The Onco Fertility Journal (Onco Fertil J)

Ethical concerns in fertility preservation in the young Nalini Mahajan The Onco Fertility Journal 2018 1(2):59-60

Breast cancer and Fertility Part 2- Pregnancy Associated Breast Cancer Nalini Mahajan The Onco Fertility Journal 2018 1(2):61-70 Pregnancy-associated breast cancer (PABC) refers to breast cancer (BC) diagnosed during pregnancy or within the first postpartum year. The increasing incidence follows the increase in age at first childbirth. Diagnostic delay due to physiological breast changes of pregnancy leads to the tumor being diagnosed at a more advanced stage. Since the termination of pregnancy does not alter the course of disease, patients can be offered BC management during pregnancy with a good outcome. Chemotherapy (CT) can be given safely during the second and third trimester of pregnancy. In the first trimester, the option of surgery is available while during puerperium, radiotherapy can be safely administered in addition to CT. Prognosis is related to the stage and grade of the tumor. Neonatal outcomes are reassuring. This article gives an overview of the diagnosis, management, and prognosis of PABC.

Fertility preservation network in Asia: Current status and issues of fertility preservation network in Japan Yasushi Takai The Onco Fertility Journal 2018 1(2):71-73 Fertility preservation (FP)/oncofertility is a crucial facet of cancer supportive care. The publication of FP guidelines is becoming increasingly prevalent in Japan. However, the viability of the guidelines is predicted on a well-developed FP network comprising of cancer hospitals, assisted reproductive technology (ART) hospitals/clinics, and oncofertility center, and the quality of the FP network in Japan varies greatly based on the region. Oncofertility care availability is influenced by the sustainability of each network and public financial support which may be facilitated by oncofertility registry system which recently launched in Japan.

Comparison of ovarian reserve and response to gonadotropin stimulation in fertile and infertile Indian women based on ovarian reserve markers, anti-Mullerian hormone and antral follicle count Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):74-80 Background: Poor ovarian response to gonadotropin (GT) stimulation during assisted reproductive technology cycles is often encountered in infertile women and is considered to be a cause of their infertility. Poor ovarian response is mostly a result of a low ovarian reserve (OR), implying that there may be an earlier depletion of the oocyte pool in infertile women. Aim of the Study: To evaluate whether infertile Indian women below the age of 35 years have an earlier depletion of their OR and a lower ovarian response to GT in comparison to age-matched fertile controls. Materials and Methodology: A total of 146 women undergoing in vitro fertilization-intracytoplasmic sperm injection at our fertility center between March 2017 and August 2017 were prospectively enrolled in this study. Anti-Mullerian hormone and antral follicle count (AMH and AFC) assessment was done for women enrolled in the study in the early follicular phase. Flexible GnRH antagonist protocol was followed. Age, AMH, AFC, body mass index, and response to ovarian stimulation (OS) were compared between the fertile and infertile groups. We also sought to determine which among these had the best prediction for ovarian response to controlled OS. Statistical Analysis: Chi-square test was used for comparisons between study groups with respect to percentages. P < 0.05 was considered to be statistically significant. Results: When adjusted for the differences in the demographic variables, we found no difference in the AMH (P = 0.298) and AFC (P = 0.302) between the fertile and infertile women. In addition, there was no difference in the ovarian response; the mean number of oocytes retrieved was 15.8 ± 7.5 in the fertile group and 14.3 ± 7.5 in the infertile group (P = 0.510). AMH had the strongest correlation with the number of oocytes retrieved (r = 2.11) in comparison to AFC (r = 0.08) and age (r = −0.45) Conclusion: There is no difference in OR and response in fertile and infertile Indian having similar demographics and basal characteristics.

Intrauterine autologous platelet-rich plasma therapy to improve implantation rates in patients undergoing frozen embryo transfer: A pilot study Anju Madhavan, Padmaja Naidu, Kum Kum Rani, Jasneet Kaur, Nalini Mahajan The Onco Fertility Journal 2018 1(2):81-85 Background: Successful implantation is a well-orchestrated event requiring the presence of a healthy embryo, a receptive endometrium, appropriate embryo endometrial cross-talk, and adequate maternal immune protection. Despite advances in assisted reproductive technology, there are insignificant improvements in the implantation and pregnancy rates. Intrauterine infusion of platelet-rich plasma (PRP) might improve implantation rates through its paracrine effects by recruiting growth factors and cytokines that favor decidualization and implantation. Objectives: The objective of the study is to study whether intrauterine PRP improves implantation rates in patients undergoing frozen embryo transfer (FET). Subjects and Methods: In this retrospective study, we collected data of patients who underwent FET in Mother and Child Hospital for 11 months from January 2018 to November 2018. We screened data of 98 patients who had at least one previous failed FET and underwent subsequent FET. The patients were divided into a study and control group. The study group received Intrauterine PRP before FET, while the control group did not. All patients underwent the same hormone replacement therapy regimen for endometrial preparation. Main Outcome Measure: The main outcomes studied were the implantation rates and clinical pregnancy rates (CPR) after embryo transfer. Results: Patient demographics such as mean age, body mass index, and anti-mullerian hormone of both groups were comparable. Overall, the CPR was 42.8% in the control group and 47.6% in the intervention group, and the difference was not statistically significant. Conclusion: Intrauterine PRP does not increase the implantation rates/CPR significantly in patients who have had one previous FET failure.

Strategies for fertility preservation in young patients with cancer Devika Gunasheela, Jyothi Menon, N Ashwin The Onco Fertility Journal 2018 1(2):86-88 Advances in cancer therapy have given a chance for patients suffering from cancers to have a productive life. Future effects of chemotherapy or radiotherapy or fertility should be discussed with all cancer patients who have reproductive potential. Fertility preservation stratergies for females include oocyte or embryo preservation, cortical tissue cryopreservation, ovarian transportation. Fertility preservation stratergies for male involve cryopreservation of semen. Fertility preservation in cancer patients should be approached with a multidisciplinary setting.

Fertility preservation in testicular seminoma Madhuri Patil, Priyanka Reddy The Onco Fertility Journal 2018 1(2):89-95 Testicular cancer is the most common solid malignancy affecting males between the ages of 15 and 35, although it accounts for only 1% of all cancers in men. Germ cell tumors (GCTs) account for 95% of testicular cancers. Two broad categories of testicular tumors have been described, one pure seminoma (no nonseminomatous elements present) and the other is nonseminomatous GCTs. It is one the most curable neoplasm with 5 years survival rate of 98%–99% when diagnosed at an early stage. We present here one such case of metastatic seminoma, where the semen was cryopreserved for fertility preservation. Although the sample was oligoasthenospermic, a successful pregnancy and live birth was obtained with intrauterine insemination of the frozen sample in an controlled ovarian stimulation cycle. Testicular tumors can impair fertility after treatment in majority of patients. Fertility preservation methods such as semen freezing, sperm freezing using epididymal or testicular sperm extraction (TESE) or testicular tissue freezing provides hope for those who wish to father a child latter.

Fertility preservation in a premenarcheal female with sickle cell anemia Sonu Balhara Ahlawat, Sarabpreet Singh The Onco Fertility Journal 2018 1(2):96-98 The objective of the study was fertility preservation in a premenarcheal female with sickle cell anemia (SCA) using controlled ovarian hyperstimulation and oocyte preservation. The study design was a case report. The study was conducted at the reproductive medicine unit of a tertiary care private hospital. A 15-year-old premenarcheal female with Tanner stage 3 breast development and Tanner stage 1 pubic hair diagnosed with SCA, referred by a medical oncologist for fertility preservation before undergoing chemotherapy and bone marrow transplant. The interventions were evaluation of ovarian reserve, ovarian stimulation (OS), transvaginal oocyte aspiration, and oocyte cryopreservation (OC). The main outcome measure was cryopreservation of mature oocytes before the antineoplastic therapy. Controlled ovarian hyperstimulation allowed for cryopreservation of ten mature oocytes before the start of the patient's gonadotoxic treatment. OS and OC can be successfully performed in premenarcheal/peripubertal SCA patients before undergoing chemotherapy, thus providing a viable option for fertility preservation.

A case report on severe ovarian hyperstimulation syndrome in a pregnancy with torsion of bilateral enlarged ovaries with acute abdomen Sankar Kumar Das, Priyanka Roy The Onco Fertility Journal 2018 1(2):99-102 Ovarian hyperstimulation syndrome is a complication of fertility treatment, which uses pharmacological ovarian stimulation to increase the number of oocytes and therefore embryos available during assisted reproductive technology. Ovarian hyperstimulation syndrome is invariably associated with increased volume of ovaries which is itself a threat to undergo torsion, and it may cause an additional threat requiring prompt surgical intervention in many situations. Simple release of torsion, sacrificing the devitalized ovarian tissue in part and complete can have effect in continuation of pregnancy; and something like this happened in our case. The patient, 29-year-old, a known case of polycystic ovary syndrome (PCOS), conceived through ovulation induction; came with an episode of acute pain abdomen with abdominal distension toward the later part of her first trimester. Ultrasonography was done. Bilateral enlarged ovaries of around 23 cm × 11.8 cm each were seen meeting at the pouch of Douglas with ascites. It was a case of ovarian hyperstimulation syndrome, more specifically, a case of late ovarian hyperstimulation syndrome. Serum E2 level was 3263 pg/ml. Laparotomy was then done. Intraperitoneally bilateral ovarian torsion was seen with areas of necrosis. The right oophorectomy was done, while on the left side some portion of normal ovarian tissue was preserved. Following the operation, her symptoms were improved. The pregnancy continued uneventfully. Exposure of ovaries to human chorionic gonadotropin or luteinizing hormone following controlled ovarian stimulation by follicle-stimulating hormone underlies most cases of ovarian hyperstimulation syndrome. The risk of ovarian hyperstimulation syndrome is smaller when using gonadotropin-releasing hormone antagonist (GnRH) antagonist protocol instead of GnRH agonist protocol for suppression of ovulation during ovarian hyperstimulation. To avoid ovarian hyperstimulation syndrome, the best trigger is GnRH agonists. In PCOS patients, metformin is an important aid in reducing ovarian hyperstimulation syndrome.

Beware of bleomycin toxicity: Fertility preservation for dysgerminoma Ashraf M Ali, Paapa Dasari The Onco Fertility Journal 2018 1(2):103-106 An 18-year-old female who underwent fertility preservation surgery for dysgerminoma Stage IIa received adjuvant chemotherapy and bleomycin, etoposide and cisplatin of four cycles. She presented with cough and breathlessness after 45 days of the last cycle of chemotherapy. She was tachypneic and had decreased SpO2 and was managed by supportive therapy. Her X-ray chest revealed bilateral ground-glass nodular opacity and computed tomography thorax showed evidence of pulmonary fibrosis in the form of intra- and inter-lobular septal fibrosis with surrounding ground-glass opacity. She ultimately died after 5 days of admission due to respiratory failure. Her body weight was 37 kg and she received standard dose of bleomycin and the cumulative dose was 360 U. Bleomycin dose recommendation is not per kg bodyweight, and the complication of pulmonary fibrosis could have been prevented if the dosage schedule as per bodyweight (0.25–0.5 U/kg) is advocated.

Observation and mechanism study of bladder wound healing after transurethral holmium laser resection of bladder tumor

Abstract

This research aims to observe and compare the wound healing process of urethral bladder after transurethral holmium laser resection of bladder tumor (HoLRBT) and transurethral resection of bladder tumor (TURBT) and explore the possible mechanism of wound healing and bladder re-epithelialization after HoLRBT. An animal model of canine achieving HoLRBT and TURBT was established. Cystoscopy was performed at different time points (3 days and 1, 2, 3, and 4 weeks) after operation to observe the wound healing and re-epithelialization of bladder epithelium. Bladder mucosa specimens were obtained and histopathological changes of the bladder epithelium were observed under light microscope after HE staining. Immunochemistry was used to determine the cell expression ofCK5, CK14, EGF, EGFR; microRNA expressions of CK5, CK14, EGF, and EGFR were measured by qRT-PCR. The changes of urinary EGF concentration were detected by ELISA. The bladder epithelial wound was repaired and re-epithelialized at 1 week after HoLRBT. At the 4th week, the bladder wound was basically completed and re-epithelialized; repair of bladder epithelial wounds recapitulates the wounds with the proliferation and migration of residual epithelial cells under the wound and the bladder epithelium that proliferates alongside the wound surface to complete re-epithelialization. The process begins at 1 week after surgery and basically completes at 4 weeks after surgery. CK5 and CK14 positive cells were detected in the basal cells of the bladder epithelium after HoLRBT, and the expression of CK5 and CK14 mRNA in the basal cells of the bladder epithelium under hyperplasia was significantly higher than that of the normal bladder epithelial basal cells. Bladder epithelial wound repair of TURBT group was performed by the proliferative differentiation of the peri-bladder epithelium adjacent to the wound edge and crawled to the wound surface to complete the re-epithelialization process. The wound repair and re-epithelialization were significantly slower than HoLRBT group. The CK5 and CK14 positive cells can also be detected in the basal cells of marginal hyperplasia of basal margin, and the expression of CK5 and CK14 mRNA in the basal cells of the peri-bladder hyperplasia is obviously higher than that of the normal bladder epithelial basal cells. The expression of EGF in bladder regenerating epithelium gradually increased with time after HoLRBT. Bladder basal cells and bladder regenerating epithelium express high levels of EGFR after HoLRBT. The concentration of EGF in urine after HoLRBT and TURBT increased significantly after surgery, and peaked at 3 days after operation. The urinary EGF concentration in HoLRBT group was higher than that in TURBT group at 3 and 4 weeks after operation. The re-epithelialization process can be seen 1 week after the cystectomy with holmium laser cystectomy, and the epithelialization rate is faster than the traditional transection surgery. This is because the residual bladder epithelial stem cells and wound marginal epithelial cells are involved in the process of wound repair and re-epithelialization following HoLRBT. But only the marginal epithelial tissue participates in the re-epithelialization process after TURBT, so the repair rate of TURBT is slower. The repair of bladder epithelium after HoLRBT is related to the stimulation of tissue factor EGF. The regenerated bladder epithelium also participates in the wound repair process by means of autocrine of EGF.

https://ift.tt/2GJHfin

Laboratory Monitoring Requirements During Mycophenolate Mofetil Therapy for Dermatologic Conditions: A Single Institution Retrospective Chart Review

Publication date: Available online 22 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Reid Waldman, Bruce E. Strober

https://ift.tt/2E38qAT

Radiation-induced morphea: association with autoimmune comorbidities, severity, and response to therapy

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Amit Mittal, Vaishali Mittal, Gauri Panse, Jennifer N. Choi, Bernice Y. Kwong, Jonathan S. Leventhal

https://ift.tt/2SSYG6h

CME article part 1: Visual perception, cognition and error in dermatologic diagnosis

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Christine J. Ko, Irwin Braverman, Richard Sidlow, Eve Lowenstein

Abstract

Dermatologic diagnosis relies on vision primarily and auditory and verbal input secondarily. Accurate dermatologic diagnosis is predicated on 1) seeing and perceiving a skin finding, 2) categorizing and naming the finding correctly, and 3) comparing the visual data and data obtained from the totality of the clinical encounter (i.e., from other sensory modalities) with one's working mental database of dermatologic diagnoses. The baseline assumption – which is false - is that a dermatologist is expert at each of the aforementioned steps and transitions sequentially between them seamlessly in an error-free fashion. Each of these steps has inherent challenges, and the transitions between steps can also be problematic. In part one of this 2-part paper, we describe the pitfalls associated with visual recognition. In part 2, we discuss cognitive heuristics as they relate to the dermatologic diagnostic process and prevention of diagnostic error.

https://ift.tt/2E14wZ8

Use of 5-0 Fast Absorbing Gut vs 6-0 Fast Absorbing Gut During Cutaneous Wound Closure on the Head and Neck: A Randomized Evaluator-Blinded Split-Wound Comparative Effectiveness Trial

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Aunna Pourang, Milene K. Crispin, Ashley K. Clark, April W. Armstrong, Raja K. Sivamani, Daniel B. Eisen

Abstract

Background

Absorbable suture material (Fast Absorbing Gut (FG)) is often employed for patient convenience, however, the optimal diameter of FG sutures is debatable.

Objective

To determine whether the use of 6-0 FG during repair of linear cutaneous surgery wounds on the head and neck improves scar cosmesis compared to 5-0 FG.

Methods

This was a prospective, randomized, split-scar intervention in patients undergoing repair of linear cutaneous wounds on the head and neck. Three months post-surgery, the scar was measured via the Physician Observer Scar Assessment Scale (POSAS), a validated instrument.

Results

There was no statistically significant difference in the sum of the POSAS component scores for 6-0 FG (12.03) compared to 5-0 FG (13.11), (p=0.26). Observer overall opinion was similar for both interventions, 2.49 for 6-0 FG versus 2.64 for 5-0 FG (p=0.54). There was no statistically significant difference in the number of complications in the 5-0 FG group (15) versus the 6-0 FG group (10), (p=0.40).

Limitations

Single-centered study with wounds limited to the head and neck in white individuals who were mostly male.

Conclusion

For linear repair of cutaneous wounds, 6-0 FG was not statistically different for cosmetic outcomes, scar width and complications than 5-0 FG.

https://ift.tt/2SRdeTW

A technique to cleanse follicular grafts

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Sandip Agrawal, Rachita Dhurat, Aseem Sharma

https://ift.tt/2E38pNl

Characterization of chronic urticaria and associated conditions in a large population of adolescents

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Yossi Rosman, Alon Y. Hershko, Keren Meir-Shafrir, Ron Kedem, Idit Lachover-Roth, Yoseph A. Mekori, Ronit Confino-Cohen

Abstract

Background

Although chronic spontaneous urticaria (CSU) affects all age groups, data regarding CSU in adolescents is scarce.

Objective

To characterize the epidemiology, demographics and co-morbidities associated with CSU in a large cross-sectional, nationwide, population of adolescents.

Methods

Medical records of 16-year-old candidate conscripts to the Israeli Defense Forces were reviewed. Data were collected on the prevalence and severity of CSU as well as the demographics, medical comorbidities, medication use, and blood test results of affected individuals.

Results

Medical records of 1,108,833 consecutive 16-year-old adolescents were reviewed. A total of 6,617 (0.6%) adolescents were diagnosed with CSU. Chronic spontaneous urticaria was increased in females [OR=1.13; CI (1.07-1.19), p<0.001], and in subjects with higher socioeconomic scores [OR=1.92; CI (1-56 - 2.32-, p<0.001). Individuals with CSU were significantly more likely to have allergic diseases, including food allergy [OR=7.31; CI (6.13-8.72)], allergic rhinitis [OR=3.9; CI (2.71-3.11)], atopic dermatitis [OR=2.35; CI (2.03-2.72)] and asthma [OR=1.46; CI (1.35-1.57)].

Conclusions

Our work provides an account of CSU in a large cohort of adolescents. We found a strong link between CSU and atopic diseases. Further investigation is needed to decipher the mechanism underlying this observed association.

https://ift.tt/2SSYmEB

Cutaneous presentations of omphalomesenteric duct remnant: a systematic review of the literature

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Efrat Solomon Cohen, Moshe Lapidoth, Igor Snast, Dan Ben-Amitai, Omri Zidan, Rivka Friedland, Michael Moshe, Daniel Mimouni, Yael Ann Leshem, Emmilia Hodak, Assi Levi

Abstract

Background

Disorders of the umbilicus are commonly seen in infancy including: hernias, infections, anomalies, granulomas and malignancies. Meticulous inspection of the umbilicus at birth may reveal a persisting embryonic remnant such as omphalomesenteric duct (OMD), manifested by a variety of cutaneous signs such as: an umbilical mass, granulation tissue or discharge.

Objective

To systematically review the available data regarding the presence and management of OMD remnant with cutaneous involvement, in order to suggest a practical approach for diagnosis and treatment.

Methods

A systematic review of the literature evaluating OMD anomalies presenting with cutaneous symptoms was performed. Additionally, an index case of an 11-months-old patient is presented.

Results

59 publications were included, reporting 536 cases. 97% of the patients whose age was noted were infants (mean age, 11 months). In 7.5% of the cases diagnosis was established only after treatment failure. In 6.4 % of the patients non-lethal complications were reported, and in 10.3% the outcome was death, partly due to delayed diagnosis or mismanagement.

Limitations

Limited quality of the collected data, reporting bias.

Conclusions

OMD is relatively rare; however the clinician must consider it while examining patients with umbilical abnormalities, since mismanagement could cause severe morbidity and mortality.

https://ift.tt/2E37Wuz

Mobile Teledermatology for Melanoma Detection. Assessment of Validity in the Framework of a Population-based Skin Cancer Awareness Campaign in Northern Italy

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): S. Cazzaniga, E. Castelli, A. Di Landro, M. Di Mercurio, G.L. Imberti, A.G. Locatelli, F. Raponi, P. Vezzoli, D. Gambini, G. Damiani, A. Zucchi, L. Naldi

https://ift.tt/2SVy7h0

The use of forceps for creating sustained pressure for slit skin smear

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kalyani Milind Deshmukh, Yugal K. Sharma, Ajay Kumar

https://ift.tt/2E37H2D

Prison malpractice litigation involving dermatologists: A cross-sectional analysis of dermatologic medical malpractice cases involving incarcerated patients from 1970-2018

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Raghav Tripathi, Rishabh S. Mazmudar, Harib H. Ezaldein, Jeremy S. Bordeaux, Jeffrey F. Scott

https://ift.tt/2SVxVhM

“More efficacious extraction of the molluscum body by supplanting needle with an angled forceps ”

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Kalyani Milind Deshmukh, Ajay Kumar, Yugal K. Sharma

https://ift.tt/2E5IdS3

Inflammatory dietary pattern and incident psoriasis, psoriatic arthritis, and atopic dermatitis in women: a cohort study

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Alanna C. Bridgman, Abrar Qureshi, Tricia Li, Fred K. Tabung, Eunyoung Cho, Aaron M. Drucker

Abstract

Background

Diet is a modulator of inflammation and may impact inflammatory skin diseases.

Objective

To assess the relationship between pro-inflammatory dietary patterns and incident psoriasis, psoriatic arthritis (PsA), and atopic dermatitis (AD).

Methods

We conducted cohort studies among women in the Nurses' Health Study II. The empirical dietary inflammatory pattern (EDIP) score was calculated at baseline and every four years. Incident psoriasis, PsA, and AD were assessed by validated self-report. We used multivariable-adjusted Cox proportional hazards models to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between EDIP quintiles and risk of psoriasis, PsA and AD.

Results

We had 85,185 participants in the psoriasis analysis and 63,443 in the AD analysis. There were 1,432 cases of psoriasis, 262 cases of PsA and 403 cases of AD. Pro-inflammatory dietary patterns were not associated with risk of the outcomes in multivariable models (all P-trend > 0.05). HRs comparing the highest to the lowest EDIP quintile were 0.99 (95% CI 0.83 – 1.18) for psoriasis, 1.22 (0.81 – 1.83) for PsA and 0.96 (0.69 – 1.34) for AD.

Limitations

Recall and self-report.

Conclusions

Our findings do not support dietary inflammatory potential as a risk factor for psoriasis, PsA or AD.

https://ift.tt/2SVxMee

Visual perception, cognition and error in dermatologic diagnosis, Part 2 of 2

Publication date: Available online 21 February 2019

Source: Journal of the American Academy of Dermatology

Author(s): Eve J. Lowenstein, Richard Sidlow, Christine Ko

Abstract

Diagnostic error in dermatology is a large practice gap that has received little attention. Diagnosis in dermatology relies heavily on a heuristic approach responsible for our perception of clinical findings. In order to improve our diagnostic accuracy, a better understanding of the strengths and limitations of heuristics (cognitive short cuts) used in dermatology is essential. Numerous methods have been proposed to improve diagnostic accuracy, including brain training, reducing cognitive load, getting feedback and second opinions. Becoming comfortable with the uncertainty intrinsic to medicine is essential. Ultimately, the practice of metacognition, or thinking about how we think, can offer corrective insights to improve accuracy in diagnosis.

https://ift.tt/2E3IBk0

Editorial Board

Publication date: March 2019

Source: Journal of Autoimmunity, Volume 98

Author(s):

https://ift.tt/2SmCSuZ

Organization of Extrastriate and Temporal Cortex in Chimpanzees Compared to Humans and Macaques

Publication date: Available online 22 February 2019

Source: Cortex

Author(s): Katherine L. Bryant, Matthew F. Glasser, Longchuan Li, Jason Jae-Cheol Bae, Nadine J. Jacquez, Laura Alarcón, Archie Fields, Todd M. Preuss

Abstract

There is evidence for enlargement of association cortex in humans compared to other primate species. Expansion of temporal association cortex appears to have displaced extrastriate cortex posteriorly and inferiorly in humans compared to macaques. However, the details of the organization of these recently expanded areas are still being uncovered. Here, we used diffusion tractography to examine the organization of extrastriate and temporal association cortex in chimpanzees, humans, and macaques. Our goal was to characterize the organization of visual and auditory association areas with respect to their corresponding primary areas (primary visual cortex and auditory core) in humans and chimpanzees. We report three results: (1) Humans, chimpanzees, and macaques show expected retinotopic organization of primary visual cortex (V1) connectivity to V2 and to areas immediately anterior to V2; (2) In contrast to macaques, chimpanzee and human V1 shows apparent connectivity with lateral, inferior, and anterior temporal regions, beyond the retinotopically organized extrastriate areas; (3) Also in contrast to macaques, chimpanzee and human auditory core shows apparent connectivity with temporal association areas, with some important differences between humans and chimpanzees. Diffusion tractography reconstructs diffusion patterns that reflect white matter organization, but does not definitively represent direct anatomical connectivity. Therefore, it is important to recognize that our findings are suggestive of species differences in long-distance white matter organization rather than demonstrations of direct connections. Our data support the conclusion that expansion of temporal association cortex, and the resulting posterior displacement of extrastriate cortex, occurred in the human lineage after its separation from the chimpanzee lineage. It is possible, however, that some expansion of the temporal lobe occurred prior to the separation of humans and chimpanzees, reflected in the reorganization of long white matter tracts in the temporal lobe that connect occipital areas to the fusiform gyrus, middle temporal gyrus, and anterior temporal lobe.

https://ift.tt/2U31NoS

Prominent Auditory Deficits in Primary Progressive Aphasia: A Case Study

Publication date: Available online 21 February 2019

Source: Cortex

Author(s): Rene L. Utianski, Joseph R. Duffy, Heather M. Clark, Mary M. Machulda, Dennis W. Dickson, Jennifer L. Whitwell, Keith A. Josephs

Abstract

Aphasia typically is associated with comparable difficulties in written and spoken modalities of language expression and comprehension. In contrast, auditory verbal agnosia is the disproportionate difficulty comprehending spoken compared to written language, also typically greater than difficulties with spoken and written language expression, in the absence of a primary sensory deficit. The terms pure word deafness and auditory verbal agnosia are often used synonymously. However, the broader term of auditory agnosia more accurately reflects difficulty processing both speech and non-speech sounds whereas individuals with auditory verbal agnosia (pure word deafness) have preserved processing of environmental sounds. Auditory agnosia is reported in the stroke literature, but rarely reported in progressive neurologic disorders. Here, we report a case of a woman who presented with what is best described as a prominent auditory deficit in the context of an initially unclassifiable, or mixed, primary progressive aphasia (PPA) with accompanying apraxia of speech. Her clinical presentation shared features with auditory agnosia, although sensory functioning was not formally assessed. We report clinical and neuroimaging data spanning 6 years and subsequent autopsy results. She presented at 65 years of age, 5 years post onset of symptoms that included insidious and progressive difficulties thinking of words, constructing sentences, pronouncing words, and understanding instructions. She had disproportionate difficulty with comprehension of spoken compared to written language. She eventually developed features of the nonfluent/agrammatic variant of PPA, as well as an apraxia of speech. Imaging with [18F]-fluorodeoxyglucose (FDG)-PET revealed progression of bilateral (left greater than right) hypometabolism involving the frontal, temporal (predominantly the lateral superior gyrus), and parietal lobes, that eventually included the supplementary motor area, anterior cingulate, and caudate. Autopsy revealed pathological lesions consistent with corticobasal degeneration.

https://ift.tt/2BLXLu0

Impairments in Action and Perception after Right Intraparietal Damage

Publication date: Available online 21 February 2019

Source: Cortex

Author(s): Jared Medina, Steven A. Jax, H. Branch Coslett

Abstract

We examined visually-guided reaching and perception in an individual who underwent resection of a small tumor in right intraparietal sulcus (pIPS). In the first experiment, she reached to targets presented on a touch screen. Vision was occluded from reach onset on half of the trials, whereas on the other half she had vision during the entire reach. For visually-guided reaching, she demonstrated significantly more reach errors for targets left of fixation versus right of fixation. However, there were no hemispatial differences when reaching without vision. Furthermore, her performance was consistent for reaches with either hand, providing evidence that pIPS encodes location based on an eye-centered reference frame. Second, previous studies reported that optic ataxics are more accurate when reaching to remembered versus visible target locations. We repeated the first experiment, adding a five second delay between stimulus presentation and reach initiation. In contrast to prior reports, she was less accurate in delayed versus immediate reaching. Finally, we examined whether a small pIPS resection would disrupt visuospatial processing in a simple perceptual task. We presented two small circles in succession in either the same location or offset at varying distances, and asked whether the two circles were presented in the same or different position. She was significantly more impaired left of fixation compared to right of fixation, providing evidence for a perceptual deficit after a dorsal stream lesion.

https://ift.tt/2U6LQhC

Neurophysiological mechanisms underlying the modulation of cognitive control by simultaneous conflicts

Publication date: Available online 21 February 2019

Source: Cortex

Author(s): Witold X. Chmielewski, Christian Beste

Abstract

Acting adequately in a given situation is complicated by the presence of ambiguous information. Being able to overcome such conflicts is a necessary prerequisite in everyday life, because it enables goal-directed behavior. On a conceptual level, different kinds of conflict can be distinguished: conflicts at a stimulus level (S-S conflicts) can be dissociated from stimulus-response (S-R) conflicts. Considering cognitive psychological frameworks, we examined whether simultaneously presented conflicts potentiate each other, or are rather integrated into a single conflict. To assess the neurophysiological mechanisms and functional neuroanatomical structures that are modulated by independent, interfering or integrative processing of conflicts, we use a Simon-Stroop paradigm in combination with EEG recordings and source localization. We show that S-R (Simon) conflict monitoring processes reflected by anterior cingulate cortex (ACC) and N2 ERP component modulations are unaffected by simultaneous S-S (Stroop) conflicts. In contrast to that, S-S (Stroop) conflicts, reflected in N450 ERP component and ACC modulations are not processed separately when there is an already existing S-R conflict. Rather, S-S (Stroop) conflicts are likely integrated into previously established S-R conflict resolution and also modulate response selection processes associated with the modulation of the P3 ERP component and dorsolateral prefrontal structures. The results suggest that even though different kinds of conflicts can be distinguished, they can become integrated during neural processing associated with medial frontal areas.

https://ift.tt/2BOXzKk