Diagnostic algorithm for glioma grading using dynamic susceptibility contrast‑enhanced magnetic resonance perfusion and proton magnetic resonance spectroscopy

The present retrospective study aimed to investigate the diagnostic capacity of and design a diagnostic algorithm for dynamic susceptibility contrast-enhanced MRI (DSCE-MRI) and proton magnetic resonance spectroscopy (1H-MRS) in grading low-grade glioma (LGG) and high-grade glioma (HGG). This retrospective study enrolled 57 patients, of which 14 had LGG and 43 had HGG, five had World Health Organization grade 1, nine had grade 2, 20 had grade 3 and 23 had grade 4 glioma. All subjects underwent a standard 3T MRI brain tumor protocol with conventional MRI (cMRI) and advanced techniques, including DSCE-MRI and 1H-MRS. The associations of grade categorization with parameters in tumor and peritumor regions in the DSCE-MRI were examined, including tumor relative cerebral blood volume (TrCBV) and peripheral relative (Pr)CBV, as well as Tr and Pr cerebral blood flow (CBF) and 1H-MRS, including the creatine (Cr) and N-acetyl aspartate (NAA) ratios of choline (Cho), i.e. the TCho/NAA, PCho/NAA, TCho/Cr and PCho/Cr metabolite ratios. The data were compared using the Mann-Whitney U-test, independent samples t-test, Chi-square test, Fisher's exact test and receiver operating characteristic curve analyses. Decision tree analysis established an algorithm based on cutoffs for specified significant parameters. The PrCBF had the highest performance in the preoperative prediction of histological glioma grading, followed by the TrCBV, PrCBF, TrCBV, PCho/NAA, PCho/Cr, TCho/NAA and TCho/Cr. An algorithm based on TrCBV, PrCBF and TCho/Cr had a diagnostic accuracy of 100% for LGG and 90.7% for HGG and a misclassification risk of 7%. The cutoffs (sensitivity and specificity) were 2.48 (86 and 100%) for TrCBV, 1.26 (83.7 and 100%) for PrCBF and 3.18 (69.8 and 78.6%) for TCho/Cr. In conclusion, the diagnostic algorithm using TrCBV, PrCBF and TCho/Cr values, which were obtained from DSCE-MRI and 1H-MRS, increased diagnostic accuracy to 100% for LGGs and 90.7% for HGGs compared to previous studies using conventional MRI. This non-invasive advanced MRI diagnostic algorithm is recommended for clinical application for constructing preoperative strategies and prognosis of patients with glioma.

Splenic Artery Embolization in Conservative Management of Blunt Splenic Injury Graded by 2018 AAST-OIS: Results from a Hospital in Vietnam

Purpose

This study was conducted to evaluate the results of conservative management of blunt splenic trauma according to the American Association for the Surgery of Trauma-Organ Injury Scale (AAST-OIS) in 2018 by embolization.

Methods

This observational study included 50 patients (42 men and 8 women) with splenic injury who underwent multidetector computed tomography (MDCT) and embolization.

Results

According to the 2018 AAST-OIS, 27 cases had higher grades than they did according to the 1994 AAST-OIS. The grades of two cases of grade II increased to grade IV; those of 15 cases of grade III increased to grade IV; and four cases of grade IV increased to grade V. As a result, all patients underwent successful splenic embolization and were stable at discharge. No patients required re-embolization or conversion to splenectomy. The mean hospital stay was 11.8±7 days (range, 6-44 days), with no difference in length of hospital stay among grades of splenic injury (p >0.05).

Conclusion

Compared with the AAST-OIS 1994, the AAST-OIS 2018 classification is useful in making embolization decisions, regardless of the degree of blunt splenic injury with vascular lacerations visible on MDCT.

Metformin suppresses progression of muscle aging via activation of the AMP kinase-mediated pathways in Drosophila adults

OBJECTIVE

Metformin, a medicine used for the treatment of type 2 diabetes, was previously reported to suppress age-dependent hyperproliferation of intestinal stem cells in Drosophila. Here, we aimed to investigate its anti-aging effects on other tissues, such as adult muscle and elucidate the mechanisms underlying the anti-ageing effect.

MATERIALS AND METHODS

To evaluate the anti-muscle ageing effect of Metformin, we visualized ubiquitinated protein aggregates accumulated in adult muscle as the flies age by immunostaining and measured the total pixel size of the aggregates. We altered gene expression in the muscle by induction of dsRNA against the relevant mRNAs or mRNAs encoding the constitutively active mutant proteins using the Gal4/UAS system. We determined the mRNA levels by quantitative Real Time-Polymerase Chain Reaction (QRT-PCR).

RESULTS

Continuous metformin feeding significantly extended the lifespan of Drosophila adults. Furthermore, the feeding suppressed the aging-dependent accumulation of ubiquitinated aggregates in adult muscle. To delineate the mechanism through which metformin influences the muscle aging phenotype, we induced the constitutively active AMPK specifically in the muscles and found that the activation of the AMPK-mediated pathway was sufficient for the anti-aging effect of Metformin. Furthermore, the AMPK-mediated downregulation of Tor-mediated pathways, subsequent induction of an eIF-4E inhibitor were involved in the effect. These genetic data suggested that the metformin effect is related to the partial suppression of protein synthesis in ribosomes. Furthermore, metformin stimulated autophagy induction in adult muscles.

CONCLUSIONS

Our results suggest that metformin can be regarded as an anti-aging compound in Drosophila muscle. The stimulation of autophagy was also involved in the anti-aging effect, which delayed the progression of muscle aging in Drosophila adults.

A survival after cardiac arrest during CT scan: The critical imaging findings

It obtains infrequently hemodynamic images of patients undergoing impending cardiac arrest. Heart pump failure causes blood stasis in the venous system and organs, which is demonstrated on imaging by the deposition and layering of contrast in the veins. We present a case of a multi-trauma patient undergoing imminent cardiac arrest during computed tomography scan under sedation. Signs of early cardiac arrest were immediately found during the examination, including contrast pooling in the inferior vena cava and hepatic veins, poor opacification of the left heart chambers and the aorta. Fortunately, the patient was quickly resuscitated, and his heart pump returned to normal. Although cardiac arrest on computed tomography scan is extremely rare, detecting imaging signs of this situation helps patients receive timely resuscitation and better survival.

Solvation force and adsorption isotherm of a fluid mixture in nanopores of complex geometry based on fundamental measure theory

A novel method based on the fundamental measure theory is developed to calculate the solvation force and adsorption isotherm of a Lennard-Jones fluid mixture in complex geometries. Fast Fourier transform and 3D-voxel discretization are used for accurately computing the confined fluid densities in a closed pore of arbitrary geometry. Given the fluid densities, the solvation force distribution at the solid surface can be calculated using a new formulation from either mechanical or thermodynamic approach. Understanding the solvation force behavior, which depends on many factors such as pore geometry, confined density distribution, molecule size, is very important to analyze the pore deformation from a poromechanical point of view. Special attention in the numerical simulations is given to the adsorption problem of CH₄and CO₂gas mixture in ellipsoidal pore.

Early abnormal fibrinolysis and mortality in patients with thermal injury: a prospective cohort study

INTRODUCTION

Abnormal fibrinolysis early after injury has been associated with increased mortality in trauma patients, but no studies have addressed patients with burn injury. This prospective cohort study aimed to characterize fibrinolytic phenotypes in burn patients and to see if they were associated with mortality.

METHODS

Patients presenting to a regional burn centre within 4 h of thermal injury were included. Blood was collected for sequential viscoelastic measurements using thromboelastography (RapidTEG™) over 12 h. The percentage decrease in clot strength 30 min after the time of maximal clot strength (LY30) was used to categorize patients into hypofibrinolytic/fibrinolytic shutdown (SD), physiological (PHYS) and hyperfibrinolytic (HF) phenotypes. Injury characteristics, demographics and outcomes were compared.

RESULTS

Of 115 included patients, just over two thirds were male. Overall median age was 40 (i.q.r. 28-57) years and median total body surface area (TBSA) burn was 13 (i.q.r. 6-30) per cent. Some 42 (36.5 per cent) patients had severe burns affecting over 20 per cent TBSA. Overall mortality was 18.3 per cent. At admission 60.0 per cent were PHYS, 30.4 per cent were SD and 9.6 per cent HF. HF was associated with increased risk of mortality on admission (odds ratio 12.61 (95 per cent c.i. 1.12 to 142.57); P = 0.041) but not later during the admission when its incidence also decreased. Admission SD was not associated with mortality, but incidence increased and by 4 h and beyond, SD was associated with increased mortality, compared with PHYS (odds ratio 8.27 (95 per cent c.i. 1.16 to 58.95); P = 0.034).

DISCUSSION

Early abnormal fibrinolytic function is associated with mortality in burn patients.

Answering Mermin's challenge with conservation per no preferred reference frame

In 1981, Mermin published a now famous paper titled, "Bringing home the atomic world: Quantum mysteries for anybody" that Feynman called, "One of the most beautiful papers in physics that I know." Therein, he presented the "Mermin device" that illustrates the conundrum of quantum entanglement per the Bell spin states for the "general reader." He then challenged the "physicist reader" to explain the way the device works "in terms meaningful to a general reader struggling with the dilemma raised by the device." Herein, we show how "conservation per no preferred reference frame (NPRF)" answers that challenge. In short, the explicit conservation that obtains for Alice and Bob's Stern-Gerlach spin measurement outcomes in the same reference frame holds only on average in different reference frames, not on a trial-by-trial basis. This conservation is SO(3) invariant in the relevant symmetry plane in real space per the SU(2) invariance of its corresponding Bell spin state in Hilbert space. Since NPRF is also responsible for the postulates of special relativity, and therefore its counterintuitive aspects of time dilation and length contraction, we see that the symmetry group relating non-relativistic quantum mechanics and special relativity via their "mysteries" is the restricted Lorentz group.

Sesamin suppresses aging phenotypes in adult muscular and nervous systems and intestines in a Drosophila senescence-accelerated model

OBJECTIVE

Sesamin is a major lignan constituent of sesame and possesses various health-promoting effects. Previous studies have demonstrated that sesamin extends the lifespan of Drosophila and Caenorhabditis elegans and corrects oxidative damage-related tissue dysfunction in mammals. To understand its anti-aging effects, we aimed to determine whether sesamin restores tissue function hampered by oxidative damage and suppresses several aging-related phenotypes using Drosophila senescence-accelerated models.

MATERIALS AND METHODS

We elucidated the anti-aging effects of sesamin on several aging-related phenotypes in the muscle, brain and midgut using the senescence-accelerated models (Sod1n1 mutant and Sod1-depleted flies) by immunostaining experiments. We determined the expression levels of several anti-oxidative and DNA repair genes using quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). We also identified the metabolite of sesamin in Drosophila by LC-MS/MS.

RESULTS

We confirmed that sesamin (0.35 and 2 mg/ml) extended the lifespan of the fly models. As observed in mammals, it can be absorbed and metabolized by Drosophila adults. The sesamin feeding suppressed the age-dependent impairment of locomotor activity and inhibited the accumulation of reactive oxygen species (ROS) in their bodies. Sesamin delayed the age-dependent accumulation of damaged proteins in the muscle, partially suppressed the loss of dopaminergic neurons in adult brains displaying ROS accumulation, and suppressed the accumulation of DNA damage and hyperproliferation of intestinal stem cells. Four antioxidative genes and two DNA repair genes were simultaneously upregulated in sesamin-fed adults.  CONCLUSIONS: These observations represent the first direct evidence of the anti-aging effects of sesamin at the individual level. We propose that sesamin exerts anti-aging effects in the muscles, brain and midgut by inducing antioxidative and DNA repair genes, resulting in extended lifespan in flies.

RGD Conjugated Dendritic Polylysine for Cellular Delivery of Antisense Oligonucleotide

Dendritic polylysines (DPL) are highly branched nano-sized spherical polymer with positively charged primary amino groups on surface. This structural feature is useful for a delivery of antisense oligonucleotide or siRNA. In this study, we modified the surface of DPL with cyclic RGD (and iRGD) peptide by conjugation reaction generating RGD (and iRGD) peptide conjugated dendritic poly-lysines, RGD-DPL or iRGD-DPL. The prepared conjugates were evaluated for integrin receptor-mediated cellular delivery of antisense oligonucleotide. The conjugation of RGD or iRGD peptide on DPL was monitored by measuring the retention time in capillary zone electrophoresis and the absorbance at UV-Vis spectroscopy. Cellular delivery by DPL-RGD (or -iRGD)/antisense oligonucleotide complex was examined by antisense splicing correction assay on integrin alpha v/beta 3 positive A375B3-Luc cells, which were stably transfected with plasmid pLuc/705. DPL-RGD (or -iRGD)/antisense oligonucleotide complexes exhibited integrin receptor mediated uptake on A375B3 cells without inducing cellular toxicity. In addition, the delivery of antisense oligonucleotide was integrin receptor-dependent with moderate efficiency.

Preparation of Pluronic Grafted Dendritic alpha,epsilon-poly(L-lysine)s and Characterization as a Delivery Adjuvant of Antisense Oligonucleotide

A series of pluronic grafted dendritic alpha,epsilon-poly(L-lysine)s (DPL-PF127) were synthesized by a conjugation reaction and evaluated the potential use of DPL-PF127 as a delivery agent of antisense oligonucleotide into A375 B3 cells. The structural features of the DPL-PF127 were identified by NMR and FT-IR. The number of pluronic F127 on DPL surface, determined by fluorescamine assay, increased proportionally to the mole ratio between DPL and activated PF127 in reaction. DPL- PF127 showed the physical properties of decrease in zetapotential and increase in size as the mole ratio of PF127 to DPL increased. The complex formation of DPL-PF127 with oligonucleotide was confirmed by running capillary zone electrophoresis (CZE) and agarose gel electrophoresis. DPL-PF127, prepared at the mole ratio of 1:10 in reaction, was the most suitable as a delivery adjuvant of oligonucleotide. In addition, DPL-PF127/oligonucleotide complexes were taken into A375B3 cell without cellular toxicity and delivered antisense oligonucleotide into cell.

Improving colorectal cancer screening in Asian Americans: Results of a randomized intervention study

BACKGROUND

The objective of this study was to use a randomized controlled trial design to test the impact of an educational intervention delivered by specially trained community health workers among Chinese, Korean, and Vietnamese participants ages 50 to 75 years on knowledge, attitudes, beliefs, and intentions regarding colorectal cancer screening.

METHODS

Baseline data were collected on participants' demographic characteristics, knowledge, attitudes, beliefs about cancer, its risk factors, and intention to keep up to date on cancer screening in the future. Fifteen intervention sessions were held between April and June of 2011. Follow-up surveys were administered in the postintervention period to both intervention and control participants. Those randomized to the control group received educational pamphlets in their native language.

RESULTS

The intervention had the greatest influence on the Chinese subgroup, which had improved scores relative to the control group for perceived behavior control and intentions (preintervention vs postintervention change: control group, -0.16; intervention group, 0.11; P = .004), behavioral beliefs on cancer screening (preintervention vs postintervention change: control group, -0.06; intervention group, 0.24; P = .0001), and attitudes toward behavior (preintervention vs postintervention change: control group, -0.24; intervention group, 0.35; P ≤ .0001). The intervention had no effect on behavioral beliefs about cancer, control beliefs, or perceived behavioral control (reliance on family). Although the intention to stay up to date for cancer screening increased in 2 study groups (Chinese and Vietnamese), these increases were not significant.

CONCLUSIONS

An educational program delivered by culturally specific community health educators using culturally appropriate language influences some knowledge, attitude, and behavioral beliefs but not others.

Heat shock proteins (HSP) for immunotherapy of rheumatoid arthritis (RA)

Rheumatoid arthritis (RA) is an inflammatory disease that primarily involves the joints and has a worldwide prevalence of about one percent, with a female to male ratio of 3:1. This chapter summarizes some of the recent progress in molecular immunology, and discusses the application of this new knowledge for therapeutic purposes. We focus on our recent experiences and that of others in modulation of antigen specific responses as a tool for manipulating autoimmune inflammation. Particular emphasis is given to the concept of exploiting for therapeutic purposes a natural mechanism of immune regulation. This mechanism is based on sequential cross recognition of bacterial and human derived heat shock protein peptides.

Fertility sparing treatment for in situ and early invasive adenocarcinoma of the cervix

OBJECTIVE

To explore the outcome and long-term follow-up of fertility sparing surgery for cervical adenocarcinoma in situ and early invasive adenocarcinoma.

METHODS

Between 1985 and 1996, all women with adenocarcinoma in situ (AIS) and stage I adenocarcinoma were identified. Data were abstracted from clinical records and pathology reviewed.

RESULTS

One hundred thirty three women with stage I adenocarcinoma of the cervix were treated. Twenty subjects met the criteria for International Federation of Gynecology and Obstetrics stage IA1 lesions. Fourteen subjects were treated with radical hysterectomy, whereas two were treated with simple hysterectomy. Because of the desire to preserve fertility, four women with adenocarcinoma were treated with cervical conization alone, and three women have gone on to deliver viable infants. Forty-two women with adenocarcinoma in situ were identified, of whom 20 were treated with fertility sparing surgery (conization). Five women treated with conization had positive margins recurring in two, and one developed an invasive adenocarcinoma 5 years after conization. None of the women with adenocarcinoma treated with cervical conization have developed recurrent disease after a median follow-up of 48 months. Cone margin status was predictive of residual disease at hysterectomy.

CONCLUSION

Women with adenocarcinoma in situ and negative margins may be treated with conservative, fertility sparing surgery. Education is essential regarding the risks of residual/recurrent disease because subjects can develop lethal recurrent disease. The fertility sparing management of invasive stage IA1 adenocarcinoma of the uterine cervix may also be entertained among women who desire future fertility and have negative margins of resection.

Ventricular fibrillation refractory to automatic internal cardiac defibrillator in Fabry's disease. Review of cardiovascular manifestations

Fabry's disease is a disorder of glycosphingolipid metabolism leading to alpha-galactosidase deficiency with systemic sequelae. Clinical cardiac manifestations include dysrhythmias, structural abnormalities apparent on echocardiography, and histologic changes secondary to glycosphingolipid deposition. The introduction of automated internal cardiac defibrillators (AICD) has been shown to decrease the incidence of circulatory collapse in individuals with known terminal arrhythmias. We present a patient with Fabry's disease, who underwent coronary angiography without finding of obstructive disease. He returned after aborted sudden cardiac death necessitating the placement of an AICD. He again presented after an episode of ventricular fibrillation refractory to internal defibrillation necessitating advanced life support, and subsequently expired. We review the electrocardiographic, cardiovascular structural, and histologic manifestations of Fabry's disease.

Thermodynamics of a nonionic sponge phase

Different suggestions for the mechanism governing the narrow stability of the L(3) (sponge) phase have led to a series of debates in recent years. There have been several models developed to describe such a mechanism via thermodynamics. To date, experimental data are insufficient to test present theories. In this study, we revisit the sponge phase with two series of thermodynamic data performed on the well-characterized C(12)E(5)-n-decane-H(2)O system. These thermodynamic data sets stem from phase equilibrium and static light scattering experiments designed to link system-specific parameters such as the temperature dependence of the spontaneous curvature H(o) and the two bending moduli kappa and (-)kappa, which have only been loosely connected in earlier experiments. The use of a well-characterized system is important in that it allows usage of molecular descriptors from earlier studies to reduce fit parameters. Another advantage for using this system is that its phase behavior is analogous to a two-component system which, from an experimental standpoint, is more practical to perform accurate measurements and, from a theoretical standpoint, more simple to model. In the present investigation, we use these tools to quantitatively test parameters obtained by different experimental techniques and assumptions inherited in theoretical models designed to interpret them.

Complete response of a stage IV uterine papillary serous carcinoma to neoadjuvant chemotherapy with Taxol and carboplatin

Uterine papillary serous carcinoma (UPSC) is an aggressive histologic subtype of endometrial cancer. Currently, no effective chemotherapy regimens exist. We report a case of complete response of a stage IV UPSC to neoadjuvant chemotherapy with Taxol and carboplatin.

Phamacokinetics of a single oral dose of dihydroartemisinin in Vietnamese healthy volunteers

Pharmacokinetics of a 240 mg single dose of oral dihydroartemisinin (DHA) was investigated in 8 healthy (5 males, 3 females) Vietnamese volunteers. Plasma concentrations were measured by high-performance liquid chromatography with electrochemical detection in the reductive mode. The concentration time profile of DHA was fitted with one-compartment model with a lag time. Pharmacokinetics of DHA is comparable between males and females even when adjusted with dosage. The median (range) values of pooled pharmacokinetics of oral DHA were: t(lag) 0.41 (0.09-0.78) hours, t(1/2z) 0.58 (0.17-1.43) hours, t(max) 1.6 (1.1-2.2) hours, Cmax 466 (128-787) ng/ml. Cmax/dosage 97.7 (27.2-124.6) ng/ml, t(1/2z) 2.0 (1.5-3.4) hours, AUC 1867 (420-3535) ng x h/ml, AUC/dosage 364.3 (89.3-559.7) ng x h/ml/dosage, Cl/f 45.8 (30.0-190.0) ml/min/kg, Vz/f 8.0 (5.5-29.9) l/kg. Interindividual variation was large, the coefficients of variation (CV) were 47.8% and 45.3% respectively to AUC and Cmax. The t(max) of DHA formulation was comparable with that of DHA metabolite of artemisinin derivatives. The t(1/2z) was longer and shorter than that of DHA metabolites of oral formulations of artesunate and artemether, respectively. For monotherapeutic regimen(s) of DHA, dosing frequency of at least twice a day is suggested. Combined regimen(s) of DHA with other potent, long half-life antimalarials may also be an alternative approach.

Single dose artemisinin-mefloquine versus mefloquine alone for uncomplicated falciparum malaria

The efficacy of the combination of a single oral dose of 500 mg artemisinin with a single 500 mg oral dose of mefloquine (AM) in the treatment of uncomplicated falciparum malaria was compared to mefloquine therapy alone (M) in a double-'blind' randomized study in an endemic area in the south of Viet Nam where single low dose treatment was employed and where mefloquine had been recently introduced. 231 patients, 117 AM and 114 M, were studied. Failure of therapy occurred in 1 AM patient and in 3 M patients. The radical cure rate was 84% for the AM regimen and 65% for the M regimen (P = 0.002). Recrudescence (including an unknown percentage of reinfections) occurred in 15% of AM patients and in 30% of M patients (P = 0.01). The mean parasite clearance time was 40 h (SD = 16) for AM and 60 h (SD = 27) for the M regimen (P = 0.0001). No effect of artemisinin was noted on gametocytes present on admission, but new gametocytes developed less frequently in the AM group. The addition of a single dose of 500 mg artemisinin to 500 mg mefloquine increased the efficacy and reduced the rate of recrudescence, but this regimen was not adequate and, for short course regimens, more doses of artemisinin as well as higher, doses of mefloquine should be studied.

Fluorescein angiographic appearance of Dalen-Fuchs nodules in sympathetic ophthalmia

A case of sympathetic ophthalmia is presented in which a single lesion located posteriorly at the level of the retinal pigment epithelium caused a serous macular detachment. We believe that this lesion represented an atypical Dalen-Fuchs nodule. Most reports of the fluorescein angiographic appearance of Dalen-Fuchs nodules describe multiple sites of choroidal leakage during the early phases, which may coalesce during the late phases of the angiogram. The lesion we detected was hypofluorescent in early phases of the fluorescein angiogram and showed late staining. The early hypofluorescence seen in the lesion may be explained by an intact retinal pigment epithelium over the presumed Dalen-Fuchs nodule, blockage of choroidal fluorescence by the nodule, and areas of granulomatous inflammation in the inner choroid and choriocapillaris. The staining in the late phases of the fluorescein angiogram may be explained by accumulation of fluorescein into the presumed Dalen-Fuchs nodule.

The effects of freezing and antibiotics on the viability of Acanthamoeba cysts

The effects of cryotherapy and antibiotics (paromomycin, neomycin, or propamidine isethionate) on the viability of Acanthamoeba polyphaga and Acanthamoeba castellani cysts were studied in vitro. Either cryotherapy or exposure to antibiotic led to a decrease in the number of viable A castellani detected; A polyphaga showed variable response to the antibiotics tested. The combination of cryotherapy and antibiotic therapy was more cysticidal than either modality alone and eliminated detectable viable organisms in five of six experiments. Of the antibiotic solutions tested, paromomycin (15 mg/mL) was the most effective.