Lateral Lesions Research Articles

Cognitive, academic, executive and psychological functioning in children with spastic motor type cerebral palsy: Influence of extent, location, and laterality of brain lesions.

To investigate, in spastic motor-type cerebral palsy, the association between 1) the location and extent of brain lesions and numerous psychological outcomes; 2) the laterality of brain lesions and performance of verbal-related cognitive functions. The semi-quantitative scale for MRI (sqMRI) was scored for 101 children with cerebral palsy. Non-verbal and verbal proxy intelligence quotients (IQ), word reading, spelling, numerical operations skills, executive functioning, and psychological adjustment were assessed. Relationships between global and regional sqMRI scores and clinical scores were examined. The best multivariable linear regression model for each outcome was identified using the Bayesian Information Criteria. Regional sqMRI scores, gross motor functioning, manual ability, and epilepsy status were considered for inclusion as covariables. Where sqMRI scores made statistically significant contributions to models of verbal-related functioning, data were reanalysed including these sqMRI scores' laterality index. Verbal-related outcomes were compared between participants with left-sided versus bilateral brain lesions. Medial dorsal thalamus and parietal lobe lesions significantly accounted for poorer verbal proxy-IQ. Left-hemisphere lateralization of temporal lobe lesions was associated with poorer verbal proxy-IQ. Participants with bilateral lesions performed significantly better than those with unilateral left-sided lesions in verbal cognitive functions. Controlling for epilepsy diagnosis, participants with ventral posterior lateral thalamus lesions presented with better Behaviour Rating Inventory of Executive Function scores, although within the normal range. sqMRI scores were not significantly associated with some psychological outcomes or these only bordered on significance after accounting for relevant control variables. The laterality of early-life lesions influences the development of verbal-related cognitive functions.

Differential Effects of the Lateral Hypothalamus Lesion as an Origin of Orexin and Blockade of Orexin-1 Receptor in the Orbitofrontal Cortex and Anterior Cingulate Cortex on Their Neuronal Activity.

Introduction: Several studies have demonstrated that orexins may regulate different forms of affective and cognitive processes during wakefulness. The Orbitofrontal Cortex (OFC) and Anterior Cingulate Cortex (ACC), as an essential part of the Prefrontal Cortex (PFC), have a crucial role in cognitive processes such as reward and decision-making. They also have a high amount of orexin receptor type 1 (OX1Rs). In the present study, we inhibited OX1Rs in this area after a 10-min baseline recording to find out the role of OX1Rs in the OFC neuron's firing rate. Next, we inhibited the lateral hypothalamus (LH) as the primary source of orexinergic neurons. Afterward, using a single-unit recording technique in rats, we detected the effects of the lateral hypothalamus on the firing rate and activity pattern of the ACC or OFC neurons. Data showed that the blockade of OX1Rs in the OFC could excite 8 and inhibit 1 neuron(s) out of 11. In addition, the blockade of OX1Rs in the ACC could excite 6 and inhibit 3 neurons out of 10. LH inactivation excited 5 out of 12 neurons and inhibited 6 in the ACC. It also excited 8 and inhibited 6 neurons out of 14 in the OFC. These data suggest that the blockade of OX1Rs excites 72% of the neurons, but LH inactivation had a stimulating effect on only 50% of neurons in two main subregions of the PFC. Accordingly, PFC neurons may receive the orexinergic inputs from the LH and indirectly from other sources. Blockade of orexin receptors 1 in ACC alter neural activity in this region.Blockade of orexin receptors 1 in OFC alter neural activity in this region.Lateral hypothalamus inhibition increase neural activity of only 50% neurons in ACC and OFC. The discovery of the neuropeptide orexin/hypocretin in 1998 and subsequent research during the past 20 years revealed an important role for the lateral hypothalamus (LH) in driving the reward pathway, sleep and awake circuits, decision making and psychotic disorders. But our knowledge towards the function of this neurotransmitter on neural activity in specific areas of the brain is limited. In this study we decided to clear the specific role of orexin receptors placed in the two crucial areas of medial prefrontal cortex (mPFC) and the orexin projections from LH on neural firing rates in those regions. In the present study, we investigated the following items by using an in vivo extracellular single-unit recording technique in rats and our data shown that the effect of blocking of orexin receptors1 in mPFC caused a different results than inhibition of the origin of orexin projection in LH as a source of it.

Gender Differences May Exist in the Presentation, Mechanism of Injury and Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Bone marrow stimulation (BMS) is indicated for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between men and women, there is scant evidence examining whether these differences affect surgical outcomes. The purpose of this study was to compare the outcomes in men and women following BMS for OLTs. A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue score. Thirty-one females and 38 males were included. In female patients, the mean FAOS pain score improved from 60 ± 16 preoperatively to 84 ± 8.9 at 1- to 2-year follow-up (p < .01), and then decreased to 80±13 at final follow-up at 3-4 years. In male patients, the mean FAOS pain score improved from 65±17 preoperatively to 83±9.2 at 1-2 year follow-up (p < .01), and then decreased to 76±14.6 at final follow-up at 3-4 years. Lateral lesions were more common in male patients. Medial lesions were more common in female patients. The outcomes following BMS in both female and male patients were good with no significant differences at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1 to 2 years postsurgery, implying a possibly faster decline than in female patients.

Impaction Bone Grafting Augmented With a Wire Coil by the Lightbulb Technique for Osteonecrosis of the Femoral Head

BackgroundOsteonecrosis of the femoral head (ONFH) is a debilitating disease that primarily affects the hips of young adults. The purpose of this study is to report the mid-term results of impaction bone grafting augmented with a wire coil using the lightbulb technique for ONFH. MethodsFrom 1998 to 2016, 50 hips with late precollapsed or early postcollapsed ONFH (28 hips with Association Research Circulation Osseous [ARCO] IIC and 22 with IIIA) were treated by impaction bone grafting augmented with a wire coil using the lightbulb technique. The survival rate was analyzed with conversion to total hip arthroplasty (THA) as the end point. ResultsThirty-one of the 50 hips had a successful clinical result without conversion to THA at a mean follow-up of 109.2 months. The 5-year survival rate was 68%, 82.1%, and 50% for the entire cohort, ARCO stage IIC, and ARCO stage IIIA, respectively. The 19 hips that had failed were converted to THA at an average of 52.8 months. The multivariable Cox proportional hazards model showed that an ARCO stage IIIA disease, a lateral lesion, and a necrotic index ≥0.67 were the independent risk factors for conversion to THA. ConclusionAs a head-preserving procedure, the lightbulb technique using impaction bone grafting augmented with a wire coil is worthwhile for patients in an earlier stage of disease and smaller lesion size to postpone the need for THA.

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Strengths and Weaknesses of an Artificial Intelligence Polyp Detection Program as Assessed by a High-Detecting Endoscopist

Meniscal anterior and posterior horn heights are associated with MRI-defined knee structural abnormalities in middle-aged and elderly patients with symptomatic knee osteoarthritis

BackgroundMeniscal morphological changes are associated with knee OA. However, the correlation of meniscal height and OA-related knee structural abnormalities is still not well understood. The purpose of present study is to investigate whether and how meniscal anterior and posterior horn heights are associated with structural abnormalities in knees with symptomatic OA.MethodsOur sample consisted of 106 patients (61 female, aged 40–73 years) with symptomatic knee OA. Kellgren-Lawrence system was used for radiographic evaluation. On sagittal sequence, medial meniscal posterior horn height (MPH), lateral meniscal anterior horn height (LAH) and lateral meniscal posterior horn height (LPH) were measured on the middle slice through the medial/lateral compartment. Knee structural abnormalities were assessed using the modified whole-organ magnetic resonance imaging score (WORMS). Associations between meniscal anterior and posterior horn heights and knee structural abnormalities were assessed using linear regression analysis.ResultsHigher MPH was significantly associated with higher WORMS score for medial meniscal anterior horn lesion (P = 0.016) but did not have a statistical association with other WORMS parameters. Increased LAH was statistically correlated with decreased WORMS scores for lateral compartmental cartilage lesions (P = 0.001–0.004) and lateral compartmental bone marrow edema patterns (BMEPs) (P = 0.021–0.027). Moreover, LPH was negatively associated with WORMS scores for lateral compartmental cartilage lesions (P = 0.007–0.041) and lateral compartmental BMEPs (P = 0.022–0.044). Additionally, higher MPH was statistically associated with lower trochlea cartilage WORMS score and higher LAH was significantly correlated with higher WORMS score for trochlea subarticular cysts.ConclusionsChanges of LAH and LPH were inversely associated with the severity of lateral compartmental cartilage lesions and BMEPs, while higher MPH was only significantly correlated with more severe medial meniscal anterior horn lesions. Besides, MPH and LAH were also significantly associated with patellofemoral structural abnormalities. The present study provided novel information for understanding the role of meniscal morphological changes in knee OA, which would be helpful in identifying and evaluating knees with or at risks for OA.

Proximal humeral bone defect in reverse shoulder arthroplasty combined with latissimus-dorsi transfer is not related with a poor outcome

BackgroundReverse total shoulder arthroplasty (RSA) associated with modified L’Episcopo (isolated LD) or L’Episcopo (combined TM and LD) procedures had been confirmed to effectively overcome the expected external rotation deficit in patient with postero-superior massive cuff tear and teres minor deficiency. The objective of this study was to evaluate the radiological bony lesions of the lateral proximal humerus following RSA combined with tendon transfer, and to determine whether these bony lesions affect the clinical outcome. Material and methodsA retrospective review of 24 RSAs (mean age 68.71 years, range 52–83) associated with modified L’Episcopo procedure (9) and L’Episcopo procedure (15) was performed. X-rays were assessed for lateral cortex lesions and were categorized into either intact, irregular or complete lytic appearances. In addition, signs of stem loosening were assessed. Clinical outcome measures included range of motion, SSV, VAS, and Constant-Murley scores. ResultsWith a mean follow-up of 44.71 months (12–97; SD 27.42), eight (33.3%) patients demonstrated intact lateral cortex, eight (33.3%) irregular and eight (33.3%) lytic lesions. 40% of cemented stems demonstrated a deformed cortex compared to 74% of cementless stems. Radiolucent lines were detected in one cemented stem (p=0.046). GT resorption (p=0.147), condensations lines (p=0.449) and spot weld (p=0.342), appeared exclusively in non-cemented stem. Postoperatively all patients (24) demonstrated significant improvements in all clinical and functional parameters. A comparison between patient with (Group 2, 16 patients) and without bony lesions (Group 1, 8 patients) revealed no significant differences in functional scores and range of motion: Constant (p=0,61), VAS (p=0,61), SSV (p=0,66) and external rotation (p=0,34). ConclusionAt short-term follow-up, RSA combined with L’Episcopo or modified l’Episcopo procedure resulted in high incidence (67%) of lateral proximal humerus lesions. Radiolucent lines were noted in cemented stems whereas, signs of stress shielding and GT resorption appeared in non-cemented stems. Yet, no case of humeral loosening was detected and these lesions did not seem to affect the clinical outcome. The use of cemented straight standard-length humeral stems should be positively considered in RSA associated with LD\\TM tendon transfer. Level of evidenceIV; retrospective study.

Consequences of Progressive Full-Thickness Focal Chondral Defects Involving the Medial and Lateral Femoral Condyles After Meniscectomy: A Biomechanical Study Using a Goat Model.

Background:Full-thickness chondral defects alter tibiofemoral joint homeostasis and, if left untreated, have the potential to progress to osteoarthritis.Purpose:To assess the effects of isolated and dual full-thickness chondral defect size and location on the biomechanical properties of the lateral femoral condyle (LFC) and medial femoral condyle (MFC) during dynamic knee flexion in goat knees without menisci.Methods:In 12 goat knees, we created progressively increasing full-thickness circular chondral defects (3-, 5-, and 7.5-mm diameter) in the weightbearing contact area of flexion and extension in the MFC, the LFC, or both. Each knee was fixed into a custom steel frame and attached to a motor with sensors inserted intra-articularly. For each testing condition, the knee was loaded to 100 N and underwent a dynamic range of motion between 90° of flexion and 30° of extension. The following parameters were collected: contact area, contact pressure, contact force, peak area, and peak pressure.Study Design:Controlled laboratory study.Results:The peak pressure at the defect rim of the MFC at full extension increased by 51.51% from no defect (1.887 MPa) to a 7.5-mm defect (2.859 MPa) (P < .001), and the peak pressure at the defect rim of the LFC at full extension increased by 139.14% from no defect (1.704 MPa) to a 7.5-mm defect (4.075 MPa) (P < .001). The peak pressures for LFC defects at all 3 diameters were significantly greater when compared with dual defects consisting of increasing LFC defect diameter and constant MFC defect diameter (P < .001 for all).Conclusion:Extremely large increases in peak pressure were seen at the rim of articular cartilage defects when evaluated under dynamic loading conditions. Isolated LFC defects experienced a greater increase in defect rim stress concentrations when compared with isolated MFC defects for equivalent increases in defect size. Defect size played a significant role independent of location for peak pressures on the MFC and LFC.Clinical Relevance:Significant rim-loading effects increase with defect size under dynamic loading and may result in increasingly rapid progression of articular cartilage lesions. Within the context of this goat model, findings suggest that lateral compartment chondral lesions are more likely to progress than medial compartment lesions of equivalent size.

Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains: Multivariate Analysis of Clinical Efficacy and Optical Coherence Tomography Appearance.

BackgroundHemoporfin-mediated photodynamic therapy (HMME-PDT) is reported to be effective and safe for port-wine stains (PWS). However, its efficacy is influenced by several factors and there is no appropriate method to evaluate efficacy so far. Therefore, this study explored the clinical efficacy of HMME-PDT for PWS on the face and neck and the feasibility of evaluating treatment potency with optical coherence tomography (OCT).MethodsA total of 211 PWS patients subjected to HMME-PDT were recruited for study and correlations of therapeutic effect with treatment sessions, age, gender, lesion distribution and treatment history analyzed. OCT was utilized for quantitative analysis of PWS lesions of 36 selected patients before and after HMME-PDT.ResultsThe efficacy of two consecutive treatments was significantly higher than that of single treatment (P < 0.05). In multivariate analysis, after the first treatment, age, lesion distribution and treatment history were correlative factors affecting treatment efficacy (P < 0.05). The improvement effect on central facial lesions was lower than that on lateral facial lesions (P < 0.05). The efficacy of therapy on the group with no history of pulsed dye laser (PDL) treatment was greater than that on effective and ineffective treatment groups (P < 0.05). After the second session, age remained the only factor correlated with efficacy (P < 0.05). Dilated vessel diameter and depth before and after treatment were significantly different (P < 0.05). With increasing treatment times, age was the most significant factor influencing treatment efficacy.ConclusionsOur collective findings indicate that HMME-PDT therapy is effective and safe for PWS and support the utility of OCT in objective assessment of the efficacy of HMME-PDT.

Lateral entorhinal cortex lesions impair odor-context associative memory in male rats.

Lateral entorhinal cortex (LEC) has been hypothesized to process nonspatial, item information that is combined with spatial information from medial entorhinal cortex to form episodic memories within the hippocampus. Recent studies, however, have demonstrated that LEC has a role in integrating features of episodic memory prior to the hippocampus. While the precise role of LEC is still unclear, anatomical studies show that LEC is ideally placed to be a hub integrating multisensory information. The current study tests whether the role of LEC in integrating information extends to long‐term multimodal item‐context associations. In Experiment 1, male rats were trained on a context‐dependent odor discrimination task, where two different contexts served as the cue to the correct odor. Rats were pretrained on the task and then received either bilateral excitotoxic LEC or sham lesions. Following surgery, rats were tested on the previously learned odor‐context associations. Control rats showed good memory for the previously learned association but rats with LEC lesions showed significantly impaired performance relative to both their own presurgery performance and to control rats. Experiment 2 went on to test whether impairments in Experiment 1 were the result of LEC lesions impairing either odor or context memory retention alone. Male rats were trained on simple odor and context discrimination tasks that did not require integration of features to solve. Following surgery, both LEC and control rats showed good memory for previously learned odors and contexts. These data show that LEC is critical for long‐term odor‐context associative memory.

Lateral Skull Base Lesions: Our Experience of 15 Years.

To analyse and report various aspects of lateral skull base surgery by describing the incidence and demographic variables, diagnostic and management challenges, surgical choices along with complications and their management and the long term morbidity and survival outcomes in our experience of 15years. Retrospective review of complete records of all cases operated for lateral skull base tumors at a tertiary care teaching institution in India between timespan of 15years from 2003 to 2018 was undertaken. 53 cases were selected and analysed. Those having follow up of less than 6months were excluded. Outcomes were assessed in terms of incidence of types of tumors, benign or malignant, age and sex variation of the patients, staging status at presentation, status of facial and other lower cranial nerves pre-operatively, surgical techniques with complications if any, recurrences and survival. Of 35 benign tumors, tympanojugular paragangliomas were most common. Average age for these was 53years with 19 females and 14 males. All were non-functional. Tinnitus and hearing loss were most common presentations. Class B2 and C1 tumors were most commonly encountered and the ITF A approach was most commonly used. Hearing loss and Facial palsy were commonest complication post-operatively. There were 2 recurrences. 18 malignancies were observed. Most were stage IV at presentation. Otorrhea and otalgia were most common presenting symptoms followed by hearing loss. 5year survival was 55%. Successful treatment of lateral skull base lesions requires a multimodality therapy with team approach. Surgical resection is the primary management choice with variable approaches. ICA status related to the tumor is the most important consideration. Malignancies require more aggressive treatment for obtaining clear margins along with pre/post-op chemoradiation. Good results with acceptable complications can be obtained even with advanced tumors.

A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms.

Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs).Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use.Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P < 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P < 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P > 0.05).Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.

Gender May Affect Mid-Term Outcomes Following Bone Marrow Stimulation for Osteochondral Lesions of the Talus

Category:AnkleIntroduction/Purpose:Bone marrow stimulation (BMS) is typically indicated as a surgical intervention for patients who have symptomatic osteochondral lesions of the talus (OLT). Despite differences in ankle biomechanics and cartilage morphology between male and female patients, there is scant evidence examining whether these differences affect outcomes following BMS. The purpose of this study was to compare the outcomes in female and male patients following BMS in the treatment of OLTs.Methods:A retrospective analysis comparing female and male patients treated with BMS for OLT between 2007 and 2015 was performed. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score.Results:Thirty-one females and 38 males were included in this study. The mean patient age was 39.6+-16.9 for females and 36.5+-14.5 years for males. There was no significant difference in age, lesion size, follow-up time, and a number of concomitant procedures. Lateral lesions occurred more frequently in male patients (p=0.034). In female patients, the mean FAOS pain score improved from 60.2 +- 15.5 preoperatively to 84.0 +- 8.9 at 1-2 year follow-up (p<0.001), and then decreased to 80.0 +- 13.1 at final follow-up at 3-4 years, which was not statistically significant (p=0.191). In male patients, the mean FAOS pain score improved from 64.7 +- 17.0 preoperatively to 83.1 +- 9.2 at 1-2 year follow-up (p<0.001), and then decreased to 76.0 +- 14.6 at final follow- up at 3-4 years (p=0.023). The mean MOCART scores were 59.3 +- 24.0 in female patients and 67.3 +- 23.6 in male patients (p=0.278).Conclusion:Lateral lesions were more common in male patients possibly indicating an acute traumatic etiology. Medial lesions were more common in female patients indicating potentially a chronic pathology. This may have implications in reducing the incidence of OLT in female patients. The outcomes following BMS in both female and male patients were good with no significant differences in FAOS pain score and MOCART score at short-term follow-up. FAOS scores in male patients were more likely to decrease after 1-2 years post-surgery, implying a possibly faster decline than in female patients.

MORPHOLOGICAL ANALYSIS OF 3D MR IMAGES OF PF JOINTS IN ASYMPTOMATIC SUBJECTS

Understanding the pathogenesis of patellofemoral osteoarthritis (PFOA) will be enhanced by elucidating the onset and progression in asymptomatic PFOA. Demonstrating of the cartilage defect of 3D MR images, obtained from a cohort population, in order from the smallest to the largest, can mimic the morphological progression process of PFOA. The purpose of this study was to clarify the frequency, classification, and morphological progression process of PFOA by observing MRI 3D images in a cohort population of subjects without a history of visiting hospitals for knee disease. The subjects were 561 at 30–79 years old who were registered in the Kanagawa Knee Study. The main exclusion criteria were those who have a past history of consecutive visits to the hospital for more than 3 months for knee symptoms. We obtained 3D MR images of the PF joints using 3D image analysis system volume analyzer (SYNAPSE 3D, Fujifilm Corporation, Tokyo). The cartilage defects were classified as medial and lateral type. MR images of the PF joints were displayed with cartilage area ratios of the patella and presented in order of highest to lowest, separated into the medial and lateral type. Of the 561 subjects, cartilage defects were detected on 3D images of the patella in 37 subjects (6.6%). Medial lesion was detected in 26 subjects (4.6%) and lateral lesion in 11 subjects (2.0%), showing that medial lesion was significantly more frequent (p=0.01). For the medial type, the patellar cartilage defect was located in the center of the medial facet, expanded to the surrounding area, and further distally and medially. 3D MR images of the patellofemoral joint showed the cartilage defect of the patella expanded along with the medial ridge of the femoral trochlea. For the lateral type, the patellar cartilage defect was located in the center of the lateral facet, expanded to the surrounding area, and further distally and laterally. 3D MR images of the patellofemoral joint showed the cartilage defect of the patella expanded along with the lateral ridge of the femoral trochlea (Fig. 1). According to 3D MR images, the frequency of the patella cartilage defect was 6.6% in 561 asymptomatic subjects. Patellar cartilage defects occurred more frequently on the medial facet than on the lateral facet. The patellar cartilage defect occurred at the center of each facet and expanded along with each side of the ridge of the femoral trochlea. Fujifilm Corporation and Japan Society for the Promotion of Science Grant JP22K09349 I Sekiya received a research grant from Fujifilm Corporation including lending of the analysis software used in this study. Kimiko Takanashi is to be thanked for technical assistance. CORRESPONDENCE ADDRESS: sekiya.arm@tmd.ac.jp

A Case of Thyroid Cancer Diagnosed After Resection of Lateral Cystic Lesion

A Case of Thyroid Cancer Diagnosed After Resection of Lateral Cystic Lesion

Serrated polyp detection rate in colonoscopies performed by gastrointestinal fellows.

Clinically significant serrated polyp detection rate (CSSDR) and proximal serrated polyp detection rate (PSDR) have been suggested as the potential quality benchmarks for colonoscopy (CSSDR = 7% and PSDR = 11%) in comparison to the established benchmark adenoma detection rate (ADR). Another emerging milestone is the detection rate of lateral spreading lesions (LSLs). This study aimed to evaluate CSSDR, PSDR, ADR, and LSL detection rates among gastrointestinal (GI) fellows performing a colonoscopy. A secondary aim was to evaluate patient factors associated with the detection rates of these lesions. A retrospective review of 799 colonoscopy reports was performed. GI fellow details, demographic data, and pathology found on colonoscopy were collected. Multiple logistic regression analysis was performed to identify the factors associated with CSSDR, PSDR, ADR, and LSL detection rates. A p value < 0.05 was considered statistically significant. For our patient population, the median age was 58 years; 396 (49.8%) were male and 386 (48.6%) were African American. The 15 GI fellows ranged from first (F1), second (F2), or third (F3) year of training. We found an overall CSSDR of 4.4%, PSDR of 10.5%, ADR of 42.1%, and LSL detection rate of 3.2%. Female gender was associated with CSSDR, while only age was associated with PSDR. GI fellow level of training was associated with LSL detection rate, with the odds of detecting them expected to be four times higher in F2/F3s than F1s. Although GI fellows demonstrated an above-recommended ADR and nearly reached target PSDR, they failed to achieve target CSSDR. Future studies investigating a benchmark for LSL detection rate are needed to quantify if GI fellows are detecting these lesions at adequate rates.

Babinski-Nageotte Syndrome: Case Report of a rare variant of Lateral Medullary Infarction

Babinski-Nageotte Syndrome (BNS) is a rare variant of lateral medullary infarction, and only a few cases have been reported. In this case, a 52-year-old African-American gentleman presented with acute onset weakness on the left side of the body. On examination, there was a palpable right supraclavicular lymph node. Neurological examination showed right-sided gaze-evoked nystagmus and left hemiparesis with grade 3/5 power. Reflexes were normal except for extensor plantar responses on the left. MRI showed a subacute right-sided lateral brainstem infarct just below the pontomedullary junction with minimal progression in a repeat MRI after 24 hours. Workup for supraclavicular adenopathy with CT chest and CT abdomen and pelvis revealed neither neoplastic nor metastatic disease. Biopsy of supraclavicular lymph node was planned as an outpatient but was deferred as it was presumed to be reactive. He was conservatively managed with daily physiotherapy, aspirin, atorvastatin, and optimal blood pressure control. Babinski-Nageotte syndrome includes all symptoms of the Wallenberg syndrome with contralateral hemiparesis due to a spread of the lateral lesion to the pyramidal tract. Atherosclerotic occlusion and lipohyalinosis of the vertebral artery and posterior inferior cerebellar artery have been identified as the most common causes.

Differential Effects of Lateral and Medial Entorhinal Cortex Lesions on Trace, Delay and Contextual Fear Memories.

The entorhinal cortex (EC), with connections to the hippocampus, amygdala, and neocortex, is a critical, yet still underexplored, contributor to fear memory. Previous research suggests possible heterogeneity of function among its lateral (LEC) and medial (MEC) subregions. However, it is not well established what unique roles these subregions serve as the literature has shown mixed results depending on target of manipulation and type of conditioning used. Few studies have manipulated both the LEC and MEC within the same experiment. The present experiment systematically manipulated LEC and MEC function to examine their potential roles in fear memory expression. Long-Evans rats were trained using either trace or delay fear conditioning. The following day, rats received an N-methyl-D-aspartate (NMDA)-induced lesion to the LEC or MEC or received a sham surgery. Following recovery, rats were given an 8-min context test in the original context. The next day, rats were tested for tone freezing in a novel context with three discrete tone presentations. Further, rats were tested for hyperactivity in an open field under both dark and bright light gradient conditions. Results: Following either LEC or MEC lesion, freezing to context was significantly reduced in both trace and delay conditioned rats. LEC-lesioned rats consistently showed significantly less freezing following tone-offset (trace interval, or equivalent, and intertrial interval) in both trace and delay fear conditioned rats. Conclusions: These data suggest that the LEC may play a role in the expression of a conjunctive representation between the tone and context that mediates the maintenance of post-tone freezing.

Autologous osteochondral transplantation provides succesful recovery in patients with simultaneous medial and lateral talus osteochondral lesions.

The aim of this study was to evaluate the success of simultaneous medial and lateral autologous osteochondral transplantation (AOT) in patients with both medial and lateral osteochondral lesions of the talus (OLT) who could not be treated with bone marrow stimulation techniques or whose previous treatments failed. Five patients who underwent medial and lateral talus AOT in the same session due to simultaneous OLT on medial and lateral talar dome were included in this retrospective study. All the patients were male, and the mean age was 34.8 (range = 26 - 42) years. Double osteochondral grafts were placed separately to the medial and lateral talar dome at the same session. Location and size of the OLT, additional ligament injuries, and postoperative evaluation of the graft were evaluated through magnetic resonance images (MRIs). The criteria of Berndt and Harty, Single Assessment Numeric Evaluation (SANE), American Orthopedic Foot and Ankle Society Score (AOFAS), visual analogue scale (VAS) score, and Tegner Activity Score were assessed preoperatively and at the last follow-up. All patients had suffered an injury with inversion of the foot while daily or sports activity. Average duration of symptoms from onset to osteochondral grafting was 25.2 months. The mean follow-up time was 61 months. The radiological evaluation showed OLT with Stage 4 or 5, anterior talofibular ligament injury and deltoid ligament strain observed in all of the patients. With the numbers available, pre and post-operative comparisons showed a significant increase in patients' satisfaction rate and significant decrease in VAS scores as well as an increase in AOFAS scores with the numbers available. No complications were encountered. Simultaneous AOT for medial and lateral OLT appears to be a reliable surgical procedure with satisfactory clinical results. Level IV, Therapeutic Study.

Surgical treatment of sinonasal inverted papilloma.

To highlight how surgery of inverted papilloma has developed during the past year. Moreover, to give our own opinion on the state of research regarding inverted papilloma surgical management. Recent studies covering surgical treatment of inverted papilloma concentrated on the optimum surgical management aiming at complete resection, least morbidity and best outcome, with special interest regarding the maxillary and frontal sinuses. In maxillary sinus inverted papilloma, to avoid empty nose and/or epiphora, recent articles exerted all attempts to preserve the integrity of both the inferior turbinate and nasolacrimal duct, yet offer best exposure of all maxillary sinus walls specially the anterior and inferior ones. These included the new modifications of the prelacrimal and Denker approaches and lateral nasal wall transposition. In frontal sinus inverted papilloma, to avoid an external approach and insure postoperative patency of frontal sinus ostium, the periorbital suspension was introduced and orbital transposition approach was comprehensively utilized especially in far lateral located lesions and/or in supraorbital recess involvement. Associated malignancy is an important issue to identify as management plans significantly differ. Recurrence occurs early within the first 2 years but long-term follow-up is mandatory. Surgical procedures of sinonasal inverted papilloma are planned according to origin rather than the tumor extent. Origin targeted surgery and proper management of the site of attachment are the key to achieve complete surgical resection of sinonasal inverted papilloma. Recent trends advise the least destructive surgical techniques that offer best exposure, complete excision SNIP and least recurrence.