Acute cytokine release syndrome after a first dose of pembrolizumab as second-line treatment for metastatic, programmed death-ligand 1-positive, non-small-cell lung cancer.

INTRODUCTION: The use of programmed death-ligand 1 (PD-L1) checkpoint inhibitor therapy is expanding, although its adverse effects are not completely known. We report on a rare case of acute cytokine release syndrome related to pembrolizumab use in a patient with lung cancer. CASE REPORT: A 79-year-old man with metastatic, PD-L1-positive, non-small-cell lung cancer developed a febrile condition associated with a systemic inflammatory response syndrome and suffered haemodynamic compromise four hours after the first intravenous administration of pembrolizumab. A thorough medical workup found no alternative cause and a grade 2 cytokine release syndrome (CRS) was diagnosed.Management and outcome: Aggressive fluid resuscitation and supportive therapy led to restitutio ad integrum. DISCUSSION: Acute CRS after the administration of a PD-L1 inhibitor is infrequent but could be a fatal condition. Supportive treatment and, if necessary, corticosteroids should be considered.

Divergent selection on milk somatic cell count in goats improves udder health and milk quality with no effect on nematode resistance.

Milk somatic cell count (SCC) is commonly higher in goats than in cattle and sheep. Furthermore, the ability of milk SCC to predict mastitis is considered lower in goats than in cattle and sheep, and the relevance of somatic cell score (SCS)-based selection in this species has been questioned. To address this issue, we created 2 divergent lines of Alpine goats using artificially inseminated bucks with extreme estimated breeding values for SCS. A total of 287 goats, 158 in high- and 129 in low-SCS lines, were scrutinized for mastitis infections. We subjected 2,688 milk samples to conventional bacteriological analyses on agarose and bacterial counts were estimated for positive samples. The SCS, milk yield, fat content, and protein content were recorded every 3 wk. Clinical mastitis was systematically noted. A subset of 40 goats (20 from each line) was subsequently challenged with Haemonchus contortus and monitored for anemia (blood packed cell volume) and fecal egg counts to see if SCS-based selection had an indirect effect on resistance to gastrointestinal nematodes. Milk production traits, including milk quantity, fat content, and protein content, were similar in both goat lines. In contrast, the raw milk SCC almost doubled between the lines, with 1,542,000 versus 855,000 cells/mL in the high- and low-SCS lines, respectively. The difference in breeding value for SCS between lines was 1.65 genetic standard deviation equivalents. The Staphylococcus spp. most frequently isolated from milk were S. xylosus, S. caprae, S. epidermidis, and S. aureus. The frequency of positive bacteriology samples was significantly higher in the high-SCS line (49%) than in the low-SCS line (33%). The highest odds ratio was 3.49 (95% confidence interval: 11.95-6.25) for S. aureus. The distribution of bacterial species in positive samples between lines was comparable. The average quantity of bacteria in positive samples was also significantly higher in high-SCS goats (69 ± 80 growing colonies) than in low-SCS goats (38 ± 62 growing colonies). Clinical cases were rare and equally distributed between high- (n = 4; 2.5%) and low-SCS (n = 3; 2.3%) lines. Furthermore, the larger the amounts of bacteria in milk the higher the SCS level. Conversely, goats with repeatedly culture-negative udders exhibited the lowest SCC levels, with an average of below 300,000 cells/mL. We therefore confirmed that SCS is a relevant predictor of intramammary infection and hygienic quality of milk in goats and can be used for prophylactic purposes. After challenge with H. contortus, goats were anemic with high fecal egg counts but we found no difference between the genetic lines. This result provides initial evidence that resistance to mastitis or to gastrointestinal nematodes infections is under independent genetic regulation. Altogether, this monitoring of the goat lines indicated that SCS-based selection helps to improve udder health by decreasing milk cell counts and reducing the incidence of infection and related bacterial shedding in milk. Selection for low SCC should not affect a goat's ability to cope with gastrointestinal nematodes.

Orthogonal Morphological Feature Size and Density Gradients for Exploring Synergistic Effects in Biology.

Gradient surfaces enable rapid screening and high-throughput investigations in various fields, such as biology and tribology. A new method is described for the preparation of material-independent morphological gradients, in which the density and height of roughness features are varied along two orthogonal axes. A polystyrene-particle-density gradient was produced by a dip-coating process on titanium-oxide-coated silicon wafers. A controlled exposure to ultraviolet light enabled the generation of a particle-height gradient in the orthogonal direction. These gradients were replicated to generate material-independent morphology gradients. MC3T3 cell proliferation studies were performed on titanium-coated replicas and showed a higher cell density on the high-feature-density region of the gradient. The cell area coverage was found to increase with decreasing particle height.

Genetic parameter estimation for major milk fatty acids in Alpine and Saanen primiparous goats.

Genetic parameters for 18 fatty acids or groups of fatty acids (FA), milk production traits, and somatic cell score (SCS) were estimated by restricted maximum likelihood with a repeatability animal model, using 45,259 test-day records from the first lactations of 13,677 Alpine and Saanen goats. Fatty acid data were collected as part of an extensive recording scheme (PhénoFinLait), and sample testing was based on mid-infrared spectra estimates. The total predicted FA content in milk was approximately 3.5% in Alpine and Saanen goats. Goat milk fat showed similar saturated FA to cattle and sheep, but higher contents of capric (C10:0) FA (~ 9.7 g/100g of milk fat). Heritability estimates ranged from 0.18 to 0.49 for FA and estimates were generally higher when FA were expressed in g/100g of milk fat compared with g/100g of milk. In general, the 3 specific short- and medium-chain goat FA, caproic acid (C6:0), caprylic acid (C8:0), and especially capric (C10:0) acid, had among the highest heritability estimates (from 0.21 to 0.37; average of 0.30). Heritability estimates for milk yield, fat and protein contents, and SCS were 0.22, 0.23, 0.39, 0.09, and 0.24, 0.20, 0.40, and 0.15, in Alpine and Saanen goats, respectively. When FA were expressed in g/100g of milk, genetic correlations between fat content and all FA were high and positive. Genetic correlations between the fat content and FA groups expressed in g/100g of fat led to further investigation of the association between fat content and FA profile within milk fat. Accordingly, in both Saanen and Alpine breeds, no significant genetic correlations were found between fat content and C16:0, whereas the correlations between fat content and specific goat FA (C6:0 to C10:0) were positive (0.17 to 0.59). In addition, the genetic correlation between fat content and C14:0 was negative (-0.17 to -0.35). The values of the genetic correlations between protein content and individual FA were similar, although genetic correlations between protein content and FA groups were close to zero. Genetic correlations of milk yield or SCS with the FA profile were weak. Results for genetic parameters for FA, however, should be further validated, because the low predicting ability of certain FA using mid-infrared spectra and the limited calibration data set might have resulted in low accuracy. In conclusion, our results indicated substantial genetic variation in goat milk FA that supported their amenability for genetic selection. In addition, selection on protein and fat contents is not expected to have an undesirable effect on the FA profile in regard to specificity of goat products and human health.

Template-stripped, ultraflat gold surfaces with coplanar, embedded titanium micropatterns.

Ultraflat gold surfaces with coplanar, embedded titanium micropatterns, exhibiting extremely low roughness over the entire surface, have been obtained by a modified template-stripping procedure. Titanium is deposited onto photolithographically predefined regions of a silicon template. Following photoresist lift-off, the entire surface is backfilled with gold, template stripping is conducted, and an ultraflat micropatterned surface is revealed. Atomic force microscopy confirms a roughness of <0.5 nm RMS on both Ti and Au regions, with a topographically indistinguishable gold-titanium interface. Detailed surface-chemical maps of the patterned surfaces have been obtained by means of imaging X-ray photoelectron spectroscopy (i-XPS) as well as time-of-flight secondary-ion mass spectrometry (ToF-SIMS). They confirm the presence of well-separated Ti and Au regions, with a chemical contrast that is sharp (as determined by ToF-SIMS) and complete (as determined by i-XPS) across the Ti-Au interface. Thus, a surface has been fabricated that is physically homogeneous down to the nanoscale incorporating chemically distinct micropatterns consisting of two different metals, with totally contrasting surface chemistries.

A first step toward genomic selection in the multi-breed French dairy goat population.

The objectives of this study were to describe, using the goat SNP50 BeadChip (Illumina Inc., San Diego, CA), molecular data for the French dairy goat population and compare the effect of using genomic information on breeding value accuracy in different reference populations. Several multi-breed (Alpine and Saanen) reference population sizes, including or excluding female genotypes (from 67 males to 677 males, and 1,985 females), were used. Genomic evaluations were performed using genomic best linear unbiased predictor for milk production traits, somatic cell score, and some udder type traits. At a marker distance of 50kb, the average r(2) (squared correlation coefficient) value of linkage disequilibrium was 0.14, and persistence of linkage disequilibrium as correlation of r-values among Saanen and Alpine breeds was 0.56. Genomic evaluation accuracies obtained from cross validation ranged from 36 to 53%. Biases of these estimations assessed by regression coefficients (from 0.73 to 0.98) of phenotypes on genomic breeding values were higher for traits such as protein yield than for udder type traits. Using the reference population that included all males and females, accuracies of genomic breeding values derived from prediction error variances (model accuracy) obtained for young buck candidates without phenotypes ranged from 52 to 56%. This was lower than the average pedigree-derived breeding value accuracies obtained at birth for these males from the official genetic evaluation (62%). Adding females to the reference population of 677 males improved accuracy by 5 to 9% depending on the trait considered. Gains in model accuracies of genomic breeding values ranged from 1 to 7%, lower than reported in other studies. The gains in breeding value accuracy obtained using genomic information were not as good as expected because of the limited size (at most 677 males and 1,985 females) and the structure of the reference population.

Genetic parameters for milk somatic cell score and relationship with production and udder type traits in dairy Alpine and Saanen primiparous goats.

Goat milk somatic cell counts have been collected for several years in France by the national milk recording organization. Information is used for health management, because repeatedly elevated somatic cell counts are a good indirect predictor of intramammary infection. Genetic parameters were estimated for 67,882 and 49,709 primiparous goats of the dairy Alpine and Saanen breeds, respectively, with complete information for milk somatic cell counts and milk production traits. About 40% of the goats had additional information for 11 udder type traits scored by official classifiers of the breeders' association CAPGENES. Estimates were obtained by REML with an animal model. The studied trait was lactation somatic cell score (LSCS), the weighted mean of somatic cell score (log-transformed SCC) adjusted for lactation stage. Heritability of LSCS was 0.20 and 0.24 in the Alpine and Saanen breeds, respectively. Relationships with milk production and udder type traits were additionally estimated by using multitrait analyses. Heritability estimates in first lactation ranged from 0.30 to 0.35 for lactation milk, fat, and protein yields; from 0.60 to 0.67 for fat and protein contents; and from 0.22 to 0.50 for udder type traits. Genetic correlations of somatic cell score with milk production traits were generally low, ranging from -0.13 to 0.12. Slightly more negative correlations were estimated for fat content: -0.18 and -0.20 in Saanen and Alpine breeds, respectively. Lactation somatic cell score was genetically correlated with udder floor position (r(g)=-0.24 and -0.19 in the Alpine and Saanen breeds, respectively), and, in Saanen, teat length, teat width, and teat form (r(g)=0.29, 0.34 and -0.27, respectively). These results suggest that a reduction in somatic cell count can be achieved by selection while still improving milk production and udder type and teat traits.

Acute pulmonary function decline and radiographic abnormalities: chronic cause?

Nitrofurantoin is a cause of drug-induced pneumonitis and can result in clinically significant respiratory symptoms manifesting as interstitial lung disease on chest CT, even if the patient has been taking the drug chronically without side-effects https://bit.ly/3v2m29h.

Management of goat reproduction and insemination for genetic improvement in France.

Reproductive seasonality observed in all breeds of goats originating from temperate latitudes and in some breeds from subtropical latitudes can now be controlled by artificial changes in photoperiod. Short days stimulate sexual activity, while long days inhibit it. This knowledge has allowed the development of photoperiodic treatments to control sexual activity in goats, for both the buck and doe. In the French intensive milk production system, goat AI plays an important role to control reproduction and, in conjunction with progeny testing, to improve milk production. Most dairy goats are inseminated out of the breeding season with deep frozen semen, after induction of oestrus and ovulation by hormonal treatments. This protocol provides a kidding rate of approximately 65%. New breeding strategies have been developed, based on the buck effect associated with AI, to reduce the use of hormones. With the development of insemination with frozen semen, a classical selection programme was set up, including planned mating, progeny testing and the diffusion of proved sires by inseminations in herds. Functional traits have become important for efficient breeding schemes in the dairy goat industries. Based on knowledge gained over the past decade, the emphasis in selective breeding has been placed on functional traits related to udder morphology and health. New windows have been opened based on new molecular tools, allowing the detection and mapping of genes of economic importance.

Suppression of UV-induced apoptosis by the human DNA repair protein XPG.

The severe xeroderma pigmentosum/Cockayne syndrome (XP/CS) syndrome is caused by mutations in the XPB, XPD and XPG genes that encode the helicase subunits of TFIIH and the 3' endonuclease of nucleotide excision repair (NER). Because XPB and XPD have been implicated in p53-mediated apoptosis, we examined the possible involvement of XPG in this process. After ultraviolet light (UV) irradiation, primary fibroblasts of XP complementation group G (XP-G) individuals with CS enter apoptosis more readily than other NER-deficient cells, but this is unlinked to unrepaired damage. These XP-G/CS cells accumulate p53 post-UV but they fail to accumulate the 90/92 kDa isoforms of Mdm2 and their cellular distribution of Mdm2 is impaired. Apoptosis levels revert to wild type, Mdm2 90/92 kDa isoforms accumulate, and Mdm2 regains its normal post-UV nuclear location in transduced XP-G/CS cells expressing wild-type XPG, but not an XPG catalytic site mutant. These results suggest that XPG suppresses UV-induced apoptosis and that this suppression, most simply, requires its endonuclease function.

Novel grooved substrata stimulate macrophage fusion, CCL2 and MMP-9 secretion.

Rough surface topographies on implants attract macrophages but the influence of topography on macrophage fusion to produce multinucleated giant cells (MGC) and foreign body giant cells (FBGC) is unclear. Two rough novel grooved substrata, G1 and G2, fabricated by anisotropic etching of Silicon <110> crystals without the use of photolithographic patterning, and a control smooth surface (Pol) were produced and replicated in epoxy. The surfaces were compared for their effects on RAW264.7 macrophage morphology, gene expression, cyto/chemokine secretion, and fusion for one and five days. Macrophages on grooved surfaces exhibited an elongated morphology similar to M2 macrophages and increased cell alignment with surface directionality, roughness and cell culture time. Up-regulated expression of macrophage chemoattractants at gene and protein level was observed on both grooved surfaces relative to Pol. Grooved surfaces showed time-dependent increase in soluble mediators involved in cell fusion, CCL2 and MMP-9, and an increased proportion of multinucleated cells at Day 5. Collectively, this study demonstrated that a rough surface with surface directionality produced changes in macrophage shape and macrophage attractant chemokines and soluble mediators involved in cell fusion. These in vitro results suggest a possible explanation for the observed accumulation of macrophages and MGCs on rough surfaced implants in vivo. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2243-2254, 2016.

Bilateral tarsometatarsal joint injuries: An unusual mechanism producing unusual variants.

Tarsometatarsal (Lisfranc) joint injuries are rare but potentially devastating conditions requiring anatomical reduction and internal fixation or arthrodesis. We describe an unusual mechanism involving forced eversion and dorsiflexion on both fully supinated feet resulting in bilateral tarsometatarsal joint injury. The injury pattern involved incongruity between the medial and middle columns extending between the cuneiform bones with associated fracture of the cuboid on the right and the cuboid, os calcis and talus on the left. Operative fixation is discussed and the clinical outcome was good at 4 years post-operatively. We believe this introduces an additional and potentially serious mechanism of injury and pattern of ligamentous and osseous disruption into the pantheon of injuries classed as Lisfranc, which surgeons should be aware of. Furthermore, we recommend attention to the mechanism of injury in consideration with classification to aid in operative reduction and fixation.

Genetic and non-genetic factors related to the success of artificial insemination in dairy goats.

The objective of this study was to evaluate genetic and non-genetic factors influencing artificial insemination (AI) success in French dairy goats. Data analysis, on a total of 584 676 and 386 517 AI records for Alpine and Saanen breed, respectively, collected from 1992 to 2009, was conducted separately on each breed. We used a linear simple repeatability animal model which combined male and female random effect and environmental fixed effects. The most important environmental factor identified was the period within year effect due to the European heat wave of 2003. The estimated values of the annual fertility exhibited a negative trend of 1% loss of AI success per 10 years for Alpine breed only. The range of variation for the flock×within years random effect was 70% and 65% for Alpine and Saanen breeds. The negative effect on AI success of antibody production after repetitive hormonal treatment was confirmed. We observed an important positive relationship between fertility and protein yield expressed as quartile within flock×years of protein 250-day yield for female with lactation number over 1, while this trend was negative for primiparous females. We detected a negative effect of the duration of conservation of semen with a difference of about 4% of AI success between extreme values (2 to 8+ or 9+ years). Heritability estimates for male fertility were 0.0037 and 0.0043 for Alpine and Saanen breed respectively, while estimates for female fertility was 0.040 and 0.049. Repeatability estimates for males were 0.008 and 0.010 for Alpine and Saanen, respectively, and 0.097 and 0.102 for females. With such low values of heritability, selection can hardly affect fertility.

Ultrathin, freestanding, stimuli-responsive, porous membranes from polymer hydrogel-brushes.

The fabrication of freestanding, sub-100 nm-thick, pH-responsive hydrogel membranes with controlled nano-morphology, based on modified poly(hydroxyethyl methacrylate) (PHEMA) is presented. Polymer hydrogel-brush films were first synthesized by surface-initiated atom transfer radical polymerization (SI-ATRP) and subsequently detached from silicon substrates by UV-induced photo-cleavage of a specially designed linker within the initiator groups. The detachment was also assisted by pH-induced osmotic forces generated within the films in the swollen state. The mechanical properties and morphology of the freestanding films were studied by atomic force microscopy (AFM). Inclusion of nanopores of controlled diameter was accomplished by performing SI-ATRP from initiator-coated surfaces that had previously been patterned with polystyrene nanoparticles. Assembly parameters and particle sizes could be varied, in order to fabricate nanoporous hydrogel-brush membranes with tunable pore coverage and characteristics. Additionally, due to the presence of weak polyacid functions within the hydrogel, the membranes exhibited pH-dependent thickness in water and reversible opening/closing of the pores.

Some characteristics of sugar ester nonionic microemulsions in view of possible food applications.

This study explores some characteristics of microemulsions composed of sucrose monostearate (SMS), medium-chain triglycerides (MCT), or R-(+)-limonene, alcohols, and water. The systems are homogeneous, soft, and waxy solids at room temperature but liquefy and structure into homogeneous microemulsions when heated to >40 degrees C. The amount of solubilized water is enhanced as a function of the alcohol/oil ratio and is inversely proportional to the alcohol chain length. Over 60 wt % water can be solubilized in systems consisting of propanol/MCT/SMS at a weight ratio of 3:1:4 (initial weight ratio). These microemulsions are unique and differ from nonionic ethoxylated-based microemulsions in that their viscosity is very low and is reduced with increasing amounts of solubilized water. The electrical conductivity increases only slightly as a function of the water content and does not show typical bicontinuous or percolated behavior. The water in the core of the microemulsion strongly binds to the headgroups of the surfactant. Only at >15 wt % solubilization of water was free or bulk water detected in the core of the microemulsions. Such unique behavior of the core water might have a possible application in systems requiring monitoring of enzymatic (lipase) reactions carried out in the microemulsions as microreactors.

Improved oil solubilization in oil/water food grade microemulsions in the presence of polyols and ethanol.

Microemulsions based on five-component mixtures for food applications and improved oil solubilization have been studied. The compositions included water, oil phase [such as R(+)-limonene and medium-chain triglycerides (MCT)], short-chain alcohols (such as ethanol), polyols (propylene glycol and glycerol), and several surfactants and their corresponding mixtures (nonionic, such as ethoxylated sorbitan esters, polyglycerol esters, sugar ester, and anionic, such as phosphatidylcholine). The phase behavior of these systems is discussed with respect to the influence of polyols and short-chain alcohols on the degree of solubilization of oils in the aqueous phase. The alcohol and polyols modify the interfacial spontaneous curvature and the flexibility of the surfactant film, enhancing the oil solubilization capacity of the microemulsions. The solubilization of R(+)-limonene was dramatically improved in the presence of the alcohol and polyols, whereas the improvement of solubilization for triglycerides containing MCT was less pronounced. In some systems high oil solubilization was achieved, and some of them can be easily diluted to infinity both with the aqueous phase and with the oil phase. Viscosity measurements along selected dilution lines [characterized by a single continuous microemulsion region starting from a pseudo binary solution (surfactant/oil phase) to the microemulsion (water/polyol corner)] indicate that at a certain composition the system inverts from a W/O to an O/W microemulsion.

Comparison of psychological symptoms of women requesting removal of breast implants with those of breast cancer patients and healthy controls.

Concern about the safety of silicone breast implants has led many women with numerous physical and psychological symptoms to seek breast implant removal. This retrospective group comparison study describes the psychological profile of women requesting breast implant removal compared with two control groups. The Brief Symptom Inventory was used to compare psychological symptoms of three groups of women: a preoperative breast implant group requesting removal of implants (n = 78), a postoperative breast cancer group without breast implants (n = 64), and a control group with no known breast disease and unknown breast implant status (n = 68). Scores were compared on the Global Severity Index of the Brief Symptom Inventory as well as on nine subscales: somatization, obsessive-compulsiveness, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The breast implant group had significantly elevated Global Severity Index scores, as well as somatization, obsessive-compulsiveness, depression, hostility, and anxiety subscale scores, when compared with the other groups. Post hoc data analysis revealed that women who had implants after subcutaneous mastectomy as prophylaxis for breast cancer (n = 18) had a significantly different symptom profile and higher Global Severity Index scores than women who had cosmetic augmentation (n = 53). Additionally, women who had subcutaneous mastectomy and implants had significantly higher subscales of interpersonal sensitivity, phobic anxiety, paranoid ideation, and psychoticism than the cosmetic implant subjects. Women requesting removal of silicone breast implants had greater psychological distress than women who were recently diagnosed with breast cancer or controls with no known breast disease and unknown implant status. Within the implant group, however, women who had subcutaneous mastectomy showed greater psychological disturbance than those who had augmentation mammaplasty.

Patterning gradients.

Surface-chemical and -morphological gradients can be extremely useful in cell-biological research as high-throughput screening tools-for example, exposing a given set of cells to many different surface conditions at once, under identical ambient conditions, in order to monitor cell behavior such as proliferation or specific gene expression. They can also be used to investigate the effects of gradients themselves on cell behavior, such as migration. A number of simple, reliable techniques for both chemical- and morphological-gradient fabrication have been developed in our laboratories and are described in detail in the following.

Neuropsychological findings in a patient with Kernohan's notch.

This case report describes the use of neuropsychological testing to Iocalize and diagnose lesions The testing was instrumental in disentangling contradictory symptoms to reveal a Kernohan's notch (later confirmed by MRI), thus ruling out incorrect diagnoses We describe the case of a 36-year-old right-handed man who developed a left epidural hematoma after suffering head trauma from a blunt instrument Sequelae 2 months post-injury included left hemiparesis (ipsilateral to the lesion), dysphonic speech, severe naming/word-finding deficits, and severe memory impairment This patient's symptom pattern presented somewhat of a mystery as his cognitive deficits appeared consistent with left hemisphere damage, while his left motor symptoms suggested right hemisphere damage Medical records were inconsistent Deficits on neuropsychological testing at 3 months post-injury included impairment in verbal and visual memory, confrontation naming, and left-sided motor function Attention, visual-spatial skills, nonverbal problem solving, and right motor speed and coordination were intact A herniation syndrome, Kernohan's notch, was considered to be the most likely explanation This phenomenon occurs when a mass occupying lesion causes significant midline shift of the midbrain, pressing the contralateral cerebral peduncle against the tentorium This pressure produces an ischemic infact in the region of the corticospinal (motor) pathways Subsequent MRI confirmed a lesion in the right cerebral crus The pattern of neuropsychological finding in this patient is discussed.

Case report 656: Malignant fibrous histiocytoma in a previous bone infarct.

A case is presented of a 55-year-old man with a MFH in a previous BI. The poor prognosis of such secondary MFH is related in part to the difficulty of its early diagnosis, its aggressive behavior, and its tendency to metastasize (mainly to bone sites and lungs). Nevertheless, although biopsy of asymptomatic bone marrow infarction is not indicated, MRI seems consistent in detecting sarcomatous transformation of symptomatic BIs and plays an important role in the patient's preoperative evaluation.