To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal ...varices in patients with liver cirrhosis by using endoscopy as the reference standard.
This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients.
There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9).
HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.
Sinusitis has rarely been associated with short‐lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome. We describe a case of symptomatic SUNCT ...syndrome caused by sinusitis, which showed typical features of SUNCT syndrome. The patient's symptoms completely resolved without recurrence after endoscopic sinus surgery followed by antibiotic treatment. We suggest that ipsilateral paranasal sinusitis accompanied by the spreading of inflammation through a dehiscence in the lamina papyracea could lead to the development of SUNCT syndrome.
Background: Human dental pulp stem cells (DPSCs) have potential applications in tissue regeneration because of their convenient cell harvesting procedures and multipotent capacity. However, the ...tissue regenerative potential of DPSCs is known to be negatively regulated by aging in long-term culture and under oxidative stress. With an aim of reducing cellular senescence and oxidative stress in DPSCs, an intracellular delivery system for superoxide dismutase 1 (SOD1) was developed. We conjugated SOD1 with a cell-penetrating peptide known as low-molecular weight protamine (LMWP), and investigated the effect of LMWP-SOD1 conjugates on hydrogen peroxide-induced cellular senescence and osteoblastic differentiation. Results: LMWP-SOD1 significantly attenuated enlarged and flattened cell morphology and increased senescence-associated β-galactosidase activity. Under the same conditions, LMWP-SOD1 abolished activation of the cell cycle regulator proteins, p53 and p21Cip1, induced by hydrogen peroxide. In addition, LMWP-SOD1 reversed the inhibition of osteoblastic differentiation and downregulation of osteogenic gene markers induced by hydrogen peroxide. However, LMWP-SOD1 could not reverse the decrease in odontogenesis caused by hydrogen peroxide. Conclusion: Overall, cell-penetrating LMWP-SOD1 conjugates are effective for attenuation of cellular senescence and reversal of osteoblastic differentiation of DPSCs caused by oxidative stress inhibition. This result suggests potential application in the field of antiaging and tissue engineering to overcome the limitations of senescent stem cells.
To evaluate technical success and clinical efficacy of crisscross-configured dual biliary stent implantation in patients with a biliary hilar tumor extending beyond the segmental ducts.
Between ...January 2002 and December 2006, two metallic stents were placed crossing each other in a hepatic hilum in 42 patients. One stent was placed between one right sectoral duct and the left hepatic duct and the other was placed between another right sectoral duct and the common bile duct. The patients ranged in age from 36 to 83 years (mean, 63.3 y) and included 26 men and 16 women. Technical success, clinical success, complications, and long-term results were analyzed by retrospective review.
Stent placement was performed through two right accesses (n = 30), one right and one left access (n = 3), or two right accesses and one left access (n = 6). Successful "trisectoral" drainage was obtained with two stents in 41 patients (98%). In one case of initial technical failure, an additional stent was needed to connect the two previously placed stents. Clinical success was obtained in 34 of the remaining 36 patients (92%). No procedure-related major complication was observed. The median primary stent patency time was 187 days and the median patient survival time was 247 days.
Crisscross-configured dual stent implantation is a feasible, safe, and effective method to maximize hepatic drainage with a minimal number of stents in patients with advanced biliary hilar malignancy.
This study was performed to investigate the significance of gastric juice analysis (GJA) as a diagnostic criterion of a positive challenge in a standard oral cow's milk challenge (OCC) to confirm ...typical cow's milk protein-induced enterocolitis (CMPIE). Data from 16 CMPIE patients (aged 14 to 44 days) were analyzed. A standard OCC was openly executed using 0.15 g/kg of protein. Three symptoms (vomiting, lethargy, and bloody or pus-like stool), and four laboratory findings (GJA 3 hr, changes in peripheral blood absolute neutrophil count ANC 6 hr, C-reactive protein 6 hr, and stool smear test for occult blood or leukocytes) were observed after OCC. Before OCC, baseline studies were conducted; a stool smear test, blood sampling, and GJA. Positive OCC results were; vomiting (87.5%) (observed 1-3 hr after OCC), lethargy (62.5%) (1-3 hr), bloody or pus-like stool (43.8%) (6-10 hr), abnormal GJA (93.8%), an ANC rise >3,500 cells/microL (93.8%), and an abnormal stool smear test (75.0%). A single GJA test after a standard OCC is a sensitive diagnostic criterion of a positive challenge, and may provide an early confirmatory diagnosis of CMPIE. An investigation of positive OCC outcomes helps to find out a diagnostic algorithm of criteria of a positive challenge in CMPIE.
A sensitive analytical method of rhodanthpyrone A in rat plasma was developed using a liquid chromatography-tandem mass spectrometry (LC-MS/MS). Rhodanthpyrone A and rhodanthpyrone B (internal ...standard) in rat plasma were extracted by a liq-uid-liquid extraction method with ethyl acetate. This extraction method gave results in high and reproducible extraction recovery in the range of 73.75-79.90% with no interfering peaks around the peak elution time of rhodanthpyrone A and B. The standard calibra- tion curves for rhodanthpyrone A ranged from 0.5 to 2000 ng/mL were linear with r 2 > 0.994 and the inter- and intra-day accuracy and precision and the stability were within acceptance criteria. Using this validated analytical method, pharmacokinetics of rhodanth-pyrone A following intravenous and oral administration of rhodanthpyrone A at doses of 2 mg/kg and 30 mg/kg, respectively, were investigated. Rhodanthpyrone A in rat plasma showed multi-exponential elimination pattern with high clearance and volume of dis-tribution values. The absolute oral bioavailability of this compound was calculated as 3.7%. Collectively, the newly developed sensi-tive LC-MS/MS analytical method of rhodanthpyrone A could be successfully applied to investigate the pharmacokinetic properties of this compound and would be useful for the further studies on the efficacy, toxicity, and biopharmaceutics of rhodanthpyrone A KCI Citation Count: 0
Thoracoscopic stapled bullectomy is a popular procedure for the treatment of primary spontaneous pneumothorax (PSP) that has a relatively high postoperative recurrence rate. One reason for PSP ...recurrence is the formation of a new bulla around the staple line. We hypothesized that different resected specimen volumes might cause differences in staple line tension. In this study, we analyzed the relationship between postoperative pneumothorax recurrence and resected lung volume.
Between April, 2009 and December 2013, 360 cases which underwent video-assisted thoracoscopic surgery (VATS) for PSP were selected. Recurrence after VATS was examined by electronic medical records and telephone survey. Resected volume and vertical area of specimen were calculated with the size of pathologic specimen.
A mean follow up period was 44.5±24.4 months and recurrence rate was 11.1% (40/360). Large volume of resected specimen (≥16 cm
) (P=0.027 by the log-rank test) and larger vertical area of resected specimen (≥2.0 cm
) (P=0.003 by the log-rank test) showed significantly high recurrence rate. Cox regression analysis demonstrated that age hazard ratio (HR), 0.083, P=0.006, vertical section area of resected specimen (HR, 1.239, P=0.020) and volume of resected pathology specimen (HR, 1.039, P=0.009) were independent risk factors of recurrence.
Bulky resection during VATS for PSP increases the risk of recurrence. Large volume and vertical area of resected specimen are associated with greater tension in stapling line. Avoidance of wide resection and the firing of stapler after full collapse of lung are recommended for reducing the pneumothorax recurrence after VATS.
Narrow-band imaging (NBI) can be used to determine whether colorectal polyps are adenomatous or hyperplastic. We investigated whether an artificial intelligence (AI) system can increase the accuracy ...of characterizations of polyps by endoscopists of different skill levels.
We developed convolutional neural networks (CNNs) for evaluation of diminutive colorectal polyps, based on efficient neural architecture searches via parameter sharing with augmentation using NBIs of diminutive (≤5 mm) polyps, collected from October 2015 through October 2017 at the Seoul National University Hospital, Healthcare System Gangnam Center (training set). We trained the CNN using images from 1100 adenomatous polyps and 1050 hyperplastic polyps from 1379 patients. We then tested the system using 300 images of 180 adenomatous polyps and 120 hyperplastic polyps, obtained from January 2018 to May 2019. We compared the accuracy of 22 endoscopists of different skill levels (7 novices, 4 experts, and 11 NBI-trained experts) vs the CNN in evaluation of images (adenomatous vs hyperplastic) from 180 adenomatous and 120 hyperplastic polyps. The endoscopists then evaluated the polyp images with knowledge of the CNN-processed results. We conducted mixed-effect logistic and linear regression analyses to determine the effects of AI assistance on the accuracy of analysis of diminutive colorectal polyps by endoscopists (primary outcome).
The CNN distinguished adenomatous vs hyperplastic diminutive polyps with 86.7% accuracy, based on histologic analysis as the reference standard. Endoscopists distinguished adenomatous vs hyperplastic diminutive polyps with 82.5% overall accuracy (novices, 73.8% accuracy; experts, 83.8% accuracy; and NBI-trained experts, 87.6% accuracy). With knowledge of the CNN-processed results, the overall accuracy of the endoscopists increased to 88.5% (P < .05). With knowledge of the CNN-processed results, the accuracy of novice endoscopists increased to 85.6% (P < .05). The CNN-processed results significantly reduced endoscopist time of diagnosis (from 3.92 to 3.37 seconds per polyp, P = .042).
We developed a CNN that significantly increases the accuracy of evaluation of diminutive colorectal polyps (as adenomatous vs hyperplastic) and reduces the time of diagnosis by endoscopists. This AI assistance system significantly increased the accuracy of analysis by novice endoscopists, who achieved near-expert levels of accuracy without extra training. The CNN assistance system can reduce the skill-level dependence of endoscopists and costs.
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The purpose of this study was to determine the optimal minimum number of liver stiffness measurements on shear wave elastography (SWE) and to evaluate the frequency of technical failures and ...unreliable stiffness measurements and the intraobserver reproducibility of SWE.
This retrospective study was approved by our Institutional Review Board, and informed consent was waived. From August 2011 to January 2013, 540 patients underwent abdominal sonography, including SWE. In 86 patients (group 1), the minimum number of examinations was determined by comparing the intraclass correlation coefficient (ICC) of subsets of the first 2 to 14 measurements with that from 15 measurements. In 454 patients (group 2), 2 SWE sessions were performed in the right lobe within 1 day. Technical failure was defined as when no or little signal was obtained in the elastogram during the first 5 acquisitions; unreliable SWE results were defined as when the interquartile range/median liver stiffness value exceeded 30%. Intraobserver reproducibility was assessed using ICCs and Bland-Altman plots.
In group 1, the ICCs did not significantly increase after the first 6 measurements. In group 2, there were technical failures and unreliable results in 47 patients (10.35%) and 74 patients (16.29%), respectively. In 407 patients, after excluding technical failures, there was no significant difference in the median liver stiffness values between the 2 sessions (6.95 versus 6.86 kPa; P > .05). The overall intraobserver reproducibility was excellent (ICC, 0.95).
In this study, the optimal minimum number of SWE measurements was 6, and SWE using 6 measurements showed excellent intraobserver reproducibility.
Reexpansion pulmonary edema (REPE) is known as a rare and fatal complication after tube thoracostomy.
We investigated the risk factors for the development of REPE in patients with spontaneous ...pneumothorax.
We selected patients who were diagnosed with spontaneous pneumothorax and were initially treated with tube thoracostomy between August 1, 2003 and December 31, 2011. The patients' electronic medical records, including operative notes and chest x-ray and computed tomography scans, were reviewed.
REPE developed in 49 of the 306 patients (16.0%). REPE was more common in patients with diabetes (14.3% vs 3.9%, P=0.004) or tension pneumothorax (46.8% vs 16.2%, P=0.000). The pneumothorax was larger in patients with REPE than without REPE (57.0±16.0% vs 34.2±17.6%, P=0.000), and the incidence of REPE increased with the size of pneumothorax. On multivariate analysis, diabetes mellitus (odds ratio (OR)=9.93, P=0.003), and the size of pneumothorax (OR=1.07, P=0.000) were independent risk factors of REPE.
The presence of diabetes increases the risk of REPE development in patients with spontaneous pneumothorax. The risk of REPE also increases significantly with the size of pneumothorax.
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