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SQSTM1 Expression in Hepatocellular Carcinoma and Relation to Tumor Recurrence After Radiofrequency Ablation. J Clin Exp Hepatol 2022; 12:774-784. [PMID: 35677515 PMCID: PMC9168718 DOI: 10.1016/j.jceh.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/04/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIMS Autophagy is a process that allows the degradation of detrimental components through the lysosome to maintain cellular homeostasis under variable stimuli. SQSTM1 is a key molecule involved in functional autophagy and is linked to different signaling pathways, oxidative responses, and inflammation. Dysregulation of autophagy is reported in a broad spectrum of diseases. Accumulation of SQSTM1 reflects impaired autophagy, which is related to carcinogenesis and progression of various tumors, including hepatocellular carcinoma (HCC). This study investigated SQSTM1 protein expression in HCC and its relation to the clinicopathological features and the likelihood of tumor recurrence after radiofrequency ablation (RFA). METHODS This study included 50 patients with cirrhotic HCC of Barcelona Clinic Liver Cancer stages 0/A-B eligible for RFA. Tumor and peritumor biopsies were obtained just prior to local ablation and assessed for tumor pathological grade and SQSTM1 expression by immunohistochemistry. Patients were followed for one year after achieving complete ablation to detect any tumor recurrence. RESULTS Serum alpha-fetoprotein level (U = 149.50, P = 0.027∗) and pathological grade of the tumor (χ2 = 12.702, P = 0.002∗) associated significantly with the tumor response to RFA. SQSTM1 expression level was significantly increased in HCC compared to the adjacent peritumor cirrhotic liver tissues (Z = 5.927, P < 0.001∗). Significant direct relation was found between SQSTM1 expression level in HCC and the pathological grade of the tumor (H = 33.789, P < 0.001∗). On follow-up, tumor and peritumor SQSTM1 expression levels performed significantly as a potential predictor of the overall survival, but not the disease recurrence. CONCLUSIONS SQSTM1 expression could determine aggressive HCC, even with reasonable tumor size and number, and identify the subset of HCC patients with short overall survival and unfavorable prognosis. SQSTM1 expression could not predict post-RFA intrahepatic HCC recurrence. SQSTM1 may be a potential biomarker and target for the selection of HCC patients for future therapies.
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Key Words
- AFP, Alpha fetoprotein
- BCLC, Barcelona Clinic Liver Cancer
- CT, Computed tomography
- CTP, Child-Turcotte-Pugh
- ELISA, Enzyme-linked immunosorbent assay
- FNAC, Fine-needle aspiration cytology
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- Keap1, Kelch-like ECH-associated protein 1
- MRI, Magnetic resonance imaging
- NF-κB, Nuclear factor kappa-light-chain-enhancer of activated B cells
- Nrf2, Nuclear factor erythroid 2-related factor 2
- RFA, Radiofrequency ablation
- SQSTM/p62, Sequestosome 1/protein 62
- SQSTM1
- hepatocellular carcinoma
- mRECIST, modified Response Evaluation Criteria in Solid Tumors
- mTORC1, mammalian target of rapamycin complex 1
- radiofrequency ablation
- tumor recurrence
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Patidar Y, Chandel K, Condati NK, Srinivasan SV, Mukund A, Sarin SK. Transarterial Chemoembolization (TACE) Combined With Sorafenib versus TACE in Patients With BCLC Stage C Hepatocellular Carcinoma - A Retrospective Study. J Clin Exp Hepatol 2022; 12:745-754. [PMID: 35677519 PMCID: PMC9168730 DOI: 10.1016/j.jceh.2021.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/14/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Advanced-stage hepatocellular carcinoma is a heterogeneous group with limited treatment options. TACE has been advocated recently by various study groups. The purpose of this study was to evaluate if TACE in combination with sorafenib, as well as TACE alone, was safe and efficacious in treating BCLC stage C HCC. METHODS A retrospective evaluation of the clinical data of 78 patients with BCLC stage C HCC who received either TACE-sorafenib (TS) combination therapy or TACE monotherapy as their first treatment was done. The two groups were compared in terms of radiological tumor response 1 month after the intervention. The two groups were also compared in terms of time to progression (TTP), overall survival (OS), and adverse events. RESULTS The disease control rate (44.9% and 25.8%, respectively, P = 0.09) was higher in the TS combination group than in the TACE monotherapy group after 1 month of treatment. The TS combination group had significantly superior TTP and OS than the TACE group (TTP was 4.6 and 3.1 months, respectively, P = 0.001), and OS was 10.1 and 7.8 months, respectively, P < 0.001). The TACE-S group had a greater cumulative survival time at 6 months, 9 months, and 1 year than the TACE group (97.9%, 51.1%, 25.7% vs. 90.4%, 51.6%, and 0%, respectively). CONCLUSION TS combination therapy in advanced-stage (BCLC-C) HCC significantly improved disease control rate, TTP, and OS compared with TACE alone, without any significant increase in adverse reactions.
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Key Words
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona-Clinic Liver Cancer
- CT, Computed tomography
- CTCAE, Common terminology criteria for adverse events
- CTP, Child–Turcotte–Pugh
- ECOG, Eastern Cooperative Group
- EHS, Extrahepatic spread
- HCC, Hepatocellular carcinoma
- MRI, Magnetic resonance imaging
- MVI, Macrovascular invasion
- OS, Overall survival
- PS, Performance status
- SPSS, Statistical Package for Social Sciences
- TACE
- TACE, Transarterial chemoembolisation
- TS, TACE-sorafenib
- TTP, Time to tumor progression
- hepatocellular carcinoma (HCC)
- m-RECIST, Modified Response Evaluation Criteria in Solid Tumors
- overall survival
- sorafenib
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The Utility of Superselective Rotational Angiography for Frameless Stereotactic Navigation During Craniotomy for Micro-Arteriovenous Malformation. World Neurosurg X 2022; 13:100116. [PMID: 35059623 PMCID: PMC8760515 DOI: 10.1016/j.wnsx.2021.100116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Micro-arteriovenous malformations (AVMs) can present challenges to neurosurgeons with respect to localization during resection. We sought to describe a novel method that merges super-selective 3-dimensional angiographic images with magnetic resonance imaging (MRI) sequences to facilitate frameless stereotaxic navigation during AVM surgery. METHODS A retrospective analysis was performed comprising cases that employed merging of angiographic and MRI images for navigation purposes. Baseline clinical and imaging features were recorded. The technique and operative experiences were analyzed descriptively and presented alongside detailed illustrative cases. RESULTS During the review period, 11 cases were identified where this technique was employed. Successful image acquisition and merging was possible in all cases. Complete obliteration of the target pathology was achieved in all cases. Precise localization of the micro-AVMs minimized dissection in eloquent cortex. CONCLUSIONS Superselective 3-dimensional angiographic images merged to baseline MRI sequences facilitates planning and navigation during surgery for micro-AVMs.
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Mishra S, Taneja S, De A, Muthu V, Verma N, Premkumar M, Duseja A, Singh V. Tuberculosis in Cirrhosis - A Diagnostic and Management Conundrum. J Clin Exp Hepatol 2022; 12:278-286. [PMID: 35535073 PMCID: PMC9077226 DOI: 10.1016/j.jceh.2021.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background Diagnosis and management of tuberculosis (TB) in patients with cirrhosis remains challenging. We studied the clinical spectrum, diagnosis, and management of TB along with the assessment of the diagnostic utility of various laboratory investigations in this cohort. Methods A retrospective review of records of patients with cirrhosis (July 2017 and December 2019) was done. Out of 30 patients with cirrhosis and TB, 20 patients with pleural/peritoneal TB (cases) were compared with 20 consecutively selected spontaneous bacterial peritonitis (SBP) controls. Composite of clinical, laboratory, radiologic features and response to antituberculosis therapy (ATT) was taken as the gold standard to diagnose TB. Results Extrapulmonary TB (EPTB) (n = 23, 76.7%) was more common. Overall, 9 (30%) patients presented with ATT-induced hepatitis. Patients with pleural/peritoneal TB had less severe hepatic dysfunction as compared to SBP group with significantly lower CTP [8 ± 1.5 vs. 9 ± 1.7 (P = 0.01)], MELD [16.3 ± 5.8 vs. 20.2 ± 6.6 (P = 0.02)] and MELD-Na [18.8 ± 5.9 vs. 22.5 ± 7.1 (P = 0.03)] scores. Median ascitic/pleural fluid total protein [2.7 (2.4-3.1) vs. 1.1 (0.9-1.2); P < 0.0001] and adenosine deaminase (ADA) levels [34.5 (30.3-42.7) vs. 15 (13-16); P < 0.0001] were significantly higher in the TB group. Total protein levels had a sensitivity and specificity 81% and 93.3%, respectively, at cut off value of >2 g/dl with an AUROC of 0.89 [(0.79-0.96); P < 0.001] whereas ADA levels at cutoff >26 IU/L showed 80% sensitivity and 90% specificity to diagnose pleural/peritoneal TB with an AUROC of 0.93 [(0.82-0.97); P < 0.001]. Only 11 (36.7%), and 8 (26.6%) patients showed positivity on GeneXpert and mTB-PCR, respectively. Patients with Child-Turcotte-Pugh scores of ≤7 and 8-10 tolerated well two and one hepatotoxic drugs, respectively. Conclusions EPTB is more frequent in patients with cirrhosis. Relatively lower cutoffs of ascitic/pleural fluid total protein and ADA may be useful to diagnose EPTB in patients with high pretest probability. Individualized ATT with close monitoring and dynamic modifications is effective and well-tolerated.
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Key Words
- ADA, Adenosine deaminase
- AFB, Acid-fast bacilli
- AKI, Acute kidney injury
- ATT, Anti-Tuberculosis therapy
- AUROC, Area under receiver operator curve
- CI, Confidence interval
- CT, Computed tomography
- CTP, Child-Turcotte-Pugh
- DILI, Drug-induced liver injury
- EPTB, Extrapulmonary Tuberculosis
- LSM, Liver stiffness measurement
- MELD, Model for End-stage liver disease
- MELD-Na, Model for End-stage liver disease with sodium
- MTB, Mycobacterium Tuberculosis
- NAAT, Nucleic acid amplification test
- SAAG, Serum-ascitic albumin gradient
- SBE, Spontaneous bacterial empyema
- SBP, Spontaneous Bacterial Peritonitis
- SD, Standard deviation
- SPAG, Serum-pleural fluid albumin gradient
- TB, Tuberculosis
- ZN, Ziehl-Neilson
- adenosine deaminase
- antituberculosis therapy
- chronic liver disease
- cirrhosis
- mTB-PCR, multiplex TB-polymerase chain reaction
- tuberculosis
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Bouferraa Y, Haibe Y, Jabra E, Charafeddine M, Kreidieh M, Raad R, Temraz S, Mukherji D, Ershaid F, Muallem N, Faraj W, Khalife M, Eid RA, Shamseddine A. Comparison Between Liver Stiffness Measurement by Fibroscan and Splenic Volume Index as NonInvasive Tools for the Early Detection of Oxaliplatin-induced Hepatotoxicity. J Clin Exp Hepatol 2022; 12:448-453. [PMID: 35535062 PMCID: PMC9077221 DOI: 10.1016/j.jceh.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022] Open
Abstract
Background Oxaliplatin remains an essential component of many chemotherapy protocols for gastrointestinal cancers; however, neurotoxicity and hepatotoxicity may be dose-limiting. The gold standard for the diagnosis of oxaliplatin-induced hepatotoxicity is liver biopsy, which is invasive and costly. Splenomegaly has also been used as a surrogate for liver biopsy in detecting oxaliplatin-induced sinusoidal obstruction syndrome (SOS), but splenic measurement is not routine and can be inaccurate and complex. We investigated the correlation between increased liver elasticity assessed by Fibroscan and the increase in spleen volume on cross-sectional imaging after oxaliplatin as a noninvasive technique to assess liver stiffness associated with oxaliplatin-induced SOS. Methods Forty-six patients diagnosed with gastrointestinal cancers and planned to take oxaliplatin containing regimens were included in this prospective study at the American University of Beirut Medical Center (AUBMC). Measurement of spleen volume using cross-sectional imaging and of liver elasticity using Fibroscan was performed at baseline, 3 and 6 months after starting oxaliplatin. Mean liver elasticity measurements were compared between patients stratified by the development of splenomegaly using the Student t-test. Splenomegaly was defined as 50% increase in spleen size compared with baseline. Results Patients who developed splenomegaly after oxaliplatin use had significantly higher mean elasticity measurements as reported by Fibroscan at 3 (16.2 vs. 7.8 kPa, P = 0.036) and 6 (9.3 vs. 6.7 kPa, P = 0.03) months. Conclusion Measurement of elasticity using Fibroscan could be potentially used in the future as a noninvasive test for predicting oxaliplatin-induced hepatotoxicity.
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Key Words
- AUBMC, American University of Beirut Medical Center
- CAP, Controlled attenuation parameter
- CT, Computed tomography
- ECOG, Eastern Cooperative Clinical Oncology Group
- ICG-R15, indocyanine green retention rate at 15 min (ICG-R15)
- IRB, Institutional review board
- ISP, IntelliSpace Portal
- MRI, Magnetic resonance imaging
- SOS, Sinusoidal obstruction syndrome
- SV, Splenic volume
- SVI, Splenic volume index
- TE, Transient elastography
- dB/m, decibels/meter
- fibroscan
- hepatotoxicity
- kPa, Kilopascal
- oxalipltin
- sinusoidal obstruction syndrome
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Intrahepatic inferior vena cava interruption with transhepatic venous continuation initially misdiagnosed as a congenital portosystemic shunt. Radiol Case Rep 2021; 17:446-449. [PMID: 34950271 PMCID: PMC8671099 DOI: 10.1016/j.radcr.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
We report a case of intrahepatic inferior vena cava interruption with azygos and transhepatic venous continuation discovered incidentally on CT angiography for acute aortic syndrome. The lesion was initially misdiagnosed as a congenital portosystemic shunt on multiphase CT of the liver but subsequent fluoroscopic venogram revealed no evidence of portosystemic shunting. While intrahepatic IVC interruption with azygos continuation is an uncommon but well-known anatomical variant, transhepatic venous continuation is extremely rare and only a few cases have been published. Excluding portosystemic shunting is important for determining management as persistent congenital portosystemic shunts can be associated with significant morbidity.
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Gallbladder wall thickening in a woman with postpartum preeclampsia: A case report. Case Rep Womens Health 2021; 33:e00370. [PMID: 34900611 PMCID: PMC8637342 DOI: 10.1016/j.crwh.2021.e00370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/22/2022] Open
Abstract
Background Preeclampsia (PE) is hallmarked by dysfunction of various organs; therefore, its diagnosis can be challenging, especially when patients present with right upper abdominal pain. Herein, we present a case of postpartum gallbladder wall thickening (GBWT) that led to a diagnosis of PE, rather than hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome or gallbladder and biliary disease. Case Presentation A 31-year-old postpartum woman presented with a fever, hypertension, headache, and right upper abdominal pain. HELLP syndrome and intracranial hemorrhage were initially suspected, due to the combination of symptoms and elevated levels of aspartate transaminase, alanine transaminase, and lactate dehydrogenase. However, hemolysis and thrombocytopenia were absent, and a computed tomography (CT) scan of the head did not indicate the presence of intracranial hemorrhage. Further, transabdominal ultrasound and CT revealed GBWT (edematous gallbladder); CT also revealed an enlarged heart, lung edema, pleural effusion, and ascites. Thus, PE, rather than HELLP syndrome or gallbladder or biliary disease, was diagnosed based on gestational hypertension and proteinuria, new-onset headache, liver dysfunction, and edema in several organs, including the lung. Nicardipine treatment quickly improved hypertension and headache, and, over time, the patient's urination increased, and edema subsided throughout the body. Furthermore, laboratory results improved, and the patient was discharged on postpartum day 11. Conclusion Postpartum gallbladder wall thickening can be a diagnostic sign of PE. Preeclampsia can cause edema in several organs. We present a case of postpartum gallbladder wall thickening. Gallbladder wall thickening can aid in the diagnosis of preeclampsia in cases with right upper abdominal pain.
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Fontana F, Piacentino F, Ossola C, Pascarella RD, Franchi C, Curti M, Coppola A, Basile A, Saverio SD, Carcano G, Venturini M. Gangliocytic paraganglioma leading to duodeno-jejunal intussusception: A case report. Radiol Case Rep 2021; 16:3977-3981. [PMID: 34729128 PMCID: PMC8545659 DOI: 10.1016/j.radcr.2021.09.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 09/19/2021] [Accepted: 09/20/2021] [Indexed: 02/07/2023] Open
Abstract
The intussusception of the small bowel is rarely encountered in adult patients and is frequently associated with a lead point that is often malignant. In a 69-year-old female patient with an episode of gastrointestinal (GI) bleeding, computed tomography (CT) showed a duodenal-jejunal intussusception caused by an intraluminal mass. Open polypectomy and reduction of intussusception were performed and the diagnosis of gangliocytic paraganglioma was made at pathological evaluation. It would be important to consider neoplasms like gangliocytic paraganglioma in the setting of adult small bowel intussusception.
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Ileal mucosa-associated lymphoid tissue lymphoma diagnosed after emergency surgery: A case report and literature review. Ann Med Surg (Lond) 2021; 71:102973. [PMID: 34840740 PMCID: PMC8606698 DOI: 10.1016/j.amsu.2021.102973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/19/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023] Open
Abstract
Introduction and importance Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, also called MALT lymphoma, is one of the entities of marginal zone lymphomas. These lymphomas are originated from indolent B-cell lymphomas and involve many organs such as the gastrointestinal tract, salivary gland, skin, lung, thyroid or breast. Ileal MALT lymphoma is relatively rare and clinical symptoms are usually atypical. Case presentation We report a case of a 99-year-old man who admitted to the emergency department with increasing and colicky periumbilical pain, vomiting and constipation. Non-contrast-enhanced computed tomography suggested small bowel obstruction due to phytobezoar. Intraoperatively, surgeon discovered the tumor at the site of phytobezoar. Histologically, there was a diffuse infiltration comprised of small to medium sized lymphocytes with monocytoid features. Immunohistochemical result confirmed CD20 positive B-lymphocytes and the Ki-67 proliferation index was 10%. Ileal mucosa-associated lymphoid tissue lymphoma was diagnosed based on histological findings and immunohistochemistry. Discussion MALToma of the gastrointestinal tract is related to chronic antigenic, inflammatory bowel disease and malabsorption syndromes. However, the etiology of ileal MALToma is unclear. Moreover, symptom of ileal MALToma is really not typical and overleaped in the context of small intestinal obstruction. It should be differentiated small intestinal MALToma from immunoproliferative small intestinal disease and an alpha heavy chain disease. Conclusion Ileal MALT lymphoma remains little known in many previous studies. It is really difficult to preoperatively diagnose. The combination of clinical presentation, postoperative histology and immunohistochemistry contribute to diagnosis and carry out appropriate management. Ileal MALT lymphoma is relatively rare compared to others gastrointestinal MALT lymphomas and symptoms are usually atypical. A 99-year-old man was hospitalized with the symptoms of bowel obstruction. Emergency surgery, postoperative histology and immunohistochemistry confirmed ileal MALT lymphoma.
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Roller FC, Yildiz SM, Kriechbaum SD, Harth S, Breithecker A, Liebetrau C, Schüßler A, Mayer E, Hamm CW, Guth S, Krombach GA, Wiedenroth CB. Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography. Eur J Radiol Open 2021; 8:100384. [PMID: 34712746 PMCID: PMC8528681 DOI: 10.1016/j.ejro.2021.100384] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/11/2021] [Indexed: 11/11/2022] Open
Abstract
Easily measurable parameters from chest CT examinations enable prediction of pulmonary hemodynamics. ECG-gated CTPA is superior to non-gated CT. Non-invasive pH therapy monitoring or follow-up might be implemented in the future.
Purpose The aim of the study was to investigate the potential of electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) as a predictor of disease severity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Method Forty-five CTEPH patients with a mean age of 63.8 years±12.7 y (±standard deviation) who had undergone ECG-gated CTPA and right heart catheterization (RHC) were included in the study. Right ventricular to left ventricular volume ratio (RVV/LVV), diameter ratio on 4-chamber view (RVD4CH/LVD4CH), pulmonary trunk (PT) diameter, PT to aortic diameter ratio (PT/A), and septal angle were correlated to mean pulmonary artery pressure (mPAP). Moreover, RVV/LVV and RVD4CH/LVD4CH were adjusted to pulmonary diameter index (PADi) and PT/A index. Areas under the curve (AUC) for predicting mPAP above 40 mmHg, 35 mmHg, and 30 mmHg were calculated. Results RVD4CH/LVD4CH revealed the strongest correlation to mPAP before (r = 0.6507) and after (r = 0.7650; p < 0.0001) PT/A adjustment. The AUCs for predicting pH with mPAP over 40 mmHg and 30 mmHg were 0.9229 and 0.864, respectively. A cutoff value of 1.298 enabled prediction of pH with mPAP over 40 mmHg with a sensitivity, specificity, positive predictive, and negative predictive value of 80.00 %, 95.83 %, 88.46 %, and 94.12 %, respectively. Intra- and interobserver variability were excellent for all parameters. Conclusion Combining different and easily evaluable ECG-gated CTPA parameters enables excellent prediction of pulmonary hemodynamics in CTEPH patients. Ventricular diameter ratio on 4-chamber view adjusted by the PT/A ratio yielded the best correlation to mPAP.
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Key Words
- 4CH, four-chamber view
- AUC, Area under the curve
- CI, Confidence interval
- CT, Computed tomography
- CTEPH
- CTEPH, Chronic thromboembolic pulmonary hypertension
- CTPA
- CTPA, Computed tomography pulmonary angiography
- ECG, Electrocardiogram
- HU, Hounsfield units
- ICC, intra-class concordance correlation coefficient
- LV, Left ventricular
- LVD, Left ventricular diameter
- LVV, Left ventricular volume
- MDCT, Multidetector computed tomography
- NPV, Negative predictive value
- PADi, Pulmonary artery diameter index
- PH, Pulmonary hypertension
- PPV, Positive predictive value
- PT, Pulmonary trunk
- Pulmonary hypertension
- RHC, Right heart catheterization
- ROC, Receiver operating characteristics
- RV, Right ventricular
- RVD, Right ventricular diameter
- RVV, Right ventricular volume
- Right heart catheterization
- SD, Standard deviation
- mPAP, mean pulmonary artery pressure
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Kido J, Matsumoto S, Takeshita E, Hayasaka C, Yamada K, Kagawa J, Nakajima Y, Ito T, Iijima H, Endo F, Nakamura K. Current status of surviving patients with arginase 1 deficiency in Japan. Mol Genet Metab Rep 2021; 29:100805. [PMID: 34646736 PMCID: PMC8495172 DOI: 10.1016/j.ymgmr.2021.100805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/14/2022] Open
Abstract
Arginase 1 (ARG1) deficiency is a rare urea cycle disorder (UCD), with an estimated frequency of 1 per 2,200,000 births in Japan. Patients with ARG1 deficiency develop symptoms in late infancy or pre-school age with progressive neurological manifestations and sometimes present with severe hepatic disease. We previously investigated the status of UCDs in Japan; however, only one patient was identified as having ARG1 deficiency. Therefore, we aimed to investigate the current status of patients with ARG1 deficiency in 2018–2021 because almost 10 years have passed since the previous study. We present the disease history, clinical outcome, and treatment of five surviving patients with ARG1 deficiency and discuss the features of ARG1 deficiency in Japan. We found that clinicians often face difficulty in diagnosing ARG1 deficiency at the early stage of onset because of interpatient variability in onset time and clinical manifestations. Blood L-arginine and guanidino compounds were considered to be the major factors causing adverse neurodevelopmental outcomes. Therefore, early detection and intervention of ARG1 deficiency is essential for improved neurodevelopmental outcomes. Liver transplantation has been considered an effective treatment option that can dramatically improve the quality of life of patients, prior to the neurological manifestation of symptoms caused by ARG1 deficiency.
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Kobe A, Zgraggen J, Messmer F, Puippe G, Sartoretti T, Alkadhi H, Pfammatter T, Mannil M. Prediction of treatment response to transarterial radioembolization of liver metastases: Radiomics analysis of pre-treatment cone-beam CT: A proof of concept study. Eur J Radiol Open 2021; 8:100375. [PMID: 34485629 PMCID: PMC8408624 DOI: 10.1016/j.ejro.2021.100375] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To investigate the potential of texture analysis and machine learning to predict treatment response to transarterial radioembolization (TARE) on pre-interventional cone-beam computed tomography (CBCT) images in patients with liver metastases. Materials and Methods In this IRB-approved retrospective single-center study 36 patients with a total of 104 liver metastases (56 % male, mean age 61.1 ± 13 years) underwent CBCT prior to TARE and follow-up imaging 6 months after therapy. Treatment response was evaluated according to RECIST version 1.1 and dichotomized into disease control (partial response/stable disease) versus disease progression (progressive disease). After target lesion segmentation, 104 radiomics features corresponding to seven different feature classes were extracted with the pyRadiomics package. After dimension reduction machine learning classifications were performed on a custom artificial neural network (ANN). Ten-fold cross validation on a previously unseen test data set was performed. Results The average administered cumulative activity from TARE was 1.6 Gbq (± 0.5 Gbq). At a mean follow-up of 5.9 ± 0.8 months disease control was achieved in 82 % of metastases. After dimension reduction, 15 of 104 (15 %) texture analysis features remained for further analysis. On a previously unseen set of liver metastases the Multilayer Perceptron ANN yielded a sensitivity of 94.2 %, specificity of 67.7 % and an area-under-the receiver operating characteristics curve of 0.85. Conclusion Our study indicates that texture analysis-based machine learning may has potential to predict treatment response to TARE using pre-treatment CBCT images of patients with liver metastases with high accuracy.
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Key Words
- 90Y-microspheres, Yttrium-90-microspheres
- 99mTc-MAA, 99mtechnetium labelled macroaggregated albumin
- ANN, Artificial neural network
- CBCT, Cone-beam Computed Tomography
- CR, Complete response
- CT, Computed tomography
- Cone-Beam CT
- DICOM, Digital Imaging and Communications in Medicine
- GLCM, Gray-level co-occurrence matrix
- GLDM, Gray-level dependence matrix
- GLRLM, Gray-level run length matrix
- GLSZM, Gray-level size zone matrix
- ICC, Intraclass-correlation coefficient
- MR, Magnetic resonance
- Machine learning
- NGTDM, Neighboring gray tone difference matrix
- PD, Progressive disease
- PET, Positron emission tomography
- PR, Partial response
- Radiomics
- SD, Stable disease
- TACE, Transarterial chemoembolization
- TARE, Transarterial radioembolization
- Transarterial radioembolization
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COVID-19 and pulmonary tuberculosis - A diagnostic dilemma. Radiol Case Rep 2021; 16:3255-3259. [PMID: 34367387 PMCID: PMC8326013 DOI: 10.1016/j.radcr.2021.07.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Meanwhile, pulmonary tuberculosis(TB) is one of the most common infective lung diseases in developing nations. The concurrence of pulmonary TB and COVID-19 can lead to poor prognosis, owing to the pre-existing lung damage caused by TB. Case presentation: We describe the imaging findings in 3 cases of COVID-19 pneumonia with co-existing pulmonary TB on HRCT thorax. The concurrence of COVID-19 and pulmonary TB can be a diagnostic dilemma. Correct diagnosis and prompt management is imperative to reduce mortality and morbidity. Hence it is pertinent for imaging departments to identify and report these distinct entities when presenting in conjunction.
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Key Words
- AFB, Acid-fast bacilli
- CO-RADS, COVID-19 Reporting and Data System
- COVID -19
- COVID-19, Coronavirus disease 2019
- CRP, C-reactive protein
- CT, Computed tomography
- Case report
- Co-infection
- DNA, Deoxyribonucleic acid
- DOTS, Directly Observed Therapy, Short-Course
- GGOs, Ground glass opacities
- Ground glass opacities
- HRCT
- HRCT, High resolution computed tomography
- ICU, Intensive care unit
- RT-PCR, Reverse transcriptase-polymerase chain reaction
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- TB, Tuberculosis
- Tuberculosis
- WBC, White blood cell
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Li L, Jie B, Yu D, Ma X, Jiang S. Common trunk of the right accessory renal artery and right inferior phrenic artery originating from the thoracic artery: An unreported variation. J Interv Med 2021; 4:152-154. [PMID: 34805965 PMCID: PMC8562297 DOI: 10.1016/j.jimed.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 11/06/2022] Open
Abstract
Accessory renal arteries (ARAs) are common and usually originate from the abdominal aorta and the renal artery. Inferior phrenic arteries (IPAs) can also arise from the abdominal aorta or its branches. In this paper, we present the first case of a common trunk of the right ARA and right IPA arising from the thoracic artery at the level of T10, which was discovered by multidetector-row computed tomography in pretherapeutic evaluation and clearly confirmed by selective angiography. It is important to recognize this anatomical variation when performing cardiovascular and interventional radiological procedures.
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A study on the clinical application of greater omental pedicle flap transplantation to correct anterior resection syndrome in patients with low rectal cancer. Regen Ther 2021; 18:146-151. [PMID: 34222567 PMCID: PMC8220312 DOI: 10.1016/j.reth.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/06/2021] [Accepted: 05/15/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Low anterior resection syndrome (LARS) is the most common complication after total mesorectal excision (TME) in patients with low rectal cancer and has been a challenge in colorectal surgery that severely impacts the quality of life of patients. This study aimed to introduce a revised surgical procedure which could effectively maintain rectal compliance and significantly improve LARS after the operation. Methods We performed mesorectal reconstruction after routine Dixon TME using greater omental pedicle flap transplantation in 11 patients with low rectal cancer (5 cases of preoperative neoadjuvant chemoradiotherapy, 5 cases of preoperative neoadjuvant chemotherapy, and 1 case of postoperative adjuvant chemotherapy), thereby simulating the initial anatomical structure of the mesorectum and significantly reducing the postoperative anterior resection syndrome. The lars precision syndrome assessment scale (LARSS) was used to access the LARS. Results At 12 weeks after the 11 patients recovered from the anal defecation function, the average score on the LARS questionnaire was 25.5 ± 1.5 (minor). The average time at which anal function began to recover was 6.2 ± 2.6 weeks after surgery. The recovery was rapid, as the rectal and anal function of all patients generally returned to normal levels within 12 weeks, and the quality of life was close to that before surgery. Conclusion Greater omental flap transplantation can significantly improve LARS after Dixon TME in patients with low rectal cancer. Omental pedicle flap transplantation is a revised and promising surgical procedure. The procedure reconstructing the mesorectum could maintain rectal compliance. The procedure can significantly improve low anterior resection syndrome.
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Vardar B, Midkiff B. Vaginal cuff dehiscence: report of two cases. Radiol Case Rep 2021; 16:2231-2235. [PMID: 34178197 PMCID: PMC8213908 DOI: 10.1016/j.radcr.2021.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Vaginal cuff dehiscence is a rare but potentially life-threatening post-hysterectomy complication. Here we report two cases of vaginal cuff dehiscence with distinct imaging features and describe the CT findings of vaginal cuff dehiscence. Both patients underwent repair surgery, and the diagnoses were confirmed. Radiologic features of vaginal cuff dehiscence are uncommonly described in the literature. Vaginal cuff mural discontinuity and omental fat tissue or bowel herniation into the vaginal canal are the most common appearances of vaginal cuff dehiscence. Pelvic hematoma, bowel obstruction, and pneumoperitoneum can accompany. These two cases highlight the CT appearances, potential presentations, and management of vaginal cuff dehiscence in the emergency setting.
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Wang S, Kadeer M, Yusufu R, Niu J, Liu Y, Rouzi P, Sui S, Wang J, Li X, Wang Y, Ren Y, Huang Y. Delayed stillbirth by hysterectomy following early-term uterine rupture with fetal demise in secundigravida. Radiol Case Rep 2021; 16:2081-2085. [PMID: 34158898 PMCID: PMC8203557 DOI: 10.1016/j.radcr.2021.04.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/13/2022] Open
Abstract
Uterine rupture and postterm pregnancy pose a number of life-threatening complications to both mother and child, including severe intra-abdominal bleeding and peritonitis, birth injury, hypoxia, and fetal loss. This report presents a rare case of a 20-year-old female experiencing fetal demise at 60 weeks of pregnancy, with uterine rupture and bone tissue discharge from her vagina without severe intra-abdominal bleeding and peritonitis. The mild clinical course despite complete uterine rupture was due to the firm adhesion of the amniotic sac to the uterus caused by inflammation. The adhesion of the intestines to the rupture site prevented dehiscence of the ruptured wound. Suppuration and bone tissue discharge relieved the pressure on the patient's abdominal cavity and prevented subsequent occurrence of severe peritonitis. Radiologists mistakenly regarded the thick amniotic sac wall on the right side of the uterine wall as a right cornual pregnancy with uterine rupture caused by chronic inflammation. This report aims to bring awareness of this rare condition to medical students and radiologists.
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Sarcoidosis or cancer? That is the question. Respir Med Case Rep 2021; 33:101426. [PMID: 34401272 PMCID: PMC8348150 DOI: 10.1016/j.rmcr.2021.101426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/08/2021] [Accepted: 05/07/2021] [Indexed: 12/03/2022] Open
Abstract
Sarcoidosis is a granulomatous inflammatory disease of unknown etiology. Sarcoid like granuloma may develop concurrently or following cancer. Detection of granuloma in mediastinal lymph nodes biopsy in patient with pulmonary nodules may be a concern for undiagnosed lung cancer. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic modality of choice for the lung lesions. We discussed A 71-year-old man with history of chronic obstructive lung disease (COPD), who presented with a lung nodule and mediastinal lymphadenopathies. The nodule was 9.9 mm when detected and his endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) of lymph nodes in station 7 & 4R showed normal lymph node structure. Two years later, his surveillance chest CT scan indicated an increase in the size of the nodule to 15 mm, and PET/CT showed Fluorodeoxyglucose (FDG) avid nodule & mediastinal Lymph nodes. He complained of Shortness of breath after 2–3 climbs of stairs, without any history of cough or fever. He quit cigarette smoking recently and smoked 50 pack years before. He underwent another set of EBUS and was referred for sarcoidosis treatment due to finding non-necrotizing granuloma in 4L and 11L lymph nodes. The patient also underwent another biopsy of the nodule concerning the possibility of cancer sarcoid syndrome. A poorly differentiated lung adenocarcinoma positive for GATA3, positive for P63 and CK7, TTF-1 was reported. Concurrent lung cancer and granulomatous reaction in mediastinal lymph nodes are being reported more often. Recent studies have shown a better survival of patients with diagnosis of cancer and granulomatous findings of sarcoidosis. Performing lung biopsy from any nodular lesion in a patient with sarcoidosis is essential for the differential diagnosis and early therapeutic measures.
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Fatima K, Dasgupta A, DiCenzo D, Kolios C, Quiaoit K, Saifuddin M, Sandhu M, Bhardwaj D, Karam I, Poon I, Husain Z, Sannachi L, Czarnota GJ. Ultrasound delta-radiomics during radiotherapy to predict recurrence in patients with head and neck squamous cell carcinoma. Clin Transl Radiat Oncol 2021; 28:62-70. [PMID: 33778174 PMCID: PMC7985224 DOI: 10.1016/j.ctro.2021.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/23/2021] [Accepted: 03/07/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE This study investigated the use of quantitative ultrasound (QUS) obtained during radical radiotherapy (RT) as a radiomics biomarker for predicting recurrence in patients with node-positive head-neck squamous cell carcinoma (HNSCC). METHODS Fifty-one patients with HNSCC were treated with RT (70 Gy/33 fractions) (±concurrent chemotherapy) were included. QUS Data acquisition involved scanning an index neck node with a clinical ultrasound device. Radiofrequency data were collected before starting RT, and after weeks 1, and 4. From this data, 31 spectral and related-texture features were determined for each time and delta (difference) features were computed. Patients were categorized into two groups based on clinical outcomes (recurrence or non-recurrence). Three machine learning classifiers were used for the development of a radiomics model. Features were selected using a forward sequential selection method and validated using leave-one-out cross-validation. RESULTS The median follow up for the entire group was 38 months (range 7-64 months). The disease sites involved neck masses in patients with oropharynx (39), larynx (5), carcinoma unknown primary (5), and hypopharynx carcinoma (2). Concurrent chemotherapy and cetuximab were used in 41 and 1 patient(s), respectively. Recurrence was seen in 17 patients. At week 1 of RT, the support vector machine classifier resulted in the best performance, with accuracy and area under the curve (AUC) of 80% and 0.75, respectively. The accuracy and AUC improved to 82% and 0.81, respectively, at week 4 of treatment. CONCLUSION QUS Delta-radiomics can predict higher risk of recurrence with reasonable accuracy in HNSCC.Clinical trial registration: clinicaltrials.gov.in identifier NCT03908684.
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Key Words
- AAC, Average acoustic concentration
- ACE, Attenuation co-efficient estimate
- ASD, Average scatterer diameter
- AUC, Area under the curve
- Acc, Accuracy
- CON, Contrast
- COR, Correlation
- CR, Complete responders
- CT, Computed tomography
- Delta-radiomics
- EBV, Epstein-Barr virus
- ENE, Energy
- FDG-PET, 18F-fluorodeoxyglucose positron emission tomography
- FLD, Fisher’s linear discriminant
- FN, False negative
- FP, False positive
- GLCM, Grey level co-occurrence matrix
- HN, Head and neck
- HNSCC, Head and neck squamous cell carcinoma
- HOM, Homogeneity
- HPV, Human papillomavirus
- Head and neck malignancy
- IGRT, Image-guided radiation therapy
- IMRT, Intensity-modulated radiation therapy
- MBF, Mid-band fit
- MRI, Magnetic resonance imaging
- Machine learning
- NR, Non-recurrence
- PET, Positron emission tomography
- PR, Partial responders
- QUS, Quantitative ultrasound
- Quantitative ultrasound
- R, Recurrence
- RF, Radiofrequency
- RFS, Recurrence-free survival
- ROI, Region of interest
- RT, Radiotherapy
- Radiomics
- Radiotherapy squamous cell carcinoma
- Recurrence
- SAS, Spacing among scatterers
- SI, Spectral intercept
- SP, Specificity
- SS, Spectral slope
- SVM, Support vector machine
- Sn, Sensitivity
- TN, True negative
- TP, True positive
- US, Ultrasound
- kNN, k nearest neighbors
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Liang C, Hui N, Liu Y, Qiao G, Li J, Tian L, Ju X, Jia M, Liu H, Cao W, Yu P, Li H, Ren X. Insights into forsythia honeysuckle (Lianhuaqingwen) capsules: A Chinese herbal medicine repurposed for COVID-19 pandemic. PHYTOMEDICINE PLUS : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2021; 1:100027. [PMID: 35399819 PMCID: PMC7833308 DOI: 10.1016/j.phyplu.2021.100027] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 04/17/2023]
Abstract
Background In December 2019, a novel coronavirus, SARS-CoV-2 caused a series of acute atypical respiratory diseases worldwide. However, there is still a lack of drugs with clear curative effects, and the clinical trial research of vaccines has not been completely finished. Purpose LH capsules are approved TCM patent medicine that are widely used for the treatment of respiratory tract infectious diseases caused by colds and flu. On April 12, 2020, LH capsules and granules were officially repurposed by the China Food and Drug Administration (CFDA) for patients with mild COVID-19 based on their safety and efficacy demonstrated through multicentre, randomized, controlled clinical trials. We hope to conduct a comprehensive review of it through modern pharmacy methods, and try to explain its possible mechanism. Methods Using the full names of LH capsules Lianhuaqingwen, Lianhua Qingwen andSARS-COV-2, COVID-19 as the keywords of the search terms, systemically search for existing related papers in various databases such as Web of Science and PubMed. And completed the collection of clinical data in ClinicalTrials.gov and Chinese Clinical Trial Registry. Last but not least, we have sorted out the anti-inflammatory and antiviral mechanisms of LH capsules through literature and Selleck. Results This review systematically sorted out the active ingredients in LH capsules. Furthermore, the related pharmacological and clinical trials of LH capsule on SARS-CoV-2, IAV and IBV were discussed in detail. Moreover, the present review provides the first summary of the potential molecular mechanism of specific substances in LH capsules involved in resistance to SARS-COV-2 infection and the inhibition of cytokine storm syndrome (CSS) caused by IL-6. Conclusion This review summarizes the available reports and evidence that support the use of LH capsules as potential drug candidates for the prevention and treatment of COVID-19. However, TCM exerts its effects through multiple targets and multiple pathways, and LH capsules are not an exception. Therefore, the relevant mechanisms need to be further improved and experimentally verified.
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Key Words
- 3C-like protease (3CLpro)
- 3CLpro, 3C-like protease
- ACE2, Angiotensin-converting enzyme 2
- AECOPD, Acute exacerbation of chronic obstructive pulmonary disease
- AIDS, Acquired immune deficiency syndrome
- AQP3, Aquaporins 3
- ARDS, Acute respiratory distress syndrome
- CAT, COPD assessment test
- CC50, 50% Cytotoxic concentration
- CCL-2/MCP-1, C—C motif ligand 2/monocyte chemoattractant protein-1
- CFDA, China Food and Drug Administration
- COPD, Chronic obstructive pulmonary disease
- COVID-19
- COVID-19, Coronavirus disease 2019
- CPE, Cytopathic effect
- CSS, Cytokine storm syndrome
- CT, Computed tomography
- CXCL-10/IP-10, C-X-C Motif Chemokine Ligand 10/ Interferon Gamma-induced Protein 10
- Cytokine storm syndrome (CSS)
- DMSO, Dimethyl sulfoxide
- E protein, Envelope protein
- ERK, Extracellular signal-regulated kinase
- FBS, Fatal bovine serum
- Forsythia honeysuckle (Lianhuaqingwen,LH) capsules
- Grb2, Growth factor receptor-bound protein 2
- HIV, Human immunodeficiency virus
- HPLC, High-performance liquid chromatography
- HSV-1, Herpes simplex virus type 1
- HVJ, Hemagglutinating virus of Japan
- Hep-2, Human epithelial type 2
- Huh-7, Human Hepatocellular Carcinoma-7
- IAV, Influenza A virus
- IBV, Influenza B virus
- IC50, 50% Inhibition concentration
- IFN-λ1, Interferon-λ1
- IL-6, Interleukin-6
- IL-6R, IL-6 Receptor
- IL-8, Interleukin-8
- IP-10, Interferon-inducible protein-10
- JAK/STAT, Janus kinase/signal transducers and activators of transcription
- JAK1/2, Janus kinase1/2
- LD50, 50% Lethal dose
- LH capsules, Forsythia honeysuckle (Lianhuaqingwen) capsules
- M protein, Membrane protein
- MAPK, Mitogen-activated protein kinase
- MCP-1, Monocyte chemotactic protein 1
- MDCK, Madin-darby canine kidney
- MEK, Mitogen-activated protein kinase kinase
- MERS, Middle east respiratory syndrome
- MIP-1β, Macrophage Inflammatory Protein-1β
- MLD50, 50% Minimum lethal dose
- MOF, Multifunctional organ damage
- MOI, Multiplicity of infection
- MTT, Methyl Thiazolyl Tetrazolium
- NF-kB, Nuclear transcription factor kappa-B
- NHC, National Health Commission
- ORFs, Open reading frames
- PBS, Phosphate buffered saline
- PHN, Phillyrin
- PI3K, Phosphoinositide 3-kinases
- PKA/p-CREB, Protein kinase A /phosphorylated cAMP response element-binding protein
- PKB, Akt, Protein kinase B
- PLpro, Papain-like proteases
- PRC, People's Republic of China
- QC, Quality control
- RANTES, Regulated on activation normal T cell expressed and secreted
- RSV, Respiratory syncytial virus
- RT-PCR, Reverse transcription PCR
- Ras, Ras GTPase
- SARS-CoV-2
- TCID50, 50% Tissue culture infective dose
- TD0, Non-toxic Dose
- TD50, Half-toxic dose
- Vero E6, African Green Monkey Kidney Epithelial-6
- gp-130, Glycoprotein 130
- mIL-6R, Membrane-bound form IL-6 Receptor
- mTOR, Mammalian target of rapamycin
- nsps, Non-structural proteins
- qPCR, Quantitative PCR
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Branco D, Kry S, Taylor P, Rong J, Zhang X, Frank S, Followill D. Evaluation of image quality of a novel computed tomography metal artifact management technique on an anthropomorphic head and neck phantom. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 17:111-116. [PMID: 33898789 PMCID: PMC8058027 DOI: 10.1016/j.phro.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/27/2022]
Abstract
Background and purpose Artefacts caused by dental amalgam implants present a common challenge in computed tomography (CT) and therefore treatment planning dose calculations. The goal was to perform a quantitative image quality analysis of our Artifact Management for Proton Planning (AMPP) algorithm which used gantry tilts for managing metal artefacts on Head and Neck (HN) CT scans and major vendors’ commercial approaches. Materials and methods Metal artefact reduction (MAR) algorithms were evaluated using an anthropomorphic phantom with a removable jaw for the acquisition of images with and without (baseline) metal artifacts. AMPP made use of two angled CT scans to generate one artifact-reduced image set. The MAR algorithms from four vendors were applied to the images with artefacts and the analysis was performed with respective baselines. Planar HU difference maps and volumetric HU differences were analyzed. Results AMPP algorithm outperformed all vendors’ commercial approaches in the elimination of artefacts in the oropharyngeal region, showing the lowest percent of pixels outside +− 20 HU criteria, 4%; whereas those in the MAR-corrected images ranged from 26% to 67%. In the region of interest within the affected slices, the commercial MAR algorithms showed inconsistent performance, whereas the AMPP algorithm performed consistently well throughout the phantom’s posterior region. Conclusions A novel MAR algorithm was evaluated and compared to four commercial algorithms using an anthropomorphic phantom. Unanimously, the analysis showed the AMPP algorithm outperformed vendors’ commercial approaches, showing the potential to be broadly implemented, improve visualizations in patient anatomy and provide accurate HU information.
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Key Words
- AMPP, Artifact Management for Proton Planning
- Algorithm
- Artifacts
- CT, Computed tomography
- Computed X ray tomography
- Gantry tilts
- HU, Hounsfield Unit
- Head and neck neoplasms
- MAR, metal artifact reduction
- OAR, Organs at Risk
- OMAR, orthopedic metal artifact reduction
- SEMAR, single-energy metal artifact reduction
- SmartMAR, Smart metal artifact reduction
- iMAR, iterative metal artifact reduction
- kVp, Kilovoltage peak
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Watanabe K, Imamura N, Yusa J, Koezuka S, Yamanaka S. Pleurography (thoracography) for pleural fistulas: A case series. JTCVS Tech 2021; 7:285-291. [PMID: 34318272 PMCID: PMC8312103 DOI: 10.1016/j.xjtc.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
Background Pleurography (PG) has been described previously but has not gained popularity. PG can determine the exact air leak points in the lung, which is important for treating pneumothorax and pleural fistulas. We believe that the usefulness of PG should be reassessed, and here we describe the method, air leak detection rate, and common complications. Methods From the 1210 cases of pleural fistulas that were treated at our institution between March 2015 and October 2018, 275 patients with recurrent primary pneumothorax or secondary spontaneous pneumothorax were selected for this study. PG was performed in 127 patients with persistent air leakage during exhalation. In addition, 35 patients with postoperative complications of air leakage persisting for 7 days or longer were included. Results Air leak points were detected in 119 patients (73%), in the apex of the lung in 65 cases, in the basal segment in 13 cases, and in the middle lobe or lingular segment in 9 cases. There were 8 cases of hilar lesions, 12 cases of S6 lesions, 8 cases of upper lobe lesions other than apex, and 4 cases of upper mediastinal lesions. Complications within 30 days were observed in 10 cases (6.2%), with 8 grade 2 cases involving fever, 1 grade 3 case involving infection, and one grade 1 case with abdominal distension. Conclusions The incidence of grade ≥3 adverse events after PG was 0.6%, which is considered acceptable. Our findings suggest that PG is a safe examination method to identify air leaks before surgery for pleural fistulas.
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Koike T, Kin T, Tanaka S, Takeda Y, Uchikawa H, Shiode T, Saito T, Takami H, Takayanagi S, Mukasa A, Oyama H, Saito N. Development of Innovative Neurosurgical Operation Support Method Using Mixed-Reality Computer Graphics. World Neurosurg X 2021; 11:100102. [PMID: 33898969 PMCID: PMC8059082 DOI: 10.1016/j.wnsx.2021.100102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/06/2021] [Indexed: 12/22/2022] Open
Abstract
Background In neurosurgery, it is important to inspect the spatial correspondence between the preoperative medical image (virtual space), and the intraoperative findings (real space) to improve the safety of the surgery. Navigation systems and related modalities have been reported as methods for matching this correspondence. However, because of the influence of the brain shift accompanying craniotomy, registration accuracy is reduced. In the present study, to overcome these issues, we developed a spatially accurate registration method of medical fusion 3-dimensional computer graphics and the intraoperative brain surface photograph, and its registration accuracy was measured. Methods The subjects included 16 patients with glioma. Nonrigid registration using the landmarks and thin-plate spline methods was performed for the fusion 3-dimensional computer graphics and the intraoperative brain surface photograph, termed mixed-reality computer graphics. Regarding the registration accuracy measurement, the target registration error was measured by two neurosurgeons, with 10 points for each case at the midpoint of the landmarks. Results The number of target registration error measurement points was 160 in the 16 cases. The target registration error was 0.72 ± 0.04 mm. Aligning the intraoperative brain surface photograph and the fusion 3-dimensional computer graphics required ∼10 minutes on average. The average number of landmarks used for alignment was 24.6. Conclusions Mixed-reality computer graphics enabled highly precise spatial alignment between the real space and virtual space. Mixed-reality computer graphics have the potential to improve the safety of the surgery by allowing complementary observation of brain surface photographs and fusion 3-dimensional computer graphics.
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Key Words
- 2D, 2-Dimensional
- 3D, 3-Dimensional
- 3DCG, 3-Dimensional computer graphics
- AR, Augmented reality
- Brain shift
- CT, Computed tomography
- Computer graphics
- FOV, Field of view
- Glioma
- Landmark
- MRCG, Mixed-reality computer graphics
- MRI, Magnetic resonance imaging
- Mixed-reality
- TE, Echo time
- TR, Repetition time
- Target registration error
- Thin-plate spline
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Goldman CC, Dall CP, Sholklapper T, Brems J, Kowalczyk K. Complex space of Retzius lymphocele resulting in iliac compression and submassive pulmonary embolism after robotic Retzius sparing prostatectomy. Urol Case Rep 2021; 36:101598. [PMID: 33659187 PMCID: PMC7890136 DOI: 10.1016/j.eucr.2021.101598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Lymphoceles are common following prostatectomy with lymph node dissection, but the vast majority are asymptomatic. We present a unique case of a large complex lymphocele tracking into the anterior space of Retzius following Retzius sparing prostatectomy and bilateral pelvic lymphadenectomy. The patient initially presented with shortness of breath and subsequent diagnosis of a submassive pulmonary embolism. Further evaluation revealed compression of the iliac vessels by the fluid collection. Following multiple failed attempts of drainage percutaneously, the patient required return to the operating room for peritoneal marsupialization, drainage of fluid collection, and evacuation of large amounts of clot within the collection.
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Rhodes E, Stone T, Spruill L, Hardie AD. A case report of inverted Meckel's diverticulum. Radiol Case Rep 2021; 16:1118-1122. [PMID: 33732404 PMCID: PMC7937938 DOI: 10.1016/j.radcr.2021.02.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
Abstract
Inverted Meckel's diverticulum is an entity often discovered incidentally or through a clinical evaluation for gastrointestinal bleeding. While rare, inverted Meckel's diverticulum should be considered in the evaluation of a patient presenting with gastrointestinal bleeding, intestinal obstruction, or intussusception. In this case, a 67-year-old female with a remote history of surgically treated breast cancer presents to an urgent care facility with weakness and fatigue. She was found to be anemic with hemoglobin of 4. Imaging revealed a blind-ending pouch in the mid to distal ileum consistent with an inverted Meckel's diverticulum. Inverted Meckel's diverticulum is identified on computerized tomography as an intraluminal, blind-ending structure in the mid to distal ileum. The possibility of a lead point should be investigated and surgical resection is indicated to prevent intestinal obstruction.
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