Successful treatment of refractory secondary immune thrombocytopenia (antiphospholipid antibody syndrome-associated) with the combination of rituximab and romiplostim at the cost of severe bone pain: A case report and review of literature

Introduction Immune thrombocytopenia is an autoimmune disorder associated with increased thrombocyte destruction and impaired production in the bone marrow. Proposed mechanisms include an antibody or autoreactive T-cell-associated autoimmunity and thrombopoietin deficiency among others. Clinical manifestations are predominantly mucocutaneous hemorrhages including petechiae, purpura, mucosal bleeding in the urinary or the gastrointestinal tracts, menorrhagia, and epistaxis. The purpose of the treatment is to prevent bleeding rather than normalizing the platelet counts. First-line treatments include corticosteroids +/- intravenous immunoglobulin and Anti-D which mainly decrease antibody-mediated platelet destruction and increase the number of peripheral Tregs. Second-line and subsequent therapies include splenectomy, chimeric anti-CD20 antibody (rituximab), which eliminates B cells and act as an immunomodulatory agent, and Thrombopoietin receptor agonists (romiplostim), which promote platelet production. Case report We describe a 40-year-old male patient diagnosed with immune thrombocytopenia that was refractory to first-line corticosteroid and intravenous immunoglobulin and second-line romiplostim monotherapy treatments. Management and outcome:The patient was given the romiplostim and rituximab combination which not only successfully treated thrombocytopenia but also resulted in grade 3 bone pains and the patient's subsequent refusal to continue therapy. Discussion Common adverse effects of rituximab are infusion reactions and prolonged immunosuppression; those of romiplostim include thrombosis, headaches, arthralgia-myalgia, and gastrointestinal symptoms. This case shows that romiplostim has not caused any discernible side effects when given alone, while combination with rituximab resulted in severe bone and joint pains. We hypothesize that this combination regimen shows a synergistic effect both in terms of efficacy and adverse-effect probability and/or severity

The Influences of Whole Brain Radiotherapy on Social Cognition and Association with Hippocampal and Frontal Dosimetry

The influence of brain radiotherapy on neurocognition is a major concern. Social cognition is a mental process in the meaning of social interaction and the recognition of facial emotion is a domain of social cognition. Thus, we aimed to investigate the early effect of whole brain radiotherapy on facial emotion recognition ability. Thirteen patients with various brain tumors in the study. Beck depression and anxiety inventory and the facial emotion recognition test by using a set of photographs were performed at the beginning and post radiotherapy. The severity of depression (16.40 +/- A 12.16 vs 04.00 +/- A 02.38 points) and anxiety (14.47 +/- A 11.96 vs 04.54 +/- A 03.30 points) were significantly higher in patients. The only significance according to facial emotion recognition rate between initial phase of patients and healthy controls was identifying neutral facial em otion (p = 0.002). The patients after brain radiotherapy had significantly better rate of recognizing fear facial emotions (p = 0.039). This study is the first that investigated the effects of cranial irradiation on facial emotion recognition ability and compares this ability with healthy controls. Interestingly, in the early phase the patients seem to be improved in fear facial emotion after brain radiotherapy without sparing cognition specific regions as hippocampus and frontal regions

2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women

We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients

Use of volumetric CT scanning to predict tumor staging and survival in pancreatic cancer patients that are to be administered curative resection

Background This study evaluates the achievability of CT volumetry of pancreatic cancer and its correlation with pTNM stage and survival

Kranioplastide Cortoss™'un Osteointegrasyonunun Değerlendirilmesi: Tavşanlarda Bir Deneysel Çalışma

Amaç: Kalvariyal defektler kozmetik nedenlerle veya kalvariyal içeriğin korunması amacıyla kapatılmalıdır. Bu çalışmada bir biyouyumlu sentetik kemik doldurucu olan Cortoss™'un kranial defektlerde yeterli osteointegrasyon sağlayıp sağlayamadığını incelemeyi amaçladık. Materyal ve Metod: Yirmi Yeni Zellanda beyaz erişkin tavşan 4 gruba ayrıldı: kraniektomi (n = 6), kranioplasti (n = 6), sham (n = 6) ve kontrol (n = 2) grupları. Kraniektomi grubunda kalvarial defekt oluşturulup kapatılmadı. Kranioplasti grubunda defektler Cortoss™ ile tamir edildi. Sham grubunda sadece cilt insizyonu yapıldı ve defekt oluşturulmadı. Kontrol grubuna ise cerrahi bir işlem uygulanmadı. Bütün hayvanlar cerrahi işlemden 6 ay sonra sakrifiye edildi ve materyaller Cortoss™'un osteointegrasyonunun değerlendirilmesi amacıyla histopatolojik ve radyolojik olarak incelendi. Bulgular: Radyolojik incelemelerde Cortoss™ ile kemik kaynaşmasının arada defekt kalmaksızın tam olduğu ve kozmetik sonuçların da yeterli olduğu görüldü. Radyolojik bulguları destekleyen şekilde Cortoss™ implantı etrafında herhangi bir fibröz bant olmaksızın tam osteointegrasyonu gösteren histopatolojik inceleme sonuçları elde edildi. Sonuç: Tavşan kalvarial defektlerinin tamirinde Cortoss™ 24. haftada belirgin osteointegrasyon sağlamaktadır. Bu in vivo çalışmanın sonuçları Cortoss™'un kalvarial defekt rekonstrüksyonunda kullanımının güvenli ve etkili olduğunu desteklemektedir.Objectives: Calvarial defects must be closed for either cosmetic reasons or for protection of the calvarial contents. We aimed to assess whether Cortoss™, a biocompatible synthetic cortical bone void filler, can provide satisfactory osteointegration in cranial defects. Methods: Twenty New Zealand white adult rabbits were divided into 4 groups: craniectomy (n = 6), cranioplasty (n = 6), sham (n = 6) and control (n = 2) groups. Treatment for each group was as follows: craniectomy group had calvarial defects that were left empty; the cranioplasty group the defects were reconstructed with Cortoss™; the sham group had only a skin incision and no defect; and in the control group no surgery was performed. All the animals were sacrificed 6 months after the procedures and the materials were examined histopathologically and radiologically in order to assess osteointegration of Cortoss™. Results: Radiological examination demonstrated almost complete apposition of the bone to Cortoss™ without any defect or sutures and the cosmetic outcomes were satisfactory. Radiological findings were supported by the histopathologic examinations which revealed that osteointegration had been completed without any fibrous band formation surrounding the Cortoss™ implant. Conclusion: Cortoss™ leads to significant osteointegration at 24 weeks in rabbit calvarial defects. The results of this in vivo study suggest that Cortoss™ may be considered a safe and effective material for the reconstruction of calvarial defects

Assessment of Osteointegration of Cortoss (TM) in Cranioplasty: An Experimental Study in Rabbits

Objectives: Calvarial defects must be closed for either cosmetic reasons or for protection of the calvarial contents. We aimed to assess whether Cortoss (TM), a biocompatible synthetic cortical bone void filler, can provide satisfactory osteointegration in cranial defects