Assessment of Neuropsychological Late Effects in Survivors of Childhood Leukemia

The neurologic dysfunctions caused by treatment may affect health and quality of life in survivors of childhood leukemia. The objective of this study was to identify the neuropsychological late effects of leukemia treatment to provide an assessment about the degree and incidence of these late effects. Neurological and ophtalmological examination, cranial magnetic resonance imaging (MRI), auditory and neurocognitive tests, and questionnaires of quality of life were performed to 44 acute leukemia survivors at least 5 years after diagnosis. Median time since completion of chemotherapy was 7.5 years (2–18) and median age at the time of the study was 16.4 years (8–31). At least one or more late effects detected by physical examination (PE), neurological tests, or neurocognitive tests encountered in 80% of the patients, and 64% of the patients specified at least one complaint in the quality of life questionnaire. MRI revealed pathological findings in 18% and electroencephalogram (EEG) abnormalities were present in 9% of the patients. Evaluation of total intelligence scores revealed that 30% of patients’ IQ scores were <80 and 70% of the patients’ scores demonstrated neurocognitive dysfunctions. The patients >6 years at the time of diagnosis were found to have more psychological problems and higher rates of smoking and alcohol consumption. The most frequent complaint was headache and the most common problem in school was denoted as difficulty in concentration. Our study demonstrated that most of the survivors of childhood leukemia are at risk of developing neuropsycological late effects.     

微创冷冻消融迷宫Ⅳ手术治疗二尖瓣病变合并心房颤动的近中期结果

目的 分析胸腔镜辅助下微创切口二尖瓣手术同期行冷冻消融治疗心房颤动的近中期结果.方法 回顾性分析中南大学湘雅二医院心血管外科2013年8月至2017年10月完成的68例胸腔镜辅助下右胸微创切口二尖瓣手术同期行冷冻消融治疗心房颤动患者的临床资料,其中男28例、女40例,平均年龄(38.7±9.3)岁.于术后定期复查24h...     

Correlation of 3-T MRI and CT findings with patient symptoms and treatment outcome in radiofrequency ablation of osteoid osteoma

ObjectiveThe aim of this prospective study was to evaluate pre- and post-treatment MRI and CT findings of osteoid osteoma (OO) patients treated with radiofrequency thermo-ablation (RFTA) and to compare these findings with visual analog scale (VAS) scores.MethodsSixteen patients (4 females and 12 males; mean age of 18.87 ± 8.75 years (range: 8–37)) with OO were examined with CT and MRI, at baseline and at an average of 3 months following the procedure. On pre- and post-procedural CT and MRIs, OO-related findings were recorded. Treatment success was evaluated with VAS scores.ResultsBaseline VAS scores were 8 or 9 and follow-up scores were 0 or 1, indicating no early recurrences.Nidus diameters decreased significantly after the procedure (p = 0.027, p = 0.002, and p = 0.002; and p = 0.001, p = 0.001, p = 0.001 for AP, ML and CC nidus diameters for CT and MRI, respectively).The mean nidus volume were significantly decreased after the procedure (p = 0.001, for CT and MRI).On post-procedural images, cortical thickening, the signal intensity and contrast enhancement of the nidus and the extent of periostitis were significantly decreased (p = 0.019, p = 0.001, p = 0.001 and p = 0.034, respectively). There was no significant change in nidus calcification, perinidal cortical and intramedullary sclerosis, periosteal reaction, bone deformity, bone marrow and soft tissue edema, joint effusion and synovitis after the procedure (p = 0.253, p = 0.062, p = 0.245, p = 1, p = 1, p = 0.429, p = 0.371, p = 0.625, p = 1).ConclusionAlthough the changes in imaging findings may be helpful in early follow-up of OO patients treated with RFTA, these changes alone cannot be used with accuracy in predicting treatment response.Level of EvidenceLevel IV, Therapeutic Study.     

Isola spinal instrumentation system for idiopathic scoliosis

Since the definition of three-dimensional components of the scoliotic deformity, there have been important improvements in the surgical treatment of the problem. A derotation maneuver was proposed as a treatment option with CD instrumentation, but the reports of imbalance and decompensation with this system repopularized sublaminar wiring and translation as a corrective maneuver. Isola spinal instrumentation is one of the modern systems that utilizes vertebral translation instead of rod rotation. This study analyzes the results of 24 patients with idiopathic scoliosis who had been followed up for at least 2 years, and were surgically treated with titanium Isola Spinal Instrumentation in the Department of Orthopaedics and Traumatology, Ankara Social Security Hospital. Patients were grouped according to the King-Moe classification. Patients with type III, IV or V curves received only posterior instrumentation while this procedure followed anterior release and discectomy in the same session in patients with type I or II curves. A translation maneuver was utilized in the correction of scoliotic curves using the cantilever technique, either alone or supplemented by sublaminar wiring with Songer multifilament titanium cables. This study aimed to elucidate the effects of this technique in the frontal and sagittal plane curves and the trunk balance. The balance was analyzed clinically and radiologically by measurement of the lateral trunk shift (LT), shift of stable vertebra (SS), and shift of head (SH) in vertebral units (VU). The postoperative correction was significant in the frontal plane for all types of curves (p < 0.05). The postoperative correction was 80.9% +/- 9.5% in type III curves. Overall, the mean Cobb angle of the major curve value in the frontal plane was 66.9 degrees +/- 18.8 degrees, and it was corrected by 62.8% +/- 20.1%. The correction loss of Cobb angles in the frontal plane was 5.4 degrees +/- 5.5 degrees at the last follow-up visit. A normal physiologic thoracic contour (30 degrees - 50 degrees) was achieved in 83.3% of the patients and normal lumbar contour (40 degrees - 60 degrees) in 66.7% of the patients in the sagittal plane. The correction was found to be significant in all balance values (p < 0.05). The postoperative correction in LT values correlated with the correction of the Cobb angle values in the frontal plane. All patients had complete balance (SH: 0 VU and SS: 0 VU) or balanced curves (0 VU < SH, SS < 0.5 VU).Finally, the study concluded that the translation maneuver, especially when used with the cantilever technique, resulted in high correction rates in the frontal plane. Additionally, the technique was also successful in obtaining normal sagittal contours and correcting balance values.     

ConA诱导肝细胞损伤机理及CsA对其损伤的影响

目的　探讨NO、脂质过氧化反应及蛋白巯基状态改变在ConA诱导肝组织细胞损伤过程中的作用以及CsA对其损伤的影响。方法 :尾静脉注射ConA( 2 0mg·kg-1)于雄性BALB/c小鼠作为试验组 ;提前半小时予以CsA( 2 5mg·kg-1)后再按试验组处理作为CsA组。观察血清中ALT、AST、NO-2 及肝组织MDA、TSH、PSH含量在 3h、6h、9h和 12h的动态变化。结果　试验组血清中ALT、AST进行性升高 ,在 12h时与对照组、CsA组比较均P <0 .0 1。试验组动物体内有大量的NO合成 ,血清中NO-2 随时间呈明显上升趋势 ,在 12h时与对照组、CsA组比较均P <0 .0 1。试验组动物肝组织MDA含量逐步升高 ,在 12h与对照组、CsA组比较P <0 .0 1。试验组动物肝组织TSH含量不断下降在 12h与对照组、CsA组比较P <0 .0 5 ;PSH含量亦不断下降在 12h与对照组、CsA组比较P <0 .0 1。对照组和CsA组血清中ALT、AST及NO-2 前后变化不大 ,肝组织MDA、TSH、PSH含量变化亦不明显。结论　在ConA所致肝损伤中 ,动物体内NO生物合成机制被激活 ,是肝细胞损伤的重要介质之一。同时脂质过氧化的发生以及蛋白巯基持续消耗致肝组织细胞的抗氧化能力和解毒能力下降也均是ConA性肝损伤机制之一。免疫抑制剂CsA预处理能阻断ConA性肝损伤的发生 ,免疫介导机制亦可能是其损伤     

河南省低中度氟暴露地区成年男性骨密度的影响因素分析

目的:探索河南省低中度氟暴露地区成年男性骨密度的影响因素。方法:采用整群随机抽样方法,于2017年4-5月选择河南省开封市通许县低中度氟暴露地区的成年男性村民为调查对象。通过问卷调查、体格测量获得调查对象的基本人口学资料,并收集晨尿样本。采用离子选择电极法测定尿氟含量,使用超声波骨密度仪测量骨密度（以T值表示）,利用偏...     

Multidiciplinary treatment of complicated subgingivally fractured permanent central incisors: two case reports

Abstract – Subgingival crown fractures with pulp exposure in permanent teeth present both endodontic and restorative problems with unfavorable prognosis. Numerous restorative techniques such as resin composite restorations with and without pins, crowns and reattachment of the fractured dental fragment could be listed as the treatment options. There are several successful cases in the literature where advantages of less microleakage and proper gingival biocompatibility in cases with reattachment of the tooth fragment were reported. Two cases of palatinal subgingival crown fractures are reported. Both had been restored by reattachment of the fragment and composite with the help of the flap surgery. Follow up visits (Case 1 for 4 years and Case 2 for 1 year) revealed satisfactory esthetics and function.     

A rare cause of retinal artery embolism: Accessory mitral valve tissue

A 42‐year‐old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst‐like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue.