IRON MAN interacts with Cu-DEFICIENCY INDUCED TRANSCRIPTION FACTOR 1 to maintain copper homeostasis

Copper (Cu) is essential for plant growth and development. IRON MAN (IMA) is a family of small peptides that can bind both iron (Fe) and Cu ions. It was reported that IMAs mediate Fe homeostasis in Arabidopsis thaliana. However, it remains unclear whether IMAs are involved in Cu homeostasis. The transcript abundance of IMA genes decreased in response to Cu deficiency. The combined disruption of all IMA genes caused enhanced tolerance to Cu deficiency and resulted in an increase in the transcript abundance of Cu uptake genes, whereas the overexpression of IMA1 or IMA3 led to the opposite results. Protein interaction assays indicated that IMAs interact with Cu-DEFICIENCY INDUCED TRANSCRIPTION FACTOR1 (CITF1), which is a positive regulator of the Cu uptake genes. Further studies showed that IMAs not only interfere with the DNA binding of CITF1 but also repress the transcriptional activation activity of CITF1, hence resulting in downregulation of the Cu uptake genes. Genetic analyses indicated that IMAs modulate Cu homeostasis in a CITF1-dependent manner. Our findings indicate that IMAs inhibit the functions of CITF1 in regulating Cu deficiency responses, thereby providing a conceptual framework for comprehending the regulation of Cu homeostasis.

Evaluation of maternal serum thiol and ischemia-modified albumin levels in cases of placenta previa: A case-control study in a tertiary center

AIM

We aim to compare the maternal serum thiol and ischemia-modified albumin (IMA) levels between pregnant women with placenta previa and those with uncomplicated pregnancies and to determine whether changes in these levels were useful in predicting cases of abnormally invasive placenta (AIP).

METHODS

Fifty-five pregnant women diagnosed with placenta previa according to the diagnostic criteria (case group) were compared to 100 women with uncomplicated pregnancies of similar demographic characteristics (control group). The patients with placenta previa were further divided into two subgroups: AIP (n = 20) and placenta previa without invasion (n = 35). The maternal serum native thiol, total thiol, disulfide, and IMA levels of the groups were evaluated.

RESULTS

The native thiol, total thiol, and IMA values were significantly lower in the case group than in the control group (p < 0.001). The disulfide values were similar between the study and control groups (p = 0.488). When the AIP and placenta previa without invasion groups were compared, the levels of native thiol, total thiol, disulfide, and IMA were similar (p > 0.05).

CONCLUSIONS

Maternal serum thiol and IMA levels were lower in placenta previa cases compared to the control group. However, these parameters were not useful in predicting AIP cases.

The thiol/disulfide balance is shifted towards oxidation in psoriatic arthritis compared to controls and is associated with higher disease activity

OBJECTIVE

This study was designed to compare thiol/disulfide and ischemia-modified albumin (IMA) levels between psoriatic arthritis (PsA) and healthy controls and evaluate the correlation between these molecules and the disease activity scores used in PsA.

METHODS

A total of 63 PsA patients and 49 healthy volunteers were included in the study. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), modified disease activity score 28 (DAS28), and Bath Ankylosing Spondylitis Functional Index (BASFI) scores were used as disease activity indices for PsA patients. Calculations of native thiol (-SH), disulfide (-SS), and total thiol (-SH+-SS) molecules were made by the automatic spectrophotometric method, and the albumin cobalt binding test was used to measure IMA levels.

RESULTS

In the PsA group, -SS/-SH and -SS/(-SH+-SS) levels were higher and -SH/(-SH+-SS) levels were lower than in controls. In the linear regression analysis, a significant correlation relationship was detected between DAS28-erythrocyte sedimentation rate (ESR) and -SS/(-SH+-SS) (β = 0.795, CI 95%, 0.196-1.395; P = .010), -SH/(-SH+-SS) (β = -0.475, CI 95%, 0.114-0.836; P = .010) and IMA (β = 3.932, CI 95%, 0.859-7.005; P = .013). Additionally, a significant correlation was detected between IMA and BASDAI and BASFI.

CONCLUSION

In PsA, thiol/disulfide homeostasis has shifted in favor of disulfide as an oxidative indicator. Serum thiol/disulfide levels are correlated with PsA disease activity indices.

Facial Pain Triggered by Inferior Turbinate Partial Resection in a Patient with a Previous History of Inferior Meatal Antrostomy: A Case Report

OBJECTIVES

Inferior meatal antrostomy (IMA) is regarded as a safe method, with minimal complications, for managing various lesions in the maxillary sinus. However, in patients with persisting IMA window, resection of the inferior turbinate may result in direct airflow into the antrum, irritating the antral mucosa.

METHODS

Case report and review of literature.

RESULTS/CASE

The present report describes a 29-year-old man who previously underwent unilateral IMA for the excision of a dentigerous cyst. The patient did not report any facial pain following the excision of the cyst. One year later, this patient underwent partial resection of the inferior turbinate for the resolution of nasal stuffiness by another surgeon. Soon after surgery, the patient developed severe facial and ocular pain on the side of the IMA, with the pain being especially aggravated upon inhalation. Endoscopy and computed tomography (CT) revealed a persisting IMA window. The patient's severe discomfort was thought to result from direct airflow into the maxillary sinus, as the resected turbinate may have altered normal nasal airflow. A unilateral inferior meatal augmentation procedure (IMAP) with an autologous ear cartilage implant was performed, resulting in complete relief of pain and discomfort.

CONCLUSIONS

Although IMA alone is a relatively safe surgical procedure, care should be taken when performing inferior turbinoplasty in patients with persistent IMA opening.

Arc of Riolan revisited-proposal of a new classification system

BACKGROUND

The arterial supply of the large colon is provided by the superior mesenteric artery (SMA) and inferior mesenteric artery (IMA). A particularly important area, especially in the field of colorectal surgery is the splenic flexure of the colon. There is a noticeable misunderstanding in the correct nomenclature of the major arterial anastomoses between SMA and IMA - Drummond's Marginal Artery (DMA), Arc of Riolan (AOR), and Moskovitz Artery (MA). The aim of this study is to organize the nomenclature and propose a new simplified one to facilitate communication between physicians of various specialties.

MATERIALS AND METHODS

Fourteen formalin-fixed cadavers (9 male, 5 female) accessible from the Chair of Anatomy of the Jagiellonian University Collegium Medicum were dissected to examine and describe the anatomical variations of anastomoses between SMA and IMA.

RESULTS

The artery of Drummond was present in all 14 specimens maintaining the continuity of the vessel along its entire course. The Arc of Riolan was found in 7 out of 14 cadavers (50%). The artery of Moskovitz was not found. The average length measured between IMA and aortic bifurcation and between IMA and SMA was 51,00 mm and 84,68mm respectively.  CONCLUSIONS: SMA and IMA anastomoses form an arterial network that is characterized by high variability and trail in surgically strategic areas. For this reason, simplifying the terminology and using unambiguous names of these vessels based on their trail and anatomical relationship with IMV are crucial for the proper planning and execution of surgical procedures performed on the colon.

Investigation of serum ischemic-modified albumin, galectin-3, paraoxonase-1, and myeloperoxidase activity levels in patients with acute brucellosis

OBJECTIVES

Infection remains current as an important discussion topic in the etiological factors of atherosclerosis. Ischemic-modified albumin (IMA), galectin-3 (gal-3), paraoxonase-1 (PON-1), and myeloperoxidase (MPO) are biomolecules that play an important role in the pathogenesis of atherosclerosis. Our aim is to investigate serum IMA, gal-3, PON-1, and MPO activity in acute brucellosis infection.

MATERIALS AND METHODS

Forty patients with acute brucellosis and 40 healthy individuals were included in the study. Serum IMA, gal-3, PON-1, and MPO activity were analyzed by the ELISA method.

RESULTS

In acute brucellosis infection, serum gal-3, IMA, and MPO activities were found to be significantly increased compared to the control group, and PON-1 activity was found to be significantly decreased compared to the control group (p < 0.001). There was a positive correlation between serum IMA, and MPO activity (r = 0.707 p = 0.000) and a negative correlation (r = -0.943, p = 0.000) between PON-1 activity. There was a positive correlation between serum gal-3 and MPO activity (r = 0.683, p = 0.000) and IMA level (r = 0.927, p = 0.000) and a negative correlation between PON-1 activity (r = -0.951, p = 0.000).Conclusion, it was found that serum gal-3, IMA levels and MPO activity increased, while PON-1 activity decreased. These results showed that the oxidant-anti-oxidant balance is impaired in acute brucellosis infection. In addition, these results indicate that brucella infection may be increase the risk of atherosclerosis. Further studies are needed to support our findings.

Claudin18.2 expression in pulmonary mucinous adenocarcinoma

BACKGROUND

Pulmonary invasive mucinous adenocarcinoma (IMA) is a unique type of lung adenocarcinoma with a high recurrence rate and limited treatment strategies. The tight-junction-associated protein claudin18.2 is a new therapeutic target for several solid tumors. This study aimed to detect the expression of claudin18.2 in IMA and its clinicopathological association with the disease.

METHODS

 The expression of claudin18.2 was immunohistochemically evaluated in an IMA cohort of 84 patients, who underwent partial pneumonectomy between January 2017 and December 2021. Positive staining for claudin18.2 was defined as ≥ 10% of tumor cells showing ≥ 1 + membrane staining or any ≥ 2 + membrane staining.

RESULTS

Claudin18.2 was detected in 76.2% (64/84) of IMA patients, significantly higher than that in non-mucinous adenocarcinoma (NMA). 46.4% (39/84) of the IMA patients met the enrollment criteria of the clinical trials of monoclonal antibodies (≥ 75% of tumor cells demonstrating ≥ 2 + staining intensity). Positive staining for claudin18.2 was significantly associated with smaller tumor size (p = 0.010), less pleural invasion (p = 0.019), and earlier pN stage (p < 0.001). Expression of claudin18.2 was not related to prognosis in multivariate analysis.

CONCLUSIONS

To summarize, in this study we found that claudin18.2 was remarkably highly expressed in IMA and the overexpression was associated with low invasive capacity. Thus, this protein appears to be a promising therapeutic target and deserves further investigation in IMA patients.

IMA peptides function in iron homeostasis and cadmium resistance

Iron (Fe), an essential micronutrient, participates in photosynthesis, respiration, and many other enzymatic reactions. Cadmium (Cd), by contrast, is a toxic element to virtually all living organisms. Both Fe deficiency and Cd toxicity severally impair crop growth and productivity, finally leading to human health issues. Understanding how plants control the uptake and homeostasis of Fe and combat Cd toxicity thus is mandatory to develop Fe-enriched but Cd-cleaned germplasms for human beings. Recent studies in Arabidopsis and rice have revealed that IRON MAN (IMA) peptides stand out as a key regulator to respond to Fe deficiency by competitively interacting with a ubiquitin E3 ligase, thus inhibiting the degradation of IVc subgroup bHLH transcription factors (TFs), mediated by 26 S proteasome. Elevated expression of IMA confers tolerance to Cd stress in both Arabidopsis and wheat by activating the iron deficiency response. Here, we discuss recent breakthroughs that IMA peptides function in the Fe-deficiency response to attain Fe homeostasis and combat Cd toxicity as a potential candidate for phytoremediation.

Could ischemia-modified albumin levels predict the severity of disease in SARS-CoV-2 infection?

INTRODUCTION

Ischemia-modified albumin (IMA) level increases in inflammatory conditions. We aimed to investigate the association between IMA levels and the severity of coronavirus disease 2019 (COVID-19) infection in adult patients.

METHODOLOGY

We grouped adult patients with COVID-19 infection: Group A - mild symptoms, but normal computed tomography (CT), Group B - mild/moderate illness, and Group C - severe or critical illness. We measured IMA levels at the time of diagnosis of COVID-19 infection.

RESULTS

Mean age of the total number of patients (n = 90) was 54.43 (± 8.11) year, and 46.7% (n = 42) were female. IMA levels were highest in Group C and lowest in A (p < 0.001). The most important factor predicting COVID-19 disease severity was IMA. Type 2 diabetes was more frequent in Group C (n = 31) than in Group B (n = 30) (p = 0.042). Asthma was less frequent, and coronary artery disease was more frequent in Group C than in Group A (n = 29) and B (p = 0.009). Duration of hospitalization was highest in Group C (p < 0.001).

CONCLUSIONS

We analyzed a sample of patients with COVID-19 infection and found that IMA predicted severe COVID-19 disease. Disease severity grouping was based on patients' clinical and radiological features. IMA level measured when SARS-CoV-2 infection is diagnosed may be a useful marker in predicting likely disease severity or intensive care need.

Surgical resection of a large invasive mucinous adenocarcinoma: A case report

Invasive mucinous adenocarcinoma often presents with pneumonia-like findings on imaging, which complicates its diagnosis. This case demonstrates that aggressive bronchoscopy is useful for examining infiltrating shadows in the lung field and large tumors occupying the entire lung lobe should be treated cautiously when lung parenchyma develops.

Recurrence Rates With Longer-Term Follow-up After Hallux Valgus Surgical Treatment With Distal Metatarsal Osteotomies: A Systematic Review and Meta-analysis

BACKGROUND

Recurrence of hallux valgus (HV) following corrective surgery is a frequent concern. A recent systematic review estimated recurrence of HV in only 4.9%, which may be an underestimation, as most included studies had short- to mid-term follow-up. The purpose of this systematic review and meta-analysis was to assess long-term outcomes of distal osteotomies of the first metatarsal (M1) to treat HV without inflammatory disease or degenerative arthritis, and to assess HV recurrence rates reported in studies that had a minimum follow-up of 5 years.

METHODS

This systematic review conforms to the PRISMA guidelines. The authors conducted a search using PubMed, Embase, and Cochrane Central Register of Controlled Trials databases. Studies that report outcomes of distal osteotomies of the M1 for noninflammatory and nondegenerative HV at a minimum follow-up of 5 years.

RESULTS

We found 17 eligible studies comprising 18 data sets, reporting outcomes of 4 categories of osteotomies: Chevron, Mitchell, Bösch, and "others." The HV recurrence rate was 64% considering the threshold of >15 degrees hallux valgus angle (HVA), 10% having >20 degrees, and 5% having >25 degrees.

CONCLUSION

At a minimum of 5 years following distal osteotomies of the M1, the mean weighted postoperative HVA was significantly higher for Mitchell osteotomies compared with the 3 other osteotomies reviewed. There were otherwise no significant differences in recurrence rates using the 3 HVA thresholds, or intermetatarsal angle among any of the surgical techniques reported in 2 or more studies. The pooled HV recurrence rates considering the various thresholds of HVA were as follows: 64% having >15 degrees, 10% having >20 degrees, and 5% having >25 degrees. The recurrence rates in the long term for all categories of surgical procedures suggest that better understanding of pathogenesis and prognosis of HV is required before modifying or introducing new surgical techniques.

LEVEL OF EVIDENCE

Level IV, meta-analysis.

Routine Inferior Mesenteric Artery Embolisation is Unnecessary Before Endovascular Aneurysm Repair

OBJECTIVE

A type II endoleak is the most common complication during surveillance after endovascular aneurysm repair (EVAR), and a patent inferior mesenteric artery (IMA) is a known risk factor for an endoleak. The effect of routine IMA embolisation prior to EVAR on overall outcome is unknown. The aim of the study was to compare two strategies: routine attempted IMA embolisation prior to EVAR (strategy in centre A) and leaving the IMA untouched (strategy in centre B).

METHODS

Patients were treated with EVAR in two centres during the period 2005 - 2015, and the data were reviewed retrospectively. The primary endpoints were re-intervention rate due to type II endoleaks and the late IMA embolisation rate. Secondary endpoints included EVAR related re-intervention, sac enlargement, aneurysm rupture, and open conversion rates.

RESULTS

Strategy A was used to treat 395 patients. The IMA was patent in 268 (67.8%) patients, and embolisation was performed in 164 (41.5%). The corresponding figures for strategy B were 337 patients with 279 (82.8%) patent IMAs, two (0.6%) of which were embolised. The mean duration of follow up was 70 months for strategy A and 68.2 months for strategy B. The re-intervention rates due to a type II endoleak were 12.9% and 10.4%, respectively (p = .29), with no significant difference in the rate of re-interventions to occlude a patent IMA (2.0% and 4.7%, respectively; p = .039). The EVAR related re-intervention rate was similar, regardless of strategy (24.1% and 24.6%, respectively; p = .93). Significant sac enlargement was seen in 20.3% of cases treated with strategy A and in 19.6% treated with strategy B (p = .82). The rupture and conversion rates were 2.5% and 2.1% (p = .69) and 1.0% and 1.5% (p = .40), respectively.

CONCLUSION

The strategy of routinely embolising the IMA does not seem to yield any significant clinical benefit and should therefore be abandoned.

Modified Lapidus Procedure and Hallux Valgus: A Systematic Review and Update on Triplanar Correction

This review article examines contemporary methods and assesses radiographic outcomes and postoperative complications following the modified Lapidus procedure. A systematic review demonstrated significant improvements in intermetatarsal angle, hallux valgus angle, and tibial sesamoid position. We are updating a modified Lapidus technique for achieving triplanar correction of hallux valgus. Two cases of hallux valgus, one primary and one recurrent, are presented. As demonstrated in the systematic review, outcomes of Lapidus procedures create future opportunities. Surprisingly, only 78% of the studies assessed for this review reported on the hallux valgus angle and only 33% reported on tibial sesamoid position.

A Case-Control Study of 3D vs 2D Weightbearing CT Measurements of the M1-M2 Intermetatarsal Angle in Hallux Valgus

BACKGROUND

Weightbearing computed tomography (WBCT) 3-dimensional measurements may be reliable in assessing hallux valgus (HV). The objective of this study was to compare 2D and 3D WBCT measurements of the M1-M2 intermetatarsal angle (IMA) in patients with HV and in healthy controls. We hypothesized that 2D and 3D IMA measurements would correlate and have similar reliability in both HV and controls.

METHODS

Retrospective multicenter comparative study included WBCT scans from 83 feet (41 HV, 42 controls). IMA was measured on digitally reconstructed radiographs (DRR-IMA). 3D angle (3D-IMA) and its projection on the weightbearing plane (2D-IMA) were calculated from 3D coordinates of the first and second metatarsals. Intraobserver reliability and intermethod correlations were calculated using intraclass correlation coefficients (ICCs).

RESULTS

Intraobserver reliability was very strong for DRR-IMA (0.95) and 3D-IMA (0.99). Intermethod correlation between the 3 modalities in HV patients ranged from moderate (DRR vs 2D, 0.48; DRR vs 3D, 0.48) to very strong (2D vs 3D, 0.91). Similarly, intermethod correlation in the control group ranged from moderate (DRR vs 2D, 0.56; DRR vs 3D, 0.60) to very strong (2D vs 3D, 0.92).

CONCLUSION

Measurements for IMA are similar using DRR, 3D and 2D projected angles, with very strong intraobserver reliability and moderate to very strong intermethod correlations. This is the first head-to-head comparison between these measurement modalities in HV. Further investigations are warranted before formulating guidelines for the clinical use of 3D angles.

LEVEL OF EVIDENCE

Level III, case-control study.

The Dilemma of the Level of the Inferior Mesenteric Artery Ligation in the Treatment of Diverticular Disease: A Systematic Review of the Literature

Background and aim: Although sigmoidectomy is a well-standardized procedure for diverticular disease, there are still unclear areas related to the varying morphology and vascular supply of the sigmoid colon. The level of vascular ligation could affect the functional outcomes of patients operated on for diverticular disease. The aim of this review is to primarily evaluate sexual, urinary and defecatory function outcomes, as well as postoperative results, in patients who underwent surgery for diverticular disease, with or without inferior mesenteric artery (IMA) preservation. Materials and methods: The MEDLINE/PubMed, WOS and Scopus databases were interrogated. Comparative studies including patients who underwent sigmoidectomy for diverticular diseases were considered. Bowel function, genitourinary function, anastomotic leak, operation time, conversion to open surgery, anastomotic bleeding, bowel obstruction were the main items of interest. Results: Twelve studies were included in the review, three randomized and nine comparative studies. Bowel and genitourinary function are not differently affected by the level of vascular ligation. The site of ligation of IMA did not influence the rate of functional complications, anastomotic leak and bleeding. Of note, the preservation of IMA is associated with a higher conversion rate and longer operative time. Conclusions: Despite the heterogeneity of patient groups, and although the findings should be interpreted with caution, functional and clinical outcomes after sigmoidectomy for diverticular disease do not seem to be affected by the level of vascular ligation as long as the IMA is ligated far from its origin.

Dynamic thiol/disulphide homeostasis and ischemic modified albumin levels in isolated oligohydramnios

OBJECTIVE

Oligohydramnios is defined as amniotic fluid index in ultrasonographic measurement is less than 5 percentile according to gestational age, the amniotic fluid volume is ≤ 5 cm, or if the single deepest dial is < 2 cm. The condition of oligohydramnios that not with fetal structural/chromosomal abnormalities, intrauterine growth retardation, intrauterine infection and maternal disease is described as isolated oligohydramnios (IO). The aim of this study is to examine whether oxidative stress and reactive oxygen species (ROS) have a place in the pathophysiology of IO.

MATERIALS AND METHODS

In this prospective case-control study, a total of 126 participants were included. The patient group consisted of 65 patients who were diagnosed IO, and the control group consisted of 61 healthy normal pregnants. Native thiol (-SH), total thiol (-SH + -SS), dynamic disulfide (-SS), IMA values from maternal serum were measured and compared between groups.

RESULTS

Maternal serum -SH and -SH + -SS values were significantly lower in the IO group than in the control group (409.47 ± 55.36 μmol/L vs. 437.40 ± 48.68 μmol/L, p = 0.03 and 457.40 ± 63.01 μmol/L vs. 484.59 ± 52.75 μmol/L, p = 0.01). In the IO group when -SS/-SH and -SS/-SH + -SS ratio was found to be statistically significantly higher than control group (5.84 ± 1.1 vs 5.41 ± 0.71, p = 0.01 and 5.2 ± 0.88 vs 4.8 ± 0.58, p = 0.01), -SH/-SH + -SS ratio was significantly lower (89.56 ± 1.7 vs 90.24 ± 1.16, p = 0.01). There was no significant difference in terms of -SS value (p = 0.66). IMA value was significantly higher in the IO group than control group (0.76 ± 0.10 ABSU vs 0.68 ± 0.06, p < 0.01). It is seen as a result of ROC analysis that -SH, -SH + -SS, -SS/-SH, -SS/-SH + -SS, -SH/-SH + -SS and IMA values have a diagnostic value for IO (p < 0.05).

CONCLUSION

The thiol/disulfide balance shifted towards oxidative stress in IO compared to control group. So oxidative stress and ROS have a place in the pathophysiology of IO.

NRG1 and NRG2 fusions in non-small cell lung cancer (NSCLC): seven years between lights and shadows

INTRODUCTION

Fusions in neuregulin 1 (NRG1) and neuregulin 2 (NRG2) genes are molecular features of non-small cell lung cancer (NSCLC). These rearrangements enhance ectopic expression of the NRG/ErbB receptor-ligand and induce the triggering of downstream pathways. Evidence suggests the involvement of the NRG1/ErbB3 axis deregulation in the progression and treatment resistance of NSCLC cancer (NSCLC) and that NRG1 fusions are prognostic/predictive markers for targeted therapy.

AREAS COVERED

Biological and prognostic/predictive value of NRG1 and NRG2 fusions in NSCLC and their related cellular pathways are described and discussed. Publications in English language, peer-reviewed, high-quality international journals were identified on PubMed, as well as scientific official sites were used to update the international clinical trials progress.

EXPERT OPINION

NRG1 and NRG2 fusions should be considered as novel markers for biological therapy targeting ErbB2/ErbB3. There is evidence for the involvement of the NRG1/ErbB3 axis deregulation in cancer stem cell phenotype, tumor progression, and resistance to NSCLC therapy. Neuregulin fusions are very complex, hence many question marks must be tackled before translating these molecular lesions into clinical practice. Biology, and aggressiveness of the NRG1 and NRG2 fusions warrant further investigations.

Evaluation of a Weightbearing CT Artificial Intelligence-Based Automatic Measurement for the M1-M2 Intermetatarsal Angle in Hallux Valgus

BACKGROUND

Weightbearing cone beam computed tomography (WBCT) has been gaining traction as a useful imaging modality in the diagnosis and follow-up of foot and ankle musculoskeletal pathologies due to the ability to perform quick, low-dose, 3-dimensional (3D) scans. However, the resulting wealth of 3D data renders daily clinical use time-consuming. The aim of this study was to evaluate a new artificial intelligence (AI)-based automatic measurement for the M1-M2 intermetatarsal angle (IMA) in hallux valgus (HV). We hypothesized that automatic and manual measurements would have a strong correlation, and that the AI software would yield better reproducibility and would be faster compared with manual measurements.

METHODS

This was a multicenter retrospective comparative case-control study in which a total of 128 feet were included from 93 patients who underwent WBCT scans as part of their routine follow-up: 59 feet with symptomatic HV and 69 controls. The IMA was measured automatically using the AI software and manually on digitally reconstructed radiographs (DRRs). The AI software produced both an automatic 2D (auto 2D) and 3D (auto 3D) measurement.

RESULTS

There were strong intermethod correlations between the DRR IMA and the auto 2D (HV, r = 0.61; control, r = 0.60; all P < .0001) and auto 3D (HV, r = 0.63; control, r = 0.52; all P < .0001) measurements, respectively. The intrasoftware reproducibility was very close to 100%. Measurements took 23.6 ± 2.31 seconds and 14.5 ± 1.18 seconds, respectively, when taken manually on DRRs and automatically. Controls demonstrated a mean DRR IMA of 8.6 (95% CI, 8.1-9.1), mean auto 2D of 11.2 (95% CI, 10.7-11.7), and mean auto 3D IMA of 11.0 (95% CI, 10.5-11.5). The HV group demonstrated significantly increased IMA compared with controls (P < .0001), with a mean DRR IMA of 15.4 (95% CI, 14.8-16.1), mean auto 2D of 17.8 (95% CI, 17.2-18.4), and mean auto 3D IMA of 16.8 (95% CI, 16.8-17.4).

CONCLUSION

Measurements generated by the WBCT AI-based automatic measurement system for IMA demonstrated strong correlations with manual measurements, with near-perfect reproducibility. Further developments are warranted in order to make this tool more usable in daily practice, particularly with respect to its use in the presence of hardware in the foot.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Feasibility and Safety of Neoadjuvant Alectinib in Pulmonary Invasive Mucinous Adenocarcinoma with ALK Rearrangement: Case Report and Literature Review

Background

Pulmonary invasive mucinous adenocarcinoma (IMA) is a rare variant of lung adenocarcinoma that rarely shows anaplastic lymphoma kinase (ALK) rearrangement. Alectinib (tyrosine kinase inhibitors) has been listed as category 1 recommendations for advanced ALK + NSCLC first-line therapy due to low toxicity and excellent efficacy, and its median progression-free survival is 34.8 months. Here, we report a case of a patient with ALK-rearranged lung IMA who showed favorable results to neoadjuvant alectinib.

Case

A 67-year-old man with no history of smoking was diagnosed with clinical stage as IIIB invasive mucinous adenocarcinoma based on clinical symptoms, chest CT and pathological findings. The anaplastic lymphoma kinase (ALK) fusion status was assessed by real-time PCR. After acquiring informed consent from the patient, we offered neoadjuvant alectinib at a dosage of 150 mg twice per day for three cycles (84 days), all lesions were undetectable on chest CT. Later, a thoracoscopic left lobectomy was performed. The postoperative pathological showed that a small amount of tumor cells remained, and the TNM stage was downstaged as T1aN0M0 IA.

Conclusion

To our knowledge, this is the first case discussing the treatment of ALK-rearranged IMA of the lung with neoadjuvant alectinib. Alectinib is an effective ALK inhibitor, and in cases of lung adenocarcinoma with ALK rearrangement, alectinib treatment is a reasonable and priority option. Neoadjuvant alectinib may be clinically feasible and well tolerated in locally advanced NSCLC.

IRON MAN interacts with BRUTUS to maintain iron homeostasis in Arabidopsis

IRON MAN (IMA) peptides, a family of small peptides, control iron (Fe) transport in plants, but their roles in Fe signaling remain unclear. BRUTUS (BTS) is a potential Fe sensor that negatively regulates Fe homeostasis by promoting the ubiquitin-mediated degradation of bHLH105 and bHLH115, two positive regulators of the Fe deficiency response. Here, we show that IMA peptides interact with BTS. The C-terminal parts of IMA peptides contain a conserved BTS interaction domain (BID) that is responsible for their interaction with the C terminus of BTS. Arabidopsis thaliana plants constitutively expressing IMA genes phenocopy the bts-2 mutant. Moreover, IMA peptides are ubiquitinated and degraded by BTS. bHLH105 and bHLH115 also share a BID, which accounts for their interaction with BTS. IMA peptides compete with bHLH105/bHLH115 for interaction with BTS, thereby inhibiting the degradation of these transcription factors by BTS. Genetic analyses suggest that bHLH105/bHLH115 and IMA3 have additive roles and function downstream of BTS. Moreover, the transcription of both BTS and IMA3 is activated directly by bHLH105 and bHLH115 under Fe-deficient conditions. Our findings provide a conceptual framework for understanding the regulation of Fe homeostasis: IMA peptides protect bHLH105/bHLH115 from degradation by sequestering BTS, thereby activating the Fe deficiency response.

First case report of bilateral breast necrosis following coronary artery bypass graft using left internal mammary artery

Coronary artery bypass grafting (CABG) using internal mammary artery is a frequently performed procedure for the treatment of coronary artery disease nowadays. Ipsilateral breast necrosis is a rare and seldom reported complication that may mimic breast cancer on presentation. However, contralateral breast necrosis has not been reported to date. We are reporting the first case of bilateral breast necrosis after CABG using the left internal mammary artery. We discuss the different underlying mechanisms and possible co-factors behind the development of this rare complication, and we also share a successful management approach to conserve the breast and improve the patient's outcome.

A novel rapid measurement of hallux valgus parameters using the built-in photo edit function of smartphones

Objective

The objective of this study was to assess the accuracy and reliability of and time taken by a novel method using the built-in photo-edit function of smartphones compared with PACS in measuring hallux valgus parameters.

Methods

Seventy patients (124 ft) admitted to our hospital with a diagnosis of hallux valgus without previous surgical procedures were retrospectively reviewed. The foot radiographs of all the patients were extracted from PACS. The hallux valgus angle (HVA) and the first and second intermetatarsal angles (IMAs) were measured by PACS and by this novel method using the built-in photo-edit function of a smartphone. The results of these two methods were compared, and the accuracy and reliability were assessed between these two methods.

Results

The average parameters measured by PACS were as follows: HVA average: 37.43 ± 9.61°; IMA average: 13.37 ± 4.01°. The average parameters measured by smartphones were as follows: HVA average: 37.09 ± 9.52° and IMA average: 13.49 ± 3.91°. When compared by the independent-samples T test, the average parameters between PACS and smartphones were not significantly different (HVA PACS vs HVA smartphones: P = 0.776; IMA PACS vs IMA smartphones: P = 0.816). The variability of the HVA (F = 0.166, P = 0.992) and IMA (F = 0.215, P = 0.982) measurements was similar for the PACS and smartphones. The ICCs of the average parameters of four measurements of HVA and IMA between PACS and smartphones were 0.995 (0.991–0.997) and 0.970 (0.958–0.979), indicating that the two methods were highly correlated. For the smartphone measurement, the interobserver and intraobserver reliability was very good for HVA and IMA. The average measurement time of PACS was 25.41 ± 0.86 s, and the average measurement time of smartphones was 20.29 ± 1.22 s. The smartphone time was significantly faster than that of PACS by approximately 5 s (P<0.001).

Conclusion

This novel method using the built-in photo-edit function of smartphones is accurate, reliable, convenient and time-saving in measuring the angles of hallux valgus.

A Comparison Between X-ray Imaging and an Innovative Computer-aided Design Method Based on Weightbearing CT Scan Images for Assessing Hallux Valgus

With the development of recent technology, radiographs can be saved digitally, and angular measurements can be processed using various software packages. We developed an innovative computer-aided design method with Materialize Interactive Medical Image Control System software to measure hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the distal metatarsal articular angle (DMAA) and assessed its concordance with traditional X-ray imaging methods. All measurements were carried out on 42 feet from 26 adult patients diagnosed with hallux valgus who were prospectively selected from July 2016 to April 2018. Standing X-ray radiograph and weightbearing computed tomography scans were conducted on all patients, and HVA, IMA, and DMAA were generated using both a traditional X-ray method and our innovative method. Two different observers assessed measurements for each patient. Finally, statistical analyses were conducted to assess the reliability of the measurements. Both X-ray imaging and our innovative method had strong interobserver and test-retest reliability. The ICC of X-ray imaging was 0.945, p < .001, and the ICC of the innovative method was 0.915, p < .001. There was no statistical difference between the 2 methods for HVA and IMA measurements (p > .05); however, a difference was detected for DMAA (p < .05). Bland-Altman analyses demonstrated a high degree of agreement between the 2 methods for HVA and IMA, but a significant difference for DMAA. From the results, we concluded that our innovative computer-aided design method is a feasible, reliable way to quantitatively assess HVA, IMA, and DMAA, and it is likely more accurate for measuring DMAA.

Serum ischemia-modified albumin level returns to its premenopausal level with 1-year hormone therapy in healthy menopausal women

Introduction

To assess the effect of hormone therapy (HT) on serum ischemia modified albumin (IMA) levels in healthy menopausal women.

Material and methods

Thirty surgical menopausal women who were admitted to our menopausal polyclinic during a 1-year period and diagnosed with menopause and planned to have HT for menopausal symptoms were enrolled in this prospective study. The serum İMA levels were recorded before and after (3 months, 6 months, 12 months later) hormone treatment (2 mg estradiol hemihydrate).

Results

The mean age of women was 47.60 ± 2.34 years. The mean serum IMA levels were 0.610 ± 0.096 absorbance units (ABSU) at the beginning and 0.484 ± 0.080 ABSU after 3 months of hormone therapy. Following 6 months of hormone therapy, serum IMA level was 0.546 ± 0.075, and reached 0.580 ± 0.089 ABSU following 12 months of therapy.

Conclusions

These findings suggest that HT may not block the menopause induced ischemia process. Although HT had a positive effect on serum IMA levels following 3 months’ use, serum IMA levels returned to baseline levels after 12 months’ use. Based on this study’s findings, long-term use of HT may not have a positive effect on cardiovascular disease protection.

Clinical diagnostic value of combined detection of IMA, D-D and MCP-1 in acute myocardial infarction

The aim of the study was to analyze the clinical value of the combined detection of ischemia-modified albumin (IMA), D-dimer (D-D) and monocyte chemoattractant protein-1 (MCP-1) in the diagnosis of acute myocardial infarction (AMI). Altogether 87 patients with AMI from January 2017 to January 2018 were enrolled in the AMI group, and 82 patients without coronary artery disease were included in the control group. The serum levels of IMA, D-D, MCP-1, cardiac troponin (CTnT) and high-sensitivity C-reactive protein (hs-CRP) in the two groups were detected by ELISA. The blood lipids of the two groups and the levels of IMA, D-D, MCP-1 after treatment were detected. The association between IMA, D-D, MCP-1, CTnT, hs-CRP and blood lipid in patients with AMI was analyzed. The values of IMA, D-D, and MCP-1 alone and combined in the diagnosis of AMI were analyzed by ROC curve. The levels of IMA, D-D, MCP-1, CTnT and hs-CRP in the AMI group were significantly higher than those in the control group (P<0.05). The levels of IMA, D-D and MCP-1 in the patients with poor prognosis were significantly higher than those of the good prognosis group (P<0.05). The changes of IMA, D-D and MCP-1 levels were positively correlated with the levels of CTT and hs-CRP (P<0.05). The AUC, specificity and sensitivity of patients with AMI diagnosed with MCP-1 alone were 0.8084, 81.61 and 69.51%, respectively. Those of patients diagnosed by D-D were 0.7302, 59.77 and 81.71%, those of patients diagnosed by IMA alone were 0.7289, 58.62 and 80.49%, and those of patients detected by the combination of MCP-1, D-D and IMA were 0.9047, 58.62 and 93.90%. In conclusion, the levels of IMA, D-D and MCP-1 in AMI patients are higher than those in the control group. The levels of IMA, D-D and MCP-1 were positively correlated with CTnT and hs-CRP levels in AMI patients. Combined detection of IMA, D-D, and MCP-1 can improve the accuracy.

Technical considerations depending on the level of vascular ligation in laparoscopic rectal resection

AIM

In addition to ischemia there is also anastomotic ends tension proven to be a risk factor for anastomotic leak. HT vascular ligation is accepted as a rule, in attempt to achieve tension-free anastomosis. LT is a preferred option, based on the more accurate preservation of proximal intestinal segment microperfusion and lower risk of damage to the hypogastric plexus. The aim of this study is evaluation of comparative indicators in high tie (HT) and low tie (LT) laparoscopic rectal resections.

METHODS

A prospective nonrandomized comparative cohort study of patients in our department with cancer of the rectum in clinical stage I-III, operated on in laparoscopic approach over a 6-years period.

RESULTS

For the period 2015-2020, a number of 208 laparoscopic surgeries have been done for rectal cancer. Patients were divided into three groups-group A with HT vascular ligation 116 pts. (69%), group B-53 pts. (25%), underwent low ligation-LT and group C-39pts. (19%) low tie plus lymph node dissection of the apical LN group (LT-appic LND). The distribution was made without randomization, based on the operators' expertise. Anastomotic leaks were 3.8% in group A, 3.0% in group B and 2.9% in group C (p > 0.05) with no significance difference. There is no significant difference in the number of lymph nodes obtained in group A and group B, while in group C the number of the harvested lymph nodes was higher (p < 0.05). The indicators for intestinal / defecation dysfunction, as well as for urinary/sexual dysfunction, according to our data, are significantly more favorable in patients with LT, in contrast to the other two groups.

CONCLUSION

HT vascular ligation attempts to achieve tension-free anastomosis and more harvested lymph nodes. However, LT could be a preferred option, based on the lack of significant evidence for a difference in specific oncological survival and due to more accurate preservation of proximal intestinal segment microperfusion to prevent anastomosis dehiscence, also for its lower risk of damage to the hypogastric plexus. Splenic flexure mobilization provides elongation of the proximal intestinal segment, but has no proven effect on anastomotic leakage incidence. It increases surgical duration and is in fact necessary in up to 30% of the cases. At the present moment there is no precise data whether LT has an advantage in terms of prevention of autonomic nervous and urogenital dysfunction. New prospective randomized and highly probative studies are needed to standardize the procedures in specific clinical situations.

The Diagnostic Value of ischemia-modified albumin (IMA) and signal peptide-CUB-EGF domain-containing protein-1 (SCUBE-1) in an Experimental Model of Strangulated Mechanical Bowel Obstruction

BACKGROUND

Mechanical bowel obstruction (MBO) is one of the principal pathologies requiring emergency surgery and a significant worldwide cause of morbidity. The identification of patients in whom bowel obstruction resolves spontaneously is important in terms of preventing unnecessary surgical interventions and future potential adhesions. The decision-making process is difficult in patients presenting without classic examination findings.

METHODS

36 female Sprague-Dawley rats randomly divided into six experimental groups. In Group 1, 3 and 5, laparotomy was performed, with blood and tissue specimens being collected after 1, 2 and 6 h, respectively. In Group 2, 4 and 6, the ileum segment was ligated following laparotomy, and blood and tissue specimens were collected after 1, 2 and 6 h, respectively. The ileum specimens were examined macroscopically, after which 1-cm sections were taken and examined in terms of histopathological changes. IMA and SCUBE-1 levels were determined for each group, and macro- and microscopic tissue examination findings were compared between the groups.

RESULTS

Comparison within the groups exposed to waiting times of 1 h (groups 1 and 2), 2 h (groups 3 and 4) and 6 h (groups 5 and 6) revealed higher mean IMA and SCUBE-1 levels in rats undergoing ligation together with incision (groups 2, 4, and 6) compared to those undergoing laparotomy only (groups 1, 3, and 5). Correlation analysis was applied to determine the relationship between total scores obtained from histopathological examination and IMA and SCUBE-1 values. The analysis revealed strong, significant and positive correlation between histopathological examination scores and IMA (r=0.643, p=0.000) and SCUBE-1 (r=0.509, p=0.002) values.

CONCLUSION

The study findings showed that both IMA and SCUBE-1 values increased in a strangulated MBO model in rats. We think that IMA and SCUBE-1 values can be used as a markers of damage in the early period in strangulated MBO, and that the patient's surgery requirement can thus be determined in the early period.

Water Immersion During the Labour and Effects on Oxidative Stress

Objective: The study aims to investigate maternal serum thiol/disulfide homeostasis and ischemia-modified albumin (IMA) levels of women who were submerged during labor. Material and methods: Sixty-four pregnant women were enrolled in this study. Thirty-four women were submerged during the first stage of labor and 30 women were not. Native thiol, total thiol, disulfide, albumin, IMA, disulfide/native thiol, disulfide/total thiol and native thiol/total thiol concentrations were measured and demographic data were obtained. Results: Cord blood pH, serum disulfide levels and (disulfide/total thiol) × 100 levels were significantly lower in the water immersion group (P < 0.01, P = 0.01 and P < 0.01, respectively). Native thiol, total thiol, albumin and IMA levels were higher in the water immersion group P < 0.01, P < 0.01, P = 0.001 and P < 0.01, respectively). Conclusion: Water immersion during the first stage of labor was found to be associated with deterioration of thiol-disulfide homeostasis with respect to antioxidant status while IMA levels were higher, suggesting an ischemic condition.

Game schedule congestion affects weekly workloads but not individual game demands in semi-professional basketball

To quantify and compare workloads encountered by basketball players during individual games played across 1-, 2-, and 3-day periods in the same week, and during weeks where 1, 2, and 3 games are scheduled. Eight semi-professional male players were monitored. External workload was determined as absolute and relative (·min-1) PlayerLoad (PL), and total and high-intensity jumps, accelerations, decelerations, and changes of direction (COD). Internal workload was determined as absolute and relative summated heart rate zones (SHRZ), session-rating of perceived exertion (sRPE), and RPE. Game workloads were tabulated considering the order in which they were scheduled weekly (game 1, 2, or 3), and each week considering the number of games scheduled (1, 2, or 3 games). Analysing weekly workloads, duration was higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 6.65-18.19). High-intensity decelerations and COD were higher during 3-game than 1-game weeks (P <0.05, ES = 1.26-1.55). Absolute PL, jumps, accelerations, decelerations, COD, and high-intensity jumps and accelerations were higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 0.69-2.63). Absolute SHRZ and sRPE were higher during 3-game than 1- and 2-game weeks (P <0.05, ES = 0.86-2.43). Players completed similar individual game workloads regardless of the number of games played on consecutive days in the week. Workloads were similar during 1- and 2-game weeks, while the addition of a third game significantly increased the overall weekly workloads encountered.

Long noncoding RNA HOXC-AS3 facilitates the progression of invasive mucinous adenocarcinomas of the lung via modulating FUS/FOXM1

Invasive mucinous adenocarcinoma of the lung (IMA), a mucinous variant of lung adenocarcinoma, is strongly linked with a worse prognosis. Therefore, a deeper understanding about its molecular mechanism may conduce to a promising IMA therapy. Long non-coding RNAs (lncRNAs) have recently caught great attention for their crucial roles in diverse diseases regarding tumor initiation and progression. However, the potential role of the lncRNA HOXC-AS3 IMA is not well established. Hence, the purpose of present study is to manifest HOXC-AS3-regulated inner mechanism in IMA development. It revealed that HOXC-AS3 was highly expressed in IMA cells. Additionally, it was identified that the significant down-regulation of HOXC-AS3 obstructed cell proliferation and migration in IMA. As far as mechanism is concerned, it found that HOXC-AS3 recruited FUS to stabilize FOXM1 mRNA, accelerating IMA progression. Taken together, these data suggested that HOXC-AS3 may be recognized as a novel therapeutic target for patients with IMA or at least offer new views for molecular therapy.

Ischemia-Modified Albumin, a Novel Predictive Marker of In-Hospital Mortality in Acute Aortic Dissection Patients

Background

This work explored the prognostic prediction capabilities of ischemia-modified albumin (IMA) in patients suffering from acute aortic dissection (AAD).

Methods

We conducted a retrospective analysis using electronic health records. This study included AAD patients admitted to the Second Xiangya Hospital of Central South University from January 2015 to December 2018 in ≤24 h from the onset of symptoms to hospital admission. The levels of IMA were recorded upon admittance and the final was the all-cause mortality during hospitalization.

Results

This study enrolled 731 AAD patients. Among who, 160 passed away in the course of medication while 571 of them survived. Those who passed away exhibited higher levels of IMA (94.35 ± 26.84 vs. 69.14 ± 14.70, p < 0.001) than the survivors. Following the adjustment confounders, the fully adjusted model showed IMA to be an independent forecastor for in-hospital mortality for AAD patients (OR 1.10, 95% CI 1.08–1.13, p < 0.001). Analysis based on receiver operating characteristic (ROC) revealed that 79.35 μ/ml was the best threshold of IMA level. The area under the curve (AUC) based on this IMA level was 0.854 (95% CI 0.822–0.898) while the specificity and sensitivity to anticipate in-hospital death were 84.8 and 80.6%, respectively.

Conclusion

Admission IMA was an independent forecastor for in-hospital mortality among people suffering from AAD.

Gene signature driving invasive mucinous adenocarcinoma of the lung

Though invasive mucinous adenocarcinoma of the lung (IMA) is pathologically distinctive, the molecular mechanism driving IMA is not well understood, which hampers efforts to identify therapeutic targets. Here, by analyzing gene expression profiles of human and mouse IMA, we identified a Mucinous Lung Tumor Signature of 143 genes, which was unexpectedly enriched in mucin-producing gastrointestinal, pancreatic, and breast cancers. The signature genes included transcription factors FOXA3, SPDEF, HNF4A, mucins MUC5AC, MUC5B, MUC3, and an inhibitory immune checkpoint VTCN1/B7-H4 (but not PD-L1/B7-H1). Importantly, induction of FOXA3 or SPDEF along with mutant KRAS in lung epithelium was sufficient to develop benign or malignant mucinous lung tumors, respectively, in transgenic mice. FOXA3 and SPDEF induced MUC5AC and MUC5B, while HNF4A induced MUC3 in human mucinous lung cancer cells harboring a KRAS mutation. ChIP-seq combined with CRISPR/Cas9 determined that upstream enhancer regions of the mucin genes MUC5AC and MUC5B, which were bound by SPDEF, were required for the expression of the mucin genes. Here, we report the molecular signature and gene regulatory network driving mucinous lung tumors.

Ischemia modified albumin (IMA) in acute coronary syndrome (ACS) and left bundle branch block (LBBB). Does it make the difference?

BACKGROUND

Management of patients with a suspected ACS and LBBB is a challenge to the clinician.

AIM

To detect the ability of IMA to exclude myocardial ischemia in suspected patients with ACS and LBBB.

MATERIAL AND METHODS

A total of 68 patients with suspected ACS and LBBB (group I) and another twenty patients age and sex matched known to have LBBB with normal coronary angiography (group II) were included in this study and subjected to: routine laboratory tests, 12 lead ECG, echocardiography, and measurement of serum troponin I (TnI) and IMA (measured by ELISA). Diagnostic coronary angiography was performed on all patients and scored by severity and modified Gensini scores.

RESULTS

IMA and TnI levels are significantly increased in group I compared to group II (P value <0.001). IMA with a cutoff value >95 could predict significant CAD (lesions >50%) with AUC of 0.923, sensitivity of 88%, specificity of 83.33%, PPV of 93.6%, NPV of 71.4% and accuracy 86.76%. Moreover, by using both simple and multiple logistic regression analyses IMA could also independently detect significant CAD. The combined use of IMA and TnI significantly improved the sensitivity and the negative predictive value to 98% and 90.9% respectively.

CONCLUSION

There was a distinct advantage of measuring IMA in patients presenting to the emergency department with acute chest pain and LBBB to rule out a final diagnosis of ACS.

CyTOF Mass Cytometry for Click Proliferation Assays

Novel cell analyzers, including polychromatic flow cytometers and isotopical cytometry by time of flight (CyTOF) mass cytometers, enable simultaneous measurement of virtually bondless characteristics at the single-cell level. BrdU assays for quantifying cellular proliferation are common but have several limitations, including the need for a DNA denaturation step and inability to simultaneously resolve multiple parameters and phenotypic complexity. Click chemistry reactions have become popular in the past decade, as they can resolve these issues. This protocol introduces a novel assay able to bridge flow cytometry and CyTOF analysis for active S-phase determination in cell cycle applications, combining well-established click chemistry with a novel iodo-deoxyuridine (IdU) azide derivative and a cross-reactive anti-IdU antibody for detecting incorporated EdU during DNA synthesis. This method is preferred over traditional BrdU-based assays for complex and multiparametric experiments. It provides a feasible cost-effective approach for detecting ethynyl-labeled nucleotides, with the advantage of combining flow and mass cytometry analyses. © 2017 by John Wiley & Sons, Inc.

Hyperemesis gravidarum is associated with increased maternal serum ischemia-modified albumin

AIM

Our objective was to measure the circulating levels of ischemia-modified albumin (IMA) among pregnant with hyperemesis gravidarum (HEG) and to compare their levels with age- and body mass index (BMI)-matched control pregnant women.

METHOD

The pregnant subjects were classified into the HEG group diagnosed with HEG (n=45) and age- and BMI-matched control group without a diagnosis of HEG (n=45) during their pregnancies. Serum IMA, hemoglobin, hematocrit, white blood cells, platelet, fasting blood glucose, creatinine, lipid profile, aspartate aminotransferase (AST) urea, alanine aminotransferase (ALT), sodium, potassium and thyroid-stimulating hormone (TSH) levels of the groups were measured.

RESULT

Serum hemoglobin, hematocrit, white blood cells, platelet, fasting blood glucose, creatinine, lipid profile, AST, urea, ALT, sodium, potassium and TSH levels of the groups were statistically similar. Serum IMA values were significantly higher in subjects with HEG compared to the subjects without HEG.

CONCLUSIONS

We found that HEG was related to increased maternal serum IMA levels. HEG might be due to an ischemic intrauterine environment leading to elevated serum IMA concentrations.

The Role of Ischemia Modified Albumin and D-dimer as Early or Late Biochemical Markers in Ovarian Torsion

OBJECTIVE

Our aim was to examine the potential roles of ischemia modified albumin(IMA) and D-dimer as reliable early diagnostic markers of ovarian torsion.

MATERIALS AND METHODS

24 Wistar albino rats were included and randomized into three groups. Control (sham) rats underwent laparotomy then bilateral ovaries removed for histopathological examination and concomitant blood sampling for IMA and D-dimer assays after 4 h. In the remaining groups, ovarian ischemia was achieved by rotating bilateral ovaries 1080° clockwise then blood samples were obtained and ovaries were removed after 4 h and 24 h. IMA and D-dimer levels as well as the histopathological injury scores were assessed in all groups.

RESULTS

A statistically higher significant difference in D-dimer levels in the 4-h torsion group (Group 2) than the other groups (P = 0.001, P < 0.01). Despite absence of statistical significance, the difference in IMA levels between the groups was close to statistical significance (P = 0.064; P > 0.05); accordingly IMA levels were higher in the 24-h torsion group (Group 3), than in 4-h torsion (Group 2) or sham (Group 1) group.

CONCLUSION

Our results suggest that D-dimer may represent a valuable acute marker of ovarian torsion. The cut-off value for D-dimer was 402 ng/ml. Although rats in Group3 had higher IMA than in other groups, the difference was only close to statistical significance. Also, increasing duration of torsion was associated with reduced D-dimer levels, while IMA levels exhibited an increase during the 24 h period. In contrast with previous studies, IMA appeared to be a potential marker in the long term rather than the short term.

Ischaemic Markers in Acute Hepatic Injury

INTRODUCTION

Hepatic injury of varied aetiology may progress to Acute Liver Failure (ALF). Compromised microcirculation is thought to be a deciding factor of hepatic hypoxia may be involved in disease progression that needs early detection. Ischaemia markers like serum Ischaemia- modified albumin (IMA), ALT-LDH ratio and ALT-LDH index have been suggested for its detection at early stage.

AIM

To find out the association of Ischaemia markers like serum IMA, ALT-LDH ratio and ALT-LDH index in acute hepatic injury cases.

MATERIALS AND METHODS

Forty one diagnosed acute liver injury cases of varied aetiology admitted in Department of Medicine, and Gastroenterology of SCB Medical College, Cuttack were enrolled in the study along with 30 age and sex matched healthy controls. Blood collected at time of admission and at time of discharge (1(st) day and 7(th) day) were evaluated for FPG, RFT, LFT, Serum Albumin along with serum LDH, IMA, PT-INR and platelet count.

RESULT

Serum bilirubin, hepatic enzymes, IMA, PT-INR was more markedly raised in cases than controls on the 1(st) day of admission. ALT-LDH ratio and index were significantly low in complicated cases. However, on responding to treatment the ALT-LDH index on 7(th) day registered a rise in comparison to the 1(st) day, while serum IMA revealed an insignificant decline showing improvement in hepatic hypoxia. ALT-LDH ratio remains more or less same on response to treatment.

CONCLUSION

Serum IMA and ALT-LDH Index reveals association with disease process in Acute Hepatic Injury cases both clinically and biochemically and can be used as supportive parameters for the diagnosis of disease process.

Tachycardia in breast reconstructive microsurgery: Affirmation of the IMA tachycardia syndrome

INTRODUCTION

The internal mammary vessels are frequently chosen as recipient vessels for breast free flap reconstruction. We have noticed that when using the internal mammary recipients that these patients have a propensity for tachycardia that was not previously observed. Our aim was to investigate the factors related to perioperative tachycardia in the microsurgical breast reconstruction population and to address whether use of the internal mammary system is a causative factor in tachycardia.

METHODS

A retrospective chart review was conducted to identify patients who underwent abdominal-based microvascular breast reconstruction at the Washington University School of Medicine between 2002 and 2012 to identify the presence of tachycardia. After application of exclusion criteria, 76 microvascular abdominal-based free flap reconstructions were identified. The internal mammary (IM) TRAM group (n = 24) and the thoracodorsal (TD) TRAM group (n = 52) were compared. A binomial logistic regression was performed with the presence of tachycardia as the dependent variable.

RESULTS

There was a higher incidence of tachycardia in the IM TRAM group when compared to the TD TRAM group (p = 0.004). The variables predictive of tachycardia in our logistic regression model were IMA recipient (p = 0.04), need for transfusion (p = 0.03), and presence of fever (p = 0.01).

CONCLUSION

Our study reaffirms that there are several factors that are predictive of tachycardia in the setting of microvascular breast reconstruction. The IMA syndrome should be a recognized cause of tachycardia as using these recipient vessels are shown to be predictive of postoperative tachycardia as shown in our study.

Clinical and angiographic results after hybrid coronary revascularization

BACKGROUND

With hybrid coronary revascularization (HCR), minimally invasive left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) grafting is combined with percutaneous coronary intervention (PCI) of non-LAD vessels. The purpose of this study was to examine the short-term clinical and angiographic results in one of the largest HCR series to date.

METHODS

From 2003 to 2012, 300 consecutive patients (aged 64±12 years, female 31.7%, predicted risk of mortality 1.6%±2.1%) underwent HCR on an intent-to-treat basis at a single institution. After robotic or thoracoscopic LIMA harvest, off-pump LIMA to LAD grafting was performed through a 3- to 4-cm sternal-sparing, non-rib-spreading thoracotomy. PCI was utilized to treat non-LAD lesions either before, after, or concomitant with the surgical procedure.

RESULTS

Of the 300 patients undergoing HCR on an intent-to-treat basis, HCR was performed with surgery first in 192 patients (64.0%), PCI first in 56 (18.7%), and as a concomitant procedure in 21 (7.0%). Of the 31 patients (10.1%) who did not undergo HCR, 24 patients (8.0%) did not have PCI and thus were incompletely revascularized. For all patients, 30-day mortality, stroke, and nonfatal myocardial infarction occurred in 4 (1.3%), 3 (1.0%), and 4 (1.3%), respectively. Angiographic LIMA evaluation was performed in 248 patients and revealed a FitzGibbon A LIMA patency rate of 97.6% (242 of 248 patients). Repeat revascularization was required in 13 of 300 patients (4.3%).

CONCLUSIONS

Hybrid coronary revascularization represents an alternative approach for patients with multivessel coronary disease with excellent short-term outcomes. It provides a minimally invasive alternative to traditional coronary artery bypass graft surgery and may prove more durable than multivessel PCI.

Ischemia-modified albumin levels in children having seizure

Convulsions are one of the frequently seen problems for a neurologist in the daily routine. It is difficult to distinguish the seizure from pseudo-seizure because of lack of conclusive tests. The aim of this study is to investigate the relationship between seizure types and seizure periods by studying IMA serum levels in children having seizure. Two groups were included (patients and control) in our study. The patient group consisted of the children admitted to Pediatric Emergency Care during January 2008-January 2010 with seizure and the control group consisted of healthy children. Serum Ischemia modified albumin (IMA) level in the group having seizures was 99.7 and 83.2U/ml in the control group. In the comparison of the patient and control groups, significant differences were found between their IMA values (p=0.000). There was a significant difference between IMA values of the group having generalized tonic-clonic seizures and those of the control group (p=0.001). In comparison of the IMA values of the group having febrile convulsions and those of the control group, a significant difference was determined (p=0.011). It has been shown that if the seizure was prolonged over 5 min, IMA level increased, and there was a significant difference between the groups experiencing over 5 min of seizures and the groups experiencing less than 5 min of seizures (p=0.001). An increase in IMA levels in febrile convulsion supports the hypoxia development in the brain during the seizure. Serum IMA levels increased with the elongation of the seizure period and may be an indicator for status epilepticus.

Arterial grafts balance survival between incomplete and complete revascularization: a series of 1000 consecutive coronary artery bypass graft patients with 98% arterial grafts

OBJECTIVE

Coronary artery bypass grafting (CABG) with incomplete revascularization (ICR) is thought to decrease survival. We studied the survival of patients with ICR undergoing total arterial grafting.

METHODS

In a consecutive series of all-comer 1000 patients with isolated CABG, operative and midterm survival were assessed for patients undergoing complete versus ICR, with odds ratios and hazard ratios, adjusted for European System for Cardiac Operative Risk Evaluation category, CABG urgency, age, and comorbidities.

RESULTS

In this series of 1000 patients with 98% arterial grafts (2922 arterial, 59 vein grafts), 73% of patients with multivessel disease received bilateral internal mammary artery grafts. ICR occurred in 140 patients (14%). Operative mortality was 3.8% overall, 8.6% for patients with ICR, and 3.2% for patients with complete revascularization (P = .008). For operative mortality using multivariable logistic regression, after controlling for European System for Cardiac Operative Risk Evaluation category (P < .001) and CABG urgency (P = .03), there was no evidence of a statistically significant increased risk of death due to ICR (odds ratio, 1.73; 95% confidence interval, 0.80-3.77). For midterm follow-up (median, 54 months [interquartile range, 27-85 months]), after controlling for European System for Cardiac Operative Risk Evaluation category (P < .001) and comorbidities (P = .017) there was a significant interaction between age ≥ 80 years and ICR (P = .017) in predicting mortality. The adjusted hazard ratio associated with ICR for patients older than age 80 years was 5.7 (95% confidence interval, 1.8-18.0) versus 1.2 (95% confidence interval, 0.7-2.1) for younger patients.

CONCLUSIONS

This is the first study to suggest that ICR in patients with mostly arterial grafts is not associated with decreased survival perioperatively and at midterm in patients younger than age 80 years. Arterial grafting, because of longevity, may balance survival between complete revascularization and ICR.

Adoption and effectiveness of internal mammary artery grafting in coronary artery bypass surgery among Medicare beneficiaries

OBJECTIVES

The aim of this study was to assess the pattern of the adoption of internal mammary artery (IMA) grafting in the United States, test its association with clinical outcomes, and assess whether its effectiveness differs in key clinical subgroups.

BACKGROUND

The effect of IMA grafting on major clinical outcomes has never been tested in a large randomized trial, yet it is now a quality standard for coronary artery bypass graft (CABG) surgery.

METHODS

We identified Medicare beneficiaries ≥66 years of age who underwent isolated multivessel CABG between 1988 and 2008, and we documented patterns of IMA use over time. We used a multivariable propensity score to match patients with and without an IMA and compared rates of death, myocardial infarction (MI), and repeat revascularization. We tested for variations in IMA effectiveness with treatment × covariate interaction tests.

RESULTS

The IMA use in CABG rose slowly from 31% in 1988 to 91% in 2008, with persistent wide geographic variations. Among 60,896 propensity score-matched patients over a median 6.8-year follow-up, IMA use was associated with lower all-cause mortality (adjusted hazard ratio: 0.77, p < 0.001), lower death or MI (adjusted hazard ratio: 0.77, p < 0.001), and fewer repeat revascularizations over 5 years (8% vs. 9%, p < 0.001). The association between IMA use and lower mortality was significantly weaker (p ≤ 0.008) for older patients, women, and patients with diabetes or peripheral arterial disease.

CONCLUSIONS

Internal mammary artery grafting was adopted slowly and still shows substantial geographic variation. IMA use is associated with lower rates of death, MI, and repeat coronary revascularization.

Fractional flow reserve-guided coronary artery bypass grafting: can intraoperative physiologic imaging guide decision making?

OBJECTIVES

Fractional flow reserve-guided coronary artery bypass grafting is emerging in cardiac surgery, in which the nature (anatomic and functional characteristics) of the target vessel epicardial coronary artery stenosis is important in graft site selection. The nature of the stenosis might determine a different physiologic response to bypass grafting. We report our recent experience using near infrared fluorescence complex angiography and perfusion analysis to identify the nature of stenoses in the target vessel by imaging the physiologic response to grafting.

METHODS

In 167 patients who underwent consecutive multivessel coronary artery bypass grafting cases (63% off-pump coronary artery bypass grafting) with traditional anatomy-based revascularization, we imaged and analyzed 359 grafts (53% arterial). This platform provides angiographic data of both the target vessel epicardial coronary artery and graft simultaneously (to assess the imaged competitive flow); and because a change in fluorescence intensity is proportional to the change in blood flow and perfusion, the quantified change (if any) in regional myocardial perfusion surrounding the grafted target vessel epicardial coronary artery.

RESULTS

The patient outcomes in our series were excellent. All 359 grafts were widely patent by angiography, and 24% of the arterial and 22% of the saphenous vein grafts showed no regional myocardial perfusion change in response to bypass grafting. In 165 in situ internal mammary artery grafts to the left anterior descending artery (>70% stenosis), 40 had no change in regional myocardial perfusion, and 32 of the 40 had competitive flow imaged.

CONCLUSIONS

An important number of angiographically patent bypass grafts demonstrated no change in regional myocardial perfusion, suggesting anatomic, but nonfunctional, stenoses in those target vessel epicardial coronary arteries. In in situ arterial grafts, imaged competitive flow is associated with nonfunctional stenoses in the target vessel epicardial coronary artery. Imaging these physiologic responses to target vessel revascularization might be useful in the emerging fractional flow reserve-guided era.

Impact of lipid-lowering medications and low-density lipoprotein levels on 1-year clinical outcomes after coronary artery bypass grafting

BACKGROUND

Studies investigating lipid-lowering medication (LLM) use and LDL levels in coronary artery bypass grafting patients are limited.

STUDY DESIGN

The Veterans Affairs Randomized On/Off Bypass Trial's patient records were analyzed for LLM use and 1-year LDL levels. Mortality, acute MI (AMI), and repeat revascularization rates were compared at 1 year between patients with and without LLM at discharge. In addition, AMI, repeat revascularization, and graft patency were compared between patients that did and did not achieve a 1-year LDL target level of <100 mg/dL.

RESULTS

The LLM data were available for 86.4% (1,904 of 2,203) of patients. Rates of LLM use were 83.4% (1,316 of 1,577) at discharge and 90.0% (1,713 of 1,904) at 1 year. Patients discharged after coronary artery bypass grafting on LLMs had a significantly lower 1-year mortality rate (1.9% vs 5.4%; p < 0.01) than those not discharged on LLM, and 1-year AMI and repeat revascularization rates were not significantly different. Of the patients with 1-year LDL measurements, 69.4% (1,200 of 1,729) achieved an LDL target level of <100 mg/dL. No differences were seen in AMI, revascularization, or graft occlusion rates between patients who achieved target LDL levels and those who did not.

CONCLUSIONS

Rates of LLM use among veterans post-coronary artery bypass grafting are high. Discharge on LLM might be associated with improved intermediate-term survival. Patients who achieved an LDL target of <100 mg/dL at 1-year did not experience improved 1-year clinical outcomes or graft patency. Longer-term follow-up might reveal differences in cardiac outcomes related to achievement of target LDL levels.

Interference-free determination of ischemia-modified albumin using quantum dot coupled X-ray fluorescence spectroscopy

Ischemia-modified protein (IMA) is the most sensitive diagnostic biomarker of ischemic heart disease, but differentiation of IMA from human serum albumin (HSA), a ubiquitous serum protein, is still challenging owing to the shared antigenicity. In this investigation, we developed a rapid and interference-free approach for IMA determination using quantum dots-coupled X-ray Fluorescence Spectroscopy (Q-XRF). In a typical Q-XRF assay, serum total HSA is quantified using quantum dot-coupled sandwich immunoassay, and intact HSA (iHSA) is determined using a XRF spectroscopy, by measuring XRF intensity of Co (II) bonded to iHSA. IMA concentration is automatically determined within 30 min by calculating the difference between total HSA and iHSA. This strategy can effectively eliminate the interference from native HSA level. Results show that no significant influences have been observed from hemolysis or high levels of cholesterol (7 mg/L), triglyceride (5.2 mg/L), IgG (10 g/L), and fibrinogen (4 g/L). A linearity of 1-100mg/mL is obtained in iHSA determination using XRF (r(2)=0.979). The proposed Q-XRF assay demonstrates a lowest detection limit of 0.05 U/mL. Receiver-operating characteristic (ROC) curves reveal that Q-XRF assay provide an improved sensitivity than ACB assay (95.9% vs. 82.9%) in differentiating ischemic patients from health individuals, at an optimal cutoff point of 79.2U/mL. The proposed approach provides a new strategy for interference-free, simple and rapid evaluation of IMA concentration by combining sandwich immunoassay and XRF spectroscopy.

Ischemia-modified albumin, a predictive marker of major adverse cardiovascular events in continuous ambulatory peritoneal dialysis patients

OBJECTIVES

The aim of this study was to evaluate the efficiency of ischemia-modified albumin (IMA) for predicting major adverse cardiovascular events (MACE) in continuous ambulatory peritoneal dialysis (CAPD) patients.

DESIGN AND METHODS

A prospective observational study was conducted with 120 CAPD patients and 37 healthy volunteers. Demographic and clinical data were collected. The primary end point is the occurrence of MACE.

RESULTS

A total of 157 participants with a mean age of 43.64 years finally completed this study. The CAPD patients had a significantly high rate of MACE (P=0.001) and high levels of IMA than healthy controls (P<0.001). Compared with CAPD patients with normal levels of IMA, the CAPD patients with high levels of IMA (>85 kU/L) had lower non-MACE survival rate (P<0.001), which indicated that the high IMA CAPD patients may suffer a high rate of MACE. In addition, the high IMA CAPD patients also had a low level of serum albumin (P<0.001) and hemoglobin (P=0.018). The correlation analysis showed that the serum albumin level was the most effective factor influencing IMA (B=-0.967, P<0.001).

CONCLUSIONS

CAPD patients with high levels of IMA had a high incidence rate of MACE. IMA was a good predictive marker of MACE and might be important in cardiovascular risk stratification of CAPD patients.

Allosteric modulation of zinc speciation by fatty acids

BACKGROUND

Serum albumin is the major protein component of blood plasma and is responsible for the circulatory transport of a range of small molecules that include fatty acids, hormones, metal ions and drugs. Studies examining the ligand-binding properties of albumin make up a large proportion of the literature. However, many of these studies do not address the fact that albumin carries multiple ligands (including metal ions) simultaneously in vivo. Thus the binding of a particular ligand may influence both the affinity and dynamics of albumin interactions with another.

SCOPE OF REVIEW

Here we review the Zn(2+) and fatty acid transport properties of albumin and highlight an important interplay that exists between them. Also the impact of this dynamic interaction upon the distribution of plasma Zn(2+), its effect upon cellular Zn(2+) uptake and its importance in the diagnosis of myocardial ischemia are considered.

MAJOR CONCLUSIONS

We previously identified the major binding site for Zn(2+) on albumin. Furthermore, we revealed that Zn(2+)-binding at this site and fatty acid-binding at the FA2 site are interdependent. This suggests that the binding of fatty acids to albumin may serve as an allosteric switch to modulate Zn(2+)-binding to albumin in blood plasma.

GENERAL SIGNIFICANCE

Fatty acid levels in the blood are dynamic and chronic elevation of plasma fatty acid levels is associated with some metabolic disorders such as cardiovascular disease and diabetes. Since the binding of Zn(2+) to albumin is important for the control of circulatory/cellular Zn(2+) dynamics, this relationship is likely to have important physiological and pathological implications. This article is part of a Special Issue entitled Serum Albumin.

Image microarrays derived from tissue microarrays (IMA-TMA): New resource for computer-aided diagnostic algorithm development

BACKGROUND

Conventional tissue microarrays (TMAs) consist of cores of tissue inserted into a recipient paraffin block such that a tissue section on a single glass slide can contain numerous patient samples in a spatially structured pattern. Scanning TMAs into digital slides for subsequent analysis by computer-aided diagnostic (CAD) algorithms all offers the possibility of evaluating candidate algorithms against a near-complete repertoire of variable disease morphologies. This parallel interrogation approach simplifies the evaluation, validation, and comparison of such candidate algorithms. A recently developed digital tool, digital core (dCORE), and image microarray maker (iMAM) enables the capture of uniformly sized and resolution-matched images, with these representing key morphologic features and fields of view, aggregated into a single monolithic digital image file in an array format, which we define as an image microarray (IMA). We further define the TMA-IMA construct as IMA-based images derived from whole slide images of TMAs themselves.

METHODS

Here we describe the first combined use of the previously described dCORE and iMAM tools, toward the goal of generating a higher-order image construct, with multiple TMA cores from multiple distinct conventional TMAs assembled as a single digital image montage. This image construct served as the basis of the carrying out of a massively parallel image analysis exercise, based on the use of the previously described spatially invariant vector quantization (SIVQ) algorithm.

RESULTS

Multicase, multifield TMA-IMAs of follicular lymphoma and follicular hyperplasia were separately rendered, using the aforementioned tools. Each of these two IMAs contained a distinct spectrum of morphologic heterogeneity with respect to both tingible body macrophage (TBM) appearance and apoptotic body morphology. SIVQ-based pattern matching, with ring vectors selected to screen for either tingible body macrophages or apoptotic bodies, was subsequently carried out on the differing TMA-IMAs, with attainment of excellent discriminant classification between the two diagnostic classes.

CONCLUSION

The TMA-IMA construct enables and accelerates high-throughput multicase, multifield based image feature discovery and classification, thus simplifying the development, validation, and comparison of CAD algorithms in settings where the heterogeneity of diagnostic feature morphologic is a significant factor.

Clampless off-pump surgery reduces stroke in patients with left main disease

BACKGROUND

Surgical revascularization is the most appropriate therapy for patients with significant left main coronary-artery disease (LMD). An incidence of perioperative stroke remains an issue when compared to the early outcomes to percutaneous coronary intervention (PCI). This study evaluates the safety and impact of standardized "clampless" OPCAB techniques, composed of either complete in situ grafting or "clampless" device enabled techniques for stroke reduction in patients undergoing surgical revascularization for LMD.

METHODS

Between 1999 and 2009, 1031 patients with LMD underwent myocardial-revascularization at our institution. Of these, 507 patients underwent "clampless" OPCAB and 524 patients underwent conventional on-pump CABG (ONCABG). Data-collection was performed prospectively and a propensity-adjusted regression-analysis was applied to balance patient characteristics. LMD was defined as a stenosis >50% and endpoints were mortality, stroke, a cardiac-composite (including death, stroke and myocardial-infarction); a non-cardiac composite and complete-revascularization.

RESULTS

In OPCAB patients, the cardiac composite (3.0% vs. 7.8%; propensity-adjusted (PA)OR=0.27; CI95% 0.12-0.65; p=0.003) as well as the occurrence of stroke (0.4% vs. 2.9%; PAOR=0.04; CI95% 0.003-0.48; p=0.012) were significantly lower while the mortality-rate was well comparable between groups (1.8% vs. 2.5%; PAOR=0.44; CI95% 0.11-1.71; p=0.24). The non-cardiac composite was also significantly decreased after OPCAB (8.9% vs. 19.7%; PAOR=0.55; CI95% 0.34-0.89; p=0.014) and complete revascularization was achieved for similar proportions in both groups (95.1% vs. 93.7%; p=0.35).

CONCLUSIONS

This study shows the superiority of OPCAB for patients with LMD with regards to risk-adjusted outcomes other than mortality. A "clampless OPCAB strategy", effectively reduces stroke yielding similar early outcomes as PCI.

Image microarrays (IMA): Digital pathology's missing tool

Introduction:

The increasing availability of whole slide imaging (WSI) data sets (digital slides) from glass slides offers new opportunities for the development of computer-aided diagnostic (CAD) algorithms. With the all-digital pathology workflow that these data sets will enable in the near future, literally millions of digital slides will be generated and stored. Consequently, the field in general and pathologists, specifically, will need tools to help extract actionable information from this new and vast collective repository.

Methods:

To address this limitation, we designed and implemented a tool (dCORE) to enable the systematic capture of image tiles with constrained size and resolution that contain desired histopathologic features.

Results:

In this communication, we describe a user-friendly tool that will enable pathologists to mine digital slides archives to create image microarrays (IMAs). IMAs are to digital slides as tissue microarrays (TMAs) are to cell blocks. Thus, a single digital slide could be transformed into an array of hundreds to thousands of high quality digital images, with each containing key diagnostic morphologies and appropriate controls. Current manual digital image cut-and-paste methods that allow for the creation of a grid of images (such as an IMA) of matching resolutions are tedious.

Conclusion:

The ability to create IMAs representing hundreds to thousands of vetted morphologic features has numerous applications in education, proficiency testing, consensus case review, and research. Lastly, in a manner analogous to the way conventional TMA technology has significantly accelerated in situ studies of tissue specimens use of IMAs has similar potential to significantly accelerate CAD algorithm development.