Spatial and temporal patterns in dynamic-contrast enhanced intraoperative fluorescence imaging enable classification of bone perfusion in patients undergoing leg amputation

Dynamic contrast-enhanced fluorescence imaging (DCE-FI) classification of tissue viability in twelve adult patients undergoing below knee leg amputation is presented. During amputation and with the distal bone exposed, indocyanine green contrast-enhanced images were acquired sequentially during baseline, following transverse osteotomy and following periosteal stripping, offering a uniquely well-controlled fluorescence dataset. An unsupervised classification machine leveraging 21 different spatiotemporal features was trained and evaluated by cross-validation in 3.5 million regions-of-interest obtained from 9 patients, demonstrating accurate stratification into normal, suspicious, and compromised regions. The machine learning (ML) approach also outperformed the standard method of using fluorescence intensity only to evaluate tissue perfusion by a two-fold increase in accuracy. The generalizability of the machine was evaluated in image series acquired in an additional three patients, confirming the stability of the model and ability to sort future patient image-sets into viability categories.     

Irish data on the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease

Abstract

Introduction: Vedolizumab (VDZ) is a monoclonal antibody designed to inhibit α4β7 integrin and result in gut-selective anti-inflammatory activity. Real-world data are important in providing information to clinicians on the effectiveness and safety of this agent.

Methods: A retrospective, multi-centre study was conducted across 9 Irish academic centres. Adult (≥18?years) patients receiving VDZ for active IBD (ulcerative colitis [UC] or Crohn’s disease [CD]) with at least 6?months follow-up were included in the study cohort. Primary study endpoints were defined as 3-month clinical response and 6-month corticosteroid-free remission. Secondary endpoints included 3-month corticosteroid-free clinical remission, 6-month clinical response, change from baseline in CRP, albumin and faecal calprotectin, and adverse events.

Results: One hundred and twenty-nine patients were included in total (64 UC, 65?CD). In the UC cohort, baseline median PMCS was 7 [0 – 9] and 78.1% had prior anti-tumour necrosis factor alpha (anti-TNFα) exposure. Three-month and 6-month endpoints were achieved in 40% and 31%, respectively. Milder disease, CRP, albumin and prior anti-TNFa were associated with endpoints. One minor adverse event was documented. In the CD cohort, baseline HBI was 12 [0 – 29] and 94% previously received anti-TNFa therapy. Three-month and 6-month primary endpoints were achieved in 52% and 48%, respectively. Six-month remission was positively associated with Montreal B1 disease and negatively associated with perianal disease and baseline faecal calprotectin. Adverse events occurred in 11% of cases.

Conclusion: These real-world data support the effectiveness and safety of vedolizumab in the treatment of IBD and give valuable insight into predictors of treatment outcomes.

SUMMARY

This study reviews the safety and efficacy of treatment with vedolizumab for patients with inflammatory bowel disease across 9 Irish hospitals. It generates valuable and timely real-world data on treatment outcomes to add to the existing evidence base. Our population represents a refractory cohort with most patients previously exposed to at least one anti-TNFa agent and expressing an inflammatory phenotype. Results are reassuringly similar to larger international studies with additional insights into potential predictors of treatment response. This study further supports the safety and efficacy of vedolizumab in the treatment of inflammatory bowel disease.

1. Key Summary

2. Vedolizumab has growing real world data on its safety and efficacy in the treatment of IBD. Data on predictors of response are lacking. Studies such as VARSITY require new real-world data to help identify the place VDZ will occupy in the treatment algorithm for IBD

3. This study provides national Irish data on the safety and efficacy of VDZ in the treatment of IBD. It gives insight into various predictors of response for both UC and CD. It strengthens the available body of evidence on the use of VDZ and helps us determine its position on the treatment algorithm.

     

Iron deficiency in Indian children with attention deficit hyperactivity disorder

A case control study was conducted at the Child Development and Early Intervention Clinic to determine the body iron status of children with ADHD, and study the correlation between the body iron status and ADHD symptoms. Serum ferritin was measured in newly diagnosed cases with ADHD and compared with that of controls. Correlation was studied between serum ferritin levels and the severity of ADHD symptoms as determined by Conners’ Rating Scale. Serum ferritin was found to be significantly lower in children with ADHD (6.04 ± 3.85 ng/mL) as compared to controls (48.96 ± 41.64 ng/mL, P value<0.001). There was a significant negative correlation between serum ferritin levels and oppositional subscore on Conners’ Rating Scale.     

Etiology and clinical spectrum of constipation in Indian children

Objective  

To analyze the etiology, clinical spectrum and outcome of constipation in children.     

Bioadjuvants for complex ankle and hindfoot reconstruction

Many reconstructive options exist for symptomatic hindfoot and ankle problems. Hindfoot and tibiotalar fusions are reliable procedures with consistent results. Unfortunately, many potential complications have been cited throughout the literature. Although the most important aspect in any fusion surgery is meticulous technique, advances in technology, including PRP, bone stimulators, and BMPs seem to be useful additions in the quest to achieve solid fusions with decreased complications.     

Fiber dissection of the visual pathways: analysis of the relationship of optic radiations to lateral ventricle: a cadaveric study

Objective: Using a fiber-dissection technique, our aim is to study the fiber bundles of the optic radiation. We focused on the course, the length, anatomical relations with lateral ventricle and the relevance of these finding during surgery in the region. Materials and Methods: Five previously frozen and formalin-fixed cadaveric human brains were used. The dissection was done using the operating microscope. Fiber dissection techniques described by Klingler were adopted. The primary dissection tools were handmade, thin, and wooden and curved metallic spatulas with tips of various sizes. Lateral and inferior temporal approaches were made and the optic fiber tracts were dissected. Results: Resections that extend through the roof of the temporal horn more than 30 mm behind the temporal pole cross the Meyer's loop. In the middle temporal gyrus approach, resection that is taken through the lateral wall of the temporal horn more than 55-60 mm behind the temporal pole may cross the optic radiation during their course here on the lateral wall. Conclusion: The presented fiber dissection study clarifies the relationship of optic radiation. Such fiber dissection studies are only few in the literature.