Preoperative Localization of Parathyroid Adenomas Using 4-Dimensional Computed Tomography: A Pictorial Essay

AbstractAccurate preoperative localization is the key to successful parathyroid surgery in the era of minimally invasive parathyroid surgery. This article presents and discusses the embryologic basis of parathyroid gland and ectopic location and different imaging modalities helpful in diagnosing and localizing parathyroid adenomas and/or hyperplasia. We also aim to review the current surgical concepts in treatment of parathyroid adenomas and/or hyperplasia, the utility of 4-dimensional computed tomography for accurate preoperative localization of hyperfunctioning parathyroid glands, imaging classification of adenomas and/or hyperplasia, and, finally, present some of the limitations of 4-dimensional computed tomography

Imaging Findings in Non-Neoplastic Sinonasal Disease: Review of Imaging Features With Endoscopic Correlates

Non-neoplastic sinonasal disease is common and imaging often plays an important role in establishing the proper diagnosis, guiding clinical management, and evaluating for complications. Both computed tomography and magnetic resonance imaging are commonly employed in the imaging evaluation and it is important to understand the imaging characteristics of the unique types of pathology affecting the sinonasal cavities. This article reviews a variety of infectious, inflammatory, and other non-neoplastic sinonasal pathologies, highlighting imaging features that aid in their differentiation

Recurrent Thrombectomy in Patients with Prior Mechanical Endovascular Revascularization: A Single Center Experience

Background: Mechanical endovascular reperfusion therapy (MER) has become the standard of care for treatment of large vessel occlusion (LVO) acute ischemic strokes (AIS) with expansion of treatment window to 24 hours from LNW. Nearly 25% of all stroke patients have a recurrent event within 5 years. Intravenous alteplase use in AIS patients with recent ischemic stroke history is often restricted due to the risk of intracranial hemorrhage, however this may not apply for MER. Bouslama et al found no statistically significant differences in the reperfusion rates, hemorrhagic complications, clinical outcomes, and mortality between patients who underwent repeated thrombectomy (RT) and those who had a single thrombectomy. Methods:This was a retrospective case series study of the endovascular database for patients who underwent RT in our institution from March 2016 till March 2018. Demographic data, clinical presentation, imaging, procedural data and clinical outcomes were evaluated. Results:Of the total 145 patients with AIS that received MER, 8 (5.5%) RT occurred in 5 patients. Mean age was 67 ± 21 years. Four of the five patients were females. All five patients achieved successful reperfusion (TICI 2b-3). Three patients underwent one RT, one had two RT, and one had three RT. The average time between consecutive MER (8 total periods) was 106 days. The time between the first to last MER for each patient ranged from 3 days to 2 years. All patients were optimized on their medical therapy after the first stroke. Four of the five patients (80%) had RT in the same vascular territory. One patient had post-procedure focal high-grade stenosis after the 3rd intervention in the same artery that was treated later with elective angioplasty. One RT was complicated with fatal intracranial hemorrhage due to late presentation despite presence of large area of penumbra. 3 months MRS was 2. Conclusion: In patients presented with recurrent LVO, RT appears to be effective and relatively safe. Based on the available literature, prior MER should not discourage aggressive treatment that may potentially lead to a good clinical outcome. It is unclear if prior MER therapies cause endothelial injury leading to a predilection for local in-situ thrombus or denovo stenosis formation predisposing to re-occlusions. The risk of reperfusion injury in a recently infarcted territory should be weighted carefully when considering as hemorrhagic complications remain possible.https://scholarlycommons.henryford.com/merf2019clinres/1031/thumbnail.jp

Spatio-temporal insights into microbiology of the freshwater-to-hypersaline, oxic-hypoxic-euxinic waters of Ursu Lake

Ursu Lake is located in the Middle Miocene salt deposit of Central Romania. It is stratified, and the water column has three distinct water masses: an upper freshwater-to-moderately saline stratum (0–3 m), an intermediate stratum exhibiting a steep halocline (3–3.5 m), and a lower hypersaline stratum (4 m and below) that is euxinic (i.e. anoxic and sulphidic). Recent studies have characterized the lake's microbial taxonomy and given rise to intriguing ecological questions. Here, we explore whether the communities are dynamic or stable in relation to taxonomic composition, geochemistry, biophysics, and ecophysiological functions during the annual cycle. We found: (i) seasonally fluctuating, light-dependent communities in the upper layer (≥0.987–0.990 water-activity), a stable but phylogenetically diverse population of heterotrophs in the hypersaline stratum (water activities down to 0.762) and a persistent plate of green sulphur bacteria that connects these two (0.958–0.956 water activity) at 3–3.5 to 4 m; (ii) communities that might be involved in carbon- and sulphur-cycling between and within the lake's three main water masses; (iii) uncultured lineages including Acetothermia (OP1), Cloacimonetes (WWE1), Marinimicrobia (SAR406), Omnitrophicaeota (OP3), Parcubacteria (OD1) and other Candidate Phyla Radiation bacteria, and SR1 in the hypersaline stratum (likely involved in the anaerobic steps of carbon- and sulphur-cycling); and (iv) that species richness and habitat stability are associated with high redox-potentials. Ursu Lake has a unique and complex ecology, at the same time exhibiting dynamic fluctuations and stability, and can be used as a modern analogue for ancient euxinic water bodies and comparator system for other stratified hypersaline systems

Repeated Mechanical Endovascular Thrombectomy for Recurrent Large Vessel Occlusion: A Multicenter Experience

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO) stroke. However, little is known about the frequency and outcomes of repeat MT (rMT) for patients with recurrent LVO. METHODS: This is a retrospective multicenter cohort of patients who underwent rMT at 6 tertiary institutions in the United States between March 2016 and March 2020. Procedural, imaging, and outcome data were evaluated. Outcome at discharge was evaluated using the modified Rankin Scale. RESULTS: Of 3059 patients treated with MT during the study period, 56 (1.8%) underwent at least 1 rMT. Fifty-four (96%) patients were analyzed; median age was 64 years. The median time interval between index MT and rMT was 2 days; 35 of 54 patients (65%) experienced recurrent LVO during the index hospitalization. The mechanism of stroke was cardioembolism in 30 patients (56%), intracranial atherosclerosis in 4 patients (7%), extracranial atherosclerosis in 2 patients (4%), and other causes in 18 patients (33%). A final TICI recanalization score of 2b or 3 was achieved in all 54 patients during index MT (100%) and in 51 of 54 patients (94%) during rMT. Thirty-two of 54 patients (59%) experienced recurrent LVO of a previously treated artery, mostly the pretreated left MCA (23 patients, 73%). Fifty of the 54 patients (93%) had a documented discharge modified Rankin Scale after rMT: 15 (30%) had minimal or no disability (modified Rankin Scale score ≤2), 25 (50%) had moderate to severe disability (modified Rankin Scale score 3-5), and 10 (20%) died. CONCLUSIONS: Almost 2% of patients treated with MT experience recurrent LVO, usually of a previously treated artery during the same hospitalization. Repeat MT seems to be safe and effective for attaining vessel recanalization, and good outcome can be expected in 30% of patients

Recent results on heavy-ion induced reactions of interest for neutrinoless double beta decay at INFN-LNS

Abstract. The possibility to use a special class of heavy-ion induced direct reactions, such as double charge exchange reactions, is discussed in view of their application to extract information that may be helpful to determinate the nuclear matrix elements entering in the expression of neutrinoless double beta decay halflife. The methodology of the experimental campaign presently running at INFN - Laboratori Nazionali del Sud is reported and the experimental challenges characterizing such activity are describe

Study of the doubly charmed tetraquark T+cc

Quantum chromodynamics, the theory of the strong force, describes interactions of coloured quarks and gluons and the formation of hadronic matter. Conventional hadronic matter consists of baryons and mesons made of three quarks and quark-antiquark pairs, respectively. Particles with an alternative quark content are known as exotic states. Here a study is reported of an exotic narrow state in the D0D0π+ mass spectrum just below the D*+D0 mass threshold produced in proton-proton collisions collected with the LHCb detector at the Large Hadron Collider. The state is consistent with the ground isoscalar T+cc tetraquark with a quark content of ccu⎯⎯⎯d⎯⎯⎯ and spin-parity quantum numbers JP = 1+. Study of the DD mass spectra disfavours interpretation of the resonance as the isovector state. The decay structure via intermediate off-shell D*+ mesons is consistent with the observed D0π+ mass distribution. To analyse the mass of the resonance and its coupling to the D*D system, a dedicated model is developed under the assumption of an isoscalar axial-vector T+cc state decaying to the D*D channel. Using this model, resonance parameters including the pole position, scattering length, effective range and compositeness are determined to reveal important information about the nature of the T+cc state. In addition, an unexpected dependence of the production rate on track multiplicity is observed

Venous Thrombectomy Sinus Stenting & Thrombectomy

https://scholarlycommons.henryford.com/detstrokeconf2019/1009/thumbnail.jp

Role of pial collateral flow in acute ischemic stroke outcomes.

Objective: In the patients with acute ischemic stroke (AIS) due to middle cerebral artery (MCA) occlusion who underwent endovascular treatment (ET), we explored the relationship between digital subtraction angiography (DSA) pial collateral status and clinical outcomes. Background: Collateral flow can influence the pace and extent of evolution to irreversible tissue damage and thus have a significant impact on the clinical outcome of patients with AIS. Design/Methods: We reviewed the data of all patients with acute MCA occlusion treated with ET within the past 5 years. Baseline DSA collaterals were classified as - no (0), poor (1), intermediate (2) and good (3). Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) at 24-48 hours and at the time of discharge. Multivariable regression analysis was done to evaluate association of DSA collateral score with the outcome. The regression model was adjusted for age, baseline NIHSS, infusion of intravenous (IV) thrombolytic (tPA) and symptom-onset to angiographic recanalization time. Results: 50 patients with the MCA occlusion were treated with ET and 25 (50%) patients received IV tPA prior to ET. Median baseline NIHSS score was 19.5. Median time from the onset to IV tPA was 122 minutes and from onset to angiographic recanalization was 277 minutes. Every 1-point increase in the DSA collateral score was associated with 4.5-point reduction in NIHSS at 24-48 hours and 4.9 point reduction in NIHSS at the time of discharge (standard error 1.4, p\u3c0.01 for both). Conclusions: In the patients with acute ischemic stroke due to MCA occlusion, better collaterals on the DSA are independently associated with improved neurological outcome at 24-48 hour after ET and at the time of discharge. This concept needs to be explored further in a larger dataset that will also include additional imaging parameters