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BackgroundIncreased postural sway has been repeatedly documented in children with autism spectrum disorder (ASD). Characterizing the control processes underlying this deficit, including postural orientation and equilibrium, may provide key insights into neurophysiological mechanisms associated with ASD. Postural orientation refers to children’s ability to actively align their trunk and head with respect to their base of support, while postural equilibrium is an active process whereby children coordinate ankle dorsi-/plantar-flexion and hip abduction/adduction movements to stabilize their upper body. Dynamic engagement of each of these control processes is important for maintaining postural stability, though neither postural orientation nor equilibrium has been studied in ASD.MethodsTwenty-two children with ASD and 21 age and performance IQ-matched typically developing (TD) controls completed three standing tests. During static stance, participants were instructed to stand as still as possible. During dynamic stances, participants swayed at a comfortable speed and magnitude in either anterior-posterior (AP) or mediolateral (ML) directions. The center of pressure (COP) standard deviation and trajectory length were examined to determine if children with ASD showed increased postural sway. Postural orientation was assessed using a novel virtual time-to-contact (VTC) approach that characterized spatiotemporal dimensions of children’s postural sway (i.e., body alignment) relative to their postural limitation boundary, defined as the maximum extent to which each child could sway in each direction. Postural equilibrium was quantified by evaluating the amount of shared or mutual information of COP time series measured along the AP and ML directions.ResultsConsistent with prior studies, children with ASD showed increased postural sway during both static and dynamic stances relative to TD children. In regard to postural orientation processes, children with ASD demonstrated reduced spatial perception of their postural limitation boundary towards target directions and reduced time to correct this error during dynamic postural sways but not during static stance. Regarding postural equilibrium, they showed a compromised ability to decouple ankle dorsi-/plantar-flexion and hip abduction/adduction processes during dynamic stances.ConclusionsThese results suggest that deficits in both postural orientation and equilibrium processes contribute to reduced postural stability in ASD. Specifically, increased postural sway in ASD appears to reflect patients’ impaired perception of their body movement relative to their own postural limitation boundary as well as a reduced ability to decouple distinct ankle and hip movements to align their body during standing. Our findings that deficits in postural orientation and equilibrium are more pronounced during dynamic compared to static stances suggests that the increased demands of everyday activities in which children must dynamically shift their COP involve more severe postural control deficit...

Colorectal cancer patients have a high incidence of liver metastasis (ml-CRC). Surgical resection is the gold standard for treatment of hepatic metastasis but only a small percent of patients are traditional candidates based on disease extent and adequate size of the future liver remnant (FLR). Interventions such as portal vein embolization (PVE) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) are performed to increase FLR for operative conversion. Limitations to PVE include intrahepatic disease progression, portal vascular invasion, and utilization with concurrent chemotherapy. ALPPS is associated with a high morbidly and mortality. Radiation lobectomy (RL) with yttrium-90 (Y-90) delivers transarterial ablative brachytherapy to the future hepatectomy site which generates FLR hypertrophy similar or greater than PVE. Early results indicate that RL is safe, effective, and may offer unique benefits by providing cytoreduction of hepatic metastases which extends FLR hypertrophy time and allows FLR surveillance to gauge disease biology. A retrospective analysis of four patients with ml-CRC treated with RL prior to hepatectomy was performed to evaluate initial safety, efficacy, FLR hypertrophy, and radiopathologic correlation. Adverse events after RL and hepatectomy were evaluated. Imaging findings were analyzed for efficacy defined as FLR hypertrophy and disease control. Radiopathologic correlation was performed after histologic analysis. RL was well tolerated without major adverse events or hepatic decompensation. FLR hypertrophy ranged from 24.9% to 119% at mean follow-up of three months. The majority of complications were related to surgical instrumentation of the FLR due to upstaging at time of surgery. Hepatectomy specimen histology demonstrated complete pathologic response in 50% of patients, 50% radiopathologic concordance rate, and no significant hepatic fibrosis. Initial experience with neoadjuvant RL for ml-CRC is safe and provides both durable disease control and FLR hypertrophy with concurrent chemotherapy. A 50% complete pathologic response rate raises the possibility of definitive chemoradiation in poor surgical candidates. Prospective investigation is required.

The absence of hepatocyte-specific contrast uptake, increased signal on T2-weighted sequences, and plateau or persistent enhancement in the angiosome may represent MRI surrogates of CPN following TARE of HCC. These findings correlated with EASL and mRECIST response criteria. Further investigation is needed to determine the role of these findings as possible adjuncts to conventional imaging criteria.

Endoscopic submucosal dissection in a rare case of carcinoma cuniculatum of the esophagus initially misdiagnosed as benign squamous papilloma A 65-year-old woman presented for evaluation of a large esophageal mass, diagnosed on biopsy as squamous cell papilloma. Computed tomography (CT) showed no lymphadenopathy or distant metastases. The patient refused surgery. Endoscopic mucosal resection (EMR) was attempted at a tertiary referral center but could not be carried out because of difficulty in lifting the lesion. Thus, she was referred to our center for endoscopic submucosal dissection (ESD). Esophagogastroduodenoscopy (EGD) revealed a large, circumferential, partially obstructive esophageal mass extending from 22 to 30 cm from the incisors (• " Fig. 1 a, b). Successful circumferential ESD was carried out on the proximal 6 cm of the lesion (• " Fig. 2 a, b), however, the distal 2 cm could not be resected owing to severe submucosal fibrosis. Histopathological analysis of the ESD specimen revealed an unusual histomorphologic pattern including hyperkeratosis, acanthosis, dyskeratosis, intraepithelial neutrophils, keratin-filled furrows, and koilocyte-like cells consistent with carcinoma cuniculatum (• " Fig. 3). Invasion in the submucosa was present. Laparoscopy-assisted esophageal resection was performed, and the resected specimen was staged pathologically as T1bN0. The patient had an uneventful recovery. Carcinoma cuniculatum of the esophagus is a very rare and extremely well differentiated variant of squamous cell carcinoma, first described in 2005 [1]. Since then, it has been reported in less than 15 cases [2,3]. The etiology is unknown but there have been reported associations with chronic esophageal irritation, achalasia, diverticulum, and prior caustic injury [1,4]. Carcinoma cuniculatum of the esophagus has traditionally been managed with esophagectomy [3]. This is the first reported case of carcinoma cuniculatum in which ESD was attempted with partial success. The success was limited owing to submucosal invasion but adequate staging was still achieved: the ESD specimen provided an accurate histopathologic diagnosis and staging to guide further therapy. Thus, ESD could be used not only as a treatment option but also as a staging tool to assess the depth of invasion. Endoscopy_UCTN_Code_TTT_1AO_2ACCompeting interests: None Fig. 3 Histopathological analysis of the ESD specimen from an esophageal mass in a 65-year-old woman. Low power view (2 ×) showing well differentiated squamous epithelium with extensive hyperkeratosis, acanthosis, dyskeratosis, intraepithelial neutrophils, and koilocyte-like cells. Cases and Techniques Library (CTL) E531Coman Roxana M et al. ESD for carcinoma cuniculatum misdiagnosed as benign squamous papilloma … Endoscopy 2014; 46: E531-E532This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited.