effects of cannabinoids on tinnitus. Recent findings Despite the fact that cannabinoids have been shown to decrease neuronal hyperactivity in many parts of the brain, the current evidence suggests that in auditory brain regions such as the dorsal cochlear nucleus, they have the potential to facilitate neuronal hyperactivity and ex...

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Influence of stimulus presentation rate on intraoperative ECAP thresholds in cochlear implant users

. (Source: International Journal of Audiology)

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Round Window Niche Drilling with Intratympanic Steroid Is a Salvage Therapy of Sudden Hearing Loss

Conclusion: Round window niche drilling increases the contact area and time of methylprednisolone. It is an effective and safe salvage therapy of idiopathic SSNHL and its induced tinnitus.Audiol Neurotol 2018;23:309 –315 (Source: Audiology and Neurotology)

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Cannabinoid drugs: will they relieve or exacerbate tinnitus?

Purpose of review Recent enthusiasm for cannabinoid drugs for the treatment of chronic pain and some forms of epilepsy, raises the question of whether they could be useful for other disorders associated with abnormal neuronal activity in the brain, such as subjective tinnitus. Indeed, there is evidence to indicate that some tinnitus sufferers self-medicate using Cannabis. The aim of this review is to critically evaluate the available evidence relating to the effects of cannabinoids on tinnitus. Recent findings Despite the fact that cannabinoids have been shown to decrease neuronal hyperactivity in many parts of the brain, the current evidence suggests that in auditory brain regions such as the dorsal cochlear nucleus, they have the potential to facilitate neuronal hyperactivity and ex...

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Influence of stimulus presentation rate on intraoperative ECAP thresholds in cochlear implant users

. (Source: International Journal of Audiology)

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The additional genetic diagnosis of homozygous sickle cell disease in a patient with Waardenburg-Shah syndrome: a case report

ConclusionSickle cell disease can be diagnosed by newborn screening but, as in this case, may have a delayed presentation. The delay in diagnosis of homozygous sickle cell disease illustrates that other genetic disorders should be considered in patients who already have a diagnosis of one Mendelian disorder but show atypical features. (Source: Journal of Medical Case Reports)

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The additional genetic diagnosis of homozygous sickle cell disease in a patient with Waardenburg-Shah syndrome: a case report

ConclusionSickle cell disease can be diagnosed by newborn screening but, as in this case, may have a delayed presentation. The delay in diagnosis of homozygous sickle cell disease illustrates that other genetic disorders should be considered in patients who already have a diagnosis of one Mendelian disorder but show atypical features. (Source: Journal of Medical Case Reports)

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Special edition on unilateral deafness and hearing loss: An introduction and overview

Publication date: February 2019

Source: Hearing Research, Volume 372

Author(s): K.A. Gordon, B.C. Papsin

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Editorial Board

Publication date: February 2019

Source: Hearing Research, Volume 372

Author(s):

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Special edition on unilateral deafness and hearing loss: An introduction and overview

Publication date: February 2019

Source: Hearing Research, Volume 372

Author(s): K.A. Gordon, B.C. Papsin

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Editorial Board

Publication date: February 2019

Source: Hearing Research, Volume 372

Author(s):

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A practical guide to linking brain-wide gene expression and neuroimaging data

Publication date: Available online 12 January 2019

Source: NeuroImage

Author(s): Aurina Arnatkevic̆iūtė, Ben D. Fulcher, Alex Fornito

Abstract

The recent availability of comprehensive, brain-wide gene expression atlases such as the Allen Human Brain Atlas (AHBA) has opened new opportunities for understanding how spatial variations on the molecular scale relate to the macroscopic neuroimaging phenotypes. A rapidly growing body of literature is demonstrating relationships between gene expression and diverse properties of brain structure and function, but approaches for combining expression atlas data with neuroimaging are highly inconsistent, with substantial variations in how the expression data are processed. The degree to which these methodological variations affect findings is unclear. Here, we outline a seven-step analysis pipeline for relating brain-wide transcriptomic and neuroimaging data and compare how different processing choices influence the resulting data. We suggest that studies using AHBA should work towards a unified data processing pipeline to ensure consistent and reproducible results in this burgeoning field.

Graphical abstract

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Clinical outcomes and management of facial nerve in patients with parotid gland cancer and pretreatment facial weakness

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Woori Park, Jongwon Park, Song I. Park, Hackjung Kim, Hyunsik Bae, Junhun Cho, Hojeong Won, Minsu Park, Han-Sin Jeong

Abstract

Objectives

In parotid gland cancer (PGC), it is not clear whether facial weakness always reflects tumor invasion of the facial nerve (FN) requiring nerve resection. The aims of this study were to evaluate oncological and functional outcomes in patients with PGC and pre-treatment facial weakness, and to analyze local tumor invasion of the FN.

Materials and methods

The clinical outcomes of patients (n = 45) with PGC and pretreatment facial weakness were retrospectively analyzed. Patients had undergone 1 of 4 types of treatments: complete tumor resection, FN sacrifice with or without FN reconstruction, tumor resection with FN preservation and primary non-surgical treatments. Pathologic specimens in patients with nerve resection patients (n = 26) were reviewed to identify FN invasion by the tumor.

Results

Patients with PGC and facial weakness had poor clinical outcomes (44.0%, 3Y progression-free survival), and 86.7% of tumors were high-grade. In these subjects, regional or distant metastasis was an independent prognostic factor for survival. Recovery from facial weakness was suboptimal in patients with FN graft. In cases with nerve resection, 26.9% had intra-neural tumor invasion, 42.3% had perineural invasion, and 30.8% had no neural invasion in the FN.

Conclusion

Facial weakness did not always indicate tumor invasion of the FN in PGC. Thus, the decision regarding FN resection can reasonably be further based on intraoperative findings. In cases with incomplete facial weakness and safe separation of the FN from the tumor, FN preservation offers the best functional outcomes, without compromising oncological outcomes.

Graphical abstract

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A practical guide to linking brain-wide gene expression and neuroimaging data

Publication date: Available online 12 January 2019

Source: NeuroImage

Author(s): Aurina Arnatkevic̆iūtė, Ben D. Fulcher, Alex Fornito

Abstract

The recent availability of comprehensive, brain-wide gene expression atlases such as the Allen Human Brain Atlas (AHBA) has opened new opportunities for understanding how spatial variations on the molecular scale relate to the macroscopic neuroimaging phenotypes. A rapidly growing body of literature is demonstrating relationships between gene expression and diverse properties of brain structure and function, but approaches for combining expression atlas data with neuroimaging are highly inconsistent, with substantial variations in how the expression data are processed. The degree to which these methodological variations affect findings is unclear. Here, we outline a seven-step analysis pipeline for relating brain-wide transcriptomic and neuroimaging data and compare how different processing choices influence the resulting data. We suggest that studies using AHBA should work towards a unified data processing pipeline to ensure consistent and reproducible results in this burgeoning field.

Graphical abstract

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Clinical outcomes and management of facial nerve in patients with parotid gland cancer and pretreatment facial weakness

Publication date: February 2019

Source: Oral Oncology, Volume 89

Author(s): Woori Park, Jongwon Park, Song I. Park, Hackjung Kim, Hyunsik Bae, Junhun Cho, Hojeong Won, Minsu Park, Han-Sin Jeong

Abstract

Objectives

In parotid gland cancer (PGC), it is not clear whether facial weakness always reflects tumor invasion of the facial nerve (FN) requiring nerve resection. The aims of this study were to evaluate oncological and functional outcomes in patients with PGC and pre-treatment facial weakness, and to analyze local tumor invasion of the FN.

Materials and methods

The clinical outcomes of patients (n = 45) with PGC and pretreatment facial weakness were retrospectively analyzed. Patients had undergone 1 of 4 types of treatments: complete tumor resection, FN sacrifice with or without FN reconstruction, tumor resection with FN preservation and primary non-surgical treatments. Pathologic specimens in patients with nerve resection patients (n = 26) were reviewed to identify FN invasion by the tumor.

Results

Patients with PGC and facial weakness had poor clinical outcomes (44.0%, 3Y progression-free survival), and 86.7% of tumors were high-grade. In these subjects, regional or distant metastasis was an independent prognostic factor for survival. Recovery from facial weakness was suboptimal in patients with FN graft. In cases with nerve resection, 26.9% had intra-neural tumor invasion, 42.3% had perineural invasion, and 30.8% had no neural invasion in the FN.

Conclusion

Facial weakness did not always indicate tumor invasion of the FN in PGC. Thus, the decision regarding FN resection can reasonably be further based on intraoperative findings. In cases with incomplete facial weakness and safe separation of the FN from the tumor, FN preservation offers the best functional outcomes, without compromising oncological outcomes.

Graphical abstract

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Four or 6 implants in the maxillary posterior region to support an overdenture: 5‐year results from a randomized controlled trial

Abstract

Objective

To compare clinical and patient‐reported outcomes when providing maxillary overdentures on 4‐bar and 6‐bar connected implants placed in the posterior region during a 5‐year follow‐up period.

Materials and methods

Sixty‐six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either 4 or 6 implants in the posterior maxilla and 4 implants in the mandible. After 3 months of osseointegration, a bar‐supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri‐implant bone height changes and patient satisfaction were assessed.

Results

Sixty patients completed the 5‐year follow‐up. Implant survival was 100% in the 4‐implants group and 99.5% in the 6‐implants group. No new overdentures had to be made in the 4‐implants group, three new overdentures were made in the 6‐implants group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58±0.51 mm in the 4‐implants group and 0.60±0.58 mm in the 6‐implants group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups.

Conclusion

Following a bilateral maxillary sinus floor elevation procedure, a bar‐supported overdenture on 4 implants in the posterior maxillary region is not inferior to an overdenture supported by 6 implants after a 5‐year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption.

This article is protected by copyright. All rights reserved.

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Bone Response to Porous Tantalum Implants in a Gap Healing Model

Abstract

Objectives

The objective of this study was to determine the relative osteogenic behavior of titanium implants with or without a porous tantalum modification when placed with a gap between the implant and existing bone.

Materials and Methods

A gap‐healing model in the rabbit tibia was used for placement of titanium implants. Forty‐eight rabbits received 96 implants, with 48 of the implants containing a porous tantalum middle section and the remaining 48 implants were composed of solid titanium. After 4, 8 and 12 weeks of healing, biomechanical stability was measured with removal torque testing, implant‐adherent cells were isolated for analysis of osteogenic gene expression, and histomorphometric analysis was performed on sections of the implants and surrounding bone.

Results

Increased osteogenic activity at 4 weeks was demonstrated by upregulation of key osteogenic genes at implants containing porous tantalum which was accompanied by greater bone‐implant contact at 4, 8 and 12 weeks and significantly greater removal torque at 8 and 12 weeks.

Conclusions

Implants containing porous tantalum demonstrated increased peri‐implant bone formation within this gap‐healing model as shown by significant differences in biomechanical and histomorphometric outcomes. Such implants may represent an alternative to influence bone healing in surgical sites with an existing gap.

This article is protected by copyright. All rights reserved.

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High 222Rn concentrations and dynamics in Shawan Cave, southwest China

Publication date: April 2019

Source: Journal of Environmental Radioactivity, Volumes 199–200

Author(s): Yanwei Wang, Weijun Luo, Guangneng Zeng, Yang Wang, Hanling Yang, Meifang Wang, Lin Zhang, Xianli Cai, Jia Chen, Anyun Cheng, Shijie Wang

Abstract

Cave ²²²Rn has been a major health issue and subject of scientific debate for decades. While the basics of natural ventilation physics are well understood, it is difficult to make blind predictions of ²²²Rn concentrations in a given cave due to the complexity of cave systems. In-situ continuous observation is necessary to improve our ability to quantify radiation dose exposure and reduce radiation hazard to cave users, and trace the air exchange patterns occurring in caves. In this study, continuous monitoring using a RAD7 radon detector revealed high ²²²Rn concentrations and large fluctuations in ²²²Rn concentration in a small karst cave in southwest China, Shawan Cave. From August 2016 to July 2017, the average annual concentration was 47,419 Bqm⁻³ and ranged between 3720 and 123,000 Bqm⁻³, with lower values during summer than other seasons. Taking Shawan Cave as a case study, we suggest a framework to evaluate the potential dose exposure, allowing cave users to minimize risk of exposure to hazardous levels of ²²²Rn. Furthermore, we comparing results from this study with other studies in 35 caves worldwide, and conclude that there are three patterns of seasonal ²²²Rn variation. They were classified into five types of ventilation mode based on diversity of cave locations, geometry and connectivity of bed rock fracture networks, together with temperature differences between outside atmosphere and cave air.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AHr1S8

Four or 6 implants in the maxillary posterior region to support an overdenture: 5‐year results from a randomized controlled trial

Abstract

Objective

To compare clinical and patient‐reported outcomes when providing maxillary overdentures on 4‐bar and 6‐bar connected implants placed in the posterior region during a 5‐year follow‐up period.

Materials and methods

Sixty‐six fully edentulous patients with functional maxillary denture complaints and insufficient bone volume to allow implant placement were scheduled for a maxillary sinus floor elevation procedure with bone from the anterior iliac crest and randomized to receive either 4 or 6 implants in the posterior maxilla and 4 implants in the mandible. After 3 months of osseointegration, a bar‐supported overdenture was constructed. Maxillary implant survival, overdenture survival, clinical scores, peri‐implant bone height changes and patient satisfaction were assessed.

Results

Sixty patients completed the 5‐year follow‐up. Implant survival was 100% in the 4‐implants group and 99.5% in the 6‐implants group. No new overdentures had to be made in the 4‐implants group, three new overdentures were made in the 6‐implants group due to excessive wear of the denture base and teeth (90.9% overdenture survival). Clinical parameters did not differ significantly between groups. Mean marginal bone loss compared to baseline was 0.58±0.51 mm in the 4‐implants group and 0.60±0.58 mm in the 6‐implants group, respectively. Overall, patient satisfaction improved significantly, but did not differ between groups.

Conclusion

Following a bilateral maxillary sinus floor elevation procedure, a bar‐supported overdenture on 4 implants in the posterior maxillary region is not inferior to an overdenture supported by 6 implants after a 5‐year evaluation period in patients with functional maxillary denture complaints and marked posterior resorption.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AIRVcl

Bone Response to Porous Tantalum Implants in a Gap Healing Model

Abstract

Objectives

The objective of this study was to determine the relative osteogenic behavior of titanium implants with or without a porous tantalum modification when placed with a gap between the implant and existing bone.

Materials and Methods

A gap‐healing model in the rabbit tibia was used for placement of titanium implants. Forty‐eight rabbits received 96 implants, with 48 of the implants containing a porous tantalum middle section and the remaining 48 implants were composed of solid titanium. After 4, 8 and 12 weeks of healing, biomechanical stability was measured with removal torque testing, implant‐adherent cells were isolated for analysis of osteogenic gene expression, and histomorphometric analysis was performed on sections of the implants and surrounding bone.

Results

Increased osteogenic activity at 4 weeks was demonstrated by upregulation of key osteogenic genes at implants containing porous tantalum which was accompanied by greater bone‐implant contact at 4, 8 and 12 weeks and significantly greater removal torque at 8 and 12 weeks.

Conclusions

Implants containing porous tantalum demonstrated increased peri‐implant bone formation within this gap‐healing model as shown by significant differences in biomechanical and histomorphometric outcomes. Such implants may represent an alternative to influence bone healing in surgical sites with an existing gap.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2SRb2b3

High 222Rn concentrations and dynamics in Shawan Cave, southwest China

Publication date: April 2019

Source: Journal of Environmental Radioactivity, Volumes 199–200

Author(s): Yanwei Wang, Weijun Luo, Guangneng Zeng, Yang Wang, Hanling Yang, Meifang Wang, Lin Zhang, Xianli Cai, Jia Chen, Anyun Cheng, Shijie Wang

Abstract

Cave ²²²Rn has been a major health issue and subject of scientific debate for decades. While the basics of natural ventilation physics are well understood, it is difficult to make blind predictions of ²²²Rn concentrations in a given cave due to the complexity of cave systems. In-situ continuous observation is necessary to improve our ability to quantify radiation dose exposure and reduce radiation hazard to cave users, and trace the air exchange patterns occurring in caves. In this study, continuous monitoring using a RAD7 radon detector revealed high ²²²Rn concentrations and large fluctuations in ²²²Rn concentration in a small karst cave in southwest China, Shawan Cave. From August 2016 to July 2017, the average annual concentration was 47,419 Bqm⁻³ and ranged between 3720 and 123,000 Bqm⁻³, with lower values during summer than other seasons. Taking Shawan Cave as a case study, we suggest a framework to evaluate the potential dose exposure, allowing cave users to minimize risk of exposure to hazardous levels of ²²²Rn. Furthermore, we comparing results from this study with other studies in 35 caves worldwide, and conclude that there are three patterns of seasonal ²²²Rn variation. They were classified into five types of ventilation mode based on diversity of cave locations, geometry and connectivity of bed rock fracture networks, together with temperature differences between outside atmosphere and cave air.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2AHr1S8

Transcranial Direct Current Stimulation (tDCS) and trigeminal pain: a pre‐clinical study

Abstract

Objective

Our objective was to evaluate the tDCS effect on facial allodynia induced by chronic constriction of the infraorbital nerve (CCI‐ION) and on the brainstem levels of TNF‐α, NGF, IL‐10 and, serum LDH in rats.

Methods

Rats were exposed to the CCI‐ION model. Facial allodynia was assessed by Von Frey filaments test at baseline, 3, 7, 10 and 14 days post‐surgery and24h and 7 days after the bimodal tDCS sessions for 20 min/day/8 days.

Results

CCI‐ION induced a significant decrease in the mechanical threshold 14 days after surgery. This effect was reversed by tDCS treatment, with the mechanical threshold returning to basal levels at 24h after the end of the treatment and it persisted for 7 days after the end of the treatment. tDCS also decreased LDH serum levels compared to those in the control group. There was an interaction between pain and treatment with respect to brainstem levels of NGF, TNF‐α, and IL‐10.

Conclusion

CCI‐ION model was effective in establishing trigeminal neuropathic pain on 14 days after surgery, and tDCS reduced allodynia and LDH serum levels and promoted alterations in NGF, TNF‐α, and IL‐10 brainstem levels. Thus, we suggest that tDCS may be a potential therapy in the trigeminal pain treatment.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RJibgs

Transcranial Direct Current Stimulation (tDCS) and trigeminal pain: a pre‐clinical study

Abstract

Objective

Our objective was to evaluate the tDCS effect on facial allodynia induced by chronic constriction of the infraorbital nerve (CCI‐ION) and on the brainstem levels of TNF‐α, NGF, IL‐10 and, serum LDH in rats.

Methods

Rats were exposed to the CCI‐ION model. Facial allodynia was assessed by Von Frey filaments test at baseline, 3, 7, 10 and 14 days post‐surgery and24h and 7 days after the bimodal tDCS sessions for 20 min/day/8 days.

Results

CCI‐ION induced a significant decrease in the mechanical threshold 14 days after surgery. This effect was reversed by tDCS treatment, with the mechanical threshold returning to basal levels at 24h after the end of the treatment and it persisted for 7 days after the end of the treatment. tDCS also decreased LDH serum levels compared to those in the control group. There was an interaction between pain and treatment with respect to brainstem levels of NGF, TNF‐α, and IL‐10.

Conclusion

CCI‐ION model was effective in establishing trigeminal neuropathic pain on 14 days after surgery, and tDCS reduced allodynia and LDH serum levels and promoted alterations in NGF, TNF‐α, and IL‐10 brainstem levels. Thus, we suggest that tDCS may be a potential therapy in the trigeminal pain treatment.

This article is protected by copyright. All rights reserved.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RJibgs

Variations in right colic vascular anatomy observed during laparoscopic right colectomy

This study aimed to analyze right colonic vascular variability.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RoMolj

Variations in right colic vascular anatomy observed during laparoscopic right colectomy

This study aimed to analyze right colonic vascular variability.

from #Head and Neck by Sfakianakis via simeraentaxei on Inoreader http://bit.ly/2RoMolj