Contrast-Enhanced Ultrasound in the Diagnosis of Solid Renal Lesions.

The availability of imaging methods has enabled increased detection of kidney lesions, which are a common clinical problem. It is estimated that more than half of patients over the age of 50 have at least one undetermined mass in the kidney. The appropriate characterization and diagnosis of lesions imaged in the kidney allows for proper therapeutic management. Previously, contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance imaging (MRI) have been used in their extended diagnosis. However, the limitations of these techniques, such as radiation exposure, renal toxicity, and allergies to contrast agents, must be considered. Contrast-enhanced ultrasound (CEUS) is increasingly being used as an examination to resolve interpretive doubts that arise with other diagnostic methods. Indeed, it can be considered both as a problem-solving technique for diagnosing and distinguishing lesions and as a technique used for observation in preservative treatment. Evaluation of the enhancement curve over time on CEUS examination can help to differentiate malignant renal cell carcinoma (RCC) subtypes that should be resected from benign lesions, such as oncocytoma or angiomyolipoma (AML), in which surgery can be avoided. It allows for distinguishing between benign and malignant tumors, renal and pseudotumors, and solid and cystic tumors. Therefore, with recent advances in ultrasound technology, CEUS has emerged as a fast, reliable, and cost-effective imaging tool in the preoperative evaluation and diagnosis of solid renal masses.

Contrast-Enhanced Ultrasound Feasibility in Assessing Carotid Plaque Vulnerability-Narrative Review.

The risk assessment for carotid atherosclerotic lesions involves not only determining the degree of stenosis but also plaque morphology and its composition. Recently, carotid contrast-enhanced ultrasound (CEUS) has gained importance for evaluating vulnerable plaques. This review explores CEUS's utility in detecting carotid plaque surface irregularities and ulcerations as well as intraplaque neovascularization and its alignment with histology. Initial indications suggest that CEUS might have the potential to anticipate cerebrovascular incidents. Nevertheless, there is a need for extensive, multicenter prospective studies that explore the relationships between CEUS observations and patient clinical outcomes in cases of carotid atherosclerotic disease.

Current Insights into the Potential Role of fMRI in Discovering the Mechanisms Underlying Obesity.

Obesity is becoming one of the major global health concerns. This chronic disease affects around 650 million people worldwide and is an underlying cause of a number of significant comorbidities. According to the World Health Organization (WHO) report on obesity from 2022, this disorder became the fourth leading cause of deaths in Europe. Thus, understanding the mechanisms underlying obesity is of essential importance to successfully prevent and treat this disease. The aim of this study was to review the current insights into the potential role of fMRI in discovering the mechanisms underlying obesity on the basis of recent scientific literature published up to December 2022 and searches of the PubMed, Google Scholar and Web of Science databases. The literature assessed indicated that a growing body of evidence suggests that obesity leads to changes in both structure and connectivity within the central nervous system. Emerging data from recent functional magnetic resonance imaging (fMRI) studies prove that obese individuals present an increased motivational drive to eat as well as impaired processing in reward- and control-related brain regions. Apart from this, it is clear that fMRI might be a useful tool in detection of obesity-induced changes within the central nervous system.

Pleural Neoplasms-What Could MRI Change?

The primary pleural neoplasms constitute around 10% of the pleural tumors. The currently recommended method for their imaging is CT which has been shown to have certain limitations. Strong development of the MRI within the last two decades has provided us with a number of sequences that could potentially be superior to CT when it comes to the pleural malignancies' detection and characterization. This literature review discusses the possible applications of the MRI as a diagnostic tool in patients with pleural neoplasms. Although selected MRI techniques have been shown to have a number of advantages over CT, further research is required in order to confirm the obtained results, broaden our knowledge on the topic, and pinpoint the sequences most optimal for pleural imaging, as well as the best methods for reading and analysis of the obtained data.

Ischemic and Hemorrhagic Cerebrovascular Events Related to COVID-19 Coagulopathy and Hypoxemia.

Since the very beginning of the COVID-19 pandemic, numerous researchers have made an effort to determine the molecular composition of the SARS-CoV-2 virus, and the exact pathomechanism through which the virus exerts such a devastating effect on the host/infected organism. Recent scientific evidence highlights the affinity of the virus towards ACE2 receptors, which are widespread in multiple human systems, including the central nervous system (CNS) and cerebral vessels. Such an affinity may explain endothelial dysfunction and damage that is observed in COVID-positive patients in histopathological studies, with subsequent dysregulation of the cerebral circulation leading to transient or acute cerebrovascular accidents. In this paper, we aimed to evaluate the effects of COVID-related hypoxemia and direct viral invasion on the cerebral circulation, with special respect to the postulated pathomechanism, vulnerable groups of patients, clinical course and outcomes, as well as diagnostic imaging findings.

Functional Magnetic Resonance Imaging and Obesity-Novel Ways to Seen the Unseen.

Obesity remains a pandemic of the 21st century. While there are many causes of obesity and potential treatments that are currently known, source data indicate that the number of patients is constantly increasing. Neural mechanisms have become the subject of research and there has been an introduction of functional magnetic resonance imaging in obesity-associated altered neural signaling. Functional magnetic resonance imaging has been established as the gold standard in the assessment of neuronal functions related to nutrition. Thanks to this, it has become possible to delineate those regions of the brain that show altered activity in obese individuals. An integrative review of the literature was conducted using the keywords ""functional neuroimaging" OR "functional magnetic resonance "OR "fmri" and "obesity" and "reward circuit and obesity" in PubMed and Google Scholar databases from 2017 through May 2022. Results in English and using functional magnetic resonance imaging to evaluate brain response to diet and food images were identified. The results from functional magnetic resonance imaging may help to identify relationships between neuronal mechanisms and causes of obesity. Furthermore, they may provide a substrate for etiology-based treatment and provide new opportunities for the development of obesity pharmacotherapy.

An Equivocal SCC Lesion-Antiepileptic-Induced CLOCC.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).

Parkinson's Disease in Light of the COVID-19 Pandemic.

In this review we attempt to collate the existing scientific evidence regarding the possible role of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the pathophysiology of Parkinson's disease (PD), as well as to investigate the impact of PD/parkinsonism on the clinical course of the viral infection itself. Since etiology of PD is not completely understood, various studies suggest different potential links between coronavirus disease 2019 (COVID-19) and PD. Suggested connections include, among others, similar prodromal symptoms, renin-angiotensin-aldosterone system involvement, or gut microbiome dysbiosis participation. Despite the initial assumptions that, as a mainly elderly population suffering from rigidity of respiratory muscles, impairment of cough reflex, and dyspnea, PD patients would be more susceptible to viral infection, and would experience a more aggressive course of COVID-19, the published scientific reports contain mutually exclusive data that require further investigation and meta-analysis.

Predictors of favorable outcome after endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion in young patients.

BACKGROUND: Mechanical thrombectomy (MT) became a standard of care for patients with acute ischemic stroke (AIS) with its efficacy demonstrated by meta-analysis and randomized studies. Although ischemic stroke is associated more with older patients, it may also have devastating neurological effects on young patients. PURPOSE: To present our experience with stroke patients aged <50 years treated with endovascular means and to evaluate clinical and procedural factors associated with outcome and mortality. MATERIAL AND METHODS: This study was conducted on 34 young stroke patients treated with MT. Clinical features including baseline results, radiological imaging, procedural details, and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated after three months using mRS. Mortality rate was calculated. RESULTS: The rate of successful recanalization (TICI ≥2c) was 79% (27/34). Symptomatic intracranial hemorrhage (sICH) was observed in 5 (15%) patients. After 90 days, the mortality rate was 12%. Favorable clinical outcome (mRs 0-2) was regained in 65% of the patients whereas satisfactory clinical outcome was seen in 85%. Poor clinical outcome (mRs >2) was observed in 9 (23.7%) patients. CONCLUSION: In conclusion, the results of this study demonstrate that MT for AIS in young patients is feasible and provides an excellent rate of arterial recanalization and high rate of favorable outcomes. Statistical analysis showed that shorter time from onset to arrival and reperfusion, successful recanalization and absence of hemorrhagic transformation are the predictors of favorable clinical outcome and overall survival rate.

The Impact of Study Mode (Online vs. Hybrid) on Early Symptoms of Depression and Coping Strategies among University Students in Poland in Time of COVID-19 Pandemic-Preliminary Study.

INTRODUCTION: mental health has been one of the most important issues surrounding the COVID-19 pandemic; mental disorders can be exacerbated by isolation during lockdowns or online learning. The aim of this study was to analyze the relationship between non-clinical (early) symptoms of depressed moods, personality traits, and coping strategies, as well as whether the learning mode (online versus hybrid) differentiates the experiences of these early symptoms and coping strategies. METHODS: 114 university students aged 19 to 34, whose education model was changed from stationary to hybrid or online due to COVID-19 restrictions, participated in the study. The participants completed the online questionnaire, which consisted of two sections: (1) demographic questions to characterize the subjects and 44 questions based on the literature review. (2) Mini-COPE Inventory. RESULTS: the study showed that the fully online study mode has a negative impact on the mental health of students; hybrid students are more likely to use active and positive coping strategies, which effectively help to control negative thoughts and/or reduce negative mental states. CONCLUSIONS: the COVID-19 pandemic has had significant psychological effects that will extend to coming years; therefore, implementing systemic psychological care is of utmost importance.

Mechanical thrombectomy for acute ischemic stroke in the posterior circulation: assessment of efficacy and outcome and identification of prognostic factors.

BACKGROUND: Mechanical thrombectomy (MT) is well-established in the treatment of acute ischemic anterior circulation stroke. However, there is no evidence from randomized trials or meta-analyses that MT is safe and effective in the treatment of patients with acute ischemic posterior circulation stroke (PCS). PURPOSE: To evaluate the clinical and procedural factors associated with recanalization and outcome of patients with PCS treated with MT. MATERIAL AND METHODS: Forty-three patients with PCS (median age 73 years) who underwent treatment with MT were included. Data including demographics, baseline stroke severity, radiological imaging, procedure and post-procedure complications were documented. Clinical outcome was evaluated using the modified Rankin Scale (mRS). The patients were classified into two groups based on clinical outcome (favorable vs. unfavorable mRS after 90 days). RESULTS: Median baseline National Institute of Health Stroke Scale (NIHSS) was 17. Twenty patients were eligible for intravenous thrombolysis and received recombinant tissue plasminogen activator before MT. Successful recanalization was observed in 88.4% of patients. After 90 days, favorable outcome (defined as mRS 0-2) was achieved in 26 patients; six patients had an unfavorable outcome (mRs >2). Final mortality rate was 25.5%. Baseline NIHSS, onset to reperfusion time, procedure duration, and successful recanalization had a statistically significant association with outcome. Failed recanalization and occurrence of intracranial hemorrhage were found to be associated with a higher mortality rate. CONCLUSION: MT is feasible and effective method in treatment of PCS. Baseline NIHSS and onset to reperfusion time were found to be independent predictive factors of clinical outcome.

Predictors of outcome after mechanical thrombectomy for acute ischemic stroke in patients aged ≥90 years.

BACKGROUND: Mechanical thrombectomy (MT) has established its role as a first-line treatment of acute ischemic stroke due to large vessel occlusions (LVO). However, patients older than 85 or even 80 years of age are commonly excluded from large randomized controlled stroke studies as this group was found to be associated with significantly poorer clinical outcome and increased mortality compared to younger patients. The aim of this study was to evaluate clinical and procedural factors associated with clinical outcome and mortality among nonagenarians with acute ischemic stroke treated with mechanical thrombectomy. MATERIALS AND METHODS: This retrospective, single-center study was conducted on 38 patients with LVO treated with MT. Clinical features including baseline results, radiological imaging, procedural details and outcome results were documented and evaluated. Recanalization was assessed according to the TICI score. The clinical condition was evaluated on admission (NIHSS) and after 3 months (mRS). RESULTS: The rate of successful recanalization (TICI ≥2b) was 84.2 % (32/38). Symptomatic intracranial hemorrhage (sICH) was observed in 3 (7.9 %) patients. After 90 days, the mortality rate was 47.4 %. Favorable clinical outcome (mRs 0-2) was regained in 28.9 % of the patients (11/38). Poor clinical outcome (mRs<2) was observed in 9 patients (23.7 %). CONCLUSION: Very elderly patients with LVO should not be excluded from MT even if prognosis for good clinical outcome in this age group remains low and the procedure is more challenging. Long-term outcome is predicted by stroke severity (baseline NIHSS and occluded vessel) and hospital arrival time.

Effectiveness and safety of ICA stenting in conjunction with mechanical thrombectomy (antegrade approach) in acute ischaemic stroke patients due to tandem occlusion.

AIM OF STUDY: We investigated the effectiveness and safety of an antegrade approach consisting of emergency ICA stenting in conjunction with mechanical thrombectomy (MT) in a one-stage procedure as a treatment for Tandem Occlusion (TO). CLINICAL RATIONALE FOR STUDY: We here describe our experience in the treatment of TO with an antegrade approach with long-term results. We also discuss the advantages and drawbacks of this treatment modality with special attention to possible haemorrhagic complications that can be encountered in patients with ischaemic stroke who receive antiplatelet treatment. We believe that our study adds to the limited number of reports on this topic. MATERIALS AND METHODS: We selected 34 patients diagnosed with acute ischaemic stroke due to ICA and ipsilateral intracranial occlusion treated with ICA stenting in conjunction with MT. We analysed the short- and long-term results as well as investigating complications with special regard to haemorrhagic transformation associated with the need for antiplatelet treatment after stent implantation in patients after acute ischaemic stroke treatment. RESULTS: A favourable angiographic outcome was defined as mTICI 2b-3. This was achieved in 33/34 patients (97%). On average, NIHSS at 24 hours after the procedure was 8.5 ± 7, which indicates a significant clinical improvement. Four cases of symptomatic ICH were observed (11.8%). One re-occlusion in stent was noted. At three-month follow-up, mRS scores were 0 in 11 (34.3%), 1 in 5 (16%), 2 in 1 (3%), 3 in 3 (9.3%), 4 in 3 (9.3%), and 5 in 2 (6%) patients. Seven patients did not survive (22%). Overall, a favourable outcome (mRS 0-2) was achieved in 17/34 patients (50%). The final mortality rate was 26.5% (9/34 patients). CONCLUSIONS AND CLINICAL IMPLICATIONS: We conclude that an antegrade approach is a feasible and effective method for treating acute TO stroke, giving the patient the chance to regain his or her full independence in everyday life, with low overall complication and final mortality rates.