Determination of periodic deformation from InSAR results using the FFT time series analysis method in Gediz Graben

Permanent Scatterers (PS) point velocities obtained by the interferometric synthetic aperture radar (InSAR) method are generally determined using the linear regression model, which ignores periodic and seasonal effects. In this study, software was developed that can detect periodic effects by applying fast Fourier transformation (FFT) time series analysis to InSAR results. Using the FFT time series analysis, the periodic components of the surface movements at the PS points were determined, and then the annual velocity values free from periodic effects were obtained. The study area was chosen as the Gediz Graben, a tectonically active region where aseismic surface deformations have been observed in recent years. As a result, using the developed method, seasonal effects were successfully determined with the InSAR method at the PS points in the study area with a period of 384 days and an average amplitude of 19 mm. In addition, groundwater level changes of a water well in the region were modeled, and 0.93 correlation coefficient values were calculated between seasonal InSAR displacement values and water level changes. Thus, using the developed methodology, the relationship between the tectonic movement in the Gediz Graben in Turkey and the seasonal movements and the change in the groundwater level was determined.

Evaluate the safety and efficacy of dura sealant patch in reducing cerebrospinal fluid leakage following elective cranial surgery (ENCASE II): study protocol for a randomized, two-arm, multicenter trial

BACKGROUND

Cerebrospinal fluid (CSF) leakage is a frequent and challenging complication in neurosurgery, especially in the posterior fossa, with a prevalence of 8%. It is associated with substantial morbidity and increased healthcare costs. A novel dural sealant patch (LIQOSEAL) was developed for watertight dural closure. The objective of this study is to clinically assess the safety and effectiveness of LIQOSEAL as a means of reducing intra- as well as postoperative CSF leakage in patients undergoing elective posterior fossa intradural surgery with a dural closure procedure compared to the best currently available dural sealants.

METHODS

We will conduct a two-arm, randomized controlled, multicenter study with a 90-day follow-up. A total of 228 patients will be enrolled in 19 sites, of which 114 will receive LIQOSEAL and 114 an FDA-approved PEG sealant. The composite primary endpoint is defined as intraoperative CSF leakage at PEEP 20 cm H₂O, percutaneous CSF leakage within 90 days of, wound infection within 90 days of or pseudomeningocele of more than 20cc on MRI or requiring intervention. We hypothesize that the primary endpoint will not be reached by more than 10 patients (9%) in the investigational arm, which will demonstrate non-inferiority of LIQOSEAL compared to control.

DISCUSSION

This trial will evaluate whether LIQOSEAL is non-inferior to control as a means of reducing CSF leakage and safety TRIAL REGISTRATION: ClinicalTrials.gov NCT04086550 . Registered on 11 September 2019.

POS1357 THE 10-YEAR OUTCOME OF PATIENTS WITH BEHCET’S SYNDROME: A SINGLE-CENTER EXPERIENCE

Background

Behcet’s syndrome (BS) is a vasculitis characterized by recurrent oral and genital ulcers, as well as ocular, cutaneous, vascular, gastrointestinal, musculoskeletal, and central nervous system manifestations.

Objectives

The study aimed to evaluate the 10-year outcome of patients with BS.

Methods

A cohort of 682 patients diagnosed with BS between January 2007 and December 2009 in the rheumatology outpatient clinic of Gulhane Training and Research Hospital were re-evaluated in November 2021. The data regarding the clinical course of 84 patients (84/682) were obtained from patients’ files and detailed telephone interviews.

Results

The study included 84 patients (63 male, 21 female) with a mean age of 47.1±10.6 years. The mean disease duration was 17.6±5.7 years. At the time of the diagnosis, the mean age of the patients was 29.5±9.4 years. Oral ulcer (100%), papulopustular lesions (82.1%), genital ulcer (77.4%), and erythema nodosum (59.5%) were the most frequent manifestations at the time of diagnosis. Ocular (46.4%), musculoskeletal (35.7%), vascular (19%), gastrointestinal (3.6%), and neurological (1.2%) manifestations were seen in decreasing frequency. The most frequent ocular disease was posterior uveitis, whereas superficial thrombophlebitis and deep venous thrombosis were the most prevalent forms of vascular involvement. One patient had transverse myelitis as neurological involvement. Colchicine (88.1%) and corticosteroids (57.1%) were the most preferred drugs for the initial treatment. Fifty-one (60.7%) patients received at least one immunosuppressive agent. After 10-year, there was a statistically significant decrease in all manifestations of BS (Table 1). Nevertheless, 9 (10.7%) patients (8 male, 1 female) had new clinical findings. Five patients had (5.9%) mucocutaneous, 2 (2.4 %) arthritis and 2 (2.4%) vascular lesions as new clinical manifestations. The mean age of the patients with newly onset clinical findings was 48±8.9 years. There was no statistically significant difference between patients with and without new clinical findings with respect to age (p=0.79). The new onset mucocutaneous manifestations were genital ulcer and erythema nodosum. Besides, new onset vascular lesions were superficial and deep venous thrombosis of the lower extremities. The mean age of the patients who developed venous thrombosis at the time of the assessment was 37.0±7.07 years. Vascular involvement was detected more frequently in younger patients (p=0.03). However, ocular involvement is a frequent symptom after mucocutaneous involvement at the beginning, none of the patients had new eye involvement at the end of the follow-up. Colchicine, corticosteroid, and azathioprine were associated with the highest drug survival. Twenty-one (41.1%) patients of who were administered immunosuppressive agents as initial therapy were still using immunosuppressives 10 year later. The most frequently prescribed immunosuppressives were azathioprine and cyclosporine during the follow-up.

Table 1.

Clinical manifestations of Behcet’s syndrome

InitialAfter 10 yearspNoYesOral ulceration, n (%)No000<0.001*Yes84 (100)42 (50)42 (50)Genital ulceration, n (%)No19 (22.7)16 (84.2)3 (15.8)<0.001**Yes65 (77.4)54 (83.1)11 (16.9)Erythema nodosum and Papulopustular lesions, n (%)No6 (7.1)4 (66.7)2 (33.3)<0.001**Yes78 (92.9)44 (56.4)34 (43.6)Arthritis, n (%)No54 (64.3)52 (96.3)2 (3.7)<0.001**Yes30 (35.7)21 (70)9 (30)Vascular involvement, n (%)No68 (81)66 (97.1)2 (2.9)0.013**Yes16 (19)12 (75)4 (25)Gastrointestinal involvement, n (%)No81 (96.4)81 (100)0<0.001*Yes3 (3.6)3 (100)0Ocular involvement, n (%)No45 (53.6)45 (100)0<0.001**Yes39 (46.4)29 (74.4)10 (25.6)Neurological involvement, n (%)No83 (98.8)83 (100)0<0.001*Yes1 (1.2)1 (100)0

*McNemar-Bowker Test, **McNemar Test

Conclusion

The frequency of newly onset clinical manifestations decreases with age in BS, especially after age 40. Besides, especially male Behcet’s patients should be followed-up regularly for complications that may develop regardless of age.

Disclosure of Interests

None declared

Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura

OBJECTIVE

Helicobacter pylori (H. pylori) eradication therapy is known to increase the platelet count, but in immune thrombocytopenic purpura (ITP), the effect of H. pylori infection on the response to treatment is not clear. This study aims to determine whether the response to the first-line treatment is affected by the states of H. pylori-positivity and -negativity in ITP patients.

PATIENTS AND METHODS

Adult newly diagnosed or chronic ITP patients who had not received eradication therapy for H. pylori infection were included. Characteristics of the patients, presence and severity of bleeding, initial platelet count, administered treatments, and treatment response rates were inspected.

RESULTS

Of 119 total patients, 66 (55.5%) were female, 32 (26.9%) were H. pylori-positive, 87 (73.1%) were H. pylori-negative. H. pylori-positive and H. pylori-negative groups were not significantly different in terms of age (p=0.127), gender (p=0.078), diagnosis status (p=0.094) and the distribution of bleeding symptoms (p=0.712). The most common treatment was standard-dose steroid in both groups (62.5% vs. 68.9%, p=0.524). Rates of complete response, partial response, no response were comparable for the two groups (respectively, 75% vs. 73.6%, and 18.8% vs. 19.5%, and 6.2% vs. 6.9%), and there was no significant difference between the groups (p=0.283).

CONCLUSIONS

It can be stated according to the present study that in ITP patients in whom treatment is indicated, the response to the first-line treatment without the administration of H. pylori eradication therapy is similar between H. pylori-positive and H. pylori-negative patients.

The clinicopathological features and survival of Castleman disease: a multicenter Turkish study

OBJECTIVE

In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns.

PATIENTS AND METHODS

This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey.

RESULTS

The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died.

CONCLUSIONS

It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Serum asymmetric-dimethylarginine, apelin and NT-pro BNP levels in dialysis patients

Background

The relationships among serum Apelin, Asymmetric- dimethylarginine (ADMA), N-terminal probrain natriureticpeptide (NT-proBNP) levels, and blood pressures in dialysis patients are not well known.

Materials and Methods

Age and sex matched 30 hemodialysis (HD), 30 peritoneal dialysis (PD) patients, and 20 healthy controls were recruited. Serum apelin-36, ADMA, NT-proBNP levels, and blood pressures of both patients and healthy controls were measured and compared.

Results

Serum ADMA and Apelin levels in HD patients were significantly higher than in PD patients. In multiple regression analyses the predictors of higher serum apelin levels were higher BMI, higher ADMA and lower systolic blood pressure. The predictors of serum ADMA levels were being on HD. The predictors of serum NT-proBNP levels were lower serum albumin and higher systolic blood pressure.

Conclusion

Being on HD is a predictor of high ADMA levels. HD might be less effective on ADMA removal than PD. It seems that higher serum apelin levels related with lower sytolic blood pressure levels, whereas higher NT-proBNP levels related with higher sytolic blood pressure levels indicating potential roles as independent prognostic factors for systolic hypertension in dialysis patients.

Does the plasma application time affect the tensile bond strength between PMMA and a silicone-based denture liner?

Aims

This study evaluated the effect of oxygen plasma and argon plasma treatments with different application times on tensile bonding of a silicone-based denture liner to polymethylmetacrylate (PMMA).

Methods

Seven groups (n = 5) were prepared and six of them treated by argon plasma or oxygen plasma with 30s, 60s, and 120s, respectively; one group was left untreated served as control. After processing of denture liner, the specimens were deflasked and stored dry for 24 h, and they were then subjected to tensile bond strength testing. Differences in tensile bond strength values were determined using one-way ANOVA (α = 0.05).

Results

Highest tensile bond strengths were observed in the oxygen plasma groups, followed by untreated group and argon plasma groups in turn in order. Tensile bond strenght were increased with time for both type of plasma applications tested.

Conclusion

This study suggests that the adhesion between PMMA and denture liner is improved under conditions of oxygen plasma treatment with extended exposure time rather than argon plasma treatment.

Distinguishing Extravascular from Intravascular Ferumoxytol Pools within the Brain: Proof of Concept in Patients with Treated Glioblastoma

BACKGROUND AND PURPOSE

Glioblastoma-associated macrophages are a major constituent of the immune response to therapy and are known to engulf the iron-based MR imaging contrast agent, ferumoxytol. Current ferumoxytol MR imaging techniques for localizing macrophages are confounded by contaminating intravascular signal. The aim of this study was to assess the utility of a newly developed MR imaging technique, segregation and extravascular localization of ferumoxytol imaging, for differentiating extravascular-from-intravascular ferumoxytol contrast signal at a delayed 24-hour imaging time point.

MATERIALS AND METHODS

Twenty-three patients with suspected post-chemoradiotherapy glioblastoma progression underwent ferumoxytol-enhanced SWI. Segregation and extravascular localization of ferumoxytol imaging maps were generated as the voxelwise difference of the delayed (24 hours) from the early (immediately after administration) time point SWI maps. Continuous segregation and extravascular localization of ferumoxytol imaging map values were separated into positive and negative components. Image-guided biologic correlation was performed.

RESULTS

Negative segregation and extravascular localization of ferumoxytol imaging values correlated with early and delayed time point SWI values, demonstrating that intravascular signal detected in the early time point persists into the delayed time point. Positive segregation and extravascular localization of ferumoxytol imaging values correlated only with delayed time point SWI values, suggesting successful detection of the newly developed extravascular signal.

CONCLUSIONS

Segregation and extravascular localization of ferumoxytol MR imaging improves on current techniques by eliminating intrinsic tissue and intravascular ferumoxytol signal and may inform glioblastoma outcomes by serving as a more specific metric of macrophage content compared with uncorrected T1 and SWI techniques.

The impact of TFPI on coronary atherosclerotic burden

OBJECTIVES

We aimed to associate a coronary artery disease (CAD) presence and severity with endothelial dysfunction (ED), carotid intima media thickness (CIMT) and Tissue Factor Pathway Inhibitor (TFPI).

BACKGROUND

ED has a central role in atherosclerosis. CIMT and TFPI activity are also related with atherosclerosis and CAD.

METHODS

In our prospective observational study, 50 patients had CAD and 30 had normal coronary arteries. Endothelial function was evaluated by endothelium-dependent flow-mediated dilatation (FMD) and nitroglycerine-mediated dilatation (NMD) measurements. CIMT and Serum TFPI levels were also measured.

RESULTS

TFPI was a statistically significant determinant between the two groups with an increased level in CAD (+) group (84.9 ± 19.3 vs 70.2 ± 14.7, p = 0.001). There was a positive correlation between CIMT and Gensini (r = 0.34, p = 0.014). There was a strong negative correlation between Gensini and FMD-NMD, statistically significant (FMD: r = -0.715, p < 0.001; NMD: r = -0.718, p < 0.001).

CONCLUSION

We observed that ED, increased CIMT and TFPI levels were associated with CAD. Additionally, increased CIMT measurements and decreased FMD and NMD values had a positive correlation with GSS (Tab. 4, Fig. 6, Ref. 50).

Vascular calcification is not related to serum fetuin-A and osteopontin levels in hemodialysis patients

INTRODUCTION

Vascular calcification (VC) in hemodialysis (HD) patients is a sign of severe cardiovascular disease and can predict cardiovascular outcomes. Fetuin-A and osteopontin (OPN) inhibit VC. Serum fetuin-A levels are lower in patients with end-stage kidney disease (ESKD) and in those who are on chronic HD therapy. However, there are limited data concerning OPN in patients who are on dialysis. The aim of our study was to determine VC in HD patients, the relationship between VC and 25-OH-vitamin D, fetuin-A, and OPN levels, and independent predictors of VC.

MATERIALS AND METHODS

Ninety-three patients with ESKD on HD therapy were recruited. Among these patients, 44 were male and 49 were female. The patient group was compared with a group of 20 healthy controls of similar age and sex. A plain radiograph of the hand was taken using a mammography machine for the evaluation of VC. Serum fetuin-A, OPN, and 25-OH-vitamin D levels of both patients and controls were measured.

RESULTS

VC was detected in 45 (48.4%) HD patients. When patients were compared with healthy controls, fetuin-A levels (p < 0.029) were significantly lower in patients, whereas OPN (p < 0.000) and VC (p < 0.002) were significantly higher in the patient group. Age [odds ratio (OR) 1.036], the presence of diabetes mellitus (DM) (OR 17.527), and high parathyroid hormone (PTH) levels (OR 1.002) were independent predictors of VC in a logistic regression model including the following factors: age, the presence of DM, HD duration, and serum albumin, phosphate, PTH, 25-OH-vitamin D, fetuin-A, OPN, and calcium levels. No significant correlation was found between patients with VC and patients without VC in terms of fetuin-A, OPN, and 25-OH-vitamin D levels.

CONCLUSIONS

VC is a frequent sign in patients undergoing HD and is not related to serum fetuin-A and osteopontin levels. Age, the presence of DM, and high PTH levels were independent predictors of VC in patients undergoing HD. Further studies are warranted to understand the mechanism underlying and the factors contributing to VC.

Investigation of the relationship between non-alcoholic fatty liver disease and coronary artery disease

AIMS

The purpose of the study was to examine the association between visceral adiposity form of non-alcoholic fatty liver and coronary artery disease severity and also to investigate the relationship between the epicardial adipose tissue thickness and non-alcoholic fatty liver disease with clinical and anthropometric measurements.

MATERIALS AND METHODS

This study included 105 patients (mean age of patients were 57 ± 11, 82 of them male) who were hospitalized for coronary angiography because of chest pain. Nonalcoholic fatty liver disease was investigated by using ultrasonography. Thickness of the epicardial adipose tissue was measured by transthorasic echocardiography to right ventricular free wall adjacent to the parasternal long and short axis images. Gensini score was used for the severity of coronary artery disease.

RESULTS

In patients with non-alcoholic fatty liver disease, right ventricular free wall epicardial adipose tissue thickness average of parasternal long and short axis were thicker than those who do not have non alcholic fatty liver disease (0,90 ± 0,19 cm; 0.58 ± 0.18 cm, p<0.001). Also, in patients with severe coronary artery disease, right ventricular free wall parasternal long and short axis average thickness of epicardial fat tissue was thicker than those of patients without severe coronary stenosis (0.86 ± 0.21 cm; 0,66 ± 0.26 cm, p=0.001). For predictability of coronary artery disease, Receiver Operating Characteristic analysis of the area under the curve was found to be 0.60 (50.2 to 74.7, 95% Confidence Limits).

CONCLUSIONS

Not only the fatty tissue which surrounds the heart effects the coronary arteries but also other visceral organs adiposity effects the coronary arteries atherosclerotic process.

Ninety-five orthotopic transplantations in 74 women of ovarian tissue after cytotoxic treatment in a fertility preservation network: tissue activity, pregnancy and delivery rates

STUDY QUESTION

What is the success rate in terms of ovarian activity (menstrual cycles) as well as pregnancy and delivery rates 1 year after orthotopic ovarian transplantations conducted in a three-country network?

SUMMARY ANSWER

In 49 women with a follow-up >1 year after transplantation, the ovaries were active in 67% of cases and the pregnancy and delivery rates were 33 and 25%, respectively.

WHAT IS KNOWN ALREADY

Cryopreservation of ovarian tissue in advance of cytotoxic therapies and later transplantation of the tissue is being performed increasingly often, and the total success rates in terms of pregnancy and delivery have been described in case series. However, published case series have not allowed either a more detailed analysis of patients with premature ovarian insufficiency (POI) or calculation of success rates based on the parameter 'tissue activity'.

STUDY DESIGN, SIZE, DURATION

Retrospective analysis of 95 orthotopic transplantations in 74 patients who had been treated for cancer, performed in the FertiPROTEKT network from 2008 to June 2015. Of those 95 transplantations, a first subgroup (Subgroup 1) was defined for further analysis, including 49 women with a follow-up period >1 year after transplantation. Of those 49 women, a second subgroup (Subgroup 5) was further analysed, including 40 women who were transplanted for the first time and who were diagnosed with POI before transplantation.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Transplantation was performed in 16 centres and data were transferred to the FertiPROTEKT registry. The transplantations were carried out after oncological treatment had been completed and after a remission period of at least 2 years. Tissue was transplanted orthotopically, either into or onto the residual ovaries or into a pelvic peritoneal pocket. The success rates were defined as tissue activity (menstrual cycles) after 1 year (primary outcome) and as pregnancies and deliveries achieved.

MAIN RESULTS AND THE ROLE OF CHANCE

The average age of all transplanted 74 women was 31 ± 5.9 years at the time of cryopreservation and 35 ± 5.2 at the time of transplantation. Twenty-one pregnancies and 17 deliveries were recorded. In Subgroup 1, tissue was cryopreserved at the age of 30 ± 5.6 and transplanted at 34 ± 4.9 years. Ovaries remained active 1 year after transplantation in 67% of cases (n = 33/49), the pregnancy rate was 33% (n = 16/49) and the delivery rate was 25% (n = 12/49). In Subgroup 5, tissue was cryopreserved at the age 30 ± 5.9 years and transplanted at 34 ± 5.2 years. Ovaries remained active 1 year after transplantation in 63% of cases (n = 25/40), the pregnancy rate was 28% (n = 11/40) and the delivery rate was 23% (n = 9/40). The success rates were age dependant with higher success in women who cryopreserved at a younger age. In Subgroup 5, tissue was exclusively transplanted into the ovary in 10% (n = 4/40) of women and into a peritoneal pocket in 75% (n = 30/40), resulting in spontaneous conceptions in 91% of patients (n = 10/11).

LIMITATIONS, REASONS FOR CAUTION

The data were drawn from a retrospective analysis. The cryopreservation and transplantation techniques used have changed during the study period. The tissue was stored in many tissue banks and many surgeons were involved, leading to heterogeneity of the procedures. However, this does reflect the realistic situation in many countries. Although patients with POI were evaluated before transplantation to allow specific analysis of the transplanted tissue itself, the possibility cannot be excluded that residual ovarian tissue was also reactivated.

WIDER IMPLICATIONS OF THE FINDINGS

This is the largest case series worldwide to date and it confirms that cryopreservation and transplantation of ovarian tissue can be a successful option for preserving fertility. Persistent tissue activity 12 months after transplantation suggests that the pregnancy and delivery rates may increase further in the future. As transplantation into the peritoneum results in a high success rate, this approach may be an alternative to transplantation into the ovary. However, in order to establish the best transplantation site, a randomized study is required.

STUDY FUNDING/COMPETING INTEREST

This study was in part funded from the Deutsche Forschungsgemeinschaft (# DI 1525) and the Wilhelm Sander Foundation (2012.127.1) and did not receive any funding from a commercial company. No competing interests.

TRIAL REGISTRATION NUMBER

None.

Preoperative Association of Abdominal Striae Gravidarum with Intraabdominal Adhesions in Pregnant Women with a History of Previous Cesarean Section: a Cross-sectional Study

Introduction: Intraabdominal adhesions that develop because of prior abdominal or pelvic surgery may cause problems during surgery. Complications can include difficult intraabdominal entry; injury to the urinary bladder, uterus or small intestine; longer operation times, and increased blood loss. The goal of the present study was to evaluate the association between abdominal striae gravidarum and intraabdominal adhesions in the preoperative period in pregnant women with a history of cesarean section. Materials and Methods: The study included 247 pregnant women at ≥ 37 weeks of gestation admitted to the labor unit for delivery; all had undergone at least one previous cesarean section. Abdominal striae were assessed preoperatively using the Davey scoring system; the severity and intensity of adhesions were subsequently evaluated intraoperatively according to the modified Nair scoring system. Results: No striae were seen in 104 pregnant women; 41 had mild striae and 102 had severe striae. Overall, 113 cases had no adhesions (grade 0), 106 had grade 1-2 adhesions, and 28 had grade 3-4 adhesions. Among patients with grade 0 adhesions, 34 (13.7 %) had no striae, while 79 (31.9 %) had mild-to-severe striae (p < 0.001; sensitivity 55 %; specificity 67 %; positive predictive value 69 %; negative predictive value 52 %). Among women with grade 1-2 adhesions, 48 (19.4 %) had no striae, while 58 (23.4 %) had mild-to-severe striae. Finally, among women with grade 3-4 adhesions, 22 (8.9 %) had no striae, while 6 (2.4 %) had mild-to-severe striae (p < 0.001). A p-value < 0.05 was taken to indicate statistical significance. Conclusions: The abdominal adhesion score dropped as the abdominal striae gravidarum score rose during the preoperative period. Addition of this useful, easy-to-apply, inexpensive, adjunctive, observational, abdominal scoring method to the obstetrical work-up can provide important clues about the intraabdominal adhesion status of pregnant women scheduled for cesarean delivery because of previous cesarean section.

Clonal B cells in Waldenström's macroglobulinemia exhibit functional features of chronic active B-cell receptor signaling

Waldenström's macroglobulinemia (WM) is a B-cell non-Hodgkin's lymphoma (B-NHL) characterized by immunoglobulin M (IgM) monoclonal gammopathy and the medullary expansion of clonal lymphoplasmacytic cells. Neoplastic transformation has been partially attributed to hyperactive MYD88 signaling, secondary to the MYD88 L265P mutation, occurring in the majority of WM patients. Nevertheless, the presence of chronic active B-cell receptor (BCR) signaling, a feature of multiple IgM+ B-NHL, remains a subject of speculation in WM. Here, we interrogated the BCR signaling capacity of primary WM cells by utilizing multiparametric phosphoflow cytometry and found heightened basal phosphorylation of BCR-related signaling proteins, and augmented phosphoresponses on surface IgM (sIgM) crosslinking, compared with normal B cells. In support of those findings we observed high sIgM expression and loss of phosphatase activity in WM cells, which could both lead to signaling potentiation in clonal cells. Finally, led by the high-signaling heterogeneity among WM samples, we generated patient-specific phosphosignatures, which subclassified patients into a ‘high' and a ‘healthy-like' signaling group, with the second corresponding to patients with a more indolent clinical phenotype. These findings support the presence of chronic active BCR signaling in WM while providing a link between differential BCR signaling utilization and distinct clinical WM subgroups.

Obstetric and neurodevelopmental outcome in fetal cerebral ventriculomegaly

PURPOSE

The purpose of this study is to establish the obstetric and early neurological outcomes of fetuses diagnosed with intrauterine ventriculomegaly (VM).

MATERIALS AND METHODS

This retrospective study included 27 fetuses with VM diagnosed by ultrasound (US) and referred for in utero magnetic resonance imaging (MRI). US and MRI reports and laboratory test results were obtained including chromosome analysis, congenital infections, and first and second trimester screening tests. Infants were evaluated for clinical outcome for six to 24 months of age.

RESULTS

Twenty (51%) fetuses had mild and 19 (49%) fetuses had severe VM. Accompanying central nervous system (CNS) anomalies were statistically significantly more common in severe VM group. The outcome of mild VM group was statistically significantly better than in the severe VM group.

CONCLUSIONS

The authors conclude that ventricular dimension is a significant prognostic factor to detennine the outcome of fetal cerebral VM. The presence of accompanying CNS anomalies is more common with severe VM and may be considered as an unfavorable indicator for a better outcome.

Stage-III and -IV endometrial cancer: A single oncology centre review of 104 cases

The objective of this study was to evaluate the clinicopathological characteristics, treatment and prognosis of advanced endometrial cancer (EC). Patients who underwent surgery for advanced EC between January 1995 and December 2012 were retrospectively reviewed. Patients with missing data, concurrent cancers or uterine sarcomas and those who did not undergo surgery were excluded. The effects of clinicopathological factors on progression-free survival (PFS) and overall survival (OS) were analyzed. A total of 104 patients were included. Most presented with endometrioid histology (74%) and stage-III disease (87.5%), and 76.9% underwent optimal cytoreduction. A multivariate analysis confirmed that lymphovascular space invasion (LVSI) is an independent poor prognostic factor for PFS [odds ratio (OR): 21.37, p = 0.005] and OS [OR: 8.09, p = 0.044]. Suboptimal cytoreduction is another independent poor prognostic factor for PFS [OR: 5.68, p < 0.001]. Our study demonstrated that LVSI and optimal cytoreduction are the most significant factors affecting the survival of advanced EC patients.

Whole-exome analysis reveals novel somatic genomic alterations associated with outcome in immunochemotherapy-treated diffuse large B-cell lymphoma

Lack of remission or early relapse remains a major clinical issue in diffuse large B-cell lymphoma (DLBCL), with 30% of patients failing standard of care. Although clinical factors and molecular signatures can partially predict DLBCL outcome, additional information is needed to identify high-risk patients, particularly biologic factors that might ultimately be amenable to intervention. Using whole-exome sequencing data from 51 newly diagnosed and immunochemotherapy-treated DLBCL patients, we evaluated the association of somatic genomic alterations with patient outcome, defined as failure to achieve event-free survival at 24 months after diagnosis (EFS24). We identified 16 genes with mutations, 374 with copy number gains and 151 with copy number losses that were associated with failure to achieve EFS24 (P<0.05). Except for FOXO1 and CIITA, known driver mutations did not correlate with EFS24. Gene losses were localized to 6q21-6q24.2, and gains to 3q13.12-3q29, 11q23.1-11q23.3 and 19q13.12-19q13.43. Globally, the number of gains was highly associated with poor outcome (P=7.4 × 10⁻¹²) and when combined with FOXO1 mutations identified 77% of cases that failed to achieve EFS24. One gene (SLC22A16) at 6q21, a doxorubicin transporter, was lost in 54% of EFS24 failures and our findings suggest it functions as a doxorubicin transporter in DLBCL cells.

Fetal abdominal wall defects: six years experience at a tertiary center

The authors' aim was to detect the associated anomalies and their effect on the management of the fetuses with omphalocele and gastroschisis. Between the period of 2007-2013, the data of fetuses with abdominal wall defects were analyzed. Chromosomal abnormalities and associated morphologic anomalies diagnosed by ultrasonography and autopsy were evaluated. Of the. 61 fetuses, ten (20.4%) omphalocele cases and nine (75%) gastroschisis cases were isolated. Chromosomal abnormalities were found in seven fetuses with omphalocele cases. All fetuses with abnormal karyotypes had multiple additional anomalies. Termination rate was 65.3% for omphalocele group versus none in the gastroschisis group. To give better counseling about the prognosis and outcome of the fetuses with abdominal wall defects, detection of additional anomalies as well as type of the defect are essential tools even if the karyotype is normal.

Prednisolone as an Effective Treatment for Epilepsy

Rasmussen encephalitis is a chronic inflammatory disease commonly seen in children. Hemispheric atrophy, intellectual disability, and hemiparesis are characteristics of this rare disease. The main pathological findings are chronic meningeal and parenchymal inflammation attributed to T lymphocytes. Plasmapheresis, immunomodulators, and immunosuppressives are commonly used for treatment. In this article, a patient suffering from Rasmussen encephalitis whose seizures were treated with prednisolone is discussed according to the literature.