Computed Tomography Measurement and Evaluation of the Subarachnoid Space Over Cerebral Convexities in Infants Aged 1-24 Months

A widened subarachnoid space might be pathologic, potentially pathologic, or simply a normal developmental variant. However, the definition of a normal subarachnoid space width in infants remains unclear, especially on computed tomography (CT) images. To determine the physiological subarachnoid space width among infants aged 1-24 months, its upper limit, and changes with age, we measured the cerebrospinal fluid width on 538 CT images. Measurements were obtained at fixed planes and fixed positions to prevent variance and increase comparability between patients. We observed an asymmetry in the cerebrospinal fluid width of the temporal region. The width increased in all positions until 4-6 months of age, after which it began to decrease, reaching a relatively stable range in infants aged 13-24 months. We suggest considering the 95th percentile of the cerebrospinal fluid width as the upper limit. The correlation between age and the subarachnoid space width should be considered during clinical diagnosing.

Combination therapy with percutaneous osteoplasty and transcatheter arterial chemoembolization for the treatment of pelvic bone metastases: preliminary report

PURPOSE

To compare the clinical efficacies of percutaneous osteoplasty (POP) and combination therapy with percutaneous osteoplasty and transcatheter arterial chemoembolization (POPTACE) for the treatment of pelvic bone metastases.

METHODS

A retrospective study of 100 patients with pelvic bone metastases who had been treated by POP (n = 50) and POPTACE (n = 50) was conducted in this work. The clinical efficacies of these two treatments were evaluated by comparing their pain and functional abilities and bone metastases ability at the pre- and post-operative time points.

RESULTS

POPTACE and POP treatments had no significant differences (P > 0.05) in VAS scores and KPS scores. Concerning tumor response, a partial response in 37 of 50 (74%) patients at 1 month for the POPTACE group and a partial response in 26 of 50 (52%) patients at 1 month for the POPC group were observed (P = 0.04). Although POPTACE and POP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of pelvic bone metastases, POPTACE treatment had a significantly better tumor response ability (partial response and stable response) compared with POP treatment.

CONCLUSION

Both POP and POPTACE were effective methods for the treatment of pelvic bone metastases. Moreover, these initial outcomes suggest POPTACE treatment may be better than POP treatment. POPTACE treatment has great value and is worth promoting vigorously in orthopedics clinics.

Safety and Efficacy Studies of Vertebroplasty with Dual Injections for the Treatment of Osteoporotic Vertebral Compression Fractures: Preliminary Report

PURPOSE

To evaluate the clinical safety and efficacies of percutaneous vertebroplasty (PVP), percutaneous vertebroplasty with dual injections (PVPDI), and percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCFs), a retrospective study of 90 patients with OVCFs who had been treated by PVP (n = 30), PVPDI (n = 30), and PKP (n = 30) was conducted in this work.

METHODS

The clinical efficacies of these three treatments were evaluated by comparing their PMMA cement leakages, cement patterns, height restoration percentages, wedge angles, visual analogue scales, and Oswestry disability index (ODI) at the pre- and postoperative time points.

RESULTS

Ten percent, 6.7%, and 0% of patients had PMMA leakage in PVP, PVPDI, and PKP groups, respectively. Three (solid, trabecular, and mixed patterns), two (trabecular and mixed patterns), and two (solid and mixed patterns) types of cement patterns were observed in PVP, PVPDI, and PKP groups, respectively. PVP and PVPDI treatments had similar and less height restoration ability than PKP treatment. All the PVP, PVPDI, and PKP treatments had significant and similar ability in pain relief and functional recovery ability for the treatment of OVCFs. Microfractures after the surgery occurred after PVP and PKP treatments.

CONCLUSION

These results indicate minimally invasive techniques were effective methods for the treatment of OVCFs. Moreover, these initial outcomes suggest PVPDI treatment has great value and is worth promoting vigorously in orthopedics clinics.

Gastric cancer patients display a distinctive population of IFNg+IL10+ double positive CD8 T cells, which persists longer during prolonged activation

IL10 is generally regarded as a broad-spectrum regulatory cytokine. However, the role of IL10 in CD8 T cells remains controversial. In this study, we investigated the characteristics of endogenous IL10 by CD8 T cells in gastric cancer (GC) patients. Using intracellular staining, we found that in both GC patients and healthy controls, the majority of IL10-expressing CD8 T cells also presented concurrent IFNg expression. Interestingly, the frequency of IFNg⁺IL10⁺ CD8 T cells was significantly higher in GC patients than in healthy controls, while the frequency of IFNg⁺IL10^- CD8 T cells was significantly lower in GC patients than in healthy controls. Compared to the IFNg^-IL10^- CD8 T cells, both IFNg⁺IL10^- and IFNg⁺IL10⁺ CD8 T cells presented significantly higher expression of activation/inhibitory markers. Interestingly, the IFNg⁺IL10⁺ cells presented lower PD1 and TIM3 and higher KLRG1 than the IFNg⁺IL10^- CD8 T cells. Remarkably, the IFNg⁺IL10⁺ CD8 T cells, but not the IFNg⁺IL10^- CD8 T cells, were highly enriched in the CD45RO⁺CXCR5⁺ subset. Prolonged activation resulted in significant enrichment of IFNg⁺IL10⁺ CD8 T cells over time. Interestingly, compared to the CD45RO⁺CXCR5^- CD8 T cells, the CD45RO⁺CXCR5⁺ CD8 T cells presented stronger proliferation capacity at later stages of stimulation, and higher viability throughout the stimulation process. Overall, our investigation demonstrated that GC patients were enriched with a distinctive population of IFNg⁺IL10⁺ double positive CD8 T cells, which resembled T follicular cytotoxic cells and could persist longer during prolonged activation.

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Gastric cancer patients presented an enrichment of IFNg⁺IL10⁺ CD8 T cells.

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IFNg⁺IL10⁺ CD8 T cells showed unique patterns of PD1, KLRG1, and TIM3 expression.

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IFNg⁺IL10⁺ CD8 T cells were enriched during prolonged stimulation.

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CD45RO⁺CXCR5⁺ CD8 T cells presented better proliferation and lower death.

Diagnostic performance of MRI for detecting intraplaque hemorrhage in the carotid arteries: a meta-analysis

OBJECTIVES

To investigate the diagnostic performance of MRI in diagnosing carotid atherosclerotic intraplaque hemorrhage (IPH) and to provide a clinical guide for MRI application.

METHODS

We searched MEDLINE, Embase, and Cochrane library from the earliest available date of indexing through November 30, 2017. All investigators screened and selected studies comparing the use of MRI with histology. The accuracy to diagnose pathological IPH was expressed by sensitivity, specificity, negative likelihood ratios (LRs), positive LRs, and the area under summary receiver-operating characteristic (SROC) curve. We calculated the post-test probability to assess the clinical utility of MRI.

RESULTS

We analyzed 696 patients from 20 articles. The sensitivity and specificity were 87% (95% CI, 81-91%) and 92% (95% CI, 87-95%), respectively. The positive and negative LRs were 10.27 (95% CI, 6.76-15.59) and 0.15 (95% CI, 0.10-0.21), respectively. The area under SROC curve was 0.95 (95% CI, 0.93-0.97). MRI was accurate in confirming or in ruling out disease over a wide range of pre-test probabilities of IPH: MRI could increase the post-test probability to > 80% in patients with a pre-test probability > 27% and could decrease the post-test probability to < 20% in patients with a pre-test probability < 64%.

CONCLUSION

Non-invasive MRI has excellent specificity and good sensitivity for diagnosing IPH. MRI is a tool for confirming or ruling out carotid atherosclerotic IPH.

KEY POINTS

• Non-invasive MRI has excellent performance for diagnosing IPH, which is a component of vulnerable plaque. • The high accuracy of MRI for IPH helps clinicians analyze the prognosis of clinical events and plan personalized treatment.

Meta-analysis: diagnostic accuracy of coronary CT angiography with prospective ECG gating based on step-and-shoot, Flash and volume modes for detection of coronary artery disease

OBJECTIVES

To investigate the diagnostic performance of coronary computed tomographic angiography (CCTA) with prospective electrocardiograph (ECG) gating based on step-and-shoot (SAS), Flash and volume imaging modes.

METHODS

We searched the electronic databases PubMed for all published studies regarding CCTA. We used an exact binomial rendition of the bivariate mixed-effects regression model developed for synthesis of diagnostic data.

RESULTS

A total of 21,852 segments, 4,851 vessels and 1,375 patients were identified using database searches. Patient-level pooled sensitivity was 0.99 (95 % confidence interval [CI], 0.98-1.00); specificity was 0.88 (CI, 0.85-0.91). The results showed that the sensitivity and specificity for detection of significant stenosis did not differ in the three protocols (P = 0.24). No heterogeneity was found at the patient level for sensitivity (Q = 26.23; P = 0.12; I (2) = 27.56 % [CI, 0.00-67.02 %]) and specificity (Q = 19.54; P = 0.42; I (2) = 2.78 % [CI, 0.00-66.26 %]).

CONCLUSIONS

CCTA with prospective ECG gating has similar high diagnostic value to rule out CAD in all three presented modes.

KEY POINTS

• The accuracy of CCTA with different prospective ECG gating is similar • CCTA with prospective ECG gating is effective to exclude coronary artery disease • The radiation dose of volume mode increases with higher heart rate.

The diagnostic performance of coronary artery angiography with 64-MSCT and post 64-MSCT: systematic review and meta-analysis

PURPOSE

To comprehensively investigate the diagnostic performance of coronary artery angiography with 64-MDCT and post 64-MDCT.

MATERIALS AND METHODS

PubMed was searched for all published studies that evaluated coronary arteries with 64-MDCT and post 64-MDCT. The clinical diagnostic role was evaluated by applying the likelihood ratios (LRs) to calculate the post-test probability based on Bayes' theorem.

RESULTS

91 studies that met our inclusion criteria were ultimately included in the analysis. The pooled positive and negative LRs at patient level were 8.91 (95% CI, 7.53, 10.54) and 0.02 (CI, 0.01, 0.03), respectively. For studies that did not claim that non-evaluable segments were included, the pooled positive and negative LRs were 11.16 (CI, 8.90, 14.00) and 0.01 (CI, 0.01, 0.03), respectively. For studies including uninterruptable results, the diagnostic performance decreased, with the pooled positive LR 7.40 (CI, 6.00, 9.13) and negative LR 0.02 (CI, 0.01, 0.03). The areas under the summary ROC curve were 0.98 (CI, 0.97 to 0.99) for 64-MDCT and 0.96 (CI, 0.94 to 0.98) for post 64-MDCT, respectively. For references explicitly stating that the non-assessable segments were included during analysis, a post-test probability of negative results >95% and a positive post-test probability <95% could be obtained for patients with a pre-test probability of <73% for coronary artery disease (CAD). On the other hand, when the pre-test probability of CAD was >73%, the diagnostic role was reversed, with a positive post-test probability of CAD >95% and a negative post-test probability of CAD <95%.

CONCLUSION

The diagnostic performance of post 64-MDCT does not increase as compared with 64-MDCT. CTA, overall, is a test of exclusion for patients with a pre-test probability of CAD<73%, while for patients with a pre-test probability of CAD>73%, CTA is a test used to confirm the presence of CAD.

Analysis of risk factors of subsequent fractures after vertebroplasty

PURPOSE

The purpose of this study is to identify risk factors related to the development of subsequent fractures after vertebroplasty.

METHOD

A retrospective study was conducted to review 175 patients with a 1-year follow-up who underwent vertebroplasty for first-time and single-level osteoporotic vertebral fractures. Subsequent fractures were diagnosed as recurrent intractable back pain, post-operatively correlated with MR image. Clinical parameters, such as age, gender, baseline VAS-score, lumbar bone mineral density (BMD) T-score, history of use of steroids, bisphosphonate therapy, symptom-free interval, the amount of bone cement injected, vacuum clefts, leakage of cement into the disk space, treated level and the changes of spinal geometry were recorded.

RESULTS

During the follow-up period, subsequent fractures developed in 37 (21.1 %) of 175 patients. Significant differences (P < 0.05) were found between the patients with subsequent fractures and the patients without subsequent fractures in regard to their BMD T-score, and treated vertebrae location. Average BMD T-score was -3.4 ± 1.5 in patients with subsequent fractures and -2.9 ± 1.6 in patients without subsequent fractures. The percentage of subsequent fractures was 13.9 % (10 of 72) for treated vertebrae located in non-thoracolumbar junction, and 26.2 % (27 of 103) in the thoracolumbar junction.

CONCLUSION

The most important risk factors affecting subsequent fractures after vertebroplasty were osteoporosis and treated level at the thoracolumbar junction.