Introduction
Primary central nervous system (CNS) involvement of Hodgkin's lymphoma is very uncommon. There are only a few previous reports of Hodgkin's lymphoma of nodular lymphocyte predominant ...histology involving the CNS concurrently with systemic disease.
Case presentation
A 12-year-old boy with a history of painless left inguinal swelling and acute diplopia. There was an intensely enhancing lesion in the right midbrain on magnetic resonance imaging. The patient was diagnosed with stage IV Hodgkin's lymphoma of nodular lymphocyte predominance type by routine microscopy and immunohistochemistry of left inguinal lymph node biopsy with computed tomography-assisted staging. It was planned to treat him with six cycles of chemotherapy with intrathecal methotrexate, followed by radiotherapy to the CNS lesions. After two cycles of chemotherapy, the patient entered complete remission of all lesions including the CNS lesion documented by the positron emission tomography scan.
Conclusion
We are describing the course of this rare presentation of Hodgkin's lymphoma of nodular lymphocyte predominant histology involving the CNS and clinical challenge in its diagnosis and management of this case.
Background: There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden ...change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. Methods: This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6–9 months) and late follow-up (9–16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. Results: The overall portomesenteric thrombosis burden improved in eight (72%) TIPS patients, three (27%) anticoagulated patients, and two (10%) untreated patients at early follow-up (p = 0.001) and in seven (78%) TIPS patients, two (29%) anticoagulated patients, and three (17%) untreated patients in late follow-up (p = 0.007). No bleeding complications attributable to anticoagulation were observed. Conclusion: TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.
•Reddit is one of the most popular websites in the world, with a layout that allows users to post and discuss content in a unique message-board format; novice users can create impactful posts that ...reach a large audience.•Radiology-related posts to the r/radiology and r/medicine subreddits were most frequently submitted by physicians, but radiologists were a minority within this group (30%).•Posts by physicians had significantly more popularity “points” and comments than half of other users (p= <0.01-0.04), highlighting a high-yield opportunity for radiologist engagement.•Reddit was used as an educational tool to share imaging case presentations, featuring a variety of subspecialties and imaging modalities, and as a tool for physician-to-physician consultations.•Posts relating to wellness and burnout had significantly more points and comments than 15 of 15 and 14 of 15 other post types (P = <0.01-0.03).
Social media use in radiology has been well documented, primarily pertaining to Twitter and Facebook. We evaluated radiology-related posts and users on Reddit, a popular platform with users who post and discuss content in a message-board format.
Two subreddits were reviewed: r/radiology (top 100 posts) and r/medicine (search queries: radiology, x-ray, CT scan, MRI, ultrasound, PET scan, and mammogram). Post aims and user types were categorized. Kruskal-Wallis H and post-hoc pairwise Mann-Whitney U tests were performed to assess user and post types associated with greater post comments and points.
A total of 323 posts submitted by 258 unique users over a 9 year period with a median of 21 comments (range 0-568) and 119 points (0-1877) were reviewed. These were most commonly posted by physicians (41%), radiologic technologists (18%), and medical students (12%). Radiologists represented 30% of physicians and 12% of all users. Posts by physicians had significantly higher median comments and points than half of other user categories (P = <0.01-0.04). Most posts related to imaging case presentations (25%), comedic content (18%), and imaging appropriateness (10%). The most common radiology subspecialties featured were musculoskeletal (26%), neuroradiology (22%), abdominal (21%), and cardiothoracic (20%). Although only 1% of posts featured wellness and burnout, they had significantly higher median comments and points than 14 of 15 and 15 of 15 other post categories, respectively (P = <0.01-0.03).
Reddit hosts a diverse community providing an interface for education, consultation, and humor. Radiologists represent a small, although impactful, portion of this community and should embrace Reddit as an avenue for engagement.
Abstract Purpose Medical societies are incorporating Twitter to communicate with their members and connect with patients. This study compares the online presence of 3 major oncologic societies. ...Methods and materials All available tweets in 2014 by the American Society for Radiation Oncology (ASTRO), American Society of Clinical Oncology (ASCO), and Society of Surgical Oncology (SSO) were collected. We analyzed whether posts were original content or retweets. The monthly tweet rate was followed to assess trends. We created 2 new metrics, supporter ratio and tweet density, to correlate online presence and engagement with offline membership breadth. The supporter ratio is the number of people following the organization divided by the number of registered members of each society. The tweet density is the total number of posts divided by the number of registered members of each society. Results In February 2015, ASCO, ASTRO, and SSO had 36,385; 10,899; and 2721 members, respectively. ASCO's Twitter handle had 33,974 followers, with a supporter ratio of 0.93. A total of 2563 original tweets and 1416 retweets were estimated, which represents a tweet density of 0.11. @ASTRO_org had 5445 followers and a supporter ratio of 0.50. In 2014, ASTRO posted 415 original content tweets and 9 retweets, with a tweet density of 0.039. SSO had a supporter ratio of 0.91 on the basis of 2481 followers. In 2014, SSO posted 207 original tweets and 190 retweets, with a tweet density of 0.15. An increase in tweets and retweets was seen during the month of each society's annual meeting. ASTRO's 61% increase in September 2014 was smaller than SSO's 462% and ASCO's 84%. Conclusion ASTRO's use of Twitter lags behind ASCO and SSO. Although all 3 societies show increased Twitter use during their annual meetings, they should work toward more meaningful engagement throughout the year. The new metrics of tweet density and supporter ratio will serve as benchmarks for member engagement in future studies.
Pulsatile blood flow in the human carotid artery bifurcation has been simulated by solving the incompressible Navier–Stokes equations. Subject-specific data were obtained from two volunteers. ...Threedimensional vascular geometry was extracted from magnetic resonance imaging scans and periodic velocity profiles were constructed using Doppler ultrasonography and used as boundary conditions. Flow separation and associated reversed wall shear stress were observed in some bifurcations. Even mild stenoses that do not affect the overall blood flow were associated with a significant local flow alteration.
We report a case of fungal retinal vasculitis in a 32 week gestational age, 1200 g premature infant detected during routine screening for retinopathy of prematurity at 78 days of age. The patient ...subsequently developed sepsis with perinephric abscess but responded rapidly to systemic therapy. Fortuitous detection of retinal vasculitis as the first evidence of a systemic fungal infection in an immunocompetent and asymptomatic infant has not, to our knowledge, been previously reported.
Critical changes in protein expression that enable tumors to initiate and progress originate in the local tissue microenvironment, and there are increasing indications that these microenvironmental ...alterations in protein expression play critical roles in shaping and directing this process. As a model to better understand how patterns of protein expression shape the tissue microenvironment, we analyzed protein expression in tissue derived from squamous cell carcinoma of the oral cavity through an antibody microarray approach for high‐throughput proteomic analysis. Utilizing laser capture microdissection to procure total protein from specific microscopic cellular populations, we demonstrate that quantitative, and potentially qualitative, differences in expression patterns of multiple proteins within epithelial cells reproducibly correlate with oral cavity tumor progression. Furthermore, differential expression of multiple proteins was also found in stromal cells surrounding and adjacent to regions of diseased epithelium that directly correlated with tumor progression of the epithelium. Most of the proteins identified in both cell types are involved in signal transduction pathways, thus we hypothesize that extensive molecular communication involving complex cellular signaling between epithelium and stroma play a key role in driving oral cavity cancer progression.
The H6 homeobox genes Hmx1, Hmx2, and Hmx3 (also known as Nkx5-3; Nkx5-2 and Nkx5-1, respectively), compose a family within the NKL subclass of the ANTP class of homeobox genes. Hmx gene family ...expression is mostly limited to sensory organs, branchial (pharyngeal) arches, and the rostral part of the central nervous system. Targeted mutation of either Hmx2 or Hmx3 in mice disrupts the vestibular system. These tandemly duplicated genes have functional overlap as indicated by the loss of the entire vestibular system in double mutants. Mutants have not been described for Hmx1, the most divergent of the family.
Dumbo (dmbo) is a semi-lethal mouse mutation that was recovered in a forward genetic mutagenesis screen. Mutants exhibit enlarged ear pinnae with a distinctive ventrolateral shift. Here, we report on the basis of this phenotype and other abnormalities in the mutant, and identify the causative mutation as being an allele of Hmx1. Examination of dumbo skulls revealed only subtle changes in cranial bone morphology, namely hyperplasia of the gonial bone and irregularities along the caudal border of the squamous temporal bone. Other nearby otic structures were unaffected. The semilethality of dmbo/dmbo mice was found to be ~40%, occured perinatally, and was associated with exencephaly. Surviving mutants of both sexes exhibited reduced body mass from ~3 days postpartum onwards. Most dumbo adults were microphthalmic. Recombinant animals and specific deletion-bearing mice were used to map the dumbo mutation to a 1.8 Mb region on Chromosome 5. DNA sequencing of genes in this region revealed a nonsense mutation in the first exon of H6 Homeobox 1 (Hmx1; also Nkx5-3). An independent spontaneous allele called misplaced ears (mpe) was also identified, confirming Hmx1 as the responsible mutant gene.
The divergence of Hmx1 from its paralogs is reflected by different and diverse developmental roles exclusive of vestibular involvement. Additionally, these mutant Hmx1 alleles represent the first mouse models of a recently-discovered Oculo-Auricular syndrome caused by mutation of the orthologous human gene.
To uncover transcriptional stress responses related to p53, we used cDNA microarrays (National Cancer Institute Oncochips comprising 6500 different genes) to characterize the gene expression profiles ...of wild-type p53 HCT-116 cells and an isogenic p53 knockout counterpart after treatment with topotecan, a specific topoisomerase I inhibitor. The use of the p53 knockout cells had the advantage over p53-overexpressing systems in that p53 activation is mediated physiologically. RNA was extracted after low (0.1 microM)- and high (1 microM)-dose topotecan at multiple time points within the first 6 h of treatment. To facilitate simultaneous study of the p53 status and pharmacological effects on gene expression, we developed a novel "cross-referenced network" experimental design and used multiple linear least squares fitting to optimize estimates of relative transcript levels in the network of experimental conditions. Approximately 10% of the transcripts were up- or down-regulated in response to topotecan in the p53+/+ cells, whereas only 1% of the transcripts changed in the p53-/- cells, indicating that p53 has a broad effect on the transcriptional response to this stress. Individual transcripts and their relationships were analyzed using clustered image maps and by a novel two-dimensional analysis/visualization, gene expression map, in which each gene expression level is represented as a function of both the genotypic/phenotypic difference (i.e., p53 status) and the treatment effect (i.e., of topotecan dose and time of exposure). Overall, drug-induced p53 activation was associated with a coherent genetic program leading to cell cycle arrest and apoptosis. We identified novel p53-induced and DNA damage-induced genes (the proapoptotic SIVA gene and a set of transforming growth factor beta-related genes). Genes induced independently of p53 included the antiapoptotic cFLIP gene and known stress genes related to the mitogen-activated protein kinase pathway and the Fos/Jun pathway. Genes that were negatively regulated by p53 included members of the antiapoptotic protein chaperone heat shock protein 70 family. Finally, among the p53-dependent genes whose expression was independent of drug treatment was S100A4, a small Ca(2+)-binding protein that has recently been implicated in p53 binding and regulation. The new experimental design and gene expression map analysis introduced here are applicable to a wide range of studies that encompass both treatment effects and genotypic or phenotypic differences.
This study aimed to compare the image quality of portal venous phase-derived virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) with energy-integrating dual-energy ...computed tomography (EI-DECT) in the same patient using quantitative and qualitative analyses.
Consecutive patients retrospectively identified with available portal venous phase-derived VNC images from both PCCT and EI-DECT were included. Patients without available VNC in picture archiving and communication system in PCCT or prior EI-DECT and non-portal venous phase acquisitions were excluded. Three fellowship-trained radiologists blinded to VNC source qualitatively assessed VNC images on a 5-point scale for overall image quality, image noise, small structure delineation, noise texture, artifacts, and degree of iodine removal. Quantitative assessment used region-of-interest measurements within the aorta at 4 standard locations, both psoas muscles, both renal cortices, spleen, retroperitoneal fat, and inferior vena cava. Attenuation (Hounsfield unit), quantitative noise (Hounsfield unit SD), contrast-to-noise ratio (CNR) (CNR vascular , CNR kidney , CNR spleen , CNR fat ), signal-to-noise ratio (SNR) (SNR vascular , SNR kidney , SNR spleen , SNR fat ), and radiation dose were compared between PCCT and EI-DECT with the Wilcoxon signed rank test. A P < 0.05 indicated statistical significance.
A total of 74 patients (27 men; mean ± SD age, 63 ± 13 years) were included. Computed tomography dose index volumes for PCCT and EI-DECT were 9.2 ± 3.5 mGy and 9.4 ± 9.0 mGy, respectively ( P = 0.06). Qualitatively, PCCT VNC images had better overall image quality, image noise, small structure delineation, noise texture, and fewer artifacts (all P < 0.00001). Virtual noncontrast images from PCCT had lower attenuation (all P < 0.05), noise ( P = 0.006), and higher CNR ( P < 0.0001-0.04). Contrast-enhanced structures had lower SNR on PCCT ( P = 0.001, 0.002), reflecting greater contrast removal. The SNRfat (nonenhancing) was higher for PCCT than EI-DECT ( P < 0.00001).
Virtual noncontrast images from PCCT had improved image quality, lower noise, improved CNR and SNR compared with those derived from EI-DECT.
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