Magnetic Resonance Imaging in Assessing Chemotherapy-Induced Peripheral Neuropathy: Systematic Review

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of many anticancer drugs that may cause various symptoms altering the quality of life. We conducted a systematic review to evaluate the peripheral and central nervous system changes associated with CIPN and detected by magnetic resonance imaging (MRI). Medical literature databases (PubMed, Scopus, Thomson Reuters - Web of Science and Embase) were searched for original studies reporting the use of MRI in the evaluation of CIPN. A total of 31 studies were identified and 9 were eligible for analysis. Results indicate few changes of the peripheral nervous system, most CIPN-associated nervous alterations involving pain processing areas and circuits inside the central nervous system. Distinct patterns of pain processing, changes in cerebral perfusion and gray matter density together with chronic activation of somatosensory areas have been observed in patients with CIPN compared to healthy subjects or cancer patients who did not develop CIPN. Identification of vulnerable brain areas and circuits may indicate future targets for novel therapies directed to prevent or treat CIPN. A preexisting vulnerability suggested by a unique pattern of brain activation following nociceptive stimulation prior to chemotherapy could help identify high-risk individuals, candidates to close monitoring and preventive strategies.</p

Leptin and adiponectin dynamics at patients with rectal neoplasm - Gender differences.

BackgroundNumerous studies associate adipokines with colorectal malignancy, but few data deal with patients suffering exclusively of rectal carcinoma (RC).AimsWe evaluated leptin and adiponectin levels in RC patients compared to healthy population and their dynamics after surgery.Material and methodsSerum leptin and adiponectin were evaluated before surgery in 59 RC consecutive patients (38 males and 21 females), and in age and weight matched healthy controls. Measurements were repeated at 24, 72 hours and 7 days after surgery.ResultsAdipokine levels were higher in women. Controls had higher leptin (32.±4.34 vs 9.51±1.73 ng/ml in women and 11±2.66 vs 2.54±0.39 ng/ml in men, p = 0.00048 and 0.0032) and lower adiponectin (9±0.64 vs 11.85±1.02 μg/ml in women and 7.39±0.51 vs 8.5±0.62 μg/ml in men, p = 0.017 and 0.019) than RC patients. Surgery caused an increase of leptin from 5.11±0.8 to 18.7±2.42 ng/ml, p = 6.85 x 10¨8, and a decrease of adiponectin from 9.71±0.58 to 7.87±0.47 μg/ml, p = 1.4 x 10¨10 for all RC patients and returned thereafter to the initial range at 7 days. Adipokines were correlated with body weight (BW). The significance of correlation persisted after surgery only in males, but disappeared in females. Adipokines were not modified by tumor position, presurgical chemoradiotherapy or surgical technique. Women with RC experiencing weight loss had higher adiponectin than women without weight modifications (pConclusionsAdipokine levels of patients with RC differ from the healthy population, possibly reflecting an adaptation to disease. Adipokine modifications after surgery may be related to acute surgical stress. Whether leptin and adiponectin directly interact is not clear. Women have higher adipokine levels, more so after significant weight loss, but the strength of their correlation with BW decreases after surgery. These data suggest gender differences in the adipokine profile of RC patients which may find clinical applications

The Usefulness of Assessing Heart Rate Variability in Patients with Acute Myocardial Infarction (HeaRt-V-AMI)

Background: Heart rate variability (HRV) could have independent and critical prognostic values in patients admitted for ST segment elevation myocardial infarction (STEMI). There are limited data in the literature regarding HRV assessment in STEMI setting. Thus, we aim to investigate the potential correlations between HRV and adverse outcomes in a contemporary cohort of patients presenting with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods: We will perform a prospective, observational cohort study in a single healthcare center. Adult patients aged ≥18 years presenting with STEMI in sinus rhythm will be enrolled for primary PCI within 12 h from symptoms onset. Time domain, frequency domain, and nonlinear HRV parameters will be measured using a medically approved wrist-wearable device for 5 min segments during myocardial revascularization by primary PCI. Additional HRV measurements will be performed one and six months from the index event. The primary composite outcome will include all-cause mortality and major adverse cardiovascular events (during the hospital stay, one month, and one year following admission). Several secondary outcomes will be analyzed: individual components of the primary composite outcome, target lesion revascularization, hospitalizations for heart failure, ventricular arrhythmias, left ventricular ejection fraction, and left ventricular diastolic function. Conclusions: Our study will enlighten the reliability and usefulness of HRV evaluation as a prognostic marker in contemporary patients with STEMI. The potential validation of HRV as a risk marker for adverse outcomes following STEMI will ensure a background for including HRV parameters in future risk scores and guidelines

Predicting the Feasibility of Curative Resection in Low Rectal Cancer: Insights from a Prospective Observational Study on Preoperative Magnetic Resonance Imaging Accuracy

Background and Objectives: A positive pathological circumferential resection margin is a key prognostic factor in rectal cancer surgery. The point of this prospective study was to see how well different MRI parameters could predict a positive pathological circumferential resection margin (pCRM) in people who had been diagnosed with rectal adenocarcinoma, either on their own or when used together. Materials and Methods: Between November 2019 and February 2023, a total of 112 patients were enrolled in this prospective study and followed up for a 36-month period. MRI predictors such as circumferential resection margin (mCRM), presence of extramural venous invasion (mrEMVI), tumor location, and the distance between the tumor and anal verge, taken individually or combined, were evaluated with univariate and sensitivity analyses. Survival estimates in relation to a pCRM status were also determined using Kaplan–Meier analysis. Results: When individually evaluated, the best MRI predictor for the detection of a pCRM in the postsurgical histopathological examination is mrEMVI, which achieved a sensitivity (Se) of 77.78%, a specificity (Sp) of 87.38%, a negative predictive value (NPV) of 97.83%, and an accuracy of 86.61%. Also, the best predictive performance was achieved by a model that comprised all MRI predictors (mCRM+ mrEMVI+ anterior location+ p Conclusions: The use of selective individual imaging predictors or combined models could be useful for the prediction of positive pCRM and risk stratification for local recurrence or distant metastasis

Halotherapy&mdash;An Ancient Natural Ally in the Management of Asthma: A Comprehensive Review

The increasing production of modern medication emerges as a new source of environmental pollution. The scientific community is interested in developing alternative, ecological therapies in asthma. Halotherapy proved its benefits in asthma diagnosis, treatment, and prevention and may represent a reliable therapeutic addition to the allopathic treatment, due to its ecological and environment-friendly nature, in order to prevent or prolong the time to exacerbations in patients with asthma. We aimed to review up-to-date research regarding halotherapy benefits in asthma comprehensively. We searched the electronic databases of PubMed, MEDLINE, EMBASE for studies that evaluated the exposure of asthmatic patients to halotherapy. Eighteen original articles on asthma were included. Five studies in adults and five in children assessed the performance of hypertonic saline bronchial challenges to diagnose asthma or vocal cord dysfunction in asthmatic patients. Three papers evaluated the beneficial effects of halotherapy on mucociliary clearance in asthmatic adults. The therapeutic effect of halotherapy on acute or chronic asthma was appraised in three studies in adults and one in children. The preventive role was documented in one paper reporting the ability of halotherapy to hinder nocturnal asthma exacerbations. All studies seem to sustain the overall positive effects of halotherapy as adjuvant therapy on asthma patients with no reported adverse events. Halotherapy is a crucial natural ally in asthma, but further evidence-based studies on larger populations are needed

Pulmonary Arterial Hypertension and Adverse Outcomes after Kidney Transplantation: A Systematic Review and Meta-Analysis

Pulmonary arterial hypertension (PH) has a high prevalence in chronic kidney disease (CKD) patients, especially those undergoing kidney transplantation (KT). We aimed to systematically review and calculate the pooled effect size of the literature evaluating the association between pre-existing PH documented by transthoracic echocardiography (TTE) or invasively and adverse outcomes following KT. The primary composite outcome extracted from the included studies was represented by the mortality from any cause following KT and delayed graft function (DGF), graft dysfunction, or graft failure. The secondary outcomes were represented by individual components of the primary composite outcome. Twelve studies meeting the inclusion criteria were selected. The main finding is that pre-existing PH was associated with increased mortality and a higher rate of DGF, kidney graft dysfunction, or failure in KT recipients. The effect remained significant for all outcomes irrespective of PH evaluation, invasively or using TTE. Consequently, patients with PH defined only by TTE were at higher risk of death, DGF, or graft failure. Our findings support the routine assessment of PH in patients on the KT waitlist. PH might represent an extensively available and valuable tool for risk stratification in KT patients. These data should be confirmed in large prospective clinical trials

Pregnancy Outcomes in a Cohort of Patients Who Underwent Double-J Ureteric Stenting—A Single Center Experience

Background and Objectives: Minimally invasive procedures, such as double-J ureteric stenting, could be a promising therapeutic alternative to conservative management of obstructive urinary tract pathology. We aimed to evaluate the safety and effectiveness of double-J ureteric stenting in pregnant women with ureterohydronephrosis or urolithiasis, along with their infectious complications, and to assess the pregnancy outcomes of this cohort of patients in comparison with a control group. Materials and Methods: This observational retrospective study included 52 pregnant patients who underwent double-J ureteric stenting for urologic disorders in the Urology Department of ‘C.I. Parhon’ University Hospital, and who were followed up at a tertiary maternity hospital- ‘Cuza-Voda’, Iasi, Romania. The control group (63 patients) was randomly selected from the patient’s cohort who gave birth in the same time frame at the maternity hospital, without urinary pathology. Clinical, sonographic, and laboratory variables were examined. Descriptive statistics, non-parametric tests, and a one-to-one propensity score-matched analysis were used to analyze our data. Results: The univariate analysis indicated a significant statistical difference between the control group and the interventional group regarding maternal age (p = 0.018), previous maternal history of renal colic (p = 0.005) or nephrolithiasis (p = 0.002). After applying the propensity score-matched analysis, cesarean delivery rates (p p = 0.039), premature rupture of membranes (p = 0.026), preterm birth rates (p = 0.002), and post-partum UTI rates (p = 0.012) were significantly different between the control group and the matched treatment group. Ureterohydronephrosis, whether simple (n = 37; 71.2%) or infected (n = 13; 25%), was the main indication for double-J ureteric stenting. Complications such as pain (n = 21; 40.3%), stent migration (n = 3; 5.76%) or encrustation (n = 2; 3.84%), as well as reflux pyelonephritis (n = 2; 3.84%) and gross hematuria (n = 1; 1.92%) were recorded during follow-up. Conclusions: Our results show that double-J stenting is a safe and effective treatment option for pregnant patients with obstructive urological disorders

Left Atrial Structural Remodelling in Non-Valvular Atrial Fibrillation: What Have We Learnt from CMR?

Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase &ldquo;AF begets AF&rdquo;. A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing

The brainstem and its neurosurgical history

International audienceBrainstem is one of the most complex structures of the human body, and has the most complex intracranial anatomy, which makes surgery at this level the most difficult. Due to its hidden position, the brainstem became known later by anatomists, and moreover, brainstem surgery cannot be understood without knowing the evolution of ideas in neuroanatomy, neuropathology, and neuroscience. Starting from the first attempts at identifying brainstem anatomy in prehistory and antiquity, the history of brainstem discoveries and approach may be divided into four periods: macroscopic anatomy, microscopic anatomy and neurophysiology, posterior fossa surgery, and brainstem surgery. From the first trepanning of the posterior fossa and later finger surgery, to the occurrence of safe entry zones, this paper aims to review how neuroanatomy and brainstem surgery were understood historically, and how the surgical technique evolved from Galen of Pergamon up to the twenty-first century

Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study

Background and Objectives: Acute urologic complications, including bladder and/or ureteric injury, are rare but known events occurring at the time of caesarean section (CS). Delayed or inadequate management is associated with increased morbidity and poor long-term outcomes. We conducted this study to identify the risk factors for urologic injuries at CS in order to inform obstetricians and patients of the risks and allow management planning to mitigate these risks. Materials and Methods: We reviewed all cases of urological injuries that occurred at CS surgeries in a tertiary university centre over a period of four years, from January 2016 to December 2019. To assess the risk factors of urologic injuries, a case-control study of women undergoing caesarean delivery was designed, matched 1:3 to randomly selected women who had an uncomplicated CS. Electronic medical records and operative reports were reviewed for socio-demographic and clinical information. Descriptive and univariate analyses were used to characterize the study population and identify the risk factors for urologic complications. Results: There were 36 patients with urologic complications out of 14,340 CS patients, with an incidence of 0.25%. The patients in the case group were older, had a lower gestational age at time of delivery and their newborns had a lower birth weight. Prior CS was more prevalent among the study group (88.2 vs. 66.7%), as was the incidence of placenta accreta and central praevia. In comparison with the control group, the intraoperative blood loss was higher in the case group, although there was no difference among the two groups regarding the type of surgery (emergency vs. elective), uterine rupture, or other obstetrical indications for CS. Prior CS and caesarean hysterectomy were risk factors for urologic injuries at CS. Conclusions: The major risk factor for urological injuries at the time of CS surgery is prior CS. Among patients with previous CS, those who undergo caesarean hysterectomy for placenta previa central and placenta accreta are at higher risk of surgical haemostasis and complex urologic injuries involving the bladder and the ureters