Ultrasound-guided injection through the rotator cuff interval: a clinical perspective of one institution's results and description of technique.

CONTEXT: Fluoroscopic injection through the rotator cuff interval (RCI) is a common technique for diagnostic arthrography and therapeutic intervention. Ultrasound approaches through the RCI have been less commonly studied, but there is a growing body of literature. OBJECTIVES: The purpose of this study was to present a standardized technique of ultrasound-guided injection into the glenohumeral joint utilizing the RCI in magnetic resonance imaging (MRI) arthrography (MRA) and to report one medical group's experience with the technique. METHODS: A retrospective chart review of all ultrasound-guided injections into the glenohumeral joint utilizing the RCI was performed from July 1, 2014 through June 1, 2021. Data were compiled for age, gender, body mass index (BMI), and prior surgery on the shoulder. The primary endpoint was successful administration of intra-articular dilute gadolinium contrast adequate for radiologic interpretation. A total of 487 injections into the glenohumeral joint via the RCI were performed. One hundred and fifty-five patients had previous shoulder surgery, with the remainder naive to intervention. RESULTS: The success rate of injections into the glenohumeral joint was 99.4 %, with only three injections considered unsuccessful. The three unsuccessful injections did not succeed because of a lack of intra-articular contrast media present. This success rate is impressive and promising, particularly when considering that 155 of the patients had previous surgery, which could potentially cause complications, and because these injections were performed over a long period of 7 years. CONCLUSIONS: Accessing the RCI under ultrasound guidance is a very successful technique for injection within the glenohumeral joint.

Disaggregating the effects of daytime and nighttime light exposures on obesity, overweight, prostate and breast cancer morbidity worldwide.

Hormone-dependent cancers and overweight/obesity are not necessarily linked but might have similar underlying causes, such as circadian disruption, lack of physical activity, and unhealthy nutrition. Several empirical studies also attribute the rise in these types of morbidity to vitamin D deficiency, linked in turn to insufficient sunlight exposure. Other studies place an emphasis on melatonin (MLT) hormone suppression, associated with artificial light at night (ALAN) exposure. Yet no studies, carried out to date, have attempted to determine which of these environmental risk factors is associated stronger with the morbidity types in question. In this study, we aim to narrow this knowledge gap by analyzing data available for 100+ countries worldwide, while controlling ALAN and solar radiation exposure estimates by several potential confounders, such as GDPpc, GINI inequality index and unhealthy food consumption. As the study reveals, all the morbidity types under analysis are significantly and positively associated with ALAN exposure estimates (p < 0.05), while solar radiation appears to be significantly associated with prostate cancer rates only (p < 0.05), but not with breast cancer or overweight/obesity rates (p > 0.1). To the best of our knowledge, this study is the first that separates the effects of ALAN and daylight exposures on the abovementioned types of morbidity.

Investigating the combined effect of ALAN and noise on sleep by simultaneous real-time monitoring using low-cost smartphone devices.

The association between artificial light at night (ALAN) and noise, on the one hand, and sleep, on the other, is well established. Yet studies investigating these associations have been infrequent and mostly conducted in controlled laboratory conditions. As a result, little is known about the applicability of their results to real-world settings. In this paper, we attempt to bridge this knowledge gap by carrying out an individual-level real-world study, involving 72 volunteers from different urban localities in Israel. The survey participants were asked to use their personal smartphones and smartwatches to monitor sleep patterns for 30 consecutive days, while ALAN and noise exposures were monitored in parallel, with inputs reported each second. The volunteers were also asked to fill in a questionnaire about their individual attributes, daily habits, room settings, and personal health, to serve as individual-level controls. Upon cointegration, the assembled data were co-analyzed using bivariate and multivariate statistical tools. As the study reveals, the effect of ALAN and noise on sleep largely depends on when the exposure occurred, that is, before sleep or during sleep. In particular, the effect of ALAN exposure was found to be most pronounced if it occurred before sleep, while exposure to noise mattered most if it occurred during the sleep phase. As the study also reveals, the effects of ALAN and noise appear to amplify each other, with a 14-15.3% reduction in sleep duration and an 8-9% reduction in sleep efficiency observed at high levels of ALAN-noise exposures. The study helped to assemble a massive amount of real-time observations, enabling a robust individual-level analysis.

Using mobile phones as light at night and noise measurement instruments: a validation test in real world conditions.

Exposure to noise from road traffic and industries is known to be linked to various health dysfunctions, including hypertension, cardiovascular diseases and hearing loss. Exposure to artificial light at night (ALAN) is also increasingly recognized as being associated with ecosystem damage and various illnesses, including cancers, excessive weight gain and sleep disorders. However, measuring and monitoring these environmental risk factors by professional equipment are laborious and expensive, which impede large-scale research and various citizen science initiatives. In this study, we test a possibility that reliable noise and ALAN exposure estimates can be gathered using smartphones (SPs) sensors. To verify this assumption, we develop a standardized testing protocol, and use Andro-Sensor app, installed on three different Samsung Galaxy SPs - S7, S20FE5G, and SM520F, - to perform measurements of ALAN and noise in real-world conditions while comparing these measurements with measurements performed by professional (type 2) equipment - SL814 for noise and LX-1330B for illumination. The analysis of 3450 measurements, performed in two different locations in Israel, reveals that the SPs measurements and measurements performed by control instruments correlate strongly for noise (r = 0.76-0.94) and are nearly identical for ALAN (r = 0.998-0.999). The association between the two types of measurements is also found to be close to linear, with the slope of the trend line being close to 45° for ALAN and varying between 30° and 45° for noise, depending on the SPs used. Our conclusion is that the level of accuracy of ALAN measurements by SPs is greater for ALAN than for noise, which can make SPs a useful tool for large-scale ALAN studies that do not require the accuracy of professional instruments.

Nerve Ablation in the Foot and Ankle.

Ablation therapies in the foot and ankle are accessible adjuncts to surgery and comprehensive pain management in recalcitrant pain syndromes. Techniques are best applied to individual patient anatomy with strong advantages in a working knowledge of neuromuscular real-time imaging with ultrasound. Interventionists face the unique challenge in this region of preserving balance and proprioception as well as intrinsic muscle function, while optimizing pain relief. A decision-making approach emphasizing selectivity by using regional and target-specific ablations is optimal. This article reviews basic technique, approaches, potential complications, and ultrasound anatomy for a practical introduction to ablation options in the foot and ankle.

Assessing the impacts of ALAN and noise proxies on sleep duration and quality: evidence from a nation-wide survey in Israel.

Sleep is a reversible state that sustains physiological and psychological processes in humans. As well established, individual-level factors, such as stress, smoking, drugs, and caffeine intake, reduce sleep duration and quality. However, studies of the effect of environmental risk factors, such as artificial light at night (ALAN) and noise, on sleep have been infrequent. Using records obtained from the 2017 Social Survey of Israel and combined with ALAN satellite data and various proxies for traffic noise, the present study aimed to determine how the combination of ALAN and traffic noise impact sleep duration and quality in urban areas. The increase of road density at the place of residence reduces average sleep duration by ~4.5% (~18 min.) and increases the frequency of reported sleep difficulties by ~3.5%, all other factors held equal. Similarly, an increase in ALAN exposure reduces average sleep duration by ~3% (~12 min) and increases the frequency of reported sleep difficulties by ~11%. The study also reveals a significant interaction between the two environmental risk factors in question, with the adverse impact of ALAN on sleep quality especially pronounced in high noise exposure areas.

Mesenchymal stem cells induced to secrete neurotrophic factors attenuate quinolinic acid toxicity: a potential therapy for Huntington's disease.

Huntington's disease (HD) is a hereditary, progressive and ultimately fatal neurodegenerative disorder. Excitotoxicity and reduced availability of neurotrophic factors (NTFs) likely play roles in HD pathogenesis. Recently we developed a protocol that induces adult human bone marrow derived mesenchymal stem cells (MSCs) into becoming NTF secreting cells (NTF(+) cells). Striatal transplantation of such cells represents a promising autologous therapeutic approach whereby NTFs are delivered to damaged areas. Here, the efficacy of NTF(+) cells was evaluated using the quinolinic acid (QA) rat model for excitotoxicity. We show that NTF(+) cells transplanted into rat brains after QA injection survive transplantation (19% after 6 weeks), maintain their NTF secreting phenotype and significantly reduce striatal volume changes associated with QA lesions. Moreover, QA-injected rats treated with NTF(+) cells exhibit improved behavior; namely, perform 80% fewer apomorphine induced rotations than PBS-treated QA-injected rats. Importantly, we found that MSCs derived from HD patients can be induced to become NTF(+) cells and exert efficacious effects similarly to NTF(+) cells derived from healthy donors. To our knowledge, this is the first study to take adult bone marrow derived mesenchymal stem cells from patients with an inherited disease, transplant them into an animal model and evidence therapeutic benefit. Using MRI we demonstrate in vivo that PBS-treated QA-injected striatae exhibit increasing T(2) values over time in lesioned regions, whereas T(2) values decrease in equivalent regions of QA-injected rats treated with NTF(+) cells. We conclude that NTF cellular treatment could serve as a novel therapy for managing HD.

Delay in diagnosis of children with cancer: a retrospective study of 315 children.

To determine the demographic and systemic parameters in children with solid malignancies and to ascertain which of them affected the delay in diagnosis, a retrospective study was performed on 315 children diagnosed with a solid tumor at our hospital, including epidemiological, social, and medical issues concerning the family, the child, the medical system, and the tumor. Lag time, defined as the interval between onset of symptoms and final diagnosis, including parent delay and physician delay, was estimated for each child. Mean lag time: 15.75 weeks (w), median: 7 w, range: 0-208 w. Lowest mean values appeared in kidney tumors, highest in epithelial, brain and soft tissue sarcomas. Mean parent delay: 4.42 w, median: 1 w, range: 0-130 w. Mean physician delay: 11.17 w, median: 4 w, range: 0-206 w. Among the demographic and personal parameters, the best predictors for diagnosis delay were age of child and father's ethnic origin. Several factors influenced diagnosis delay of childhood solid tumors. Recognizing these factors could minimize the delay, thereby improving the child's chances of survival.

Long-term follow-up of children with retinoblastoma.

Twenty-one pediatric retinoblastoma (RB) patients treated between 1976 and 1994 were evaluated for late treatment-related complications. Median age at diagnosis was 24 months; median age at follow-up was 12 years; median follow-up time was 12 years. Of the 21 patients, 14 had unilateral RB and 7 had bilateral RB. Thirteen patients had received external radiotherapy and 8 children were treated by chemotherapy. Twenty-one patients had undergone enucleation. Radiation-induced cataracts were found in 3 patients, radiation retinopathy in 1, enucleation and postradiotherapy contracted socket in 1, very low visual acuity postradiotherapy in 3, severe hypotelorism in 2, growth hormone deficiency in 2, neurocognitive disorders in 6, and orbital deformation due to radiation bone atrophy was moderate-severe in 12 patients. Azoospermia was found in 1 patient treated by cyclophosphamide and vincristine. The most frequent sequela in this group of RB-cured children were postradiotherapy orbital deformation due to bone atrophy and neurocognitive disabilities. Late radiation effects must be avoided by using modern, innovative, and more sophisticated radiotherapeutic techniques. Late treatment-related complications justify the long-term follow-up of childhood RB survivors.

Latitude-correlated genetic polymorphisms: selection or gene flow?

Latitude-correlated polymorphisms can be due to either selection-driven evolution or gene flow. To discriminate between them, we propose an approach that studies subpopulations springing from a single population that have lived for generations at different latitudes and have had a low genetic admixture. These requirements are fulfilled to a large extent by Ashkenazi and Sephardi Jews. The original population lived at a latitude of 35 degrees N, where the Sephardis still live. The Ashkenazis, however, moved to a latitude of 50 degrees N, starting about 10 centuries ago. The present study examines 3 latitude-correlated polymorphisms: PGP, PGM1, and AHSG. We found that PGP*2 and AHSG*2 alleles most likely underwent selection-driven evolution, but that PGM1*ts allele was not similarly affected. Since temperature might have been considered a reasonable selective factor, we also studied a population living at >800 m above sea level from Aosta Valley (Italy).

Carcinosarcoma of the lung: a case report.

The clinical and pathological data of a single case of carcinosarcoma of the lung observed in the period from 1978 to 1998 were reviewed. The diagnosis was based on immunohistochemical examination of the surgical specimen after a lower left lobectomy. The patient was given adjuvant chemotherapy. The local recurrence showed only sarcomatous features. The characteristics of this rare tumor are discussed in this case report.

Pediatric thyroid carcinoma: 22 years of experience at the Northern Israel Oncology Center (1973-1995).

Over the past 22 years, 16 children with thyroid carcinoma were referred to the Northern Israel Oncology Center. All patients had undergone surgical procedures, either total or subtotal thyroidectomy, and 7 patients had undergone cervical lymph node dissections. Postoperatively, 5 patients underwent thyroid ablation with radioactive 131I as first treatment. Two patients received postoperative external radiation therapy to a field encompassing the cervical region, superior mediastinum, and both supraclavicular grooves. After a median follow-up of 60 months (range, 5-169 months), all patients are alive with no evidence of recurrent disease. Two patients who had recurrences, one in the submaxillary lymph nodes and one in the lungs, were salvaged successfully with retreatment with 131I therapy. No severe acute or long-term side effects were exhibited. The long-term results of treatment of pediatric thyroid carcinoma are excellent, but there remains disagreement over the extent of surgical and postsurgical treatment required.

The role of chemotherapy in childhood soft tissue sarcomas other than rhabdomyosarcomas: experience of the Northern Israel Oncology Center.

Forty-three children with nonrhabdomyosarcomatous soft tissue sarcomas (NRSTS) were treated at the Northern Israel Oncology Center in Haifa, Israel, from 1971 to 1996. The male:female ratio was 1.5:1 and the median age of patient was 10 years (range, 3 months-18 years). The most common histopathologic diagnoses were fibrosarcoma (32.5%) and synovial sarcoma (16%). The sites of primary tumor were lower limb (35%), trunk (18%), upper limb (16%), head and neck (16%), and retroperitoneum (11%). By Intergroup Rhabdomyosarcoma Study classifications, 13 patients presented as group I, 15 patients as group II, 10 patients as group III, and 5 patients as group IV. Median follow-up time was 63 months (range, 6 months-18 years). The estimated survival after a 5-year period is 72% (SE +/- 17) for patients in group I, 75 +/- 15% in group II, 90 +/- 9% for patients in group III, and 40 +/- 21% for patients in group IV. Eleven patients relapsed; 4/6 who developed local relapse were cured and are alive with disease, while 4/5 who developed distant metastases are dead. For the 28 patients who underwent complete resection at diagnosis, the estimated survival after a 5-year period is 87 +/- 5% vs. 60 +/- 17% for the 15 patients who underwent partial excision or biopsy. Local radiotherapy was delivered after surgery to group III patients. Preoperative and postoperative chemotherapy was delivered to the patients of groups III and IV, and postoperative chemotherapy only to group II patients. Chemotherapy produced demonstrable gain in survival for group II and III patients but not for patients with metastases. The authors conclude that an aggressive surgical approach is needed in patients with NRSTS. Chemotherapy may help as a preoperative treatment in bulky disease or as a postoperative treatment for microscopic residual disease.

Prognostic significance of DNA ploidy in childhood astrocytomas.

The ability to divide subsets of children with astrocytoma into prognostic groups is limited because only a few clinical and pathologic variables are available. This study evaluated DNA ploidy as a potential prognostic factor in 30 children with diagnosed gliomas and examined the correlation of flow cytometric analysis to other parameters such as sex, age at diagnosis, histologic grading, localization of tumor, and completeness of surgical resection. Seventeen children with low-grade glioma and 13 with high-grade glioma were retrospectively reviewed; mean age of the patients was 8.2 years, and mean follow-up of the population was 7.6 years. The tumor was localized to the cerebrum in 19 patients, the cerebellum in 7 patients, the brain stem in 3 patients, and the spine in 1 patient. Fourteen patients underwent complete excision and 16 patients underwent partial excision. DNA diploidy was demonstrated in 21 patients and aneuploidy in 9 patients. Twenty children had no evidence of disease and 10 died of disease. Of the patients with diploid tumors, 81% survived, compared to only 33% survival among patients with aneuploid tumors (p < .011). By Cox regression analysis with age, gender, type of excision, grade, location of tumor, and ploidy as independent variables, ploidy was a statistically significant predictor of survival (p = .043). This investigation provides further evidence that flow cytometry may have prognostic value in children with gliomas. Thus, a larger number of tumors can be studied to extend and validate these observations.

The new international staging system for lung cancer. Evolution of the system and concerned remarks.

The rationale of the Staging System of Lung Cancer is discussed from his presentation (Mountain, 1985) to the recent revision and proposals of new classifications. Survival rates offered a strong statistical support to the latest revision in 1997. Stage Group have become 7 out of Stage 0 (Tis). In the New Lymph Node Map, station 4 is confirmed as mediastinal (N2). The improved definition of Stage Grouping requires a golden standard of staging and a worldwide consensus on the surgical approach to mediastinal lymphadenectomy. IASLC, the International Association for the Study of Lung Cancer, is now moving to collect a new largest database with the aim to offer the next expected Revision.

The "Will Rogers effect" on stage grading.

Will Rogers phenomenon affects survival statistics applied to clinical research and could determine a misreading of results. Stage migration due to new methods of diagnostic imaging and staging invasive procedures could improve actuarial survival in each stage. TNM System is impaired when survival rates come from different inhomogeneous countries, regions and eras. Randomized trials suffer this fallacious phenomenon when staging depends on the different treatments which are to be evaluated.

The invasive staging and the role of complete resection in the surgical treatment of NSCLC.

Years of debates couldn't solve the discussion between the NSCLC assessment founded on CT scan and mediastinoscopy as in the Western countries and the refined extensive bronchoscopy, CT imaging and exploratory thoracotomy as practiced in Japan. Recently, the clinical onset of combined therapy protocols, the recognised value of the intrathoracic staging (also in the West) and survival rates in the earlier N2 disease moved towards change this steady situation. The role of complete resection in N2 NSCLC is therefore debated from the preoperative assessment to survival results in resected cases. Accuracy of CT scan and cervical mediastinoscopy is discussed also in the light of neoadjuvant therapy. The clinical value of intrathoracic staging is improved by Japanese experiences while a rationale assessment of Complete/Incomplete Resections is defined. Moreover, technical details of intraoperative recognition are cleared.

Considerations about tumor size as a factor of prognosis in NSCLC.

A literature review of the initial attempt to correlate tumor size in NSCLC with the expectancy of survival is presented starting from the 60s. The larger size was connected with an increased risk of metastatic diffusion. In the 70s resulted evident the relationship between tumor size and lymph node involvement so affecting survival. In the context of the TNM Staging System (Mountain 1986) size appeared a well assessed factor of prognosis and is recognised to play a major role in Stage I where the subsets T1N0 and T2N0 showed a consistent difference in survival across the 3 cm cut-off. The peculiar relation between largest size and mediastinal lymph node metastases is discussed as well as the proposal to allocate T2 descriptor within the range 3-5 cm. Finally, series of clinical observations from Japanese experience about small sized T1N0 tumors are presented and discussed.

[Adrenalectomy in metastasis of primary pulmonary carcinoma: an emerging issue]. / La surrenectomia per metastasi da carcinoma primitivo del polmone: una problematica emergente.

Such a novel surgical project is supported by a large basic knowledge on molecular biology of solid tumours progression as well as the already assessed clinical experience in the parallel field of surgery for lung, brain and liver metastases. While pathology and the clinical work up have for a long time pointed out the steady rate of adrenal metastatic involvement from lung cancer (from 25 to 28% of all cases at the autopsy and, on clinical grounds, the most important site of extrapulmonary tumour spread just after the first one represented by the mediastinal lymphatic groups), the surgical approach to the problem is still very limited and the few operated cases previously reported in world literature (summing up to a total of 21) are not truly homogeneous and even largely scattered in time. The Authors report on their personal contribution in this field with four consecutive cases who underwent surgery during the last five years. The most important clinical features together with the initial remarkable result obtained in one patient who is still free of disease more than 3 years after the sequential radical resection of the primary lung tumour and the metastatic ipsilateral adrenal gland, are presented. In the light of this preliminary positive experience, the Authors are planning a sound clinical research based on the combined resection of those NSC Lung Cancers which appear surgically resectable but already included in an unresectable Stage IV Disease only because of the contemporary adrenal metastases (M1). An adjuvant chemotherapy in usually added.

Carcinoma embrionário associado a teratoma, em índio Xikrin / Embryonic carcinoma associated to teratoma, in a Xikrin indian

Os autores apresentam um caso de carcinoma do testículo (CT) nao-seminoma (NS) num jovem índio Xikrin, Caiapó setentrional, do sudeste do Pará, na Amazônia oriental. RELATO DE CASO. O índio desenvolveu uma metásase supraclavicular vegetante à esquerda com evoluçao progressiva num prazo de cinco meses. No exame físico, após sua remoçao a Sao Paulo, observaram que o testículo direito era tumoral. Os exames laboratoriais mostraram alfa-fetoproteína (AFP) l82U/mL, gonadotropina coriônica fraçao (beta-HCG) 43mUI/mL. O exame anatomopatológico da metástase supraclavicular foi de carcinoma embrionário e o anatomopatológico do testículo direio foi de carcinoma NS, embrionário, com áreas de teratoma maduro. Foi submetido à ressecçao cirúrgica parcial da metástase supraclavicular, à retirada cirúrgica do testículo tumoral, a três ciclos de quimioterapia. A AFP e a beta-HCG normalizaram-se após a quimioterapia. DISCUSSAO E CONCLUSAO. No mundo há registro de aumento da incidência de carcinomas germinativos entre caucasóides. O interesse desta apresentaçao está no fato de ser a primeira incidência de carcinoma diferenciado, NS, no grupo étnico de índios brasileiros e na boa evoluçao do caso, apesar de o diagnóstico ter sido estabelecido tardiamente.