Intra- and interlimb effects of gait retraining in individuals with knee hyperextension.

BACKGROUND: Gait retraining, which typically focuses on the most severely affected limb or joint, has shown promising results in treating faulty running and walking patterns. The closed-chain nature of gait during the stance phase may influence kinematic changes in the adjacent joints of the trained leg. In addition, the coupled nature of the lower extremity motion of gait suggests that changes in one leg may transfer to the other. This study aimed to assess the intra- and inter-limb transfer of kinematic changes following gait retraining to reduce knee extension in individuals with hyperextension walking patterns. METHODS: Seventeen women with knee hyperextension gait patterns participated in six treadmill retraining sessions. All participants received verbal and real-time visual kinematic feedback in the form of knowledge of results. This intervention study took place at the Gait Analysis Laboratory at the University of Iowa. Mean peak sagittal-plane lower extremity joint kinematics during overground walking at pretraining, post-training, and 1- and 8-month follow-ups were calculated for analysis and comparisons. FINDINGS: The post-training changes in ankle range of motion returned to baseline values by the 8-month follow-up. There was a significant transfer effect of kinematic changes to the untrained knee following gait retraining. INTERPRETATION: Training one knee did not result in long-term compensatory kinematic changes in the other joints. In addition, the improvements in knee extension range of motion were transferred to the untrained knee and retained at the 8-month follow-up. This study supports the use of gait retraining as an effective clinical intervention.

AI Use in Mammography for Diagnosing Metachronous Contralateral Breast Cancer.

Although several studies have been conducted on artificial intelligence (AI) use in mammography (MG), there is still a paucity of research on the diagnosis of metachronous bilateral breast cancer (BC), which is typically more challenging to diagnose. This study aimed to determine whether AI could enhance BC detection, achieving earlier or more accurate diagnoses than radiologists in cases of metachronous contralateral BC. We included patients who underwent unilateral BC surgery and subsequently developed contralateral BC. This retrospective study evaluated the AI-supported MG diagnostic system called FxMammo™. We evaluated the capability of FxMammo™ (FathomX Pte Ltd., Singapore) to diagnose BC more accurately or earlier than radiologists' assessments. This evaluation was supplemented by reviewing MG readings made by radiologists. Out of 1101 patients who underwent surgery, 10 who had initially undergone a partial mastectomy and later developed contralateral BC were analyzed. The AI system identified malignancies in six cases (60%), while radiologists identified five cases (50%). Notably, two cases (20%) were diagnosed solely by the AI system. Additionally, for these cases, the AI system had identified malignancies a year before the conventional diagnosis. This study highlights the AI system's effectiveness in diagnosing metachronous contralateral BC via MG. In some cases, the AI system consistently diagnosed cancer earlier than radiological assessments.

Detection of Contralateral Malignancies on Breast MRI.

INTRODUCTION: Women with unilateral breast cancer are at increased risk for having simultaneous cancer of the contralateral breast. Overall, earlier detection of contralateral breast cancer prevents the burden of additional surgery or chemotherapy rounds and is associated with higher overall survival. However, MRI screening for the contralateral breast is seldom done following an initial unilateral breast cancer diagnosis. The purpose of this study is to retrospectively evaluate patients with known, biopsy-proven malignancy who went on to obtain a breast MRI and were later found to have cancer of the contralateral breast.  Methods: This was a retrospective study that reviewed the charts of women aged over 18 years who were determined to have synchronous bilateral breast cancer from January 2017 to January 2022 at the University of Florida, Gainesville, FL. The study extracted data from this institution's cancer registry database, which provided information on patients with breast cancer diagnoses. The study conducted a review of mammography (MAM) and MRI imaging reports to ascertain the presence or absence of contralateral breast cancer identified by each respective imaging modality. Surgical pathology reports from the biopsy of the contralateral breast were reviewed to obtain information on the histological type of cancer and TNM (tumor, node, metastasis) staging. RESULTS: Of the 17 cases in which MAM missed contralateral cancer, follow-up MRI detected contralateral malignancy in 12 cases (70.59%) and subsequently changed management, resulting in additional imaging, biopsy, and eventual diagnosis and treatment of contralateral breast cancer. Examining the number of contralateral breast cancers detected by patients who had undergone MAM followed by MRI and those who had only undergone MAM, the study found that the detection rate of contralateral breast cancer from MAM was 45.45% (15/33). The tumor stages of the missed cancers were all T1 or Tis stage with one T1mi, and there was no nodal involvement.  Conclusion: In addition to its utility in staging breast cancers, MRI also has the superior ability to detect otherwise undetected contralateral breast malignancy. This retrospective study found that MRI imaging led to a considerable increase in the detection of contralateral cancer. The study found that these undetected contralateral breast cancers by MAM were often of lower staging with no nodal involvement, highlighting the opportunity for MRI to assist in early cancer detection while the patient's prognosis is still good. Its high cost should be balanced with staging and occult malignancy detection utility in future practice.

Aloperine protects the testis against testicular ischemia/reperfusion injury in rats.

BACKGROUND: Testicular torsion/detorsion can cause testis loss and infertility. Aloperine is a major active alkaloid extracted from Sophora alopecuroides Linn. It has been shown to have organ-protective effects. However, the effects of aloperine on the testis and its underlying mechanisms remain unclear. OBJECTIVES: This study investigated the effect of aloperine on testicular torsion/detorsion injury in rats. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomized to the sham-operated (sham), testicular I/R (TI/R), or aloperine preconditioning (ALOPre) or postconditioning (ALOPost) groups. All rats except for the sham-operated rats were subjected to 3 h of right spermatic cord torsion (720°, clockwise), followed by 3 h of detorsion. Aloperine (10 mg/kg) was intravenously administered before testicular torsion (ALOPre) or at the onset of testicular detorsion (ALOPost). The therapeutic efficacy of aloperine was evaluated by histological analysis, oxidative stress evaluation, inflammatory response examination, apoptosis analysis, protein analysis, and immunohistological assessment. RESULTS: Compared with TI/R, aloperine protected both the ipsilateral and contralateral testes against unilateral testicular I/R, as evidenced by a reduced testicular weight to body weight (TW/BW) ratio (ALOPre: p = 0.0037; ALOPost: p = 0.0021) and volume (ALOPre: p = 0.0020; ALOPost: p = 0.0009), less structural damage with better Johnsen (ALOPre: p = 0.0013; ALOPost: p = 0.0021), and Cosentino scores (ALOPre: p < 0.0001; ALOPost: p < 0.0001), increased mean seminiferous tubule diameter and mean seminiferous tubule epithelial height, decreased testicular apoptosis, and less oxidative stress and inflammatory response. In addition, aloperine significantly stimulated the phosphorylation of signal transducer and activator of transcription (STAT)-3 in the ipsilateral testes following detorsion. Administration of Ag490 suppressed STAT-3 phosphorylation, thereby abrogating the protective effects exerted by aloperine on the ipsilateral testis. DISCUSSION AND CONCLUSION: Aloperine has a strong testicular protective effect on the ipsilateral and contralateral testes after testicular torsion/detorsion. This aloperine-induced ipsilateral testicular protection is mediated via the STAT-3 signaling pathway.

Offloading effect in the unoperated contralateral knee after unilateral medial open wedge high tibial osteotomy: A SPECT/CT analysis.

BACKGROUND: An open wedge high tibial osteotomy (OWHTO) may lead to gait alteration, which change the contact loading in the contralateral knee, while clear evidence about the impact on contralateral knee still lacks. The purpose of the current study was to evaluate the change in scintigraphic uptake using SPECT-CT in the medial compartment of the contralateral knee following OWHTO. METHODS: Contralateral radiographic measurements were performed for patients with medial osteoarthritis and varus malalignment of >5° treated with OWHTO in this retrospective analysis. The medial compartmental changes according to SPECT/CT analysis before and 1-year after OWHTO were evaluated on the contralateral side. RESULTS: The study comprised 72 patients. The mean preoperative mechanical femorotibial angle was a mean varus of 7.6° (range, 5.1° - 13.0°), corrected to a mean valgus of 2.5° (range, 1.9° - -8.5°) postoperatively. The average grading of the scintigraphic uptakes in the medial compartment of the contralateral knee was significantly decreased 1 year postoperatively than after the surgery (from 2.8 ± 0.4 to 2.1 ± 0.6, p < 0.001). Measurable differences in varus alignment on radiographs of the contralateral limb were identified. The preoperative mechanical axis value decreased from 8.0° ± 2.4° to 6.7° ± 2.6° at the 3-month postoperative visit (p = 0.011). The overall decrease in varus alignment remained at the 2-year final postoperative follow-up. CONCLUSION: Alignment correction by OWHTO results in reducing scintigraphy uptakes in medial compartment and improvement in mechanical alignment of the contralateral knee. LEVEL OF EVIDENCE: Therapeutic Level IV.

Impact of contralateral prophylactic mastectomy on survival outcomes in patients with unilateral breast cancer: A systematic review and meta-analysis.

Objective: To synthesize contemporary evidence of the impact of contralateral prophylactic mastectomy (CPM) on survival outcomes in patients with unilateral breast cancer (UBC). Methods: PubMed, EMBASE and Scopus databases were searched for observational studies published up to November 15, 2023. Random-effects model was used to obtain pooled effect estimates that were reported as hazards ratio (HR) with 95% confidence intervals (CI). The outcomes of interest were overall survival (OS), breast cancer-specific survival (BCSS), recurrence free survival (RFS) and risk of contralateral breast cancer (CBC). Results: Twenty-one studies were included. Most studies had a retrospective design. CPM was associated with significant improvement of OS (HR 0.80, 95% CI: 0.75, 0.85), BCCS (HR 0.82, 95% CI: 0.74, 0.90), and RFS (HR 0.72, 95% CI: 0.60, 0.86) and significantly reduced risk of CBC (HR 0.05, 95% CI: 0.03, 0.09) in patients with UBC. No evidence of publication bias was detected. Conclusion: Our results provide strong evidence supporting the positive impact of CPM on survival outcomes in patients with UBC. Further research and long-term follow-up studies are warranted to validate these findings.

Comparison of actual prognosis between unilateral and bilateral central neck dissection in modified radical neck dissection patients with no clinical central lymph node metastasis: a retrospective cohort study.

Purpose: This study aimed to evaluate the long-term prognosis of contralateral central neck dissection (CND) in papillary thyroid cancer (PTC) patients with ipsilateral lateral neck metastasis. We compared the actual recurrence rate according to the extent of CND-ipsilateral and contralateral sides. Methods: A total of 708 PTC patients who underwent total thyroidectomy and concomitant ipsilateral or bilateral CND with ipsilateral lateral neck dissection between January 1997 and December 2022 at Samsung Medical Center were retrospectively analyzed. Results: The median follow-up time was 118 months. Locoregional recurrence was observed in 26 patients (7.9%) and 30 patients (7.9%) in the ipsilateral and bilateral CND groups, respectively. There were 6 contralateral recurrence cases (1.8%) in the ipsilateral CND group and 6 cases (1.6%) in the bilateral CND group. There was only 1 contralateral central neck recurrence in the ipsilateral CND group. The incidence of hypocalcemia (P = 0.007) was higher in the bilateral CND group compared to the ipsilateral CND group. Conclusion: Surgeons may consider performing only unilateral CND-the side where tumor is for therapeutic purposes to reduce surgical complications.

Outcomes of fenestrated and branched endovascular aneurysm repair with an inverted contralateral limb.

OBJECTIVE: To report technical success and evaluate clinical outcomes of fenestrated and branched endovascular aortic repair (F/B-EVAR) incorporating a contralateral inverted limb. METHODS: Patients who underwent F/B-EVAR with a custom-made bifurcated device containing an inverted limb between January 2010 and September 2023 were retrospectively analyzed. Time-to-event data were analyzed using the Kaplan-Meier method. RESULTS: A total of 32 patients (26 men; mean age 77±6.2 years) were included in the analysis. Technical success was achieved in 28 patients (87.5%). Two technical failures resulted from misplaced contralateral limbs in patients with previous endovascular aortic repair (EVAR), necessitating one open conversion due to a type 3b endoleak, and one femoro-femoral crossover bypass after occlusion of a misplaced contralateral limb. Additionally, two technical failures were attributed to a type 3c endoleak and a type 1c endoleak, originating from a fenestrated device at the level of the left and right renal artery, respectively. One patient (3.1%) died <30 days post-operatively due to a subdural hemorrhage. Estimated patient survival after 1 and 2 years was 92.7%±5.1%, and 74.3%±10.1%, respectively. No aneurysm-related deaths were observed. During the median follow-up of 13 months, one (3.1%) inverted limb occluded, in addition to the occlusion resulting from a misplaced contralateral limb, and was treated with a femoro-femoral crossover bypass. One target vessel (right renal artery) occluded (0.9%), resulting in a permanent, significantly reduced renal function. Freedom from overall reintervention after 1 and 2 years was 73.5%±8.0% and 68.3%±9.0%, respectively. An additional four patients (12.5%) presented with a type 3c endoleak during follow-up scans, three of which originated from fenestrations at the level of the renal stents. There were no junctional problems between the inverted limb device and the main endograft, and no significant correlation was found between the one-sealing-stent inverted limb device design and the onset of type 3 endoleak (log-rank p=.064). CONCLUSION: F/B-EVAR incorporating an inverted limb can be a viable endovascular option to manage complex aneurysms with a short renal artery to bifurcation distance. However, using the inverted limb presents a notable technical challenge and could be associated with a higher need for reintervention. Carefully confirming correct cannulation of the inverted limb is warranted.

Predictive model for contralateral inguinal hernia repair within three years of primary repair: a nationwide population-based cohort study.

BACKGROUND: Limited reports have discussed the risk factors for contralateral inguinal hernia (CIH) repair. We generated a risk factor scoring system to predict CIH within 3 years after unilateral inguinal hernia repair. METHODS: We extracted the admission data of patients aged ≥ 18 years who underwent primary unilateral inguinal hernia repair without any other operation from the National Health Insurance Research Database. Patients were randomly divided into 80% and 20% validation cohorts. Multivariate analysis with a logistic regression model was used to generate the scoring system, which was used in the validation group. RESULTS: Overall, 170,492 adult men were included, with a median follow-up of 87 months. The scoring system ranged from 0-5 points, composited with age (< 45 years, 0 points; 45-65 years, 2 points; 65-80 years, 3 points; > 80 years, 2 points) and two comorbidities (cirrhosis and prostate disease: 1 point each). The areas under receiver operating characteristic (ROC) curves were 0.606 and 0.551 for the derivation and validation groups, respectively. The rates and adjusted odds ratios (OR) of CIH repair in the derivation group were 3.0% at 0-2 points, 5.5% (1.854, p < 0.001) at 3, 6.7% (2.279, p < 0.001) at 4, and 6.9% (2.348, p < 0.001) at 5, with similar results in the validation group [2.3% at 0-2 points, 3.8% (1.668, p < 0.001) at 3, 5.4% (2.386, p < 0.001) at 4, and 6.8% (3.033, p < 0.001) at 5]. CONCLUSIONS: The CIH scoring system effectively predicted CIH repair within three years of primary unilateral inguinal hernia repair. Surgeons could perform laparoscopic surgery with CIH scores > 2 points which enables easier contralateral exploration and repair during the same surgery, without additional incisions, to minimize the need for future surgeries. However, further prospective validation of this scoring system is required.

Associations between the medial olivocochlear reflex, middle-ear muscle reflex, and sentence-in-noise recognition using steady and pulsed noise elicitors.

The middle-ear muscle reflex (MEMR) and medial olivocochlear reflex (MOCR) modify peripheral auditory function, which may reduce masking and improve speech-in-noise (SIN) recognition. Previous work and our pilot data suggest that the two reflexes respond differently to static versus dynamic noise elicitors. However, little is known about how the two reflexes work in tandem to contribute to SIN recognition. We hypothesized that SIN recognition would be significantly correlated with the strength of the MEMR and with the strength of the MOCR. Additionally, we hypothesized that SIN recognition would be best when both reflexes were activated. A total of 43 healthy, normal-hearing adults met the inclusion/exclusion criteria (35 females, age range: 19-29 years). MEMR strength was assessed using wideband absorbance. MOCR strength was assessed using transient-evoked otoacoustic emissions. SIN recognition was assessed using a modified version of the QuickSIN. All measurements were made with and without two types of contralateral noise elicitors (steady and pulsed) at two levels (50 and 65 dB SPL). Steady noise was used to primarily elicit the MOCR and pulsed noise was used to elicit both reflexes. Two baseline conditions without a contralateral elicitor were also obtained. Results revealed differences in how the MEMR and MOCR responded to elicitor type and level. Contrary to hypotheses, SIN recognition was not significantly improved in the presence of any contralateral elicitors relative to the baseline conditions. Additionally, there were no significant correlations between MEMR strength and SIN recognition, or between MOCR strength and SIN recognition. MEMR and MOCR strength were significantly correlated for pulsed noise elicitors but not steady noise elicitors. Results suggest no association between SIN recognition and the MEMR or MOCR, at least as measured and analyzed in this study. SIN recognition may have been influenced by factors not accounted for in this study, such as contextual cues, warranting further study.

Kinematic effects of unilateral TKA on the contralateral knee in Chinese patients with advanced osteoarthritis: a prospective gait analysis study.

Background: Patients with knee osteoarthritis (OA) who receive unilateral total knee arthroplasty (TKA) often report reduced pain and enhanced function in the untreated knee, yet the kinematic mechanisms are not fully understood. Our study aimed to clarify these effects through a gait analysis of the untreated knee following unilateral TKA. Methods: This study enrolled 118 end-stage OA patients with varus deformity scheduled for TKA, categorized into the contralateral osteoarthritis group (Contra-OA), consisting of patients with end-stage OA in both knees requiring surgical treatment, and the contralateral TKA group (Contra-TKA), which included patients who had undergone TKA on one knee and had end-stage OA in the untreated knee awaiting surgery. Kinematic data of the knee joint during treadmill walking were collected using the Opti_Knee gait analysis system, and a comparative analysis was conducted. Results: The Contra-TKA group exhibited improvements in step length, anterior-posterior translation, range of motion, vertical translation, and internal-external rotation compared to the Contra-OA group (p-values ranging from 0.0013 to 0.0463). Notable differences in flexion-extension angles and abduction/adduction rotation were also observed (p = 0.0013 and 0.0166, respectively). At the initial contact (IC), obvious differences in internal-external rotation, anterior/posterior translation, and vertical translation were noted. At the opposite toe-off (OT), significant differences in internal-external rotation. At the tibia vertical (TV) moment, significant differences were observed in all three translation indicators of joint translation. At other pivotal gait cycle points, vertical and anterior/posterior translations in Contra-TKA group continued to exhibit more meaningful decrease. Collectively, these findings underscore the protective kinematic effects of TKA on the untreated contralateral knee, indicating an improved biomechanical adaptation following TKA surgery. Conclusion: In summary, the study's findings indicate that unilateral TKA imparts kinetic effects on the untreated contralateral knee, as evidenced by significant improvements in key gait parameters. These enhancements, observed at both initial contacts and throughout the gait cycle, suggest a positive biomechanical support post-TKA, might contribute to better gait efficiency and reduced load on the contralateral untreated knee.

Revisiting the Venoarteriolar Reflex-Further Insights from Upper Limb Dependency in Healthy Subjects.

The venoarteriolar reflex (VAR) is described as a vasoconstriction occurring in response to an increase in venous transmural pressure. Its underlying mechanisms are still not clarified, particularly the neural pathway that supposedly evokes this reflex. In addition, recent studies have shown that the postural maneuvers that evoke VAR also produce a decrease in contralateral perfusion, which is also poorly understood. Our study aimed to explore the contralateral response to unilateral upper limb dependency and its underlying mechanisms. Fifteen young, healthy subjects (24.1 ± 5.8 y.o.) participated in this study after giving informed consent. While seated, subjects remained for 7 min with both arms at heart level (baseline), after which a random hand was placed 40 cm below the heart level for 5 min (dependency) before resuming the initial position for another 7 min (recovery). Skin perfusion was assessed bilaterally with photoplethysmography, and electrodermal activity (EDA) was assessed in the contralateral hand. During hand dependency, perfusion decreased significantly in both limbs, although it was more pronounced in the dependent limb, corroborating previous reports that unilateral limb dependency evokes a decrease in contralateral perfusion. Transient EDA peaks were detected in the first seconds of the dependency and recovery phases. These results support the participation of the sympathetic nervous system as a mechanism regulating contralateral perfusion during unilateral limb dependency. This sympathetic activation is probably attributed to the postural changes themselves and is likely not related to the VAR.

Contralateral submental artery island flap for oral tongue reconstruction - a retrospective study in patients with oral tongue squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months. RESULTS: Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up. CONCLUSION: In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction.

Incidence of contralateral metachronous inguinal hernia on long term follow-up after unilateral inguinal hernia repair: a systematic review and meta-analysis.

BACKGROUND: The repair of inguinal hernias is a common surgical procedure. Some patients will need a second operation after developing a metachronous contralateral inguinal hernia (MCIH). The suggestion has been made to strengthen the contralateral side at the same time as primary unilateral surgery. In this systematic review we aim to determine how many adult patients with a unilateral inguinal hernia will develop a MCIH. METHODS: This review was reported in line with PRISMA guidelines. We performed a literature review in PubMed Publisher, Embase, Google Scholar and Cochrane Library until May 2021, including articles reporting MCIH after unilateral inguinal hernia repair in adults. As outcome measure, the number of patients diagnosed with a MCIH was registered. RESULTS: A total of 19 articles with a total of 277,288 patients were included. The combined estimate for MCIH after meta-analysis equaled 8.3% (95% CI 7.1%-9.5%), with a high index of heterogeneity (I2 = 97.9%). A random-effects meta-regression was performed to obtain the percentage of MCIH as a function of median follow-up time. The percentage of MCIH at 3, 5 and 10 years was estimated at 5.2%, 8.0% and 17.1%, respectively. CONCLUSION: We suggest that there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. We propose a patient-specific approach in the decision to perform prophylactic repair, taking into account potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement.

Examining the lateralization of electrophysiological correlates of auditory awareness.

The neurological basis for perceptual awareness remains unclear, and theories disagree as to whether sensory cortices per se generate awareness. Critically, neural activity in the sensory cortices is only a neural correlate of consciousness (NCC) if it closely matches the contents of perceptual awareness. Research in vision and touch suggest that contralateral activity in sensory cortices is an NCC. Similarly, research in hearing with two sound sources (left and right) presented over headphones also suggests that a candidate NCC called the auditory awareness negativity (AAN) matches perceived location of sound. The current study used 13 different sound sources presented over loudspeakers for natural localization cues and measured event-related potentials to a threshold stimulus in a sound localization task. Preregistered Bayesian mixed models provided moderate evidence against an overall AAN and very strong evidence against its lateralization. Because of issues regarding data quantity and quality, exploratory analyses with aggregated data from multiple loudspeakers were conducted. Results provided moderate evidence for an overall AAN and strong evidence against its lateralization. Nonetheless, the interpretations of these results remain inconclusive. Therefore, future research should reduce the number of conditions and/or test over several sessions to procure a sufficient amount of data. Taken at face value, the results may suggest issues with AAN as an NCC of auditory awareness, as it does not laterally map onto experiences in a free-field auditory environment, in contrast to the NCCs of vision and touch.

Automatic virtual reconstruction of acetabular fractures using a statistical shape model.

PURPOSE: Automatic virtual reconstruction of complex fractures would be helpful for pre-operative surgical planning. We developed a statistical shape model (SSM) which contains data of 200 intact 3D hemipelves. It allows for quantification of shape differences and is able to reconstruct abnormal shaped pelvises. We applied our SSM to reconstruct elementary and associate type acetabular fractures and assessed the reconstruction performance of the SSM, by comparing the reconstructed shape with the intact contralateral hemipelvis. METHODS: In this retrospective diagnostic imaging study, we used our SSM to virtually reconstruct fractured hemipelves of eighty-three patients with an acetabular fracture. A root mean square error (RMSE) was computed between the reconstructed shape and intact contralateral shape for the whole hemipelvis and for regions relevant for plate-fitting. These plate-fitting relevant regions were defined as: (1) Iliopectineal line length and radius; (2) ischial body line length and radius; (3) acetabular diameter, (4) quadrilateral slope and (5) weight-bearing acetabular dome. RESULTS: The median RMSE of the whole hemipelvis of the elementary type fractures was 2.2 (1.7-2.5) mm versus 3.2 (2.2-3.9) mm for the associate type fractures (p < 0.001). The median RMSE for the plate-fitting regions of elementary type fractures was 1.7 (1.4-2.1) mm versus 2.7 (2.0-4.1) mm for associate type fractures (p < 0.001). CONCLUSION: Using a statistical shape model allows for accurate virtual reconstructions of elementary and associate type acetabular fractures within a clinically acceptable range, especially within regions important for plate-fitting. SSM-based reconstructions can serve as a valuable tool for pre-operative planning in clinical practice, when a template of the contralateral hemipelvis is unavailable.

Contralateral Testicular Biopsy in Men with Testicular Cancer.

Testicular germ cell tumors (TGCTs) are an uncommon disease accounting for roughly 1% of newly diagnosed cancers in men worldwide. Incidence rates vary from 7 to 10 per 100000 males in Europe and North America. Approximately 2-5% of patients with unilateral TGCT will also harbor germ cell neoplasia in situ (GCNIS) in the contralateral testicle, which may progress to cancer in at least 50% of individuals. The question of whether routine contralateral testicular biopsy should be performed in patients with testicular cancer to detect the presence of GCNIS remains controversial. Screening and treatment of GCNIS are warranted only if the patient's outcome will be improved and there will be little impact on testicular function. In this review, we evaluate current guideline recommendations and the issues concerning contralateral testicular biopsy. PATIENT SUMMARY: Among men with cancer in one testicle, about 2-5% will also have cells with cancerous potential, called germ cell neoplasia in situ (GCNIS), in the other testicle. This mini-review discusses issues related to routine biopsy of the other testicle and the risk factors and treatment options for GCNIS in men with testicular cancer.

sICAM-1 concentrations are associated with inflammation in contralateral carotid plaque in patients with ischemic stroke.

BACKGROUND: Atherosclerotic plaques in the internal carotid artery are responsible for more than 15% of ischemic strokes. Carotid 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) detects plaque inflammation. Plasma ICAM-1 and LRP1 concentrations have been associated with inflammation in ipsilateral carotid plaque. The aim of the present study was to test the association between the soluble (s) form of these biomarkers and contralateral carotid plaques. METHODS: Prospective study conducted in 53 patients with a recent ischemic stroke and at least one atherosclerotic plaque in both carotid arteries. All of the patients underwent an early carotid 18F-FDG PET, and a blood sample was obtained at 7±1 days. Several plasma inflammatory markers were evaluated by Multiplex and sLRP1 levels were measured by commercial ELISA. Bivariate and multivariable linear regression was used to assess the association between inflammatory markers and the clinical variables, including contralateral maximum standardized uptake value (SUVmax) and mean SUVmax (mean of contralateral and ipsilateral SUVmax) of 18F-FDG uptake. Hazard ratio (HR) was estimated with Cox models adjusted for potential confounding factors to evaluate recurrence. RESULTS: Multivariable linear regression analysis showed an independent association between sICAM-1 and sVCAM-1 and mean SUVmax (CI=-0.064-0.325, p=0.004; CI=0.079-0.554, p=0.010). In addition, in bivariate regression analysis, sICAM-1 was associated with contralateral SUVmax (CI=0.049-0.382, p=0.012). Cox regression showed that mean SUVmax was associated with stroke recurrence (HR=5.604, p=0.044). CONCLUSIONS: sICAM-1 was independently associated with mean carotid plaque inflammation and with inflammation in contralateral plaque. sICAM-1 could be an indicator of plaque inflammation even in asymptomatic plaques.

Incidental dose distribution to contralateral internal mammary nodes in breast cancer patients undergoing adjuvant radiotherapy.

Background and purpose: In a relevant number of primary breast cancer patients, lymphatic drainage to the contralateral internal mammary nodes (cIMN) is being observed. Nevertheless, so far lymphatic drainage pathway to the cIMN is largely neglected during adjuvant radiotherapy. Materials and methods: This study evaluated the incidental dose to the cIMN for 120 volumetric modulated arc therapy (VMAT) treatment plans for node positive breast in dependence of internal mammary node irradiation (IMNI) and deep inspiration breath hold (DIBH). Additionally, incidental dose distribution to the cIMN based on the field design in the MA20, EORTC22922/10925 and AMAROS trials was assessed. Results: The incidental dose (Dmean ± SD) to the cIMN-CTV was 13.0 (±4.7) Gy with a maximum dose of < 30 Gy in 113/120 cases. If IMNI was included (n = 80), the Dmean to the cIMN-CTV was significantly higher compared to no IMNI, but still comparably low (n = 40; 14.3 Gy vs. 9.6 Gy; p = 0.0001). Furthermore, the dose in the cIMN during free breathing (n = 80) was higher compared to DIBH (n = 40; 13.9 Gy vs. 11.2 Gy; p = 0.002).Simulated treatment plans based on the randomized RNI trials revealed neglectable dose coverage of the cIMN (Dmean 1.0-1.8 Gy) for all protocols. Conclusion: Neither in the randomized RNI trials nor during contemporary treatment techniques clinically relevant dose distribution to the cIMN was observed. Further studies are warranted to assess the potential impact of intended irradiation of cIMN in high-risk patients.