Optimising diffusion-weighted imaging of the thyroid gland using dedicated surface coil

AIM

To assess the feasibility of applying field-of-view (FOV) optimised and constrained undistorted single-shot (FOCUS) diffusion-weighted imaging (DWI) in the thyroid gland by comparing its image quality with conventional DWI (C-DWI) qualitatively and quantitatively using a dedicated surface coil exclusively designed for the thyroid gland at 3 T magnetic resonance imaging (MRI).

MATERIALS AND METHODS

In this prospective study, 32 healthy volunteers who had undergone 3 T the thyroid gland MRI with FOCUS-DWI and C-DWI were enrolled. Two independent reviewers assessed the overall image quality, artefacts, sharpness, and geometric distortion based on a five-point Likert scale. The signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC) were quantified for both sequences. Interobserver agreement, qualitative scores, and quantitative parameters were compared between two sequences.

RESULTS

Agreement between the two readers was good for FOCUS-DWI (κ = 0.714-0.778) and moderate to good for C-DWI (κ = 0.525-0.672) in qualitative image quality assessment. Qualitatively, image quality (overall image quality, artefacts, sharpness, and geometric distortion) was significantly better in FOCUS-DWI than that in the C-DWI (all p<0.05); however, quantitatively, FOCUS-DWI had significantly lower SNRs (p<0.001) and CNRs (p=0.012) compared with C-DWI. The ADC value on FOCUS-DWI was significantly higher than that on C-DWI (p<0.001).

CONCLUSION

FOCUS-DWI depicted the thyroid gland with significantly better image quality qualitatively and less ghost artefacts, but had significantly lower SNR and CNR quantitatively, compared with C-DWI, suggesting that both DWI sequences have advantages and could be chosen for different purposes.

[Value of indocyanine green fluorescence tracer in laparoscopic cholecystectomy for acute cholecystitis]

Objective: To explore the value of low-dose indocyanine green (ICG) fluorescence imaging in laparoscopic cholecystectomy (LC) for acute cholecystitis. Methods: Clinical data of 198 patients with acute cholecystitis and had received LC in Changzhou No.2 People's Hospital from January 2020 to September 2021 were collected. In the fluorescence group (n=97), peripheral intravenous injection of ICG was performed 15 minutes before LC, while conventional white light was applied in the control group (n=101). The efficiency of bile duct discrimination, operation time, intraoperative bleeding and postoperative complications were compared between the two groups. Results: Of the 198 patients, 86 were males and 112 females. The differences were not statisticly significant in age [52 (44, 63) vs 56 (46, 68) years, P>0.05], history of chronic inflammation [34(35.1%) vs 31(30.7%) cases, P>0.05] and other clinical baseline data between the two groups. Compared with the control group, the fluorescence group had higher efficiency of bile duct identification [18 (16,19) vs 38 (28,55) min,P<0.001], shorter operation time [45 (40,60) vs 80 (65,100) min,P<0.001], less intraoperative bleeding [10 (5,15) vs 60 (20,100) ml,P<0.001], and less postoperative liver function damage [alanine aminotransferase 35.0 (23.4,51.0) vs 98.3 (67.0,134.8)U/L,P<0.001]. In the control group, there was one case of biliary duct injury during operation, one case of postoperative biliary fistula, and one case of postoperative hemorrhage. No similar adverse event was found in fluorescence group. Conclusions: ICG fluorescence imaging can improve the efficiency of LC for patients with acute cholecystitis. It is easy to operate and has a good clinical application value.

[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017]

Objective: To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. Methods: This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed. Results: Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn't be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%. Conclusions: More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.

[Analysis of non-invasive prenatal screening detection in fetal chromosome aneuploidy]

Objective: To evaluate the efficacy of non-invasive prenatal screening (NIPS) in the detection of fetal aneuploidies. Methods: Cell free DNA was sequenced in 5 566 pregnant women to identify the fetal aneuploidies in the First Affiliated Hospital of Zhengzhou University from January 1(st), 2015 to March 15(th), 2016. Among them, 5 230 (93.96%, 5 230/5 566) were singleton pregnancies and 336 (6.04%, 336/5 566) were twin pregnancies. In singleton pregnancies, 1 809 (34.59%, 1 809/5 230) were women with advanced maternal age, and 3 421 (65.41%, 3 421/5 230) were young women. The positive results of NIPS were validated by karyotyping through invasive procedures and neonatal outcomes were followed up by telephone. Results: Among the 5 566 women, 69 (1.24%, 69/5 566) got positive NIPS results, with 66 in singleton pregnancies and 3 in twin pregnancies. Two were monochorionic diamniotic twins and 1 was dichorionic twin pregnancy. The positive predictive value of NIPS for trisomy 21, 18 and 13 were 100.0%, 90.9% and 100.0%, and was 55.6% for sex chromosome aneuploidies. There was no false negative case found during the follow-up. In the advanced maternal age group and young women group, the prevalence rates of fetal chromosomal aneuploidies were 1.11%(20/1 809) and 0.94%(32/3 421), respectively. In the young women with soft markers in fetal ultrasound, the prevalence of fetal chromosomal aneuploidies was 1.44% (7/487), and in serum high risk women, it was 0.94% (7/747). In women with the serum screening risk with cut-off value, 0.89%(9/1 016) had fetal aneuploidies, and the prevalence was 0.77%(9/1 171) in volunteers. There was no statistically significant difference among these groups (P=0.636). Conclusions: There is no difference in the detection rate of fetal aneuploidies between high-risk women in serum screening and volunteers in NIPS. NIPS is more suitable as a first line screening test for women without fetal ultrasound abnormalities. It should be used carefully when there is ultrasound abnormalities.

Annealing effect on the structure and electronic transport properties in La5/8Ca3/8MnO3/ErMnO3 multilayer thin films

Ferromagnetic La5/8Ca3/8MnO3 (LCMO) and Ferroelectric ErMnO3 (EMO) multilayer thin films with sandwich structure (LCMO/EMO/LCMO) were grown on (LaAlO3)0.3(Sr2AlTaO6)0.7 (001) [LSAT (001)] substrates by pulsed laser deposition (PLD) method. For these films, the structural characterization was carried out by X-ray diffraction (XRD), and the temperature-dependence resistivity (p-T) showing the metal-insulator transition (Tp) also was measured. In the multilayer thin films the LCMO (002) peak move to lower Bragg angles after annealing at 900 degrees C for 30 hours under 1atm Oxygen pressure, and this condition is much different from the LCMO single layer films where the (002) peak moves to higher Bragg angle after annealing due to the lattice mismatch between the LCMO layer and the substrate. By increasing the thickness of LCMO, the multilayer samples show two MR peaks in a wide temperature range during the process of M-l transition. This phenomenon is attributed to a new (La5/8Ca3/8)xEr(1-x)MnO3 layer produced by the solubility between LCMO and EMO layers after high-temperature annealing. In this paper, we provide some evidence of dissolution between LCMO and EMO layers, and discuss the influence on structure and electronic transport properties in the composite thin films by annealing.

Prolongation of rat intestinal allograft survival by administration of triptolide-modified donor bone marrow-derived dendritic cells

Severe graft rejection remains an important obstacle in intestinal transplantation. In this study, dendritic cells (DCs) isolated from rat bone marrow were cultured for 5 days, and triptolide applied for 3 more days. The recipient rats were pretreated with donor triptolide-modified or not modified DC. Small bowel transplantation was performed to observed survival times. We demonstrated that triptolide markedly inhibited both the expression of CD80 and MHCII expression on DCs. Triptolide-modified DCs stimulated lower proliferative responses among allogeneic T cells, prolonging the survival of intestinal allografts in rats. These results suggested that pretreatment with triptolide-modified DC prolonged the survival of rat small bowel allografts after transplantation.

Intraspecies and interspecies comparison of the compressive properties of the medial meniscus

Quantification of the compressive material properties of the meniscus is of paramount importance, creating a "gold-standard" reference for future research. The purpose of this study was to determine compressive properties in six animal models (baboon, bovine, canine, human, lapine, and porcine) at six topographical locations. It was hypothesized that topographical variation of the compressive properties would be found in each animal model and that interspecies variations would also be exhibited. To test these hypotheses, creep and recovery indentation experiments were performed on the meniscus using a creep indentation apparatus and analyzed via a finite element optimization method to determine the material properties. Results show significant intraspecies and interspecies variation in the compressive properties among the six topographical locations, with the moduli exhibiting the highest values in the anterior portion. For example, the anterior location of the human meniscus has an aggregate modulus of 160 +/- 40 kPa, whereas the central and posterior portions exhibit aggregate moduli of 100 +/- 30 kPa. Interspecies comparison of the aggregate moduli identifies the lapine anterior location having the highest value (450 +/- 120 kPa) and the human posterior location having the lowest (100 +/- 30 kPa). These baseline values of compressive properties will be of help in future meniscal repair efforts.

[Enantioseparation of twelve pharmaceutical racemates with high performance capillary electrophoresis using L-leucine as chiral selector]

A rapid enantiomeric separation method using L-leucine as chiral selector was established. Capillary zone electrophoresis (CZE) has been used for the enantiomeric separation of twelve pharmaceutical racemates with bare fused silica capillary and employing L-leucine as chiral selector. The enantiomeric resolution was influenced by L-leucine concentration and pH of background electrolyte (BGE). The effects of the BGE types and concentrations on the enantiomeric separation were also investigated. The results showed that in the solution containing 50 mmol/L borax and 70 mmol/L L-leucine (pH 9.0), all the twelve drugs were on baseline separated in less than 11 minutes.

Effects of aging and dietary restriction on the structural integrity of rat articular cartilage

The objectives of this study were to investigate the effects of aging and diet restriction on the biomechanical properties of articular cartilage, using a well-controlled rat model (Fischer 344). This animal model is recommended by the National Institute of Aging specifically to study aging and diet issues. The intrinsic biomechanical properties of articular cartilage were obtained using a creep indentation approach. The ages chosen (6, 12, 18, 24 months of age) correspond to approximate human ages of 20 to 80 years old. The diet regimen employed in this study used either an ad libitum fed group or a group fed 60% of the mean food intake of the ad libitum group. The results demonstrate that, unlike bone, rat articular cartilage biomechanical properties are not affected in a discernible manner by diet restriction, despite the fact that diet-restricted animals were significantly lighter in terms of body weight. Age effects on biomechanical properties are found only at 6 and 12 months probably due to developmental reasons, but not at later ages. It appears that aging and diet restriction have profoundly different effects on articular cartilage and bone. Another significant result of this study was to establish the rat as a suitable animal model to study cartilage biomechanical properties. Thus, the rat can be added to the list of animals that can be used to study structure-function and pathophysiological relationships in articular cartilage.

Effects of diabetes mellitus on the biomechanical properties of human ankle cartilage

Metabolic changes attributable to diabetes mellitus affect numerous organ systems in the body. For example, patients with diabetes have an increased number of musculoskeletal injuries and afflictions compared with patients without diabetes and experience more morbidity associated with injury and treatment. Although diabetes also may afflict articular cartilage, no studies have shown a conclusive link between diabetes and cartilage structural integrity. The objective of this study was to obtain and compare the intrinsic material properties of human ankle articular cartilage from patients with diabetes and those without diabetes. These biomechanical properties (aggregate modulus, Poisson's ratio, shear modulus, and permeability) were found to differ significantly between specimens from patients with diabetes and patients without diabetes. Specifically, cartilage from patients with diabetes was significantly softer and more permeable than cartilage from control subjects. For example, in the central portion of the talus, cartilage from patients with diabetes had a 38% smaller aggregate modulus, 37% smaller shear modulus, and 111% larger permeability than did tissue from patients without diabetes. These results provide evidence that joint pathologic processes in patients with diabetes may be associated with compromised structural integrity of articular cartilage.

Exercise affects the mechanical properties and histological appearance of equine articular cartilage

Dorsal carpal osteochondral injury is a major cause of reduced performance in horses undergoing high-intensity training. It was hypothesised that the mechanical behaviour and histology of cartilage are influenced by the intensity of exercise and by location within a joint. Relationships between histology and mechanical behaviour were identified in 2-year-old horses undergoing 19 weeks of high-intensity treadmill training or low-intensity exercise and then compared between groups. Dorsal and palmar test sites were identified on radial, intermediate, and third carpal articular surfaces after euthanasia. The mechanical properties of cartilage were determined with an automated creep indentation apparatus as previously described for equine cartilage. Cartilage morphology was assessed with use of sections stained with haematoxylin and eosin and toluidine blue. Dorsal cartilage was less permeable, thinner, and had a loss of chondrocyte alignment compared with palmar cartilage. Cartilage from strenuously trained horses showed more fibrillation and chondrocyte clusters than did cartilage from gently exercised animals. Dorsal radial carpal cartilage and third carpal cartilage of strenuously trained animals were significantly less stiff than that from gently exercised animals, and the former had reduced superficial toluidine blue staining compared with that from the gently exercised group. These results indicate that topographical and exercise-related differences exist in the morphology and mechanical properties of carpal cartilage and suggest that strenuous training may lead to deterioration of cartilage at sites with a high clinical incidence of lesions.

The effects of intra-articular methylprednisolone and exercise on the mechanical properties of articular cartilage in the horse

INTRODUCTION

Intra-articular corticosteroids are widely used as anti-inflammatory agents for symptomatic management of arthritis, but their administration with concurrent exercise remains controversial. Biochemical and morphologic analysis of treated cartilage has revealed conflicting results, but previous biomechanical assessment has not been undertaken.

OBJECTIVE

To compare the biomechanical properties of intra-articular methylprednisolone acetate (MPA) and diluent treated cartilage in treadmill exercised horses.

METHODS

Eight 2-year-old female horses had MPA or diluent administered into contralateral middle carpal joints at 14 day intervals for a total of four treatments per horse. Horses underwent a standard treadmill exercise protocol until euthanasia (day 70). Standard sites were tested on the third, radial and intermediate carpal bones using an automated indentation apparatus to obtain the creep and recovery behavior of the articular cartilage. Using previously validated biphasic creep indentation methodology, aggregate modulus, Poisson's ratio, permeability, shear modulus, thickness, creep and recovery equilibrium times and percent recovery were obtained at each site. Results were analyzed using ANOVA and multiple comparisons of the means (P < 0.05).

RESULTS

Cartilage intrinsic material properties and thickness demonstrated significant differences between MPA and diluent treated joints. Diluent treated cartilage had a 97% increase in compressive stiffness modulus (P = 0.0001), was 121% more permeable (P = 0.0001), had 88% increase in shear modulus (P = 0.0001), and was 24% thicker (P = 0.0001) than MPA treated articular cartilage.

CONCLUSIONS

The findings indicate that repetitive intra-articular administration of MPA to exercising horses alters the mechanical integrity of articular cartilage, which could lead to early cartilage degeneration.

Human articular cartilage biomechanics of the second metatarsal intermediate cuneiform joint

Intrinsic material properties and histomorphometry of freshly frozen, human cadaveric cartilage from the second metatarsal intermediate cuneiform (SMIC) articulation were obtained to provide biomechanical mapping of the surfaces. The biphasic creep indentation methodology and an automated creep indentation apparatus were used to measure aggregate modulus, Poisson's ratio, permeability, shear modulus, and thickness. Biomechanical experiments were performed on four sites of the SMIC joint in 14 specimens (seven pairs): two sites in the second metatarsal base and two sites in the intermediate cuneiform head. Results of the study indicate that no significant variations exist in the biomechanical comparisons between specific articulations, gross articulations, and left and right joints. For example, cartilage from the second metatarsal base and intermediate cuneiform head had an aggregate modulus of 0.99 MPa and 1.05 MPa, respectively. The Poisson's ratio and permeability of all test sites grouped together were found to be 0.08 and 3.05 x 10(-15) m4/N.s, respectively. Cartilage thickness was measured at 0.61 mm. This biomechanical study suggests that similarities in cartilage properties may be beneficial in preventing the human SMIC articulation from developing early degenerative changes. Histological evaluation demonstrated that SMIC cartilage exhibits structural characteristics (such as the absence of chondrocyte columnar arrangement in the deep zone) which may be typical of cartilage that does not experience habitually high compressive stresses. This knowledge could aid surgeons in generating a deeper perspective of the relationship between clinical pathologies of articular cartilage and intrinsic biomechanical etiologies of degenerative joint diseases.

Biochemical effects of estrogen on articular cartilage in ovariectomized sheep

Cartilage is a sex-hormone-sensitive tissue but the role of estrogen in the pathogenesis of osteoarthritis (OA) remains controversial. In this study, intrinsic material properties and thickness of articular cartilage of the knee joint of ovariectomized (OVX) and estrogen-treated sheep were measured. Skeletally mature ewes (N = 36, same breed, same housing 4-5 years old) were divided into; sham treated (n = 9), OVX (N = 13), OVX plus one estradiol implant (OVXE; N = 10) and OVX plus two estradiol implants (OVX2E; N = 4). Twelve months following sham procedure or OVX, sheep were euthanized and articular cartilage from a total of 216 points in the left femorotibial (knee) joints was tested for aggregate modulus, Poisson's ratio, permeability, thickness and shear modulus (six sites per sheep). When all of the sites in each knee were grouped together, OVX had a significant effect on articular cartilage. The sham cartilage of all sites grouped together had a larger aggregate modulus (P = 0.001) and a larger shear modulus (P = 0.054) than the OVX tissue. No statistically significant differences were seen for permeability and thickness between OVX, sham, OVXE and OVX2E. Differences existed in biomechanical properties at the different sites that were tested. Overall, no one location tended to be lowest or highest for all variables. This biomechanical study suggests that OVX may have a detrimental effect on the intrinsic material properties of the articular cartilage of the knee, even though the cartilage of the OVX animals appeared normal. Treatment with estradiol implants ameliorated these deleterious effects and may have helped maintain the tissue's structural integrity. Our study supports epidemiological studies of OA in women after menopause. The protective effect of estrogen and it's therapeutic effect remain to be further defined. This model may allow the relationship of estrogen and estrogen antagonists to be studied in greater detail, and may be valuable for the study of the pathogenesis and therapies of OA of postmenopausal women, particularly in its early stages.

[Observation on 104 senile chronic renal insufficiency patients treated with integrated traditional Chinese and Western medicine]

A clinical study on 104 cases of senile chronic renal insufficiency (SCRI) was conducted. In order to analyze the clinical features of SCRI and the efficacy of integrated TCM-WM treatment, all cases were treated by this combined therapy, except for the treatment of primary diseases and removing the aggravating factors. It was concluded that the effective rate reached 57% it had no significant difference with 61% of non-senile group, P > 0.05. The senile patients featured Kidney Yang Deficiency in TCM Syndrome Differentiation. It could guide the clinical treatment and thus the senile patient's Yang should be strengthened at usual time. When Kidney Qi was insufficient and frequent nocturia appeared, sufficient water supply as well as Warming Kidney Yang drugs should be given and that Yang Qi should be protected all the time. Also diuretics and purgatives should not be misused which might damage Yin and Yang.