Predilection Sites Research Articles

Abnormal aortic hemodynamics at predilection sites for dissection in patients with Marfan Syndrome: a 4D flow study

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AMC Foundation Horstingstuit Foundation Introduction Patients with Marfan syndrome (MFS) may develop aneurysmatic dilatation and dissection of the aorta with a consequence of sudden death at relatively young age. We performed an aortic 4D flow MRI analysis, providing a comprehensive quantification and visualization of abnormal aortic velocity and wall shear stress (WSS) magnitude and direction with recently developed techniques (1,2). We hypothesize that abnormal hemodynamics are found at predilection sites for aortic dissection in MFS patients. Methods This prospective study included 56 MFS patients and 25 healthy subjects as controls. Aortic 4D flow MRI was performed on a 3T Philips Ingenia system (Best, Netherlands). The aorta was manually segmented on time-averaged phase contrast MR angiogram images (phase contrast images multiplied by absolute velocity) by thresholding, watershed, and manual voxel in-/exclusion. The segmentations were used to mask the velocities, calculate WSS, and co-registration for quantification of abnormal hemodynamics (3). Abnormally elevated velocity and WSS were defined as higher than the three-dimensional 95% confidence interval as determined in the control group. Abnormally directed velocity and WSS were defined as vector angle differences higher than 120°. The aorta was subdivided in six regions of interest (ROIs) for total multiple linear regression with age, aortic diameter, and blood pressure characteristics. Independent predictors were defined as characteristics that were significant in the total model. Significance was defined as p < 0.05 with Bonferonni correction. The 3D-maps with abnormal hemodynamics were co-registered and added to create 3D-maps that show the incidence of abnormal hemodynamics. Results Figure 1 shows examples of maps with abnormal velocity and WSS magnitude and direction respectively. Ascending elevated velocity was associated with age, aortic diameter and blood pressure characteristics, whereas elevated WSS was associated with blood pressure characteristics only. No independent predictors were found for abnormally directed hemodynamics. Figure 2 shows the incidence maps for abnormally elevated velocity and abnormally directed WSS in two patients. The maximum incidence for elevated velocity and WSS were 32% and 20%, respectively, and found in the ascending aorta. The maxima for abnormally directed velocity and WSS were 18% and 39%, respectively, and found in the inner proximal descending aorta. Conclusion Altered aortic geometry and wall properties in MFS patients cause detectable hemodynamic effects in 30% of our cohort at known predilection sites for aortic dissection in MFS patients: the ascending aorta and proximal descending aorta. Independent measures of altered hemodynamics could possibly indicate individual patients at risk for aortic dissection.

Warfarin Treatment Is Associated to Increased Internal Carotid Artery Calcification.

Background: Long-term treatment with the vitamin K antagonist warfarin is widely used for the prevention of venous thrombosis and thromboembolism. However, vitamin K antagonists may promote arterial calcification, a phenomenon that has been previously studied in coronary and peripheral arteries, but not in extracranial carotid arteries. In this observational cohort study, we investigated whether warfarin treatment is associated with calcification of atherosclerotic carotid arteries.Methods: Overall, 500 consecutive patients underwent carotid endarterectomy, 82 of whom had received long-term warfarin therapy. The extent of calcification was assessed with preoperative computed tomography angiography, and both macroscopic morphological grading and microscopic histological examination of each excised carotid plaque were performed after carotid endarterectomy.Results: Compared with non-users, warfarin users had significantly more computed tomography angiography-detectable vascular calcification in the common carotid arteries (odds ratio 2.64, 95% confidence interval 1.51–4.63, P < 0.001) and even more calcification in the internal carotid arteries near the bifurcation (odds ratio 18.27, 95% confidence interval 2.53–2323, P < 0.001). Histological analysis revealed that the intramural calcified area in plaques from warfarin users was significantly larger than in plaques from non-users (95% confidence interval 3.36–13.56, P = 0.0018).Conclusions: Long-lasting warfarin anticoagulation associated with increased calcification of carotid atherosclerotic plaques, particularly in locations known to be the predilection sites of stroke-causing plaques. The clinical significance of this novel finding warrants further investigations.

Find Me If You Can: First Clinical Experience Using the Novel CARTOFINDER Algorithm in a Routine Workflow for Atrial Fibrillation Ablation.

Aims: The CARTOFINDER module allows for simultaneous and automated detection of repetitive focal and rotational activations in patients with atrial arrhythmias. This study aimed to validate the CARTOFINDER algorithm for the detection of potential drivers for atrial fibrillation (AF) and to access their potential impact on individual arrhythmia substrates. Methods: Fifty consecutive patients underwent AF ablation for persistent AF (PERS), using a 3D-mapping system with the integrated CARTOFINDER module. Regions of interest (ROIs) were identified before and after ablation, and their spatial and temporal relationship was correlated with areas of fibrosis. Results: Procedural success was achieved in all patients and 42% received ablation beyond pulmonary vein isolation (PVI). AF termination was observed in 6 patients (12%). The mean procedure duration was 134 ± 29 min. ROIs were revealed in all patients (mean n = 77 ± 52) and there was no statistical evidence for a predilection site. There was no significant anatomical correlation between ROIs and bipolar low voltage. Remapping confirmed the elimination of ROIs in relation to the individual ablation site, a limited reproducibility of rotational ROIs and persistent focal activity over time in some anatomical segments. ROIs were not a predictor for AF recurrence during following ablation. Conclusions: CARTOFINDER mapping can be integrated into a routine workflow for AF ablation. ROIs could be discriminated in all patients and an ablation effect was observed in some patients, whereas persistent activity was found in certain anatomical segments, even after ablation. ROIs might be an additional ablation target when we are able to understand the individual substrate.

Recurrent Apocrine Hidrocystoma of Scalp

Sir, Hidrocystomas are rare benign cystic tumors of epidermal appendages (estimated incidence of one per thousand of submitted cutaneous biopsies) and traditionally classified into apocrine and eccrine types based on their classical histopathology and histogenesis.[12] In 1964, Mehregan first described apocrine hidrocystoma (apocrine cystadenoma) as a benign cystic adenomatous proliferation of the secretory coil of apocrine glands.[134] Postulated pathogenesis of apocrine hidrocystoma implies retention of sweat and subsequent dilation of sweat duct apparatus due to occlusion or blockage. Clinically, they appear as a solitary, cystic, well-circumscribed, dome-shaped reddish or blackish brown, nontender, skin-colored lesion measuring 3–15 mm usually between 30 and 70 years of age. Their most common site of predilection is head-and-neck region and their occurrence in the scalp is rarely reported.[15] Although usually appearing as solitary lesions, multiple apocrine hidrocystomas have rarely been described in association with Gorlin-Goltz and Schopf–Schulz–Passarge syndromes.[12] Excision biopsy and histopathology are essential for confirmation of the diagnosis. Herein, we report a rare case of recurrent apocrine hidrocystoma occurring on the scalp, an unusual site.[356] A 42-year-old female presented with a reddish-brown, nontender, well-circumscribed, gradually progressive mobile cystic swelling on the scalp measuring 3.0 cm × 2.5 cm for 6 months' duration. She gave a history of a similar lesion on the scalp about 5 years back which after surgical resection and histopathological examination was diagnosed to be apocrine hidrocystoma. No history of trauma or any other significant medical history was observed. Based on history and symptoms, a clinical diagnosis of the recurrent apocrine hidrocystoma was made and the lesion was surgically excised with clear margins which sent for histopathological examination. Macroscopic examination of skin ellipse measured 2.5 cm × 2.2 cm × 1.8 cm and contained a cyst measuring 1.6 cm in maximum dimension with a thin wall. The cyst contained minimal clear fluid and its wall was devoid of any firm nodules or papillary excrescences. Microscopic examination of hematoxylin and eosin-stained slides revealed a multilocular bilayered dermal cyst lined by an inner layer of cuboidal and tall columnar secretory cells of variable heights showing eosinophilic cytoplasm with luminal decapitation secretion, suggesting apocrine differentiation and surrounded by a peripheral layer of elongated myoepithelial cells [Figures 1 and 2]. There was no evidence of squamous or mucous metaplasia seen. There was no inflammation or cytological atypia seen. Based on characteristic histolopathogical features, a diagnosis of recurrent apocrine hidrocystoma of the scalp was made. The patient was kept on follow-up and has not reported any recurrence so far for the past 1 year.Figure 1: Multilocualted cystic lesion in the scalp showing various sized cysts (H and E stain, ×100)Figure 2: Cyst wall lined by double-layered epithelium showing the inner layer of apocrine-like secretory epithelium showing eosinophilic cytoplasm with apocrine snouts and fringes and outer layer of elongated myoepithelial cells (H and E stain, ×200)Due to their typical clinical appearance and anatomical site location, apocrine hidrocystoma must be differentiated from other similar benign lesions, such as eccrine hidrocystoma, sebaceous cyst, epidermal inclusion cyst, hemangioma, lymphangioma, and cystic basal cell epithelioma, as well as malignant lesions such as basal cell carcinoma and malignant melanoma (due to its typical blueblack color).[13456] Eccrine hidrocystoma, in particular, shares the same clinical presentation, anatomical locations, and age predilection. However, they are usually multiple lesions lined by 1–2 layered epithelial lining without any decapitation secretions and myoepithelial cells. Immunohistochemical (IHC) analysis of apocrine hidrocystoma shows positivity for human milk fat globules, gross cystic disease fluid protein 15 (GCDFP-15), cytokeratin (CK) 7, CK 8, CK 18, and CK 19 proteins in the inner layer of epithelium and alpha-smooth muscle actin (a-SMA) and p63 in the outer myoepithelial cells, while negativity for S-100 protein. Contrary to it, eccrine hidrocystoma shows positivity for CK 1, CK 5, CK 10, and CK 14 while negativity for human milk fat globules and GCDFP-15.[124567] Particularly, in long-standing apocrine hidrocystoma, IHC analysis in arriving at a correct diagnosis as increased intraluminal pressure in the cyst wall flattens them and abolishes their characteristic decapitation secretion.[7] Treatment depends on the solitary or multiple nature of the lesion and includes various medical treatment options such as anticholinergic creams, trichloroacetic acid, botulinum toxin, cryotherapy, and, carbon dioxide vaporization laser treatment, especially for multiple lesions and surgical approaches such as simple needle puncture (high chance of local recurrence), surgical excision with clear margins and electrodesiccation.[1267] Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Association of ticks with seasons, age, and cattle color of North-Western region of Nigeria

Ticks harbor pathogens that contribute to the spread of infections in a host; yet, studies aimed at investigating the seasonality in abundance and distribution of ticks on cattle population are very few. We investigated the abundance and site predilection of tick species with the sampling season, sampling site, sex, age, and the cattle color of the North-Western region of Nigeria. We screened 1,264 cattle (564 males and 700 females) from Wamakko, Kware, Sokoto North, Sokoto South, Dange-Shuni of Sokoto State, and encountered more Rhipicephalus (Boophilus) spp than Hyalomma and Amblyomma spp. Tick abundance related significantly (p < 0.05) with sampling seasons while the site predilection of ticks related (p < 0.05) to age and color of cattle. In contrast to the females, the male cattle had more ticks in the dry season. Cattle age, coat color, and sampling seasons influenced the distribution of ticks on a host, however, to assure an accurate evaluation of ticks on a host, other studies should consider studying ticks in these regions using a larger host sample size for a longer period of time or studies should be conducted between host of different species.

Ventral Osteochondroma of the Scapula Causing Snapping and Static Winging- A Case Report

Osteochondromas are a relatively common entity when we talki about benign bone tumours and they can occur in almost any bone although they have a predilection for certain sites. Flat bones like scapula are a rare location for occurrence of such a lesion. Ventral osteochondromas of scapula are rarer than dorsal ones and can cause a host of symptoms ranging from just scapular pain to pseudo winging of scapula and snapping syndromes. The treatment of such lesions is by excision of the tumour and here we present a case report of a young male with a ventral scapular osteochondroma with static wingingg of scapula and snapping. The patient was adequately managed by en bloc excision and has been relievd of all complaints without any signs of recurrence at one year of followup.

The unveiled reality of human papillomavirus as risk factor for oral cavity squamous cell carcinoma

The prognostic impact of human papillomavirus (HPV) in oropharyngeal cancer is generally acknowledged, and HPV-status is assessed routinely in clinical practice. Paradoxically, while the oral cavity seems the predilection site for productive HPV-infections, figures on HPV-attribution in oral cavity squamous cell carcinoma (OCSCC) differ widely, and prognostic impact is uncertain. Major obstacles are the lack of reproducible assays to detect HPV in nonoropharyngeal cancers, the relatively small cohorts studied and consequently the shortfall of convincing data. In our study, we used a validated, nucleic acid-based workflow to assess HPV-prevalence in a consecutive cohort of 1016 OCSCCs, and investigated its prognostic impact. In parallel, we analyzed p16-immunohistochemistry (p16-IHC) as surrogate marker for transforming HPV-infection and independent prognosticator. All OCSCC-patients diagnosed between 2008 and 2014 at two Dutch university medical centers were included (N = 1069). Formalin-fixed, paraffin-embedded (FFPE)-samples of 1016 OCSCCs could be retrieved. Punch biopsies were taken from the tumor area in the FFPE-blocks and tested for HPV. P16-IHC was performed on 580 OCSCCs, including all HPV-positive tumors. From 940 samples (92.5%), nucleic acids were of sufficient quality for HPV-testing. In total, 21 (2.2%) OCSCCs were HPV DNA-positive. All HPV DNA-positive tumors were E6 mRNA-positive and considered as true HPV-positive. There was no difference in survival between HPV-positive and HPV-negative OCSCCs. In total, 46 of 580 (7.9%) OCSCCs were p16-immunopositive, including all HPV-positive tumors. Survival was comparable in p16-positive and p16-negative OCSCCs. To conclude, HPV-prevalence is very low in OCSCC and neither HPV-status nor p16-status affects outcome. Based on these data, determining HPV-status in OCSCC seems irrelevant for clinical management.

Mesenteric Lipoma as an Uncommon Cause of Abdominal Discomfort

Lipoma is the most frequent benign mesenchymal tumor that resembles normal white fat. Gastrointestinal tract lipomas are rare. The small bowel is the second predilection site of lipomas following the colon. Mesenteric lipomas mainly occur in adults without gender predilection. They are usually asymptomatic and discovered incidentally. However; these tumors may present with intussusception and intestinal bleeding. CT is the key imaging modality to diagnose mesenteric lipoma. They typically present as well-circumscribed, non-enhancing masses with homogeneous fatty attenuation, which are often contained and separate from free mesenteric fat (Figure 1 and 2: white arrows). On MRI, mesenteric lipomas demonstrate homogeneous signal intensity identical to that of fat. Thin fibrous septa of low signal intensity on T1- and T2-weighted images may be present.

A clinical and biological review of keratoacanthoma.

Keratoacanthoma (KA) is a common skin tumour that remains controversial regarding classification, epidemiology, diagnosis, prognosis and management. Classically, a KA manifests as a rapidly growing, well-differentiated, squamoid lesion with a predilection for sun-exposed sites in elderly people and a tendency to spontaneously regress. Historically, KAs have been considered a variant of cutaneous squamous cell carcinoma (cSCC) and are often reported as KA-type cSCC. However, the penchant for regression has led many to categorize KAs as biologically benign tumours with distinct pathophysiological mechanisms from malignant cSCC. The clinical and histopathological similarities between KA and cSCC, particularly the well-differentiated variant of cSCC, have made definitive differentiation difficult or impossible in many cases. The ambiguity between entities has led to the general recommendation for surgical excision of KAs to ensure a potentially malignant cSCC is not left untreated. This current standard creates unnecessary surgical morbidity and financial strain for patients, especially the at-risk elderly population. There have been no reports of death from a definitive KA to date, while cSCC has an approximate mortality rate of 1·5%. Reliably distinguishing cSCC from KA would shift management strategies for KAs towards less-invasive treatment modalities, prevent unnecessary surgical morbidity, and likely reduce associated healthcare costs. Herein, we review the pathophysiology and clinical characteristics of KA, and conclude on the balance of current evidence that KA is a benign lesion and distinct from cSCC.

Reduction of Conduction Velocity in Patients with Atrial Fibrillation.

It is unknown to what extent atrial fibrillation (AF) episodes affect intra-atrial conduction velocity (CV) and whether regional differences in local CV heterogeneities exist during sinus rhythm. This case-control study aims to compare CV assessed throughout both atria between patients with and without AF. Patients (n = 34) underwent intra-operative epicardial mapping of the right atrium (RA), Bachmann’s bundle (BB), left atrium (LA) and pulmonary vein area (PVA). CV vectors were constructed to calculate median CV in addition to total activation times (TAT) and unipolar voltages. Biatrial median CV did not differ between patients with and without AF (90 ± 8 cm/s vs. 92 ± 6 cm/s, p = 0.56); only BB showed a CV reduction in the AF group (79 ± 12 cm/s vs. 88 ± 11 cm/s, p = 0.02). In patients without AF, there was no predilection site for the lowest CV (P5) (RA: 12%; BB: 29%; LA: 29%; PVA: 29%). In patients with AF, lowest CV was most often measured at BB (53%) and ranged between 15 to 22 cm/s (median: 20 cm/s). Lowest CVs were also measured at the LA (18%) and PVA (29%), but not at the RA. AF was associated with a prolonged TAT (p = 0.03) and decreased voltages (P5) at BB (p = 0.02). BB was a predilection site for slowing of conduction in patients with AF. Prolonged TAT and decreased voltages were also found at this site. The next step will be to determine the relevance of a reduced CV at BB in relation to AF development and maintenance.

The Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging for the Evaluation of Blood-Brain Barrier Disruption in Traumatic Brain Injury: What Is the Evidence?

(1) Background: Blood brain barrier (BBB) disruption following traumatic brain injury (TBI) results in a secondary injury by facilitating the entry of neurotoxins to the brain parenchyma without filtration. In the current paper, we aimed to review previous dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies to evaluate the occurrence of BBB disruption after TBI. (2) Methods: In electronic databases (PubMed, Scopus, Embase, and the Cochrane Library), we searched for the following keywords: dynamic contrast-enhanced OR DCE AND brain injury. We included studies in which BBB disruption was evaluated in patients with TBI using DCE-MRI. (3) Results: Four articles were included in this review. To assess BBB disruption, linear fit, Tofts, extended Tofts, or Patlak models were used. and were increased, and the values of were decreased in the cerebral cortex and predilection sites for diffusion axonal injury. These findings are indicative of BBB disruption following TBI. (4) Conclusions: Our analysis supports the possibility of utilizing DCE-MRI for the detection of BBB disruption following TBI.

Histopathological Review on Discoid Lupus Erythematous Mimicking Granuloma Faciale

Discoid lupus erythematosus is the most common forms of chronic cutaneous lupus erythematosus. It is characterized by clinical manifestations of erythematous macules, papules, or plaques with a coin-like shape and the face is the most common predilection site. Clinical features often resemble granuloma faciale. This case report aimed to distinguish discoid lesions on the face based on the histopathological examination. A 71-year-old male with a few reddish lumps appeared on his face since three months ago. Physical examination showed multiple discrete erythematous plaques with overlying squamous. Hematoxylin and eosin staining on the epidermis demonstrated basket weave type orthokeratosis, basal vacuolar cell degeneration, epidermal atrophy with flat rete ridges, and follicular plugging while in the dermis obtained inflammatory cell infiltrates, especially in periadnexal areas. Histopathological features of DLE are hyperkeratosis, pilosebasea gland atrophy, follicular plugging, basal membrane thickening, and cellular infiltrate in periadnexa or perivascular areas more visible than in other types of CLE. In DLE, no subepidermal gren zone and eosinophil infiltrate were found, like histological features of granuloma faciale. Histopathological examination can be used to establish a diagnosis for discoid lesions on the face, although serology examination remains as the gold standart. Keywords: Discoid lupus erythematosus; Granuloma faciale; Histopathology

Giving Extra Virgin Olive Oil To Wound Healing (Grade Of Inflammation) In Atopic Dermatitis Patients

Atopic dermatitis (AD) is a chronic and recurrent skin inflammation, accompanied by itching, occurs in certain predilection sites and is based on the presence of an inherited inherited hypersensitivity. This dermatitis is the most common form of dermatitis in infants and children. Other names are atopic eczema, dermatitis eczema, Besnier's prurigo and neurodermatitis. Dermatitis can occur for years, even for life, often recurring and interfering with daily activities due to intense itching. Knowing the effect of giving extra virgin olive oil on wound healing (degree of inflammation) in atopic dermatitis patients, the type of research used was pre-experimental because it revealed a cause-and-effect relationship involving only one group of subjects. so there's no control. strict on variables. The type of research design chosen was The One Group Pratest Posttest, which is an experimental design that was carried out in one group without a comparison group. This model has used a pre-test (pratest) then after being given treatment, a measurement (posttest) is carried out again to determine the consequences of the treatment, so that it can be seen the magnitude of the effect of the experiment. The results of the study can be interpreted that before being given olive oil most (75%) of the respondents had a severe degree of dermatitis and after being given olive oil half (50%) of the respondents had a mild degree of dermatitis, and half (50%) of the respondents had a moderate degree of dermatitis. It can be seen that the Z value is -4.916 with a significance of p = 0.000, so H0 is rejected so that H1 is accepted, which means that there is a difference in the degree of dermatitis before and after being given olive oil. Virgine Olive Oil Can Be Used As A Non-pharmacological Therapy In Overcoming The Degrees Of Atopic Dermatitis Both In Public Health Centers And Networks And In Hospitals

The clinicopathological characteristics, gene mutation characteristics and survival analysis of carcinoma of unknown primary origin.

e15098 Background: Analyze the characteristics of CUPS clinicopathology and gene mutation spectrum, and discuss CUPS drug treatment strategies. Methods: A retrospective analysis of the data of 30 patients with metastatic cancer of CUP admitted to our department from April 2015 to April 2020. Including clinicopathological characteristics, treatment process and methods, gene molecular information, follow-up survival period. The follow-up was until February 1, 2021 or the patient died. Results: The pathological types of these cases were adenocarcinoma (14/30,46.7%), squamous cell carcinoma (5/30, 16.7%), neuroendocrine carcinoma (3/30,10%), small cell carcinoma (2/30,6.7%), sarcomatoid carcinoma (2/30,6.7%), large cell carcinoma (1/30,3.3%), lymphoepithelial carcinoma (1/30,3.3%), and poorly differentiated carcinoma (2/30,6.7%) . The most predilection site was lymph nodes, accounting for 70%. Primary lesions were not found in 23 cases in the course of diagnosis and treatment. They were head and neck in 1 case, lung in 1 case, mammary gland in 1 case, digestive tract in 3 cases and thymus in 1 case. 23 patients received chemotherapy alone or combined with antiangiogenic therapy, 2 patients received molecular targeted agents, 1 patient received ICI combined with antiangiogenic therapy, and the remaining 4 patients died without antitumor therapy or gave up treatment. The survival time of 26 patients was between 1 to 143 months, and the median survival time was 8.6 months. The 1-year, 2-year, 3-year and 5-year OS rate were 40%, 20%, 6.7% and 3.3%, respectively. Mean survival time was significantly longer among patients without visceral metastasis vs. with visceral metastasis (15.6m vs. 7.3m, P = 0.023). OS rate were 70% vs. 25%, 30% vs. 15%, 20% vs. 0% and 10% vs. 0%, respectively. The median survival time were 18.3m (with targeted therapy), 8.8m (without targeted therapy), 23.2m (with primary lesion), 8.4m (without primary lesion), The 1-year, 2-year, 3-year and 5-year OS were 53.3% vs. 26.7%, 40% vs. 0%, 23.3% vs. 0% and 6.7% vs. 0% for patients with targeted therapy vs. without targeted therapy, respectively. The 1-year, 2-year, 3-year and 5-year OS were 85.7% vs. 261%, 42.9% vs. 13%, 28.6% vs. 0% and 14.3% vs. 0% for patients with primary lesion vs. without primary lesion, respectively. 20 patients were interrogated genes using NGS of ctDNA. 80% of patients exhibited ctDNA alterations; TP53-associated genes were most commonly altered (13/20,65%) followed by genes involved in the MAPK pathway (20%), PI3K signaling (10%) and the cell cycle machinery (5%). The genomic profiles help guide treatment in 4 cases. Conclusions: CUPS has a poor prognosis. The pathological type is mostly adenocarcinoma, and lymph node metastasis is the first diagnosis. Chemotherapy is still the main treatment method. Molecular detection is helpful for individualized treatment.

Histopathological Correlation (World Health Organization Classification) of Meningiomas and Their Anatomical Localization: A Multicenter Epidemiological Study in Mexico

To determine the epidemiology of the localization and histological type of meningiomas in the Mexican population and the distribution of the different histological patterns and their relationship to tumor localization and patient demographics. A retrospective analysis was performed in 5 hospitals in Mexico from 2009 to 2019. For qualitative variables, mean values were compared using Pearson χ2 test for the correlation between location and histological pattern as well as the clinical presentation and the patient's sex. Student t test was performed for age and its correlation with location and histology. Analysis of 179 patients revealed significant differences in histopathological pattern, patient sex, and tumor location. No significant differences were found for age or clinical presentation in association with any specific histological pattern. There was a correlation between the histology of the 15 histopathological varieties of meningiomas and the predilection site of appearance as well as certain demographic aspects, such as sex. This study lays the foundation for future studies in Mexico on the differentiation and typing of meningiomas regardless of the histological grade to which they belong, as the exact behavior of these tumors, including grade I tumors, remains unknown to date.

Vitiligo: An Updated Narrative Review.

Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.

Is Mucormycosis an inevitable complication of Covid-19 in India?

Mucormycosis or black fungus infection is a less common disease but highly fatal infection, infecting the immunocompromised individuals. The site of predilection of the fungus is found to be lungs and brain in addition to its sequestration in sinusoidal spaces. Presently with the ongoing COVID 19 pandemic, the prevalence of this infection is found to be high in the Indian population. The fungus establishes itself by affecting the compromised immune system of an individual and thereby making the individual susceptible to other diseases/infection. The reasons attributed to the sudden upsurge are steroidal therapeutics abuse, tocilizumab therapy and diabetes mellitus.To avert the cytokine storm, the medical health workers are necessitated to include steroid drugs in COVID 19 treatment protocol however inclusion of these drugs in patients who do essentially require steroids can have their immune system debilitated and permit the invasion of this fungus. According to International Diabetes Federation (IDF), 77 million Indians are known to be diabetic, cautioning the physicians to be vigilante of the impending black fungus infection in the event of COVID19 affliction in such individuals. There is causal relationship between anti-hyperglycemic drugs and weakened immune system and opportunity for the fungus invasion. This review attempts to explain the inter-relatedness of COVID19 infection, its treatment and eventual black fungus infection risk.

RNA‐sequencing reveals plantar keloid has potential bone/cartilage characteristics

RNA‐sequencing reveals plantar keloid has potential bone/cartilage characteristics

Long-Term Results of the Modular Physiological Wrist Prosthesis (MPW®) in Patients with Inflammatory Diseases.

The wrist is among the predilection sites of over 90% of cases of rheumatoid arthritis (RA). In advanced cases, total wrist arthroplasty (TWA) is an alternative to arthrodesis. The aim of this study is to present the long-term results of the modular physiological wrist prosthesis (MPW®) and to match them in context with the results of a standard population survey. In a retrospective study with follow-up, patients with an MPW® endoprosthesis were evaluated concerning the clinical and radiological outcome, complications were reviewed (incidence and type), and conversion to wrist fusion was assessed. Patient function measurements included the Mayo wrist score, the patient-specific wrist test, and therefore the DASH score (arm, shoulder, and hand). Thirty-four MPW® wrist prostheses were implanted in 32 patients, including thirty primary implantations and four changes of the type of the endoprosthesis. Sixteen patients (18 prostheses) underwent clinical and radiological follow-up. The average follow-up time was 8.5 years (1 to 16). Poor results of the MPW prosthesis are caused by the issues of balancing with luxation and increased PE wear. Salvage procedures included revision of the TWA or fusion. In successful cases, the flexion and extension movement averaged 40 degrees. The grip force was around 2.5 kg. The common DASH score was 79 points, with limited and problematic joints of the upper extremity. The MPW wrist prosthesis offered good pain relief and functional movement in over 80% of cases. The issues of dislocation and increased PE wear prevent better long-term results, as do the joints affected. A follow-up study with fittings under a contemporary anti-rheumatic therapy with biologicals suggests increasing score results. Type of study/level of evidence: Case series, IV.

Mechanism of White Matter Injury and Promising Therapeutic Strategies of MSCs After Intracerebral Hemorrhage.

Intracerebral hemorrhage (ICH) is the most fatal subtype of stroke with high disability and high mortality rates, and there is no effective treatment. The predilection site of ICH is in the area of the basal ganglia and internal capsule (IC), where exist abundant white matter (WM) fiber tracts, such as the corticospinal tract (CST) in the IC. Proximal or distal white matter injury (WMI) caused by intracerebral parenchymal hemorrhage is closely associated with poor prognosis after ICH, especially motor and sensory dysfunction. The pathophysiological mechanisms involved in WMI are quite complex and still far from clear. In recent years, the neuroprotection and repairment capacity of mesenchymal stem cells (MSCs) has been widely investigated after ICH. MSCs exert many unique biological effects, including self-recovery by producing growth factors and cytokines, regenerative repair, immunomodulation, and neuroprotection against oxidative stress, providing a promising cellular therapeutic approach for the treatment of WMI. Taken together, our goal is to discuss the characteristics of WMI following ICH, including the mechanism and potential promising therapeutic targets of MSCs, aiming at providing new clues for future therapeutic strategies.