Toward mechanistic medical digital twins: some use cases in immunology

A fundamental challenge for personalized medicine is to capture enough of the complexity of an individual patient to determine an optimal way to keep them healthy or restore their health. This will require personalized computational models of sufficient resolution and with enough mechanistic information to provide actionable information to the clinician. Such personalized models are increasingly referred to as medical digital twins. Digital twin technology for health applications is still in its infancy, and extensive research and development is required. This article focuses on several projects in different stages of development that can lead to specific-and practical-medical digital twins or digital twin modeling platforms. It emerged from a two-day forum on problems related to medical digital twins, particularly those involving an immune system component. Open access video recordings of the forum discussions are available.

Forum on immune digital twins: a meeting report

Medical digital twins are computational models of human biology relevant to a given medical condition, which are tailored to an individual patient, thereby predicting the course of disease and individualized treatments, an important goal of personalized medicine. The immune system, which has a central role in many diseases, is highly heterogeneous between individuals, and thus poses a major challenge for this technology. In February 2023, an international group of experts convened for two days to discuss these challenges related to immune digital twins. The group consisted of clinicians, immunologists, biologists, and mathematical modelers, representative of the interdisciplinary nature of medical digital twin development. A video recording of the entire event is available. This paper presents a synopsis of the discussions, brief descriptions of ongoing digital twin projects at different stages of progress. It also proposes a 5-year action plan for further developing this technology. The main recommendations are to identify and pursue a small number of promising use cases, to develop stimulation-specific assays of immune function in a clinical setting, and to develop a database of existing computational immune models, as well as advanced modeling technology and infrastructure.

A survey of open questions in adaptive therapy: Bridging mathematics and clinical translation

Adaptive therapy is a dynamic cancer treatment protocol that updates (or 'adapts') treatment decisions in anticipation of evolving tumor dynamics. This broad term encompasses many possible dynamic treatment protocols of patient-specific dose modulation or dose timing. Adaptive therapy maintains high levels of tumor burden to benefit from the competitive suppression of treatment-sensitive subpopulations on treatment-resistant subpopulations. This evolution-based approach to cancer treatment has been integrated into several ongoing or planned clinical trials, including treatment of metastatic castrate resistant prostate cancer, ovarian cancer, and BRAF-mutant melanoma. In the previous few decades, experimental and clinical investigation of adaptive therapy has progressed synergistically with mathematical and computational modeling. In this work, we discuss 11 open questions in cancer adaptive therapy mathematical modeling. The questions are split into three sections: (1) integrating the appropriate components into mathematical models (2) design and validation of dosing protocols, and (3) challenges and opportunities in clinical translation.

Correlation-Driven Charge Order in a Frustrated Two-Dimensional Atom Lattice

We thoroughly examine the ground state of the triangular lattice of Pb on Si(111) using scanning tunneling microscopy and spectroscopy. We detect electronic charge order, and disentangle this contribution from the atomic configuration which we find to be 1-down-2-up, contrary to previous predictions from density functional theory. Applying an extended variational cluster approach we map out the phase diagram as a function of local and nonlocal Coulomb interactions. Comparing the experimental data with the theoretical modeling leads us to conclude that electron correlations are the driving force of the charge-ordered state in Pb/Si(111). These results resolve the discussion about the origin of the well-known 3×3 reconstruction. By exploiting the tunability of correlation strength, hopping parameters, and band filling, this material class represents a promising platform to search for exotic states of matter, in particular, for chiral topological superconductivity.

Antigen dose affects disease kinetics in a murine model of demyelinating disease

Multiple sclerosis is an autoimmune disorder caused by immune cell damage to the myelin sheath lining nerve cells, leading to neuronal damage and dysfunction. The murine model of the disease - experimental autoimmune encephalomyelitis (EAE) - is induced by inoculation with MOG (myelin oligodendrocyte glycoprotein) peptide and an adjuvant, leading to recapitulation of disease that is mediated primarily by CD4 T cells. In this study, we look at the effect of MOG dosage on demyelinating disease kinetics in WT and MOG-deficient animals, as MOG-deficient mice have different numbers of MOG specific CD4 Teff and Tregs. The T cells from MOG deficient animals have a higher affinity for MOG, expand faster, and cause exacerbated disease in an adoptive transfer model compared to CD4 T cells from wildtype mice. Our results indicate that the dose of MOG peptide used to induce disease can also modulate disease course. Using tenfold lower doses changes T cell and disease kinetics resulting in disease that resolves compared to controls. Taken together, we can use varying doses of MOG as a tool to probe CD8 and CD4 T cell expansion and monitor migration of immune cells to the CNS. Further understanding of the cellular tides during disease course enables us to gain insight on how cell ratios in different sites contribute to disease pathogenesis. Using this information, we are developing mathematical modeling tools that could be used to analyze and predict disease progression.

Invited review: Examining farmers' personalities and attitudes as possible risk factors for dairy cattle health, welfare, productivity, and farm management: A systematic scoping review

We aimed to determine how research regarding farmers' personalities and attitudes as risk factors is reported (methodological approaches to assessing, extracting, and processing data and analyzing risk factors) and to explore evidence for the effect of farmers' attitudes and personalities on dairy cattle health, welfare, productivity, and management. Therefore, we conducted a systematic review of studies on personality and attitude as risk factors for dairy cattle health, welfare, productivity, and farm management. Database searches captured 1,144 records, and 38 were finally included in the review. Thirty-three manuscripts assessed farmers' attitudes, 1 assessed their personalities, and 4 assessed both as risk factors. These potential risk factors were checked for relationships with more than 50 different outcome variables regarding farm management (17 manuscripts), animal health (13 manuscripts), animal productivity (11 manuscripts), and animal welfare (4 manuscripts). The approaches to assessing risk factors and processing and interpreting data varied greatly; thus, drawing conclusions regarding the effects of attitude and personality as risk factors is impeded because manuscripts are difficult to compare. Our findings highlight the need for harmonization of attitudes and personality assessments in future research. Furthermore, researchers should carefully consider which depth of detail to apply when planning and evaluating related research. Nevertheless, results highlight the importance of the effect of personality and attitude on outcomes. Farmers' personality and attitudes are associated with dairy cattle health, welfare, productivity, and management. In general, attitudes indicating higher degrees of technical knowledge, affection with problems, perceived responsibility, perception of control of a situation, a better human-animal relationship, or a positive evaluation of the benefits of management decisions tended to affect outcomes in a beneficial way. "Agreeableness" and "conscientiousness" were shown to promote better farm performance, whereas "neuroticism" had a negative effect. Therefore, further research on attitude and personality and their consideration by professionals and decision-makers within the dairy sector and politics is strongly recommended. This might provide the chance to better understand the needs of dairy farmers and therefore develop tailored advice and support strategies to improve both satisfactory and constructive cooperation.

An introduced parasitic fly may lead to local extinction of Darwin's finch populations

Introduced pathogens and other parasites are often implicated in host population level declines and extinctions. However, such claims are rarely supported by rigorous real-time data. Indeed, the threat of introduced parasites often goes unnoticed until after host populations have declined severely. The recent introduction of the parasitic nest fly, Philornis downsi, to the Galápagos Islands provides an opportunity to monitor the current impact of an invasive parasite on endemic land bird populations, including Darwin's finches.In this paper we present a population viability model to explore the potential long-term effect of P. downsi on Darwin's finch populations. The goal of our study was to determine whether P. downsi has the potential to drive host populations to extinction and whether management efforts are likely to be effective.Our model is based on data from five years of experimental field work documenting the effect of P. downsi on the reproductive success of medium ground finch Geospiza fortis populations on Santa Cruz Island. Under two of the three scenarios tested, the model predicted medium ground finches are at risk of extinction within the next century.However, sensitivity analyses reveal that even a modest reduction in the prevalence of the parasite could improve the stability of finch populations. We discuss the practicality of several management options aimed at achieving this goal.Synthesis and applications. Our study demonstrates the predicted high risk of local extinction of an abundant host species, the medium ground finch Geospiza fortis due to an introduced parasite, Philornis downsi. However, our study further suggests that careful management practices aimed at reducing parasite prevalence have the potential to significantly lower the risk of host species extinction.

Vital Signs: Estimated Effects of a Coordinated Approach for Action to Reduce Antibiotic-Resistant Infections in Health Care Facilities - United States

BACKGROUND

Treatments for health care-associated infections (HAIs) caused by antibiotic-resistant bacteria and Clostridium difficile are limited, and some patients have developed untreatable infections. Evidence-supported interventions are available, but coordinated approaches to interrupt the spread of HAIs could have a greater impact on reversing the increasing incidence of these infections than independent facility-based program efforts.

METHODS

Data from CDC's National Healthcare Safety Network and Emerging Infections Program were analyzed to project the number of health care-associated infections from antibiotic-resistant bacteria or C. difficile both with and without a large scale national intervention that would include interrupting transmission and improved antibiotic stewardship. As an example, the impact of reducing transmission of one antibiotic-resistant infection (carbapenem-resistant Enterobacteriaceae [CRE]) on cumulative prevalence and number of HAI transmission events within interconnected groups of health care facilities was modeled using two distinct approaches, a large scale and a smaller scale health care network.

RESULTS

Immediate nationwide infection control and antibiotic stewardship interventions, over 5 years, could avert an estimated 619,000 HAIs resulting from CRE, multidrug-resistant Pseudomonas aeruginosa, invasive methicillin-resistant Staphylococcus aureus (MRSA), or C. difficile. Compared with independent efforts, a coordinated response to prevent CRE spread across a group of inter-connected health care facilities resulted in a cumulative 74% reduction in acquisitions over 5 years in a 10-facility network model, and 55% reduction over 15 years in a 102-facility network model.

CONCLUSIONS

With effective action now, more than half a million antibiotic-resistant health care-associated infections could be prevented over 5 years. Models representing both large and small groups of interconnected health care facilities illustrate that a coordinated approach to interrupting transmission is more effective than historical independent facilitybased efforts.

IMPLICATIONS FOR PUBLIC HEALTH

Public health-led coordinated prevention approaches have the potential to more completely address the emergence and dissemination of these antibiotic-resistant organisms and C. difficile than independent facility-based efforts.

GaInN/GaN-Heterostructures and Quantum Wells Grown by Metalorganic Vapor-Phase Epitaxy

The dependence of the In-incorporation efficiency and the optical properties of MOVPE-grown GaInN/GaN-heterostructures on various growth parameters has been investigated. A significant improvement of the In-incorporation rate could be obtained by increasing the growth rate and reducing the H2-partial pressure in the MOVPE reactor. However, GaInN layers with a high In-content typically show an additional low energy photoluminescence peak, whose distance to the band-edge increases with increasing In-content. For GaInN/GaN quantum wells with an In-content of approximately 12%, an increase of the well thickness is accompanied by a significant line broadening and a large increase of the Stokes shift between the emission peak and the band edge determined by photothermal deflection spectroscopy. With a further increase of the thickness of the GaInN layer, a second GaInN-correlated emission peak emerges. To elucidate the nature of these optical transitions, power-dependent as well as time-resolved photoluminescence measurements have been performed and compared to the results of scanning transmission electron microscopy.

[Kyphoplasty in combination with intraoperative radiotherapy. Technical and regulatory characteristics of a concept for treatment of vertebral metastases]

BACKGROUND

Operative and radiotherapeutic procedures are available for the treatment of symptomatic vertebral metastases. The method for treatment of vertebral metastases presented in this article involves a combination of intraoperative radiotherapy (IORT) and kyphoplasty.

METHODS AND RESULTS

Kyphoplasty-IORT allows treatment of symptomatic vertebral metastases between vertebrae T3 and L5. With the patient under intubation narcosis an extrapedicular or bipedicular access to the vertebra is selected as for conventional kyphoplasty. This is followed by insertion of special sheaths of the radiation applicator and radiation therapy is intraoperatively administered via a radiation generator (Intrabeam®, Carl Zeiss Surgical, Oberkochen, Germany). The radiation dose is 8 Gy at a depth of 5-10 mm depending on the study protocol (50 kV X-radiation). Following radiation a conventional kyphoplasty procedure (Medtronic, USA) is carried out and the vertebra stabilized with cement.

CONCLUSIONS

The procedure presented demonstrates a new approach to treatment of vertebral metastases and represents a valuable alternative to previously established methods.

Intraosseous CSF fistula in a patient with Gorham disease resulting in intracranial hypotension

A 7-year-old girl with a history of headaches and Gorham disease was surgically treated in infancy for Chiari I malformation. Subsequent investigation revealed that her cerebellar tonsillar ectopia was due to a long-standing spinal CSF-lymphatic fistula causing intracranial hypotension. Percutaneous fistula closure was performed several times, resulting in transient symptomatic improvement.

Optical frequency comb spectroscopy

Optical frequency combs offer enormous potential in the detection and control of atoms and molecules by combining their vast spectral coverage with the extremely high spectral resolution of each individual comb component. Sensitive and multiplexed trace gas detection via cavity-enhanced direct frequency comb spectroscopy has been demonstrated for various molecules and applications; however, previous demonstrations have been confined to the visible and near-infrared wavelength range. Future spectroscopic capabilities are created by developing comb sources and spectrometers for the deep ultraviolet and mid-infrared spectral regions. Here we present a broadband high resolution mid-infrared frequency comb-based Fourier transform spectrometer operating in the important molecular fingerprint spectral region of 2100-3600 cm(-1) (2.8-4.8 microm). The spectrometer, employing a multipass cell, allows simultaneous acquisition of broadband, high resolution spectra (down to 0.0035 cm(-1) of many molecular species at concentrations in the part-per-billion range in less than 1 min acquisition time. The system enables precise measurements of concentration even in gas mixtures that exhibit continuous absorption bands. The current sensitivity, 2 x 10(-8) cm(-1) Hz-1/2 per spectral element, is expected to improve by two orders of magnitude with an external enhancement cavity. We have demonstrated this sensitivity increase by combining cavity-enhanced frequency comb spectroscopy with a scanning Fourier transform spectrometer in the near-infrared region and achieving a sensitivity of 4.7 x 10(-10) cm(-1) Hz(-1/2). A cavity-enhanced mid-infrared comb spectrometer will provide a near real-time, high sensitivity, high resolution, precisely frequency calibrated, broad bandwidth system for many applications.

Highly versatile confocal microscopy system based on a tunable femtosecond Er:fiber source

The performance of a confocal microscopy setup based on a single femtosecond fiber system is explored over a broad range of pump wavelengths for both linear and nonlinear imaging techniques. First, the benefits of a laser source in linear fluorescence excitation that is continuously tunable over most of the visible spectrum are demonstrated. The influences of subpicosecond pulse durations on the bleaching behavior of typical fluorophores are discussed. We then utilize the tunable near-infrared output of the femtosecond system in connection with a specially designed prism compressor for dispersion control. Pulses as short as 33 fs are measured in the confocal region. As a consequence, 2 mW of average power are sufficient for two-photon microscopy in an organotypic sample from the mouse brain. This result shows great prospect for deep-tissue imaging in the optimum transparency window around 1100 nm. In a third experiment, we prove that our compact setup is powerful enough to exploit even higher-order nonlinearities such as three-photon absorption that we use to induce spatially localized photodamage in DNA.

Mid-infrared difference-frequency generation of ultrashort pulses tunable between 3.2 and 4.8 microm from a compact fiber source

We report single-pass difference-frequency generation of mid-infrared femtosecond pulses tunable in the 3.2-4.8 microm range from a two-branch mode-locked erbium-doped fiber source. Average power levels of up to 1.1 mW at a repetition rate of 82 MHz are obtained in the mid infrared. This is achieved via nonlinear mixing of 170 mW, 65 fs pump pulses at a fixed wavelength of 1.58 microm, with 11.5 mW, 40 fs pulses tunable in the near-infrared range between 1.05 and 1.18 microm. These values indicate that the tunable near-infrared input component is downconverted with a quantum efficiency that exceeds 30%.

12-fs pulses from a continuous-wave-pumped 200-nJ Ti:sapphire amplifier at a variable repetition rate as high as 4 MHz

We demonstrate a novel compact femtosecond Ti:sapphire laser system operating at repetition rates from 10 kHz to 4 MHz. The scheme is based on the combination of a broadband cavity-dumped oscillator and a double-pass Ti:sapphire amplifier pumped by a low-noise cw solid-state laser. Amplified pulses with an extremely smooth spectrum, a duration of only 12 fs, and less than 0.25% rms fluctuation are generated in a beam with M2 < 1.2. A maximum pulse energy of 210 nJ and an average output power of as much as 720 mW are achieved. This output energy is sufficient to generate a stable continuum in a sapphire disk.

A comparison between bipedal and quadrupedal rats: do bipedal rats actually assume an upright posture?

STUDY DESIGN

A basic science animal investigation.

OBJECTIVES

To determine if bipedal rats differ in upright posture compared with quadrupedal rats.

SUMMARY OF BACKGROUND DATA

It has been reported that surgically induced bipedalism in the rat leads to habitual upright posture. Based on this finding, bipedal rats have been used to study the changes erect posture induces in bone, ligament, muscle, and intervertebral discs. Previous studies have used direct observation as a means to describe posture. This study is the first to quantify postural differences between bipedal and quadrupedal rats.

METHODS

Eleven bipedal rats were created by forelimb and tail amputation within 24 hours of birth. Eleven quadrupedal rats served as controls. Specialized cages were used with infrared sensors, and a computer program measured the total amount of time in the upright stance, the number of stands, and the amount of horizontal movement in the upright stance. Statistical comparisons were made between bipedal and quadrupedal rats hourly and over a 24-hour period of time.

RESULTS

Quadrupedal rats assumed an upright posture for a significantly greater amount of time than bipedal rats when monitored over 24 hours (P = 0.016). Quadrupedal and bipedal rats did not differ in the number of stands (P = 0.63) or in the amount of horizontal movement in the upright stance (P = 0.34) over 24 hours. Similar results were obtained when comparing hourly intervals.

CONCLUSION

This study quantifiably indicates that bipedal rats do not assume a more erect posture and spend no more time in an upright position compared with quadrupedal rats. The upright posture may not be the cause of some previously reported anatomic changes observed in the bipedal rat.

Nonrecurrent laryngeal nerve during carotid artery surgery: case report and literature review

The anomalous position of a nonrecurrent inferior laryngeal nerve predisposes it to injury during surgery in the neck. We present the case of a patient who underwent a carotid endarterectomy in which a rare left nonrecurrent laryngeal nerve was found intraoperatively. This abnormality, which occurs much less often on the left than the right side of the neck, should be familiar to vascular surgeons. Historical, embryologic, and surgical significance of this anomaly is addressed.

Relevance of muscular sensitivity, muscular activity, and cognitive variables for pain reduction associated with EMG biofeedback in fibromyalgia

18 patients suffering from primary fibromyalgia received nine training sessions using EMG biofeedback over a period of four weeks. Pre- and posttreatment measurement of the baseline EMG activity of the trapezius, muscular sensitivity, and cognitive variables (helplessness and belief of control) were taken. Analysis indicated a significant reduction occurred in general intensity of pain and in EMG activity as well as a significant increase in muscular sensitivity. Multiple regression analyses indicated that the increase in muscular sensitivity correlated with the decrease of EMG activity in the trapezius baseline. Self-reported pain reduction was predicted by a change in cognitive variables.

A meta-analysis of the efficacy of non-operative treatments for idiopathic scoliosis

With use of data culled from twenty studies, members of the Prevalence and Natural History Committee of the Scoliosis Research Society conducted a meta-analysis of 1910 patients who had been managed with bracing (1459 patients), lateral electrical surface stimulation (322 patients), or observation (129 patients) because of idiopathic scoliosis. Three variables - the type of treatment, the level of maturity, and the criterion for failure - were analyzed to determine which had the greatest impact on the outcome. We also examined the effect of the type of brace that was used and the duration of bracing on the success of treatment. The number of failures of treatment in each study was determined by calculating the total number of patients who had unacceptable progression of the curve (as defined in the study), who could not comply with or tolerate treatment, or who had an operation. The percentage of patients who completed a given course of treatment without failure, adjusted for the sample sizes of the studies in which that treatment was used, yielded the weighted mean proportion of success for that treatment. The weighted mean proportion of success was 0.39 for lateral electrical surface stimulation, 0.49 for observation only, 0.60 for bracing for eight hours per day, 0.62 for bracing for sixteen hours per day, and 0.93 for bracing for twenty-three hours per day. The twenty-three-hour regimens were significantly more successful than any other treatment (p < 0.0001). The difference between the eight and sixteen-hour regimens was not significant, with the numbers available. Although lateral electrical surface stimulation was associated with a lower weighted mean proportion of success than observation only, the difference was not significant, with the numbers available. This meta-analysis demonstrates the effectiveness of bracing for the treatment of idiopathic scoliosis. The weighted mean proportion of success for the six types of braces included in this review was 0.92, with the highest proportion (0.99) achieved with the Milwaukee brace. We found that use of the Milwaukee brace or another thoracolumbosacral orthosis for twenty-three hours per day effectively halted progression of the curve. Bracing for eight or sixteen hours per day was found to be significantly less effective than bracing for twenty-three hours per day (p < 0.0001).

Biochemical characterization of a novel KRAS insertion mutation from a human leukemia

A novel alteration in exon 1 of KRAS was detected by single strand conformational polymorphism analysis of DNA amplified from the bone marrow of a 4-year-old child with myeloid leukemia. Sequencing of this mutant allele revealed an insertion of three nucleotides between codons 10 and 11 resulting in an in-frame insertion of glycine. Expression of the mutant protein in NIH 3T3 cells caused cellular transformation, and expression in COS cells activated the Ras-mitogen-activated protein kinase signaling pathway. Surprisingly, Ras.GTP levels measured in COS cells established that this novel mutant accumulates to 90% in the GTP state, considerably higher than a residue 12 mutant. Biochemical analysis confirmed that the higher Ras.GTP levels correspond to a dramatic decrease in intrinsic GTP hydrolysis as well as resistance to GTPase-activating proteins. This mutation is the first dominant Ras mutation found in human cancer that does not involve residues 12, 13, or 61, and its biochemical properties should help elucidate the mechanism of oncogenic activation.

Loss of NF1 results in activation of the Ras signaling pathway and leads to aberrant growth in haematopoietic cells

Individuals with neurofibromatosis type 1 (NF1) are predisposed to certain cancers including juvenile chronic myelogenous leukaemia (JCML). The NF1 tumour-suppressor gene encodes a protein (neurofibromin) that accelerates GTP hydrolysis on Ras proteins. Here we show that primary leukaemic cells from children with NF1 show a selective decrease in NF1-like GTPase activating protein (GAP) activity for Ras but retain normal cellular GAP activity. Leukaemic cells also show an elevated percentage of Ras in the GTP-bound conformation. JCML cells are hypersensitive to granulocyte-macrophage colony stimulating factor (GM-CSF), and we observed a similar pattern of aberrant growth in haematopoietic cells from Nf1-/- mouse embryos. These data define a specific role for neurofibromin in negatively regulating GM-CSF signaling through Ras in haematopoietic cells and they suggest that hypersensitivity to GM-CSF may be a primary event in the development of JCML.

Interactions between quantitative trait loci in soybean in which trait variation at one locus is conditional upon a specific allele at another

A large recombinant inbred population of soybean has been characterized for 220 restriction fragment-length polymorphism (RFLP) markers. Values for agronomic traits also have been measured. Quantitative trait loci (QTL) for height, yield, and maturity were located by their linkage to RFLP markers. QTL controlling large amounts of trait variation were analyzed for the dependence of trait variation on particular alleles at a second locus by comparing cumulative distributions of the trait for each genotype (four genotypes per pair of loci). Interesting pairs of loci were analyzed statistically with maximum likelihood and Monte Carlo comparison of additive and epistatic models. For each locus affecting height, variation was conditional upon the presence of a particular allele at a second unlinked locus that itself explained little or no trait variation. The results show that interactions between QTL are frequent and control large effects. Interactions distinguished between different QTL in a single linkage group and between QTL that affect different traits closely linked to one RFLP marker--i.e., distinguished between pleiotropy and closely linked genes. The implications for the evolution of inbreeding plants and for the construction of agronomic breeding strategies are discussed.

Population variation in tooth, jaw, and root size: a radiographic study of two populations in a high-attrition environment

Radiographs were taken of the jaws of skeletal remains of two populations of different-phenotype Prehistoric Australians from Roonka and Early New Zealanders (Maoris). On these radiographs crown, root, and corpus size were measured. Corpus height was subdivided into alveolar bone height, defined as the bone superior to the mandibular canal, and basal bone height, defined as that inferior to the mandibular canal. Both between and within the two populations there was a significant and negative correlation between crown size and corpus height. The differences between the two populations in corpus height were associated with differences in alveolar bone height rather than basal bone height and support hypotheses associating continued eruption of adult teeth with growth of the alveolar bone. The findings also support previous studies that have shown only a low correlation between crown size, root size, and corpus height.

[Therapeutic transfemoral testicular vein occlusion of varicocele]

It is reported on the percutaneous transfemoral obliteration of the testicular vein with ethoxysclerol. This method was used in 75 patients for the treatment of the varicocele. 81.3% could successfully be treated by this means. The applicability of the method is restricted by anatomical particularities in the course of the testicular vein. Advantages and disadvantages of the method are discussed.

Post-pleistocene changes in tooth root and jaw relationships

Mandibles of 126 sexed skeletal specimens, from Near Eastern sites dating over the past 12,000 years were radiographed. From the radiographs obtained, digitised tracings were made of crown length (mesiodistal), root height and width, and corpus height mesial to the premolars and first and second molars. The data obtained were analysed using rank transformation procedures. The significance of unidirectional trends in relation to periods sampled was examined graphically and analytically through linear regression analysis of the ranks on the chronological scale, and Spearman's rank correlation was used to compare relationships between different parameters of individual teeth in different periods. Significant reduction was found in crown length between 12,000 B.P. and 6,000 B.P., but no further reduction was found between 6,000 B.P. and 1,000 B.P. Little change was observed in root size, but corpus height showed significant reduction over the past 6,000 years. The differences observed in the timing and extent of reduction in crown, root, and corpus height are associated with a low intrapopulation correlation between them.

[Varicocele and fertility--spermiographic and histologic findings]

The results of the treatment of 251 patients with varicocele are demonstrated. By means of spermiographic and histologic investigations the fertility-disturbing influence of this vascular disease of the testis shall be proved and the effect of the operative sanation shall be estimated. For many years the high ligature of the testicular vein has been favoured method of operation; since 1984 exclusively the percutaneous transfemoral occlusion of the testicular vein has been performed, when a left-sided varicocele is present. In 61% of the patients examined an improvement of the spermiogram is to be proved, in which case the most conspicuous rate of increase lies at the motility of spermatozoa with 58%. After removal if the varicocele the investigations of the testicular tissue reveal in 42% of the cases an improvement of the findings by decrease of the tubular atrophy and increase of the tubular cell number. Among the number of our patients the rate of conception is 49%. The treatment of varicocele is a fertility-protective measure and therefore should be performed in all adolescents and males at fertile age.

Hemangiomas of the cecum. Colonoscopic diagnosis and therapy

Five cases of hemangiomas of the cecum and gastrointestinal bleeding are presented. All were demonstrated by colonscopy after more conventional diagnostic methods failed. The hemangiomas were bright red, flat lesions clearly seen through the colonscope. They were successfully treated by electrocoagulation. All patients in this series had some type of associated cardiac or vascular disease. These patients may represent a syndrome of gastrointestinal blood loss of obscure cause, hemangiomas of the cecum, and cardiovascular disease.

New technics in the operative treatment of scoliosis

Preoperative correction of scoliotic curves by traction and casting improves the results achieved by operation. Use of the halo-hoop apparatus allows controlled correction when combined with spinal osteotomies. The anterior approach to the spine allows better correction and fusion of the more difficult curves of congenital scoliosis and those associated with neurofibromatosis and myelomeningocele.