Torcular dural sinus malformation

The dural sinus malformation (DSM) are rare congenital vascular anomalies with variable anatomic features, clinical conditions, and outcomes. There are two forms of disease: a lateral subtype, affecting the jugular bulb with associated high flow arteriovenous fistula; and a midline subtype, called torcular DSM. The torcular subtype is more common and characterized by a giant dural sinus lake involving the confluens sinuum (torcular Herophili). We present a case of a 28-year-old woman with an ultrasound at 32 weeks’ gestation showing a fetal intracranial thrombosed lesion, measuring 6x4 cm. An elective c-section was performed at 38 weeks’ gestation, and a male neonate was born. He remained asymptomatic, and a brain MRI performed 9 days later showed a thrombosed midline mass due to a torcular DSM. The outcome with conservative treatment was favorable, and further development was unremarkable. The 2-year follow-up imaging demonstrated spontaneous involution of the clot. The torcular DSM is frequently diagnosed prenatally as an intraluminar lake thrombosis, and differential diagnosis include tumors, subdural collections, vein of Galen aneurysmal malformations, pial malformations, arachnoid and dermoid cysts. A literature review involving 126 patients with torcular DSM found an overall mortality of 22.1%. Torcular DSM seems to have better prognosis than those having dural arteriovenous shunts, and the worst outcomes were associated to brain damage and patent feeders. In addition, antenatal diagnosis and thrombosis of pouch have good prognosis, possibly because the clot may spontaneously obliterate the fistulas. Treatment options must be individualized, and include conservative, embolization, ventriculoperitoneal shunt and endoscopic third ventriculostomy. Although systemic anticoagulation is controverse in infants, it should be considered for patients with sinovenous thrombosis affecting outflow pathways, especially those aggravated by venous congestion. Intervention is recommended for grade III patients because they progress to grade IV, and endovascular treatment is the gold standard therapy due to the risk of fatal intraoperative exsanguination. Whenever possible, embolization should be prioritized over hydrocephalus treatment because it may avoid ventriculoperitoneal shunt. Close follow-up imaging is recommended to detect any changes, with lesion reduction indicating favorable outcome.

TWIST1 expression is associated with high-risk neuroblastoma and promotes primary and metastatic tumor growth

The embryonic transcription factors TWIST1/2 are frequently overexpressed in cancer, acting as multifunctional oncogenes. Here we investigate their role in neuroblastoma (NB), a heterogeneous childhood malignancy ranging from spontaneous regression to dismal outcomes despite multimodal therapy. We first reveal the association of TWIST1 expression with poor survival and metastasis in primary NB, while TWIST2 correlates with good prognosis. Secondly, suppression of TWIST1 by CRISPR/Cas9 results in a reduction of tumor growth and metastasis colonization in immunocompromised mice. Moreover, TWIST1 knockout tumors display a less aggressive cellular morphology and a reduced disruption of the extracellular matrix (ECM) reticulin network. Additionally, we identify a TWIST1-mediated transcriptional program associated with dismal outcome in NB and involved in the control of pathways mainly linked to the signaling, migration, adhesion, the organization of the ECM, and the tumor cells versus tumor stroma crosstalk. Taken together, our findings confirm TWIST1 as promising therapeutic target in NB.

Severe Neonatal COVID Pneumonia With Cytokine Storm

COVID infection is not as common in children as in adults. In the first wave, symptomatic SARS-CoV-2 infection was less common with mild symptoms in children and neonates. But in the second wave, more children and neonates were affected with severe manifestations. COVID infection in neonates is mostly asymptomatic and published data from various neonatal units of India shows that most COVID positive newborns have good prognosis; poor outcomes are due to perinatal complications and rarely due to COVID. 1 However, in the second wave, newborns too were affected. We are presenting the case of a preterm neonate who developed severe COVID pneumonia on day 10 of life with cytokine storm and succumbed to death.

Bias Investigation in Artificial Intelligence Systems for Early Detection of Parkinson’s Disease: A Narrative Review

Background and Motivation: Diagnosis of Parkinson’s disease (PD) is often based on medical attention and clinical signs. It is subjective and does not have a good prognosis. Artificial Intelligence (AI) has played a promising role in the diagnosis of PD. However, it introduces bias due to lack of sample size, poor validation, clinical evaluation, and lack of big data configuration. The purpose of this study is to compute the risk of bias (RoB) automatically. Method: The PRISMA search strategy was adopted to select the best 39 AI studies out of 85 PD studies closely associated with early diagnosis PD. The studies were used to compute 30 AI attributes (based on 6 AI clusters), using AP(ai)Bias 1.0 (AtheroPointTM, Roseville, CA, USA), and the mean aggregate score was computed. The studies were ranked and two cutoffs (Moderate-Low (ML) and High-Moderate (MH)) were determined to segregate the studies into three bins: low-, moderate-, and high-bias. Result: The ML and HM cutoffs were 3.50 and 2.33, respectively, which constituted 7, 13, and 6 for low-, moderate-, and high-bias studies. The best and worst architectures were “deep learning with sketches as outcomes” and “machine learning with Electroencephalography,” respectively. We recommend (i) the usage of power analysis in big data framework, (ii) that it must undergo scientific validation using unseen AI models, and (iii) that it should be taken towards clinical evaluation for reliability and stability tests. Conclusion: The AI is a vital component for the diagnosis of early PD and the recommendations must be followed to lower the RoB.

Characteristics and nomogram for primary lung lepidic adenocarcinoma

Background: Lepidic adenocarcinoma (LPA) is an infrequent subtype of invasive pulmonary adenocarcinoma (ADC). However, the clinicopathological features and prognostic factors of LPA have not been elucidated.Methods: Data from the Surveillance, Epidemiology, and End Results (SEER) database of 4087 LPA patients were retrospectively analyzed and compared with non-LPA pulmonary ADC to explore the clinicopathological and prognosis features of LPA. Univariate and multivariate Cox proportional hazard models were performed to identify independent survival predictors for further nomogram development. The nomograms were validated by using the concordance index, receiver operating characteristic curves, and calibration plots, as well as decision curve analysis, in both the training and validation cohorts.Results: Compared with non-LPA pulmonary ADC patients, those with LPA exhibited unique clinicopathological features, including more elderly and female patients, smaller tumor size, less pleural invasion, and lower histological grade and stage. Multivariate analyses showed that age, sex, marital status, primary tumor size, pleural invasion, histological grade, stage, primary tumor surgery, and chemotherapy were independently associated with overall survival (OS) and cancer-specific survival (CSS) in patients with LPA, while race was the only independent prognostic factor for OS, not for CSS. The nomograms showed good accuracy compared with the actual observed results and demonstrated improved prognostic capacity compared with TNM stage.Conclusions: Patients with LPA are more likely to be older and female. Smaller tumor size, lower histological grade and stage are the clinicopathological features of LPA, which may indicate a good prognosis. The constructed nomograms accurately predict the long-term survival of LPA patients.

Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma

The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting. Sometimes, the PCA trunk can give rise to flow-related aneurysms in association with high-flow arteriovenous shunt diseases or moyamoya disease and internal carotid artery occlusion. Some PCA trunk aneurysms require treatment, especially ruptured or large/giant aneurysms. Recently, endovascular treatment (EVT) has become the mainstream treatment for PCA trunk aneurysms, and it mainly involves reconstructive or deconstructive techniques. Traditional EVT includes selective coiling with/without stent or balloon assistance and parent artery occlusion (PAO). For proximal aneurysms, the PCA should be preserved. For distal aneurysms, PAO can be performed. However, during EVT, preservation of the PCA must naturally be the prime objective. Recently, flow-diverting stents have been used and are a revolutionary treatment for unruptured dissecting aneurysms of the PCA trunk. Despite the associated complications, EVT remains an effective method for treating PCA trunk aneurysms and can result in a good prognosis.

Performance of Nomogram Prediction Combining MiRNAs in Cervical Mucus, HPV Genotype and Age for Cervical Cancer and its Precursor Lesions

Cervical cancer is the fourth most common cancer in women worldwide. Although cytology or HPV testing is available for screening, these techniques have their drawbacks and optimal screening methods are still being developed. Here, we sought to determine whether aberrant expression of miRNAs in cervical mucus could be an ancillary test for cervical neoplasms. The presence of miRNAs in 583 and 126 patients (validation and external cohorts) was determined by real-time RT-PCR. Performance of a combination with five miRNAs (miR-126-3p, -451a -144-3p, -20b-5p and -155-5p) was estimated by ROC curve analysis. Predicted probability (PP) was estimated by nomograms comprising -ΔCt values of the miRNAs, HPV genotype and age. A combination of five miRNAs showed a maximum AUC of 0.956 (95%CI: 0.933-0.980) for discriminating cancer. Low PP scores were associated with good prognosis over the 2-year observation period (p<0.05). Accuracy for identifying cancer and cervical intraepithelial neoplasia (CIN)3+ by nomogram was 0.983 and 0.966, respectively. PP was constant with different storage conditions of materials. We conclude that nomograms using miRNAs in mucus, HPV genotype and age could be useful as ancillary screening tests for cervical neoplasia.

Correlation between the initial CT chest findings and short-term prognosis in Egyptian patients with COVID-19 pneumonia

Background The recent pandemic of COVID‐19 has thrown the world into chaos due to its high rate of transmissions. This study aimed to highlight the encountered CT findings in 910 patients with COVID-19 pneumonia in Egypt including the mean severity score and also correlation between the initial CT finding and the short-term prognosis in 320 patients. Results All patients had confirmed COVID-19 infection. Non-contrast CT chest was performed for all cases; in addition, the correlation between each CT finding and disease severity or the short-term prognosis was reported. The mean age was higher for patients with unfavorable prognosis (P < 0.01). The patchy pattern was the most common, found in 532/910 patients (58.4%), the nodular pattern was the least common 123/910 (13.5%). The diffuse pattern was reported in 124 (13.6%). The ground glass density was the most common reported density in the study 512/910 (56.2%). The crazy pavement sign was reported more frequently in patients required hospitalization or ICU and was reported in 53 (56.9%) of patients required hospitalization and in 29 (40.2%) patients needed ICU, and it was reported in 11 (39.2%) deceased patients. Air bronchogram was reported more frequently in patients with poor prognosis than patients with good prognosis (16/100; 26% Vs 12/220; 5.4%). The mean CT severity score for patients with poor prognosis was 15.2. The mean CT severity score for patients with good prognosis 8.7., with statistically significant difference (P = 0.001). Conclusion Our results confirm the important role of the initial CT findings in the prediction of clinical outcome and short-term prognosis. Some signs like subpleural lines, halo sign, reversed halo sign and nodular shape of the lesions predict mild disease and favorable prognosis. The crazy paving sign, dense vessel sign, consolidation, diffuse shape and high severity score predict more severe disease and probably warrant early hospitalization. The high severity score is most important in prediction of unfavorable prognosis. The nodular shape of the lesions is the most important predictor of good prognosis.

CD8+ mycosis fungoides: A wolf in sheep’s clothing?

Sir, CD8+ mycosis fungoides (MF) is a rare form of MF with an indolent course. Herein, we report a rare case of CD8+ fungoid mycosis preceded by lymphomatoid papulosis type D with an aggressive course. A 36-year-old female presented with several papular lesions on the trunk and extremities with a relapsing–remitting course. Histopathology and an immunohistochemical study confirmed CD8-positive lymphomatoid papulosis type D and methotrexate at 25 mg/week was initiated. After a temporary clinical improvement, the lesions worsened, became infiltrated, and grouped as vaguely annular and angular patches with serpiginous borders (Fig. 1). A second scalp biopsy was performed and a diagnosis of CD8+ MF was established. An extension workup was normal, and MF was classified as stage IB. PUVA therapy was started with acitretin at 25 mg/day. After four weeks from the beginning of treatment, the patches completely disappeared but with the concomitant appearance of four subcutaneous tumors. The evolution was spectacular in fifteen days, with the tumors rapidly increasing in size, becoming ulcerative and necrotic, and one being localized in the left cervical area compressing the upper respiratory tract (Fig. 2). A subsequent biopsy revealed massive epidermal and dermal large cell infiltration (Fig. 3a); the tumor cells were positive for CD3, CD8, and CD7 (Fig. 3b) and negative for CD4, CD5, CD3, CD2, and CD30. Antigen Ki-67 was expressed by more than 80% of T-cells (Fig. 3c). A cerebral and thoraco-abdominal CT scan revealed multiple axillary lymph nodes with hypermetabolism on a PET scan. An osteomedullar biopsy was normal, and lactate dehydrogenase (LDH) was increased to 358 U/L. Chemotherapy was performed, but the patient died after two cycles of CHOEP. In contrast to classical CD4+ mycosis fungoides, CD8+ MF is a rare cytotoxic phenotype constituting about 5% of all cases of MF [1]. It belongs to the first group of primary cytotoxic cutaneous lymphomas (PCCL) with a good prognosis, an indolent course, and a slow progression of the lesions over several years [2]. However, rare cases with a more aggressive course have been reported in the literature [3]. The main differential diagnosis of aggressive CD8+ MF is an aggressive epidermotropic cutaneous CD8+ lymphoma that is a rare cutaneous lymphoma with a poor prognosis due to rapid extracutaneous dissemination [4]. The prognosis of the CD8+ subtype of mycosis fungoides (MF) is controversial. More studies are necessary to clarify this subject.