A Comparison of the Diagnostic Accuracy and Reliability of Subjective Grading and Computer-Aided Assessment of Intranodal Vascularity in Differentiating Metastatic and Reactive Cervical Lymphadenopathy

PURPOSE

Ultrasound is a well-established imaging modality in the assessment of malignant cervical lymphadenopathy. With the use of Doppler ultrasound, intranodal vascularity can be evaluated. However, the major limitation of ultrasound is operator dependency. Therefore, this study aimed to evaluate and compare the diagnostic accuracy and reliability of the subjective grading and computer-aided approach in assessing intranodal vascularity for the differentiation of benign and malignant lymph nodes.

MATERIALS AND METHODS

The present study retrospectively assessed 99 power Doppler ultrasound images of cervical lymph nodes and evaluated the degree of intranodal vascularity using qualitative subjective grading (QSG) and quantitative computer-aided (QCA) methods. The diagnostic accuracy of the two methods in distinguishing metastatic and reactive nodes and their inter- and intra-rater reliability in assessing intranodal vascularity were evaluated and compared.

RESULTS

The results showed that the QCA method was more accurate than the QSG method with a significantly higher sensitivity (67.8 % and 61.9 %, respectively, p < 0.05) and specificity (73.3 % and 57.3 %, respectively, p < 0.05). Using the intranodal vascularity index as determined by the QCA approach, the optimum cut-off to differentiate metastatic and reactive cervical lymph nodes was 32 %. The QCA method showed higher inter- and intra-rater reliability than the QSG method.

CONCLUSION

In the assessment of the degree of intranodal vascularity, the QCA method was more accurate and reliable than the QSG method in distinguishing metastatic and reactive lymph nodes.

Natural and synthetic flavonoid modulation of TRPC5 channels

Background and Purpose

The TRPC5 proteins assemble to create calcium‐permeable, non‐selective, cationic channels. We sought novel modulators of these channels through studies of natural products.

Experimental Approach

Intracellular calcium measurements and patch clamp recordings were made from cell lines. Compounds were generated by synthetic chemistry.

Key Results

Through a screen of natural products used in traditional Chinese medicines, the flavonol galangin was identified as an inhibitor of lanthanide‐evoked calcium entry in TRPC5 overexpressing HEK 293 cells (IC₅₀ 0.45 μM). Galangin also inhibited lanthanide‐evoked TRPC5‐mediated current in whole‐cell and outside‐out patch recordings. In differentiated 3T3‐L1 cells, it inhibited constitutive and lanthanide‐evoked calcium entry through endogenous TRPC5‐containing channels. The related natural flavonols, kaempferol and quercetin were less potent inhibitors of TRPC5. Myricetin and luteolin lacked effect, and apigenin was a stimulator. Based on structure–activity relationship studies with natural and synthetic flavonols, we designed 3,5,7‐trihydroxy‐2‐(2‐bromophenyl)‐4H‐chromen‐4‐one (AM12), which inhibited lanthanide‐evoked TRPC5 activity with an IC₅₀ of 0.28 μM. AM12 also inhibited TRPC5 activity evoked by the agonist (−)‐Englerin A and was effective in excised outside‐out membrane patches, suggesting a relatively direct effect. It inhibited TRPC4 channels similarly, but its inhibitory effect on TRPC1–TRPC5 heteromeric channels was weaker.

Conclusions and Implications

The data suggest that galangin (a natural product from the ginger family) is a TRPC5 inhibitor and that other natural and synthetic flavonoids contain antagonist or agonist capabilities at TRPC5 and closely related channels depending on the substitution patterns of both the chromone core and the phenyl ring.

Disseminated amyloidosis presenting with right proximal femur pathological fracture in a haemodialysis end-stage renal failure patient

Osteoarticular amyloidosis can be one of the musculoskeletal system manifestations related to dialysis. We share our experience in dealing with a case of disseminated haemodialysis-associated amyloidosis in a 74-year-old end-stage renal failure patient. This patient suffered from a serious complication, namely an unprovoked pathological fracture at the basal neck region of the right femur. Polyarticular cystic and lytic lesions over the contralateral proximal femur, bilateral proximal humerus and the right lunate were noted on further imaging. In view of extensive amyloidotic infiltration into the proximal femur as well as the acetabulum, a cemented total hip arthroplasty operation was performed for pain relief and restoration of function. The radiological investigations, diagnostic challenges, operative as well as histopathological findings are discussed. This disease should be considered in the differential diagnosis of pathological juxta-articular fracture in patients undergoing haemodialysis.

Study of wrist posture, loading and repetitive motion as risk factors for developing carpal tunnel syndrome

Occupational risk factors of carpal tunnel syndrome (CTS) are popular current research targets, with main emphasis put on wrist posture and dynamics. In this study, we do not intend to pinpoint individual occupations, but aim to identify high risk wrist postures and actions which may occur across various occupations. It is hoped that prevention can thus be instituted in a general population by directing at the particular causative wrist actions rather than exclusively targeting isolated occupations. We performed a case-control study with 166 cases and 111 controls recruited from different hospitals in Hong Kong in 2004. All cases and controls completed the survey on their general health condition, smoking status, wrist posture and motion as well as psychosocial status at the time of diagnosis of CTS. Frequent flexion OR = 4.436 (95% CI: 1.833-10.734), frequent extension OR = 2.691 (95% CI: 1.106-6.547) of the wrist were found to be associated with CTS. Frequent sustained forceful motion of the wrist OR = 2.588 (95% CI: 1.144-5.851) was also found to be associated with CTS. Neutral wrist position and repetitive wrist motion were not associated with CTS. Adjustment was made for age, sex, BMI, smoking and psychosocial stress. Our study confirms that frequent flexion, extension and sustained force of the wrist increase the risk of developing CTS.

Spontaneous mammary tumors in aging Noble rats

Noble (Nb) rat strain has been used for the study of hormonal carcinogenesis of mammary and prostate glands, for its susceptibility to develop premalignant lesions as well as carcinomas in these organs by sex hormones. However, background information on the spontaneously developed mammary tumors in this rat strain is scarce. We report on the incidence rate, latency period and histopathology of mammary tumors spontaneously developed in the senile intact and untreated Nb rats compared with those induced by either combined treatments with sex steroids or 7,12-dimethylbenz[a]anthracene (DMBA) in the same rat strain. We observed that the incidence rate of spontaneous mammary tumors was 45% in female Nb rats and 3% in the males. The average age of the female Nb rats to develop palpable tumors was 14 months and rarely detected in animals less than 12 months old. It was also noted that the incidence rate of the spontaneous mammary tumors was similar to those induced by combined treatments with sex steroids for 8-10 months (46.7% for T+E2 and 55.6% for T+DES) but less than those by DMBA treatment in 8 months (over 80%). Histologically, majority of the spontaneous mammary tumors were fibroadenomas, which comprised 70% of all collected tumors and about 20% were carcinomas whereas tumors induced by steroid hormones and DMBA were all carcinomas. Distant metastases of spontaneous mammary carcinomas to lung, liver and lymph nodes were also noted, but rarely.

Malaise scores in adulthood of children and young people who have been in care

Data from the National Child Development Study are used to assess the risk of high Malaise scores (indicating a tendency towards depression) amongst young adults at age 23 and 33. Results indicate that adults who have been in care are more likely to have high Malaise scores than are those who have not been in care. For men this risk increases as they grow older. Those with an early experience of social disadvantage are also more vulnerable to a high Malaise score than those not so disadvantaged. Overall, when other factors are controlled, the risk of a high Malaise score in adulthood is significantly greater for young adults who have been in care than those who have experienced severe social disadvantage in their childhood, except for women at age 33, where an early experience of social disadvantage carries a greater risk than the care experience.

Oestrogen receptor status and survival in Chinese females with breast cancer

Oestrogen receptor assay was performed on one hundred and sixty-eight patients with proven breast cancer. Fifty-two per cent were positive for receptors; there was a lower incidence of positives in both the pre- and postmenopausal women, when compared with corresponding figures for American women. Patients were randomized into different modes of treatment. It was found that oestrogen receptor positive patients fared better than the negative ones irrespective of the stage of the disease or the treatment received, and this difference was statistically significant in patients with early disease (stages one and two). In patients assigned to some form of endocrine manipulation, 77% of receptor positive, and 7% receptor negative patients showed a response to treatment; in those receiving chemotherapy, receptor negative patients fared better than the positive ones, though the difference was not statistically significant.