Association between Extracranial Carotid Artery Plaque and Cognitive Dysfunction: A Systematic Review and Meta-Analysis.

BACKGROUND: Extracranial carotid atherosclerosis has been variably associated with dementia. Prior studies have focused on the association of carotid intima media thickness or carotid stenosis; however, there is evidence that carotid plaque may contribute to dementia, perhaps via microembolic phenomena. OBJECTIVES: We sought to evaluate the role of carotid plaque in contributing to cognitive impairment by performing a systematic review and meta-analysis to summarize the association between extracranial carotid plaque and cognitive dysfunction and dementia. METHODS: We performed a comprehensive literature search evaluating the association of extracranial carotid plaque with cognition. We included studies measuring carotid plaque on ultrasound, computed tomography, or MR and also evaluated cognition through neuropsychological testing. Meta-analyses with assessment of study heterogeneity and publication bias were performed. Results were presented in a forest plot and summarized using a random-effects model. RESULTS: After screening 1,674 studies, we included 40 for systematic review and 16 and 7 studies for two meta-analyses with a total of 19,029 and 27,325 patients, respectively. We found a positive relationship between the presence of extracranial carotid plaque and cognitive dysfunction with a pooled random-effects odds ratio (OR) of 1.83 (95% CI, 1.50, 2.24) and a pooled random-effects hazard ratio (HR) of 1.47 (95% CI, 1.15, 1.89), respectively. A sensitivity analysis of only longitudinal studies found a persistent positive association. Measures of heterogeneity showed moderate heterogeneity in each meta-analysis, respectively (I-squared statistic = 57% and 70%). CONCLUSION: The presence of extracranial carotid plaque is significantly associated with cognitive dysfunction and dementia in both cross-sectional and longitudinal analyses. After further confirmation, our results support carotid plaque being a potentially modifiable risk factor in the development of dementia.

Incidence and Risk Factors for Sigmoid Venous Thrombosis Following CPA Tumor Resection.

OBJECTIVE: Our primary aim was to determine the incidence of sigmoid venous thrombosis (SVT) and determine risks factors and sequelae of SVT following cerebellopontine angle tumor resection. STUDY DESIGN: Retrospective cohort study. SETTING: Academic tertiary care hospital. PATIENTS: Patients over 18 years of age who underwent resection of cerebellopontine angle meningioma or vestibular schwannoma from January 2005 to April 2016 who had postoperative magnetic resonance imaging. INTERVENTION(S): Diagnostic. MAIN OUTCOME MEASURE(S): Incidence of postoperative sigmoid venous thrombosis (SVT) from official radiology reports was compared with retrospective imaging review by our institutional neuroradiologists. Data collected included age, length of stay, body mass index, surgical approach, and postoperative complications. RESULTS: A total of 127 patients were identified. Official radiology reads significantly underreported the incidence of postoperative SVT compared with retrospective review by our institutional neuroradiologist for patients who underwent routine postoperative imaging (n = 4 [3.1%] versus n = 22 [17.3%]; p < 0.001). There was a statistical trend toward increased risk for thrombosis in patients undergoing translabyrinthine and staged resection that did not reach significance (p = 0.068). Cerebrospinal fluid (CSF) leak incidence in patients with thrombosis was significantly increased (n = 9 [37.5%] versus n = 13 [12.6%]; p = 0.007). When controlling for approach, the presence of thrombus was associated with a more then three-fold increase in odds of CSF leak (OR = 3.28, 95% CI: 1.12-9.48, p = 0.030). There was no correlation between SVT and age (p = 0.788), body mass index (p = 0.686), length of stay (p = 0.733), preoperative tumor size (p = 0.555), or increased postoperative ICP (p = 0.645). Only one patient was symptomatic from sigmoid thrombosis compared with 21 who were not. CONCLUSION: Incidence of SVT is significantly underreported and may predispose patients to increase risk for CSF leak. Staged and translabyrinthine approaches demonstrate an increased trend toward thrombosis risk. Our findings suggest it may not be necessary to treat asymptomatic SVT.

Blunt renal trauma in children with pre-existing renal abnormalities.

The kidneys are the most commonly injured genitourinary organ in children following blunt abdominal trauma. Though the retroperitoneal location affords the kidneys some protection from the forces experienced in blunt abdominal trauma, the kidneys are at greater risk of injury when a disease process exposes them from their normal shielded location. In such cases, the injuries may appear to be disproportionate in relation to the severity of the trauma history, confusing the imaging findings. Recognition of both the underlying disease process as well as the manifestations of acute trauma is important; therefore, we present a pictorial essay of traumatized kidneys in children with pre-existing renal abnormalities.

Characterization of Leishmania major phosphatidylethanolamine methyltransferases LmjPEM1 and LmjPEM2 and their inhibition by choline analogs.

Phosphatidylcholine (PC) is the most abundant phospholipid in the membranes of the human parasite Leishmania. It is synthesized via two metabolic routes, the de novo pathway that starts with the uptake of choline, and the threefold methylation of phosphatidylethanolamine. Choline was shown to be dispensable for Leishmania; thus, the methylation pathway likely represents the primary route for PC production. Here, we have identified and characterized two phosphatidylethanolamine methyltransferases, LmjPEM1 and LmjPEM2. Both enzymes are expressed in promastigotes as well as in the vertebrate form amastigotes, suggesting that these methyltransferases are important for the development of the parasite throughout its life cycle. These enzymes are maximally expressed during the log phase of growth which correlates with the demand of PC synthesis during cell multiplication. Immunofluorescence studies combined with cell fractionation have shown that both methyltransferases are localized at the endoplasmic reticulum membrane. Heterologous expression in yeast has demonstrated that LmjPEM1 and LmjPEM2 complement the choline auxotrophy phenotype of a yeast double null mutant lacking phosphatidylethanolamine methyltransferase activity. LmjPEM1 catalyzes the first, and to a lesser extent, the second methylation reaction. In contrast, LmjPEM2 has the capacity to add the second and third methyl group onto phosphatidylethanolamine to yield (lyso)PC; it can also add the first methyl group, albeit with very low efficiency. Finally, we have demonstrated using inhibition studies with choline analogs that miltefosine and octadecyltrimethylammonium bromide are potent inhibitors of this metabolic pathway.

Anatomic description of the middle meatus and classification of the hiatus semilunaris into five types based upon morphological characteristics.

Anatomical variation of the lateral nasal wall, including the pathway from the frontal, ethmoidal, and maxillary sinuses may affect the communication between the paranasal sinuses and the nasal cavity. The middle meatus and hiatus semilunaris are areas where variations can occur which predispose patients to recurring sinusitis. Endoscopy allows for visualization of the entire nasal cavity, for both diagnostic and therapeutic uses. The purpose of this study was to provide an accurate characterization of the middle meatus and hiatus semilunaris for the purposes of endoscopic procedures. Ninety seven cadaveric lateral nasal walls were observed. The middle meatus was measured at three distinct points. Cranial length was also recorded. A 3D digitizer was used to record spatial relationships for the openings of the paranasal sinuses and the morphology of the hiatus semilunaris. The average widths for the middle meatus were 1.69-mm anteriorly, 2.83 mm at the transition angle, and 4.74-mm posteriorly. The posterior width was significantly larger than either of the two other measurements. The length of the hiatus semilunaris was found to be shorter on both left-sides and in females. The hiatus semilunaris was categorized into five types according to the varying morphologies. Given that the middle meatus was significantly wider posteriorly, our findings support the recommendation that entering the middle meatus posteriorly may allow an endoscopic surgeon easier access to the structures of the lateral nasal wall. Knowing the discrepancy of hiatus semilunaris lengths between right and left sides and males versus females may guide advancement of endoscopic instruments into the nasal cavity. Describing the five distinct types of the hiatus semilunaris allows the distinction of normal variation in this anatomic space versus pathologic condition.

Descriptive anatomy of the interscalene triangle and the costoclavicular space and their relationship to thoracic outlet syndrome: a study of 60 cadavers.

OBJECTIVE: Thoracic outlet syndrome classically results from constrictions in 1 or more of 3 specific anatomical locations: the interscalene triangle, costoclavicular space, and coracopectoral tunnel. Magnetic resonance and computed tomographic imaging studies suggest that, of the 3 potential locations for constriction, the costoclavicular space is the most susceptible to compression. This study of human cadavers aims to expand on the descriptive anatomy of the interscalene triangle and associated costoclavicular space. METHODS: The interscalene angle, interscalene triangle base, and costoclavicular space were measured on 120 sides of embalmed human cadavers. Linear distances and angles were measured using a caliper and protractor, respectively. The data were analyzed by calculating the mean, range, and standard deviation. RESULTS: The range for the interscalene base was 0 to 21.0 mm with a mean of 10.7 mm. For the interscalene angle, the range was 4° to 22° with a mean of 11.3°. Measurements for the costoclavicular space ranged from 6 to 30.9 mm with a mean of 13.5 mm. CONCLUSIONS: No significant differences were observed between left and right interscalene triangles or costoclavicular spaces; furthermore, there were no differences between the sexes concerning these 2 locations.