Hilar Region Research Articles

RIGHT INFERIOR HILAR MASS: COULD THIS BE A DILATED AZYGOS VEIN?

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The differential diagnosis for right inferior hilar mass includes paratracheal malignancy, mediastinal lymphadenopathy, and on rare occasions, dilated vascular structures, primarily the Azygos vein. We present a 66-year-old man who was referred to us for biopsy of a right inferior hilar mass. On further evaluation and imaging, the mass structure was found to be a dilated Azygous vein. CASE PRESENTATION: A 66-year-old man with past medical history significant for essential hypertension, liver cirrhosis, and portal hypertension was admitted to tertiary care hospital for Acute Type 1 respiratory failure due to volume overload. Pulmonary service was consulted for possible Bronchoscopy with Endobronchial ultrasound (EBUS) of masslike consolidation along the right inferior hilar region that was apparent on Chest Xray(Figure 1). For further evaluation, the patient had a CT scan of the chest(Figure 2) during his hospitalization, which showed 4.5 x 3.4 cm right upper posteromedial chest mass positioned adjacent to the trachea and esophagus. This structure appeared to be continuous with an elongated structure extending through the posterior mediastinum adjacent to the esophagus. Given the patient history of portal hypertension and the connection of the mass to a tubular structure that was most likely venous in origin, ruling out dilated azygos vein as a possible diagnosis was mandatory. The patient underwent an MRI scan of his chest(Figure 3), which confirmed the mass to be a dilated Azygos vein, and Bronchoscopy was deferred. DISCUSSION: Right inferior hilar mass differential includes malignancy, whether primary or metastasis, mediastinal lymphadenopathy (inflammatory, neoplastic, or infectious in origin), and on rare occasions, dilated vascular structures, primarily the Azygos vein[1]. Our patient had a dilated Azygos vein presenting as a solid mass on Chest x-ray and CT chest. There are multiple causes of dilated Azygos vein, including congenital ( Superior or Inferior vena cava interruption or congenital portoazygos shunt ) and acquired causes (aortoazygos fistula, congestive heart failure, constrictive pericarditis, superior or inferior vena cava obstruction, or acquired portoazygos shunt)[2]. Our patient had an acquired portoazygos shunt due to portal hypertension as a cause for his dilated Azygos vein. Diagnosis based mainly on contrast-enhanced imaging with either CT scan or MRI, both of which can provide a detailed evaluation of the portal and systemic venous systems and the collateral pathways between them if present[3]. Ruling out the possibility of a dilated azygos vein is important to avoid any additional intervention. CONCLUSIONS: Although rare, physicians should be aware of the possibility of dilated azygous vein as one of the differential diagnoses of masses in the right inferior hilar region. Reference #1: Toma CL, Dumitrache-Rujinski S, Belaconi IN, et al. Unilateral pulmonary hilar tumor mass: is it always lung cancer? Maedica (Buchar) 2013;8 (1):30–33. Reference #2: Gebrael J, Yu H, Hyslop WB. Spontaneous Portoazygos Shunt in a Patient with Portal Hypertension. J Radiol Case Rep [Internet] 2013 [cited 2020 Mar 9];7 (7):32–36. Reference #3: Ishikawa T, Tsukune Y, Ohyama Y, Fujikawa M, Sakuyama K, Fujii M. Venous abnormalities in portal hypertension demonstrated by CT. AJR Am J Roentgenol 1980; 134 (2):271–276. DISCLOSURES: No relevant relationships by Ibrahim Haddad, source=Web Response No relevant relationships by Girendra Hoskere, source=Web Response No relevant relationships by Sajin Karakattu, source=Web Response No relevant relationships by Akesh Thomas, source=Web Response

Dormancy breaking in Teramnus labialis (L.f.) Spreng seeds through liquid nitrogen exposure is based on the modification of the hilar region, cuticle, and macrosclereid

Teramnus labialis (L.f.) Spreng is a legume that plays an important role in mixed agroecosystems, due to its use as animal feed and its role in restoring soil nitrogen levels. However, its wide-scale use in agriculture and revegetation efforts is limited due to its physically dormant seeds. In our previous study on the effects of seed cryopreservation on seedling vigor in this species, our preliminary findings (using scanning electron microscopy) indicated that liquid nitrogen (LN) disrupted the seed coat in this species and led to improved seedling emergence. In our present study, we use light microscopy to investigate whether LN exposure influences the structure/integrity of the hilar region, cuticle, and macrosclereid in relation to seed imbibitional rate and germination. In terms of thickness, statistically significant differences between treated and control seeds were not observed in the cuticle, macrosclereid, osteosclereid or the counter-packed cell layer. Contrastingly, the percentage of seeds with the hilar region open reached 45% in seeds treated with LN but only 10% in the control seeds. Additionally, 85% of seeds immersed in LN showed cracks and breaks in the cuticle and macrosclereid, which were not present in the control. Seed exposure to LN improved seed imbibition rate and germination significantly relative to control seeds/seedlings. Cryo-stored seeds showed a 5.6 fold-increase in imbibition rate, and 2.6 fold-increase in germination. The results validate the use of LN exposure for breaking physical dormancy in seeds of other legumes that display seed anatomy similar to T. labialis.

Left Ventricular Thrombus in a Patient Infected by COVID-19

A 74-year-old woman presented with generalized malaise with nausea and vomiting. The patient had no known systemic disease, history of trauma, or medication. On physical examination, the patient was confused and had abdominal tenderness. The chest roentgenogram showed cardiomegaly and bilateral pleural effusions. Computed tomography (CT) of the chest (Figure 1A) showed bilateral pleural effusions (black asterisks), consolidated areas with air bronchograms in the right hilar region (white arrow) and ground-glass densities in some peripheral locations (black arrows).

Research progress in the Hepatobiliary Surgery operation of hepatic hilar plate system

An estimate of about 50% of new liver cancer cases worldwide occur in China every year.Surgical resection is still the major treatment choice for longer survival of patients with hepatocellular carcinoma. Blocking hepatic blood flow and reducing intraoperative bleeding ensure the success of the operation. Anatomic separation of hepatic hilar region is the precondition of hepatic inflow occlusion. The hepatic hilar plate system involves a thick layer of connective tissue covering the hepatic inflow ducts of hepatic hilar region. The descending part of hilar plate assists in reducing the anatomical difficulty of the hepatic hilar region. The "forth porta hepatis" that is hidden in the hepatic hilar plate system involves the accumulation area of "short hepatic portal veins" .The communicating branch vessels between the hepatic inflow vessels form the anatomical basis in reducing the indocyanine green fluorescence stain effect.The relatively fixed position of the hepatic portal plate is considered as a positioning marker for accurate liver resection. The intrahepatic Glisson sheath is connected with thick connective tissue of the hepatic portal panel system, and is regarded as the physical barrier in limiting the proliferation and hypertrophy of hepatocytes and continuation of hepatic portal panel system in the liver.This paper summarizes the anatomy and application of hepatic hilar plate system during hepatobiliary surgery.

The dose\u2013response characteristics of four NTCP models: using a novel CT-based radiomic method to quantify radiation-induced lung density changes

Multiple competing normal tissue complication probability (NTCP) models have been proposed for predicting symptomatic radiation-induced lung injury in human. In this paper we tested the efficacy of four common NTCP models applied quantitatively to sub-clinical X-ray computed tomography (CT)-density changes in the lung following radiotherapy. Radiotherapy planning datasets and follow-up chest CTs were obtained in eight patients treated for targets within the lung or hilar region. Image pixel-wise radiation dose exposure versus change in observable CT Hounsfield units was recorded for early (2–5 months) and late (6–9 months) time-points. Four NTCP models, Lyman, Logistic, Weibull and Poisson, were fit to the population data. The quality of fits was assessed by five statistical criteria. All four models fit the data significantly (p < 0.05) well at early, late and cumulative time points. The Lyman model fitted best for early effects while the Weibull Model fitted best for late effects. No significant difference was found between the fits of the models and with respect to parameters D50 and γ50. The D50 estimates were more robust than γ50 to image registration error. For analyzing population-based sub-clinical CT pixel intensity-based dose response, all four models performed well.

A Novel Sulfonamide, 4-FS, Reduces Ethanol Drinking and Physical Withdrawal Associated With Ethanol Dependence.

Carbonic anhydrase (CA) is abundant in glial cells in the brain and CA type II isoform (CA II) activity in the hippocampus plays an important role in buffering extracellular pH transients produced by neural activity. Chronic ethanol exposure results in respiratory and metabolic acidosis, producing shifts in extracellular pH in the brain and body. These neurophysiological changes by ethanol are hypothesized to contribute to the continued drinking behavior and physical withdrawal behavior in subjects consuming ethanol chronically. We explored whether chronic ethanol self-administration (ethanol drinking, 10% v/v; ED) without or under the influence of chronic intermittent ethanol vapor (CIE-ED) experience alters the expression of CA II in the hippocampus. Postmortem hippocampal tissue analyses demonstrated that CA II levels were enhanced in the hilus region of the hippocampus in ED and CIE-ED rats. We used a novel molecule—4-fluoro-N-(4-sulfamoylphenyl) benzenesulfonamide (4-FS)—a selective CA II inhibitor, to determine whether CA II plays a role in ethanol self-administration in ED and CIE-ED rats and physical withdrawal behavior in CIE-ED rats. 4-FS (20 mg/kg, i.p.) reduced ethanol self-administration in ED rats and physical withdrawal behavior in CIE-ED rats. Postmortem hippocampal tissue analyses demonstrated that 4-FS reduced CA II expression in ED and CIE-ED rats to control levels. In parallel, 4-FS enhanced GABAA receptor expression, reduced ratio of glutamatergic GluN2A/2B receptors and enhanced the expression of Fos, a marker of neuronal activation in the ventral hippocampus in ED rats. These findings suggest that 4-FS enhanced GABAergic transmission and increased activity of neurons of inhibitory phenotypes. Taken together, these findings support the role of CA II in assisting with negative affective behaviors associated with moderate to severe alcohol use disorders (AUD) and that CA II inhibitors are a potential therapeutic target to reduce continued drinking and somatic withdrawal symptoms associated with moderate to severe AUD.

Water Uptake and Germination of Caper (Capparis spinosa L.) Seeds

Caper is a perennial deciduous sub-shrub that grows in almost all circum-Mediterranean countries. The specialized literature presents three possible dormancy types that can cause low germination of caper seeds: Physiological dormancy (PD), physical dormancy (PY), and combinational dormancy (PY + PD). We conducted three experiments to analyze the imbibition, viability, and germination of seeds of different ages, provenances, and the level of deterioration of the seed cover. None of the commercialized lots of standard seeds tested exceeded 6% germination, nor 35% viability, while the owned seeds reached 90% in both parameters, indicating that all viable seeds germinated. The seed moisture content along the soaking period followed the first two phases of the typical triphasic model of water uptake in seed germination: The imbibition and lag phases (phase I and II of germination, respectively). Seed hydration began through the hilar region. The fact that all viable owned seeds germinated, together with their moisture content being lower than that of standard seeds, indicated that caper seeds do not have a water-impermeable coat sensu stricto, i.e., they do not show PY; nevertheless, the need to use gibberellic acid to obtain high germination percentages, demonstrated the presence of PD.

Seed coat anatomy ofCercis chinensisand its relationship to water uptake

The hard seed coat of Cercis chinensis Bunge is an important factor of its dormancy. A study of the characteristics of water absorption is vital for understanding seed dormancy and germination. This investigation found that soaking in water at an initial temperature of 80 °C for 5 min was optimal for breaking the hardness of C. chinensis seeds. Scanning electron microscopy (SEM), dye-tracking, and blocking experiments were used to examine the major water entry sites and the relationship between water uptake and seed coat structure during C. chinensis seed imbibition. The SEM images showed that the seed coat consisted of three layers: epidermis, palisade, and sclereid. Special light line, vascular bundle, and counter-palisade layer structures were found in the side of the hilum. The blocking experiments showed that the hilar region was an important water absorption site because, if the region was not blocked, it showed the highest water absorption when imbibed for 3–12 h. However, all parts of the seed coat can absorb water if enough time is allowed after the seed coat hardness has been broken. The dye-tracking test showed that after 3 h water entered the seed only via the hilum fissure. Therefore, the hilum fissure acts as the initial site of water absorption. When more time was allowed, water moved more rapidly on the side with vascular bundles than on the opposite side.

Utilization of a new technology of 3D biliary CT for ERCP-related procedures: a case report

BackgroundEndoscopic retrograde cholangiopancreatography (ERCP) is still performed using two-dimensional (2D) X-ray images. The success rate and risk of complications are considered operator-dependent. We explored performing an ERCP-related procedure with 3D-computed tomography (CT) biliary imaging for preoperative simulation and intraoperative reference in a patient with malignant biliary obstruction.Case presentationThe patient was a 66-year-old man who underwent rectal resection and postoperative chemotherapy for rectal cancer. A liver metastasis caused obstructive jaundice and acute cholangitis, necessitating emergency hospitalization. A 3.5 cm mass in the hilar region of the biliary tree caused type IV biliary obstruction according to the Bismuth-Corlette classification of hilar cholangiocarcinoma. ERCP and biliary drainage were performed repeatedly, but had no effect. Given that selective bile duct drainage had proven extremely difficult with the conventional procedures, three-dimensional (3D) images were created from preoperative CT image data using a 3D image reconstruction system (SYNAPSE VINCENT version 5, FUJIFILM Corporation, Tokyo, Japan). Using the 3D images for preoperative planning and intraoperative reference, biliary drainage and stent placement were successfully performed without complications. Postoperatively, the patient had no further cholangitis or need for stent replacement up to his death.ConclusionsWe report the first case of an ERCP-related procedure with 3D biliary imaging for preoperative simulation and intraoperative reference in a patient with malignant biliary obstruction. The 3D image reconstruction is useful for preoperative planning and could contribute to an increased success rate, decreased complications, a shorter operation time, and reduced radiation exposure to the operator.

A gland-sparing, intraoral sialolithotomy approach for hilar and intraparenchymal multiple stones in the submandibular gland

Multiple intraglandular sialolithiasis for stones deep in the glandular parenchyma may require submandibulectomies, especially if sialendoscopic facilities are unavailable. We describe a gland-sparing intraoral sialolithotomy approach for both hilar and intraparenchymal multiple sialoliths. Nine patients with obstructive sialadenitis resulting from multiple sialoliths in both the deep hilar region and the submandibular gland parenchyma were selected for this study. Ultrasonography and computer tomography (CT) scans were performed to determine the location, number and sizes of the calculi and the distance between hilar and intraparenchymal sialoliths. All sialoliths were removed via gland-sparing, intraoral sialolithotomy. In all, 27 stones were found in the 9 patients. The hilar and deeper sialoliths were 4.5–11 and 0.8–4.5 mm, respectively, in diameter. The largest distance between the hilar and intraparenchymal sialoliths was 28.3 mm. Sialoliths in the hilar region were excised through an intraoral incision before deeper intraparenchymal stones were eased out of the same incision site. Postoperative follow-up imaging verified complete sialolith removal. Therefore, submandibular gland multiple sialoliths in the hilum and parenchyma can be successfully removed via an intraoral sialolithotomy under general anesthesia, thereby preserving the gland and restoring its secretory function.

Multimodal Imaging of Schwannoma in Hepatic Hilar Region.

Multimodal Imaging of Schwannoma in Hepatic Hilar Region.

Prospective Study of Spatial Distribution of Missed Lung Nodules by Readers in CT Lung Screening Using Computer-assisted Detection

To evaluate the spatial patterns of missed lung nodules in a real-life routine screening environment. In a screening institute, 4,822 consecutive adults underwent chest CT, and each image set was independently interpreted by two radiologists in three steps: (1) independently interpreted without computer-assisted detection (CAD) software, (2) independently referred to the CAD results, (3) determined by the consensus of the two radiologists. The locations of nodules and the detection performance data were semi-automatically collected using a CAD server integrated into the reporting system. Fisher's exact test was employed for evaluating findings in different lung divisions. Probability maps were drawn to illustrate the spatial distribution of radiologists' missed nodules. Radiologists significantly tended to miss lung nodules in the bilateral hilar divisions (p < 0.01). Some radiologists had their own spatial pattern of missed lung nodules. Radiologists tend to miss lung nodules present in the hilar regions significantly more often than in the rest of the lung.

Novel Model of Bile Duct Paucity Demonstrates the Critical Role of Yap1 in Biliary Morphogenesis in Development and Regeneration

BackgroundYes‐associated protein 1 (Yap1) is a critical regulator of liver embryonic development, regeneration and tumorigenesis. Previous studies have shown that Yap1 regulates bile duct formation and hepatocyte transdifferentiation to cholangiocytes, but the mechanisms by which Yap1 regulates biliary morphogenesis as well as the functions of Yap1 in early embryonic liver development remain unknown.MethodsTo elucidate the role of Yap1 in early liver development, we developed a novel mouse model (Yap1 KO) in which Yap1 is deleted from the foregut endoderm progenitors by E12.5 using the Foxa3 promoter to drive Cre recombinase expression. Here, we comprehensively characterize the Yap1 KO mice through histology, whole organ tissue clearing and confocal microscopy and additional functional techniques.ResultsYap1 KO mice lack Yap1 in the liver from early development. Strong nuclear expression of Yap1 that was seen in hepatoblasts in WT livers at E14.5 was clearly absent in the KO mice. Although Yap1 KO mice were viable and have fully formed liver and digestive organs, they exhibited jaundice and stunted growth. Histological analysis identified a failure of intrahepatic bile duct formation. Yap1 deletion did not block Notch activation as shown by the appearance of Hes1‐positive and Sox9‐positive ductal plate cells in both WT and KO mice. Rather, Yap1 deletion prevented the morphological assembly of a two‐cell layer with a lumen from an asymmetrical single‐layered ductal plate. Surprisingly, KO mice survive long‐term with normalization of serum liver enzymes despite persistent cholestatic injury, suggesting hepatocyte adaptation to injury. While a recent study of Notch‐deficient livers (a model of Alagille syndrome) described complete de novo hepatocyte‐derived generation of bile ducts by 4 months of age, Yap1‐deficient livers fail to regenerate bile ducts by 8 months of age. Liver tissue clearing and 3D whole liver immunofluorescence imaging showed severely abbreviated biliary tree in KO mice relative to WT. Notably, we observe the appearance of a ductular reaction in the hilar region of the liver consisting of Yap1‐positive ducts surrounded by fibrosis and inflammation. Although all hepatocytes remain Yap1‐negative, the extrahepatic biliary tree remains unaffected by the Cre and is Yap1‐positive, suggesting a potential source of Yap1‐positive ductular cells.ConclusionsOur results demonstrate that Yap1 is dispensable for early development of the liver and foregut but is critical for biliary morphogenesis. We further show absence of hepatocyte‐to‐cholangiocyte transdifferentiation in Yap1 KO. Thus, Yap1 is essential for biliary morphogenesis regardless of the cellular origin, whether from hepatoblasts in development or from hepatocytes in liver regeneration.Support or Funding InformationThis work was supported by NIH grants 1R01DK62277, 1R01DK100287, 1R01DK116993 and Endowed Chair for Experimental Pathology to S.P.M, 1P30DK120531‐01 to the Pittsburgh Liver Research Center, and T32EB0010216 to LM.

Dynamic causal modeling of hippocampal activity measured via mesoscopic voltage-sensitive dye imaging

The aim of this paper is to present a dynamic causal modeling (DCM) framework for hippocampal activity measured via voltage-sensitive dye imaging (VSDI). We propose a DCM model of the hippocampus that summarizes interactions between the hilus, CA3 and CA1 regions. The activity of each region is governed via a neuronal mass model with two inhibitory and one/two excitatory neuronal populations, which can be linked to measurement VSDI by scaling neuronal activity. To optimize the model structure for the hippocampus, we propose two Bayesian schemes: Bayesian hyperparameter optimization to estimate the unknown electrophysiological properties necessary for constructing a mesoscopic hippocampus model; and Bayesian model reduction to determine the parameterization of neural properties, and to test and include potential connections (morphologically inferred without direct evidence yet) in the model by evaluating group-level model evidence. The proposed method was applied to model spatiotemporal patterns of accumulative responses to consecutive stimuli in separate groups of wild-type mice and epileptic aristaless-related homeobox gene (Arx) conditional knock-out mutant mice (Arx−/+;Dlx5/6CRE−IRES-GFP) in order to identify group differences in the effective connectivity within the hippocampus. The causal role of each group-differing connectivity in generating mutant-like responses was further tested. The group-level analysis identified altered intra- and inter-regional effective connectivity, some of which are crucial for explaining mutant-like responses. The modelling results for the hippocampal activity suggest the plausibility of the proposed mesoscopic hippocampus model and the usefulness of utilizing the Bayesian framework for model construction in the mesoscale modeling of neural interactions using DCM.

Seizure-induced neuroinflammation contributes to ectopic neurogenesis and aggressive behavior in pilocarpine-induced status epilepticus mice

Epilepsy is a chronic neurological disorder often associated with recurrent seizures. A growing body of evidence suggests that seizures cause structural and functional alterations of the brain. It is reported that behavioral abnormalities frequently occur in patients with epilepsy and experimental epilepsy models. However, the precise pathological mechanisms associated with these epilepsy comorbidities remain largely unknown. Neurogenesis persists throughout life in the hippocampal dentate gyrus (DG) to maintain proper brain function. However, aberrant neurogenesis usually generates abnormal neural circuits and consequently causes neuronal dysfunction. Neuroinflammatory responses are well known to affect neurogenesis and lead to aberrant reorganization of neural networks in the hippocampal DG. Here, in this study, we observed a significant increase in neuroinflammation and in the proliferation and survival of newborn granular cells in the hippocampus of pilocarpine-induced status epilepticus (SE) mice. More importantly, these proliferating and surviving newborn granular cells are largely ectopically located in the hippocampal DG hilus region. Our behavior test demonstrated that SE mice displayed severe aggressive behavior. Pharmacological inhibition of neuroinflammation, however, suppressed the ectopic neurogenesis and countered the enhanced aggressive behavior in SE mice, indicating that seizure-induced neuroinflammation may contribute to ectopic neurogenesis and aggressive behavior in SE mice. These findings establish a key role for neuroinflammation in seizure-induced aberrant neurogenesis and aggressive behavior. Suppressing neuroinflammation in the epileptic brain may reduce ectopic neurogenesis and effectively block the pathophysiological process that leads to aggressive behavior in TLE mice.

Topographic distribution of first landing sites of lymphatic metastases from patients with renal cancer

Adjuvant studies with checkpoint inhibitors have attracted new interest in accurate pathological lymph node (LN) staging in renal cell carcinoma. Sentinel lymph node (SN) studies in cN0 patients revealed the pattern of lymphatic radiotracer drainage from renal tumors. The aim of this study was to describe the location of single- or oligometastatic LN and analyze if the topography of these first landing sites matches the drainage pattern observed in SN studies of renal tumors. We collected data from 8 referral centers from 1990 to 2018 of all patients with pT1-4 cN0 or cN1 M0 renal cell carcinoma with pathologically confirmed single- or oligometastases in locoregional LN. The location of LN metastases, number, size of metastatic LN, and survival were analyzed using descriptive statistics with SPSS version 22 (IBM, Chicago, IL). From 3,794 patients with histologically confirmed pN1, a total of 76 patients (2%) with single- or oligometastatic pN1 were identified, of whom 24 (31.6%) and 52 (68.4%) were cN0 and cN1, respectively. On the left side, LN metastases were predominantly located in the para-aortal (48.0%; 95% confidence interval [CI] 29.22-63.12%) and hilar (31.42%; 95% CI 17.4-49.4%) area. On the right side, metastases located in retrocaval (26.82%; 95% CI 14.7-43.2%), hilar (26.82%; 95% CI 14.7-43.2%), interaortocaval (26.82%; 95% CI 14.7-43.2%), and paracaval (17.07%; 95% CI 7.6-32.6%) LNs. These landing sites exactly matched the lymphatic drainage pattern of intratumorally injected radiotracer reported in SN studies for both sides. Single- or oligometastatic LNs in renal cancer are mainly located in the hilar, retro-, para, and interaortocaval region on the right side and para-aortal region on the left side. These first landing sites match the drainage pattern reported in SN trials.

Dentate Gyrus Proliferative Responses After Traumatic Brain Injury and Binge Alcohol in Adult Rats.

Background:Traumatic brain injury is a significant public health issue that results in serious disability in survivors. Traumatic brain injury patients are often intoxicated with alcohol when admitted to the hospital; however, it is not clear how acute intoxication affects recovery from a traumatic brain injury. Our group has previously shown that binge alcohol prior to traumatic brain injury resulted in long-term impairment in a fine sensorimotor task that was correlated with a decreased proliferative and neuroblast response from the subventricular zone. However, whether binge alcohol prior to traumatic brain injury affects the proliferative response in the hippocampal dentate gyrus is not yet known.Methods:Male rats underwent binge alcohol (3 g/kg/day) by gastric gavage for 3 days prior to traumatic brain injury. Cell proliferation was labeled by BrdU injections following traumatic brain injury. Stereological quantification and immunofluorescence confocal analysis of BrdU+ cells in the hippocampal dorsal dentate gyrus was performed at 24 hours, 1 week and 6 weeks post traumatic brain injury.Results:We found that either traumatic brain injury alone or binge alcohol alone significantly increased dentate gyrus proliferation at 24 hours and 1 week. However, a combined binge alcohol and traumatic brain injury regimen resulted in decreased dentate gyrus proliferation at 24 hours post-traumatic brain injury. At the 6 week time point, binge alcohol overall reduced the number of BrdU+ cells. Furthermore, more BrdU+ cells were found in the dentate hilar region of alcohol traumatic brain injury compared to vehicle traumatic brain injury groups. The location and double-labeling of these mismigrated BrdU+ cells was consistent with hilar ectopic granule cells.Conclusion:The results from this study showed that pre-traumatic brain injury binge alcohol impacts the injury-induced proliferative response in the dentate gyrus in the short-term and may affect the distribution of newly generated cells in the dentate gyrus in the long-term.

Unidentical Double Trouble- A Rare Case Report

Collision tumours are relatively rare entities and are thus, not well recognised. Collision tumour can be defined as two coexisting but histologically different malignancies involving the same organ or adjacent organ with an equivocal intermediate transitional zone between them. Collision tumours of the lung and oesophagus are very rare. Such cases are diagnosed by Computerised Tomogram (CT) Scan or Chest X-Ray for complaint of dysphagia. Definitive diagnosis is made by tissue biopsy. Here, a 66-year-old male is admitted for evaluation of an anterior mediastinal mass. Radiology revealed an anterior mediastinal mass extending in to the left hilar region and upper lobe of right lung anteriorly and in to the lower end of oesophagus posteriorly. Biopsy was performed. Microscopically, transbronchial biopsy revealed a cellular lesion, composed of round-to-oval cells with streaming nucleus, positive for Immunohistochemistry (IHC) markers, CD-56 and Synaptophysin pertaining to a diagnosis of small cell carcinoma. Biopsy of the oesophageal growth shows nest of dysplastic squamous epithelium which infiltrates into underlying muscularis propria showing features of a squamous cell carcinoma. Multiple fragments of squamous epithelium are also seen with necrotic tissue in vicinity and acute inflammatory exudate. Few cells show multinucleation, molding and margination of chromatin, showing the characteristic morphological features of Herpes oesophagitis. The patient was administered platinum-based Chemotherpy.

Ultrasound-guided percutaneous microwave ablation of hepatocellular carcinoma in challenging locations: oncologic outcomes and advanced assistive technology

Purpose To assess the oncologic outcomes of the hepatocellular carcinoma (HCC) patients in challenging locations (CLs) underwent ultrasound-guided percutaneous microwave ablation (US-PMWA) and the efficacy and safety of the advanced assistive technology (AAT). Materials and methods Data for 489 treatment-naïve patients with HCC who met Milan criteria and subsequently underwent US-PMWA were reviewed from March 2012 to November 2016. According to the distance (<5 mm) between the tumor and surrounding structures, the patients were divided into two groups: a CL group and a non-CL group. Regarding MWA assisted by AAT, the CL group was further subdivided into two groups: an AAT group and a non-AAT group. Technique effectiveness, complications and survival outcomes (i.e., overall survival [OS] and recurrence-free survival [RFS]) were compared between CL and non-CL groups. Local tumor progression (LTP) was compared between AAT and non-AAT groups. Results Technique effectiveness and complications in the CL group were similar to those in the non-CL group (p = .873 and p = .828, respectively). The OS and RFS in six types of CL groups were comparable with those in non-CL group (p = .131–.117) including adjacent vital structures, gallbladder, hepatic hilar regions, major vessels, diaphragm and capsule, respectively. The LTP rates in the AAT group were significantly higher than those in the non-AAT group (p = .001). Conclusions US-PMWA assisted by AAT to treat HCC lesions in CLs was safe and effective; also, this technique had comparable success and survival outcomes with those of patients in non-CL.

Definitive pneumonectomy for advanced lung cancer at hilar region through intrapericardial cavity

Definitive pneumonectomy for advanced lung cancer at hilar region through intrapericardial cavity