Common Location Research Articles

A Climate Adaptation Asset Risk Management Approach for Resilient Roadway Infrastructure

As climate change intensifies, roadway infrastructure is increasingly at risk from extreme weather events including floods, hurricanes, and wildfires. This paper presents a system-of-systems performance-based asset risk management approach, designed to integrate various elements for effective investment prioritization and infrastructure resilience. Central to this approach are an Asset Inventory Database and a Risk Registry Database, supported by a Common Reference Location System (GIS). These components are the foundation for analytical modules to assess vulnerability and resilience based on exposure, sensitivity, and adaptive capacity. The approach includes an actionable framework to support a proactive data-driven performance-based management process for prioritizing investments. The project prioritization process consists of four steps: identifying risk factors, integrating climate data, conducting advanced risk assessments, and project prioritization. The goal is to prioritize resource allocation and develop climate-adaptive risk mitigation management strategies. Key performance indicators (KPIs) are recommended for setting goals, monitoring the outcomes of these strategies, and measuring their benefits. A Climate Impact Vulnerability Score (CIVS) is proposed to assess the susceptibility of infrastructure assets to environmental conditions. The approach also leverages artificial intelligence (AI) tools to analyze roadway infrastructure vulnerabilities and climate risk exposure. A case study applied to bridges using k-means clustering and multi-criteria decision analysis (MCDA) demonstrates the potential of advanced analytical methods in improving decision-making. This research concludes that the approach will contribute to enhancing resource allocation, supporting strategic decisions, aligning goals with budgets prioritizing investments, and strengthening the resilience and sustainability of roadway infrastructure.

Unusual pontine metastasis of endometrial papillary serous carcinoma: illustrative case.

Endometrial papillary serous carcinoma (EPSC) is a rare gynecological malignancy that often metastasizes before the presentation of symptoms or diagnosis of the primary disease. The most common locations of metastases for this malignancy are the lungs, liver, and bones. Metastases to the central nervous system (CNS) are rare. Solitary CNS metastases without other anatomical site spread are exceedingly rare. A 65-year-old female with a past medical history of EPSC presented with right-sided weakness, gait instability, and progressive dysarthria. Neurological evaluation revealed right hemiparesis and dysarthria. Head computed tomography showed an ovoid area of hypoattenuation in the left pons. Magnetic resonance imaging confirmed a 2.6-cm pontine lesion. A biopsy revealed histomorphology and immunophenotype consistent with metastasis of previously diagnosed serous carcinoma of the endometrium. Gynecological malignancies, in particular EPSC, can metastasize to atypical locations even without evidence of systemic disease. The authors hypothesize that this may be due to hematogenous spread through the Batson venous plexus. https://thejns.org/doi/10.3171/CASE24513.

Characteristics and prognosis of small bowel tumors: A retrospective study.

Small bowel tumors (SBTs) are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5% of all gastrointestinal tumors. Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs. However, few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs. To investigate the clinical characteristics, managements and prognosis of SBTs in a medical center in Taiwan. The study enrolled 51 patients aged 58.9 ± 8.8 years (range, 22-93) diagnosed with SBTs from November 2009 to July 2021. We retrospectively recorded clinical characteristics, indications, endoscopic findings, pathological results, management, and outcomes for further analysis. A male preponderance was observed (56.8%). The most common indications were suspected small intestinal tumors (52.9%) and obscure gastrointestinal bleeding (39.2%). The most common tumor location was the ileum (41.2%). The performance of imaging studies (P = 0.004) and the types of findings (P = 0.005) differed significantly between malignant and benign SBTs. The most frequent imaging finding was a small intestinal mass (43.1%). The top three malignant tumor types were gastrointestinal stromal tumors (GISTs), adenocarcinomas, and lymphomas. Moreover, the proportions of benign and malignant tumors were 27.5% and 72.5%, respectively. The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly (P = 0.015). Kaplan-Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups (P = 0.04). All patients with lymphoma underwent chemotherapy (n = 7/8, 87.5%), whereas most patients with GISTs underwent surgery (n = 13/14, 92.8%). Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs. Therefore, a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

Epidemiology of Pediatric Fractures and Effect of Socioeconomic Status on Fracture Incidence in Türkiye: A Nationwide Analysis of 2 Million Fractures.

Childhood fractures are an important public health issue worldwide as they potentially lead to long-term complications. This is the first study reporting a nationwide data pool of 2 million children. We aimed to investigate the epidemiology of pediatric fractures by sex, age, geographical region, and socioeconomic status (SES). Medical records of children diagnosed with fractures between 2016 and 2022 were collected from Türkiye's e-health database. Fractures were divided into 16 anatomic locations. Age was evaluated in four categories: <5, 5-9, 9-14, and 15-19 years. Regional rankings were stratified based on SES. A total of 1,989,212 pediatric fractures were analyzed (1,371,398 boys, 617,814 girls). The overall fracture incidence was 1117/100,000 person-years, being higher for boys (n=1501) compared with girls (n=713) (P<0.001). The mean fracture incidence between 0 and 19 years of age was 21.2% (boys: 28.5%; girls: 13.5%). The overall fracture incidence increased with age, peaking at 10 to 14 years for all children and decreasing thereafter. The 4 most common fracture locations were in the upper extremities. Wrist fractures accounted for 28.9% (575,192) of all pediatric fractures. Provinces with higher SES had significantly increased fracture risks. This study provides the most accurate epidemiological analysis of childhood fractures in the Turkish population with landmark nationwide analysis for the pediatric literature. One fifth of children experienced fractures before maturity. The results highlight the influence of SES on fracture rates, as children in more urbanized and developed areas had an elevated risk of fractures. Level III-diagnostic.

Clinical Characteristics, Management and Outcomes of Colitis-associated Colorectal Cancer and the Comparison to Sporadic Colorectal Cancer in Taiwan.

We explored the clinical characteristics, treatment, and outcomes of colitis-associated colorectal cancer and compared with sporadic colorectal cancer in Taiwan. In this retrospective study spanning 1987-2022, colitis-associated colorectal cancers diagnosed according to endoscopic and pathological reports from 14 tertiary centers were reported to our cohort. Clinical demographics, endoscopic findings, histological results, treatment modalities, and outcomes were analyzed. Sporadic colorectal cancer data were retrieved from the Cancer Registry Annual Report, Ministry of Health and Welfare, Taiwan. We enrolled 65 colitis-associated colorectal cancer patients (median age: 56 years; male: 66.2%). Distal colon was the most common tumor location (41.5%). Of ulcerative colitis patients, 77.2% had extensive colitis and 76.5% had Mayo endoscopic subscores of ≥2. Moreover, 50% of lesions were nonpolypoid with indistinct borders in 66.7%. Signet-ring cell subtype consisted 12.3%. Surveillance colonoscopy adherence was 78.4%, yet 51.3% interval cancers occurred. Disease stage 0-4 distribution was 15%, 20%, 13.3%, 20%, and 31.7%, respectively. Endoscopic resection was feasible for 14%, while 67.7% required surgery. During follow-up (median: 21.5 months), we recorded 23.2% recurrence and 34.5% mortality. Lesions with indistinct borders were associated with adverse outcomes (adjusted odds ratio = 11.5 [1.35-98.16]). Colitis-associated rectal cancers, diagnosed later (p < 0.001), had worse outcomes than sporadic rectal cancers. This is the largest Asian colitis-associated colorectal cancer cohort study, emphasizing the need for stringent disease control, improving detection and reducing interval cancers. Signet-ring cell subtype was prevalent. Rectal colitis-associated cancers were diagnosed later with poorer outcomes then sporadic rectal cancers.

Drug-Eluting Stent versus Interwoven Bare-Metal Stent in Clinically Significant Vein-Graft Anastomotic Stenosis of Hemodialysis Arteriovenous Graft.

To date, no direct comparison has been made between the patency rates of drug-eluting stents (DESs) and interwoven stents (IWSs) in addressing hemodialysis access dysfunction. This study aims to directly compare the primary patency rates of DES and IWS in clinically significant vein-graft anastomotic stenosis of arteriovenous grafts (AVGs). Between January 2015 and October 2022, we enrolled all hemodialysis patients with clinically significant vein-graft anastomotic stenosis of AVGs who presented at our institution. Patient demographics, AVG details, lesion characteristics, and primary patency data for each stent group were systemically recorded. Following this, a Kaplan-Meier analysis of the primary stent patency was performed, with statistical significance set at p<0.05. A total of 51 patients (19 men and 32 women; mean age=64 years; range=49-79 years) were enrolled. Among them, 16 were treated with DES and 35 were treated with IWS. Notably, the most common stent placement location in each group was the vein-graft anastomosis of the brachioaxillary grafts, and the primary patency rate was monitored over a follow-up period of 24 months. At 6, 12, and 24 months, the primary patency rates for DES vs IWS were 100% vs 62.7%, 91.7% vs 38.8%, and 62.9% vs 21.4%, respectively (p<0.001). Our findings suggest that DES may be a more effective treatment choice for clinically significant vein-graft anastomotic stenosis in AVGs for hemodialysis access than nondrug-coated IWS. Drug-eluting stents (DES) have been widely recognized for their efficacy in reducing reintervention rates in coronary and femoropopliteal pathologies. However, their application in managing failing hemodialysis access remains inadequately explored. This study highlights the promising potential of DES in addressing clinically significant vein-graft anastomotic stenosis in hemodialysis arteriovenous grafts (AVG). DES may represent a viable alternative for mitigating substantial immediate recoil stenosis following balloon angioplasty and for preventing early restenosis at the vein-graft anastomosis of AVG, offering a novel therapeutic avenue for future clinical practice.

Clinicopathological Characteristics of Extranodal Marginal Zone Lymphoma of the Mucosa Associated Lymphoid Tissue (MALT-Lymphoma) of the Intestine: A Single Center Analysis.

Extranodal marginal zone B-cell lymphoma of the mucosa associated lymphoid tissue (MALT-lymphoma) is an indolent B-cell lymphoma with a distinct affinity for mucosal structures. Most commonly arising in the stomach, only roughly 2% of MALT-lymphomas occur in the colon or the intestine. In view of this, we have retrospectively assessed all patients with MALT-lymphoma involving the intestine for clinicopathological characteristics. Data of all patients with MALT-lymphoma and intestinal involvement (i.e. both primary and secondary), treated and followed at the Medical University of Vienna between 1999 and 2021 were retrospectively collected from hospital records and analyzed. Differences in baseline and therapy characteristics, as well as survival between primary and secondary, and between intestinal and gastric MALT-lymphoma (as the most common subgroup of patients) were investigated. In total, 42 patients were identified; 24/484 (5%) were classified as primary and 18 (3.7%) as secondary intestinal MALT-lymphomas. The most common primary intestinal location was the colon (10/24) and the most frequent primary site in the 18 cases with secondary intestinal MALT-lymphomas was the stomach (14/18). A total of 28/42 (66.7%) patients presented with LUGANO stage I, 7/42 (16.7%) with stage II/IIE and 7/42 (16.7%) with stage IV disease. Translocation t (11; 18) (q21; q21) was positive in 47% of patients with secondary and 25% of primary intestinal MALT-lymphomas. Median OS in for intestinal MALT-lymphoma was 301months (95% CI n.a.) with 89.1% alive at 5years and 77.2% alive at 10years. Median PFS in the entire cohort was 50.4months (95% CI 38.4-62.4months), with an overall response rate and disease control rate of 73% and 97.3%, respectively. No difference in OS and PFS between primary and secondary intestinal, as well as between intestinal and gastric MALT-lymphoma was detected. Our data suggest that dissemination within the GI tract does not seem to be an adverse prognostic feature and highlights the preferred use of the Lugano staging system in such patients, which also summarizes multiple lesions within the GI-tract as Stage I.

CLINICAL PROFILE AND MANAGEMENT OF HYPERTROPHIC SCARS AT DR. SOETOMO GENERAL ACADEMIC HOSPITAL SURABAYA, INDONESIA

Highlights: Most hypertrophic scar patients were aged 17 to 25, mainly female, and the scars were mostly caused by burns on the face and upper extremities. Surgical techniques were the most common treatment, with most scars measuring 1 to 5 cm². Abstract: Introduction: Scars is a prevalent clinical concern that is often more complex than commonly perceived. Hypertrophic and keloid scars results from atypical wound healing responses following trauma, characterized by an excessive deposition of connective tissue. In Indonesia, there are remains a paucity of data on the clinical profile and management of hypertrophic scars. To address this gap, researchers conducted a descriptive study to systematically examine various variables associated with hypertrophic scars, aiming to enhance understanding and inform more effective management strategies. Methods: This research is a retrospective descriptive analysis utilizing secondary data from medical records of patients with hypertrophic scars treated at Dr. Soetomo General Academic Hospital in Surabaya during the 2019 – 2020 period. The data were collected and processed according to key variables, including age, gender, occupation, etiology, anatomical location of the hypertrophic scars, scar size, and therapeutic interventions. Results:The number of patients with hypertrophic scars at Dr. Soetomo General Academic Hospital, Surabaya, Indonesia, from 2019 to 2020 was 68. Most patients were aged 17 to 25 years. The gender distribution was nearly equal, with 50% male and 50.9% female patients. Among the patients, 12.5% and 43% were students. Burns caused 37.5% and 25% of cases. The most common scar locations were the face (25%) and upper extremities (25%). Most scars measured 1 to 5 cm² (25%). The most common treatment was surgical techniques (80% and 48%). Conclusion: Most hypertrophic scar patients were aged 17 to 25 years, predominantly female, and students. The primary cause of the scars was burns, with the scars most commonly located on the face and upper extremities. The majority of scars measured between 1 and 5 cm², and surgical techniques were the most widely used therapy.

Erosive bilateral glenohumeral osteoarthritis caused by urosepsis-induced septic arthritis.

Staphylococcus aureus is a common cause of bacterial infections of the skin, soft tissues, bones, bloodstream, and respiratory system. When the infection spreads to the joints, it is known as septic arthritis. The shoulder is the third most common location for septic arthritis in adults. Treatment is arthroscopic or open irrigation and debridement, but even after eradicating the bacteria, cartilage and bone destruction can occur. This article describes a patient who developed bilateral septic arthritis of the shoulders shortly after a urinary tract infection, and was treated with a relatively rare reverse shoulder hemiarthroplasty procedure.

Hand and Wrist Dog-Leash Injuries in the Outpatient Setting: A Review of 443 Cases.

Injuries sustained from dog leashes often result in visits to hand surgeons. This study presents an analysis of dog-leash-related upper-extremity injuries at a single orthopedic practice, including treatment options for these injuries, and guidance for prevention. We identified all outpatients who presented to a hand surgeon at a single institution from 2016 to 2021 following an upper-extremity injury related to a dog leash. Charts were reviewed and demographics, injury description and mechanism, and details of treatment were recorded. We identified 443 patients that presented for a dog-leash-related injury. The average time from injury to outpatient visit was 23 days. Surgery occurred following injury in 96 patients (21.6%). The most common injury locations were the ring finger, followed by the wrist, third finger, and fifth finger. Interphalangeal joint sprain was the most common injury type followed by phalangeal fracture. The majority of injuries were caused by the extremity catching in the leash while being pulled (337, 75.9%). Among the 96 patients requiring surgery, open reduction and internal fixation was the most commonly performed procedure followed by closed reduction with percutaneous pinning. For patients not requiring surgery (348, 78.4%), splinting or bracing was the most common treatment recommended. The majority of dog-leash injuries were caused by the patient's extremity catching in the leash as it was pulled, resulting in interphalangeal joint injures and phalanx fractures. The most common treatment required for these patients was nonoperative.

A 10-year Retrospective Comparison of Endovascular and Open Aneurysm Repair for Infective Native Abdominal Aortic Aneurysm

BackgroundThis study compared outcomes of endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) in patients with infective native abdominal aortic aneurysms (INAAA), evaluating perioperative and in-hospital mortality, antibiotic treatment duration, complications, overall survival rates, and reintervention-free times at 10 years. MethodsA retrospective cohort study of 125 INAAA patients (80 EVAR, 45 OAR) diagnosed between January 2004 and December 2019 was conducted. Patients were categorized as fit or unfit for open surgery based on cardiac, respiratory, and renal status, following the guidelines established in the EVAR-1 and EVAR-2 trials. Primary outcomes included 30-day and in-hospital mortality. Secondary outcomes encompassed early and late complications requiring reintervention, antibiotic treatment duration, 10-year overall survival, 10-year reintervention-free survival, and factors influencing 30-day mortality. Statistical analysis used chi-square, t-tests, and Mann-Whitney U tests. Logistic regression assessed mortality. Kaplan-Meier estimation evaluated survival. Analyses used SPSS version 18.0 (p < 0.05 considered significant) ResultsMales predominated in both OAR (37/45, 82.2%) and EVAR (62/80, 77.5%) groups (P = 0.693). Mean age was 64.8 ± 9.8 years for OAR and 69.0 ± 12.6 years for EVAR (P = 0.063). The abdominal aorta was the most common aneurysm location, accounting for 91/125 (72.8%) cases. Salmonella spp. accounted for 19/45 (42.2%) of positive culture cases, and 34/125 (27.2%) patients had ruptured aneurysms. The EVAR group had a higher proportion of unfit patients (41/80, 51.2%) compared to OAR (10/45,22.2%; P=0.003). 30-day mortality rates were 6/80 (7.5%) for EVAR and 2/45 (4.4%) for OAR; OR = 1.75 (95% CI: 0.34 - 9.06), P = 0.508, while in-hospital mortality rates were 7/80 (8.8%) and 5/45 (11.1%); OR = 0.77 (95% CI: 0.23 - 2.58), P = 0.668. No significant differences were found in antibiotic treatment duration (median 11 vs 6 months, P=0.594), 10-year overall survival rates (62.8% vs 64.8%, P=0.90), or reintervention-free time (83.8% vs 82.2%, P=0.922), and aneurysm-related death (84.7% vs 92.9%, P=0.159), Unfit patient status was an independent predictor of 30-day mortality (adjusted OR, 10.654; 95% CI, 1.041-109.030; P=0.046). ConclusionsOur study demonstrates that EVAR and OAR provide comparable outcomes in INAAA management, despite EVAR being performed more frequently in unfit patients. The similar early mortality rates, antibiotic treatment durations, and long-term survival between the two approaches support EVAR as a viable alternative to OAR. Importantly, our finding that unfit patient status independently predicts perioperative mortality emphasizes the critical role of patient selection in treatment decisions. These results collectively suggest that EVAR may be particularly beneficial for high-risk INAAA patients unsuitable for OAR, potentially expanding treatment options for this challenging condition.

Ethnobotanical review of traditional use of wild food plants in Japan

BackgroundJapan, which has a diverse climate, is home to 8118 species of wild vascular plants, with more than 1000 of these species considered edible. However, there are fewer studies on the use of wild food plants in Japan than in other parts of the world. This research aims to provide an ethnobotanical review of the traditional food use of wild plants in Japan. It draws upon the largest database of traditional Japanese foodways, with a specific focus on the period approximately 1930. This occurred prior to Japan’s rapid economic growth, which resulted in significant changes in the use of wild plants.MethodsThe use of wild food plants in Japan was reviewed by studying the collection of Japanese foodways (Nihon no shokuseikatsu zenshu), which is the largest database on Japanese traditional foodways and contains records of approximately 52,000 dishes, including food uses of wild plants. The review extracted the local and common names, use locations, uses, processing and cooking methods, habitats and other relevant details pertaining to the reported use of wild food plants. This information was subsequently analyzed via Excel.ResultsA total of 268 taxa belonging to 87 families used in Japan approximately 1930 were documented. Asteraceae was the most frequently reported family as well as the most species-rich family. In terms of use, vegetables composed the largest group, followed by dessert fruits. The majority of species have been documented in only a limited number of reports. The review revealed local traditional uses of plants, including the use of plants as binders for making rice cake, the selection of plants according to their sex, and techniques for detoxifying toxic plants.ConclusionA comparison with those of previous studies on wild species used in other Asian regions revealed a similar preference for vegetables. However, notably, in Japan, ferns are also consumed in considerable quantities. Conversely, further elucidation is clearly needed with respect to certain matters, including the perception of plant sex and the relationships between diverse ash components and detoxification techniques. It is evident that further ethnobotanical research is needed, both in the form of an examination of ethnographic records and in the field, to gain a deeper understanding of the use of wild food plants in Japan.

Recurrences and Subsequent Treatments After Curative-Intent Surgery for Localised and Locally Advanced Renal Cell Carcinoma.

There is a lack of evidence concerning recurrent patterns and treatment of repeat recurrences for surgically treated renal cell carcinoma (RCC). Thus, the objective was to describe patterns of recurrences and subsequent treatments in patients with recurrent RCC. We identified 525 patients who received surgical treatment for RCC at our institution in 2010-2015. The treatment of recurrences was classified as no active treatment, treatmentwith the aim to achieve no evidence of disease (NED) or systemic oncological treatment (OT). Relationships were analysed using multivariable Cox regression and log-rank analysis. The median follow-up was 7.8 [interquartile range (IQR 6.5-9.4)] years. Ninety-one patients experienced a first recurrence, of which 49 received NED-aimed treatment-47 of these patients had their recurrence more than 2 years after surgery. Thirty patients experienced a second recurrence with 17 patients undergoing NED-aimed treatment. Eight patients had a third recurrence with four undergoing NED-aimed treatment. The most common locations of recurrence were pulmonary, local or multiple sites-30% and 38% of patients experienced a second or third recurrence in the same location, respectively. The 3-year overall survival estimates for patients receiving NED-aimed treatment for their first recurrence were 83.1% [95% confidence interval (CI) 72.3-93.8%] and 79.3% (95% CI 58.4-100%) for patients receiving NED following a second recurrence. Treatments aimed at achieving NED seem to provide good oncological control and in repeat recurrences, 50% or more were managed with repeat NED-aimed treatments.

The Amazonian snakebite burden: Unveiling seasonal dynamics in a region with tenfold higher incidence compared to the Brazilian average.

Accidents caused by snakes constitute a serious public health problem in Latin America and worldwide. The situation in the Brazilian Amazon region is neglected, resulting in the highest incidence of cases per capita in the country. Furthermore, the distance from urban areas makes it difficult for the population to access timely and effective medical care, including antivenom treatment. The Brazilian Amazon is characterised by high ethnic and cultural diversity, yet it lacks robust epidemiological information that would allow for the development of surveillance and prevention policies. This study aimed to assess the epidemiological profile of individuals affected by snakebite accidents from 2007 to 2021 in a poorly studied region of the Brazilian Amazon. To assess the relationship between snakebite accidents, rainfall and river flood levels, cross-correlation functions were employed. Data from the public healthcare system database was used for this analysis. The results indicate that the study area experiences a snakebite rate 10 times greater than the Brazilian average and double that of other Amazonian regions. The most affected victims consist of adult males residing in rural areas, with snakebite accidents being more common during the rainy season. Viperid snakes were responsible for most bites, with the lower limbs being the most common location of injury. The data revealed a positive correlation between the number of snakebite accidents both rainfall and fluvial data. The accident peak coincides with the Brazil nut harvest season, a highly significant forest product for the economy of rural communities. Our data reinforces the need for public policies focused on environmental education and prevention, such as the use of boots and leg guards. These preventive measures have the potential to reduce the number of snakebites accidents by approximately 85%.

Multispectral Fluorescence Imaging as a Tool to Distinguish Pelvic Lymphatic Drainage Patterns During Robot-assisted Lymph Node Dissection in Prostate Cancer.

The invasive nature of extended pelvic lymph node dissection (ePLND) prompts the need for alternative lymphatic mapping technologies. To change the focus to "sparing nodes that are not involved," the first step is to research the feasibility of intraoperatively distinguishing the lymph drainage patterns of the prostate from healthy organs. We performed a prospective study (NCT05120973) that included 16 patients who underwent a robot-assisted radical prostatectomy + ePLND + sentinel node (using indocyanine green-99mTc-nanocolloid). After general anesthesia, a second fluorescent dye (fluorescein) was injected unilaterally in two deposits into the intradermis of the upper leg (n = 8) or abdominal wall (n = 8), because these are the most common locations of lymphedema in prostate cancer surgery. To distinguish between the drainage patterns, in vivo and ex vivo multispectral fluorescence imaging was performed by using a fluorescence endoscope. Indocyanine green and fluorescein were visible in the same regions within the ePLND-template and co-accumulated in lymph vessels in vivo. At histopathology, fluorescein was seen in only 10 of 370 lymph nodes (possibly owing to tracer properties), none of which overlapped with indocyanine green and none were tumor-positive. Administration of fluorescein did not result in discomfort or abnormal postoperative recovery. Multispectral imaging can be used to distinguish lymphatic drainage patterns. Our in vivo findings indicate that within the ePLND-template, lymphatic drainage patterns of the prostate at least partly overlap with those of upper leg and abdominal wall. The properties of fluorescein render it unsuitable for confirmation of fluorescence at histopathology.

The correlation of Alkaline Phosphatase, lactate dehydrogenase, C-Reactive protein, erythrocyte sedimentation rate, and apparent diffusion coefficient values with Enneking staging and osteosarcoma subtypes

Apparent diffusion coefficient (ADC) values obtained from Magnetic Resonance Imaging (MRI) have shown potential as predictors of osteosarcoma staging and subtype, along with laboratory results for alkaline phosphatase (ALP), lactate dehydrogenase (LDH), c-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). However, studies investigating this correlation are still relatively limited. These tests may be an alternative for osteosarcoma staging and subtyping, especially in low-resource settings. This study aims to investigate the correlation between the ADC value and laboratory findings with the staging and subtype of osteosarcoma. This retrospective study analyzed data from osteosarcoma patients from August 2021 to August 2023, including serum levels of ALP, LDH, CRP, ESR, and ADC values from MRI. A study of 39 osteosarcoma patients found that most were male (61.5%), with an average age of 19. The distal femur was the most common tumor location (33.3%), and osteosarcoma chondroblast type was the predominant subtype (30.8%). Enneking stage IIB was the most prevalent (79.5%). ALP, LDH, CRP, and ESR biomarkers significantly correlated with Enneking staging (p&lt;0.05). However, no correlations were found between these biomarkers and osteosarcoma subtype (p&gt;0.1). Additionally, no significant correlations were observed between the mean ADC and Enneking staging (p=0.061) or osteosarcoma subtype (p=0.084). ALP, LDH, CRP, and ESR levels have a strong and significant correlation to the staging of Enneking osteosarcoma. However, the mean ADC values on MRI do not have a significant correlation to the osteosarcoma subtype based on histopathology.

Extensive Epidural Hemorrhage Associated with Thoracolumbar Disc Extrusion in French Bulldogs.

(1) Background: Intervertebral disc extrusion may be accompanied by extensive epidural hemorrhage (EEH) and result in spinal cord compression. EEH is more commonly seen in French Bulldogs compared to other breeds. The majority of French Bulldogs have lumbar intervertebral disc extrusion, but it is unclear if there is an association between the site of thoracolumbar disc extrusion and EEH. This retrospective study's aim was to investigate the association and prevalence between the site of thoracolumbar intervertebral disc extrusion and EEH in French Bulldogs. (2) Methods: Thoracolumbar MRI of French Bulldogs was examined for the site of intervertebral disc extrusion and the presence, distribution, and extent of EEH. (3) Results: In 148 French Bulldogs with thoracolumbar intervertebral disc extrusion, the most common location was L4/L5 (22%), followed by L3/L4 (20%) and T13/L1 (15%), and 70.3% had EEH. The highest incidence of EEH across all thoracolumbar sites was seen at L1/L2 (84.2%), followed by L5/L6 (81.3%) and L2/L3 (72.2%). The incidence of EEH was 70.5% across all lumbar sites and 66.9% for all thoracic sites. (4) Conclusion: In this population of French Bulldogs, the prevalence of lumbar disc extrusion was high, and 70.3% had EEH. There was no significant difference between the site of thoracolumbar intervertebral disc extrusion and EEH.

Clinical features of midzonal iris pigment epithelial cysts: surprising findings revealed by ultrasound biomicroscopy.

Midzonal iris pigment epithelial (IPE) cysts are typically asymptomatic but can pose a differential diagnostic challenge by mimicking ciliary body melanoma. We conducted a case series study of the clinical characteristics of these iris cysts, particularly their shapes and sizes and associated lesions revealed by ultrasound biomicroscopy (UBM). Charts of patients with midzonal IPE cysts encountered by one or more of the authors were reviewed retrospectively. Pertinent demographic information and clinical data about these patients and their cysts were abstracted. 69 patients were identified. At initial diagnosis, patients ranged in age from 14.8 to 89.5years (median: 66.0years). Only one patient was < 30years old at diagnosis. 38 patients (55.1%) were female. 74 eyes (39 right, 35 left) contained one or more clinically identified midzonal IPE cysts. The cysts involved the right eye alone in 34 (49.3%), the left eye alone in 30 (43.5%), and both eyes in 5 (7.2%) patients. The midzonal IPE cysts were located most often inferotemporally (51.4%) and second most often temporally (23.0%). UBM imaging had been performed on 44 of the 74 affected eyes. The median largest basal diameter of the midzonal IPE cysts evaluated by UBM was 4.5mm (extremes: 1.5 to 13mm), and the median height of these cysts was 1.5mm (extremes: 0.6 to 6mm). The largest lesion was a complete ring cyst. All 3 UBM-evaluated eyes that appeared by slit lamp biomicroscopy to have two or more distinct midzonal IPE cysts were shown by UBM to have a single sausage or kidney-bean shaped partial ring cyst with radial folds between the lobules and not separate multiple cysts. UBM imaging also identified peripheral IPE cysts in 32 of 44 evaluated eyes (72.7%). Our case series confirmed previously reported findings regarding age at diagnosis and most common locations of midzonal IPE cysts. However, our UBM images revealed that at least some IPE cysts identified by slit lamp biomicroscopy as multifocal are partial ring cysts with radial folds in the cyst wall between lobules and not true independent multiple cysts. What is known Midzonal IPE cysts occur most often unilaterally and inferotemporally. Midzonal IPE cysts are frequently associated with peripheral IPE cysts. What is new UBM imaging of eyes with two-clinically detected IPE cysts showed that they were confluent as opposed to separate cysts. The median largest basal diameter of midzonal IPE cysts evaluated by UBM was 4.5 mm (extremes: 1.5 and 13 mm). The median height of midzonal IPE cysts evaluated by UBM was 1.5 mm (extremes: 0.6 and 6 mm).

RETROSPECTIVE ANALYSIS OF GLIOBLASTOMA OUTCOMES

Background Glioblastoma (GBM) is one of the most aggressive brain cancers, with a median overall survival (OS) of about 15 months. This retrospective study focuses on 144 GBM cases treated over 12 years in our clinic in Romania, analyzing factors affecting progression-free survival (PFS) and OS, including genetic markers and treatment modalities. Methods This study involved patients treated between 2012 and 2024 at the National Institute of Neurology and Neurovascular Diseases in Bucharest. The cohort included 144 patients, with variables such as age, gender, tumor location, IDH mutation status, Karnofsky Performance Status (KPS), and genetic markers (MGMT methylation and EGFR amplification) analyzed. Survival outcomes were evaluated using Kaplan-Meier curves and log-rank tests. Results - Patient Demographics: The cohort included 64 males (44.4%) and 80 females (55.6%) with a mean age of 60.7 years. - Tumor Characteristics: The most common tumor location was the frontal lobe (31.9%), followed by multilobular GBM (26.3%). Right-side tumors were more prevalent (51.3%). - Genetic Markers: MGMT promoter was methylated in 46 patients (31.9%), and EGFR was amplified in 76 patients (52.7%). - Treatment Modalities: 105 patients (72.9%) received chemotherapy with temozolomide (TMZ), and 116 patients (80.5%) underwent radiotherapy. - Survival Outcomes: Median PFS was 5 months, and median OS was 8.5 months. Kaplan-Meier survival curves indicated significantly increased OS in patients with MGMT methylation undergoing chemotherapy (p&lt;0.005) and radiotherapy (p&lt;0.005). Similarly, OS was significantly higher in patients without EGFR amplification receiving chemotherapy (p&lt;0.005) and radiotherapy (p&lt;0.005). Conclusion The study emphasizes the importance of MGMT methylation and EGFR amplification in predicting survival outcomes in GBM patients. Immediate postoperative adjuvant therapy significantly improves PFS and OS. The findings underscore the need for coordinated care and timely access to adjuvant therapies to enhance survival rates in GBM patients. Second surgical interventions also showed a survival benefit, highlighting their potential role as salvage therapy in recurrent GBM cases.

Anatomical description of malformations of the neck of the left atrial appendage.

The recently-described left atrial appendage (LAA) neck is a truncated cone-shaped structure that connects the LAA orifice to its lobe. It shows malformations in some cases, but their exact description and clinical significance are unknown. Therefore, the aim of this study was to provide a detailed anatomical and morphometric analysis of LAA neck malformations in clinical context. A total of 250 autopsied human hearts (20.0% women, 46.7 ± 18.2 years old) were examined for mural malformations: spikes and bulges. Endocardial roughness of the LAA neck with a depth <2 mm and no recognizable epicardial protrusion was defined as ectopic trabeculation. LAA neck malformations were found in 13.6%, bulges in 10.0% of the hearts examined, spikes in only 3.2%, and ectopic trabeculations in 24.8%. In one case, both a bulge and a spike were found in the LAA neck. Most LAA neck roughness was observed on the aortic and venous surfaces of the LAA neck. Those surfaces were the most common locations for malformations and ectopic trabeculations. The LAA wall was significantly thinner than the surrounding neck wall within the bulges and the ectopic trabeculations, but not in the spikes.