Dandy-Walker malformation: is the "tail sign" the key sign?

OBJECTIVE.To demonstrate the value of the "tail sign" in the assessment of Dandy-Walker Malformation (DWM). METHODS: A total of 31fetal MRI, performed before 24 weeks of gestation after second-line US examination between May 2013 and September 2014, were examined retrospectively. All MRI examinations were performed using a 1.5 Tesla magnet without maternal sedation. RESULTS: MRI diagnosed 15/31 cases of Dandy-Walker Malformation, 6/31 cases of vermian partial caudal agenesis, 2/31 of vermian hypoplasia, 4/31 of vermian malrotation, 2/31 of Walker-Warburg Syndrome, 1/31 of Blake pouch cyst, 1/31 of rhombencephalosynapsis. All data were compared with fetopsy results, Fetal MR after the 30th week or postnatal MRI; the follow up depended on the maternal decision to terminate or continue pregnancy. In our review study we found the presence of the "tail sign"; this sign was visible only in Dandy-Walker Malformation and Walker-Warburg Syndrome. CONCLUSION: The "tail sign" could be helpful in the difficult differential diagnosis between Dandy Walker, vermian malrotation, vermian hypoplasia and vermian partial agenesis

The 'full-blown' MRI of sudden hearing loss: 3D FLAIR in a patient with bilateral metastases in the internal auditory canals

We report a case of a 57-year-old man with bilateral masses in the internal auditory canal. The peculiar findings at magnetic resonance imaging with tridimensional fluid-attenuated inversion recovery sequence combined with clinical data provided new insights into understanding the pathophysiology of the hearing loss

Comparison of intrascalar location of straight vs perimodiolar electrode array by flat-panel computerized tomography

Introduction, One of the fields of technological advancement in cochlear implants (CI) pursued by all manufacturers is the development of less traumatic electrodes that can conform to the anatomy of the cochlea, and possibly enhance the outcomes. Recently, a slim precurved perimodiolar electrode with an insertion guidance sleeve has been designed in order to facilitate the insertion and to avoid the inter-scalar dislodgement that frequently occurs at the first basal turn. Aim of this study was to evaluate the intracochlear position of different Nucleus electrode arrays in aduld and pediatric CI recipients by means of flat-panel volume computerized tomography (FPCT). Methods, Fifty-six CI recipients (37 females, 19 males), 1 to 80 years of age, operated by the same surgeon with the same technique, were included. All underwent FPCT with a C-arm angiographic system including a digital flat panel detector 30 x 40 cm, with a source-to-image-receptor distance of 120cm. The imaging assessment was performed the day after surgery in all cases. Sequential and simultaneous CI were included and a total of 68 ears have been analyzed. The primary objective was to identify the scalar location of the array (completely in scala tympani vs. partially dislodged in scala vestibuli) and the site of dislocation. Secondarily, we measured the medial-lateral position within the scala, the insertion depth (mm and angles). The FPCT findings were also contrasted with the type of cochleostomy (round window (RW), extended RW, promontorial) and with the residual hearing preservation. Results, Fifty-nine ears were implanted with a perimodiolar electrode, either Nucleus CI532 (n=45) or a CI412 / CI512 Contour Advance (n=14), while 9 received a straight one (Nucleus CI422/CI522). A RW approach was performed more frequently (41 out of 45 = 91.1 %) with CI532 than with the other arrays (10 out of 23 = 43.5%). Inferior and/or anterior cochleostomy were never performed. The CI532 showed the most consistent and reliable intrascalar position, close to the modiolus and in the scala tympani. Scala vestibuli dislodgement was observed in (14.3%) of the Contour Advance electrodes and in (6.7%) of the CI532. Pre-operative residual hearing was preserved within 10 dB HL in 62% of the cases. Conclusions: the CI532 electrode array achieved the most consistent and reliable perimodiolar location by FPCT; in our small series it appeared to be dislodged in the scala tympani in the minority of cases

Optimizing Two-Color Semiconductor Nanocrystal Immunoassays in Single Well Microtiter Plate Formats

The simultaneous detection of two analytes, chicken IgY (IgG) and Staphylococcal enterotoxin B (SEB), in the single well of a 96-well plate is demonstrated using luminescent semiconductor quantum dot nanocrystal (NC) tracers. The NC-labeled antibodies were prepared via sulfhydryl-reactive chemistry using a facile protocol that took <3 h. Dose response curves for each target were evaluated in a single immunoassay format and compared to Cy5, a fluorophore commonly used in fluorescent immunoassays, and found to be equivalent. Immunoassays were then performed in a duplex format, demonstrating multiplex detection in a single well with limits of detection equivalent to the single assay format: 9.8 ng/mL chicken IgG and 7.8 ng/mL SEB

Mother-child histocompatibility and risk of rheumatoid arthritis and systemic lupus erythematosus among mothers.

The study objective was to test the hypothesis that having histocompatible children increases the risk of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), possibly by contributing to the persistence of fetal cells acquired during pregnancy. We conducted a case control study using data from the UC San Francisco Mother Child Immunogenetic Study and studies at the Inova Translational Medicine Institute. We imputed human leukocyte antigen (HLA) alleles and minor histocompatibility antigens (mHags). We created a variable of exposure to histocompatible children. We estimated an average sequence similarity matching (SSM) score for each mother based on discordant mother-child alleles as a measure of histocompatibility. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals. A total of 138 RA, 117 SLE, and 913 control mothers were analyzed. Increased risk of RA was associated with having any child compatible at HLA-B (OR 1.9; 1.2-3.1), DPB1 (OR 1.8; 1.2-2.6) or DQB1 (OR 1.8; 1.2-2.7). Compatibility at mHag ZAPHIR was associated with reduced risk of SLE among mothers carrying the HLA-restriction allele B*07:02 (n = 262; OR 0.4; 0.2-0.8). Our findings support the hypothesis that mother-child histocompatibility is associated with risk of RA and SLE

MR Imaging in Menière Disease: Is the Contact between the Vestibular Endolymphatic Space and the Oval Window a Reliable Biomarker?

BACKGROUND AND PURPOSE: No reliable MR imaging marker for the diagnosis of Meniere disease has been reported. Our aim was to investigate whether the obliteration of the inferior portion of the vestibule and the contact with the stapes footplate by the vestibular endolymphatic space are reliable MR imaging markers in the diagnosis of Meniere disease. MATERIALS AND METHODS: We retrospectively enrolled 49 patients, 24 affected by unilateral sudden hearing loss and 25 affected by definite Meniere disease, who had undergone a 4-hour delayed 3D-FLAIR sequence. Two readers analyzed the MR images investigating whether the vestibular endolymphatic space bulged in the third inferior portion of the vestibule contacting the stapes footplate. This sign was defined as the vestibular endolymphatic space contacting the oval window. RESULTS: We analyzed 98 ears: 27 affected by Meniere disease, 24 affected by sudden sensorineural hearing loss, and 47 that were healthy. The vestibular endolymphatic space contacting the oval window showed an almost perfect interobserver agreement (Cohen κ = 0.87; 95% CI, 0.69–1). The vestibular endolymphatic space contacting oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 88%, and negative predictive value = 93% in differentiating Meniere disease ears from other ears. The vestibular endolymphatic space contacting the oval window showed the following: sensitivity = 81%, specificity = 96%, positive predictive value = 96%, negative predictive value = 82% in differentiating Meniere disease ears from sudden sensorineural hearing loss ears. CONCLUSIONS: The vestibular endolymphatic space contacting the oval window has high specificity and positive predictive value in differentiating Meniere disease ears from other ears, thus resulting in a valid tool for ruling in Meniere disease in patients with mimicking symptoms

MR Imaging in Sudden Sensorineural Hearing Loss. Time to Talk

SUMMARY: Sudden sensorineural hearing loss is defined as acute hearing loss of the sensorineural type of at least 30 dB over 3 contiguous frequencies that occurs within a 72-hour period. Although many different causative factors have been proposed, sudden sensorineural hearing loss is still considered "idiopathic" in 71%–85% of cases, and treatments are empiric, not based on etiology. MR imaging implemented with a 3D FLAIR sequence has provided new insights into the etiology of sudden sensorineural hearing loss. Herein, we review the current management trends for patients with sudden sensorineural hearing loss, from the initial clinical diagnosis to therapeutic strategies and diagnostic work-up. We focused primarily on MR imaging assessment and discuss the relevance that MR imaging findings might have for patient management, pointing out different perspectives for future clinical research

Extracellular matrix features discriminate aggressive HER2-positive breast cancer patients who benefit from trastuzumab treatment

We previously identified an extracellular matrix (ECM) gene expression pattern in breast cancer (BC), called ECM3, characterized by a high expression of genes encoding structural ECM proteins. Since ECM is reportedly implicated in response to therapy of BCs, the aim of this work is to investigate the prognostic and predictive value of ECM3 molecular classification in HER2-positive BCs. ECM3 resulted in a robust cluster that identified a subset of 25-37% of HER2-positive tumors with molecular aggressive features. ECM3 was significantly associated with worse prognosis in two datasets of HER2-positive BCs untreated with adjuvant therapy. Analyses carried out on two of our cohorts of patients treated or not with adjuvant trastuzumab showed association of ECM3 with worse prognosis only in patients not treated with trastuzumab. Moreover, investigating a dataset that includes gene profile data of tumors treated with neoadjuvant trastuzumab plus chemotherapy or chemotherapy alone, ECM3 was associated with increased pathological complete response if treated with trastuzumab. In the in vivo experiments, increased diffusion and trastuzumab activity were found in tumors derived from injection of HER2-positive cells with Matrigel that creates an ECM-rich tumor environment. Taken together, these results indicate that HER2-positive BCs classified as ECM3 have an aggressive phenotype but they are sensitive to trastuzumab treatment

Learning about Actions and Events in Shared NeMuS

The categorization process of information from pure data or learned in unsuper- vised artificial neural networks is still manual, especially in the labeling phase. Such a process is fundamental to knowledge representation [6], especially for symbol-based systems like logic, natural language processing and textual infor- mation retrieval. Unfortunately, applying categorization theory in large volumes of data does not lead to good results mainly because there is no generic and systematic way of categorizing such data processed by artificial neural networks and joining investigated conceptual structures. Connectionist approaches are capable of extracting information from arti- ficial neural networks, but categorizing them as symbolic knowledge have been little explored. The obstacle lies on the difficulty to find logical justification from response patterns of these networks [2]. This gets worse when considering induc- tive learning from dynamic data which is very important to Cognitive Sciences that considers categorization as a mental operation of classifying objects, actions and events [1]. We shall address the discoveries of our on-going investigation on the problem of inductively learning (IL) from dynamic data by applying a novel framework for neural-symbolic representation and reasoning called share Neural Multi-Space (NeMuS) used in the Amao system[4]. Instead of woking like traditional ap- proaches for ILP, e.g. [5], Amao uses a shared NeMuS of a give background knowledge (BK) and uses inverse unification as the generalization mechanism of a set of logically connected expressions from the Herbrand Base (HB) of BK that defines positive examples

Flat panel angiography in the cross-sectional imaging of the temporal bone: Assessment of image quality and radiation dose compared with a 64-section multisection CT scanner

BACKGROUND AND PURPOSE: Cross-sectional imaging of the temporal bone is challenging because of the complexity and small dimensions of the anatomic structures. We evaluated the role of flat panel angiography in the cross-sectional imaging of the temporal bone by comparing its image quality and radiation dose with a 64-section multisection CT scanner. MATERIALS AND METHODS: We retrospectively collected 29 multisection CT and 29 flat panel angiography images of normal wholehead temporal bones. Image quality was assessed by 2 neuroradiologists, who rated the visualization of 30 anatomic structures with a 3-point ordinal scale. The radiation dose was assessed with an anthropomorphic phantom. RESULTS: Flat panel angiography showed better image quality than multisection CT in depicting the anterior and posterior crura of the stapes, the footplate of the stapes, the stapedius muscle, and the anterior ligament of the malleus (P &lt; .05). In contrast, multisection CT showed better image quality than flat panel angiography in assessing the tympanic membrane, the bone marrow of the malleus and incus, the tendon of the tensor tympani, the interscalar septum, and the modiolus of the cochlea (P &lt; .05). Flat panel angiography had a significantly higher overall image quality rating than multisection CT (P =.035). A reduction of the effective dose of approximately 40% was demonstrated for flat panel angiography compared with multisection CT. CONCLUSIONS: Flat panel angiography shows strengths and weaknesses compared with multisection CT. It is more susceptible to artifacts, but due to the higher spatial resolution, it shows equal or higher image quality in assessing some bony structures of diagnostic interest. The lower radiation dose is an additional advantage of flat panel angiography