The mammillary bodies as part of the hypothalamic nuclei are in the central limbic circuitry of the human brain. The mammillary bodies are shown to be directly or indirectly connected to the amygdala, hippocampus, and thalami as the major gray matter structures of the human limbic system. Although it is not primarily considered as part of the human limbic system, the thalamus is shown to be involved in many limbic functions of the human brain. The major direct connection of the thalami with the hypothalamic nuclei is known to be through the mammillothalamic tract. Given the crucial role of the mammillothalamic tracts in memory functions, diffusion tensor imaging may be helpful in better visualizing the surgical anatomy of this pathway noninvasively. This study aimed to investigate the utility of high spatial resolution diffusion tensor tractography for mapping the trajectory of the mammillothalamic tract in the human brain. Fifteen healthy adults were studied after obtaining written informed consent. We used high spatial resolution diffusion tensor imaging data at 3.0 T. We delineated, for the first time, the detailed trajectory of the mammillothalamic tract of the human brain using deterministic diffusion tensor tractography.

ObjectiveThyroid orbitopathy is a poorly understood extrathyroidal manifestation of Graves' disease that can cause disfiguring proptosis and vision loss. Orbital decompression surgery for Graves' orbitopathy (GO) can address both cosmetic and visual sequelae of this autoimmune condition. Endonasal endoscopic orbital decompression provides unmatched visualization and access to inferomedial orbital wall and orbital apex. This review examines the state of the art approaches employed in endonasal endoscopic orbital decompression for GO.MethodsReview of literature evaluating novel surgical maneuvers for GO.ResultsStudies examining the efficacy of endonasal endoscopic orbital decompression are heterogenous and retrospective in design; however, they reveal this approach to be a safe and effective technique in the management of GO.ConclusionSubtle variations in endoscopic techniques significantly affect postsurgical outcomes and can be tailored to the specific clinical indication in GO making endonasal endoscopic decompression the most versatile approach available.Level of EvidenceNA.

OBJECTIVE: Preeclampsia (PreE) contributes to long-term maternal cardiovascular disease risk. By 2025, it is estimated that more women than men will have hypertension (HTN), yet the mechanisms contributing to the development of HTN in women are less understood. Anti-and pro-inflammatory T helper (Th) responses are dysregulated in PreE. A persistent imbalance of these Th responses following PreE may underlie the future development of HTN in women. Therefore, the objective of this study was to determine if the immune Th changes observed during PreE persist post-partum (PP). STUDY DESIGN: De-identified and coded plasma samples were obtained from the Magee-Women's Research Institute & Foundation or the University of Iowa Maternal-Fetal Tissue Bank (IRB 201808705) from women 1-3 (N¼93) or 8-10 (N¼58) years (yrs) following a normotensive or PreE-affected pregnancy. PP HTN was defined as having stage 1 or higher HTN as designated in the updated 2017 ACC/AHA guidelines. Th cytokine concentrations were determined via ELISAs and normalized to total protein. Average cytokine concentrations are reported in pg/g. RESULTS: Women with prior PreE had higher rates of HTN at 1-3 and 8-10 yrs PP (Table 1), compared to women with a normotensive pregnancy. At 1-3 yrs PP, concentrations of anti-inflammatory cytokines IL-4, IL-10, and TGFb were reduced in women with a prior PreE pregnancy. At 8-10 yrs PP, pro-inflammatory IL-6 and TNFa were significantly increased in women with prior PreE compared to women with a normotensive pregnancy (Table 2). CONCLUSION: Women with a prior PreE pregnancy had a higher incidence of HTN early (1-3 yrs) and late (8-10 yrs) PP compared to women with a normotensive pregnancy. Following PreE, anti-inflammatory Th cytokines continue to be suppressed in the early PP period, creating an inflammatory milieu. By 8-10 yrs PP, this inflammatory environment is further exacerbated by elevated levels of IL-6 and TNFa. This Th-associated inflammation is associated with increased rates of HTN and thus, may underlie the future development of HTN in women with a history of PreE.

medical reasons only. No association was found between stage of labor in which the previous CD was performed and a successful IOL (Table 1). The factors that were associated with a successful IOL in the multivariate logistic regression included augmentation in P2 (OR¼4.17, 95% CI 1.73-10.05), epidural anesthesia in P2 (OR 3.30, 95% CI 1.12-9.73) and birth weight in P2 < 4000g (OR¼5.88, 95% CI 1.11-33.33). CONCLUSION: Stage-of-labor at which the cesarean was performed in first delivery is not associated with a successful IOL at the following delivery.