Objectives
To evaluate the diagnostic performance of adult-based “American College of Radiology- Thyroid Imaging Reporting And Data System” (ACR-TIRADS) and “American Thyroid Association” (ATA) in ...the pediatric population.
Methods
MEDLINE/PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched for articles investigating the diagnostic performance of each stratification system (ACR-TIRADS or ATA) and evaluated them according to three aspects: (a) the risk of malignancy in each category; (b) diagnostic performance using the classic indicators (sensitivity, specificity); and (c) diagnostic performance regarding fine needle aspiration/biopsy recommendation. In addition to pathologic diagnosis, we allowed imaging follow-up as the reference standard for benign nodules.
Results
Eight articles (1036 thyroid nodules) were included. For ACR-TIRADS, the pooled risk of malignancy in category was as follows: category 5 (59.3%); 4 (20.7%); 3 (11.0%); 2 (6.0%), and 1 (5.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.84 and 0.64. For ATA, the pooled risk of malignancy was as follows: category 5 (55.4%); 4 (34.2%); 3 (12.2%); and 2 (7.5%). For nodules of high suspicion of malignancy (category 4 or 5), the pooled sensitivity and specificity were 0.90 and 0.50. For category 5 nodules, the pooled specificity was significantly higher in ACR-TIRADS (
p
= 0.02). For ACR-TIRADS, the missed malignancy rate was 21.7% and the unnecessary biopsy rate was 62.7%. Information was not sufficient for this calculation with ATA.
Conclusions
The diagnostic performance of ACR-TIRADS and ATA in the pediatric population was somewhat modest. Large studies are mandatory for further validation and future amendments.
Key Points
•
The pooled sensitivity and specificity for highly suspicious nodules (category 4 or 5) for ACR-TIRADS were 0.84 and 0.64, and for ATA were 0.90 and 0.50, respectively.
• When applying ACR-TIRADS for children, the pooled missed malignancy rate (21.7%) and unnecessary biopsy rates (62.7%) are still reasonably high. Insufficient information was available to perform these calculations for the ATA system.
• Current risk stratification systems, especially ACR-TIRADS, require modification by focusing more on increasing the sensitivity and decreasing the missed malignancy rate. Lowering size cut-off for biopsy would be a reasonable option
.
The extracellular matrix (ECM) offers a structural basis for regulating cell functions while also acting as a collection point for bioactive molecules and connective tissue cells. To perform ...pathological functions under a pathological condition, the involved cells need to regulate the ECM to support their altered functions. This is particularly common in the development of cancer. The ECM has been recognized as a key driver of cancer development and progression, and ECM remodeling occurs at all stages of cancer progression. Thus, cancer cells need to change the ECM to support relevant cell surface adhesion receptor–mediated cell functions. In this context, it is interesting to examine how cancer cells regulate ECM remodeling, which is critical to tumor malignancy and metastatic progression. Here, we review how the cell surface adhesion receptor, syndecan, regulates ECM remodeling as cancer progresses, and explore how this can help us better understand ECM remodeling under these pathological conditions
Purpose
To verify and integrate the prevalence and phenotype of abnormalities in the sellar region in patients with growth hormone deficiency (GHD) using MRI data.
Methods
We searched PubMed and ...EMBASE up to December 14, 2020. The inclusion criteria were as follows: (1) pediatric patients diagnosed with nonacquired GHD and (2) detailed data sufficient to assess the proportion of sellar and parasellar abnormalities on brain MRI scans. Finally, thirty-two studies with 39,060 children (mean or median age, 3.4–14.1 years) were included. The number and type of MRI findings from all included studies were pooled by two authors. The heterogeneity across studies was evaluated with the
Q
test or the inconsistency index (
I
2
) statistic. Subgroup analyses were performed according to the type of GHD (isolated GHD IGHD vs. multiple pituitary hormone deficiency MPHD), MRI magnet, geographical region, and cutoff serum growth hormone (GH) level.
Results
The pooled proportion of sellar and parasellar abnormalities was 58.0% (95% CI, 47.1–68.6%;
I
2
, 98.2%). The MPHD group showed a higher proportion of sellar and parasellar abnormalities and pituitary stalk interruption syndrome than the IGHD group (91.4% vs. 40.1%,
P
<0.001; 65.3% vs. 20.1%,
P
<0.001). The patients in studies with low peak GH levels on stimulation tests were more associated with severe MR abnormalities (cutoff GH ≤ 5 μg/l vs. cutoff GH = 10 μg/l; 72.8 % vs. 38.0%;
P
<0.001).
Conclusion
The types and incidence of MRI abnormalities of the sellar region differ significantly between the IGHD and MPHD groups.
Background: It is known that hand strength and fingertip force are used as an indicator of muscle strength and are also highly related to the various chronic symptoms and even lifespan. To use the ...individual fingertip force (IFF) as a quantitative index for clinical evaluation, the IFF should be measured and analyzed with various variables from various subjects, such as the normal range of fingertip force and the difference in its distribution by disease. Objects: We tried to measure and analyze the mean maximum IFF distribution during grasping a cylindrical object in healthy adults and patients with spinal cord injury (SCI). Methods: Five Force-sensitive resistor (FSR) sensors were attached to the fingertips of 24 healthy people and 13 patients with SCI. They were asked to grip the object three times for five seconds with their maximum effort. Results: The mean maximum IFF of the healthy adult group’s thumb, index, and middle finger was similar statistically and showed relatively larger than IFF of the ring and small finger. It is a 3-point pinch grip pattern. All fingertip forces of patients with SCI decreased by more than 50% to the healthy group, and their IFF of the middle finger was relatively the largest among the five fingertip forces. The cervical level injured SCI patients showed significantly decreased IFFs compared to thoracic level injured SCI patients. Conclusion: We expect that this study results would be helpful for rehabilitation diagnosis and therapy goal decision with robust further study.
원통형 물체 쥐기 시 건강한 성인과 척수마비 환자의 최대 손가락 끝 힘 분포 비교 황지선; Jisun Hwang; 이재선 ...
Han'guk Chŏnmun Mulli Ch'iryo Hakhoe chi = Journal of the Korean Academy of University Trained Physical Therapists,
02/2022, Letnik:
29, Številka:
1
Journal Article
Odprti dostop
Background: It is known that hand strength and fingertip force are used as an indicator of muscle strength and are also highly related to the various chronic symptoms and even lifespan. To use the ...individual fingertip force (IFF) as a quantitative index for clinical evaluation, the IFF should be measured and analyzed with various variables from various subjects, such as the normal range of fingertip force and the difference in its distribution by disease.
Objects: We tried to measure and analyze the mean maximum IFF distribution during grasping a cylindrical object in healthy adults and patients with spinal cord injury (SCI).
Methods: Five Force-sensitive resistor (FSR) sensors were attached to the fingertips of 24 healthy people and 13 patients with SCI. They were asked to grip the object three times for five seconds with their maximum effort.
Results: The mean maximum IFF of the healthy adult group’s thumb, index, and middle finger was similar statistically and showed relatively larger than IFF of the ring and small finger. It is a 3-point pinch grip pattern. All fingertip forces of patients with SCI decreased by more than 50% to the healthy group, and their IFF of the middle finger was relatively the largest among the five fingertip forces. The cervical level injured SCI patients showed significantly decreased IFFs compared to thoracic level injured SCI patients.
Conclusion: We expect that this study results would be helpful for rehabilitation diagnosis and therapy goal decision with robust further study.
Objectives
To evaluate the outcome of staging chest CT and to identify clinicoradiological factors predictive of lung metastasis in patients with hepatoblastoma based on the 2017 PRE-Treatment EXTent ...of tumor (PRETEXT) system.
Methods
This bi-center study retrospectively identified patients diagnosed with hepatoblastoma between January 1998 and September 2019 in two tertiary hospitals. The primary outcome was the proportion of the patients who had lung metastasis at staging chest CT. The diagnostic accuracy of staging chest CT was calculated based on the 2017 PRETEXT criteria. The secondary outcome was the identification of factors predictive of lung metastasis using multivariable logistic regression.
Results
In total, 123 patients (median age, 1 year; interquartile range, 0–4 years; 59 female) were included. Among those, 28% (35/123; 95% confidence interval CI, 21–37%) had lung metastasis at staging chest CT. The overall accuracy of staging chest CT was 96.8%. The proportion of lung metastasis in patients with stage I, II, III, and IV was 0%, 24% (12 of 49; 95% CI, 14–38%), 23% (9 of 40; 95% CI, 12–38%), and 56% (14 of 25; 95% CI, 37–73%), respectively. Multifocality (adjusted odds ratio, 6.7; 95% CI, 2.7–17.5;
p
< .001) and male sex (adjusted odds ratio, 3.1; 95% CI, 1.2–8.6;
p =
.02) were associated with the presence of lung metastasis.
Conclusions
Twenty-eight percent of the patients with hepatoblastoma had lung metastasis at staging chest CT. Multifocality and male sex were predictive factors for lung metastasis on staging chest CT.
Key Points
• The proportion of lung metastasis in patients with hepatoblastoma was 28%.
• The overall accuracy of staging chest CT was 97% based on the 2017 PRETEXT system.
• Hepatic tumor multifocality and male sex were predictors of lung metastasis.
The aim of this study was to validate the postnatal urinary tract dilation (UTD) classification system by correlating it with the need for surgical intervention.
Young infants who underwent ...ultrasound (US) examinations for prenatal hydronephrosis were retrospectively identified. The kidney units (KUs; right, left, or bilateral) were graded from UTD P0 (very low risk) to P3 (high risk) based on seven US criteria from the UTD system. Surgery-free survival curves were constructed using the Kaplan-Meier method. Univariable and multivariable Cox proportional-hazards regression analysis clustered by patients was performed. Interobserver agreement was analyzed using the weighted kappa coefficient.
In total, 504 KUs from 336 patients (mean age, 18.3±15.9 days; range, 1 to 94 days; males, n=276) were included, with a median follow-up of 24.2 months. Fifty-eight KUs underwent surgical intervention. Significant differences were observed among the Kaplan-Meier curves stratified into UTD groups (P<0.001). The presence of anterior-posterior renal pelvic diameter ≥15 mm (hazard ratio HR, 8.602; 95% confidence interval CI, 1.558 to 43.065), peripheral calyceal dilation (HR, 8.190; 95% CI, 1.558 to 43.065), ureteral dilation (HR, 2.619; 95% CI, 1.274 to 5.380), parenchymal thickness abnormality (HR, 3.371; 95% CI, 1.574 to 7.223), bladder abnormality (HR, 12.209; 95% CI, 3.616 to 41.225) were significantly associated with the occurrence of surgery. The interobserver agreement was moderate to almost perfect agreement for US features (κ=0.564-0.898) and substantial for final UTD grades (κ=0.716).
The UTD classification system is reliable and appropriately stratifies the risk of surgical intervention.
Intussusception involves an invagination of the proximal bowel into the distal bowel, with ileocolic intussusception being the most common type. However, a diagnostic delay can lead to intestinal ...ischemia, bowel infarction, or even death; therefore, its early diagnosis and management are important. The primary role of abdominal radiography is to detect pneumoperitoneum or high-grade bowel obstruction in cases of suspected intussusception, and ultrasonography is the modality of choice for its diagnosis. Nonoperative enema reduction, the treatment of choice for childhood intussusception in cases without signs of perforation or peritonitis, can be safely performed with a success rate of 82%. Enema reduction can be performed in various ways according to image guidance method (fluoroscopy or ultrasonography) and reduction medium (liquid or air). Successful enema reduction is less likely to be achieved in children with a longer symptom duration, younger age, lethargy, fever, bloody diarrhea, unfavorable radiologic findings (small bowel obstruction, trapped fluid, ascites, absence of flow in the intussusception, intussusception in the left-sided colon), and pathological lead points. This review highlights the current concepts of intussusception diagnosis, nonsurgical enema reduction, success rates, predictors of failed enema reduction, complications, and recurrence to guide general pediatricians in the management of childhood intussusception.
We previously showed that a synthetic peptide (S2-P) corresponding to a portion of the human syndecan-2 (SDC2) sequence can bind to the pro-domain of matrix metalloproteinase-7 (MMP-7) to inhibit ...colon cancer activities. Since S2-P had a relatively weak binding affinity for the MMP-7 pro-domain, we herein modified the amino acid sequence of S2-P to improve the anticancer potential. On the basis of the interaction structure of S2-P and MMP-7, four peptides were generated by replacing amino acids near Tyr 51, which is critical for the interaction. The SDC2-mimetic peptides harboring an Ala-to-Asp substitution at the C-terminal side of Tyr 51 (S2-D) or with an Ala-to-Phe substitution at the N-terminal side of Tyr 51 and an Ala-to-Asp substitution at the C-terminal side of Tyr 51 (S2-FE) showed improved interaction affinities for the MMP-7 pro-domain. Compared to S2-P, S2-FE was better able to inhibit the SDC2-MMP-7 interaction, the cell surface localization of MMP-7, the gelatin degradation activity of MMP-7, and the cancer activities (cell migration, invasion, and colony-forming activity) of human HCT116 colon cancer cells in vitro. In vivo, S2-FE inhibited the primary tumor growth and lung metastasis of CT26 mouse colon cancer cells in a xenograft mouse model. Together, these data suggest that S2-FE could be useful therapeutic anticancer peptides for colon cancer.
Despite the known importance of the transmembrane domain (TMD) of syndecan receptors in cell adhesion and signaling, the molecular basis for syndecan TMD function remains unknown. Using in vivo ...invertebrate models, we found that mammalian syndecan-2 rescued both the guidance defects in C. elegans hermaphrodite-specific neurons and the impaired development of the midline axons of Drosophila caused by the loss of endogenous syndecan. These compensatory effects, however, were reduced significantly when syndecan-2 dimerization-defective TMD mutants were introduced. To further investigate the role of the TMD, we generated a chimera, 2eTPC, comprising the TMD of syndecan-2 linked to the cytoplasmic domain of platelet-derived growth factor receptor (PDGFR). This chimera exhibited SDS-resistant dimer formation that was lost in the corresponding dimerization-defective syndecan-2 TMD mutant, 2eT(GL)PC. Moreover, 2eTPC specifically enhanced Tyr 579 and Tyr 857 phosphorylation in the PDGFR cytoplasmic domain, while the TMD mutant failed to support such phosphorylation. Finally, 2eTPC, but not 2eT(GL)PC, induced phosphorylation of Src and PI3 kinase (known downstream effectors of Tyr 579 phosphorylation) and promoted Src-mediated migration of NIH3T3 cells. Taken together, these data suggest that the TMD of a syndecan-2 specifically regulates receptor cytoplasmic domain function and subsequent downstream signaling events controlling cell behavior.
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