Advanced Interventional Treatments in Retinoblastoma Management: A Comprehensive Review.

Retinoblastoma is the most common eye malignancy in children that if left untreated can invade intraocular structures, metastasize, and rarely lead to death. Traditionally treated with systemic chemotherapy, Intra-arterial chemotherapy is gaining popularity as it allows for the direct administration of chemotherapy through the ophthalmic artery, thus reducing systemic side effects. Intra-arterial chemotherapy procedures have evolved, with refinements to reduce risks and radiation exposure. Intra-arterial chemotherapy boasts an impressive technical success rate and one year ocular survival even amongst advanced cases. This review offers a thorough examination of the technique, indications, contraindications, outcomes, and alternative options for Intra-arterial chemotherapy.

Exposure to IR Rotations in Osteopathic Medical Schools: Trends in Residency Applications and Matching.

Medical student exposure to interventional radiology (IR) through dedicated rotations represents a vital component for students to consider IR as a career and to ensure a successful match into the integrated residency pathway. Students from osteopathic medical schools have historically been underrepresented in integrated IR positions. During the 2022 match, 84.1% of successfully matched applicants overall were from U.S. allopathic medical schools, whereas 15.9% were from osteopathic medical schools. This brief report aims to categorize the landscape of IR rotation exposure at osteopathic medical schools and proposes a framework to increase student access to IR.

A systematic method for diagnosis of hepatitis disease using machine learning.

Hepatitis is among the deadliest diseases on the planet. Machine learning approaches can contribute toward diagnosing hepatitis disease based on a few characteristics. On the UCI dataset, authors assessed distinct classifiers' performance in order to develop a systematic strategy for hepatitis disease diagnosis. The classifiers used are support vector machine, logistic regression (LR), K-nearest neighbor, and random forest. The classifiers were employed without class balancing and in conjunction with class balancing using SMOTE strategy. Both studies, classification without class balancing and with class balancing, were compared in terms of different performance parameters. After adopting class balancing, the efficiency of classifiers improved significantly. LR with SMOTE provided the highest level of accuracy (93.18%).

Management of Patients when Superficial Venous Disease Arises from Pelvic Escape Points.

Chronic pelvic pain (CPP) is a common condition in women that carries with it significant morbidity. It is commonly seen in patients presenting to obstetrics and gynecology outpatient clinic visits. CPP is a presenting symptom of various pathologies including pelvic varicocele, pelvic adhesions, spastic colon syndrome, uterine fibroids, endometriosis, and psychosomatic disorders. Pelvic congestion syndrome has more recently been termed "pelvic venous insufficiency (PVI)" due to the underlying retrograde flow through incompetent ovarian and pelvic veins that are thought to cause the symptoms of CPP. Pelvic varices can commonly present alongside vulvar, perineal, and lower extremity varices. There are some predictable "escape pathways" for these varices that may present for interventional treatment. This article introduces the reader to current terminology, clinical presentation, diagnosis, and treatment of patients with pelvic varices due to PVI.

Endovascular treatment of arteriovenous graft dysfunction as a result of graft delamination and fracture.

BACKGROUND: Graft thrombosis due to fabric delamination is a rare cause of delayed failure of arteriovenous grafts. Graft delamination is primarily an imaging diagnosis and is confirmed with the help of ultrasound which shows the separation of graft fabric layers. Only two such cases have been described in the literature so far. CASE PRESENTATION: We present a case of upper extremity arteriovenous graft thrombosis in a 79 year old COVID-19 positive patient with end-stage renal disease. The diagnosis was established on ultrasonography which revealed separation of the graft fabric layers with thrombosis within the "false" and "true" lumen of the graft. The patient was managed with angioplasty and embolectomy of the clot material followed by stent-graft placement across the delaminated portion of the graft. Post-procedural angiography confirmed brisk flow across the graft and patient could successfully have subsequent hemodialysis sessions. CONCLUSIONS: Identification of graft delamination as a cause of graft failure is important as its management differs from other conventional causes since it requires stent-grafts to cover the area of delamination to re-establish flow and salvage the AV graft. The recognition of this phenomenon is essential to provide quality care and successful reuse of the AV graft. LEVEL OF EVIDENCE: Level 4, Case Report.

Training by the Numbers: A Survey-Based Analysis of the Number of Positions Available in New Interventional Radiology Training Pathways.

OBJECTIVE: As of June 30, 2020, interventional radiology (IR) fellowships will cease to exist and will be replaced by the integrated IR, independent IR, and early specialization in IR (ESIR) pathways. The objective of this study is to determine the alignment in the number of available positions between the ESIR and independent IR pathways. METHODS: An analysis was performed of 150 residency programs offering at least 1 of the 3 IR training pathways. Information regarding the most up-to-date list for integrated IR, independent IR, ESIR, and IR fellowship programs were obtained from the Society of Interventional Radiology (SIR), the Electronic Residency Application Service (ERAS), and the Accreditation Council for Graduate Medical Education (ACGME) websites. A 4-question survey was distributed to residency program directors and residency program coordinators to confirm the number of positions offered in each of the training pathways at their institution. RESULTS: Ninety-nine of 113 ESIR programs (87.6% response rate) reported a total of 176 approved ESIR positions. One hundred and eleven fellowship programs in the United States currently offer a total of 331 positions. Seventy-seven integrated IR programs and 48 independent IR programs offer 150 and 133 positions, respectively, for a total of 283 advanced IR training positions. DISCUSSION: A substantial discrepancy currently exists with IR training pathways, as the number of available ESIR positions far outnumbers the available independent IR pathway positions. There is a continuing need for communication with residency programs and frequent reevaluation of the various IR training pathways to maintain the most accurate database.

Axillary Hidradenitis: Risk Factors for Recurrence after Surgical Excision in 214 Patients.

Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the apocrine sweat glands. Although the mainstay of surgical treatment is excision, the disease has a high tendency to recur, for reasons that are not well understood. We sought to better characterize the natural history of this disease, focusing on patients who required operative intervention. Two hundred and fourteen patients with axillary HS underwent 293 surgical procedures. We divided the cohort into two groups based on recurrence and then compared them to identify the factors most associated with recurrent axillary HS. Mean age of onset of HS was 32.1 years. The patients were overwhelmingly female (84.1%), black (93%), and obese (average body mass index = 33.4). Of them, 35.5 per cent of the patients had bilateral axillary disease and 8.4 per cent had extra-axillary disease. Of the 214 patients, 22 (10.3%) had recurrent disease. The vast majority of interventions included excision of disease (median area = 78.6 cm2). Closure versus nonclosure was not associated with a proclivity toward recurrence. The patients with HS were overwhelmingly obese and female, and many of them smoked. Surgical excision was the most common intervention and closure was used in roughly half of the patients. Recurrence after excision was not associated with extra-axillary disease and did not seem to correlate with the manner in which the wounds were managed after excision. Weight loss and smoking cessation may play a more significant role in the prevention of recurrence of HS than surgical treatment alone.

Bacteremia due to Elizabethkingia meningoseptica.

Elizabethkingia meningoseptica is a nonfermentative gram-negative bacillus that is ubiquitously found in hospital environments and as such, it has been associated with various nosocomial infections. Immunocompromised individuals are particularly at increased risk for developing severe infections due to E. meningoseptica, including bacteremia. E. meningoseptica is resistant to multiple antimicrobials commonly used for gram-negative bacteria and conventional empirical antimicrobials targeting those organisms may result in unfavorable outcome. We report a case of bacteremia due to E. meningoseptica in a patient who necessitated chronic hemodialysis therapy to heighten awareness of this emerging pathogen among patients on hemodialysis.

Laser in-situ keratomileusis for refractive error following radial keratotomy.

AIM: To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK). DESIGN: Retrospective study. MATERIALS AND METHODS: A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. STATISTICAL SOFTWARE: STATA-9.0. RESULTS: The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 ( P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was -5.37 ± 4.83 diopters (D) and -0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK. CONCLUSION: LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap.

Orbital dermoids in children.

Orbital dermoid cysts are benign congenital choristomas. They are common in pediatric population, developing adjacent to suture lines, most commonly located in antero-lateral fronto-zygomatic suture, and are slowly progressive. Complete surgical excision without rupture of cyst is the standard of care. Deep orbital cysts cause proptosis, require imaging, and may present a surgical challenge with a difficult approach. Rupture of the cyst leads to severe inflammatory reaction in surrounding tissues. Overall prognosis remains good with isolated reports of malignancy masquerading as dermoid cysts.

CD226 is specifically expressed on the surface of Th1 cells and regulates their expansion and effector functions.

Surface molecules that are differentially expressed on Th1 and Th2 cells may be useful in regulating specific immune responses in vivo. Using a panel of mAbs, we have identified murine CD226 as specifically expressed on the surface of differentiated Th1 cells but not Th2 or Th0 cells. Although CD226 is constitutively expressed on CD8 cells, it is up-regulated on CD4 cells upon activation. Th1 differentiation results in enhanced CD226 expression, whereas expression is down-regulated upon Th2 polarization. We demonstrate that CD226 is involved in the regulation of T cell activation; in vivo treatment with anti-CD226 results in significant reduction of Th1 cell expansion and in the induction of APCs that inhibit T cell activation. Furthermore, anti-CD226 treatment delays the onset and reduces the severity of a Th1-mediated autoimmune disease, experimental autoimmune encephalomyelitis. Our data suggest that CD226 is a costimulatory molecule that plays an important role in activation and effector functions of Th1 cells.

Role of 0.02% polyhexamethylene biguanide and 1% povidone iodine in experimental Aspergillus keratitis.

PURPOSE: To determine the efficacy of 0.02% polyhexamethylene biguanide and 1% povidone iodine in experimental keratitis. METHODS: Aspergillus fumigatus keratitis was induced by corneal intrastromal injection of spores in 24 healthy rabbits that were randomly divided into four groups of six rabbits each. Drugs used were 5% natamycin (standard antifungal), 0.02% polyhexamethylene biguanide (PHMB) (test drug), 1% povidone iodine (test drug), and 0.5% hydroxypropylmethyl cellulose (HPMC) (control). RESULTS: The average healing times of the ulcer were 21.5 +/- 3.08 days with 5% natamycin, 27.8 +/- 2.28 days with 0.02% PHMB, 36.4 +/- 2.57 days with 1% povidone iodine, and 38.2 +/- 4.74 days with 0.5% HPMC. While no corneal perforations occurred with natamycin treatment, one perforation was noted with PHMB, three perforations were noted with povidone iodine, and five perforations were noted with controls. CONCLUSION: Polyhexamethylene biguanide (0.02%) is a moderately effective drug for experimental Aspergillus keratitis, but 1% povidone iodine is not effective.