Reorganization of language-related neuronal networks in patients with left temporal lobe epilepsy - an fMRI study

To investigate the inter- and intrahemispheric reorganization of the language cortex in left temporal lobe epilepsy (TLE) with left-sided hippocampal sclerosis. A functional magnetic resonance imaging was performed on 13 right-handed patients suffering from medically intractable left TLE, and in 13 sex- and age-matched healthy controls. The activation paradigm used was a silent word generation task. A language laterality index (LI) was calculated from the number of activated voxels in the right and left anterior two-thirds of the hemispheres. Significant differences between the patients and the controls were observed in the activation of the left-sided inferior frontal gyrus. Less consistent findings in this region, as well as the relative protection of Broca's area from the activation, were revealed in the patients. In addition, different patterns of activation were proven in the cerebellum and other cortical as well as subcortical brain structures within both hemispheres. Significant differences were also found in the values of the language LIs between the investigated groups: these values suggested a more bihemispheric language representation in the patients. As anticipated, lateralization of the language functions in the epileptics significantly decreased in connection with an earlier age of initial insult. Our results support the hypothesis of a significant intra- and interhemispheric functional reorganization of language-related neuronal networks in left TLE.

An event-related fMRI study of self-paced alphabetically ordered writing of single letters

The spatial location of activation for writing individual letters and for writing simple dots was studied using event-related functional MRI. Ten healthy right-handed subjects were scanned while performing two different protocols with self-paced repetitive movement. In the first protocol with self-paced dot writing, we observed significant activation in regions known to participate in motor control: contralateral to the movement in the primary sensorimotor and supramarginal cortices, the supplementary motor area (SMA) with the underlying cingulate, in the thalamus and, to a lesser extent, in the ipsilateral inferior parietal and occipital cortices. In the second protocol, we investigated an elemental writing feature--writing single letters. We observed statistically significant changes in the premotor, sensorimotor and supramarginal cortices, the SMA and the thalamus with left predominance, and in the bilateral premotor and inferior/superior parietal cortices. The parietal region that was active during the writing of single letters spanned the border between the parietal superior and inferior lobuli Brodmann area (BA 2, 40), deep in the intraparietal sulcus, with a surprising right-sided dominance. The direct comparison of the results of the two protocols was not significant with a confidence level of P<0.05 corrected for whole brain volume. Thus, the ROI approach was used, and we tried to find significant differences within the two predefined regions of interest (ROI) (BA 7, BA 37). The differences were found with a confidence level of P<0.05 corrected for the volume of these predicted areas. The ROI were located in the posterior parts of hemispheres, in the ventral and in the dorsal visual pathway. The right-sided posterior cortices may play a role in the elemental mechanisms of writing. It is possible that activation of this region is linked with the spatial dimension of the writing.

A comparative study of the anatomical, radiological and therapeutic features of the lumbar facet joints

An anatomical study of the lumbar apophyseal joints was carried out to facilitate recognition of facet joint lesions, which we now examine routinely by percutaneous arthrography. Special attention was given to the configuration of the different compartments of the joint space and to its relationships with the contents of the intervertebral foramen. The abnormalities seen on lumbar facet joint arthrography are very varied; two major groups should be stressed: synovial fringe hypertrophy and pseudodiverticular synovial ectasia. The percutaneous approach to lumbar facet joint arthrography allows it to be used a therapeutic measure, with injection of anti-inflammatory drugs into the joint space, the beneficial effects of which were confirmed in our series. The precision, efficiency and cost-effectiveness of this outpatient technique justify and should encourage its more widespread application in the diagnosis and treatment of low back pain.

Therapy-related change of corpus callosum in a young patient with epilepsy

Focal nonhemorrhagic lesion in the splenium of the corpus callosum in a patient with epilepsy treated with antiepileptic drugs was observed with MRI imaging. We have found only one such case during the past 2 years (series of MRI examinations of approximately 500 patients with various forms of epilepsy).

Use of 3D geometry modeling of osteochondrosis-like iatrogenic lesions as a template for press-and-fit scaffold seeded with mesenchymal stem cells

Computed tomography (CT) is an effective diagnostic modality for three-dimensional imaging of bone structures, including the geometry of their defects. The aim of the study was to create and optimize 3D geometrical and real plastic models of the distal femoral component of the knee with joint surface defects. Input data included CT images of stifle joints in twenty miniature pigs with iatrogenic osteochondrosis-like lesions in medial femoral condyle of the left knee. The animals were examined eight and sixteen weeks after surgery. Philips MX 8000 MX and View workstation were used for scanning parallel plane cross section slices and Cartesian discrete volume creation. On the average, 100 slices were performed in each stifle joint. Slice matrices size was 512 x 512 with slice thickness of 1 mm. Pixel (voxel) size in the slice plane was 0.5 mm (with average accuracy of +/-0.5 mm and typical volume size 512 x 512 x 100 voxels). Three-dimensional processing of CT data and 3D geometrical modelling, using interactive computer graphic system MediTools formerly developed here, consisted of tissue segmentation (raster based method combination and 5 % of manual correction), vectorization by the marching-cubes method, smoothing and decimation. Stifle- joint CT images of three individuals of different body size (small, medium and large) were selected to make the real plastic models of their distal femurs from plaster composite using rapid prototyping technology of Zcorporation. Accuracy of the modeling was +/- 0.5 mm. The real plastic models of distal femurs can be used as a template for developing custom made press and fit scaffold implants seeded with mesenchymal stem cells that might be subsequently implanted into iatrogenic joint surface defects for articular cartilage-repair enhancement.

Circular stereotactic callosotomy: a preliminary report. Technical note

The authors propose a new method for performing stereotactic callosotomy, which they have named circular callosotomy. The operating device is the original Riechert-Mundinger's string electrode, which can be protruded through a side window and by rotating the probe it is possible to cut the commisural pathways to the extent required. The anatomical results of the operation can be checked using MRI scanning.

An Event-Related fMRI Study of Self-Paced Writing of Simple Dots

The spatial locations of brain activation related to self-paced repetitive movements, i.e., writing simple dots, were studied using event-related fMRI. Ten healthy right-handed subjects were scanned while performing the protocol with self-paced repetitive movement. In a protocol with self-paced dot writing, we observed significant activation in regions known to participate in motor control: Contralateral to the movement in the primary sensorimotor and supramarginal cortices, the supplementary motor area (SMA) and the underlying cingulate, and, to a lesser extent, the sensorimotor region ipsilateral to the writing hand. When the fMRI was compared with the map of the brain areas electrically active with self-paced movements (intracerebral recordings; Rektor et al., 1994 , 1998 , 2001, b , c , 2003 ), there was an evident overlap of most results. Nevertheless, the electrophysiological studies were more sensitive in uncovering small active areas, i.e., in the premotor and prefrontal cortices. The Bereitschafspotential (BP) with Movement Accompanying Potential (MAP) and hemodynamic changes overlap in regions where the BP were displayed consistently. In some other regions, the BP recordings were inconsistent, i.e., in the prefrontal cortex, where about half of the contacts displayed BP generators while the other half did not. In these regions the hemodynamic changes were not significant. The spatial limitations of the intracerebral electrodes is a result of the fact that the electrodes are submerged in the cerebral tissue and record in their immediate vicinity. The fMRI that indirectly measures activity of larger populations of neurons has better spatial resolution. Electrophysiological techniques with intracranial recordings may reveal even subtle generators of electrical activity.

Mechanical response of porous scaffolds for cartilage engineering

Mechanical properties of scaffolds seeded with mesenchymal stem cells used for cartilage repair seem to be one of the critical factors in possible joint resurfacing. In this paper, the effect of adding hyaluronic acid, hydroxyapatite nanoparticles or chitosan nanofibers into the cross-linked collagen I on the mechanical response of the lyophilized porous scaffold has been investigated in the dry state at 37 oC under tensile loading. Statistical significance of the results was evaluated using ANOVA analysis. The results showed that the addition of hyaluronic acid significantly (p<<0.05) reduced the tensile elastic modulus and enhanced the strength and deformation to failure of the modified cross-linked collagen I under the used test conditions. On the other hand, addition of hydroxyapatite nanoparticles and chitosan nanofibers, respectively, increased the elastic modulus of the modified collagen ten-fold and four-fold, respectively. Hydroxyapatite caused significant reduction in the ultimate deformation at break while chitosan nanofibers enhanced the ultimate deformation under tensile loading substantially (p<<0.05). The ultimate tensile deformation was significantly (p<<0.05) increased by addition of the chitosan nanofibers. The enhanced elastic modulus of the scaffold was translated into enhanced resistance of the porous scaffolds against mechanical load compared to scaffolds based on cross-linked neat collagen or collagen with hyaluronic acid with similar porosity. It can be concluded that enhancing the rigidity of the compact scaffold material by adding rigid chitosan nanofibers can improve the resistance of the porous scaffolds against compressive loading, which can provide more structural protection to the seeded mesenchymal stem cells when the construct is implanted into a lesion. Moreover, scaffolds with chitosan nanofibers seemed to enhance cell growth compared to the neat collagen I when tested in vitro as well as the scaffold stability, extending its resorption to more than 10 weeks.

[The role of magnetic resonance angiography in the follow-up of intracranial arteriovenous malformations treated by an intravascular approach]

The purpose of our work was to measure the accuracy and reliability of MR-Angiography in the study and follow-up of intracranial arteriovenous malformations, and in particular to evaluate the results of endovascular treatment. Over an 18-month period 4 patients with such malformations were examined by MR-Angiography. There was an angioma of the corpus callosum, a left parieto-rolandic angioma, a posterior thalamic angioma and a cerebellar angioma. All examinations were performed with a Magneton-Impact 1 Tesla machine (Siemens, Erlangen, Germany), using a head coil, MR-Angiography with time-of-flight sequences and differential arterial and venous saturations. Each patient was examined by MR-Angiography first at the beginning of treatment, then when ambulatory after embolization. The morphological study applied to the afferent vessels, the nidus and the efferent veins. MR-Angiography proved to be very good in identifying the arteries feeding the malformation, and this made it easier to evaluate the reduction of their input after treatment, without having recourse to any arteriography. Beside, analysis of the nidus was facilitated by the judicious arrangement of arterial and venous saturations. In fact, the systematic use of MR-Angiography in the follow-up of intracranial arteriovenous malformations makes it possible to measure, with full reliability, the efficacy of the endovascular treatment under conditions of comfort unequalled in these out-patients, and selective angiography sequences need to be performed only during therapeutic phases.

[Central diabetes insipidus in adult patients--the first sign of Langerhans cell histiocytosis and Erdheim-Chester disease. Three case studies and literature review]

Central diabetes insipidus with an onset in adulthood is very rare. Unlike in children, central diabetes insipidus in adults is more frequently caused by inflammatory processes and neoplastic infiltrations that do not originate from the neuronal tissue than primary neuronal tissue tumours. Rare histiocytic neoplasias (Langerhans cell histiocytosis, xanthogranulomatosis and Erdheim-Chester disease) have a specific affinity to hypothalamus and the pituitary stalk not only in paediatric patients but also when occurring in adults. We describe 3 cases of central diabetes insipidus with an onset in adulthood. Diabetes insipidus was the first sign of Langerhans cell histiocytosis in 2 patients, and it was the first sign of Erdheim-Chester disease in one patient. MR imaging showed pathological infiltration and dilated pituitary stalks in all 3 patients. PET-CT proved useful in differential diagnosis, showing further extracranial pathological changes either on the basis of significant glucose accumulation or on the basis of CT imaging. The Langerhans cell histiocytosis in the first patient has also manifested itself as an infiltration of the perianal area with intensive accumulation of fluorodeoxyglucose (FDG) - SUV 8.6 and gingival inflammation indistinguishable from parodontosis. Histology of the perianal infiltrate confirmed Langerhans cell histiocytosis. Infiltration of the pituitary stalk disappeared from the MR image after 4 cycles of 2-chlordeoxyadenosin (5 mg/m2 5 consecutive days). The PET-CT of the 2nd patient showed only borderline accumulation of FDG in the ENT area, while simultaneously performed CT imaging showed cystic restructuring of the pulmonary parenchyma and nodulations consistent with pulmonary Langerhans cell histiocytosis. Bronchoalveolar lavage identified higher number of CD1 and S100 positive elements, consistent, once again, with pulmonary LCH also affecting pituitary stalk and ear canal. The PET-CT of the third patient showed increased activity in the long bones and ilium near the sacroiliac joint. Biopsy of the focus in the ilium confirmed foam histiocyte infiltration immunochemically corresponding to Erdheim-Chester disease. Additional imaging assessments revealed the presence of further signs of the disease. Pituitary infiltrate biopsy in this patient did not elucidate the diagnosis but resulted in complete panhypopituarism. Central diabetes insipidus in adulthood might be the first sign of so far undiagnosed extracranial disease, in our case of histiocytic neoplasias, and PET-CT has an excellent potential to detect extracranial symptoms of these conditions. Therefore, the high-risk pituitary stalk infiltrate biopsy should always be preceded by comprehensive examination aimed at identification of extracranial manifestations of the pituitary gland diseases.

The function of the cerebrospinal fluid space and its expansion

In addition to its nutritive and protective effects, the basic function of the cerebrospinal fluid space resides in dynamic equilibration of pressure fluctuations caused by volume changes in three compartments contained within the rigid skull cavity: brain tissue, blood and cerebrospinal fluid. An increase in volume in one of them brings about a compliant withdrawal in volume in the other two. The degree of cerebrospinal fluid compliance can be expressed by means of the pressure/volume index which is directly proportional to this compliance. On the other hand an expansion of fluid space which forces the brain to withdraw its tissue, brings about the dilatation of brain ventricles. The degree of their dilatation depends on the effective pressure of cerebrospinal fluid which counteracts with the resistance of brain venous collectors. The blood in the venous network of the brain and cerebral extracellular fluid play a reversible role in cerebral mass restoration and reduction. These facts explain the reason why, from the physical point of view, the brain is considered to represent a viscous and elastic spongious matter. (Ref. 21.)

Haplotype analysis of IL-10 gene polymorphism in couples with spontaneous abortions and aborted fetuses

Spontaneous abortion is the loss of pregnancy during an early gestational period. Interleukin-10 is an anti-inflammatory cytokine which plays an important role in successful pregnancy outcome. The aim of the study is to elucidate an association of IL-10 gene promoter polymorphisms (-1082G/A, -819 C/T, -592C/A) in spontaneous abortions from Telangana state of South India. The present population-based retrospective case-control triad study includes a total of 80 case families with spontaneous abortions and 100 control families with medically terminated pregnancies. Peripheral blood from all the couples and fetal tissues of <20 weeks of gestation were collected. Genotype analysis was carried out by a standard amplification refractory mutation system-polymerase chain reaction followed by agarose gel electrophoresis. The strength of the association between IL-10 gene promoter polymorphisms and spontaneous abortions were measured by odd ratios and their respective 95% confidence intervals. Haplotype analysis was carried out for the three polymorphisms to establish an association of specific haplotypes with spontaneous abortions. The increased frequency of AA genotype and A allele of -1082G/A, TT genotype and T allele of -819C/T, and AA genotype and A allele of -592C/A was observed in case fetuses and case mothers compared to their respective controls. Haplotype analysis revealed that A-C-A, G-C-A haplotypes in fetuses and haplotypes A-C-C, G-T-C, A-T-A, and G-C-A in mothers were associated with increased risk of spontaneous abortions. IL-10 gene promoter polymorphisms may act as a major genetic regulator in the etiology of spontaneous abortions with maternal genome imprinting effects.

An influence of structural changes in ammonium cations on ecotoxicity of 2,2'-thiodiacetate mono and bis-salts

2,2'-Thiodiacetates with their excellent complexing properties may be used as metal extraction agents, fluorescent and superparamagnetic materials, antibacterial and anticancer medical agents, however there are no data concerning the environmental impact of 2,2'-thiodiacetates derivatives and data definying the potential hazard connected with their use. This study describes the ecotoxicity assessment of seven 2,2'-thiodiacetates with non-metallic, alkyl and aryl ammonium cations, which were obtained in an environmentally friendly, solvent-free syntheses. The ecotoxicity of these water soluble compounds was tested in aquatic and benthic environments using luminescent marine bacteria Vibrio fischeri (Microtox^® test) and the crustaceans Heterocypris incongruens (Ostracodtoxkit F™), respectively. The antimicrobial and antifungal activity against Trichoderma viridis, Aspergillus niger, Rhizoctonia solani and Escherichia coli was also investigated. The results showed how structural changes within ammonium cations themselves influence ecotoxicity: the QASs with alkylammonium cations exhibited a similar, rather low toxicity both to Vibrio fischeri and Heterocypris incongruens, and they would not pose a risk to these organisms in case of leakage. Higher toxicity was observed in case of two isoquinolinium salts, however it was rather associated with the heteroaromatic cation, than with the 2,2'-thiodiacetate anion.

[Teleangiectasia hereditaria haemorrhagica--Osler-Weber-Rendu syndrome. Case study and treatment experience]

Hereditary haemorrhagic telangiectasy is an inborn disease with autosomal dominant transmission. Nose bleeding usually occurs during the 2nd decade of life as the first sign of the disease. Later, during the 3rd or 4th decade of life, typical subtle, pinhead-sized (1-2 mm in diameter) vascular arteriovenous malformations occur. These are usually found on the oral mucosa and in the stomach and small intestine. During later stages of the disease, nose as well as gastrointestinal bleeding causes severe anaemia requiring transfusions. Advanced stages of hereditary hemorrhagic telangiectasy are associated with a development of ateriovenous vascular malformations in the liver, lungs and possibly the brain. Vascular ateriovenous malformations in the liver cause hyperkinetic circulation that may lead to heart failure. Blood within the pulmonary ateriovenous malformations bypasses filtration in the pulmonary capillary circulation and thus infected microtrombi may pass from the inferior vena cava to, for example, the brain. At first, local treatment - stopping epistaxis - is used. Symptomatic embolisation treatment and, sometimes, liver transplantation are used in advanced forms of the disease with anaemisation, despite iron substitution, and clinically significant ateriovenous malformations. Angiogenesis-inhibiting substances have been shown effective in patients with an advanced disease. Older clinical studies confirmed benefits of combined oestrogen-progesterone treatment, later also treatment with raloxifene or antioestrogens. Many post-2000 publications showed thalidomide and bevacizumab to be effective in this indication. Treatment with bevacizumab has led not only to increased haemoglobin concentrations but, through regression of ateriovenous malformations, provided control of hyperkinetic circulation. Discussion section provides an overview of treatment modalities. The main text describes a case of a 56 years old female patient with hypochromic anaemia despite maximum oral iron substitution. The patient lost blood through repeated epistaxes as well as continuous mild bleeding into gastrointestinal tract. The patient also had confirmed large ateriovenous malformations in the liver. Interferon alpha was used as the first line of treatment. The patient unexpectedly developed fast and pronounced myelosuppression. The number of neutrophils fell down from 1.15 x 109/l to 0.6 × 109/l as soon as after 3 injections of interferon alpha at a starting dose of 1.5 million units 3 times a week. Therefore, interferon alpha was discontinued. Blood count returned to normal following interferon discontinuation. The patient was started on thalidomide in December 2011. The patient reported lower incidence of epistaxes and smaller blood loss than before treatment as soon as during the first month of therapy. Regular administration of thalidomide reduced intensity and frequency of epistaxes in this patient.

[The value of various imaging techniques in diagnosing and monitoring the disease activity of multiple myeloma]

Imaging techniques such as RTG, CT, MR and PET are key in diagnosing multiple myeloma. Their selection, combinations and sequence of their application are important for early and correct diagnosis. It is the clinical experience with this condition complemented by suitable imaging diagnostics that leads effective treatment.

Oligometastatic Prostate Cancer

BACKGROUND

With advancements in diagnostic techniques, oligometastatic prostate cancer is diagnosed in patients who were, in the past, considered to have localized disease. Moreover, evidence of the effectiveness of treatment intensification for this disease is increasing, focusing on primary tumors as well as metastatic lesions. Thus, we can delay the start of systemic palliative treatment and improve overall survival. Many questions remain unclear, such as the definition of oligometastasis disease, or which patients should be offered aggressive treatment. Data are limited and come from small retrospective studies but show conclusively the benefits of survival in targeted primary prostate and metastatic prostate cancer therapy with surgery or radiotherapy. Often, stereotactic radiotherapy is used in this indication, with minimal side effects. In retrospective studies, 3-5 metastatic lesions were generally accepted for definition of oligometastatic disease, but patient subgroups were heterogeneous. A recent study attempts to better define oligometastatic disease and find out the right degree of intensification of treatment. When and in which patient to use metastasis-targeted therapy and when the standard systemic treatment is already meaningful. It is already clear that selected patients benefit from targeted personalized treatment.

PURPOSE

The purpose of this review is to offer an update of the problem of oligometastatic prostate cancer. The article presents an overview of data from contemporary literature, modern possibilities of diagnostic imaging methods and treatment options of oligometastatic prostate cancer including surgery and radiotherapy.  authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 2. 2019 Accepted: 5. 3. 2019.

Pregnancy-related factors induce immune tolerance through regulation of sCD83 release

A well-balanced maternal immune system is crucial to maintain fetal tolerance in case of infections during pregnancy. Immune adaptations include an increased secretion of soluble mediators to protect the semi-allogeneic fetus from excessive pro-inflammatory response. B lymphocytes acquire a higher capacity to express CD83 and secrete soluble CD83 (sCD83) upon exposure to bacteria-derived components such as LPS. CD83 possesses immune modulatory functions and shows a promising therapeutic potential against inflammatory conditions. The administration of sCD83 to pregnant mice reduces LPS-induced abortion rates. The increased CD83 expression by endometrial B cells as compared to peripheral blood B cells suggests its modulatory role in the fetal tolerance, especially in the context of infection. We postulate that in pregnancy, CD83 expression and release is controlled by pregnancy-related hormones. The intra- and extracellular expression of CD83 in leukocytes from peripheral blood or decidua basalis and parietalis at term were analyzed by flow cytometry. After treatment with pregnancy-related hormones and LPS, ELISA and qPCR were performed to study sCD83 release and CD83 gene expression, respectively. Cleavage prediction analysis was used to find potential proteases targeting CD83. Expression of selected proteases was analyzed by ELISA. Higher levels of CD83 were found in CD11c+ dendritic cells, CD3+ T cells and CD19+ B cells from decidua basalis and decidua parietalis after LPS-stimulation in vitro. An increase of intracellular expression of CD83 was also detected in CD19+ B cells from both compartments. Stimulated B cells displayed significantly higher percentages of CD83+ cells than dendritic cells and T cells from decidua basalis and peripheral blood. Treatment of B lymphocytes with pregnancy-related molecules (E2, P4, TGF-β1 and hCG) enhanced the LPS-mediated increase of CD83 expression, while dexamethasone led to a reduction. Similarly, the release of sCD83 was increased under TGF-β1 treatment but decreased upon dexamethasone stimulation. Finally, we found that the hormonal regulation of CD83 expression is likely a result from a balance between gene transcription from CD83 and the modulation of the metalloproteinase MMP-7. Thus, data supports and complements our previous murine studies on hormonal regulation of CD83 expression, reinforcing its immunomodulatory relevance in anti-bacterial responses during pregnancy.

[Advances in the diagnosis of tumours by imaging methods (possibilities of three-dimensional imaging and application to volumetric resections of brain tumours with evaluation in virtual reality and subsequent stereotactically navigated demarcation]

Oncological problems are so varied that it is very difficult to record all advances in different diagnostic branches in a comprehensive manner. In the first part the authors focus attention on an example of the possible use of imaging examination methods in conjunction with different types of three-dimensional imaging used in their hospital. The second part is devoted to volumetric resections of brain tumours with navigated demarcation. In 17 patients the authors used the PC working station equipped with navigation software STEREOPLAN PLUS for planning volumetric resection of different brain tumours in virtual reality. The demarcation proper of the brain tumour size during surgery was implemented by means of a stereotactic apparatus ZAMORANO-DUJOVNY and a pointer in the field of the microscope. The accuracy of navigation of the whole system for demarcation of the tumourous affection was +/- 1 mm. The intervention was supplemented by functional examination by means of surface electrodes during partial awakening of the patient for mapping the functional areas of the cerebral cortex. The result was resection of relatively precise volumes of tumourous tissue with the possibility of maximum preservation in particular of motor but also other functions of the CNS.