Benign lymphoid hyperplasia mimicking oligometastasis from non-small cell lung cancer after stereotactic ablative radiotherapy.

BACKGROUND: Benign lymphoid hyperplasia (BLH) is a rare lymphoproliferative disorder of normal polyclonal B lymphocytes, but is sometimes difficult to distinguish from malignancy. CASE: An 87-year-old man with a history of localized non-small cell lung cancer (NSCLC) was referred for evaluation and treatment of an elastic hard tumor in the left supraclavicular fossa one year after stereotactic ablative radiotherapy (SABR). Whole-body PET scan showed high 18F-fluorodeoxyglucose uptake in the left supraclavicular fossa, and a dia-gnosis of oligometastasis was made. The tumor was homogeneously high signal on T2-weighted image with homogeneous enhancement after contrast administration. Since the palpation and MRI findings were inconsistent with those of metastatic NSCLC, a bio-psy was performed. Pathological and immunohistochemical investigation revealed the lesion to be BLH. CONCLUSION: In a patient with suspected oligometastasis after SABR for NSCLC, caution should be exercised before undergoing SABR for oligometastasis because BLH may be present.

Metal artifact-free MRI-guided re-irradiation for recurrent spinal metastases from thyroid cancer.

BACKGROUND: Soft tissue tumors near metal implants are sometimes difficult to treat with real-time image-guided radiation therapy. Low-field MRI was utilized to clearly delineate the tumor and spinal cord while avoiding metal artifacts, and re-irradiation was performed for recurrent spinal metastases. CASE DESCRIPTION: A 57-year-old woman with a history of thyroid cancer was referred for re-irradiation for recurrent painful bone metastases in the thoracolumbar spine. She had already undergone conventional radiation therapy followed by stereotactic ablative radiotherapy and multiple fusion surgeries. Since the radiation dose to the spinal cord should have been limited, metal artifact-free low-field MRI-guided re-irradiation was performed with no significant adverse events. CONCLUSION: Low-field MRI-guided re-irradiation may be feasible for recurrent spinal metastases, even after metal implants have been placed.

Exploring fetal response to acidosis in ewes: Choosing an adequate experimental model.

INTRODUCTION: Knowledge of fetal physiology during labor has been largely generated from animal models. Our team recently developed a new index to assess parasympathetic activity using different experimental protocols to obtain acidosis. The objective of the present study was to discuss the different protocols and to review other models proposed in the literature. MATERIAL AND METHODS: Pregnant ewes underwent a surgical procedure at the 123±2 days gestational age (term=145 days). Three experimental protocols were used: protocol A consisted of 25%, 50% and 75% umbilical cord occlusion (UCO) for 20min. Protocol B consisted of partial 75% UCO until reaching a pH<7.10. Protocol C consisted of brief, repetitive complete occlusion until severe acidosis occurred. Hemodynamic and blood gas parameters were compared to those of the stability period before UCO. RESULTS: Protocol A led to a progressive response depending on the degree of occlusion (decrease in fetal heart rate, arterial hypertension and pH). Protocol B led to severe acidosis, although the duration of UCO varied per animal. Protocol C also progressively led to acidosis. We observed high inter individual variability in the acidosis response. CONCLUSION: Pregnant ewes are a relevant model for exploring fetal response to acidosis. The frequency of UCO and partial or complete occlusion should be adapted to the expected effects. Knowledge of these protocols is important to respect ethical guidelines and to reduce the required number of animals. Moreover, it is important to consider the high individual variability of the acidosis response in the interpretation of the results.

Correlation of a new index reflecting the fluctuation of parasympathetic tone and fetal acidosis in an experimental study in a sheep model.

The autonomic nervous system plays a leading role in the control of fetal homeostasis. Fetal heart rate variability (HRV) analysis is a reflection of its activity. We developed a new index (the Fetal Stress Index, FSI) reflecting parasympathetic tone. The objective of this study was to evaluate this index as a predictor of fetal acid-base status. This was an experimental study on chronically instrumented fetal lambs (n = 11, surgery at 128 +/- 2 days gestational age, term = 145 days). The model was based on 75% occlusion of the umbilical cord for a maximum of 120 minutes or until an arterial pH ≤ 7.20 was reached. Hemodynamic, gasometric and FSI parameters were recorded throughout the experimentation. We studied the FSI during the 10 minutes prior to pH samplings and compared values for pH>7.20 and pH≤ 7.20. In order to analyze the FSI evolution during the 10 minutes periods, we analyzed the minimum, maximum and mean values of the FSI (respectively FSImin, FSImax and FSImean) over the periods. 11 experimentations were performed. During occlusion, the heart rate dropped with an increase in blood pressure (respectively 160(155-182) vs 106(101-120) bpm and 42(41-45) vs 58(55-62) mmHg after occlusion). The FSImin was 38.6 (35.2-43.3) in the group pH>7.20 and was higher in the group pH less than 7.20 (46.5 (43.3-52.0), p = 0.012). The correlation of FSImin was significant for arterial pH (coefficient of -0.671; p = 0.004) and for base excess (coefficient of -0.632; p = 0.009). The correlations were not significant for the other parameters. In conclusion, our new index seems well correlated with the fetal acid-base status. Other studies must be carried out in a situation close to the physiology of labor by sequential occlusion of the cord.

INJURIES OF BOKO HARAM INSURGENCY IN SOUTH-EAST NIGER REPUBLIC.

BACKGROUND: Currently, wounds of wars, terrorism and criminality are increasing and constitute major public health problem worldwide. AIM: To present the epidemiological, clinical and therapeutic characteristics of the wounds observed during the Boko Haram (BH) insurgency in the South-east of the Republic of Niger. METHODOLOGY: This was a cross-sectional study from December 2014 to December 2016 at Diffa Regional Hospital, Diffa, Niger of individuals whose injuries were as a result of Boko Haram insurgency. RESULTS: In the period of this study, 573 injuries from Boko Haram insurgency were managed at the Regional Hospital at Diffa. The majority, 513(89.5%), were males while females constituted 60(10.5%) with a male/female ratio of 8.55. The mean age was 30,94(SD24,91) years (range 1 to 97 years). Civilian victims accounted for 379 (66.1%) while Nigerien soldiers accounted for 160(27.9%) and 34 (5.9%) were Boko Haram fighters. Firearms and explosives accounted for injuries in 489 (85.3%) and 7(1.2%) of patients respectively; 42 (7.3%) suffered injuries from a variety of traditional weapons. Injuries to limbs accounted for 361(63%) of cases and polytrauma in 65(11.34%). The main surgical management included wound debridement in 409 (71.4%), external bone fixation in 38 (6.6%), laparotomy in 30 (5.2%), thoracic drainage in 27 (4.7%), and major limb amputations in 13 (2.3%) cases.Postoperative follow-up was uneventful in 460 (80.28%) of cases; there were 29 deaths, giving a mortality rate of 5.1%. Predictors of death after injuries of Boko Haram terrorism in this study included: being civilian patients (OR = 3.38 [1.15-9.85], p=0.018), injuries to head, neck, trunk or spine (OR 3.45[1.58-7.58], p= 0.001) or the presence of polytrauma on admission (OR = 17.30 [7.72-38.80], p<0.0001). CONCLUSION: This study has shown that injuries sustained in Boko Haram insurgency in Niger were mainly firearm injuries and injuries from the use of traditional weapons, affecting mostly young civilian males. The part of the body most commonly involved were the extremities, with mainly soft tissue injuries. Wound debridement was the commonest surgical procedure performed and the mortality rate was 5.1%. Predictors of mortality were being civilian patients, injuries of head, neck, trunk or spine and polytrauma. The ICRC has played a major role in strengthening our hospital for the task of caring for the victims, in terms of provision of material resources and in the further training of our personnel.

Masticatory performance-related factors in preschool children: establishing a method to assess masticatory performance in preschool children using colour-changeable chewing gum.

A knowledge gap regarding masticatory performance in preschool children exists, which in turn delays intervention for preventive care; therefore, a method to easily assess performance is needed. The purpose of this study is to investigate the feasibility of assessing masticatory performance using colour-changeable chewing gum and to investigate masticatory performance-related factors in preschool children. This cross-sectional survey was conducted in two childcare facilities and our laboratory. First, a one-third quantity of colour-changeable chewing gum was masticated by six adults to assess the nature and progression of colour changes in this quantity. Then, masticatory performance in 370 children 4-6 years of age was assessed using the same quantity of colour-changeable chewing gum (60 chew strokes). The maximum bite force, body height, weight, age and number of healthy teeth were recorded. A t-test was performed to determine whether gum-chewing experience or lack thereof produced a significant difference in masticatory performance. The Spearman's rank correlation coefficient was then determined for masticatory performance assessment values and other factors solely for children with gum-chewing experience. Measurements from 259 children were obtained. Children with gum-chewing experience demons trated significantly higher assessment values and were deemed to have been correctly assessed. A very weak but significant positive correlation was observed only between masticatory performance and the number of healthy teeth. The masticatory performance of preschool children was easily assessed using colour-changeable chewing gum. The assessment values demonstrated significant correlation with the number of healthy teeth, but not with maximum bite force, body height, weight or age.

The relationship between the pre-admission CHA2DS2-VASc score and proximal artery occlusion in patients with acute stroke and atrial fibrillation.

BACKGROUND AND PURPOSE: The CHA2DS2-VASc score is associated with severity and outcome of ischaemic stroke in patients with atrial fibrillation (AF). It was hypothesized that a high CHA2DS2-VASc score was related to severity and outcome because of its association with proximal artery occlusion (PAO). This study aimed to elucidate the relationship between the CHA2DS2-VASc score and PAO and to determine whether the effect of the CHA2DS2-VASc score on severity or outcome is independent of PAO. METHODS: Acute stroke patients with AF were retrospectively enrolled. PAO was defined as occlusion at the internal carotid artery or proximal middle cerebral artery on admission magnetic resonance angiography. Multivariable analyses were performed to identify independent factors associated with PAO and determine the associations of the CHA2DS2-VASc score with the initial National Institutes of Health Stroke Scale (NIHSS) score and poor functional outcome (discharge modified Rankin scale score 4-6). RESULTS: In all, 213 patients [102 women; median age 80 (interquartile range 71-86) years; NIHSS score 16 (9-22)] were enrolled. On multivariable analysis, the CHA2DS2-VASc score (odds ratio 1.40, 95% confidence interval 1.12-1.76 per 1 point) was independently associated with PAO and correlated with the initial NIHSS score (standardized coefficient 0.198, P = 0.017). This association was not significant after further adjustment for PAO (0.080, P = 0.241). The CHA2DS2-VASc score was independently related to poor outcome even adjusted for PAO (odds ratio 1.39, 95% confidence interval 1.03-1.88). CONCLUSION: The CHA2DS2-VASc score was associated with PAO in acute ischaemic stroke patients with AF. The CHA2DS2-VASc score may be correlated with the NIHSS score through the presence of PAO and with poor functional outcome independently of PAO.

Association between near occlusal contact areas and mixing ability.

This study investigated the relationship between occlusal contact and near contact areas defined by clenching intensity using electromyograms (EMGs) and mixing ability assessed with colour-changeable chewing gum. Participants comprised 44 dentate adults (24 men, 20 women) with a mean age of 28·2 ± 6·8 years. Silicone material was used to measure the occlusal contact and near contact areas (the area of each type of tooth, the total area of the first molar and second molar, the second premolar to the second molar and the first premolar to the second molar) defined by clenching intensity at 10% maximum voluntary contraction (MVC). Colour-changeable chewing gum was used to assess mixing ability. A colorimeter was used to measure colour changes, and the calculated colour difference (ΔE) was used as a measure of mixing ability. Correlation analysis of ΔE and occlusal contact and near contact areas revealed a significant positive correlation of 0·47 at 0-160 µm thicknesses of the silicone registration material of the second molar (P < 0·01). The near contact area with a thickness up to 200 µm was correlated with mixing ability, with the correlation strengthening as the interocclusal distance increased up to 160 µm. Notably, occlusal contact and near contact areas of the second molar were strongly correlated with mixing ability in dentate adults.

Interleukin 12 is a primary cytokine responding to influenza virus infection in the respiratory tract of mice.

We have reported previously that an increase in interleukin 12 (IL-12) production in the lungs of mice infected with Influenza A virus or an intranasal (i.n.) administration of IL-12 to the infected mice alleviated pneumonia (Tsurita et al., J. Pharmacol. Exp. Therapeut. 298, 362-368, 2001). In this study, we found that in the bronchoalveolar lavage fluids (BALF) obtained from mice infected i.n. with Influenza A virus IL-12 was elevated on day 1 post infection (p.i.) and was followed by tumor necrosis factor alfa (TNF-alfa), IL-18, and interferons alfa, beta, and gama (IFN-alfa, -beta, and -gama) on day 2 p.i. Histochemical analyses of the infected lungs on day 1 p.i. showed the presence of IL-12 and IL-12 mRNA in mononuclear and macrophage-like cells and co-localization of macrophages with viral antigen, while other cytokines were absent. Thus, IL-12 was produced by macrophages infiltrating the infected epithelium as the first response cytokine and its production at the site of infection may direct an early immune defense to alleviate the severity of infection.

Topology studies of hydrodynamics using two-particle correlation analysis.

The effects of fluctuating initial conditions are studied in the context of relativistic heavy ion collisions where a rapidly evolving system is formed. Two-particle correlation analysis is applied to events generated with the NEXSPHERIO hydrodynamic code, starting with fluctuating nonsmooth initial conditions (IC). The results show that the nonsmoothness in the IC survives the hydroevolution and can be seen as topological features of the angular correlation function of the particles emerging from the evolving system. A long range correlation is observed in the longitudinal direction and in the azimuthal direction a double peak structure is observed in the opposite direction to the trigger particle. This analysis provides clear evidence that these are signatures of the combined effect of tubular structures present in the IC and the proceeding collective dynamics of the hot and dense medium.

Importance of granular structure in the initial conditions for the elliptic flow.

We show the effects of the granular structure of the initial conditions of a hydrodynamic description of high-energy nucleus-nucleus collisions on some observables, especially on the elliptic-flow parameter v2. Such a structure enhances production of isotropically distributed high-pT particles, making v2 smaller there. Also, it reduces v2 in the forward and backward regions where the global matter density is smaller and, therefore, where such effects become more efficacious.

Inferior vena cava duplication and left renal aplasia: incidental findings?

A duplicated inferior vena cava and renal aplasia is rare and absence of one kidney has been considered to occur exclusively on the right side. We report an unusual case of a duplicated inferior vena cava and left renal aplasia and discuss the interrelationship between these developmental anomalies.

Examining the necessity to include event-by-event fluctuations in experimental evaluations of elliptical flow.

Elliptic flow at BNL RHIC is computed event by event with NeXSPheRIO. We show that when symmetry of the particle distribution in relation to the reaction plane is assumed, as usually done in the experimental extraction of elliptic flow, there is a disagreement between the true and reconstructed elliptic flows (15%-30% for eta=0, 30% for p perpendicular=0.5 GeV). We suggest a possible way to take into account the asymmetry and get good agreement between these elliptic flows.

Single-shot two-dimensional spectral interferometry for ultrafast laser-produced plasmas.

Coherent white light was used as a light source for spectral interferometry of ultrafast laser-produced plasmas. Using a narrowband filter, two-dimensional images of field ionization in helium were obtained with a 14 fs time resolution.

Portal vein gas after concurrent chemoradiotherapy for advanced oesophageal carcinoma.

Portal vein gas is a rare but potentially lethal condition commonly caused by mucosal damage, bowel distention and sepsis. However, the association between portal vein gas and concurrent chemoradiotherapy has not been documented. We present the case of a 56-year old woman with portal vein gas revealed on computed tomography (CT) after concurrent chemoradiotherapy for advanced oesophageal carcinoma. The portal vein gas totally disappeared 10 days later without any specific treatment. This case demonstrates that the option of close observation for portal vein gas after concurrent chemoradiotherapy is appropriate for consideration. If physical examination, CT findings and laboratory data are unremarkable, it is essential that the patient undergoes close observation and repeated follow-up CT.

Erythropoietin-producing renal cell carcinoma arising from autosomal dominant polycystic kidney disease.

Erythropoietin (EPO)-producing renal cell carcinomas (RCC) in patients with chronic renal failure secondary to autosomal dominant polycystic kidney disease (ADPKD) has not previously been reported. We report a case of EPO-producing RCC associated with ADPKD in a 66-year-old woman, and discuss the clinical and radiological findings.

Liver abscess formation after hepatic chemoembolization for metastatic pancreatic neuroendocrine tumor.

Hepatic chemoembolization is an effective treatment of unresectable hypervascular hepatic tumors, but history of bilioenteric anastomosis is a major risk factor for liver abscess due to the retrograde enteric bacterial contamination. We report a case of culture-negative liver abscess developed after hepatic chemoembolization for a metastatic pancreatic endocrine tumor, and discuss the pathogenesis of liver abscess formation. We also present a potential pitfall for the prophylactic antibiotic therapy in a patient with a history of bilioenteric anastomosis. This is the first report of a culture-negative liver abscess caused by hepatic chemoembolization for a metastatic pancreatic endocrine tumor.