Osteolytic clear cell meningioma of the petrous bone occurring 36 years after posterior cranial fossa irradiation: Case report

Objective and importance While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intraosseous meningiomas are rare and their occurrence in the skull base is an extraordinary exception. Moreover, radiation-induced meningiomas represent a unique clinical dilemma given the fact that patients with these tumors had often received a prior full course of radiotherapy. Clinical presentation A 42-year-old man presented with a 3-month history of progressively worsening facial asymmetry. His medical history was consistent for a posterior cranial fossa irradiation at the age of 6 years for a non-confirmed brain stem tumor. On admission his Karnofsky performance status was graded as 50% and his neurological examination showed a complete right facial nerve paralysis and hearing impairment. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumor invading the whole right petrous bone without intracranial involvement. Intervention As the tumor reached the external auditory canal, a tissue sample was obtained locally. Pathological examination of the lesion identified a grade II clear cell meningioma and the patient was consequently addressed for an intensity modulated radiation therapy. His condition remained unchanged till the most recent follow-up examination, 8 months later. Conclusions To the best of our knowledge, a radiation induced osteolytic clear cell meningioma of the petrous bone has not been previously reported. As little literature exists regarding the use of adjuvant therapies for these tumors, intensity modulated radiation therapy remains an attractive treatment option in case of pervious irradiation and general status alteration

Les cancers de l’orbite etude retrospective à propos de 31 cas

locorégionale rendant le traitement difficile et mutilant. Dans ce travail, nous rapportons notre expérience dans la prise en charge diagnostique et thérapeutique de ces tumeurs. Matériels et méthodes : Notre étude rétrospective a concerné 31 cas de cancers de l’orbite colligés sur 13 ans (1993- 2005). Tous les patients ont bénéficié d’un examen clinique complet, d’une imagerie du massif facial (TDM et/ou IRM) et d’une biopsie de la tumeur. Le traitement a été basé sur la chirurgie, la radiothérapie et/ou la chimiothérapie. Résultats : La symptomatologie clinique était dominée par les signes ophtalmologiques et les algies faciales. L’imagerie a montré dans tous les cas un processus expansif tissulaire à point de départ orbitaire, avec lyse osseuse orbitaire chez 16 patients (51,6%), une extension au massif facial chez 7 patients (22,6%), endocrâniennes chez 6 patients (19,4%) et des formes bilatérales atteignant les deux orbites dans 3 cas (9,7%) l’anatomopathologie montrait une prédominance des lymphomes malins non hodgkiniens (32,3%) et des carcinomes épidermoïdes (32,3%), suivis des rhabdomyosarcomes embryonnaires (19,4 %). Douze patients ont été traités par chirurgie et radiothérapie postopératoire, dix patients par une association radio-chimiothérapie, et neuf autres par une chimiothérapie néo-adjuvante. La survie globale était de 67,8% à 3 ans, 48,4% à 5 ans et 22,6% à 10 ans. Conclusion : Les cancers de l’orbite sont de mauvais pronostic. Un diagnostic précoce et un traitement radical et adapté au type histologique permet d’améliorer la survie et la qualité de vie chez les patients atteints de ces tumeurs.Mots-clés : Orbite, cancer, lymphome, carcinome épidermoïde, rhabdomyosarcom

EEG for good outcome prediction after cardiac arrest: a multicentre cohort study.

AIM Assess the prognostic ability of a non-highly malignant and reactive EEG to predict good outcome after cardiac arrest (CA). METHODS Prospective observational multicentre substudy of the "Targeted Hypothermia versus Targeted Normothermia after Out-of-hospital Cardiac Arrest Trial", also known as the TTM2-trial. Presence or absence of highly malignant EEG patterns and EEG reactivity to external stimuli were prospectively assessed and reported by the trial sites. Highly malignant patterns were defined as burst-suppression or suppression with or without superimposed periodic discharges. Multimodal prognostication was performed 96 hours after CA. Good outcome at 6 months was defined as a modified Rankin Scale score of 0-3. RESULTS 873 comatose patients at 59 sites had an EEG assessment during the hospital stay. Of these, 283 (32%) had good outcome. EEG was recorded at a median of 69 hours (IQR 47-91) after CA. Absence of highly malignant EEG patterns was seen in 543 patients of whom 255 (29% of the cohort) had preserved EEG reactivity. A non-highly malignant and reactive EEG had 56% (CI 50-61) sensitivity and 83% (CI 80-86) specificity to predict good outcome. Presence of EEG reactivity contributed (p<0.001) to the specificity of EEG to predict good outcome compared to only assessing background pattern without taking reactivity into account. CONCLUSION Nearly one-third of comatose patients resuscitated after CA had a non-highly malignant and reactive EEG that was associated with a good long-term outcome. Reactivity testing should be routinely performed since preserved EEG reactivity contributed to prognostic performance

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses.

BACKGROUND: Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. METHODS: We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. RESULTS: We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. CONCLUSIONS: GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities

Adaptive Oblivious Transfer and Generalization

International audienceOblivious Transfer (OT) protocols were introduced in the seminal paper of Rabin, and allow a user to retrieve a given number of lines (usually one) in a database, without revealing which ones to the server. The server is ensured that only this given number of lines can be accessed per interaction, and so the others are protected; while the user is ensured that the server does not learn the numbers of the lines required. This primitive has a huge interest in practice, for example in secure multi-party computation, and directly echoes to Symmetrically Private Information Retrieval (SPIR). Recent Oblivious Transfer instantiations secure in the UC framework suf- fer from a drastic fallback. After the first query, there is no improvement on the global scheme complexity and so subsequent queries each have a global complexity of O(|DB|) meaning that there is no gain compared to running completely independent queries. In this paper, we propose a new protocol solving this issue, and allowing to have subsequent queries with a complexity of O(log(|DB|)), and prove the protocol security in the UC framework with adaptive corruptions and reliable erasures. As a second contribution, we show that the techniques we use for Obliv- ious Transfer can be generalized to a new framework we call Oblivi- ous Language-Based Envelope (OLBE). It is of practical interest since it seems more and more unrealistic to consider a database with uncontrolled access in access control scenarii. Our approach generalizes Oblivious Signature-Based Envelope, to handle more expressive credentials and requests from the user. Naturally, OLBE encompasses both OT and OSBE, but it also allows to achieve Oblivious Transfer with fine grain access over each line. For example, a user can access a line if and only if he possesses a certificate granting him access to such line. We show how to generically and efficiently instantiate such primitive, and prove them secure in the Universal Composability framework, with adaptive corruptions assuming reliable erasures. We provide the new UC ideal functionalities when needed, or we show that the existing ones fit in our new framework. The security of such designs allows to preserve both the secrecy of the database values and the user credentials. This symmetry allows to view our new approach as a generalization of the notion of Symmetrically PIR

Contributing factors affecting the prognosis surgical outcome for thoracic OLF

The thoracic ossification of ligamentum flavum (OLF) is a disease that produces spastic paraparesis, and there are various factors that may affect the surgical outcome of thoracic OLF patients. The authors of this study treated 19 of these thoracic OLF patients from 1998 to 2002, and retrospectively reviewed the patients′ age, sex, symptom duration, involved disease level, preoperative clinical features, neurological findings, radiological findings, the other combined spinal diseases and the surgical outcomes. There were excellent or good surgical outcomes in 16 patients, but 3 patients did not improve after thoracic OLF surgery: this included 1 patient, whose motor function worsened after decompressive thoracic OLF surgery. The favorable contributing factors of surgical outcome in thoracic OLF are a short preoperative symptom duration, single-level lesion, and unilateral lesion type on CT axial scan. On the contrary, the poor prognostic factors are beak type lesion and intramedullary signal changes on T2-weighted sagittal MRI. The complete preoperative evaluation including radiologic findings will provide valuable aid in presuming the surgical outcome for the thoracic OLF patients.ope

Evidence for Widespread Genomic Methylation in the Migratory Locust, Locusta migratoria (Orthoptera: Acrididae)

The importance of DNA methylation in mammalian and plant systems is well established. In recent years there has been renewed interest in DNA methylation in insects. Accumulating evidence, both from mammals and insects, points towards an emerging role for DNA methylation in the regulation of phenotypic plasticity. The migratory locust (Locusta migratoria) is a model organism for the study of phenotypic plasticity. Despite this, there is little information available about the degree to which the genome is methylated in this species and genes encoding methylation machinery have not been previously identified. We therefore undertook an initial investigation to establish the presence of a functional DNA methylation system in L. migratoria. We found that the migratory locust possesses genes that putatively encode methylation machinery (DNA methyltransferases and a methyl-binding domain protein) and exhibits genomic methylation, some of which appears to be localised to repetitive regions of the genome. We have also identified a distinct group of genes within the L. migratoria genome that appear to have been historically methylated and show some possible functional differentiation. These results will facilitate more detailed research into the functional significance of DNA methylation in locusts

Intra-household agreement of urinary elemental concentrations in Tanzania and Kenya: potential surrogates in case–control studies

Element deficiencies and excesses play important roles in non-communicable disease aetiology. When investigating their roles in epidemiologic studies without prospective designs, reverse-causality limits the utility of transient biomarkers in cases. This study aimed to investigate whether surrogate participants may provide viable proxies by assessing concentration correlations within households. We obtained spot urine samples from 245 Tanzanian and Kenyan adults (including 101 household pairs) to investigate intra-household correlations of urinary elements (As, Ba, Ca, Cd, Co, Cs, Cu, Fe, Li, Mn, Mo, Ni, Pb, Rb, S, Se, Sr, Tl, V and Zn) and concentrations (also available for: Bi, Ce, Sb, Sn and U) relative to external population-levels and health-based values. Moderate-strong correlations were observed for As (r = 0.65), Cs (r = 0.67), Li (r = 0.56), Mo (r = 0.57), Se (r = 0.68) and Tl (r = 0.67). Remaining correlations were <0.41. Median Se concentrations in Tanzania (29 µg/L) and Kenya (24 µg/L) were low relative to 5738 Canadians (59 µg/L). Exceedances (of reference 95th percentiles) were observed for: Co, Mn, Mo, Ni and U. Compared to health-based values, exceedances were present for As, Co, Mo and Se but deficiencies were also present for Mo and Se. For well correlated elements, household members in East African settings provide feasible surrogate cases to investigate element deficiencies/excesses in relation to non-communicable diseases