Comparison of Neuroplastic Responses to Cathodal Transcranial Direct Current Stimulation and Continuous Theta Burst Stimulation in Subacute Stroke

Objective

To investigate the effects of cathodal transcranial direct current stimulation (tDCS) and continuous theta burst stimulation (cTBS) on neural network connectivity and motor recovery in individuals with subacute stroke.

Locally advanced adenocarcinomas of the gastric cardia: results of pre-operative chemoradiotherapy

Overall prognosis of adenocarcinomas of the gastro-esophageal junction remains poor as most patients present with advanced disease. AIM: To examine the effects of preoperative chemoradiotherapy in locally advanced adenocarcinomas of the gastro-esophageal junction. METHODS: Forty-two consecutive patients received a course of radiotherapy (45 Gy, administred in 25 fractions) with concurrent infusion of 5-Fluorouracil and cisplatin, followed by surgery. Endoscopic ultrasonography was used to assess response to chemoradiotherapy. A transhiatal or a transthoracic approach was used for surgical resection. Tumor size, node invasion and margins of resection were analyzed. RESULTS: Thirty-eight patients underwent subsequent surgery and complete resection (RO) was achieved in 34. Operative mortality was 13.2% (5/38). A histological complete response was observed in 6 patients. Median survival was 23 months (range: 15-31) and median disease-free survival was 19 months (range: 15-23). At one and two years, 70.7 and 45.6% of the patients were alive, respectively. The pTNM status, node involvement and tumor size were predictors of survival. CONCLUSIONS: Pre-operative chemoradiotherapy is effective in patients with locally advanced carcinoma of the gastro-esophageal junction, resulting in high resection rates. However it seems to increase operative morbidity and mortality. Certain prognostic factors such as resection margins, need to be examined in further detail.     

Short-Term Outcome After Laparoscopic or Open Restorative Mesorectal Excision for Rectal Cancer: A Comparative Cohort Study

Purpose The laparoscopic approach to rectal cancer is still a controversial procedure. A comparative cohort study was conducted to assess short-term results of laparoscopic restorative mesorectal excision. Methods From January 1998 to December 2000, laparotomy was performed on all primary rectal cancer undergoing radical excision. From January 2002 to September 2004, all cases about to undergo radical excision were considered for laparoscopy. Patients with fixed tumor or T4, indications for synchronous hepatectomy, emergencies, and medical contraindications were not included. The study was based on the intention-to-treat principle. Results Short-term outcome was compared between the laparoscopy group (n=104) and the laparotomy group (n=68). Demographic, general and tumor data, and rates of preoperative irradiation were comparable, as were surgical procedures and perioperative management. Hospital mortality (1 and 2.9 percent, P=0.33) and three-month overall morbidity (43.3 and 48.5 percent, P=0.49) were comparable between laparoscopy and laparotomy groups. Surgical complication rates were comparable (39.3 and 35.5 percent, P=0.58), but a significantly lower medical complication rate was observed in laparoscopy patients (8.7 and 20.6 percent, P=0.025), mainly because this group had fewer respiratory complications. Hospital stay was shorter in laparoscopy patients (10 and 14 days, P<0.001). Oncologic quality criteria were comparable, in terms of number of lymph nodes, lateral and distal margins, and delivery of postoperative chemotherapy. Conclusions The laparoscopic approach to restorative mesorectal excision for cancer does not increase postoperative morbidity or reduce oncologic quality. Our results suggest that the short-term outcome is probably improved with this procedure.     

Results of the GYNECO 02 study, an FNCLCC phase III trial comparing hysterectomy with no hysterectomy in patients with a (clinical and radiological) complete response after chemoradiation therapy for stage IB2 or II cervical cancer

Background.

Concomitant chemoradiation (CRT) (including brachytherapy) is considered the standard management for stage IB2 or II cervical cancer in many countries. Nevertheless, some of them discuss completion surgery (hysterectomy [HT]) after CRT. The aim of this study was to investigate the therapeutic impact of such surgery.

Methods.

A randomized trial was opened in France in 2003 to evaluate the interest in HT after CRT. Inclusion criteria were: (a) stage IB2 or II cervical cancer without extrapelvic disease on conventional imaging; (b) pelvic external radiation therapy (45 Gy with or without parametrial or nodal boost) with concomitant cisplatin chemotherapy (40 mg/m² per week) followed by uterovaginal brachytherapy (15 Gy to the intermediate risk clinical target volume); and (c) complete clinical and radiological response 6–8 weeks after brachytherapy. Patients were randomized between HT (arm A) and no HT (arm B). Unfortunately this trial was closed because of poor accrual: 61 patients were enrolled (in 2003–2006) and are reported on here.

Results.

Thirty one and 30 patients were enrolled, respectively, in arm A and arm B. Twelve patients recurred (five of them died): respectively, eight and four in arm A and arm B. The 3-year event-free survival rates were 72% (standard error [SE], 9%) and 89% (SE, 6%) (not significant [NS]) in arm A and arm B, respectively. The 3-year overall survival rates were 86% (SE, 6%) and 97% (SE, 3%) (NS) in arm A and arm B, respectively.

Conclusions.

Results of the current trial seem to suggest that completion HT had no therapeutic impact in patients with clinical and radiological complete response after CRT (but this conclusion is limited by the lack of power).     

Familial cortical myoclonic tremor with epilepsy (FCMTE): Clinical characteristics and exclusion of linkages to 8q and 2p in a large French family

Introduction

Familial cortical myoclonic tremor with epilepsy (FCMTE) is defined by an autosomal-dominant inheritance, adult onset of myoclonus of the extremities, infrequent epileptic seizures, a non-progressive course, polyspikes on electroencephalography (EEG), photosensitivity, giant somatosensory-evoked potentials (SEP), enhancement of C-reflex and a premyoclonus spike detected by jerk-locked EEG back-averaging. Two genes yet to be identified are mapped to 8q23.3-q24.1 and 2p11.1-q12.2.

Methods

The present study involved five generations of a French family presenting with FCMTE, including 76 family members. Clinical analyses were performed in 39 living subjects and electrophysiological studies in five patients. Altogether, 27 relatives (21 living and six deceased) had the clinical characteristics of FCMTE, 17 of whom were analyzed. Linkage analyses were performed with microsatellites encompassing the two known loci (8q 23.3-q24.1 and 2p11.1-q12.2).

Results

Mean age at onset in the 17 living patients was 28.8 years (range 24-41). All had myoclonus/cortical tremor, and 11/17 had generalized tonic-clonic seizures. Other clinical symptoms were photosensitivity (16 cases), partial seizures (five cases), sensitivity to starvation/exercise (six cases) and vibration (four cases), ophthalmic migraine (six cases) and gait disorders (10 cases). Electrophysiological studies confirmed the FCMTE diagnosis in the five studied patients. Of the remaining relatives, 14 were considered healthy (asymptomatic subjects aged more than 40 years) and eight were of unknown status (asymptomatic aged lesser than 40 years). The pattern of inheritance was consistent with autosomal-dominant inheritance, although the two loci responsible for FCMTE were excluded.

Conclusion

This large family highlights some unusual clinical characteristics and suggests the presence of a third gene. Genetic research is ongoing to identify the mutated gene.     

Automatic detection of abnormal vascular cross-sections based on density level detection and support vector machines

Purpose  

The goal is to automatically detect anomalous vascular cross-sections to attract the radiologist’s attention to possible lesions and thus reduce the time spent to analyze the image volume.     

Horizontal optokinetic nystagmus in unilaterally enucleated pigmented rats: role of the pretectal commissural fibers.

Monocular enucleation reduces the asymmetry of horizontal optokinetic nystagmus (H-OKN) in afoveate mammals by increasing responses to naso-temporal visual stimulation. The origin of these larger responses was investigated in adult pigmented rats monocularly enucleated as neonates or as adults by analyzing retinal and commissural projections to the deafferented nucleus of the optic tract (NOT) and the functional role of this nucleus before and after section of the posterior commissure. Anatomically, monocular enucleation reduces the volume of the contralateral deafferented NOT. Anterograde tracers injected in the intact eye reveal a crossed projection of the retina to the NOT and to the dorsal (DTN) and medial (MTN) terminal nuclei of the accessory optic system as in normal rats. In addition, there is an uncrossed projection to the MTN in the rats enucleated as neonates. Retrograde tracer injected in the deafferented NOT confirms the absence of an uncrossed retinal projection but reveals connections between both NOT via the posterior commissure as in normal rats. Electrophysiologically, the larger naso-temporal optokinetic responses in monocularly enucleated rats return to normal after posterior commissurotomy. This study demonstrates that no anatomical remodelling takes place to increase naso-temporal responses in monocularly enucleated rats. The larger responses must then result from functional changes. The role of exclusive contralateral projections of the retina to the NOT and of the commissural connections in mediating the asymmetry of the optokinetic nystagmus in afoveate mammals is discussed.     

Concurrent cisplatin/etoposide chemotherapy plus twice daily thoracic radiotherapy in limited stage small cell lung cancer: a phase II study

Thirty-one previously untreated patients with limited stage small-cell lung cancer (LSCLC) were included in a prospective study, to investigate the feasability and the efficacy of a combined modality treatment using concurrent hyperfractionated chest irradiation and cisplatin (P) plus etoposide (E) chemotherapy. All patients received intravenously P=75 mg/m(2) at day 1, plus E=120 mg/m(2) days 1-3, at 3-week intervals for six cycles. Irradiated patients received 45 Gy in two daily fractions, 5 days a week, from week 4 to week 6. During week 5, prophylactic cranial irradiation was initiated, in one daily fraction of 2.5 Gy for a total dose of 25 Gy. Twenty-nine patients were evaluable for response. Twenty-two (76%) achieved a complete response, five (17%) had a partial response. Five patients are currently alive. The overall response rate was 93% (CI 95% (83.7-100)). The median survival time was 14 months and the 2-year survival rate was 25%. Main toxicities were grade 3-4 esophagitis in half of the patients and myelosuppression. The results are not as optimistic as other studies using a similar regimen.