A tale of two gradients: differences between the left and right hemispheres predict semantic cognition

Decomposition of whole-brain functional connectivity patterns reveals a principal gradient that captures the separation of sensorimotor cortex from heteromodal regions in the default mode network (DMN). Functional homotopy is strongest in sensorimotor areas, and weakest in heteromodal cortices, suggesting there may be differences between the left and right hemispheres (LH/RH) in the principal gradient, especially towards its apex. This study characterised hemispheric differences in the position of large-scale cortical networks along the principal gradient, and their functional significance. We collected resting-state fMRI and semantic, working memory and non-verbal reasoning performance in 175 + healthy volunteers. We then extracted the principal gradient of connectivity for each participant, tested which networks showed significant hemispheric differences on the gradient, and regressed participants’ behavioural efficiency in tasks outside the scanner against interhemispheric gradient differences for each network. LH showed a higher overall principal gradient value, consistent with its role in heteromodal semantic cognition. One frontotemporal control subnetwork was linked to individual differences in semantic cognition: when it was nearer heteromodal DMN on the principal gradient in LH, participants showed more efficient semantic retrieval—and this network also showed a strong hemispheric difference in response to semantic demands but not working memory load in a separate study. In contrast, when a dorsal attention subnetwork was closer to the heteromodal end of the principal gradient in RH, participants showed better visual reasoning. Lateralization of function may reflect differences in connectivity between control and heteromodal regions in LH, and attention and visual regions in RH.

Early Treatment of Hypothalamic Hypogonadism With LH-RH Analog Improved the Long-Term Prognosis of Hypogonadism of Adult-Onset Craniopharyngioma

Object: Craniopharyngiomas frequently grow on the cisternal surface of the hypothalamic region. The survival rate for childhood craniopharyngioma has been improving with more long-term survivors. Long-term survivors of childhood craniopharyngioma suffer a number of impairments, which include visual loss, endocrinopathy, hypothalamic dysfunction, cerebrovascular problems, neurologic and neurocognitive dysfunction. GnRH neurons in hypothalamus that send axons to portal blood system in median eminence fire in coordinated, repetitive, episodic manner, producing distinct pulses of GnRH in the portal blood system. In 2001, we experienced the case of hypothalamic hypogonadism after the radical surgery of craniopharyngioma located in the right basal ganglia and hypothalamus. During the operation, pituitary gland and stalk were preserved. The patient had developed panhypopituitarism and hypothalamic hypogonadism after transcranial surgery. The diagnosis of oligospermia and asthenospermia was made. We hypothesized that the hypogonadism was due to the lack of distinct pulses of GnRH after the surgery. The aim of this program was to demonstrate the efficacy of the pulsatile subcutaneous LH-RH therapy for the recovery of gonadal function from hypothalamic hypogonadism and to observe the long-term prognosis after recovery. Method: After a diagnosis of hypothalamic hypogonadism, low dose LH-RH treatment was given to a 29-year-old male with small portable automatically-timed infusion pump, connected to a subcutaneous (s.c.) catheter. Gonadorelin acetate was prepared to the concentration of 0.8mg/ml. Sixteen micrograms of LH-RH s.c. was given every 120 min. Serum levels of gonadotropin and testosterone were monitored. The treatment was continued until his gonadal function normalized. Long-term follow up was continued after low dose LH-RH treatment. Result: After the six months of pulsatile LH-RH treatment, serum level of testosterone turned normal. Then the treatment was paused in 2003. His wife became pregnant with in-vitro fertilization (IVF) in 2007 and gave birth in 2008. Moreover, his wife became pregnant naturally without IVF in 2009 and gave birth in 2010, suggesting the recovery from oligospermia and asthenospermia of her husband. Early recovery from hypothalamic hypogonadism maintained normal gonadal function in 2020. Clinical Lessons: We demonstrated a case of successful treatment of the hypothalamic hypogonadism after the surgery of craniopharyngioma. The pulsatile subcutaneous LH-RH therapy is efficacious for the case with the lack of the distinct pulses of GnRH after radical surgery of craniopharyngioma. Early treatment of hypothalamic hypogonadism with LH-RH analog improved the long-term prognosis of hypogonadism of adult-onset craniopharyngioma.

Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

ObjectivesThe benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are well established although the financial impact of robotic-assisted hysterectomy (RH) compared with laparoscopic hysterectomy (LH) is disputed.DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Participants35 304 women having a hysterectomy for EC identified from Hospital Episode Statistics.Primary and secondary outcome measuresThe primary outcome was the association between route of surgery on cost at intervention, 30, 90 and 365 days for women undergoing an open hysterectomy (OH) or MIS (LH/RH) for EC in England. The average marginal effect was calculated to compare RH versus OH and RH versus LH which adjusted for any differences in the characteristics of the surgical approaches. Secondary outcomes were to analyse costing data for each surgical approach by age, Charlson Comorbidity Index (CCI) and hospital MIS rate classification.ResultsA total of 35 304 procedures were performed, 20 405 (57.8%) were MIS (LH: 18 604 and RH: 1801), 14 291 (40.5%) OH. Mean cost for LH was significantly less than RH, whereas RH was significantly less than OH at intervention, 30, 90 and 365 days (p<0.001). Over time, patients who underwent RH had increasing CCI scores and by the 2015/2016 year had a higher average CCI than LH. Comparing the cost of LH and RH against CCI score identified that the costs closely reflected the patients’ CCI. Increasing disparity was also seen between the MIS and OH costs with rising age. When exploring the association between provider volume, MIS rate and surgical costs, there was an association with the higher the MIS rate the lower the average cost.ConclusionsFurther research is needed to investigate costs in matched patient cohorts to determine the optimum surgical modality in different populations.

Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report

We report a case of an elderly patient with metastatic castration-resistant prostate cancer, initially treated with abiraterone acetate (1,000 mg/day) combined with LH-RH antagonist, prednisone (10 mg/day), and zoledronic acid to manage bone metastases. In consideration of his poor performance status, radiological and biochemical progression of the disease, we decided to switch abiraterone to enzalutamide (160 mg/day). Due to adverse events, we reduced enzalutamide to a dose of 80 mg/day. Currently, the disease is under control despite the use of a low dose of enzalutamide.

A tale of two gradients: Differences between the left and right hemispheres predict semantic cognition and visual reasoning

Decomposition of whole-brain functional connectivity patterns reveals a principal gradient that captures the separation of sensorimotor cortex from heteromodal regions in the default mode network (DMN); this gradient captures the systematic order of networks on the cortical surface. Functional homotopy is strongest in sensorimotor areas, and weakest in heteromodal cortices, suggesting there may be differences between the left and right hemispheres (LH/RH) in the principal gradient, especially towards its apex. This study characterised hemispheric differences in the position of large-scale cortical networks along the principal gradient, and their functional significance. We collected resting-state fMRI and semantic and non-verbal reasoning task performance in 175+ healthy volunteers. We then extracted the principal gradient of connectivity for each participant and tested which networks showed significant hemispheric differences in gradient value. We investigated the functional associations of these differences by regressing participants’ behavioural efficiency in tasks outside the scanner against their interhemispheric gradient difference for each network. LH showed a higher overall principal gradient value, consistent with its role in heteromodal semantic cognition. One frontotemporal control subnetwork was linked to individual differences in semantic cognition: when it was nearer heteromodal DMN on the principal gradient in LH, participants showed more efficient semantic retrieval. In contrast, when a dorsal attention subnetwork was closer to the heteromodal end of the principal gradient in RH, participants showed better visual reasoning. Lateralization of function may reflect differences in connectivity between control and heteromodal regions in LH, and attention and visual regions in RH.

Medullary Aplasia Revealing a Metastatic Prostatic Adenocarcinoma

In this case report, we are reporting the case of a 68-year-old male patient who was admitted in our hospital for unintended weight loss, asthenia, and anorexia. Physical examination showed clinical signs of anemia such as pallor of skin and mucous membranes; hemodynamic parameters were normal. Complete blood count (CBC) analysis showed a pancytopenia with anemia, thrombocytopenia, and leukopenia. BM biopsy was performed, showing a malignant infiltration of bone marrow by a metastatic prostate cancer confirmed by immunohistochemistry. Prostate biopsy confirmed the diagnosis of acinar adenocarcinoma with Gleason score 8 ( 4 + 4 ), ISUP grade group 4. Our patient underwent chemical castration using LH-RH analogs in association with second-line hormone therapy by abiraterone acetate. The evolution was good on both the oncological and hematological levels.

The development of method of hormonal stimulation of N.L.Gerbilsky and appearance of contemporary preparations of long-term storage

The The main discovery of the 20th century in the field of fish breeding is hormonal stimulation of final stages of maturation of fish at hatcheries. The «father» of method of pituitary injections was Leningrad ichthyologist N.L. Gerbilsky. The main achievements of N.L. Gerbilsky and his school are methods of mass extraction of fish pituitaries, their dehydration by acetone for later storage and use, testing of pituitary gonadotropic activity on different objects. The induction of ovulation in female loaches Misgurnus fossilis or spermiation reaction of Galli-Mainini in male frogs Rana ridibunda or R. temporaria were used for pituitary testing. The effective doses of dried pituitaries for sturgeons were determined in milligrams and loach units or frog units. The method of pituitary injections was used for functioning of sturgeon breeding facilities at Volga, Don, Kuban and Kura and other rivers. For guaranteed answer fish breeders used hyperdoses of dry pituitary powder because its gonadotropic activity varied in dependence on stage of maturity of fish-“donors”. The followers of N.L. Gerbilsky led by Prof. I.A. Barannikova developed the technique of production of special glycerol pituitary extract (GPE) with determined gonadotropic activity. The main role in formulation of the recipe of GPE belongs to A.A. Boyev. The use of GPE has removed the problem of hyperdosing leading to worsening quality of mature germinal cells of sturgeons. Later, A.A. Boyev on the basis of this recipe with replacement of glycerol to propylene glycol created stabilizing solution of analogue of mammal LH-RH (“surphagon”) of long-term storage with concentration of active substance from 20 to 500 micrograms/ml.

Role of centchroman versus danazol in treatment of benign breast disorders

Background: The breast is a dynamic structure that undergoes cyclical changes throughout the menstrual cycle. Any aberration from normal physiological changes in breast produces different problem in breast. Many drugs are used for treatment for these disorders like Danazol, Bromocriptine, Tamoxifen and LH-RH analogue but still no consensus for any drug is present.Methods: The aim of our study was to analyze the effectiveness of drug Centchroman and its comparison with Danazol in treatment of benign breast disorders in respect to symptoms relief, decrease in nodularity and lump size, recurrence, cost and side effects of drug. This prospective study was conducted on 250 patients of benign breast disorders attending surgical OPD between May 2018 to September 2019 in SMS medical college and Hospital, Jaipur.Results: Tolerance and improvements in symptoms in centchroman group was more than danazol (100% vs 92.8%) with less recurrence in former group. While side effects varied between the two groups with menstrual irregularities more common in centchroman group.Conclusions: The study shows that centchroman is safe, more effective and less expensive to Danazol for the treatment of benign breast disorders in long term.

Muscle Activity Asymmetry of the Lower Limbs During Sprinting in Elite Soccer Players

The analysis of movement patterns through EMG activity provides the opportunity to identify the muscle groups most involved in a particular exercise, and to determine the scope of inter-limb deficiencies. The aim of the present study was to investigate the effects of a side-to-side muscle activity asymmetry between the left and the right lower limb during sprinting in soccer players. Sixteen professional soccer players took part in the study. Their age, body mass and body height equaled 23.7 ± 7.6 years, 81.2 ± 10.8 kg and 179.3 ± 12.2 cm, respectively. The sprint test consisted of two maximal sprints over 30 m with a 5-min rest interval between each sprint. EMG was recorded bilaterally from the quadriceps, hamstrings and gluteal muscles. Regression analysis revealed a significant effect of a side-to-side average muscle activity asymmetry between the left and right hamstring (LH/RH) muscles during the speed tests at 5 m (p = 0.044), and 30 m (p = 0.045), as well as the left and right glutes (LG/RG) at 5 m (p = 0.044) and 30 m (p = 0.043). Our results indicate that hamstring and glute muscles should be selectively and additionally activated during resistance training in soccer players to prevent injuries and improve sprint performance.