Results of scalp cooling during anthracycline containing chemotherapy depend on scalp skin temperature

ObjectivesThe success of scalp cooling in preventing or reducing chemotherapy induced alopecia (CIA) is highly variable between patients undergoing similar chemotherapy regimens. A decrease of the scalp skin temperature seems to be an important factor, but data on the optimum temperature reached by scalp cooling to prevent CIA are lacking. This study investigated the relation between scalp skin temperature and its efficacy to prevent CIA.Materials and methodsIn this explorative study, scalp skin temperature was measured during scalp cooling in 62 breast cancer patients undergoing up to six cycles of anthracycline containing chemotherapy. Scalp skin temperature was measured by using two thermocouples at both temporal sides of the head. The primary end-point was the need for a wig or other head covering.ResultsMaximal cooling was reached after 45 min and was continued for 90 min after chemotherapy infusion. The scalp skin temperature after 45 min cooling varied from 10 °C to 31 °C, resulting in a mean scalp skin temperature of 19 °C (SEM: 0,4). Intrapersonal scalp skin temperatures during cooling were consistent for each chemotherapy cycle (ANOVA: P = 0,855). Thirteen out of 62 patients (21%) did not require a wig or other head covering. They appeared to have a significantly lower mean scalp skin temperature (18 °C; SEM: 0,7) compared to patients with alopecia (20 °C; SEM: 0,5) (P = 0,01).ConclusionThe efficacy of scalp cooling during chemotherapy is temperature dependent. A precise cut-off point could not be detected, but the best results seem to be obtained when the scalp temperature decreases below 18 °C.Trialregister.nl NTR number3082     

Development of visual texture segregation during the first year of life: a high-density electrophysiological study

There are important developmental changes occurring during infancy in visual cortical structures that underlie higher-order perceptual abilities. Using high-density electrophysiological recording techniques, the present study aimed to examine the development of visual mechanisms, during the first year of life, associated with texture segregation. Forty-two normal full term infants were tested at 1, 3, 6 or 12 months of age. Visual-evoked potentials to low-level stimuli varying in orientation (oriVEP) and higher-level textured stimuli (texVEP) were recorded from 128 scalp electrodes. Difference potentials were obtained to extract the VEP component associated specifically with texture segregation (tsVEP). Results show a clear developmental pattern regarding amplitude, latency and scalp distribution of tsVEP, which appears at around 3 months but does not reach maturity by 12 months of age. A reduction in latency is particularly evident between 3 and 6 months, whereas amplitude shows a gradual increase with a marked increment between 3 and 6 months for low-level orientation stimuli and between 6 and 12 months for higher-level textured stimuli. These developmental patterns are attributed to neural maturational processes such as myelination and synaptogenesis. The differential developmental rates can be explained by delayed maturational processes of brain regions involved in more complex visual processing.     

Seizure-induced miosis

Ictal autonomic pupillary dilation is common; however, miosis is rare. We describe a case of focal seizures secondary to cortical dysplasia presenting with bilateral pupillary miosis, rendered seizure free by resective surgery. The seizure-onset zone was localized within the left middle parietal gyrus by intracranial electrographic recording. Seizure onset was coincident with focal left centroparietal fast spike activity on electroencephalography (EEG). A large region of the left frontocentral cortical dysplasia was demonstrated on magnetic resonance imaging (MRI). Complete resection of the area of cortical dysplasia and additional cortical regions of ictal activity, identified using intracranial EEG, rendered the patient seizure free.     

皮肤扩张术修复头皮合并颅骨缺损

目的探讨头皮合并颅骨缺损的修复方法。方法对2000年至2007年治疗的6例头皮合并颅骨缺损患者，采用皮肤扩张术修复头皮，钛网修补颅骨缺损。结果6例患者中，1例患者出现皮瓣下积液，经抽吸、加压包扎后愈合；其余病例未出现感染、血肿及皮瓣坏死等并发症，外观满意。结论皮肤扩张术和钛网联合应用是修复头皮合并颅骨缺损的较好方法。     

P3a from visual stimuli: typicality,task, and topography

A visual three-stimulus (target, nontarget, standard) paradigm was employed in which subjects responded only to the target. Nontarget stimulus properties were varied systematically to evaluate how stimulus typicality (non-novel vs. novel) across task discrimination (easy vs. difficult) conditions affects P3a scalp topography. Nontarget stimuli consisted of letters, small squares, large squares, and novel patterns; discrimination difficulty between the target and standard was varied across conditions. When the discrimination was easy, P300 amplitude was larger for the target than the nontarget with parietal maximums for both. In contrast, when the discrimination was difficult, nontarget amplitude (P3a) was larger and earlier than the target P300 over the frontal/central electrode sites, whereas target amplitude (P3b) was larger parietally and occurred later. P3a was largest when elicited by either the large square or novel pattern stimuli. The findings suggest that stimulus context as defined by the target/standard discrimination difficulty rather than stimulus novelty determines P3a generation.     

儿童头皮深在性红斑狼疮五例

目的 探讨儿童头皮深在性红斑狼疮（LEP）临床及病理学特征。 方法 回顾性分析5例LEP患儿临床、组织病理特点及治疗和预后情况。 结果 5例儿童头皮LEP,男2例,女3例;中位发病年龄5个月（范围2 ～ 38个月）;中位病程15个月（范围4 ～ 72个月）。皮损为头部弧形或环形紫红色萎缩性斑块伴脱发,枕部及颞部最常受累。1例患儿抗核抗体（ANA）1 ∶ 100,4例患儿ANA抗Ro/SSA、La/SSB抗体检查均为阴性。组织病理学改变主要为脂肪透明变性,黏蛋白沉积及脂肪小叶淋巴细胞灶状聚集。2例口服泼尼松（1.5 ~ 2） mg·kg-1·d-1, 1例口服羟氯喹5 mg·kg-1·d-1,1例口服泼尼松1.5 mg·kg-1·d-1并联合羟氯喹5 mg·kg-1·d-1;1例患儿仅外用卤米松乳膏及0.03%他克莫司软膏。患儿皮损于治疗后2 ~ 3月均获得缓解,6个月消退,新发生长,随访1.5年未见病情反复。 结论 头皮LEP对泼尼松及羟氯喹治疗反应良好,患儿可选用强效糖皮质激素及钙调磷酸酶抑制剂外用治疗。