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Cold Spring Harbor Perspectives in... May 2018Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis,... (Review)
Review
Since its technical development in the early 1980s, magnetic resonance imaging (MRI) has quickly been adopted as an essential tool in supporting the diagnosis, longitudinal monitoring, evaluation of therapeutic response, and scientific investigations in multiple sclerosis (MS). The clinical usage of MRI has increased in parallel with technical innovations in the technique itself; the widespread adoption of clinically routine MRI at 1.5T has allowed sensitive qualitative and quantitative assessments of macroscopic central nervous system (CNS) inflammatory demyelinating lesions and tissue atrophy. However, conventional MRI lesion measures lack specificity for the underlying MS pathology and only weakly correlate with clinical status. Higher field strength units and newer, advanced MRI techniques offer increased sensitivity and specificity in the detection of disease activity and disease severity. This review summarizes the current status and future prospects regarding the role of MRI in the characterization of MS-related brain and spinal cord involvement.
Topics: Brain; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Spinal Cord
PubMed: 29358319
DOI: 10.1101/cshperspect.a028969 -
Current Pediatric Reviews 2021Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. (Review)
Review
BACKGROUND
Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life.
OBJECTIVE
To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas.
METHODS
A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article.
RESULTS
The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement.
CONCLUSION
Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
Topics: Adrenergic beta-Antagonists; Child; Child, Preschool; Conservative Treatment; Dermatologic Surgical Procedures; Hemangioma; Humans; Infant; Prognosis; Remission, Spontaneous; Skin Neoplasms; Watchful Waiting
PubMed: 32384034
DOI: 10.2174/1573396316666200508100038 -
Italian Journal of Dermatology and... Jun 2021The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma...
The indisputable contribution of dermatoscopy in early diagnosis of melanoma is widely recognized. In the last quinquennium, new data concerning specific melanoma subtypes have come to light. The dermatoscopic morphology of superficial spreading melanoma (SSM) has been extensively investigated in the literature. Atypical network, irregular dots, irregular globules, irregular streaks and irregular blotch correspond to histopathologic alterations at the level of the junction, blue-white veil and atypical vessels suggest intradermal growth, whereas regression structures, negative network and white shiny streaks might reflect junctional or dermal alterations. The list of melanoma specific criteria has been recently updated to include features that typify early melanoma, such as irregular hyperpigmented areas and prominent skin markings and features seen in melanoma on sun damaged skin such as angulated lines. Nodular melanoma lacks most of the aforementioned criteria and is typified by the coexistence of blue and black color, atypical vessels and pink color. Lentigo maligna dermatoscopic criteria mainly develop at the outline of the follicular openings. However, at an early stage these features might be very subtle and the diagnosis should be based on the exclusion of benign tumors (inverse approach). Acral lentiginous melanoma is typified by a parallel ridge pattern, but also SSM criteria should be taken into consideration. The diagnosis of subungual melanoma is based on the assessment of the color and characteristics of the pigmented nail band. For the diagnosis of mucosal melanoma, the assessment of colors is more informative than the assessment of structures and the detection of blue, white or gray should raise the suspicion of melanoma. White shiny streaks and regression structures are the most common features of desmoplastic melanoma. The diagnosis of nevoid melanoma might be highly challenging and require information on the lesion's history. Melanoma on small- and medium-sized congenital nevi is typified by an eccentric location of the suspicious area, negative network and gray angulated lines. Recent advances in knowledge on the dermatoscopic characteristics of peculiar subtypes of the tumor significantly enrich the diagnostic armamentarium of clinicians. The challenge of the forthcoming years is to better characterize biologically aggressive melanomas and to optimize the screening strategies so as to identify them.
Topics: Dermoscopy; Diagnosis, Differential; Humans; Hyperpigmentation; Melanoma; Skin Neoplasms
PubMed: 33314891
DOI: 10.23736/S2784-8671.20.06784-X -
JAMA Dermatology Dec 2019Molecular profiling of skin biopsies is the criterion standard for evaluating the cutaneous atopic dermatitis (AD) phenotype. However, skin biopsies are not always...
IMPORTANCE
Molecular profiling of skin biopsies is the criterion standard for evaluating the cutaneous atopic dermatitis (AD) phenotype. However, skin biopsies are not always feasible in children. A reproducible minimally invasive approach that can track cutaneous disease in pediatric longitudinal studies or clinical trials is lacking.
OBJECTIVE
To assess a minimally invasive approach using tape strips to identify skin biomarkers that may serve as a surrogate to biomarkers identified using whole-tissue biopsies.
DESIGN, SETTING, AND PARTICIPANTS
This cross-sectional study of 51 children younger than 5 years recruited children with moderate to severe AD and children without AD from the dermatology outpatient clinics at a children's hospital. Sixteen tape strips were serially collected from the nonlesional and lesional skin of 21 children who had AD and were less than 6 months from disease initiation and from the normal skin of 30 children who did not have AD between January 22, 2016, and April 20, 2018.
MAIN OUTCOMES AND MEASURES
Gene and protein expression were evaluated using quantitative real-time polymerase chain reaction and immunohistochemistry.
RESULTS
A total of 51 children younger than 5 years were included in the study; 21 children had moderate to severe AD with less than 6 months of disease duration, and 30 children did not have AD. Of the 21 children with AD, the mean (SD) age was 1.7 (1.7) years, and most were male (15 [71.4%] and white (15 [71.4%]). Of the 30 children without AD, the mean (SD) age was 1.8 (2.0) years, and most were female (20 [66.7%]) and white (22 [73.3%]). Seventy-seven of 79 evaluated immune and barrier gene products were detected (gene detection rate, 97%) in 70 of 71 tape strips (sample detection rate, 99%), with 53 of 79 markers differentiating between children with lesional and/or nonlesional AD from children without AD. Many cellular markers of T cells (CD3), AD-related dendritic cells (Fc ε RI and OX40 ligand receptors), and key inflammatory (matrix metallopeptidase 12), innate (interleukin 8 [IL-8] and IL-6), helper T cell 2 (TH2; IL-4, IL-13, and chemokines CCL17 and CCL26), and TH17/TH22 (IL-19, IL-36G, and S100A proteins) genes were significantly increased in lesional and nonlesional AD compared with tape strips from normal skin. For example, IL-4 mean (SE) for lesional was -15.2 (0.91) and normal was -19.5 (0.48); P < .001. Parallel decreases occurred in epidermal barrier gene products (FLG, CLDN23, and FA2H) and negative immune regulators (IL-34 and IL-37). For example, the decrease for FLG lesional was mean (SE) -2.9 (0.42) and for normal was 2.2 (0.45); P < .001. Associations were found between disease severity or transepidermal water loss and TH2 (IL-33 and IL-4R) and TH17/TH22 (IL-36G and S100As) products in lesional and nonlesional AD skin (evaluated using the SCORing Atopic Dermatitis, Eczema Area and Severity Index, and Pruritus Atopic Dermatitis Quickscore tools).
CONCLUSIONS AND RELEVANCE
In this study, tape strips provide a minimally invasive alternative for serially evaluating AD-associated cutaneous biomarkers and may prove useful for tracking pediatric AD therapeutic response and predicting future course and comorbidities.
Topics: Age of Onset; Biomarkers; Biopsy; Child, Preschool; Cross-Sectional Studies; Dermatitis, Atopic; Feasibility Studies; Female; Filaggrin Proteins; Humans; Immunohistochemistry; Infant; Infant, Newborn; Male; Real-Time Polymerase Chain Reaction; Severity of Illness Index; Skin; Water Loss, Insensible
PubMed: 31596431
DOI: 10.1001/jamadermatol.2019.2983 -
Current Opinion in Neurobiology Oct 2023Classical literature on blindsight described that some patients with lesions to the primary visual cortex could respond to visual stimuli without subjective awareness.... (Review)
Review
Classical literature on blindsight described that some patients with lesions to the primary visual cortex could respond to visual stimuli without subjective awareness. Recent studies addressed more complex arguments on the conscious state of blindsight subjects such as existence of partial awareness, namely "feeling of something happening" in the lesion-affected visual field, termed 'type II blindsight', and high-level performance in complex cognitive tasks in blindsight model monkeys. Endeavors to clarify the visual pathways for blindsight revealed the parallel thalamic routes mediating the visual inputs from the superior colliculus to extrastriate and frontoparietal cortices, which may underlie the flexible visuomotor association and cognitive control in the blindsight subjects. Furthermore, involvement of post-lesion plasticity is suggested for these neural systems to operate.
Topics: Cognition; Psychomotor Performance; Blindness; Animals; Disease Models, Animal; Haplorhini; Humans; Saccades
PubMed: 37597456
DOI: 10.1016/j.conb.2023.102764 -
Clinics in Colon and Rectal Surgery Nov 2018High-resolution anoscopy (HRA) is a form of low-resolution anal microscopy currently utilized in the screening and management of anal squamous dysplasia. No randomized... (Review)
Review
High-resolution anoscopy (HRA) is a form of low-resolution anal microscopy currently utilized in the screening and management of anal squamous dysplasia. No randomized controlled trials, national or international guidelines exist on the use of HRA for this purpose. Much of our understanding of this entity has been adapted from the literature on cervical squamous dysplasia, including the technique of HRA itself. Epidemiologic evidence has shown that the prevalence and incidence of anal dysplasia is highest in HIV-positive populations. The history of this technique parallels the evolution of our understanding of anal dysplasia. To understand the history of the use of HRA and its place in the screening and management of anal squamous dysplasia, we discuss key advances in the understanding of human papillomavirus-related squamous dysplasia. We begin with early reports in the field establishing the link between this virus and squamous dysplasia, through the marked increase in anal cancer seen with the onset of the HIV epidemic, the identification of relevant populations at risk, the performance of the test itself, to its use today.
PubMed: 30450017
DOI: 10.1055/s-0038-1668103 -
Circulation Sep 2021The necrotic core partly formed by ineffective efferocytosis increases the risk of an atherosclerotic plaque rupture. Microribonucleic acids contribute to necrotic core...
BACKGROUND
The necrotic core partly formed by ineffective efferocytosis increases the risk of an atherosclerotic plaque rupture. Microribonucleic acids contribute to necrotic core formation by regulating efferocytosis and macrophage apoptosis. Atherosclerotic plaque rupture occurs at increased frequency in the early morning, indicating diurnal changes in plaque vulnerability. Although circadian rhythms play a role in atherosclerosis, the molecular clock output pathways that control plaque composition and rupture susceptibility are unclear.
METHODS
Circadian gene expression, necrotic core size, apoptosis, and efferocytosis in aortic lesions were investigated at different times of the day in mice and mice after consumption of a high-fat diet for 12 weeks. Genome-wide gene expression and lesion formation were analyzed in bone marrow-transplanted mice. Diurnal changes in apoptosis and clock gene expression were determined in human atherosclerotic lesions.
RESULTS
The expression of molecular clock genes, lesional apoptosis, and necrotic core size were diurnally regulated in mice. Efferocytosis did not match the diurnal increase in apoptosis at the beginning of the active phase. However, in parallel with apoptosis, expression levels of oscillating strands decreased in the mouse atherosclerotic aorta. knockout abolished circadian regulation of apoptosis and reduced necrotic core size but did not affect core clock gene expression. Further, knockout upregulated expression of proapoptotic Xaf1 (XIAP-associated factor 1) in the atherosclerotic aorta, which abolished circadian expression of Xaf1. The antiapoptotic effect of was mediated by noncanonical targeting of through both strands. knockout in bone marrow cells also reduced atherosclerosis and necrotic core size. Circadian regulation of clock gene expression was confirmed in human atherosclerotic lesions. Apoptosis oscillated diurnally in phase with expression, demonstrating an early morning peak antiphase to that of the strands.
CONCLUSIONS
Our findings suggest that the molecular clock in atherosclerotic lesions induces a diurnal rhythm of apoptosis regulated by circadian expression in macrophages that is not matched by efferocytosis, thus increasing the size of the necrotic core.
Topics: Animals; Apoptosis; Atherosclerosis; Disease Models, Animal; Humans; Mice; Mice, Inbred C57BL; MicroRNAs
PubMed: 34233454
DOI: 10.1161/CIRCULATIONAHA.120.051614 -
American Heart Journal Oct 2021Advances in image processing and computer hardware have enabled the development of user-friendly software which operate in real-time and can be used in the... (Review)
Review
Advances in image processing and computer hardware have enabled the development of user-friendly software which operate in real-time and can be used in the catheterization laboratory to facilitate percutaneous coronary intervention (PCI). The two dimensional-(2D) quantitative coronary angiography (QCA) systems that have traditionally been used to assess lesion severity have been replaced by 3D-QCA systems, enabling more reliable evaluation of vessel geometry and lesion dimensions. This also allows 3D reconstruction of coronary bifurcation anatomy and generation of models that can be processed by computational fluid dynamic techniques to reliably detect flow-limiting lesions. More recently, software has been introduced that has the capability of generating a digital silhouette of the coronary arteries superimposed onto X-ray angiography to facilitate wire crossing and stent placement, and potentially reduce contrast use. In parallel, methodologies have been developed that operate with an accessible interface and can process intravascular imaging data, reliably quantify lesion severity and co-register intravascular and X-ray angiographic data to comprehensively assess plaque distribution and guide PCI. The above advances are used in daily practice to improve procedural results and outcomes. This review aims to provide an overview of the developments in the field - it presents the computer-based technologies that have been designed to accurately assess lesion severity, summarizes the advantages and limitations of the systems introduced to co-register imaging data and discusses the potential value of the existing and emerging software in the catheterization laboratory.
Topics: Cardiac Catheterization; Coronary Angiography; Coronary Vessels; Fluoroscopy; Humans; Imaging, Three-Dimensional; Percutaneous Coronary Intervention; Software; Stents; Tomography, Optical Coherence; Ultrasonography, Interventional
PubMed: 34077744
DOI: 10.1016/j.ahj.2021.05.017 -
Visceral Medicine Feb 2020Endoscopic imaging is a rapidly evolving field with a constant influx of new concepts and technologies. Since the introduction of video endoscopy and subsequently... (Review)
Review
BACKGROUND
Endoscopic imaging is a rapidly evolving field with a constant influx of new concepts and technologies. Since the introduction of video endoscopy and subsequently high-definition imaging as the first revolutions in gastrointestinal endoscopy, several technologies of virtual chromoendoscopy have been developed and brought to the market in the past decade, which have shaped and revolutionized for a second time our approach to endoscopic imaging. In parallel to these developments, microscopic imaging technologies, such as endomicroscopy and endocytoscopy, allow us to examine single cells within the mucosa in real time, thereby enabling histological diagnoses during ongoing endoscopy.
SUMMARY
In this review, we provide an overview on the technical background of different technologies of advanced endoscopic imaging, and then review and discuss their role and applications for the diagnosis and management of colorectal neoplasms as well as limitations and challenges that exist despite all technological improvements.
KEY MESSAGES
Technologies of advanced endoscopic imaging have profound impact not only on our imaging capabilities, they are also about to fundamentally change our approach to managing lesions in the gastrointestinal tract: not every lesion found during colonoscopy has to be excised or sent for histopathologic evaluation. However, before this becomes widespread reality, major obstacles such as patient acceptance, adoption by less trained endoscopists, and also legal aspects need to carefully addressed. The development of computer-aided diagnosis and artificial intelligence algorithms hold the potential to overcome the obstacles associated with the concept of optical biopsy and will most likely fundamentally facilitate, shape, and change decision making in the management of colorectal lesions.
PubMed: 32110657
DOI: 10.1159/000505411