Single Case Research Articles

Research on high-power and high-efficiency emission of crosswell electromagnetic logging

Crosswell electromagnetic (EM) logging has useful applications in oil, gas, and water monitoring as well as carbon sequestration estimation. Difficulties in the efficient propagation of EM waves through a steel casing inhibit crosswell EM logging at distances greater than 300 m. This study investigates whether high-power transmission and high-efficiency transmitting antennas can resolve the challenges of long-distance crosswell EM logging through steel casings. Theoretical analysis indicates that the emission moment should be at least 12,000 A·m2. By calculating the equivalent relative permeability and selecting the appropriate coil materials and magnetic cores, the maximum emission magnetic moment can create a high-power transmission. Based on series and parallel resonant circuits and the alternating current/direct current cable core multiplexing power supply method, the effective transmission bandwidth is broadened and the transmission efficiency increases by three times. The emission unit is fabricated and tested using single, double, and fiberglass casing. We observe that the crosswell EM technology performs better for nonmetal casing wells than that for metal casing wells. The amplitude and phase curves between two fiberglass casing wells in the range of 425 m are quite smooth. However, the receiving signals in the double-layer steel casing decrease to only a few tenths of the value in the fiberglass casing wells, highlighting the difficulty of long-distance EM wave transmission when using steel casings. Thus, studies on EM transmission through four or more layers of steel casings should be conducted in the future.

On the Benefits of Traffic “Reprofiling” the Single Hop Case

On the Benefits of Traffic “Reprofiling” the Single Hop Case

Evaluating the relationship between contouring variability and modelled treatment outcome for prostate bed radiotherapy.

Objectives.Contouring similarity metrics are often used in studies of inter-observer variation and automatic segmentation but do not provide an assessment of clinical impact. This study focused on post-prostatectomy radiotherapy and aimed to (1) identify if there is a relationship between variations in commonly used contouring similarity metrics and resulting dosimetry and (2) identify the variation in clinical target volume (CTV) contouring that significantly impacts dosimetry.Approach.The study retrospectively analysed CT scans of 10 patients from the TROG 08.03 RAVES trial. The CTV, rectum, and bladder were contoured independently by three experienced observers. Using these contours reference simultaneous truth and performance level estimation (STAPLE) volumes were established. Additional CTVs were generated using an atlas algorithm based on a single benchmark case with 42 manual contours. Volumetric-modulated arc therapy (VMAT) treatment plans were generated for the observer, atlas, and reference volumes. The dosimetry was evaluated using radiobiological metrics. Correlations between contouring similarity and dosimetry metrics were calculated using Spearman coefficient (Γ). To access impact of variations in planning target volume (PTV) margin, the STAPLE PTV was uniformly contracted and expanded, with plans created for each PTV volume. STAPLE dose-volume histograms (DVHs) were exported for plans generated based on the contracted/expanded volumes, and dose-volume metrics assessed.Mainresults. The study found no strong correlations between the considered similarity metrics and modelled outcomes. Moderate correlations (0.5 <Γ< 0.7) were observed for Dice similarity coefficient, Jaccard, and mean distance to agreement metrics and rectum toxicities. The observations of this study indicate a tendency for variations in CTV contraction/expansion below 5 mm to result in minor dosimetric impacts.Significance. Contouring similarity metrics must be used with caution when interpreting them as indicators of treatment plan variation. For post-prostatectomy VMAT patients, this work showed variations in contours with an expansion/contraction of less than 5 mm did not lead to notable dosimetric differences, this should be explored in a larger dataset to assess generalisability.

“No One Works in Isolation Here”: The Socialization of Physical Education Teachers Into a Professional Learning Community

Purpose: Drawing from occupational socialization theory and social capital theory, the purpose of this study was to investigate the socialization of physical education teachers in a professional learning community during induction. Method: Because this investigation consisted of a single school, a single instrumental case study design was utilized. The school was purposely chosen given its status as a “model professional learning community.” Two physical education teachers, three school administrators, and the founding principal participated in this study. Data collection consisted of a combination of dyadic interviews, focus groups, observations, and documents. Results: Data analysis revealed three overlapping themes with supportive categorical subthemes: (a) Dispersed and Inclusive Leadership, (b) Teacher Empowerment, and (c) Culture of Belonging. Discussion: Implications for physical education teachers include the necessity of ongoing collaboration with administrators, cross-curricular colleagues, and physical education teaching peers. Physical educators should seek to develop strong social capital within the school professional learning community.

Evaluation of corneal power from an AS-OCT thick lens model and ray tracing: reliability of the keratometer index

Purpose: To investigate and compare different strategies of corneal power calculations using keratometry, paraxial thick lens calculations and ray tracing. Setting: Tertiary care center. Design: Retrospective single-center consecutive case series. Methods: Using a dataset with 9780 eyes of 9780 patients from a cataractous population the corneal front (Ra/Qa) and back (Rp/Qp) surface radius/asphericity, central corneal thickness (CCT), and entrance pupil size (PUP) were recorded using the Casia 2 tomographer. Beside keratometry with the Zeiss (PKZ) and Javal (PKJ) keratometer index, a thick lens paraxial formula (PG) and ray tracing (PR) was implemented to extract corneal power for pupil sizes from 2 mm to 5 mm in steps of 1 mm and PUP. Results: With PUP PKZ/PKJ overestimates the paraxial corneal power PG in around 97%/99% of cases and PR in around 80% to 85%/99%. PR is around 1/6 or 5/6 diopters (D) lower compared with PKZ or PKJ. For a 2 mm pupil PR is around 0.20/0.91 D lower compared with PKZ/PKJ and for a 5 mm pupil PR is comparable with PKZ (around 0.03 D lower) but around 0.70 to 0.75 D lower than PKJ. Conclusions: “True” values of corneal power are mostly required in lens power calculations before cataract surgery, and overestimation of corneal power could induce trend errors in refractive outcome with axial length and lens power if compensated with the effective lens position.

Motor imagery for paediatric neurorehabilitation: how much do we know? Perspectives from a systematic review.

Motor Imagery (MI) is a cognitive process consisting in mental simulation of body movements without executing physical actions: its clinical use has been investigated prevalently in adults with neurological disorders. Review of the best-available evidence on the use and efficacy of MI interventions for neurorehabilitation purposes in common and rare childhood neurological disorders. systematic literature search conducted according to PRISMA by using the Scopus, PsycArticles, Cinahl, PUBMED, Web of Science (Clarivate), EMBASE, PsychINFO, and COCHRANE databases, with levels of evidence scored by OCEBM and PEDro Scales. Twenty-two original studies were retrieved and included for the analysis; MI was the unique or complementary rehabilitative treatment in 476 individuals (aged 5 to 18 years) with 10 different neurological conditions including, cerebral palsies, stroke, coordination disorders, intellectual disabilities, brain and/or spinal cord injuries, autism, pain syndromes, and hyperactivity. The sample size ranged from single case reports to cohorts and control groups. Treatment lasted 2 days to 6 months with 1 to 24 sessions. MI tasks were conventional, graded or ad-hoc. MI measurement tools included movement assessment batteries, mental chronometry tests, scales, and questionnaires, EEG, and EMG. Overall, the use of MI was stated as effective in 19/22, and uncertain in the remnant studies. MI could be a reliable supportive/add-on (home-based) rehabilitative tool for pediatric neurorehabilitation; its clinical use, in children, is highly dependent on the complexity of MI mechanisms, which are related to the underlying neurodevelopmental disorder.

Skin and not dorsal root stimulation reduces hypertonus in thoracic motor complete spinal cord injury: a single case report.

On demand and localized treatment for excessive muscle tone after spinal cord injury (SCI) is currently not available. Here, we examine the reduction in leg hypertonus in a person with mid-thoracic, motor complete SCI using a commercial transcutaneous electrical stimulator (TES) applied at 50 or 150 Hz to the lower back and the possible mechanisms producing this bilateral reduction in leg tone. Hypertonus of knee extensors without and during TES, with both cathode (T11-L2) and anode (L3-L5) placed over the spinal column (midline, MID) or 10 cm to the left of midline (lateral, LAT) to only active underlying skin and muscle afferents, was simultaneously measured in both legs with the pendulum test. Spinal reflexes mediated by proprioceptive (H-reflex) and cutaneomuscular reflex (CMR) afferents were examined in the right leg opposite to the applied LAT TES. Hypertonus disappeared in both legs but only during thoracolumbar TES, and even during LAT TES. The marked reduction in tone was reflected in the greater distance both lower legs first dropped to after being released from a fully extended position, increasing by 172.8% and 94.2% during MID and LAT TES, respectively, compared with without TES. Both MID and LAT (left) TES increased H-reflexes but decreased the first burst, and lengthened the onset of subsequent bursts, in the cutaneomuscular reflex of the right leg. Thoracolumbar TES is a promising method to decrease leg hypertonus in chronic, motor complete SCI without activating spinal cord structures and may work by facilitating proprioceptive inputs that activate excitatory interneurons with bilateral projections that in turn recruit recurrent inhibitory neurons.NEW & NOTEWORTHY We present proof of concept that surface stimulation of the lower back can reduce severe leg hypertonus in a participant with motor complete, thoracic spinal cord injury (SCI) but only during the applied stimulation. We propose that activation of skin and muscle afferents from thoracolumbar transcutaneous electrical stimulation (TES) may recruit excitatory spinal interneurons with bilateral projections that in turn recruit recurrent inhibitory networks to provide on demand suppression of ongoing involuntary motoneuron activity.

Ornamental design of textile elements in the wedding decoration of horse among the Bashkirs

The area of this study includes the south-east of the Republic of Bashkortostan (Abzelilovo, Burzyan, Baimak, Beloretsk districts) predominantly inhabited by the Bashkir people. The chronological framework of the research spans the 20th and early 21st centuries, i.e. the time when horse wedding decoration was still used by the Bashkirs in some locations, attesting to preser-vation of long-standing ethnic traditions. The aim of this study is to analyse decoration elements of horse in the wedding cere-mony among the south-eastern Bashkirs in the 20th and early 21st centuries, including caparisons, saddle blankets, breastplates, bellybands, and cruppers. The source basis includes author’s fieldwork materials collected during in 2010, 2017–2019 and 2023, as well as archival materials, museum collections in the city of Ufa and rural school museums preserving rare exhibits. Standard scientific methods, such as comparative historical research, scientific description and analysis, have been used. Du-ring the collection of field materials, traditional ethnographic research approach was also used, including observation, photofixa-tion and in-depth interviewing conducted in the Bashkir language, which allowed us recording local names of the wedding horse decoration. Analyzed were ornamented caparisons, saddle blankets, breastplates, bellybands and cruppers as attributes of the Bashkir wedding ceremony in the south-east of the Republic of Bashkortostan. The festive horse decoration was part of a bridal dowry; the bride herself participated in its making. The bridal horse decoration in the wedding ceremony performed social, sac-ral and aesthetic functions. It was enriched with sacral signs and symbols to protect from bewitching and evil spirits. A young wife moved to husband’s house on her horse decorated for wedding accompanied by her husband, girlfriends and close rela-tives. Until the 19th century, the bride would have ridden astride, but already at the turn of the 20th century that would be quite a rare phenomenon. However, in some villages there were single cases of the observance of this rite even in the mid-20th century. It has been found that in the 20th century in the south-east of the Republic of Bashkortostan several types of wedding capari-sons, different in their ornaments, materials and techniques, were used. There were several types of appliqué and kuskar em-broidery. The altered form of the wedding horse decoration has been preserved until the early 21st century.

"Well, that Was Pretty Clever!"-Ethnic Minority Women's Views on HPV Self-Sampling Devices for Cervical Cancer Screening: Attitudes to Brushes, First-Void Urine, and Menstrual Blood Devices.

Ethnic minority women are less likely to participate in cervical cancer uteri (CCU) screening compared to native women. Human Papillomavirus (HPV) self-sampling kits for CCU screening may be a potential strategy to increase participation. This study aimed to explore views and attitudes on four different types of self-sampling kits (two brushes, a first-void urine device, and a menstrual blood device) among non-Western ethnic minority women living in Denmark. The study was a social science single case study based on focus group interviews with 30 women aged 32-54 with non-Western background from a deprived area. A phenomenological approach was applied to describe the phenomenon "self-sampling" as seen from the women's lifeworlds. The interviews were transcribed verbatim and analysed using systematic text condensation. The women expressed significant interest in the possibility of using HPV self-sampling kits as an alternative to being screened by their general practitioner. They were particularly motivated to use the non-invasive self-sampling kits for CCU screening as they were deemed suitable for addressing cultural beliefs related to their bodies and virginity. The women expressed interest in the use of the invasive self-sampling kits but were cautious, primarily due to lack of confidence in correctly performing self-sampling with a brush and due to cultural beliefs. The use of non-invasive self-sampling kits, such as a first-void urine collection device and menstrual blood pad, represents a promising solution to overcome cultural barriers and promote greater equality in CCU screening participation among non-Western ethnic minority women.

Parametric shape optimization of pin fin arrays using a multi-fidelity surrogate model based Bayesian method

The current work aims to develop a multi-fidelity Bayesian optimization methodology to reduce computation time in CFD based design optimization of an internal cooling channel of a gas turbine blade. To build energy efficient gas turbine engines, it is important to increase the turbine inlet temperature, while preventing material failure of hot gas path components. Power lost due to pumping compressed air in turbine blade internal cooling channels can affect the overall efficiency of a power cycle. While designing such a cooling channel, it is important to ensure high heat transfer within a given pressure drop budget. Design optimization using CFD typically needs a sufficient number of computationally expensive high fidelity simulations to search for an optimum design. In the current work, a multi-fidelity Gaussian process surrogate based Bayesian optimization framework has been used to design a pin fin array channel, typically used for gas turbine blade trailing edge cooling, with the goal of maximizing Nusselt number at a constrained pressure loss. Data from a cheaper, low fidelity computation model has been leveraged, along with an expensive high fidelity one, in order to search for a design configuration that maximizes heat transfer at a given pressure drop constraint. The multi-fidelity approach improves upon single fidelity optimization results, at a low additional computational cost due to usage of simulation data from the cheap lowfidelity CFD model. A multifidelity approach outperformed the previous single fidelity case, with 6% higher objective while satisfying the pressure constraint, with 2% lower computational expense and 8 fewer high fidelity data point computations.

Nephrotic Syndrome with Eosinophillic Ascites: A Case Report

Minimal change disease (MCD) as a cause of nephrotic syndrome in the elderly is seen in around 15%–20% of patients. Also eosinophillic gastroenteritis (EGE) is a very rare disease. The association with minimal change nephropathy and EGE is even rarer and to the best of our knowledge there is only a single case report of the same. Theoretically atopy is a common factor in the pathogenesis of both diseases and both may be IgE mediated. Here we present the case of a gentleman with nephrotic syndrome who underwent abdominal paracentesis and was found to have eosinophillic ascitis. Renal biopsy including electron microscopy was suggestive of minimal change disease. He responded completely on starting steroids with resolution of ascitis, proteinuria and decrease in IgE levels.

Sustainable performance in advance warehousing and quality assurance through SAP: a case of Artistic Milliners

Artistic Milliners is the name of Pakistan's rising textile industry. They started their journey about half a century ago, and now Artistic Milliners have become one of the leading manufacturers and the biggest exporter of household textiles and clothing. Artistic Milliners are most concerned with evaluating the new and unique methods of warehouse management processes. The best aspect of this study is that the essential purpose is to study the old and conventional methods in the field and to fulfil new times. The most challenging job of all these workers, who don't want to adjust, is to create and enforce the techniques. My research project aims to research and apply modernized methods in warehousing management in the current practice of Artistic Milliners. Fundamentally, research is focused on quantitative analysis to recognize the impacts of study variables. The consistency and methodology of the analysis are based on a single case study. Sampling methods are used based on a probabilistic process. All data was obtained from primary sources, and Artistic Milliner's officials collected organized interviews. The finding concludes that Artistic Milliners must implement the new developments for a warehouse management system with the ability to incorporate and develop the production. It will train downstream and upstream workers to boost performance.

The Stakeholders’ Opinions on the Learner-Centred Pedagogies Used in Competence-Based Curriculum (CBC) in Selected Secondary Schools in Kampala District

The study investigated the Stakeholders’opinions on learner-centred pedagogies used in Competence-Based Curriculum (CBC) in selected Secondary schools A and B found in Kampala District. The Learner-centred Pedagogies (LCP) under the CBC place the learner at the centre of the learning process, promoting active participation and self-directed learning. The study was guided by curriculum implementation theory by Gross et al (1971). The study adopted a qualitative research approach that analysed the learner centred pedagogies from the subjective point of view while involving the study participants’ opinions. The study followed the Interpretivist paradigm which enabled participants to create and construct their social reality in line with the study. The study also adopted a single case study research design in order to get an in-depth understanding of the opinions of stakeholders on CBC. A sample of 22 participants including Headteachers (H), Teachers (T) and Students (S) were selected purposively and used for the study. This enabled the researcher to gather qualitative responses, from the best-fit participants whose responses were relevant to the study. The study employed the use of the interviews for the two headteachers and eight teachers, focus group discussions to students while considering in each group six students from each school and observation method to collect data. Through triangulation the methods enabled the researcher to collect in-depth subjective reality which was analysed using thematic analysis. The findings of the study indicated that; to some extent the learner centred pedagogies used by teachers are good and they should be used when teaching. This was because the methods encourage full participation of learners and development of skills. However, to another extent the finding of the study also revealed that, the learner centred pedagogies used by teachers are not good due to inadequate teaching skills by teachers, limited materials to use and methods are time consuming. The study recommended that, the government of Uganda through the MoES to; train teachers so as to equip them with the necessary skills of teaching, facilitate schools with enough educational facilities and materials to use and continuously monitor, supervise and evaluate CBC practices in schools.

The Stakeholders’ Views on Assessment of Competence-Based Curriculum (CBC) In Selected Secondary Schools in Kampala District

The study investigated the stakeholders ’views on assessment of Competence-Based Curriculum (CBC) in selected Secondary schools A and B found in Kampala District. Assessment under the CBC involves both formative and summative assessments, with formative assessments accounting for 20% and summative assessments accounting for 80% of the evaluation. Teachers should frequently assess the learners using new assessment methods of CBC. Teachers are also required to change from a norm-referenced to a criterion-referenced judgment of learners’ capabilities or competencies to determine their progress. The study was guided by curriculum implementation theory by Gross et al (1971). The study adopted a qualitative research approach that analysed the stakeholders’ views on assessment from the subjective point of view while involving the study participants’ opinions. The study followed the Interpretivist paradigm which enabled participants to create and construct their social reality in line with the study. The study also adopted a single case study research design in order to get an in-depth understanding of the views of stakeholders on assessment in CBC. A sample of 23 participants including a UNEB Official, Headteachers (H), Teachers (T) and Students (S) were selected purposively and used for the study. This enabled the researcher to gather qualitative responses, from the best-fit participants whose responses were relevant to the study. The study employed the use of the interviews for a UNEB Official, the two headteachers and eight teachers and focus group discussions (FGD) to twelve students while considering in each group six students to collect data. Through triangulation the methods enabled the researcher to collect in-depth subjective reality which was analysed using thematic analysis. The findings of the study indicated that, the assessment methods used in CBC were good. They included; activities of integration, continuous assessment, end of term assessment, end of year assessment and end of cycle assessment. However, as the methods were being used, schools were faced by many challenges that included; limited skills by teachers, limited sensitisation from UNEB and NCDC on CBC practices, limited facilities to use, time consuming on the side of teachers, laziness of the learners and big class sizes. The study recommended the government of Uganda through the MoES to; train teachers so as to equip them with the necessary skills of teaching, facilitate schools with enough educational facilities and materials to use and continuously monitor, supervise and evaluate CBC practices in schools.

A novel physiotherapeutic approach for the treatment of Os Naviculare: A case study.

Background: Os naviculare in general alters the functional and anatomical balances of the longitudinal plantar arch. A substantial number of the posterior tibialis tendon fibers insert on the accessory ossicle instead of its insertion on tarsal and metatarsal bones resulting in unbalanced stress forces on the tendon. The presence of an accessory navicular type II or type III is a risk factor for PTT tendinopathy and possible PTT tear. Methodology: In this single subject case study, the participant reported with the pre-diagnosed Os naviculare. On examination at initial presentation, the navicular tuberosity of the affected foot was prominent as compared to the contralateral limb. The site was tender on palpation. Ankle range of motion was within normal ranges except ankle dorsiflexion was slightly compromised. Mild pain on active and resisted was noted. Functional tests like star excursion balance test, single leg standing could not be performed due to pain. Pre and post protocol assessment was graded and measured on Cumberland ankle instability tool. The tenderness was recorded using numeric pain rating scale. Star excursion balance test was performed one on 8th day and post protocol. MWM was performed at distal tibiofibular joint on 6 days every week for 3 weeks alongside the conventional regime exercises and ultrasound was applied post treatment session. Result: Result of this study suggested that addition of MWM of distal tibiofibular joint in the conservative exercise protocol was effective in the reduction of pain, dysfunction and improved dynamic control. Conclusion: The results of this study suggests that the addition of MWM of distal tibiofibular joint alongside conservative management shows appreciable effect in improving dysfunction, dynamic stability and reducing pain in individual with congenital Os naviculare.

Intercollicular Approach for Midbrain Cavernous Malformation: 2-Dimensional Operative Video.

Previously reported midbrain cavernous malformations often exhibit lateral expansion, making their excision through the nearest brain surface incision easier.1-5 Nevertheless, excising a midbrain cavernous malformation that lacks lateral extension can be particularly challenging because of limited access.5 The anterior midline approach is typically conducted through the interpeduncular fossa zone.3,5 Still, it restricts surgical maneuverability because of the presence of the posterior communicating artery, the posterior cerebral artery, and the oculomotor nerve. On the other hand, the posterior midline approach through the intercollicular region, although reported in only a single case, lacks technical details and postoperative neurological status.3,5 In this report, we elaborate on the feasibility of surgical manipulations for midline-located midbrain cavernous angiomas through the intercollicular region and discuss the resulting postoperative neurological outcomes.

Care and services partnership in Quebec birthing centres: myth or reality?

ContextWorking with women to best meet their needs has always been central to midwifery in Quebec, Canada. The creation of birthing centres at the end of the 1990s consolidated this desire to prioritize women’s involvement in perinatal care and was intended to encourage the establishment of a care and services partnership between care providers and users. The aim of this pilot study is to evaluate the perceptions of clients, midwives and birth assistants of the way in which women are involved in partnership working in Quebec birthing centres.MethodsA single qualitative case and pilot study was conducted with midwives (n = 5), birth assistants (n = 4), a manager (n = 1), clients (n = 5) and members of the users’ committee (n = 2) at a birthing centre in Quebec, Canada in July and August 2023. The partnership was evaluated using the dimensions of a validated CADICEE questionnaire.ResultsThe women and professionals stressed that the relationship was established in a climate of trust. The caregivers also attached importance to autonomy, information sharing and decision-making, adaptation to context, empathy and recognition of the couple’s expertise. The women confirmed that they establish a relationship of trust with the professionals when the latter show empathy and that they adapt the follow-up to their knowledge and life context. Key factors in establishing this kind of care relationship are the time given, a de-medicalized environment, the comprehensive care received, and professionals who are well-informed about the partnership. In addition, the birthing centre has a users’ committee that can put forward ideas but has no decision-making powers.ConclusionsBoth the women and the professionals at the birthing centre appear to be working in partnership. However, at the organizational level, the women are not involved in decision-making. A study of all birthing centres in Quebec would provide a more comprehensive picture of the situation.

Reducing an operational access for cholecystectomy on overweight patients

The development of laparoscopic surgery, based on technological progress, and the accumulation of clinical experience makes it possible to reduce operating access, reducе the postoperative complications. Material and methods. SILS cholecystectomy were performed in 27 patients with overweight and obesity. All operations were done as planned for chronic calculousis cholecystitis. Results and discussion. We used assistive technologies for organ traction (Patent N 103722 Russian Federation) in the event of a “conflict” of instruments, which made it possible to reduce the intervention time. The mean intervention time was 55.5±6.9 minutes. In 10 patients with risk factors for the formation of trocar hernias (obesity, advanced age, functional insufficiency of the connective tissue), the access area was preventively strengthened by an implant placed over the aponeurosis. All patients were discharged in a satisfactory condition 3-4 days after surgery. Subsequently, during observation and re-examinations up to 7 years after surgery, patients did not complain about surgical intervention, felt well, and not a single case of postoperative ventral hernia was recorded. Conclusion. The advantages of cholecystectomy in overweight and obese patients using the SILS technique are obvious, associated with a reduction in the invasiveness of the operation, an excellent cosmetic result, and the achievement of a fundamentally different quality of life for patients.

Treatment of poorly differentiated neuroendocrine carcinomas of rectum and anus with chemoradiotherapy: a single-centre evaluation

PurposePoorly differentiated neuroendocrine carcinoma (PDNEC) of the rectum and anus is a rare disease exhibiting aggressive biological behaviour, even if diagnosed early. Currently, there are no agreed standard treatment approaches and management of locally advanced (LA) and metastatic PDNEC usually follows treatments used in pulmonary neuroendocrine carcinomas because of the similarities with small cell lung cancer. The role of surgery in PDNEC is still debated and the benefit of chemoradiotherapy (CRT) is unknown. This report summarises the experiences of CRT application in anorectal PDNEC in a single Danish institution.MethodsAll patients with PDNEC treated with concomitant CRT between May 2019 and January 2021 at a University hospital in Denmark were evaluated. Demographics, treatment and survival outcomes were collected and analysed.ResultsSix patients were identified. Five patients received radiotherapy with 50.4 Gy/28 fractions, and four were eligible for curative resection after the CRT. Distant metastasis was observed in four patients at diagnosis. Two patients with synchronous liver metastases were treated with RFA, and one received a liver resection. The treatment was well tolerated with limited side effects. The median follow-up time was 17 months (range 10–36 months), and the median duration of response was 11.2 months (range 8.1 to 24.2 months). One patient achieved a complete response.ConclusionA multimodal treatment approach with CRT in advanced stages of PDNEC in a highly selected patient group is well tolerated and with a high chance of achieving local control and, combined with surgery, even complete response in a single case.

Boucher-Neuhauser Syndrome: Chorioretinal Changes in a Single Case Over Time.

To describe chorioretinal changes in a single case of Boucher-Neuhauser Syndrome (BNHS) over 45 years of follow-up. Methods: Retrospective chart review was performed. Color fundus photography from 1977 to 2003 was obtained and digitized. Current fundus photography was obtained with widefield imaging. High-resolution spectral-domain optical coherence tomography (OCT) was performed. Genetic analysis was performed using an inherited retinal disorders panel. Results: Fundus examination demonstrated central chorioretinal atrophy with sclerotic choroidal vessels. Short posterior ciliary arteries became more prominent and tortuous over time. Mid-peripheral atrophy extends to the equator and demonstrates a scalloped pattern with islands of atrophy intervening with areas of normal retina. The far periphery remained minimally affected. High-resolution OCT demonstrated outer retinal atrophy and choriocapillaris loss. Genetic testing showed a homozygous variant for PNPLA6 and a heterozygous variant for TYRP1. Conclusion: Chorioretinal changes in BNHS vary in onset and severity. It is important to diagnose this condition in order to begin timely management of visual and systemic sequelae.