Anatomic variations of the T2 nerve root (including the nerve of Kuntz) and their implications for sympathectomy

AbstractObjective: The aim of this study was to clarify the anatomic variations of the intrathoracic nerve of Kuntz, and this should help delineate the resection margins during video-assisted thoracic sympathectomy. Methods: Sixty-six thoracic sympathetic chains of 39 adult Korean cadavers were dissected on both sides of the thorax in 27 cadavers (54 sides) and on one side in 12 cadavers (12 sides). Results: The intrathoracic nerve was observed in 45 (68.2%) sides and was present bilaterally in 48.1% of cadavers. No intrathoracic nerve or ascending ramus communicans arising from the second thoracic nerve was observed in only 5 (7.6%) sides. The diameter of the intrathoracic nerve was 1.25 ± 0.55 mm on average. The arising point of the intrathoracic nerve from the second thoracic nerve was 7.3 mm on average from the sympathetic trunk. Presence of the stellate ganglion was noted in 56 (84.8%) sides, and 6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers. It is hoped that this study will help to improve the recurrence of symptoms caused by the intrathoracic nerve in an upper thoracic sympathectomy for hyperhidrosis.J Thorac Cardiovasc Surg 2002;123:498-50

Lipschitz Continuous Autoencoders in Application to Anomaly Detection

Anomaly detection is the task of finding abnormal data that are distinct from normal behavior. Current deep learning-based anomaly detection methods train neural networks with normal data alone and calculate anomaly scores based on the trained model. In this work, we formalize current practices, build a theoretical framework of anomaly detection algorithms equipped with an objective function and a hypothesis space, and establish a desirable property of the anomaly detection algorithm, namely, admissibility. Admissibility implies that optimal autoencoders for normal data yield a larger reconstruction error for anomalous data than that for normal data on average. We then propose a class of admissible anomaly detection algorithms equipped with an integral probability metric-based objective function and a class of autoencoders, Lipschitz continuous autoencoders. The proposed algorithm for Wasserstein distance is implemented by minimizing an approximated Wasserstein distance with a penalty to enforce Lipschitz continuity with respect to Wasserstein distance. Through ablation studies, we demonstrate the efficacy of enforcing Lipschitz continuity of the proposed method. The proposed method is shown to be more effective in detecting anomalies than existing methods via applications to network traffic and image datasets(1).N

The Effect of Differential Modulation of the N-methyl-D-aspartate Receptor on Growth and intracellular Calcium Ion Concentration in Normal Human Oral Keratinocytes

The purpose of this study was to examine the interaction between the agents [N-methyl-D-aspartate (NMDA), arachidonic acid (AA), and Nitric Oxide Synthase Inhibitor (NOS-I)] and cultured normal human oral keratinocytes (NHOK) in order to elucidate the mechanisms by which epithelial growth and regeneration are regulated. We also examined whether AA and NOS-I could protect NHOK from glutamate cytotoxicity and the change of intracellular calcium ion concentration. NHOK were obtained from gingival tissue of 20 individuals aged 20 to 29, and third passage (P3) cells were used for this study. Cell viability was measured by the MTT assay and DNA synthesis by the BrdU assay. The microscopic features of NHOK were observed and changes in intracellular calcium ion concentration were measured. NMDA and NNA induced an initial increase in cell number. Low concentration of AA induced an increase in cell number while high concentrations of AA induced a decrease in cell number. The decrease in cell number induced by NMDA at the seventh day was abolished by the addition of low concentrations of AA or NOS inhibitors. Low concentrations of AA or NMDA with high concentrations of AA significantly increased the DNA synthesis rate at four hours. NMDA and AA both induced an increase in intracellular calcium ion concentration, and AA enhanced NMDA-induced intracellular calcium ion in a concentration-dependent manner. NMDA-induced NHOK death was associated with intracellular calcium ion change and the promotion of cell differentiation. Low concentrations of AA protected NHOK cells from NMDA-induced death.

Correlation between Histological Activity and Endoscopic, Clinical, and Serologic Activities in Patients with Ulcerative Colitis

Objectives. Recent studies suggest that histological healing is a treatment goal in ulcerative colitis (UC). We aimed to evaluate the correlation between histological activity and clinical, endoscopic, and serologic activities in patients with UC. Methods. We retrospectively reviewed medical records from patients with UC who underwent colonoscopy or sigmoidoscopy with biopsies. The Mayo endoscopic subscore was used to assess endoscopic activity. Biopsy specimens were reviewed by two blinded pathologists and scored using the Geboes scoring system. Results. We analyzed 154 biopsy specimens from 82 patients with UC. Histological scores exhibited strong correlation with endoscopic subscores (Spearman’s rank correlation coefficient r=0.774, p<0.001) and moderate correlation with C-reactive protein levels (r=0.422, p<0.001) and partial Mayo scores (r=0.403, p<0.001). Active histological inflammation (Geboes score ≥ 3.1) was observed in 6% (2 of 33) of the endoscopically normal mucosa samples, 66% (19 of 29) of mild disease samples, and 98% (90 of 92) of moderate-to-severe disease samples. Conclusions. Histological activity was closely correlated with the endoscopic, clinical, and serologic UC activities. However, several patients with mild or normal endoscopic findings exhibited histological evidence of inflammation. Therefore, histological assessment may be helpful in evaluating treatment outcomes and determining follow-up strategies

Voxel-Wise Analysis of Diffusion Tensor Imaging for Clinical Outcome of Cochlear Implantation: Retrospective Study

ObjectivesTo evaluate retrospectively, the possible difference in diffusion tensor imaging (DTI) metric of fractional anisotropy (FA) between good and poor surgical outcome cochlear implantation (CI) patients using investigator-independent voxel-wise analysis.MethodsEighteen patients (11 males, 7 females; mean age, 5.9 years) with profound sensorineural hearing loss underwent DTI scans using a 3.0 Tesla magnetic resonance scanner. Among the 18 patients, 10 patients with categories of auditory performance (CAP) score over 6 were classified into the good outcome group and 8 patients with CAP score below 6 were classified into the poor outcome group. The diffusion tensor scalar measure was calculated from the eigenvalues of the tensor on a voxel-by-voxel basis from each subject and two-sample t-test evaluation between good and poor outcome subjects were performed for each voxel of FA values, across the entire brain, with a voxel-wise intensity threshold of P<0.0005 (uncorrected) and a contiguous cluster size of 64 voxels. Individual values of FA were measured by using the region-of-interest based analysis for correlation analysis with CAP scores, open sentence and open word scores.ResultsTwo-sample t-test evaluation using SPM voxel-wise analysis found significantly higher FA values at the several brain areas including Broca's area, genu of the corpus callosum, and auditory tract in good outcome subjects compared to poor outcome subjects. Correlation analyses between FA and CAP scores, open sentence and open word scores revealed strong correlations at medial geniculate nucleus, Broca's area, genu of the corpus callosum and auditory tract.ConclusionInvestigator-independent voxel-based analysis of DTI image demonstrated that good outcome subjects showed better neural integrity at brain areas associated with language and auditory functions, suggesting that the conservation of microstructural integrity of these brain areas is important. Preoperative functional imaging may be helpful for CI