Primary Lobe Research Articles

The Network of Brodmanns Area 22 in Lexico-semantic Processing: A Pooling-data Connectivity Study

Background and Objective:Modern neuroimaging has demonstrated that cognitive functions are based in networks of interconnected modules. The purpose of this paper was to analyze the connectivity of Brodmann's area (BA) 22 in lexico-semantic tasks. MethodsA connectivity fMRI co-activation study was performed by pooling data of lexico-semantic tasks in which BA22 (core of Wernicke's area) was reported. 283 subjects reported in 21 experiments were analyzed. Analysis of Likelihood Estimates of pooled data was utilized to generate the connectivity map; thresholds at p< 0.01 were corrected for multiple comparisons with false discovery rate. Resulting images were co-registered into MNI standard space.Results:network consisting of 13 clusters of activation was obtained. Main clusters were located in the left posterior temporal and left inferior frontal gyrus; in addition to these canonical areas, left insula, pre-supplementary motor area, left BA37, primary auditory areas and left occipital lobe were also involved. Conclusions: BA22-related networks involved in lexico-semantics processing were demonstrated utilizing a pooling-data connectivity study. Significance, interpretation and limitations of the results are discussed.

Distant Multifocal Bony Metastasis of a Grade II Meningioma: Case Report

Introduction Meningioma is the most frequent neoplasm of the central nervous system, accounting for nearly one-third of all intracranial tumors. The vast majority are benign and cured by surgical resection. Grade II meningiomas may show local invasion involving the brain, intracranial venous channels, bones, soft tissue and paranasal sinuses. Distant metastasis, on the other hand, is quite rare. Case Presentation We report distant, multifocal bony metastasis of an atypical meningioma, World Health Organization grade II, from a primary occipital lobe location in a patient who initially underwent stereotactic radiosurgery followed by surgical resection 4 years prior. The patient presented clinically with pain in the lower back and gluteal region. Distant metastases were noted radiologically in the lumbar spine, pelvis, and femur and were confirmed pathologically following biopsy. Conclusion Metastasis from meningiomas is exceedingly uncommon. In the present case, hematogenous spread to the lumbar spine, pelvis, and femur may have occurred due to a residual nodular remnant within the superior sagittal sinus.

Temporal plus epilepsy is a major determinant of temporal lobe surgery failures.

Reasons for failed temporal lobe epilepsy surgery remain unclear. Temporal plus epilepsy, characterized by a primary temporal lobe epileptogenic zone extending to neighboured regions, might account for a yet unknown proportion of these failures. In this study all patients from two epilepsy surgery programmes who fulfilled the following criteria were included: (i) operated from an anterior temporal lobectomy or disconnection between January 1990 and December 2001; (ii) magnetic resonance imaging normal or showing signs of hippocampal sclerosis; and (iii) postoperative follow-up ≥ 24 months for seizure-free patients. Patients were classified as suffering from unilateral temporal lobe epilepsy, bitemporal epilepsy or temporal plus epilepsy based on available presurgical data. Kaplan-Meier survival analysis was used to calculate the probability of seizure freedom over time. Predictors of seizure recurrence were investigated using Cox proportional hazards model. Of 168 patients included, 108 (63.7%) underwent stereoelectroencephalography, 131 (78%) had hippocampal sclerosis, 149 suffered from unilateral temporal lobe epilepsy (88.7%), one from bitemporal epilepsy (0.6%) and 18 (10.7%) from temporal plus epilepsy. The probability of Engel class I outcome at 10 years of follow-up was 67.3% (95% CI: 63.4-71.2) for the entire cohort, 74.5% (95% CI: 70.6-78.4) for unilateral temporal lobe epilepsy, and 14.8% (95% CI: 5.9-23.7) for temporal plus epilepsy. Multivariate analyses demonstrated four predictors of seizure relapse: temporal plus epilepsy (P < 0.001), postoperative hippocampal remnant (P = 0.001), past history of traumatic or infectious brain insult (P = 0.022), and secondary generalized tonic-clonic seizures (P = 0.023). Risk of temporal lobe surgery failure was 5.06 (95% CI: 2.36-10.382) greater in patients with temporal plus epilepsy than in those with unilateral temporal lobe epilepsy. Temporal plus epilepsy represents a hitherto unrecognized prominent cause of temporal lobe surgery failures. In patients with temporal plus epilepsy, anterior temporal lobectomy appears very unlikely to control seizures and should not be advised. Whether larger resection of temporal plus epileptogenic zones offers greater chance of seizure freedom remains to be investigated.

Yolk Sac Tumor of the Temporal Lobe: Case Report

AbstractGerm cell tumors of the central nervous system (CNS) are usually located along the midline. Yolk sac tumor is a rare germ cell tumor very uncommonly located outside the midline, and, in such cases, it can be mistaken with other primary tumors. We report a case of a 32-year-old male patient who presented with a right temporal lobe tumor suggestive of a high grade glioma. He was submitted to a right temporal lobectomy with complete tumor removal. The histological exam revealed a germ cell tumor (later confirmed to be a yolk sac tumor). The search for a primary tumor outside of the CNS (including a positron emission tomography scan) was negative, making this a primary temporal lobe yolk sac tumor. The patient was submitted to chemotherapy and radiotherapy, but died 7 months after the surgery.

The placenta is the center of the chronic disease universe

Over the past quarter century it has become clear that adult onset chronic diseases like heart disease and type 2 diabetes have their roots in early development. The report by David Barker and colleagues showing an inverse relationship between birthweight and mortality from ischemic heart disease was the first clear-cut demonstration of fetal programming. Because fetal growth depends upon the placental capacity to transport nutrients from maternal blood, it has been a suspected causative agent since the original Barker reports. Epidemiological studies have shown that placental size and shape have powerful associations with offspring disease. More recent studies have shown that maternal phenotypic characteristics, such as body mass index and height, interact with placental size and shape to predict disease with much more precision than does birthweight alone. For example, among people in the Helsinki Birth Cohort, who were born during 1924–1944, the risk for acquiring colorectal cancer increased as the placental surface became longer and more oval. Among people in whom the difference between the length and breadth of the surface exceeded 6 cm, the hazard ratio for the cancer was 2.3 (95% CI 1.2–4.7, p=0.003) compared with those in whom there was no difference. Among Finnish men, the hazard ratio for coronary heart disease was 1.07 (1.02–1.13, P =0.01) per 1% increase in the placental weight/birthweight ratio. Thus, it appears that the ratio of birthweight to placental weight, known as placental efficiency, predicts cardiovascular risk as well. Babies born with placentas at the extremes of efficiency are more vulnerable for adult onset chronic diseases. Recent evidence suggests that placental growth patterns are sex specific. Boys’ placentas are, in general, more efficient than those made by girls. Another recent discovery is that the size, shape and efficiencies of the placenta can change over years of time with very narrow confidence limits. This suggests that the growth of the placenta within a population of women is strongly affected by their nutritional environment. Even though it is known that an individual placenta can expand to improve its nutrient acquisition capacity in the first 2/3rd of gestation, the mechanisms by which placentas grow in response to a specific nutritional environment are not known. Discovering those mechanisms is the task of the current generation of scientists. While it may seem obvious that good nutrition is highly important for women who are pregnant because it supports optimal placentation and fetal development, more research is needed to determine the mechanisms by which maternal nutrition, placenta growth and fetal health are related.

Local and systemic signaling in maintenance of hematopoietic progenitors

Past work from our laboratory and that of others has established that the developing Drosophila hematopoietic organ, the lymph gland (LG), is an excellent model system for studying hematopoiesis and hematopoietic disorders. We have described the cellular components of distinct zones within the primary lobe of the developing LG: The Cortical Zone (CZ) consisting of differentiating blood cells (hemocytes); the Medullary Zone (MZ) consisting of blood progenitors that give rise to all mature blood cell types and the Posterior Signaling Center (PSC) consisting of cells of the hematopoietic niche. We have also described many different signaling pathways that control the maintenance of the blood progenitors. A highlight of this investigation was the demonstration that this maintenance requires not only a signal from the niche, but also a backward signal from the differentiating cells that we term the “equilibrium signal”.Lately, we have concentrated on systemic signals that affect hematopoiesis. A study of the effects of starvation by others and us led to an important role of insulin signaling on maintenance of blood progenitors. The principal finding was that hematopoietic progenitors sense nutritional status, both through direct sensing of amino acids by the TOR pathway, as well as indirectly by signaling through the insulin receptor.In similar studies, we have found effects of ROS signaling, hypoxia signaling and GABA signaling in the maintenance of blood progenitors. The role of GABA is interesting as it provided a direct link between the function of the olfactory system and blood progenitor maintenance. At this meeting, we will mostly discuss our unpublished data on the effect of injury on the fate of blood cells in Drosophila. Past work from our laboratory and that of others has established that the developing Drosophila hematopoietic organ, the lymph gland (LG), is an excellent model system for studying hematopoiesis and hematopoietic disorders. We have described the cellular components of distinct zones within the primary lobe of the developing LG: The Cortical Zone (CZ) consisting of differentiating blood cells (hemocytes); the Medullary Zone (MZ) consisting of blood progenitors that give rise to all mature blood cell types and the Posterior Signaling Center (PSC) consisting of cells of the hematopoietic niche. We have also described many different signaling pathways that control the maintenance of the blood progenitors. A highlight of this investigation was the demonstration that this maintenance requires not only a signal from the niche, but also a backward signal from the differentiating cells that we term the “equilibrium signal”. Lately, we have concentrated on systemic signals that affect hematopoiesis. A study of the effects of starvation by others and us led to an important role of insulin signaling on maintenance of blood progenitors. The principal finding was that hematopoietic progenitors sense nutritional status, both through direct sensing of amino acids by the TOR pathway, as well as indirectly by signaling through the insulin receptor. In similar studies, we have found effects of ROS signaling, hypoxia signaling and GABA signaling in the maintenance of blood progenitors. The role of GABA is interesting as it provided a direct link between the function of the olfactory system and blood progenitor maintenance. At this meeting, we will mostly discuss our unpublished data on the effect of injury on the fate of blood cells in Drosophila.

Lymph Node Metastases and Prognosis in Left Upper Division Non-Small Cell Lung Cancers: The Impact of Interlobar Lymph Node Metastasis.

BackgroundLeft upper division segmentectomy is one of the major pulmonary procedures; however, it is sometimes difficult to completely dissect interlobar lymph nodes. We attempted to clarify the prognostic importance of hilar and mediastinal nodes, especially of interlobar lymph nodes, in patients with primary non-small cell lung cancer (NSCLC) located in the left upper division.MethodsWe retrospectively studied patients with primary left upper lobe NSCLC undergoing surgical pulmonary resection (at least lobectomy) with radical lymphadenectomy. The representative evaluation of therapeutic value from the lymph node dissection was determined using Sasako’s method. This analysis was calculated by multiplying the frequency of metastasis to the station and the 5-year survival rate of the patients with metastasis to the station.ResultsWe enrolled 417 patients (237 men, 180 women). Tumors were located in the lingular lobe and at the upper division of left upper lobe in 69 and 348 patients, respectively. The pathological nodal statuses were pN0 in 263 patients, pN1 in 70 patients, and pN2 in 84 patients. Lymph nodes #11 and #7 were significantly correlated with differences in node involvement in patients with left upper lobe NSCLC. Among those with left upper division NSCLC, the 5-year overall survival in pN1 was 31.5% for #10, 39.3% for #11, and 50.4% for #12U. The involvement of node #11 was 1.89-fold higher in the anterior segment than that in the apicoposterior segment. The therapeutic index of estimated benefit from lymph node dissection for #11 was 3.38, #4L was 1.93, and the aortopulmonary window was 4.86 in primary left upper division NSCLC.ConclusionsInterlobar node involvement is not rare in left upper division NSCLC, occurring in >20% cases. Furthermore, dissection of interlobar nodes was found to be beneficial in patients with left upper division NSCLC.

Mediastinal Nodal Involvement in Patients with Clinical Stage I Non–Small-Cell Lung Cancer: Possibility of Rational Lymph Node Dissection

The aim of this study is to elucidate the optimal candidate of selective lymph node dissection (LND) that reduces the extent of mediastinal LND according to clinical information including radiological evaluation in primary non-small-cell lung cancer (NSCLC) patients. Eight hundred and seventy-six patients with clinical(c)-stage I NSCLC (adenocarcinoma and squamous cell carcinoma), who underwent complete surgical resection between January 2003 and December 2009 were included in this study. We elucidated the lymph node metastatic incidence and distribution according to the primary tumor lobe location and extracted the associated clinicopathological factors, especially thin-section computed tomographic findings, with mediastinal lymph node involvement. The total incidence of mediastinal lymph node metastasis was 9.1%. There were no cases with hilar and mediastinal lymph node metastasis in ground glass opacity-predominant tumors. There was no significant association of clinical factors with subcarinal lymph node metastasis in right upper-lobe and left upper-division adenocarcinoma. An elevated preoperative serum carcinoembryonic antigen level (p < 0.001) showed significant associations with upper mediastinal lymph node metastasis in the patients with bilateral lower-lobe primary lung adenocarcinoma. It would be acceptable to perform selective LND in patients with c-stage I NSCLC with ground glass opacity- predominant tumor. Elevated serum carcinoembryonic antigen was associated with upper mediastinal lymph node involvement in lower-lobe primary lung adenocarcinoma with radiologically solid-predominant tumor. We should be careful when applying selective LND to patients with solid-predominant tumor, especially located in the lower lobe.

Limbic Tumors of the Temporal Lobe: Radiologic–Pathologic Correlation

The purpose of this study was to assess imaging and pathologic characteristics of limbic tumors. Our hypothesis was that temporal lobe limbic tumors have distinctive features from extralimbic tumors. This retrospective radiologic-pathologic correlation study of primary temporal lobe tumors (excluding glioblastoma) distinguished limbic from extralimbic tumors based on preoperative magnetic resonance imaging. Limbic tumors were categorized according to Yaşargil's classification into (1) mediobasal temporal (mbT), (2) insular-temporo-opercular (I-TO), and (3) fronto-orbital-insular-temporopolar (FO-I-TP). A total of 50 cases with a mean age at diagnosis of 38 ± 19.9 years (14 women, 36 men) were included. Pathologic diagnoses were as follows: 20 anaplastic astrocytomas, 11 gangliogliomas, 8 astrocytomas (World Health Organization grade II), 3 pilocytic astrocytomas, 2 dysembryoplastic neuroepithelial tumors, 2 oligodendrogliomas (grade II), 2 anaplastic oligodendrogliomas, 1 low-grade glioneuronal tumor, and 1 atypical extraventricular neurocytoma. In all, 36 tumors were limbic and displayed consistent growth patterns (16 mbT, 11 I-TO, 8 FO-I-TP, and 1 pantemporal) and 14 were extralimbic. There were no differences between limbic and extralimbic tumors with regard to age, sex, pathologic diagnosis, and presentation with seizures. mbT tumors had more frequent neuronal differentiation (50 %) than I-TO (0 %) and FO-I-TP (25 %) tumors (chi-square = 7.8, df = 2, p = 0.02). Neuronal differentiation correlated with lower grade (r = 0.52, p < 0.01) and younger age (r = 0.52, p < 0.01). Limbic tumors displayed consistent growth routes. mbT limbic tumors had more frequent neuronal differentiation, which may result from proximity to the neurogenic subgranular zone of the hippocampus. Neuronal differentiation was maximal in mbT and lowest in I-TO and FO-I-TP tumors and correlated with lower tumor grade and younger age at diagnosis.

Regulation of Cu-Zn superoxide dismutase on SCN2A in SH-SY5Y cells as a potential therapy for temporal lobe epilepsy

In order to evaluate SCN2A as a candidate gene for epileptic susceptibility and the use of a Cu-Zn superoxide dismutase (SOD) supplement as a potential therapy for epilepsy, SCN2A expression in the cortex and the correlation between SCN2A and Cu-Zn SOD in SH-SY5Y cells were examined. SCN2A expression and the concentration of Cu-Zn SOD in the cerebral cortexes of patients with primary and secondary temporal lobe epilepsy and normal brain cortex tissues were detected. By transfecting SH-SY5Y cells, the expression of SCN2A and the concentration of Cu-Zn SOD was analyzed and the single-cell patch clamp technique was employed in order to investigate the changes in sodium ion levels following SCN2A knockdown. SCN2A level restoration was also investigated with a Cu-Zn SOD supplement using an expression study and evaluated the changes in sodium ion levels following SCN2A knockdown. SCN2A expression and Cu-Zn SOD concentration decreased in the epileptic cerebral cortex. Following SCN2A knockdown, the concentration of Cu-Zn SOD declined and the si-SCN2A vector group showed a repeated discharge. Furthermore, the Cu-Zn SOD concentration was capable of restoring the expression of SCN2A following SCN2A knockdown in SH-SY5Y cells and the overexpression of Cu-Zn SOD prevented the repeated discharge caused by si-SCN2A. The results indicated that there is a low expression of SCN2A and Cu-Zn SOD in the epileptic cerebral cortex and provided novel insights into potential therapies for temporal lobe epilepsy.

Impact of brachytherapy on local recurrence after sublobar resection: Results from ACOSOG Z4032 (Alliance), a phase III randomized trial for high-risk operable non-small cell lung cancer (NSCLC).

7502 Background: Prior studies suggest that adjuvant brachytherapy reduces local recurrence (LR) after sublobar resection (SR) for NSCLC. A multicenter randomized study was undertaken in patients (pts) with stage I NSCLC ≤3cm comparing SR to SR with brachytherapy (SRB). Methods: High-risk operable patients with NSCLC were randomized to SR or SRB. Brachytherapy involved placement of I125 seeds incorporated into Vicryl sutures or into Vicryl mesh placed over the staple line. Wedge or segmental resection was allowed. The primary endpoint was time to local recurrence (LR) defined as recurrence within the primary tumor lobe at the staple line (local progression), away from the staple line or within hilar nodes. The trial was designed to have 90% power to detect a hazard ratio (HR) of 0.315 in favor of the SRB arm using a one-sided α of 0.05 with a sample size of 100 eligible pts per arm. Follow-up CT scans were obtained serially for 36 months. Results: 224 pts were randomized; 213 (109 SR,104 SRB) were eligible. Median (range) age was 71 (49-87) yrs; 94 (44%) were male. No differences were found in baseline characteristics. Adverse events, previously reported, were not different between arms. Median (range) follow-up was 4.06 (0.04, 5.0) yrs. There was no difference between arms in time to LR (HR = 0.87; 5% CI: 0.41, 1.86, p=0.72) or to LR or death (LRD) (HR = 0.81, 95% CI: 0.50, 1.32, p=0.40). There was no difference between arms in pattern of LR (table). In subgroups of pts with potentially compromised surgical margin (margin &lt; 1cm; margin:tumor ratio &lt;1; positive staple line cytology) SRB did not reduce LR or LRD at 3-yrs. Overall 3-yr survival was similar for SR (71%) and SRB (72%) (p=0.81). Conclusions: LR remains a concern after sublobar resection. However, local progression at the staple line was low. This trial demonstrated that adjuvant brachytherapy does not impact oncologic outcomes. Clinical trial information: NCT00107172. [Table: see text]

Brachial Plexopathy in Apical Non-Small Cell Lung Cancer Treated With Definitive Radiation: Dosimetric Analysis and Clinical Implications

Data are limited on the clinical significance of brachial plexopathy in patients with apical non-small cell lung cancers (NSCLC) treated with definitive radiation therapy. We report the rates of radiation-induced brachial plexopathy (RIBP) and tumor-related brachial plexopathy (TRBP) and associated dosimetric parameters in apical NSCLC patients. Charts of NSCLC patients with primary upper lobe or superiorly located nodal disease who received ≥50 Gy of definitive conventionally fractionated radiation or chemoradiation were retrospectively reviewed for evidence of brachial plexopathy and categorized as RIBP, TRBP, or trauma-related. Dosimetric data were gathered on ipsilateral brachial plexuses (IBP) contoured according to Radiation Therapy Oncology Group atlas guidelines. Eighty patients were identified with a median follow-up and survival time of 17.2 and 17.7 months, respectively. The median prescribed dose was 66.6 Gy (range, 50.4-84.0), and 71% of patients received concurrent chemotherapy. RIBP occurred in 5 patients with an estimated 3-year rate of 12% when accounting for competing risk of death. Seven patients developed TRBP (estimated 3-year rate of 13%), comprising 24% of patients who developed locoregional failures. Grade 3 brachial plexopathy was more common in patients who experienced TRBP than RIBP (57% vs 20%). No patient who received ≤78 Gy to the IBP developed RIBP. On multivariable competing risk analysis, IBP V76 receiving ≥1 cc, and primary tumor failure had the highest hazard ratios for developing RIBP and TRBP, respectively. RIBP is a relatively uncommon complication in patients with apical NSCLC tumors receiving definitive doses of radiation, while patients who develop primary tumor failures are at high risk for developing morbid TRBP. These findings suggest that the importance of primary tumor control with adequate doses of radiation outweigh the risk of RIBP in this population of patients.

Direct sensing of systemic and nutritional signals by haematopoietic progenitors in Drosophila

The Drosophila lymph gland is a hematopoietic organ in which progenitor cells, which are most akin to the common myeloid progenitor or CMP in mammals, proliferate and differentiate into three types of mature cells – plasmatocytes, crystal cells and lamellocytes – the functions of which are reminiscent of mammalian myeloid cells1. During the first and early second instars of larval development, the lymph gland contains only progenitors, whereas in the third instar, a medial region of the primary lobe of the lymph gland called the medullary zone (MZ) contains these progenitors2, while maturing blood cells are found juxtaposed in a peripheral region designated the cortical zone (CZ)2. A third group of cells referred to as the posterior signaling center (PSC) functions as a hematopoietic niche3,4. Similar to mammalian myeloid cells, Drosophila blood cells respond to multiple stresses including hypoxia, infection, and oxidative stress5–7. However, how systemic signals are sensed by myeloid progenitors to regulate cell fate determination has not been well described. Here, we show that the hematopoietic progenitors of Drosophila are direct targets of systemic (insulin) and nutritional (essential amino acid) signals, and that these systemic signals maintain the progenitors by promoting Wingless (WNT in mammals) signaling. We expect that this study will promote investigation of such possible direct signal sensing mechanisms by mammalian myeloid progenitors.

Which subgroup of patients with pathologic N2 non-small cell lung cancer benefit from surgery?

Patients with pathologic N2 non-small cell lung cancer comprise a heterogeneous group. The objective of this study was to evaluate which subgroup of patients with pathologic N2 benefit from surgery in terms of survival probability. This retrospective study included 141 patients who had undergone major resection with pathologically proven N2 from 1990 to 2006 (103 with adenocarcinoma, 38 with squamous cell carcinoma). Patients undergoing preoperative induction therapy were excluded. Records were examined for age, gender, tumor size, surgical procedure, surgical side, clinical N status, primary tumor lobe, curative resection, and metastatic N2 stations. In patients with adenocarcinoma, surgical procedure, clinical N status, curative resection, and metastatic N2 stations were significant prognostic factors in univariate analysis. Age and curative resection were significant factors in patients with squamous cell carcinoma. In multivariate analysis, clinical N2 (P = 0.003), incomplete resection (P = 0.04), and multi-station N2 (P = 0.004) were significant adverse prognostic factors in patients with adenocarcinoma, whereas only incomplete resection (P = 0.002) was significant in patients with squamous cell carcinoma. For adenocarcinoma patients with pathologic N2, the 5-year survival rates were 58.8% for clinical N0-1 and single-station N2, 50% for clinical N2 and single-station N2, 23.9% for clinical N0-1 and multi-station N2, and 0% for clinical N2 and multi-station N2. Prognosis of patients with pathologic N2 can be grouped according to clinical N status and metastatic N2 stations in adenocarcinoma, but not in squamous cell carcinoma. Only adenocarcinoma patients with pathologic N2 appear to have heterogeneous subgroups with different prognoses.

Multiple synchronous primary tumours in a single lobe

We present the case of a 70-year-old man with three synchronous histologically different primary tumours in the same lobe. He initially presented with an intermittent productive cough, dyspnoea and non-specific abdominal pains. Radiological investigation revealed three areas of high-intensity fludeoxyglucose uptake of varying size within the right upper lobe. He underwent thoracoscopic right upper lobectomy. Histological analysis confirmed the three lesions to be undifferentiated squamous cell carcinoma, adenocarcinoma and atypical adenomatous hyperplasia. The reclassification of the T descriptors of the tumour-node-metastasis staging of a lung cancer has lead to the transition of classification of tumour nodules in the ipsilateral primary tumour lobe from T4 to T3. In the case of our patient, this has lead to the downstaging of the tumour allowing consideration for surgical management.

Molecular typing of Treponema pallidum: a systematic review and meta-analysis.

BackgroundSyphilis is resurgent in many regions of the world. Molecular typing is a robust tool for investigating strain diversity and epidemiology. This study aimed to review original research on molecular typing of Treponema pallidum (T. pallidum) with three objectives: (1) to determine specimen types most suitable for molecular typing; (2) to determine T. pallidum subtype distribution across geographic areas; and (3) to summarize available information on subtypes associated with neurosyphilis and macrolide resistance.Methodology/Principal FindingsTwo researchers independently searched five databases from 1998 through 2010, assessed for eligibility and study quality, and extracted data. Search terms included “Treponema pallidum,” or “syphilis,” combined with the subject headings “molecular,” “subtyping,” “typing,” “genotype,” and “epidemiology.” Sixteen eligible studies were included. Publication bias was not statistically significant by the Begg rank correlation test. Medians, inter-quartile ranges, and 95% confidence intervals were determined for DNA extraction and full typing efficiency. A random-effects model was used to perform subgroup analyses to reduce obvious between-study heterogeneity. Primary and secondary lesions and ear lobe blood specimens had an average higher yield of T. pallidum DNA (83.0% vs. 28.2%, χ2 = 247.6, p<0.001) and an average higher efficiency of full molecular typing (80.9% vs. 43.1%, χ2 = 102.3, p<0.001) compared to plasma, whole blood, and cerebrospinal fluid. A pooled analysis of subtype distribution based on country location showed that 14d was the most common subtype, and subtype distribution varied across geographic areas. Subtype data associated with macrolide resistance and neurosyphilis were limited.Conclusions/SignificancePrimary lesion was a better specimen for obtaining T. pallidum DNA than blood. There was wide geographic variation in T. pallidum subtypes. More research is needed on the relationship between clinical presentation and subtype, and further validation of ear lobe blood for obtaining T. pallidum DNA would be useful for future molecular studies of syphilis.

Lung Cancer Metastasis to an Adrenal Myelolipoma Detected by PET/CT

Abstract: The patient is a 54-year-old woman with squamous cell lung carcinoma, diagnosed bronchoscopically at the bronchus intermedius. Initial staging F-18 fluorodeoxyglucose PET/CT revealed the hypermetabolic primary perihilar right lower lobe malignancy, and a 13-mm hypermetabolic nodule located within a 45-mm fat density structure at the expected location of the right adrenal gland. No normal-appearing adrenal gland was present. This PET/CT demonstrates metastatic squamous cell carcinoma to an adrenal myelolipoma. A CT-guided biopsy of the nodule confirmed squamous cell carcinoma. This is the patient's only PET-evident site of disease beyond the primary tumor, compatible with T2N0M1 disease.

Anomia as a marker of distinct semantic memory impairments in Alzheimer's disease and semantic dementia.

Many neurologically constrained models of semantic memory have been informed by two primary temporal lobe pathologies: Alzheimer's disease (AD) and Semantic Dementia (SD). However, controversy persists regarding the nature of the semantic impairment associated with these patient populations. Some argue that AD presents as a disconnection syndrome in which linguistic impairment reflects difficulties in lexical or perceptual means of semantic access. In contrast, there is a wider consensus that SD reflects loss of core knowledge that underlies word and object meaning. Object naming provides a window into the integrity of semantic knowledge in these two populations. We examined naming accuracy, errors and the correlation of naming ability with neuropsychological measures (semantic ability, executive functioning, and working memory) in a large sample of patients with AD (n = 36) and SD (n = 21). Naming ability and naming errors differed between groups, as did neuropsychological predictors of naming ability. Despite a similar extent of baseline cognitive impairment, SD patients were more anomic than AD patients. These results add to a growing body of literature supporting a dual impairment to semantic content and active semantic processing in AD, and confirm the fundamental deficit in semantic content in SD. We interpret these findings as supporting of a model of semantic memory premised upon dynamic interactivity between the process and content of conceptual knowledge.

Hematopoiesis at the onset of metamorphosis: terminal differentiation and dissociation of the Drosophila lymph gland

The Drosophila melanogaster hematopoietic organ, called lymph gland, proliferates and differentiates throughout the larval period. The lymph gland of the late larva is comprised of a large primary lobe and several smaller secondary lobes. Differentiation into two types of hemocytes, plasmatocytes and crystal cells, is confined to the outer layer (cortical zone) of the primary lobe; the center of the primary lobe (medullary zone), as well as the secondary lobes, contain only proliferating prohemocytes. A small cluster of cells located at the posterior tip of the primary lobe serves as a signaling center (PSC) that inhibits precocious differentiation of the medullary zone. The larval lymph gland is stabilized by layers of extracellular matrix (basement membranes) that surround individual hemocytes, groups of hemocytes, as well as the lymph gland as a whole. In this paper, we investigated the events shaping the lymph gland in the early pupa. The lymph gland dissociates and hemocytes disperse during the first 12h after puparium formation (APF), leaving behind empty husks of basement membrane. Prior to lymph gland dissociation, cells of the medullary zone differentiate, expressing the early differentiation marker Peroxidasin (Pxn), as well as, in part, the late differentiation marker P1. Cells of the PSC spread throughout the pupal lymph gland prior to their dispersal. Cells of the secondary lobes undergo a rapid phase of proliferation that lasts until 8h APF, followed by expression of Pxn and dispersal. These hemocytes do not express P1, indicating that they disperse prior to full maturation.

Beam steering for a long range Acoustic Hail and Warning Device for maritime applications

A new means for steering the beam of a phased line array, electromechanical steering, is described and applied to a long range Acoustic Hail and Warning Device (AHWD) developed for maritime applications. In electromechanical steering, the array elements pivot individually resulting in elements being off-set and rotated in the desired steered beam/sound projection direction. A digital signal processor is used to align the phase fronts of the elements due to the mechanical offsets. Electromechanical steering has several advantages over the purely electronic steering of the array. The electromechanically steered beams are not subject to the individual element aperture function attenuation that reduces the sound pressure level (SPL) that commonly occurs for electronically only steered beams at large steering angles. Also, the primary lobe distortion and (lower frequency) onset of grating lobes that occur when a beam is steered electronically is absent with electromechanical steering. In short, with electromechanical steering, the SPL and directivity from the AHWD is entirely equivalent to that obtained by rotating the AHWD to the desired angle with a conventional pan and tilt mount but requires much less space and provides for more flexible mounting options including improved system stealth. In addition, a novel type of line array phase shading is presented which allows the AHWD to be electronically switched from directional mode (typical beam steering highly focused mode) to non-directional wide field of regard for applications that require simultaneous ensonification of targets over large lateral angles. ©2011 Institute of Noise Control Engineering