Treatment of unilateral olfactory neuroblastoma: Appropriate extent of surgical resection and potential for olfactory preservation

Historically, comprehensive surgical resection for olfactory neuroblastoma has included the bilateral olfactory epithelium, cribriform plate, overlying dura, olfactory bulbs and tracts. This results in postoperative anosmia that may significantly impact a patient's quality of life without definitive added benefit in survival. The prevalence of occult intracranial disease is low, especially for Hyams grade I and II tumors. A unilateral approach sparing the contralateral cribriform plate and olfactory system can be considered for select cases of early stage, low-grade tumors when the disease does not cross midline to involve the contralateral olfactory cleft or septal mucosa and when midline dural margins can be cleared with frozen pathology. Approximately half of patients who undergo unilateral resection may have residual olfaction even with adjuvant unilateral radiation. Early data suggest favorable disease-free survival and overall survival for patients who underwent the unilateral approach; however, larger sample studies are needed to confirm comparability to bilateral resections regarding oncologic outcomes.

Cardiac Magnetic Resonance Fingerprinting: Potential Clinical Applications

PURPOSE OF REVIEW

Cardiac magnetic resonance fingerprinting (cMRF) has developed as a technique for rapid, multi-parametric tissue property mapping that has potential to both improve cardiac MRI exam efficiency and expand the information captured. In this review, we describe the cMRF technique, summarize technical developments and in vivo reports, and highlight potential clinical applications.

RECENT FINDINGS

Technical developments in cMRF continue to progress rapidly, including motion compensated reconstruction, additional tissue property quantification, signal time course analysis, and synthetic LGE image generation. Such technical developments can enable simplified CMR protocols by combining multiple evaluations into a single protocol and reducing the number of breath-held scans. cMRF continues to be reported for use in a range of pathologies; however barriers to clinical implementation remain. Technical developments are described in this review, followed by a focus on potential clinical applications that they may support. Clinical translation of cMRF could shorten protocols, improve CMR accessibility, and provide additional information as compared to conventional cardiac parametric mapping methods. Current needs for clinical implementation are discussed, as well as how those needs may be met in order to bring cMRF from its current research setting to become a viable tool for patient care.

Sphenoid sinus cholesterol granulomas presenting with abducens nerve palsy

We discuss two patients who presented with sphenoid sinus cholesterol granulomas and associated unilateral abducens nerve palsies. Two case reports from our institution are reported. A literature review of available articles is presented, discussing both cholesterol granulomas of the sphenoid sinus and sphenoid sinus lesions that present with unilateral abducens palsy. A total of nine cases of sphenoid sinus cholesterol granulomas have been previously reported in the literature. A wide variety of sphenoid sinus pathologies can present with unilateral abducens nerve palsies, however no sphenoid sinus cholesterol granulomas with this presentation were found in the literature. In conclusion, cholesterol granulomas should be included in the differential when a patient presents with an expansile mass of the sphenoid sinus and associated unilateral abducens nerve palsy.

Cystic Fibrosis Increases Long-Term Revision Rates of Endoscopic Sinus Surgery in Patients With Comorbid Chronic Rhinosinusitis

Background: Comorbid chronic rhinosinusitis (CRS) of adulthood is increasing among patients with cystic fibrosis (CF) due to improved median survival. However, little is known about the natural history of endoscopic sinus surgery (ESS) in this cohort. The objective of this study was to evaluate the revision rate of ESS and associated risk factors among adults with CRS and CF (CRSwCF). Methods: The Utah Population Database was queried for patients age >18 with CRS who underwent at least one ESS between 1996 and 2018. Demographic information and ESS history were collected and compared for CRSwCF versus CRS without CF (CRSsCF) using chi-square and t-tests. Risk factors for revision were analyzed using Cox proportional hazard models and logistic regression analysis. Results: A total of 34 050 patients (33 639 CRSsCF and 411 CRSwCF) were included in the final analysis. The mean duration of follow-up was 9.3 and 9.3 years, respectively (P = .98). Adult patients with CF were significantly more likely to undergo revision ESS (18.7%) than those without CF (13.4%; P < .01). Logistic regression analysis indicated that a diagnosis of CF independently elevated the risk for revision ESS in the absence of nasal polyps (odds ratio [OR] 2.18, confidence interval [CI] 1.34-3.54), asthma (OR 1.36, CI 0.94-1.98), and allergies (OR 1.29, CI 0.90-1.73). Conclusion: In the era before highly effective modulator therapies, the mean revision rate of ESS among adults with CRSwCF was 18.7%, significantly greater than that of adults with CRSsCF. CF was an independent risk factor for revision ESS in the absence of nasal polyps, asthma, and allergies.

Striatal transcriptome changes linked to drug-induced repetitive behaviors

Disruptive or excessive repetitive motor patterns (stereotypies) are cardinal symptoms in numerous neuropsychiatric disorders. Stereotypies are also evoked by psychomotor stimulants such as amphetamine. The acquisition of motor sequences is paralleled by changes in activity patterns in the striatum, and stereotypies have been linked to abnormal plasticity in these reinforcement-related circuits. Here, we designed experiments in mice to identify transcriptomic changes that underlie striatal plasticity occurring alongside the development of drug-induced stereotypic behavior. We identified three schedules of amphetamine treatment inducing different degrees of stereotypy and used bulk RNAseq to compare striatal gene expression changes among groups of mice treated with the different drug-dose schedules and vehicle-treated, cage-mate controls. Mice were identified as naïve, sensitized, or tolerant to drug-induced stereotypy. All drug-treated groups exhibited expression changes in genes that encode members of the extracellular signal-regulated kinase (ERK) cascades known to regulate psychomotor stimulant responses. In the sensitized group with the most prolonged stereotypy, we found dysregulation of 20 genes that were not changed in other groups. Gene set enrichment analysis indicated highly significant overlap with genes regulated by neuregulin 1 (Nrg1). Nrg1 is known to be a schizophrenia and autism susceptibility gene that encodes a ligand for Erb-B receptors, which are involved in neuronal migration, myelination, and cell survival, including that of dopamine-containing neurons. Stimulant abuse is a risk factor for schizophrenia onset, and these two disorders share behavioral stereotypy phenotypes. Our results raise the possibility that drug-induced sensitization of the Nrg1 signaling pathway might underlie these links.

Multisite evaluation of radiomic feature reproducibility and discriminability for identifying peripheral zone prostate tumors on MRI

Recent advances in the field of radiomics have enabled the development of a number of prognostic and predictive imaging-based tools for a variety of diseases. However, wider clinical adoption of these tools is contingent on their generalizability across multiple sites and scanners. This may be particularly relevant in the context of radiomic features derived from T1- or T2-weighted magnetic resonance images (MRIs), where signal intensity values are known to lack tissue-specific meaning and vary based on differing acquisition protocols between institutions. We present the first empirical study of benchmarking five different radiomic feature families in terms of both reproducibility and discriminability in a multisite setting, specifically, for identifying prostate tumors in the peripheral zone on MRI. Our cohort comprised 147 patient T2-weighted MRI datasets from four different sites, all of which are first preprocessed to correct for acquisition-related artifacts such as bias field, differing voxel resolutions, and intensity drift (nonstandardness). About 406 three-dimensional voxel-wise radiomic features from five different families (gray, Haralick, gradient, Laws, and Gabor) were evaluated in a cross-site setting to determine (a) how reproducible they are within a relatively homogeneous nontumor tissue region and (b) how well they could discriminate tumor regions from nontumor regions. Our results demonstrate that a majority of the popular Haralick features are reproducible in over 99% of all cross-site comparisons, as well as achieve excellent cross-site discriminability (classification accuracy of ≈ 0.8 ). By contrast, a majority of Laws features are highly variable across sites (reproducible in < 75 % of all cross-site comparisons) as well as resulting in low cross-site classifier accuracies ( < 0.6 ), likely due to a large number of noisy filter responses that can be extracted. These trends suggest that only a subset of radiomic features and associated parameters may be both reproducible and discriminable enough for use within machine learning classifier schemes.

3',4',7,8-Tetrahydroxyflavone inhibits RANKL-induced osteoclast formation and bone resorption

Osteoclasts, which are specialized bone multinuclear cells, are responsible for bone lytic diseases such as osteoporosis. 3',4',7,8-tetrahydroxyflavone is a flavonoid from Acacia confusa. In the present study, we found that 3',4',7,8-tetrahydroxyflavone markedly inhibited receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastic differentiation from mouse bone marrow-derived macrophages (BMMs). 3',4',7,8-tetrahydroxyflavone also reduced the mRNA expression levels of osteoclastic marker genes including the calcitonin receptor (CTR) and cathepsin K. In addition, 3',4',7,8-tetrahydroxyflavone decreased the bone resorption activity of osteoclasts on dentin slices. We found that 3',4',7,8-tetrahydroxyflavone inhibited RANKL-induced expression of c-Fos and nuclear factor of activated T cells c1 (NFATc1), a key transcription factor of osteoclast differentiation. Furthermore, ectopic overexpression of a constitutively active form of NFATc1 completely rescued the anti-osteoclastogenic effect of 3',4',7,8-tetrahydroxyflavone, suggesting that the anti-osteoclastogenic effect was mainly attributed to the reduction in NFATc1 expression. Taken together, our data suggest that 3',4',7,8-tetrahydroxyflavone inhibits osteoclast differentiation and bone loss and may therefore be considered a promising drug candidate for treating or preventing bone-lytic diseases.

Ability of novice clinicians to interpret high-resolution optical coherence tomography for ocular surface lesions

OBJECTIVE

To assess the ability of novice clinicians to use a commercially available high-resolution anterior segment optical coherence tomography (HR-OCT) device to diagnose various lesions of the ocular surface and cornea.

METHODS

Cross-sectional study. Twenty-six black-and-white HR-OCT images were projected, and clinicians were asked to determine whether the lesions represented ocular surface squamous neoplasia (OSSN) or another ocular surface pathology. A 20-minute instructional lecture was given on HR-OCT interpretation, and the same 26 images were shown. The clinicians were asked to repeat their assessment of the lesions. Thirty-four novice clinicians at the Bascom Palmer Eye Institute, Miami, FL, participated. A commercially available device (RTVue, Optovue, Fremont, Calif.) was specifically chosen for this study.

RESULTS

The mean frequency of correct identification of the 26 lesions was 70% (standard deviation [SD] 15%) before instruction; after a short lecture, the frequency of correct identification improved to 84% (SD 9%, p = 0.002). Novice clinicians were more accurate in correctly determining that a lesion was not an OSSN (ruling it out as a diagnosis) than in determining that a lesion was an OSSN (p = 0.001). Some lesions (both OSSN and not OSSN), however, were more difficult to interpret than others.

CONCLUSION

This study demonstrated that all levels of novice clinicians can quickly improve diagnostic accuracy with a commercially available HR-OCT after a short training session.

Pediatric invasive fungal rhinosinusitis: An investigation of 17 patients

PURPOSE

To investigate outcomes of pediatric patients at a single institution with invasive fungal rhinosinusitis (IFRS) and to determine variables that impact overall survival.

METHODS

All pediatric patients at a large tertiary children's hospital diagnosed with IFRS confirmed by surgical pathology from 2009 to 2015 were retrospectively reviewed. Demographics, underlying diseases, symptoms, antifungal therapy, absolute neutrophil count (ANC), surgical management,and outcomes were analyzed.

RESULTS

Seventeen patients were identified with IFRS with an average age of 8.7 years and 53% male. Hematologic malignancy was the most common (n = 13) underlying disease. The most common presenting symptoms were fever (82%) and congestion (41%). 15 patients had severe neutropenia (Absolute Neutrophil Count (ANC) < 500) within 2 weeks prior to diagnosis. The average ANC at time of diagnosis was 1420 cells/uL. 16 patients were treated with serial nasal endoscopy and debridement, while 1 patient was treated with an open approach. 16 received combination antifungals while 1 was treated with amphotericin monotherapy. The most common genus cultured was Fusarium (n = 6). The average number of surgical interventions was 3.4, with the average interval between interventions 6.2 days. 13 of 17 (76%) were cleared of IFRS. Overall survival at 6 months was 41%.

CONCLUSION

Pediatric IFRS is a life-threatening disease that requires a coordinated surgical and medical approach. Despite a relatively high local control rate, overall mortality remains disappointingly high, reflecting the disease's underlying pathogenesis - lack of host defense and risk of disseminated fungal infection. Further investigation is necessary to reveal optimal management with regards to antifungal therapy, surgery, and utility of labs.

Perception of colonoscopy benefits: a gap in patient knowledge?

Our study aimed to determine, for patients who had undergone recent colonoscopy, associations between specific colonoscopy patient characteristics, exam characteristics and patients' perception of colonoscopy reducing their risk of dying from colorectal cancer. A cross-sectional analysis was conducted using data (2004-2008) from the New Hampshire Colonoscopy Registry, consisting of a Self-report Questionnaire, Colonoscopy Report form, and a Follow-up Questionnaire, which measured agreement responses to the statement, "Having a colonoscopy decreased my chances of dying from colon cancer". Chi-square tests and logistic regression were used to assess differences in patient responses by patient and colonoscopy characteristics. A majority of patients (N=5,672, 81%) agreed that having a colonoscopy decreased their chances of dying from colon cancer. Patients with a personal history of polyps were more likely to agree that colonoscopy reduced their chances of dying compared to patients without prior polypectomy [OR (95% CI) =1.34 (1.06, 1.69)] and patients with a family history of colorectal cancer were 33% more likely to agree to the statement than those without a family history [OR (95% CI) =1.33 (1.12, 1.58)]. Personal history of polyps and family history of colorectal cancer are significant predictors of patients' positive perception of colonoscopy, suggesting that personal experience, rather than the potential preventive effect of colonoscopy itself, may influence the perceived benefit of colonoscopy. Intervention efforts should be made to effectively disseminate knowledge of the preventive benefit of colonoscopy.

CalDAG-GEFI down-regulation in the striatum as a neuroprotective change in Huntington's disease

Huntingtin protein (Htt) is ubiquitously expressed, yet Huntington's disease (HD), a fatal neurologic disorder produced by expansion of an Htt polyglutamine tract, is characterized by neurodegeneration that occurs primarily in the striatum and cerebral cortex. Such discrepancies between sites of expression and pathology occur in multiple neurodegenerative disorders associated with expanded polyglutamine tracts. One possible reason is that disease-modifying factors are tissue-specific. Here, we show that the striatum-enriched protein, CalDAG-GEFI, is severely down-regulated in the striatum of mouse HD models and is down-regulated in HD individuals. In the R6/2 transgenic mouse model of HD, striatal neurons with the largest aggregates of mutant Htt have the lowest levels of CalDAG-GEFI. In a brain-slice explant model of HD, knock-down of CalDAG-GEFI expression rescues striatal neurons from pathology induced by transfection of polyglutamine-expanded Htt exon 1. These findings suggest that the striking down-regulation of CalDAG-GEFI in HD could be a protective mechanism that mitigates Htt-induced degeneration.

Reliable External Actuation for Full Reachability in Robotic Modular Self-reconfiguration

External actuation in self-reconfigurable modular robots promises to allow modules to shrink down in size. Synchronous external motions promise to allow fast convergence and assembly times. XBot is a modular system that uses synchronous external actuation, but has a limited range of reachable configurations stemming from a single motion primitive of a module rotating about another. This paper proposes to extend the motion primitives by using moves with two modules swinging in a dynamic chain. The feasibility of these motion primitives is proven experimentally. A parameterization of the external actuation motion profiles is explored to define a space of physically valid motion profiles. The larger the space, the more robust the motion primitives will be to inexact initial conditions and to imprecision in the external actuation mechanisms. In addition, this paper proves that a configuration of XBot meta-modules can reach any configuration using just these motion primitives.

Mutated plant lectin library useful to identify different cells

The 24 nucleotides comprising the carbohydrate-recognition domain of Maackia amurensis hemagglutinin (MAH) cDNA were randomly mutated. The mutant lectins were expressed as glutathione-S-transferase fusion proteins in Escherichia coli and 16 clones were randomly chosen. Although all of 16 recombinant lectins reacted strongly with anti-MAH polyclonal antibody, the carbohydrate-recognition domain of each was unique. As shown by agglutination studies, each mutant MAH lectin was able to bind to erythrocytes from one or more of five animal species in very distinct patterns. Thus, novel plant lectin libraries can be used to discriminate in a highly specific manner among a variety of cell types. This technology may prove to be very useful in a number of different applications requiring a high level of specificity in cell identification.

Isolation of picomolar affinity anti-c-erbB-2 single-chain Fv by molecular evolution of the complementarity determining regions in the center of the antibody binding site

We determined the extent to which additional binding energy could be achieved by diversifying the complementarity determining regions (CDRs) located in the center of the antibody combining site of C6.5, a human single-chain Fv (scFv) isolated from a non-immune phage library which binds the tumor antigen c-erbB-2. CDR3 of the light (V(L)) and heavy (V(H)) chain variable region of C6.5 were sequentially mutated, the mutant scFv displayed on phage, and higher affinity mutants selected on antigen. Mutation of V(L) CDR3 yielded a scFv (C6ML3-9) with a 16-fold lower Kd (1.0 x 10(-9) M) than C6.5. Due to its length of 20 amino acids, four V(H) CDR3 libraries of C6ML3-9 were constructed. The greatest increase in affinity from a single library was ninefold (Kd = 1.1 x 10(-10) M). Combination of mutations isolated from separate V(H) CDR3 libraries yielded additional ninefold decreases in Kd, resulting in a scFv with a 1230-fold increase in affinity from wild-type C6.5 (Kd = 1.3 x 10(-11) M). The increase in affinity, and its absolute value, are comparable to the largest values observed for antibody affinity maturation in vivo or in vitro and indicate that mutation of V(L) and V(H) CDR3 may be a particularly efficient means to increase antibody affinity. This result, combined with the location of amino acid conservation and substitution, suggests an overall strategy for in vitro antibody affinity maturation. In addition, the affinities and binding kinetics of the single-chain Fv provide reagents with potential tumor targeting abilities not previously available.

HTLV-I-associated T-cell leukemia in Hawaii

Adult T-cell leukemia (ATL) is a disease found endemic in Southern Japan and the Caribbean basin. The human T-cell leukemia virus I (HTLV-I) has been implicated epidemiologically as the causative agent in this disease. This paper describes the identification of this disease in Hawaii in a second generation immigrant from Southern Japan. The disease was initially indolent, then clinically explosive, characterized by cutaneous lesions, leukemic lymphocytes with convoluted nuclei of T-cell phenotype, hypercalcemia, and a terminal infection.

[Cytological study of the post-embryonic development of the digestive gland of Sepia officinalis L. Mollusca : Cephalopoda (author's transl)]

A histological and ultrastructural study of the development of the digestive gland of Sepia officinalis L. was carried out on young Sepia reared in the laboratory, during the first month of post-embryonic life. The increasing complexity of the histological structure of the gland is related to the successive appearance of several cell types : immature cell, synthetizing cell, mature digestive cell ("cellule à boules"), and resting cell. These types are, in fact, just the evolutive stages of the same cell, the digestive cell. The sequence of appearance of the different cell types and the changes occurring in feeding can be used to define three stages in the post-embryonic development of the Sepia officinalis L. digestive gland : a multiplication stage (from hatching to the 5th day), a maturation stage (5th to 30th day), and adult stage (after the first month of post-embryonic life). These stages are identical to the three periods previously described by Richard and Decleir (1969) in the life of Sepia.