Magnetic resonance imaging during management of patients with transfusion-dependent thalassemia: a single-center experience

Background

Cardiac and hepatic magnetic resonance imaging evaluation during treatment can tailor physicians’ chelation therapy titrations.

Aim

The aim of the study was to assess the relationship of cardiac and hepatic T2* values with chelation therapy in patients with transfusion-dependent thalassemia (TDT).

Methods

A total of 106 patients with TDT who were followed up in Istanbul Medical Faculty Thalassemia Center were evaluated for the study. Forty-eight (45%) patients with TDT had more than one consecutive MRI examination. The patients were divided into three subgroups according to the cardiac T2* values as the high-risk group (T2* MRI?<?10 ms), medium-risk group (T2* MRI 10-20 ms), and the low-risk group (T2* MRI?>?20 ms).

Results

The majority of patients used DFX (deferasirox) (79%) and deferiprone (DFP) (17%). Approximately 80% of patients according to cardiac T2* value and 40% of patients according to hepatic T2* value were initially in the low-risk group. Patients with follow-up MRI examinations exhibited significant improvement in liver iron concentration, which correlated with an increase in hepatic T2* values. The decrease of liver iron concentration was prominent in the DFX group (p?<?0.01). The serum ferritin level was significantly correlated with liver iron concentrations (rs?=?0.65, p?<?0.001), hepatic T2* value (rs?=?? 0.62, p?<?0.001), but not with cardiac T2* value (rs?=?? 0.20, p?=?0.07).

Conclusion

Cardiovascular and hepatic MRI is a useful follow-up tool during the assessment of risk groups and chelation therapy of patients with TDT. Consecutive MRI tests showed good monitoring of cardiac and liver iron overload.

     

Anatomy and clinical significance of the trigeminocerebellar artery

The trigeminocerebellar artery (TCA) is a unique branch of the basilar artery supplying both the trigeminal nerve root and the cerebellar hemisphere. In this study, we describe and demonstrate the microanatomy of the TCA in 45 brainstems and discuss the neurological, neuroradiological and neurosurgical significance. This is the largest series of cadavers in the literature. The close relationship of the TCA to the trigeminal nerve root may have clinical implications including for the etiology of trigeminal neuralgia, thus the neurosurgeon must be aware of the vasculature of the trigeminal nerve root area and the anatomical variations.     

Treatment of Focal Epithelial Hyperplasia with Topical Imiquimod: Report of Three Cases

Abstract:   Focal epithelial hyperplasia (Heck disease) is a rare disorder caused by specific types of HPV. It mainly involves oral mucosa and children are affected more frequently. It may persist for years, producing a significant reduction in quality of life. Several treatment modalities such as surgical excision, laser ablation, cryotherapy, electrocauterization, topical, intralesional, systemic interferon, and systemic retinoic acid have been used with inconsistent results and many side effects. Here we report three children of Turkish origin with focal epithelial hyperplasia successfully treated with imiquimod 5% cream. No serious side effects were observed and recurrence did not occur during the 1-year follow-up period.     

Evaluation of a three‐session biliary dilation protocol following transplant‐related biliary stricture in pediatric patients

To evaluate whether a serial biliary dilation protocol improves outcomes and decreases total biliary drainage time for biliary strictures following pediatric liver transplantation. From 2006 to 2016, 213 orthotopic deceased and living related liver transplants were performed in 199 patients with a median patient age of 3.1 years at a single pediatric hospital. Patients with biliary strictures were managed by IR or surgically by the transplant team. Patients managed by IR were divided into two groups. The first group was managed with a standardized three‐session protocol consisting of dilation every two weeks for three dilations. The second group was managed clinically with varying number and interval of dilations as determined by a multidisciplinary team. The location of biliary stricture, duration of drainage, number of balloon dilations, balloon diameter, time interval between dilations, and success of percutaneous treatment were recorded. Thirty‐four patients developed biliary strictures. Thirty‐one patients were managed with percutaneous intervention. Three strictures could not be crossed and were converted to operative management. Ten patients were managed in the three‐session protocol, and 18 patients were managed in the clinically treated group. There was no significant difference in clinical success rates between groups, 80% and 61%, respectively. The three‐session protocol group trended toward a lower total biliary drain indwell time (median 49 days) compared with the clinically treated group (median 89 days), P = .089. Our study suggests that a three‐session dilation protocol following transplant‐related biliary stricture may decrease total biliary drainage time for some patients.     

基于AHP-熵权TOPSIS法优选磁石炮制工艺及所含重金属元素的风险评估

目的 通过AHP优化的熵权TOPSIS模型对磁石的煅淬工艺进行优选,并对煅磁石饮片的重金属元素残留量进行健康风险评估。方法 通过正交试验,分别以Fe和Pb、As、Cd、Hg、Cu元素的含量为综合评价指标,采用《中国药典》2020年版规定的Fe含量测定法（重铬酸钾滴定法）和电感耦合等离子体质谱法（inductively coupled plasma-mass spectrometry,ICP-MS）进行含量测定,基于AHP-熵权TOPSIS法优选最佳炮制工艺参数。采用风险评估方法对煅磁石的重金属元素安全性进行评估,以磁石原粉入药为例,计算靶标危害系数（target hazard quotients,THQ）,并推算煅磁石中各重金属的最大残留限量理论值。结果 优化后的磁石煅淬工艺为煅烧时间90 min,煅烧温度650 ℃,煅淬2次。炮制后的煅磁石Fe含量变化不大,重金属元素含量降低,13批煅磁石饮片较原药材的健康风险显著降低（P＜0.05）。结论 初步制定煅磁石饮片中Pb、As、Cd、Hg、Cu的残留限量理论值依次为40、90、25、17、1 500 mg/kg;为磁石及同类矿物药的临床安全用药提供参考。     

Comparison of serum acetyl hydrolase (PAF-AH) and paraoxonase 1 (PON1) values between prostate cancer patients and a control group

The aim of the study was to measure platelet-activating factor acetyl hydrolase (PAF-AH) and paraoxonase (PON1) enzyme activity levels in patients with high Psa values to compare with healthy peers and also to determine the efficacy of these parameters in predicting pathologic results of patients with high Psa values. This study included 66 patients with Psa value > 4 ng/dl (Group 1) and 44 patients with Psa <4 ng/dl (Group 2) for a total of 110 patients. Parameters measured in serum of PON1, PAF-AH, and MDA were compared between the groups. Additionally the same parameters were compared between patients with prostate biopsy performed due to high Psa and diagnosed with cancer and the control group with normal Psa values. The PAF-AH activity in Group 1 was 125.17 ± 8.64 and in Group 2 was 120.08 ± 9.23 U/ml (p = 0.003). The PON1 activity was 63.12 ± 6.74 and 65.91 ± 7.77 U/ml in the groups, respectively (p = 0.04). Additionally, there were significant differences identified between the control group and PCa diagnosis group in terms of PAF-AH and PON1 activities (p = 0.004 and p = 0.02, respectively). The enzyme activity of PAF-AH and PON1 measured in serum of patients with high Psa value and patients with diagnosis of prostate cancer (PCa) were identified to have changed by a significant amount compared to healthy peers with normal Psa value. It was concluded that these parameters may be beneficial markers for use in assessment of patients with high Psa value.