-
International Journal of Radiation... Jun 2024Few reports describe the risks of late ocular toxicities after radiation therapy (RT) for childhood cancers despite their effect on quality of life. The Pediatric Normal... (Review)
Review
PURPOSE
Few reports describe the risks of late ocular toxicities after radiation therapy (RT) for childhood cancers despite their effect on quality of life. The Pediatric Normal Tissue Effects in the Clinic (PENTEC) ocular task force aims to quantify the radiation dose dependence of select late ocular adverse effects. Here, we report results concerning retinopathy, optic neuropathy, and cataract in childhood cancer survivors who received cranial RT.
METHODS AND MATERIALS
A systematic literature search was performed using the PubMed, MEDLINE, and Cochrane Library databases for peer-reviewed studies published from 1980 to 2021 related to childhood cancer, RT, and ocular endpoints including dry eye, keratitis/corneal injury, conjunctival injury, cataract, retinopathy, and optic neuropathy. This initial search yielded abstracts for 2947 references, 269 of which were selected as potentially having useful outcomes and RT data. Data permitting, treatment and outcome data were used to generate normal tissue complication probability models.
RESULTS
We identified sufficient RT data to generate normal tissue complication probability models for 3 endpoints: retinopathy, optic neuropathy, and cataract formation. Based on limited data, the model for development of retinopathy suggests 5% and 50% risk of toxicity at 42 and 62 Gy, respectively. The model for development of optic neuropathy suggests 5% and 50% risk of toxicity at 57 and 64 Gy, respectively. More extensive data were available to evaluate the risk of cataract, separated into self-reported versus ophthalmologist-diagnosed cataract. The models suggest 5% and 50% risk of self-reported cataract at 12 and >40 Gy, respectively, and 50% risk of ophthalmologist-diagnosed cataract at 9 Gy (>5% long-term risk at 0 Gy in patients treated with chemotherapy only).
CONCLUSIONS
Radiation dose effects in the eye are inadequately studied in the pediatric population. Based on limited published data, this PENTEC comprehensive review establishes relationships between RT dose and subsequent risks of retinopathy, optic neuropathy, and cataract formation.
Topics: Humans; Cataract; Cancer Survivors; Retinal Diseases; Child; Optic Nerve Diseases; Radiation Injuries; Radiotherapy Dosage; Organs at Risk; Cranial Irradiation
PubMed: 37565958
DOI: 10.1016/j.ijrobp.2023.06.007 -
Neuroprotective Strategies for Nonarteritic Anterior Ischemic Optic Neuropathy: A Systematic Review.Korean Journal of Ophthalmology : KJO Aug 2023Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there...
PURPOSE
Nonarteritic anterior ischemic optic neuropathy (NAION) is the second most common form of optic neuropathy. Most patients show no improvement over time. Until now, there is still no definitive therapy for NAION. The available literatures on the possible treatment of NAION are quite diverse and controversial. Neuroprotection strategies have been suggested as one of the potential treatments for NAION. This review aims to critically evaluate the literature on neuroprotective strategy for NAION.
METHODS
This report was written in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. We performed a systematic literature search in Pubmed, Science Direct, Proquest, and Cochrane databases. Only neuroprotective agents that directly work in protecting neurons were included. The outcome of interest in this review is retinal ganglion cell density and apoptosis for animal studies and retinal nerve fiber layer thickness for human studies.
RESULTS
The systematic search identified 591 studies of which 24 met the eligibility criteria, including 21 animal studies and three human studies. Only a few of the studies evaluated the same treatments, showing how diverse neuroprotector treatments are currently being evaluated as NAION treatment. From 21 animal studies, 14 studies showed significantly higher retinal ganglion cell density (1.49- to 2.81-fold) with neuroprotective treatment compared to control group. Two of three human studies in this review had also found a beneficial effect of preserving retinal nerve fiber layer thickness in NAION patients.
CONCLUSIONS
This review suggests the potential of neuroprotection as a viable option in the quest for an effective treatment strategy for NAION. Further studies, particularly clinical studies, are necessary to establish its efficacy in NAION patients.
Topics: Animals; Humans; Optic Neuropathy, Ischemic; Optic Disk; Neuroprotection; Visual Acuity; Tomography, Optical Coherence
PubMed: 37563973
DOI: 10.3341/kjo.2022.0166 -
Molecular Autism Jul 2023Septo-optic dysplasia (SOD) is a rare condition diagnosed in children with two or more of the following: hypopituitarism, midline brain abnormalities, and optic nerve... (Review)
Review
BACKGROUND
Septo-optic dysplasia (SOD) is a rare condition diagnosed in children with two or more of the following: hypopituitarism, midline brain abnormalities, and optic nerve hypoplasia. Children with SOD experience varied visual impairment and endocrine dysfunction. Autistic-like behaviours have been reported; however, their nature and prevalence remain to be fully understood. The present systematic review aimed to explore the type and prevalence of neurodevelopmental impairments in children with SOD spectrum conditions.
METHODS
The search was conducted in PubMed, EMBASE, and PsycInfo. Hand-searching reference lists of included studies was conducted. All peer-reviewed, observational studies assessing behavioural and cognitive impairments or autism spectrum disorder (ASD) symptoms in children (< 18 years) with SOD, optic nerve hypoplasia, and SOD-plus were included. Studies were excluded if they did not report standardised measures of neurodevelopmental impairments or ASD outcomes.
RESULTS
From 2132 screened articles, 20 articles reporting data from a total of 479 children were included in prevalence estimates. Of 14 studies assessing cognitive-developmental outcomes, 175 of 336 (52%) children presented with intellectual disability or developmental delay. A diagnosis of ASD or clinical level of symptoms was observed in 65 of 187 (35%) children across five studies. Only five studies assessed for dysfunction across behavioural, emotional, or social domains and reported impairments in 88 of 184 (48%) of children assessed.
LIMITATIONS
Importantly, high heterogeneity among the samples in relation to their neuroanatomical, endocrine, and optic nerve involvement meant that it was not possible to statistically assess the relative contribution of these confounding factors to the specific neurodevelopmental phenotype. This was further limited by the variation in study designs and behavioural assessments used across the included studies, which may have increased the risk of information bias.
CONCLUSIONS
This systematic review suggests that the prevalence of neurodevelopmental impairments in children within the SOD spectrum may be high. Clinicians should therefore consider including formal assessments of ASD symptoms and neurodevelopmental impairments alongside routine care. There is, additionally, a need for further research to define and validate a standardised battery of tools that accurately identify neurodevelopmental impairments in SOD spectrum conditions, and for research to identify the likely causal mechanisms.
Topics: Humans; Septo-Optic Dysplasia; Autism Spectrum Disorder; Optic Nerve Hypoplasia; Hypopituitarism; Autistic Disorder
PubMed: 37491272
DOI: 10.1186/s13229-023-00559-0 -
Journal of Traditional Chinese Medicine... Aug 2023To evaluate the effectiveness and safety of Xuebijing injection (XBJ) on coronavirus disease 2019 (COVID-19) in patients. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the effectiveness and safety of Xuebijing injection (XBJ) on coronavirus disease 2019 (COVID-19) in patients.
METHODS
Related studies on multiple biological databases and websites were searched up to December 11, 2021 without language and publication time restrictions. Review Manager V.5.3 and Stata 14 software were used for data analysis.
RESULTS
Seven studies were finally included. The Metaanalysis showed that compared with the routine treatment alone, XBJ combined with the routine treatment can reduce the 28day mortality ( = 0.3, 95% : 0.12, 0.74), Creactive protein ( = -12.8, 95% : -23.13, 3.46), erythrocyte sedimentation rate ( = -9.32, 95% : -14.66, -3.98) and interleukin-6 (S = -0.6, 95% : -1.04, -0.17) levels and increase the leukocyte ( = 0.73, 95% : 0.42, 1.04) and lymphocyte count ( = 0.18, 95% : 0.07, 0.29) in peripheral blood; additionally, it has no obvious side effects ( = 1.11, 95% : 0.65, 1.9). There was no evidence that the XBJ combined therapy can improve the nucleic acid conversion rate and computed tomography improvement rate of COVID19 patients.
CONCLUSIONS
Preliminary evidence suggests that XBJ combined with routine treatment seems to be more effective than routine treatment for patients with COVID19. Limited by the number and quality of included papers, this finding still needs further validation by more studies.
Topics: Humans; COVID-19; Drugs, Chinese Herbal; Injections
PubMed: 37454247
DOI: 10.19852/j.cnki.jtcm.20230517.002 -
Medical Ultrasonography Sep 2023To compare the accuracy of the optic nerve sheath diameter (ONSD) measured by ocular ultrasonography (US) versus magnetic resonance imaging (MRI) for the diagnosis of...
Optic nerve sheath diameter measured by ultrasonography versus Magnetic Resonance Imaging for diagnosing increased intracranial pressure: a systematic review and meta-analysis.
AIMS
To compare the accuracy of the optic nerve sheath diameter (ONSD) measured by ocular ultrasonography (US) versus magnetic resonance imaging (MRI) for the diagnosis of increased intracranial pressure (ICP).
MATERIAL AND METHODS
A systematic search of studies evaluating US ONSD or MRI ONSD for the diagnosis of increased ICP was performed. Data were extracted independently by two authors. We used the bivariate random-effects model to evaluate the diagnostic feasibility of measuring the ONSD in patients increased ICP. A summary receiver operating characteristic (SROC) graph was adopted to calculate sensitivity and specificity. Subgroup analysis was used to explore potential difference in US ONSD and MRI ONSD.
RESULTS
A total of 31 studies were included, in which there were 1783 patients diagnosed with US ONSD and 730 patients diagnosed with MRI ONSD. Twenty studies reporting US ONSD were included for quantitative synthesis. The US ONSD had a high diagnostic accuracy, involving estimated sensitivity of 0.92 (95%CI 0.87-0.95), estimated specificity of 0.85 (95%CI 0.79-0.89), positive likelihood ratio (PLR) of 6.0 (95%CI 4.3-8.4), negative likelihood ratio (NLR) of 0.10 (95%CI 0.06-0.15) and Diagnostic Odds Ratio (DOR) of 62 (95%CI 33-117). The data of 11 studies adopting MRI ONSD was pooled. The MRI ONSD demonstrated estimated sensitivity of 0.70 (95%CI 0.60-0.78), estimated specificity of 0.85 (95%CI 0.80-0.90), PLR of 4.8 (95%CI 3.4-6.7), NLR of 0.35 (95%CI 0.27-0.47) and DOR of 13 (95%CI 8-22). The subgroup analysis showed that US ONSD demonstrated a higher sensitivity (0.92 versus 0.70; p<0.01) and almost equal specificity (0.85 vs. 0.85; p=0.67) compared with MRI ONSD.
CONCLUSION
Measurement of ONSD can be a useful tool to predict raised ICP. The US ONSD demonstrated better accuracy than MRI ONSD for the diagnosis of increased ICP.
PubMed: 37369031
DOI: 10.11152/mu-4037 -
Nigerian Journal of Clinical Practice May 2023The most effective treatment method for meningiomas is surgical treatment. However, complete resection of cavernous sinus meningiomas is quite difficult. The biggest...
BACKGROUND
The most effective treatment method for meningiomas is surgical treatment. However, complete resection of cavernous sinus meningiomas is quite difficult. The biggest reasons for this are; narrow surgical corridor, the optic chiasm is the close relationship between the cranial nerves and anterior cerebral and internal carotid arteries. Gamma knife radiosurgery (GKRS) may be a good option in these lesions with high mortality and morbidity.
AIM
This study aimed to evaluate and compare the early effects at a mean of 6 months and 3 years and outcomes between surgery followed by gamma knife radiosurgery (GKRS) and GKRS alone for cavernous sinus meningiomas.
METHODS
We included 20 patients with cavernous sinus meningioma treated via single fraction Leksell Gamma Knife Perfexion (Elekta Instruments; Stockholm, Sweden) between 2015 and 2018. The mean age of the patients was 54.95 (range: 32-77) years. Nine patients underwent primary surgery (for the resection of extracavernous components of the tumor) followed by GKRS (for the resection of intracavernous components of the tumor) (group A). Meanwhile, 11 patients were managed with GKRS alone (group B). The tumor volume ranged from 2.8 to 32.8 (mean: 14.76) cm3 and the isodose to the tumor margin from 10 to 13.5 (mean: 11.65) Gy.
RESULTS
In total, 20 patients were followed up at a mean time of 18.95 (range: 6-36) months. The mean Karnofsky Performance Score of the patients was 95.2%. The mean follow up times of groups A and B were 23.6 and 15 months, respectively. Meanwhile, only patients with a follow up time of at least 6 months were included in the study. The mean follow up time after GKRS in group A was 17.6 months. There was no change in the tumor volume in 15% of patients. In the remaining cases, the tumor volume decreased. The mean tumor regression rates were 82.2% in Group A and 17.7% in Group B. The tumor volume did not decrease in three patients (n = 1, group A and n = 2, group B). Cranial nerve deficits improved, worsened, and remained stable in 46.6%, 26.6%, and 26.6% of cases, respectively. The temporary morbidity rate was 10%. In group A, transient postoperative diabetes insipidus was observed in one patient and atelectasis in another. None of these complications affected the final status of patients. The mortality rate after treatment was 0%.
CONCLUSION
Volume staged GKRS is safe and effective for cavernous sinus meningioma. GKRS is effective for long term tumor growth control and has a low complication rate. Hence, it is the preferred management strategy for tumors with a suitable volume (average tumor diameter: 3 cm or volume: 10 cm3 ). In tumors with a volume of more than 10 mL and/or without a 3 mm safety margin with the optical system, it is recommended to prepare for radiosurgery by cytoreducing the tumor volume surgically. Based on our opinion, the best results were obtained by GKRS to the intracavernous.
Topics: Humans; Adult; Middle Aged; Aged; Meningioma; Meningeal Neoplasms; Radiosurgery; Cavernous Sinus; Treatment Outcome; Follow-Up Studies; Retrospective Studies
PubMed: 37357468
DOI: 10.4103/njcp.njcp_2033_21 -
Orphanet Journal of Rare Diseases Jun 2023CSF1R mutations cause autosomal-dominant CSF1R-related leukoencephalopathy with axonal spheroids and pigmented glia (CSF1R-ALSP) and autosomal-recessive brain... (Review)
Review
CSF1R mutations cause autosomal-dominant CSF1R-related leukoencephalopathy with axonal spheroids and pigmented glia (CSF1R-ALSP) and autosomal-recessive brain abnormalities, neurodegeneration, and dysosteosclerosis (BANDDOS). The former is increasingly recognized, and disease-modifying therapy was introduced; however, literature is scarce on the latter. This review analyzes BANDDOS and discusses similarities and differences with CSF1R-ALSP.We systematically retrieved and analyzed the clinical, genetic, radiological, and pathological data on the previously reported and our cases with BANDDOS. We identified 19 patients with BANDDOS (literature search according to the PRISMA 2020 guidelines: n = 16, our material: n = 3). We found 11 CSF1R mutations, including splicing (n = 3), missense (n = 3), nonsense (n = 2), and intronic (n = 2) variants and one inframe deletion. All mutations disrupted the tyrosine kinase domain or resulted in nonsense-mediated mRNA decay. The material is heterogenous, and the presented information refers to the number of patients with sufficient data on specific symptoms, results, or performed procedures. The first symptoms occurred in the perinatal period (n = 5), infancy (n = 2), childhood (n = 5), and adulthood (n = 1). Dysmorphic features were present in 7/17 cases. Neurological symptoms included speech disturbances (n = 13/15), cognitive decline (n = 12/14), spasticity/rigidity (n = 12/15), hyperactive tendon reflex (n = 11/14), pathological reflexes (n = 8/11), seizures (n = 9/16), dysphagia (n = 9/12), developmental delay (n = 7/14), infantile hypotonia (n = 3/11), and optic nerve atrophy (n = 2/7). Skeletal deformities were observed in 13/17 cases and fell within the dysosteosclerosis - Pyle disease spectrum. Brain abnormalities included white matter changes (n = 19/19), calcifications (n = 15/18), agenesis of corpus callosum (n = 12/16), ventriculomegaly (n = 13/19), Dandy-Walker complex (n = 7/19), and cortical abnormalities (n = 4/10). Three patients died in infancy, two in childhood, and one case at unspecified age. A single brain autopsy evidenced multiple brain anomalies, absence of corpus callosum, absence of microglia, severe white matter atrophy with axonal spheroids, gliosis, and numerous dystrophic calcifications.In conclusion, BANDDOS presents in the perinatal period or infancy and has a devastating course with congenital brain abnormalities, developmental delay, neurological deficits, osteopetrosis, and dysmorphic features. There is a significant overlap in the clinical, radiological, and neuropathological aspects between BANDDOS and CSF1R-ALSP. As both disorders are on the same continuum, there is a window of opportunity to apply available therapy in CSF1R-ALSP to BANDDOS.
Topics: Humans; Neuroglia; Leukoencephalopathies; Brain; Mutation; Nervous System Malformations; Atrophy
PubMed: 37349768
DOI: 10.1186/s13023-023-02772-9 -
European Radiology Nov 2023We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
We conducted a systematic review and individual participant data meta-analysis of publications reporting the ophthalmologic presentation, clinical exam, and orbital MRI findings in patients with giant cell arteritis and ocular manifestations.
METHODS
PubMed and Cochrane databases were searched up to January 16, 2022. Publications reporting patient-level data on patients with ophthalmologic symptoms, imaged with orbital MRI, and diagnosed with biopsy-proven giant cell arteritis were included. Demographics, clinical symptoms, exam, lab, imaging, and outcomes data were extracted. The methodological quality and completeness of reporting of case reports were assessed.
RESULTS
Thirty-two studies were included comprising 51 patients (females = 24; median age, 76 years). Vision loss (78%) and headache (45%) were commonly reported visual and cranial symptoms. Ophthalmologic presentation was unilateral (41%) or bilateral (59%). Fundus examination most commonly showed disc edema (64%) and pallor (49%). Average visual acuity was very poor (2.28 logMAR ± 2.18). Diagnoses included anterior (61%) and posterior (16%) ischemic optic neuropathy, central retinal artery occlusion (8%), and orbital infarction syndrome (2%). On MRI, enhancement of the optic nerve sheath (53%), intraconal fat (25%), and optic nerve/chiasm (14%) was most prevalent. Among patients with monocular visual symptoms, 38% showed pathologic enhancement in the asymptomatic orbit. Six of seven cases reported imaging resolution after treatment on follow-up MRIs.
CONCLUSIONS
Vision loss, pallid disc edema, and optic nerve sheath enhancement are the most common clinical, fundoscopic, and imaging findings reported in patients diagnosed with giant cell arteritis with ocular manifestations, respectively. MRI may detect subclinical inflammation and ischemia in the asymptomatic eye and may be an adjunct diagnostic tool.
CLINICAL RELEVANCE STATEMENT
Brain and orbital MRIs may have diagnostic and prognostic roles in patients with suspected giant cell arteritis who present with ophthalmic symptoms.
Topics: Female; Humans; Aged; Giant Cell Arteritis; Vision Disorders; Magnetic Resonance Imaging; Optic Neuropathy, Ischemic; Edema
PubMed: 37256352
DOI: 10.1007/s00330-023-09770-2 -
Diagnostics (Basel, Switzerland) May 2023(1) Background: Head trauma represents the first cause of death in abused children, but diagnostic knowledge is still limited. The characteristic findings of abusive... (Review)
Review
(1) Background: Head trauma represents the first cause of death in abused children, but diagnostic knowledge is still limited. The characteristic findings of abusive head trauma (AHT) are retinal hemorrhages (RH) and additional ocular findings, including optic nerve hemorrhages (ONH). However, etiological diagnosis must be cautious. (2) Methods: The Preferred Reporting Items for Systematic Review (PRISMA) standards were employed, and the research focus was the current gold standard in the diagnosis and timing of abusive RH. (3) Results: Sixteen articles were included for qualitative synthesis. The importance of an early instrumental ophthalmological assessment emerged in subjects with a high suspicion of AHT, with attention to the localization, laterality, and morphology of the findings. Sometimes it is possible to observe the fundus even in deceased subjects, but the current techniques of choice consist of Magnetic Resonance Imaging and Computed Tomography, also useful for the timing of the lesion, the autopsy, and the histological investigation, especially if performed with the use of immunohistochemical reactants against erythrocytes, leukocytes, and ischemic nerve cells. (4) Conclusions: The present review has made it possible to build an operational framework for the diagnosis and timing of cases of abusive retinal damage, but further research in the field is needed.
PubMed: 37238204
DOI: 10.3390/diagnostics13101722 -
Journal of Clinical Neuroscience :... Jul 2023The prediction of raised Intracranial Pressure (ICP) with accuracy in Traumatic Brain Injury (TBI) patients is a clinically important decision and therapeutic tool. This... (Meta-Analysis)
Meta-Analysis Review
Transcranial doppler in the non-invasive estimation of intracranial pressure in traumatic brain injury compared to other non-invasive methods in lower-middle income countries: Systematic review and meta-analysis.
BACKGROUND
The prediction of raised Intracranial Pressure (ICP) with accuracy in Traumatic Brain Injury (TBI) patients is a clinically important decision and therapeutic tool. This study aimed to evaluate the existing methods used for non-invasive ICP monitoring in TBI patients in LMICs.
METHODS
Systematic searches of PubMed, Google Scholar, and ScienceDirect were performed from database inception to November 2021. Studies reporting the prediction of raised ICP in TBI patients by non-invasive means in LMICs were included. Pooled estimates of sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios with 95 %CI were calculated for each index test consisting of the fifteen studies, using the MEDDECIDE module 0.0.2 for meta-analysis of diagnostic test accuracy, reliability, and decision studies in JAMOVI 2.2.5.
RESULTS
A total of 1032 studies were identified, of which, 15 included 3316 patients with male predominance (n = 2458, 74.13%). Patients' ages range from 15 to 96 years with 40-80 (n = 1205, 36.34%), the most represented population. The ICP measured by Transcranial Doppler (TCD) had a sensitivity of 92.3%, and a specificity of 70%. The positive predictive value was 66.67%, with a negative predictive value of 93.33%. Furthermore, the positive Likelihood Ratio (+LR) was 3.69; 2<+LR < 5 and the negative Likelihood Ratio (-LR) 0.103; 0.1 < -LR < 0.2. We carried out a "Medical Decision", "Plots", "Fagan Normogram" and the ROC curve to find the perfect discrimination point of all the five tests used for the non-invasive measurement of ICP in the TBI patients in LMICs.
CONCLUSION
The TCD had shown high performance in its sensitivity and specificity, placing it on top of the other four different tests used in LMICs for the management of patients with TBI.
Topics: Humans; Male; Adolescent; Young Adult; Adult; Middle Aged; Aged; Aged, 80 and over; Female; Developing Countries; Intracranial Pressure; Reproducibility of Results; Ultrasonography, Doppler, Transcranial; Brain Injuries, Traumatic; Intracranial Hypertension
PubMed: 37224611
DOI: 10.1016/j.jocn.2023.05.010