Refining the predictive value of preoperative apparent diffusion coefficient (ADC) by whole-tumor analysis for facial nerve outcomes in vestibular schwannomas

BACKGROUND

Apparent diffusion coefficient (ADC) in MRI has been shown to correlate with postoperative House-Brackmann (HB) scores in patients with vestibular schwannoma despite limited methodology. To rectify limitations of single region of interest (ROI) sampling, we hypothesize that whole-tumor ADC histogram analysis will refine the predictive value of this preoperative biomarker related to postoperative facial nerve function.

METHODS

Of 155 patients who underwent resection of vestibular schwannoma (2014-2020), 125 patients were included with requisite clinical and radiographic data. After volumetric analysis and whole-tumor ADC histogram, regression tree analysis identified ADC cutoff for significant differences in HB grade. Outcomes were extent of resection, facial nerve function, hospital length of stay (LOS), and complications.

RESULTS

Regression tree analysis defined three quantitative ADC groups (× 10-6 mm2/s) as high (> 2248.77; HB 1.7), mid (1468.44-2248.77; HB 3.1), and low (< 1468.44; HB 2.3) range (p 0.04). The mid-range ADC group had significantly worse postoperative HB scores and longer hospital LOS. Large tumor volume was independently predictive of lower rates of gross total resection (p <0.0001), higher postoperative HB score (p 0.002), higher rate of complications (p 0.04), and longer LOS (p 0.003).

CONCLUSIONS

Whole-tumor histogram yielded a robust regression tree analysis that defined three ADC groups with significantly different facial nerve outcomes. This likely reflects tumor heterogeneity better than solid-tumor ROI sampling. Whole-tumor ADC warrants further study as a useful radiographic biomarker in patients with vestibular schwannoma who are considering surgical resection.

Compatibility of standard vagus nerve stimulation and investigational microburst vagus nerve stimulation therapy with functional magnetic resonance imaging

Vagus nerve stimulation devices are conditionally approved in MRI with stimulation turned off and the requirement to modify the stimulation settings may be a barrier to scanning in some radiology practices. There is increasing interest in studying the effects of stimulation during MRI/fMRI. This study evaluated the safety of standard and investigational microburst vagus nerve stimulation therapies during MRI/fMRI. A prospective, multi-center study was conducted in patients with an investigational vagus nerve stimulation device that delivered either standard or investigational microburst vagus nerve stimulation. Thirty participants underwent sequential MRI and fMRI scans encompassing 188 total hours of scan time (62.7 hours with standard vagus nerve stimulation and 125.3 with investigational microburst vagus nerve stimulation). No adverse events were reported with active stimulation during MRI or during 12 months of follow-up. Our results support the safety and standard and investigational microburst vagus nerve stimulation therapy during MRI and fMRI scans.ABBREVIATIONS: VNS = vagus nerve stimulation; µVNS = microburst VNS; DRE = drug-resistant epilepsy; U.S. = United States; FOS = focal onset seizures; PGTC = primary generalized tonic-clonic seizures; IDE = investigational device exemption; SD = standard deviation; EEG = electroencephalogram.

Surgical outcomes in large vestibular schwannomas: should cerebellopontine edema be considered in the grading systems?

PURPOSE

Large (> 3 cm) vestibular schwannomas pose complexity in surgical management because of narrow working corridors and proximity to the cranial nerves, brainstem, and inner ear structures. With current vestibular schwannoma classifications limited in information regarding cerebellopontine edema, our retrospective series examined this radiographic feature relative to clinical outcomes and its possible role in preoperative scoring.

METHODS

Of 230 patients who underwent surgical resection of vestibular schwannoma (2014-2020), we identified 107 patients with Koos grades 3 or 4 tumors for radiographic assessment of edema in the middle cerebellar peduncle (MCP), brainstem, or both. Radiographic images were graded and patients grouped into Koos grades 3 or 4 or our proposed grade 5 with edema. Tumor volumes, radiographic features, clinical presentations, and clinical outcomes were evaluated.

RESULTS

The 107 patients included 22 patients with grade 3 tumors, 39 with grade 4, and 46 with grade 5. No statistical differences were noted among groups for demographic data or complication rates. Unlike grades 3 and 4 patients, grade 5 patients presented with worse hearing (p < 0.001), larger tumors (p < 0.001), lower rates of gross total resection (GTR), longer hospital stays, and higher rates of balance dysfunction.

CONCLUSION

With edema detected in 43% of this cohort, special considerations are warranted for grade 5 vestibular schwannomas given the preoperative findings of worse hearing, lower GTR rates, longer hospital stays, and 96% who pursued postoperative balance therapy. We propose that grade 5 with edema offers a more nuanced interpretation of a radiographic feature that holds relevance to treatment selection and patient outcomes.

A phase I/Ib trial and biological correlate analysis of neoadjuvant SBRT with single-dose durvalumab in HPV-unrelated locally advanced HNSCC

Five-year survival for human papilloma virus-unrelated head and neck squamous cell carcinomas remain below 50%. We assessed the safety of administering combination hypofractionated stereotactic body radiation therapy with single-dose durvalumab (anti-PD-L1) neoadjuvantly (n = 21) ( NCT03635164 ). The primary endpoint of the study was safety, which was met. Secondary endpoints included radiographic, pathologic and objective response; locoregional control; progression-free survival; and overall survival. Among evaluable patients at an early median follow-up of 16 months (448 d or 64 weeks), overall survival was 80.1% with 95% confidence interval (95% CI) (62.0%, 100.0%), locoregional control and progression-free survival were 75.8% with 95% CI (57.5%, 99.8%), and major pathological response or complete response was 75% with 95% exact CI (51.6%, 100.0%). For patients treated with 24 Gy, 89% with 95% CI (57.1%, 100.0%) had MPR or CR. Using high-dimensional multi-omics and spatial data as well as biological correlatives, we show that responders had: (1) an increase in effector T cells; (2) a decrease in immunosuppressive cells; and (3) an increase in antigen presentation post-treatment.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Spinal Cord Tissue Bridges Validation Study: Predictive Relationships With Sensory Scores Following Cervical Spinal Cord Injury

Background

Using magnetic resonance imaging (MRI), widths of ventral tissue bridges demonstrated significant predictive relationships with future pinprick sensory scores, and widths of dorsal tissue bridges demonstrated significant predictive relationships with future light touch sensory scores, following spinal cord injury (SCI). These studies involved smaller participant numbers, and external validation of their findings is warranted.

Objectives

The purpose of this study was to validate these previous findings using a larger independent data set.

Methods

Widths of ventral and dorsal tissue bridges were quantified using MRI in persons post cervical level SCI (average 3.7 weeks post injury), and pinprick and light touch sensory scores were acquired at discharge from inpatient rehabilitation (average 14.3 weeks post injury). Pearson product-moments were calculated and linear regression models were created from these data.

Results

Wider ventral tissue bridges were significantly correlated with pinprick scores (r = 0.31, p < 0.001, N = 136) and wider dorsal tissue bridges were significantly correlated with light touch scores (r = 0.31, p < 0.001, N = 136) at discharge from inpatient rehabilitation.

Conclusion

This retrospective study's results provide external validation of previous findings, using a larger sample size. Following SCI, ventral tissue bridges hold significant predictive relationships with future pinprick sensory scores and dorsal tissue bridges hold significant predictive relationships with future light touch sensory scores.

The effects of capparis spinosa ethanol extracts on humoral immune responses in mice treated with aflatoxin B1

The results of this investigation had demonstrated the production of aflatoxins from Aspergillus flavus and study effects on humoral immune by measuring the concentrations of immunoglobulins IgA, IgG, IgM, IgE and measurement of concentrations of the complements C3, C4 in mice with treated of Aflatoxin B1. The results of qualities analysis HPLC showed the ability of isolation of Aspergillus flavus from chips, macroni, red sun flower, shamia, hazelnut, corn and peanut and isolate from fish to produce aflatoxin with different rate. The isolation of Aspergillus flavus which isolated from peanuts recoded the highest rate of production of aflatoxin B1 which it reached to (213760.28) ppm. 40 male mice were used experimentation they divided into eight groups. Three groups of mice were gave aflatoxin B1 56.3 ppm and after 2 hours treated by ethanolic extracts crude phenol and alkaloid in 250 mg/ ml while the fourth group was given aflatoxin B1 only, while the fifth, sixth and seventh groups were treated with ethanolic extracts only and the eight group was given control groups PBS. The results of study showed a significant increase in concentrations immunoglobulins IgA, IgG, IgM in the mice that dosage of extracts crude after gave aflatoxin B1 56.3 ppm it reached the highest concentration of IgA, IgG, IgM (139. 06, 3223.80, 339.66) mg/ 100 ml respectively compared with positive control that gave aflatoxin only it reached IgA, IgG, IgM (20. 23, 108.66, 25.30) mg/ 100 ml respectively. The results of the study also recoded a significant increase in the IgE concentration of 22 IU in mice that gave the crude extract after giving aflatoxin B1 with concentrations of 56.3 ppm compared to positive control of 2.83 IU. The results of the study showed a significant increase in concentration of complements C3, C4 in mice that dosage ethanolic extracts crude phenols and alkaloid after two hours gave aflatoxin B1. The highest concentration of C3, C4 (279.33, 132.20) mg/ 100 ml respectively in mice that gave crude extract after given aflatoxin B1 in compared with positive control that gave aflatoxin B1 only it reached concentrations C3, C4 (12, 17.50) mg/ 100 ml respectively. We concluded of that caper plant has immune stimulatory effects in mice.

Building for tomorrow today: opportunities and directions in radiology resident research

RATIONALE AND OBJECTIVES

With rapid scientific and technological advancements in radiological research, there is renewed emphasis on promoting early research training to develop researchers who are capable of tackling the hypothesis-driven research that is typically funded in contemporary academic research enterprises. This review article aims to introduce radiology residents to the abundant radiology research opportunities available to them and to encourage early research engagement among trainees.

MATERIALS AND METHODS

To encourage early resident participation in radiology research, we review the various research opportunities available to trainees spanning basic, clinical, and translational science opportunities to ongoing research in information technology, informatics, and quality improvement research.

CONCLUSIONS

There is an incredible breadth and depth of ongoing research at academic radiology departments across the country, and the material presented herein aspires to highlight both subject matter and opportunities available to radiology residents eager to engage in radiologic research. The opportunities for interested radiology residents are as numerous as they are broad, spanning the basic sciences to clinical research to informatics, with abundant opportunities to shape our future practice of radiology.

Vegetarian diet as a risk factor for tuberculosis in immigrant south London Asians

BACKGROUND

In a previous retrospective study of tuberculosis in south London among Asian immigrants from the Indian subcontinent Hindu Asians were found to have a significantly increased risk for tuberculosis compared with Muslims. This finding has been further investigated by examining the role of socioeconomic and lifestyle variables, including diet, as risk factors for tuberculosis in Asian immigrants from the Indian subcontinent resident in south London.

METHODS

Using a case-control study technique Asian immigrants from the Indian subcontinent diagnosed with tuberculosis during the past 10 years and two Asian control groups (community and outpatient clinic controls) from the Indian subcontinent were investigated. Cases and community controls were approached by letter. A structured questionnaire concerning a range of demographic, migration, socioeconomic, dietary, and health topics was administered by a single trained interviewer to subjects (56 cases and 100 controls) who agreed to participate.

RESULTS

The results confirmed earlier findings that Hindu Asians had an increased risk of tuberculosis compared with Muslims. However, further analysis revealed that religion had no independent influence after adjustment for vegetarianism (common among Hindu Asians). Unadjusted odds ratios for tuberculosis among vegetarians were 2.7 (95% CI 1.1 to 6.4) using community controls, and 4.3 (95% CI 1.8 to 10.4) using clinic controls. There was a trend of increasing risk of tuberculosis with decreasing frequency of meat or fish consumption. Lactovegetarians had an 8.5 fold risk (95% CI 1.6 to 45.4) compared with daily meat/fish eaters. Adjustment for a range of other socioeconomic, migration, and lifestyle variables made little difference to the relative risks derived using either community or clinic controls.

CONCLUSIONS

These results indicate that a vegetarian diet is an independent risk factor for tuberculosis in immigrant Asians. The mechanism is unexplained. However, vitamin D deficiency, common among vegetarian Asians in south London, is known to affect immunological competence. Decreased immunocompetence associated with a vegetarian diet might result in increased mycobacterial reactivation among Asians from the Indian subcontinent.

Primary neuroendocrine carcinoma of the skin arising from the post aural region

Neuroendocrine carcinoma of the skin is an uncommon neoplasm. A case of one such tumour in the head and neck region is being presented. This case is the youngest known patient. The literature has been reviewed. The current concepts in diagnosis and management of this tumour are discussed.