Background and purpose
The purpose was to report the results of ultrasound‐guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines.
...Methods
Eighteen SMA patients (five children, five adolescents and eight adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound‐guided lumbar puncture. Ultrasound was performed with a 3.5 MHz transducer to guide a 22 gauge × 15 mm needle, which was placed in the posterior lumbar space following a parasagittal interlaminar approach.
Results
Twelve patients had undergone spinal instrumentation (nine growing rods and three spinal fusion) whilst the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescents and 50% of adult patients. In two of the unsuccessfully treated patients, computed tomography and fluoroscopy‐guided transforaminal lumbar punctures were also tried without success. After a median follow‐up of 14 months, only few adverse events, mostly mild, were observed.
Conclusion
The ultrasound‐guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines and could be considered the first option in them.
The administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines is challenging. This study provides Class IV evidence that the ultrasound‐guided lumbar puncture, following an interlaminar parasagittal approach, is safe and effective and could be considered as the first approach, especially in younger SMA patients.
Image reconstruction is an increasingly complex field in CT. Iterative Reconstruction (IR) is at present an adjunct to standard Filtered Back Projection (FBP) reconstruction, but could become a ...replacement for it. Due to its potential for scanning at lower radiation doses, IR has received a lot of attention in the medical literature and all vendors offer commercial solutions. Its use in cardiovascular CT has been driven in part due to concerns about radiation dose and image quality.
This paper is the first manuscript of a pair. It aims to review the basic principles of CT scanning, to describe image reconstruction using Filtered Back Projection, and to identify the physical processes that contribute to image noise which IR may be able to compensate for. The aim is to enable cardiovascular imagers to understand what happens to the raw data prior to the reconstruction process so they may have a better appreciation of the strengths and weaknesses of the various reconstruction techniques available.
The second manuscript of this pair will discuss the various vendor permutations of IR in more detail, including the most recent machine learning based offerings, and critically appraise the current clinical research available on the various IR techniques used in cardiovascular CT.
Human skin mast cells express photoreceptors Siiskonen, H.; Fok, J. S.; Buscone, S. ...
Journal of the European Academy of Dermatology and Venereology,
July 2024, Letnik:
38, Številka:
7
Journal Article
Purinergic signaling is involved in inflammation and cancer. Extracellular ATP accumulates in tumor interstitium, reaching hundreds micromolar concentrations, but its functional role on tumor ...vasculature and endothelium is unknown. Here we show that high ATP doses (>20 μM) strongly inhibit migration of endothelial cells from human breast carcinoma (BTEC), but not of normal human microvascular EC. Lower doses (1-10 μM result ineffective. The anti-migratory activity is associated with cytoskeleton remodeling and is significantly prevented by hypoxia. Pharmacological and molecular evidences suggest a major role for P2X7R and P2Y11R in ATP-mediated inhibition of TEC migration: selective activation of these purinergic receptors by BzATP mimics the anti-migratory effect of ATP, which is in turn impaired by their pharmacological or molecular silencing. Downstream pathway includes calcium-dependent Adenilyl Cyclase 10 (AC10) recruitment, cAMP release and EPAC-1 activation. Notably, high ATP enhances TEC-mediated attraction of human pericytes, leading to a decrease of endothelial permeability, a hallmark of vessel normalization. Finally, we provide the first evidence of in vivo P2X7R expression in blood vessels of murine and human breast carcinoma. In conclusion, we have identified a purinergic pathway selectively acting as an antiangiogenic and normalizing signal for human tumor-derived vascular endothelium.
Subgroups of pro-pPD3-groups Castellano, I.; Zalesskii, P.
Monatshefte für Mathematik,
2021/7, Letnik:
195, Številka:
3
Journal Article
Recenzirano
We study 3-dimensional Poincaré duality pro-
p
groups in the spirit of the work by Robert Bieri and Jonathan Hillmann, and show that if such a pro-
p
group
G
has a nontrivial finitely presented ...subnormal subgroup of infinite index, then either the subgroup is cyclic and normal or the subgroup is cyclic and the group is polycyclic or the subgroup is Demushkin and normal in an open subgroup of
G
. Also, we describe the centralizers of finitely generated subgroups of 3-dimensional Poincaré duality pro-
p
groups.
A CT department's ability to image with low radiation doses is determined primarily by the CT scan protocols and the radiologists' image quality expectations and to a lesser extent by the ...dose-reduction features available. The CT technology level has a smaller influence than might be expected. There are, however, exceptions where dose is directly linked to the scanner's technical capabilities. The key to appropriate image quality with low radiation dose is therefore optimised scan protocols. To optimise effectively, an in-depth understanding of the technical performance of the scanner is required. Therefore, optimisation is best carried out by a multi-disciplinary team that includes radiologists, technologists and medical physics experts. This article describes practical strategies for carrying out such exercises.
To identify clinically occult nipple–areola complex (NAC) involvement using preoperative magnetic resonance imaging (MRI), to inform selection of patients eligible for nipple-sparing mastectomy (NSM) ...or skin-sparing mastectomy (SSM).
This was a retrospective study of 195 patients, who had preoperative breast MRI (February 2011 to January 2017) before undergoing surgical treatments (NSM or SSM) for newly diagnosed breast cancer. Tumour features at MRI (mass or non-mass lesion, diameter, lesion–NAC distance LND) and pathology (lesion diameter, histopathological type, receptor status) were recorded, as well as the type of surgery (NSM/SSM) and presence (NAC+) or absence (NAC–) of tumour at intraoperative evaluation of retroareolar tissue. Mann–Whitney test, Fisher's exact test, logistic regression, and receiver operating characteristic (ROC) curve analysis were used for analysis of NAC+ versus NAC– to assess variables that predict NAC tumoural involvement.
Over the study period, NAC+ was proven histologically in 71/200 (35.5%) surgical treatments, while there were 129/200 NAC– (72 NSM and 128 SSM performed). LND at MRI was statistically (p<0.001) lower in NAC+ patients than in NAC– patients. The area under the ROC curve (0.82, 95% confidence interval CI: 0.76–0.88) indicated 10 mm as the best cut-off, with sensitivity of 82%, specificity of 72%, and accuracy of 79%. A 5-mm cut-off enhanced sensitivity, whereas a 15-mm cut-off favoured specificity.
MRI is a useful tool for identifying NAC+ patients; a 10-mm cut-off for LND assists selection of patients for NSM, although intraoperative retroareolar tissue examination remains mandatory.
•MRI is a useful tool for identifying patients with NAC tumoural involvement.•The discriminating ability of Lesion-to-Nipple distance was good by ROC analysis.•Lesion-to-Nipple distance between 5 and 15 mm allows the selection of patients suitable for NSM.•Intraoperative retroareolar tissue examination remains mandatory.
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