Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations

PURPOSE

To investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs).

METHODS

VMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly.

RESULTS

Eighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were -7.9 ± 24 cm3 in lesion volume and -123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (-9.4 ± 24 cm3) than in the failure group (21 ± 20 cm3) (P =.006). Overall, lesion volume correlated with treatment response (ρ = -0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = -0.3, P =.03), in sodium tetradecyl sulfate-treated lesions (ρ = -0.5, P =.02), and in foot lesions (ρ = -0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = -0.3, P =.01) and in bleomycin-treated lesions (ρ = -0.4, P =.04).

CONCLUSIONS

Change in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups.

Risk factors and clinical features associated with basal ganglia manganese deposition in patients with hereditary hemorrhagic telangiectasia

BACKGROUND

T1-hyperintensity of the basal ganglia (BG) due to manganese deposition is a known radiologic finding in patients with hereditary hemorrhagic telangiectasia (HHT), but risk factors and associated clinical manifestations are unclear. This study conducted a quantitative analysis of the association of T1-hyperintensity in HHT patients with specific risk factors, signs, and symptoms.

METHODS

Patients seen at our center between 2005 and 2020 with a definitive diagnosis of HHT who had an available non-contrast T1-weighted brain MRI were included. Hyperintensity was evaluated using oval regions of interest measurements. The BG: thalamus intensity ratio was used to quantitatively evaluate T1-hyperintensity. Patient laboratory values and clinical findings were collected from electronic medical records. Hyperintensity was analyzed for its association with laboratory values, and clinical findings. Variables were analyzed through regression analysis.

RESULTS

A total of 239 patients were included in this study. On 1.5 T scanners, values that were significant on multivariable regression analysis were age (p < .001), hepatic AVMs (p < .001), iron deficiency anemia (p = .0021), and cirrhosis (p = .016). On 3 T scanners, values that were significant on multivariable analysis were hepatic AVMs (p = .0024) and cirrhosis (p = .0056). On 3 T scanners, hyperintensity was significantly associated with tremor (OR = 1.17, p = .033), restless leg syndrome (OR = 1.22, p = .0086), and memory problems (OR = 1.17, p = .046).

CONCLUSIONS

BG hyperintensity due to manganese deposition is significantly associated with hepatic risk factors on 1.5 T and 3 T scanners and iron deficiency anemia on 1.5 T scanners. On 3 T scanners, T1-hyperintensity is associated with neuropsychiatric signs and symptoms, such as tremor, restless leg syndrome, and memory problems.

Racial and Ethnic Disparities among Participants in Hepatocellular Carcinoma Clinical Studies Evaluating Transarterial Therapies

PURPOSE

To evaluate the racial and ethnic representation of transarterial therapy for hepatocellular carcinoma (HCC) clinical trials in the United States.

MATERIALS AND METHODS

The ClinicalTrials.gov database was examined to identify all completed studies with transarterial therapies for the management of HCC in the United States and extract information about the observed number of participants for each racial and ethnic group (based on the Office of Management and Budget definitions). The expected number of participants was calculated by multiplying the total number of participants in a trial with the U.S.-population HCC-based proportion for each group. The effects of the study phase, funding source, number of centers involved in the study, and the location of the participating center on racial and ethnic distribution were explored.

RESULTS

Seventy-nine relevant studies were identified, of which 27 (34.2%) and 18 (22.8%) reported ethnic and race characteristics, respectively. Most study participants were White (81%, 1,591/1,964) by ethnicity and not Hispanic or Latino (93%, 937/1,008) by race. In terms of the observed-to-expected ratios by race and ethnicity in all trials, White and not Hispanic or Latino participants were overrepresented with a ratio of 1.22 (1.10-1.37) and 1.33 (1.26-1.41), respectively, and all other racial and ethnic groups were underrepresented. The enrollment of African Americans and Asian Americans varied by the study phase, and a higher enrollment of African Americans was noted in the National Institutes of Health-funded and multicenter studies (P < .05).

CONCLUSIONS

This cross-sectional study demonstrates that in HCC transarterial therapy clinical trials, racial and ethnic minorities were underrepresented and the majority of the studies identified failed to report this demographic information.

Development of an N-Cadherin Biofunctionalized Hydrogel to Support the Formation of Synaptically Connected Neural Networks

In vitro models of the human central nervous system (CNS), particularly those derived from induced pluripotent stem cells (iPSCs), are becoming increasingly recognized as useful complements to animal models for studying neurological diseases and developing therapeutic strategies. However, many current three-dimensional (3D) CNS models suffer from deficits that limit their research utility. In this work, we focused on improving the interactions between the extracellular matrix (ECM) and iPSC-derived neurons to support model development. The most common ECMs used to fabricate 3D CNS models often lack the necessary bioinstructive cues to drive iPSC-derived neurons to a mature and synaptically connected state. These ECMs are also typically difficult to pattern into complex structures due to their mechanical properties. To address these issues, we functionalized gelatin methacrylate (GelMA) with an N-cadherin (Cad) extracellular peptide epitope to create a biomaterial termed GelMA-Cad. After photopolymerization, GelMA-Cad forms soft hydrogels (on the order of 2 kPa) that can maintain patterned architectures. The N-cadherin functionality promotes survival and maturation of single-cell suspensions of iPSC-derived glutamatergic neurons into synaptically connected networks as determined by viral tracing and electrophysiology. Immunostaining reveals a pronounced increase in presynaptic and postsynaptic marker expression in GelMA-Cad relative to Matrigel, as well as extensive colocalization of these markers, thus highlighting the biological activity of the N-cadherin peptide. Overall, given its ability to enhance iPSC-derived neuron maturity and connectivity, GelMA-Cad should be broadly useful for in vitro studies of neural circuitry in health and disease.

Goffman's Asylums and the total institution model of mental hospitals

The present report is an examination and evaluation of the importance and applicability of Goffman's Asylums three decades after its first publication. The book has achieved classic status due to its extensive academic citation, anthology reprinting, use in legal proceedings, and public influence. However, over the years the accuracy and generalizability of Goffman's total institution model of mental hospitals have been seriously questioned. An analysis of the criticisms of Goffman's theories, methods, and conclusions suggested that his work was biased and deficient in a number of ways but at times was misinterpreted or misrepresented. As a research study Asylums may be outdated and of little value to mental health practitioners due to the revolutionary changes in psychiatry that have occurred since the mid-1950s. As an academic work, however, Asylums continues to enjoy a high reputation perhaps because of its theoretical utility and teaching value as well as the popularity of Goffman's many other published works. The total institution model may have been limited from the start and doubts remain as to its validity today, but the longevity of Asylums is assured as Goffman's picture of mental hospitalization is firmly planted in the minds of sociologists, psychiatrists, patients' rights advocates, and students of formal organizations.

Mental patients' attitudes toward hospital staff. A review of quantitative research

Relatively few social scientists have collected quantitative data on the attitudes of patients toward the staff of mental hospitals. The present report is a review of this body of research, with special consideration given to ascertaining the degree of patients' favorableness to staff. Results indicated that in 21 of the 27 different samples reviewed (78%), patients had favorable attitudes. Patients proved to be somewhat more favorable to staff at mental hospitals generally than staff at their own institution. Type of hospital and time of study had a negligible impact on patients' views. Staff in lower ranks in the hospital hierarchy or in nontherapeutic roles usually received lower evaluations. A content analysis of the attitude measures revealed that patients are quite positive about staff's accessibility, receptivity, support, and training, but somewhat negative toward staff's permissiveness and control. Few social or psychiatric variables were observed to affect patients' responses.

The avowal of motives for marijuana behavior

The present report is a comparative analysis of data from different studies on the motives avowed for the use and nonuse of marijuana. Qualitative data on the reasons given by users and nonusers for their behavior were first described and categorized according to 21 verbal patterns. Then these categories were utilized to analyze quantitative data by various investigators, i.e., were the means to compare the frequencies with which each kind of motive was verbalized. The results indicated that knowledge-ableness is by far the most frequently expressed motive for the initial use of marijuana. Continued use, however, is largely explained either on the grounds of self-fulfillment or with an appeal to psychological drives. Habitual users in different studies mentioned almost all categories of reasons for smoking more often than did occasional users. Explanations for the two types of nonuse were also quite dissimilar. For the discontinued use of pot, lack of interest is claimed as the chief motivation; but for never use, appeals to illegality, injury, drug addiction, and morality are asserted more frequently. Several conclusions based on these findings are drawn.

Interpersonal expectations for marijuana behavior

Interpersonal expectations for marijuana behavior were investigated by means of open-ended questions. Users and nonusers were asked how the use and nonuse of marijuana affect people's relationships, and their spontaneous replies were assembled into 22 categories. These categories were then cross-tabulated with behavioral, social, experiential, and attitudinal variables. The findings indicated that frequency of marijuana use and favorableness in drug attitude are the key variables that influence the degree to which different categories of interpersonal expectations are mentioned. Current users most often believe that social improvement is a consequence of use but have few specific expectations for nonuse. Former users and nonusers with unfavorable drug attitudes emphasize that social impairment and personal impairment follow from use and mainly expect user rejection for nonuse. Nonusers favorable to marijuana tend to anticipate no change in relationships as a result of use and see social impairment and personal impairment as important outcomes of nonuse. The findings are discussed in terms of interpersonal data from other marijuana studies.

The imputation of motives for marijuana behavior

The motives imputed to marijuana use and nonuse by both users and nonusers were investigated by means of open-ended questions. Verbal responses were categorized to symbolize typal vocabularies of motive, and these categories were tabulated against behavioral, social, experiential, and attitudinal variables. The results indicated that frequency of marijuana use and favorableness in drug attitude are the key factors that influence the degree to which different vocabular explanations are offered. Current users most often say that personal experience and personal reward are the motives behind use of the drug, and that legal sanctions and psychomedical effects largely account for its nonuse. Nonusers with unfavorable attitudes tend to verbalize emotional relief and psychological dependence as the motivations for use, and emotional independence for nonuse. Some of the vocabularies of both of these groups are emphasized by former users and nonusers with favorable attitudes. Interpretations of the data in terms of sociological theories of motives are presented.