Modern methods of neuro-visualization of brain pathology in central form of Recklinghausen's disease

The paper reviews the data available in the literature on the diagnosis of brain lesions in the central form of Recklinghausen's disease (neurofibromatosis) by magnetic resonance imaging. The results of a clinical observation of 10 children suffering trom neurofibromatosis and the data of electroencephalography, computed tomography and MRI are given and analyzed. Conclusions are made on the magnitude of and the most common site of MRI changes. It is suggested that MRI shows a higher sensitivity in detecting brain lesions in Recklinghausen's disease than other diagnostic techniques.     

A second locus for familial high myopia maps to chromosome 12q.

Myopia, or nearsightedness, is the most common eye disorder worldwide. "Pathologic" high myopia, or myopia of <=-6.00 diopters, predisposes individuals to retinal detachment, macular degeneration, cataract, or glaucoma. A locus for autosomal dominant pathologic high myopia has been mapped to 18p11.31. We now report significant linkage of high myopia to a second locus at the 12q21-23 region in a large German/Italian family. The family had no clinical evidence of connective-tissue abnormalities or glaucoma. The average age at diagnosis of myopia was 5.9 years. The average spherical-component refractive error for the affected individuals was -9.47 diopters. Markers flanking or intragenic to the genes for the 18p locus, Stickler syndromes type I and II (12q13.1-q13.3 and 6p21.3), Marfan syndrome (15q21.1), and juvenile glaucoma (chromosome 1q21-q31) showed no linkage to the myopia in this family. The maximum LOD score with two-point linkage analysis in this pedigree was 3.85 at a recombination fraction of .0010, for markers D12S1706 and D12S327. Recombination events identified markers D12S1684 and D12S1605 as flanking markers that define a 30.1-cM interval on chromosome 12q21-23, for the second myopia gene. These results confirm genetic heterogeneity of myopia. The identification of this gene may provide insight into the pathophysiology of myopia and eye development.     

Painful rib hump: a new clinical sign for detecting intraspinal rib displacement in scoliosis due to neurofibromatosis

Background

Spinal cord compression and associate neurological impairment is rare in patients with scoliosis and neurofibromatosis. Common reasons are vertebral subluxation, dislocation, angulation and tumorous lesions around the spinal canal. Only twelve cases of intraspinal rib dislocation have been reported in the literature. The aim of this report is to present a case of rib penetration through neural foramen at the apex of a scoliotic curve in neurofibromatosis and to introduce a new clinical sign for its detection.

Methods

A 13-year-old girl was evaluated for progressive left thoracic kyphoscoliotic curve due to a type I neurofibromatosis. Clinical examination revealed multiple large thoracic and abdominal "cafe-au-lait" spots, neurological impairment of the lower limbs and the presence of a thoracic gibbous that was painful to pressure at the level of the left eighth rib (Painful Rib Hump). CT-scan showed detachment and translocation of the cephalic end of the left eighth rib into the adjacent enlarged neural foramen. The M.R.I. examination of the spine showed neither cord abnormality nor neurogenic tumor.

Results

The patient underwent resection of the intraspinal mobile eighth rib head and posterior spinal instrumentation and was neurologically fully recovered six months postoperatively.

Conclusion

Spine surgeons should be aware of intraspinal rib displacement in scoliotic curves in neurofibromatosis. Painful rib hump is a valuable diagnostic tool for this rare clinical entity.     

光学相干断层成像术在近视眼视网膜神经纤维层厚度测量中的临床应用

目的:研究光学相干断层成像术(OCT)在近视眼视网膜神经纤维层(RNFL)厚度测量中的应用价值。方法:选择2016年1月到2016年5月在医院就诊的近视患者73例(138眼)纳入此次研究,根据近视情况将患者分为低度近视组(-0.30D~-3.00D)共26例(48眼)、中度近视组(-3.01~-6.00D)共24例(47眼)及高度近视组(-6.00D)共23例(43眼)。另选同期在医院体检(视力正常)的健康志愿者25例(45眼)作为对照组,对比各组不同象限的RNFL厚度,屈光度及眼轴长度,分析近视眼各象限的RNFL厚度与患者屈光度和眼轴长度的相关性。结果:高度近视组的上方象限、下方象限以及鼻侧象限的RNFL厚度均明显低于对照组及中度近视组,中度近视组的下方象限及鼻侧象限的RNFL厚度均明显低于对照组,低度近视组鼻侧象限的RNFL厚度明显低于对照组,差异均有统计学意义(均P0.05)。近视组的屈光度及眼轴长度均明显大于对照组,且高度近视组均明显大于中度近视组与低度近视组,中度近视组均明显大于低度近视组,差异均有统计学意义(均P0.05)。根据Pearson法分析相关性可知,近视眼患者上象限、下象限、鼻侧象限的RNFL厚度与其屈光度及眼轴长度均呈负相关。结论:利用OCT技术检测近视眼RNFL厚度时,应考虑屈光度及眼轴长度可能造成的影响,综合进行分析判断,以获得最佳检测数值。     

Risk factors for poor dental arch relationships in young children born with unilateral cleft lip and palate

To identify risk factors for poor dental arch relationships in children with unilateral cleft lip and palate in the United Kingdom, the authors performed a cross-sectional outcome study with retrospective data capture of treatment histories in children under the care of 44 cleft teams in the United Kingdom. The study sample comprised 238 children born with nonsyndromic complete unilateral cleft lip and palate between April 1, 1989, and March 31, 1991, who were between 5.0 and 7.7 years of age (mean age, 6.5 years) at the time of data collection. The Five-Year-Old Index was used to rank dental arch relationships from dental study models. Velopharyngeal insufficiency was assessed with the use of the Cleft Audit Protocol for Speech. An independent panel recorded surgical treatment histories from the clinical notes. There was no association between the technique and the timing of primary repair, the experience of the surgeon, or presurgical orthopedics and dental arch relationships. Secondary velopharyngeal surgery was independently associated with poor outcome (OR, 4.14; 95 percent CI, 1.6 to 10.7; p = 0.003). Primary nasal repair was protective (OR, 0.47; 95 percent CI, 0.23 to 0.93; p = 0.031) against poor dental arch relationships. Secondary velopharyngeal surgery and primary nasal repair were found to be independently associated with dental arch relationship outcomes in young children with unilateral cleft lip and palate in the United Kingdom.     

Systemic 7-methylxanthine in retarding axial eye growth and myopia progression: a 36-month pilot study

The adenosine antagonist 7-methylxanthine (7-mx) works against myopia in animal models. In a clinical trial, 68 myopic children (mean age 11.3 years) received either placebo or 7-mx tablets for 12 months. All participants subsequently received 7-mx for another 12 months, after which treatment was stopped. Axial length was measured with Zeiss IOL-Master and cycloplegic refraction with Nikon Retinomax at ?6, 0, 12, 24, and 36 months. Axial growth was reduced among children treated with 7-mx for 24 months compared with those only treated for the last 12 months. Myopia progression and axial eye growth slowed down in periods with 7-mx treatment, but when the treatment was stopped, both myopia progression and axial eye growth continued with invariable speed. The results indicate that 7-mx reduces eye elongation and myopia progression in childhood myopia. The treatment is safe and without side effects and may be continued until 18–20 years of age when myopia progression normally stops.     

On the mutation rate of neurofibromatosis.

A genetic study of 124 cases of neurofibromatosis was performed. The contingent of probands was mainly represented by a Russian population, most of the individuals being born in the European part of the RSFSR. Both parents of the probands were examined in only 58 cases, the proportion of sporadic cases in this group being 0.79, as compared to 0.77 for the whole group under study. The existing data evaluated by a direct method are not yet sufficient for a decisive estimation of the penetrance, which, however, cannot be under 80%. Segregation analysis of descendants from particular marriages showed a good correspondance to the hypothesis of Mendelian dominance (32 affected children out of 65). These results analyzed together with those obtained by other authors permit an inference on the full penetrance of neurofibromatosis. The genetic interpretation of sporadic cases as a result of new mutations is presented. The prevalence of neurofibromatosis among the 16-year-old youths was evaluated as 12.8 with 10-(5). This value is suggested to be an estimation of the incidence of the condition in the general population, the mutation rate evaluated by a direct method being equal to 4.4 with 10-(5) divided by 4.9 with 10-minus 5. The increased birth order of probands in sporadic cases (against the theoretical expectation) as well as increased paternal age (as compared with controls) were found to be statistically significant (P equals 0.004 and P equals 0.03, respectively) while the difference in maternal ages was statistically insignificant (P equals 0.008). No statistical relationship between sporadic cases and occupational exposure of parents to deleterious chemical and physical factors was found.     

A reliable positioning device for dorsoventral cephalometric radiography of the rat

In dental research, dorsoventral cephalometric radiography is often used to assess skull growth and dental movement in rat models. To ensure that images can be reproduced, radiographers must use a cephalostat to maintain the rat's head in a consistent position across imaging sessions. The authors describe a positioning device they designed that connects easily to a standard dental X-ray machine. The device enabled researchers to position rats repeatedly for radiographic imaging with very little variation.     

Automatic Diagnosis of Pathological Myopia from Heterogeneous Biomedical Data

Pathological myopia is one of the leading causes of blindness worldwide. The condition is particularly prevalent in Asia. Unlike myopia, pathological myopia is accompanied by degenerative changes in the retina, which if left untreated can lead to irrecoverable vision loss. The accurate diagnosis of pathological myopia will enable timely intervention and facilitate better disease management to slow down the progression of the disease. Current methods of assessment typically consider only one type of data, such as that from retinal imaging. However, different kinds of data, including that of genetic, demographic and clinical information, may contain different and independent information, which can provide different perspectives on the visually observable, genetic or environmental mechanisms for the disease. The combination of these potentially complementary pieces of information can enhance the understanding of the disease, providing a holistic appreciation of the multiple risks factors as well as improving the detection outcomes. In this study, we propose a computer-aided diagnosis framework for Pathological Myopia diagnosis through Biomedical and Image Informatics(PM-BMII). Through the use of multiple kernel learning (MKL) methods, PM-BMII intelligently fuses heterogeneous biomedical information to improve the accuracy of disease diagnosis. Data from 2,258 subjects of a population-based study, in which demographic and clinical information, retinal fundus imaging data and genotyping data were collected, are used to evaluate the proposed framework. The experimental results show that PM-BMII achieves an AUC of 0.888, outperforming the detection results from the use of demographic and clinical information 0.607 (increase , ), genotyping data 0.774 (increase , ) or imaging data 0.852 (increase , ) alone. The accuracy of the results obtained demonstrates the feasibility of using heterogeneous data for improved disease diagnosis through our proposed PM-BMII framework.     

Molding of the regenerate in mandibular distraction: clinical experience

Initial clinical experience with distraction osteogenesis has demonstrated the risk of developing postdistraction malocclusion that requires secondary orthodontic correction. In addition, optimal mandibular form is not always achieved. Both animal studies and preliminary clinical investigations have suggested that the regenerate can be successfully "molded" during active mandibular distraction. The authors have applied this concept clinically to obtain a more desirable occlusal relationship in a group of mandibular distraction patients. Eleven patients are described in whom angulation of the distraction device or intermaxillary/interdental elastics were employed to mold the regenerate. Two representative case studies are provided to illustrate the principles. When using elastic traction to close an anterior open bite, care must be taken that extrusion of individual teeth is minimized by distributing the force over the entire dental arch, especially the basilar portions of the jaws. The authors demonstrate that molding of the regenerate can be successfully accomplished not only during device activation but also early in the consolidation period. The outer limit of the time window in which molding is effective remains to be defined.     

Spinal Neurofibromatosis without Café-au-Lait Macules in Two Families with Null Mutations of the NF1 Gene

Spinal neurofibromatosis (SNF) is considered to be an alternative form of neurofibromatosis, showing multiple spinal tumors and café-au-lait macules. Involvement of the neurofibromatosis type 1 (NF1) locus has been demonstrated, by linkage analysis, for three families with SNF. In one of them, a cosegregating frameshift mutation in exon 46 of the NF1 gene was identified. In the present study, we report four individuals from two families who carry NF1 null mutations that would be expected to cause NF1. Three patients have multiple spinal tumors and no café-au-lait macules, and the fourth has no clinical signs of NF1. In the first family, a missense mutation (Leu2067Pro) in NF1 exon 33 was found, and, in the second, a splice-site mutation (IVS31-5A-->G) enlarging exon 32 by 4 bp at the 5' end was found. The latter mutation has also been observed in an unrelated patient with classical NF1. Both NF1 mutations cause a reduction in neurofibromin of approximately 50%, with no truncated protein present in the cells. This demonstrates that typical NF1 null mutations can result in a phenotype that is distinct from classical NF1, showing only a small spectrum of the NF1 symptoms, such as multiple spinal tumors, but not completely fitting the current clinical criteria for SNF. We speculate that this phenotype is caused by an unknown modifying gene that compensates for some, but not all, of the effects caused by neurofibromin deficiency.     

Investigation of the cytotoxic effects of DNA damaging agents on neurofibromatosis cells

Cells cultured from individuals with neurofibromatosis, a genetic syndrome associated with a predisposition to malignancy, were studied. We examined survival as measured by colony formation in skin fibroblasts from 5 patients with neurofibromatosis after exposure to X-rays, ultraviolet light and an alkylating agent. We did not observe mutagen hypersensitivity in neurofibromatosis cells as compared to normal controls.     

光诱导角膜交联及检测技术的研究进展

由于圆锥角膜疾病导致越来越多的人患有近视,常见的矫正方法有佩戴近视眼镜、隐形眼镜等.随着科技的进步,利用光对近视等眼科疾病进行屈光矫正已经成为当前临床中常用的方法.使用光诱导角膜胶原蛋白发生交联,从而达到治疗圆锥角膜疾病、提高患者视力水平的目的,这是一种新型的光治疗眼睛疾病的方法.同时这种方法由于无侵入性、对操作者能力依赖性小等优势成为新的研究热点.本文阐述光诱导角膜交联的基本原理,并介绍其发展历程,分析现有的各种交联方法和角膜检测技术的原理,并对现有交联方法和检测方法的优缺点进行讨论.最后,本文对光诱导角膜交联和检测技术的最新进展进行系统的论述,并对未来的发展趋势进行展望.     

中国直立人牙齿特征变异及其演化意义

以往研究发现,中国直立人化石呈现较大的形态变异。对于这种变异程度及造成变异的原因,在古人类学界有不同的认识。有学者提出在直立人阶段,中国古人类已经呈现明显的区域性差异,但也有人认为这些差异似乎没有规律性。近年,本文作者采用不同方法对若干地点的中国直立人牙齿特征及其变异进行了系列研究,取得了一些新的发现和认识。本文在回顾总结这些研究的基础上,结合对其它一些地点中国直立人牙齿特征的观测对比,对中国直立人牙齿特征表现特点及变异作了进一步的分析。本研究发现,中国直立人牙齿特征具有较大的变异范围。这些变异似可分为两种主要类型,元谋、建始、郧县梅铺、和县牙齿呈现出较多的原始特点,代表一种原始类型;周口店、沂源等地点的标本特征相对进步,表现出更多的典型直立人特征。其它一些地点的直立人化石呈现出混合或中间状态。值得注意的是部分呈现出原始牙齿特征类型的中国直立人的生存年代相对较晚,其牙齿特征的原始性与生存时代不具有对应关系。作者认为中国直立人牙齿特征类型反映了更新世早期和中期不同直立人群的演化状态。原始类型牙齿特征的形成不仅与演化时序性和地理分布有关,还在一定程度上反映了一些中国直立人群的演化隔离。     

Familial neurofibromatosis and juvenile chronic myelogenous leukemia

Summary Two male children with familial neurofibromatosis were observed to develop juvenile chronic myelogenous leukemia. These two cases add to previous reports which have described an increased incidence of non-lymphocytic leukemia in patients with neurofibromatosis. In particular, the rare entity juvenile chronic myelogenous leukemia would appear to be the form of non-lymphocytic leukemia that has a definite association with familial neurofibromatosis.     

Vascular Manifestations of von Recklinghausen's Disease

A casual relationship between von Recklinghausen''s disease, or neurofibromatosis, and arteriolar abnormalities has been reported in the European literature. A patient was seen who had biopsy-proved neurofibromatosis and renovascular hypertension and retroperitoneal bleeding. An arteriographic study showed multiple small aneurysms throughout the coeliac axis, the superior mesenteric artery and in several small intrarenal vessels. Renal vein renin levels were elevated particularly in the right renal vein, supporting the diagnosis of renovascular hypertension. Both the aneurysms seen in angiographic studies and the retroperitoneal hemorrhage are probably vascular manifestations of von Recklinghausen''s disease. Support for this conclusion is enhanced by the absence of clinical, laboratory or histologic data supporting the only tenable differential diagnosis, periarteritis nodosa.     

Penetrance of von Recklinghausen neurofibromatosis: a distinction between predecessors and descendants.

This paper reviews the concepts of penetrance and expressivity and examines their application to the specific disorder von Recklinghausen neurofibromatosis. The data suggest that assessments of penetrance among predecessors to probands yield results different from those of assessments of penetrance among descendants to probands. For descendants at risk, penetrance is very close to 100%. For predecessors at risk, extremely variable expressivity may confound estimates of penetrance; as a specific example, a family is described in which two brothers have bona fide von Recklinghausen neurofibromatosis and their mother manifests the neurofibromatosis mutation only as iris Lisch nodules.     

Treatment of midfacial defects using prostheses supported by ITI dental implants

The purpose of this study was to evaluate retrospectively the use of ITI dental implants used for anchoring facial prostheses in the restorative treatment of midface defects. The authors analyzed the clinical data of 26 patients with orbital defects (n = 11), orbitonasal defects (n = 4), orbitonasomaxillary defects (n = 3), and nasal defects (n = 8). Data included age, sex, primary disease, implant position, implant length, implant failure, prosthetic attachment, radiation therapy, and peri-implant skin reactions. Follow-up was at 1, 3, 6, and 12 months and then on a yearly basis. The authors noted the status of healing and complications, if any. In total, 62 implants were placed as follows: 27 (43.5 percent) for orbital prostheses, 12 (19.4 percent) for orbitonasal prostheses, 14 (22.6 percent) for orbitonasomaxillary prostheses, and nine (14.5 percent) for nasal prostheses. Thirty-eight implants (61.3 percent) were placed in previously irradiated areas in 18 patients (69.2 percent). Mild skin reactions together with mild accumulation of sebaceous crusting around implants were recorded in 14.2 percent of the skin observations. No patient experienced severe inflammation requiring administration of systemic antibiotics or surgical revision. Implant success was 100 percent in both irradiated and nonirradiated patients. In conclusion, ITI dental implants result in a high rate of success in retaining midface prostheses and offer good stability and aesthetic satisfaction.