Direct electrical stimulation of the optic radiation in patients with covered eyes

Direct electrical stimulation (DES) of the optic radiation (OR) during an awake tumor resection has been repeatedly reported. In all cases, visual function monitoring was performed in patients with open eyes which were looking at a picture. We report a new modification of the standard method, OR stimulation in patient with closed and covered eyes. To the best of our knowledge, this method was not presented before. According to our first experience, this methodology may be in some cases a potentially more sensitive form of neuromonitoring than the OR stimulation in patients with open eyes, as the phosphenes elicited by DES may be more distinct in patients with covered eyes. The technique is discussed, and a literature review on intraoperative identification of the OR is presented as well. However, a future prospective study is needed to confirm the relevance of our finding.     

Impaction bone grafting and a cemented cup after acetabular fracture

Purpose

Patients suffering from post traumatic osteoarthritis of the acetabulum often require a total hip arthroplasty at a relatively young age. Long-term data outcome studies for this population are lacking. We report on the long-term outcome of 20 acetabular fractures in 20 patients treated with impaction bone grafting and a cemented cup after a mean follow-up of 18 years (range, 12–26 years).

Methods

The group consisted of 14 males (70 %) and six females (30 %) with an average age of 53.3 years (range, 35–75 years) at time of surgery. No patients were lost to follow-up. Four patients died and three patients underwent a revision; at review 13 patients were still living with their implant in situ. tent-type=ReferenceWorkEntry&sortOrder=relevance' class='reference-link webtrekk-track' gaCategory="Internal link" gaLabel="Survivorship" gaAction="reference keyword">Survivorship analysis was performed at 20 years follow-up for three endpoints.

Results

Survival rate with endpoint revision for any reason at 20 years postoperative was 74.7 % (95 % confidence interval (CI), 40–91 %), 80.0 % (95 % CI, 41–95 %) for endpoint aseptic loosening, and 63.9 % (95 % CI 32–84 %) for endpoint radiographic failure. Three acetabular components were revised at 14.5, 15.3, and 16.7 years postoperative. Two cups failed for aseptic loosening and one cup failed due to septic loosening. The average postoperative Harris hip score was 82 (range, 56–100).

Conclusion

Acetabular reconstruction with impaction bone grafting and the use of a cemented cup after acetabular fracture is an attractive technique with acceptable long-term results and a low complication and re-operation rate.     

Pro-inflammatory cytokines favor the emergence of ETV6-RUNX1-positive pre-leukemic cells in a model of mesenchymal niche

ETV6-RUNX1 (E/R) fusion gene, arising in utero from translocation t(12;21)(p13:q22), is the most frequent alteration in childhood acute lymphoblastic leukemia (ALL). However, E/R is insufficient to cause overt leukemia since it generates a clinically silent pre-leukemic clone which persists in the bone marrow but fails to out-compete normal progenitors. Conversely, pre-leukemic cells show increased susceptibility to transformation following additional genetic insults. Infections/inflammation are the most accredited triggers for mutations accumulation and leukemic transformation in E/R⁺ pre-leukemic cells. However, precisely how E/R and inflammation interact in promoting leukemia is still poorly understood. Here we demonstrate that IL6/TNFα/ILβ pro-inflammatory cytokines cooperate with BM-MSC in promoting the emergence of E/R⁺ Ba/F3 over their normal counterparts by differentially affecting their proliferation and survival. Moreover, IL6/TNFα/ILβ-stimulated BM-MSC strongly attract E/R⁺ Ba/F3 in a CXCR2-dependent manner. Interestingly, E/R-expressing human CD34⁺IL7R⁺ progenitors, a putative population for leukemia initiation during development, were preserved in the presence of BM-MSC and IL6/TNFα/ILβ compared to their normal counterparts. Finally, the extent of DNA damage increases within the inflamed niche in both control and E/R-expressing Ba/F3, potentially leading to transformation in the apoptosis-resistant pre-leukemic clone. Overall, our data provide new mechanistic insights into childhood ALL pathogenesis.     

Magnetic resonance imaging of renal transplants: its value in the differentiation of acute rejection and cyclosporin A nephrotoxicity

The purpose of this study was to determine the value of magnetic resonance imaging (MRI) in the differentiation of acute rejection and cyclosporin A nephrotoxicity in renal transplant kidneys. Fifty-six magnetic resonance examinations in 46 patients were prospectively and independently evaluated by two radiologists. MRI was performed with a 0.5 T superconducting scanner (Gyroscan S5, Philips) applying both T1 and T2 weighted pulse sequences. Biopsies were performed in 22 cases and histology was reviewed. Fifteen normally functioning transplant kidneys and 41 kidneys with graft dysfunction due to cyclosporin A nephrotoxicity, acute rejection, chronic rejection or acute tubular necrosis were studied. Absence or reduction in cortico-medullary demarcation proved to be a sensitive, but non-specific indicator of parenchymal disease. In cases of cyclosporin A nephrotoxicity the allograft was diagnosed as being normal in 90%. The magnetic resonance appearance of acute rejection may be very similar to that of the combination of acute rejection and cyclosporin A nephrotoxicity, chronic rejection or acute tubular necrosis. However differentiation between acute rejection and cyclosporin A nephrotoxicity was possible according to the following statistical data: sensitivity 100%, specificity 75%, positive predictive value 86%, negative predictive value 100%, accuracy 90%.     

Systematic review of the predictors of health service use in pancreatic cancer

Introduction: Pancreatic cancer (PC) has a dismal prognosis, with identified disparities in survival outcomes based on demographic characteristics. These disparities may be ameliorated by equitable access to treatments and health services. This systematic review identifies patient and service-level characteristics associated with PC health service utilisation (HSU). Methods: Medline, Embase, CINAHL, PsycINFO and Scopus were systematically searched between 1^st January, 2010 and 17 May, 2021 for population-based, PC studies which conducted univariable and/or multivariable regression analyses to identify patient and/or service-level characteristics associated with use of a treatment or health service. Direction of effect sizes were reported in an aggregate manner. Results: Sixty-two eligible studies were identified. Most (48/62) explored the predictors of surgery (n=25) and chemotherapy (n=23), and in populations predominantly based in the United States of America (n=50). Decreased HSU was observed among people belonging to older age groups, non-Caucasian ethnicities, lower socioeconomic status (SES) and lower education status. Non-metropolitan location of residence predicted decreased use of certain treatments, and was associated with reduced hospitalisations. People with comorbidities were less likely to use treatments and services, including specialist consultations and palliative care but were more likely to be hospitalised. A more recent year of diagnosis/year of death was generally associated with increased HSU. Academically affiliated and high-volume centres predicted increased treatment use and hospital readmissions. Conclusion: Findings of this review may assist identification of vulnerable patient groups experiencing disparities in accessing and using treatments and therapies.     

Eruptive lingual papillitis with household transmission: a prospective clinical study

BACKGROUND: Eruptive lingual papillitis with household transmission (ELP) is an acute stomatitis of unknown cause occurring in children, with possible spread to one or several members of the family. OBJECTIVES: To verify clinical features and search for clinical characteristics of ELP. METHODS: A prospective case series, including an analysis of epidemiological and clinical factors, was conducted within private paediatric practices in collaboration with a dermatology department at the University Hospital of Nice, France. RESULTS: Thirty-eight children (21 girls and 17 boys) with clinical criteria of ELP referred from 1 February 2000 to 31 January 2002 were included in the study. Mean age at diagnosis was 3 years and 6 months. Thirty-three children attended day nursery or school. The seasonal distribution of observed cases showed a peak of incidence in spring. The eruption started abruptly. Fever was found in 15 (39%) cases. Difficulties in feeding were observed in all cases; intense salivation in 23 (61%) cases. The glossitis was characterized by inflammatory hypertrophy of the fungiform papillae on the tip and dorsolateral part of the tongue. Enlarged submaxillary or cervical lymph nodes were noted in 16 (42%) cases. Angular cheilitis was observed in four (11%) children. Spontaneous regression of the stomatitis occurred between the second and 15 days of clinical evolution. Mean duration was 7.3 days. Transmission to one or several members of the family was noted in 20 (53%) cases. Recurrence of symptoms was observed in five (13%) children. CONCLUSIONS: This study confirms some clinical characteristics of ELP: localized lesions of the fungiform papillae on the tip and dorsolateral part of the tongue, high frequency of intrafamilial transmission, and possibility of recurrence. This study also showed unsuspected clinical data such as possible occurrence of fever and angular cheilitis. ELP resembles an entity termed 'transient lingual papillitis' or commonly 'lie bumps'. The origin of this eruption remains unknown, but the transmission data could suggest a possible infectious origin.