Rapid and Reversible Recruitment of Early Visual Cortex for Touch

The loss of vision has been associated with enhanced performance in non-visual tasks such as tactile discrimination and sound localization. Current evidence suggests that these functional gains are linked to the recruitment of the occipital visual cortex for non-visual processing, but the neurophysiological mechanisms underlying these crossmodal changes remain uncertain. One possible explanation is that visual deprivation is associated with an unmasking of non-visual input into visual cortex.We investigated the effect of sudden, complete and prolonged visual deprivation (five days) in normally sighted adult individuals while they were immersed in an intensive tactile training program. Following the five-day period, blindfolded subjects performed better on a Braille character discrimination task. In the blindfold group, serial fMRI scans revealed an increase in BOLD signal within the occipital cortex in response to tactile stimulation after five days of complete visual deprivation. This increase in signal was no longer present 24 hours after blindfold removal. Finally, reversible disruption of occipital cortex function on the fifth day (by repetitive transcranial magnetic stimulation; rTMS) impaired Braille character recognition ability in the blindfold group but not in non-blindfolded controls. This disruptive effect was no longer evident once the blindfold had been removed for 24 hours.Overall, our findings suggest that sudden and complete visual deprivation in normally sighted individuals can lead to profound, but rapidly reversible, neuroplastic changes by which the occipital cortex becomes engaged in processing of non-visual information. The speed and dynamic nature of the observed changes suggests that normally inhibited or masked functions in the sighted are revealed by visual loss. The unmasking of pre-existing connections and shifts in connectivity represent rapid, early plastic changes, which presumably can lead, if sustained and reinforced, to slower developing, but more permanent structural changes, such as the establishment of new neural connections in the blind

ENSAT registry-based randomized clinical trials for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is an orphan disease lacking effective systemic treatment options. The low incidence of the disease and high cost of clinical trials are major obstacles in the search for improved treatment strategies. As a novel approach, registry-based clinical trials have been introduced in clinical research, so allowing for significant cost reduction, but without compromising scientific benefit. Herein, we describe how the European Network for the Study of Adrenal Tumours (ENSAT) could transform its current registry into one fit for a clinical trial infrastructure. The rationale to perform randomized registry-based trials in ACC is outlined including an analysis of relevant limitations and challenges. We summarize a survey on this concept among ENSAT members who expressed a strong interest in the concept and rated its scientific potential as high. Legal aspects, including ethical approval of registry-based randomization were identified as potential obstacles. Finally, we describe three potential randomized registry-based clinical trials in an adjuvant setting and for advanced disease with a high potential to be executed within the framework of an advanced ENSAT registry. Thus we, therefore, provide the basis for future registry-based trials for ACC patients. This could ultimately provide proof-of-principle of how to perform more effective randomized trials for an orphan disease

Large adrenal tumor in a 76-year-old man

Among various adrenal tumors, metastatic ones are the most common. PET/CT scanning facilitates early detection. Occurrence of isolated and synchronous metastasis is very rare and poses serious diagnostic and therapeutic challenges. © 2021 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd

Intravascular B-large cell lymphoma: An unexpected diagnosis of an incidental adrenal mass

Adrenal incidentalomas originally defined as tumors discovered serendipitously in the course of diagnostic evaluation or follow-up of unrelated disorders, may occasionally pose serious diagnostic challenges. Intravascular large B-cell lymphoma (IVLBCL) may be a rare example of such a case. We present an IVLBCL confined to the adrenal gland in a 52-year-old man focusing on its diagnostic and therapeutic aspects. On endocrine work up, the tumor was hormonally inactive and exhibited inconclusive imaging characteristics without signs of locoregional spread. After a left laparoscopic adrenalectomy, histologic sections revealed the presence of tumor cells inside dilated, thin-walled vascular spaces. Immunohistochemical stains confirmed the diagnosis of IVLBCL. The patient was then referred to a Hematology Unit for further staging and treatment and received six cycles of R-CHOP. Despite the fact that IVLBCL carries a dismal prognosis our patient remains alive and in complete remission 6 years after the initial diagnosis. © The Author(s) 2019

Carney syndrome presented as a pathological spine fracture in a 35-year-old male

Patient: Male, 35 Final Diagnosis: Carney syndrome Symptoms: Pain at the spine Medication: — Clinical Procedure: Retroperitoneal adrenalectomy Specialty: Surgery Objective: Background: Case Report: Conclusions: Congenital defects/diseases Carney complex (CNC) is a genetic disorder that presents as an adrenocorticotropic hormone (ACTH)-independent variant of endogenous Cushing syndrome. It was first reported in 1985 and was described as a form of multiple endocrine hyperplasia associated with mutations of the c-AMP-dependent protein kinase (PRKAR1A) gene that causes bilateral adrenal hyperplasia. We report a case of an incidentally found CNC in a 35-year-old male, and this case report focuses on the diagnostic scheme as well as the surgical treatment of this rare challenging condition. A-35-year-old male presented with pathological thoracic spine fracture. The patient exhibited obesity, facial flushing, red-purplish streaks on the abdominal wall, multiple pigmented nevi of the trunk, and hypertension. Family history was positive for cardiac myxoma. Laboratory investigation showed ACTH-independent Cushing syndrome. Abdominal magnetic resonance imaging and computed tomography scan showed bilateral adrenal hyperplasia. The ensuing Liddle test revealed the characteristic paradox increase of 24-hours urine cortisol for CNC. After a bilateral retroperitoneoscopic adrenalectomy, histologic examination confirmed the presence of bilateral primary pigmented nodular adrenocortical disease (PPNAD). Genetic testing revealed a unique mutation of the responsible PRKAR1A gene. CNC presence was suspected due to the family history. Its characteristic pathologic manifestation called PPNAD, clinically presents as an ACTH-independent Cushing syndrome with paradoxical positive response of urinary glucocorticosteroid excretion after dexamethasone administration (Liddle’s test). Bilateral retroperitoneoscopic adrenalectomy constitutes an acceptable surgical option for PPNAD. © Am J Case Rep, 2018;

Natural time analysis in financial markets

In this paper we introduce natural time analysis in financial markets. Due to the remarkable results of this analysis on earthquake prediction and the similarities of earthquake data to financial time series, its application in price prediction and algorithmic trading seems to be a natural choice. This is tested through a trading strategy with very encouraging results. © 2016-IOS Press and the authors. All rights reserved

Classic Primary Hyperparathyroidism Versus Normocalcemic and Normohormonal Variants: Do They Really Differ?

Background: Normocalcemic (NCpHPT) and normohormonal (NHpHPT) variants have been recognized primary hyperparathyroidism entities that pose serious challenges. We sought to define the differences among them in a series of surgically treated patients. Patients and methods: Between 2011 and 2015, 149 patients were enrolled into three groups: CpHPT (Ca CloseSPigtSPi 10.2 mg/dL, PTH CloseSPigtSPi 65 pg/mL), NCpHPT (normal Ca, PTH CloseSPigtSPi 65 pg/mL) and NHpHPT (Ca CloseSPigtSPi 10.2 mg/dL, normal PTH). Descriptive statistics and inter-group differences were computed, whereas multiple logistic/linear regression tests were used for further analysis. Results: Of these patients 125 were female and 24 male, mean age 56.3 years (range 8–83). A total of 115 (77.2%) patients presented with CpHPT, 23 (15.4%) with NCpHPT and 11 (7.4%) with NHpHPT. MGD was found in 25 (16.8%) patients and SGD in 124 (83.2%); multivariate analysis failed to reveal statistically significant association of MGD with any pHPT variant (CpHPT 16.5% vs NCpHPT 21.7% vs NHpHPT 9.1%, p = 0.726). Conversely, NCpHPT patients exhibited statistically significant smaller adenoma weight (p = 0.023). Moreover, U/S in these patients had smaller positive predictive value (p = 0.278), whereas concordance between U/S and MIBI was also lower (p = 0.669). The utility of MIBI and U/S differed significantly (p OpenSPiltSPi 0.001); more frequent use of U/S was observed for all groups. However, their predictive values did not differ significantly (p = 0.832). Conclusions: NCpHPT is more similar than different to CpHPT. NCpHPT constitutes the most challenging entity: it is associated with smaller adenoma weight, whereas U/S exhibited lower positive predictive value and lower concordance rate with MIBI. A trend for higher MGD presence in this group of patients was observed, though without statistical significance. © 2018, Société Internationale de Chirurgie