Background Obsessive–compulsive disorder (OCD) is a common, heritable neuropsychiatric disorder, hypothetically underpinned by dysfunction of brain cortical-striatal-thalamic-cortical (CSTC) ...circuits; however, the extent of brain functional abnormalities in individuals with OCD is unclear, and the genetic basis of this disorder is poorly understood. We determined the whole brain functional connectivity patterns in patients with OCD and their healthy first-degree relatives. Methods We used resting-state fMRI to measure functional connectivity strength in patients with OCD, their healthy first-degree relatives and healthy controls. Whole brain functional networks were constructed by measuring the temporal correlations of all brain voxel pairs and further analyzed using a graph theory approach. Results We enrolled 39 patients with OCD, 20 healthy first-degree relatives and 39 healthy controls in our study. Compared with healthy controls, patients with OCD showed increased functional connectivity primarily within the CSTC circuits and decreased functional connectivity in the occipital cortex, temporal cortex and cerebellum. Moreover, patients with OCD and their first-degree relatives exhibited overlapping increased functional connectivity strength in the bilateral caudate nucleus, left orbitofrontal cortex (OFC) and left middle temporal gyrus. Limitations Potential confounding factors, such as medication use, heterogeneity in symptom clusters and comorbid disorders, may have impacted our findings. Conclusion Our preliminary results suggest that patients with OCD have abnormal resting-state functional connectivity that is not limited to CSTC circuits and involves abnormalities in additional large-scale brain systems, especially the limbic system. Moreover, resting-state functional connectivity strength abnormalities in the left OFC, bilateral caudate nucleus and left middle temporal gyrus may be neuroimaging endophenotypes for OCD.
Abstract Background Context Polymethylmethacrylate (PMMA) is widely used for pedicle screw augmentation in osteoporosis. Intriguingly, there have been no biomechanical comparisons of the stability of ...pedicle screws augmented with different volumes of PMMA or studies of the relationship between screw stability and volume of PMMA, especially in different degrees of osteoporosis. Purpose The purposes of the study reported here were to compare screw stability by different volumes of PMMA augmentation, to analyze the relationship between screw stability and PMMA volume, and to make a preliminary determination of the optimum volume of PMMA augmentation for different degrees of osteoporosis. Study Design This study is a biomechanical comparison of pedicle screws augmented with various volumes of PMMA in cadaveric lumbar vertebrae. Methods Thirty-six pedicles from 18 osteoporotic lumbar vertebrae were randomly divided into groups A0 through A5, and 36 pedicles from 18 severely osteoporotic lumbar vertebrae were randomly divided into groups B0 through B5. A different volume of PMMA was injected into each one of groups A0 through A5 (0, 0.5, 1.0, 1.5, 2.0, and 2.5 mL, respectively) and into each one of groups B0 through B5 (0, 1.0, 1.5, 2.0, 2.5, and 3.0 mL, respectively), and then pedicle screws were inserted in all vertebrae. After complete solidification of the PMMA, we examined pedicle X-rays, performed axial pullout tests, and determined the maximum axial pullout strength (Fmax ) for all samples. Results No PMMA was found around the screws in groups A0 and B0. In groups A1 to A5 and B1 to B5, screws were wrapped by gradually increasing amounts of PMMA. There was no PMMA leakage or screw malpositioning in any samples. The Fmax in groups A1 through A5 increased by 32.40%, 64.42%, 116.02%, 174.07%, and 207.42%, respectively, compared with that in group A0. There were no significant differences in Fmax between groups A0 and A1, A1 and A2, A2 and A3, A3 and A4, and A4 and A5 (p>.05), but there were significant differences in Fmax between any other two groups (p<.05). The Fmax in groups B1 through B5 increased by 23.48%, 48.40%, 106.60%, 134.73%, and 210.04%, respectively, compared with that in group B0. There were no significant differences in Fmax between groups B0 and B1, B0 and B2, B1 and B2, B2 and B3, B3 and B4 (p>.05), but there were significant differences in Fmax between any other two groups (p<.05). There was a significant positive correlation between Fmax and volume of PMMA in both osteoporotic and severely osteoporotic lumbar vertebrae (p<.05). Conclusions Polymethylmethacrylate can significantly enhance stability of pedicle screws in both osteoporotic and severely osteoporotic lumbar vertebrae. There is a significant positive correlation between screw stability and volume of PMMA. Within a certain range, nevertheless, increasing the volume of PMMA does not significantly improve screw stability. We suggest that 1.5 and 3 mL, respectively, are the volumes of injected PMMA that will optimize pedicle screw stability in osteoporotic and severely osteoporotic lumbar vertebrae.
Background The stromal compartment in several organs seems to play an important role in the initiation, growth, and progression of certain neoplasms. The tumor–stroma ratio (TSR) has been found to be ...an independent factor for prognosis of several types of carcinomas, but the effect of the TSR on hepatocellular carcinoma (HCC) has not been explored yet. The objective of the study is to evaluate the prognostic importance of TSR in HCC patients after liver resection or transplantation. Methods A total of 300 patients with HCC who underwent liver resection or transplantation were included in this study. TSR was assessed on hematoxylin and eosin–stained sections by 2 independent investigators. Patients were divided into 2 groups: a stroma-rich group (stroma ≥ 50%) and a stroma-poor group (stroma < 50%). Chi-square test, Kaplan–Meier method, and Cox univariable and multivariable regression were used in to analyze the data. Results Among the post liver resection patients, the TSR was associated with overall survival (OS) in univariate and multivariate analyses (hazard ratio HR, 4.35 95% CI, 2.54–7.47 and HR, 2.55 95% CI, 1.44–4.52, respectively). Among the post liver transplant patients, the TSR was also associated with OS in univariate and multivariate analyses (HR, 2.92 95% CI, 1.63–5.23 and HR, 2.76 95% CI, 1.47–4.85, respectively), and TSR with recurrence-free survival (RFS) in univariate and multivariate analyses (HR, 2.63 95% CI, 1.42–4.86 and HR, 1.93 95% CI, 1.03–3.62, respectively). Patients with stroma-poor tumor and who were within the Milan criteria or the UCSF criteria had a better in OS and RFS. Conclusion We show for the first time that TSR is an independent prognostic factor for HCC patients after liver resection or transplantation. TSR may enable better identification of patients at risk for recurrence in HCC patients after curative treatment and may aid in patient management and development of individualized medicine for treatment of HCC.
Three-dimensional (3D) strain analysis may help overcome the limitations of Doppler and two-dimensional strain analysis for the left ventricle and become the method of choice for left ventricular ...(LV) systolic function. The aims of this study were to evaluate the feasibility and reproducibility of LV global 3D systolic strain by real-time 3D speckle-tracking echocardiography (STE) in children and to establish their maturational growth patterns and normal values.
A prospective study was conducted in 256 consecutive healthy subjects using real-time 3D echocardiography. Full-volume 3D data were acquired using a 3D matrix-array transducer. Three-dimensional LV peak systolic global strain (GS), global longitudinal strain (GLS), global radial strain (GRS), and global circumferential strain (GCS) values were determined using real-time 3D STE.
A total of 228 patients (89%) met the criteria for analysis; 28 (11%) were excluded. The correlations between age and strain variables by real-time 3D STE were poor (R(2) = 0.01-0.05, P < .05). The differences in GLS and GCS among the five age groups were statistically significant but clinically irrelevant. There were no statistical differences in GRS and GS values among the age groups, nor were there statistical differences between the genders for all 3D strain parameters. Intraobserver and interobserver variability ranged from 5.0 ± 4.3% to 10.1 ± 8.5% versus 6.9 ± 6.1% to 17.0 ± 16.2% for coefficients of variation, respectively. Interclass correlation coefficients ranged from 0.78 to 0.87 and from 0.75 to 0.79 for intraobserver and interobserver measurements for GS, GLS, GCS, and GRS, respectively.
LV global 3D systolic strain analysis using the new 3D STE is feasible and reproducible in the pediatric population. There are small maturational changes in GLS and GCS, but not in GRS and GS, that are statistically significant but probably clinically irrelevant. Further investigation is warranted for potential clinical application of this new technology in a pediatric population.
Abstract Objectives To analyze the clinical features, immediate and short-term outcome of percutaneous balloon pulmonary valvuloplasty (PBPV) of neonates with pulmonary atresia with intact ...ventricular septum (PA/IVS) or critical pulmonary stenosis with intact ventricular septum (CPS/IVS) who underwent PBPV as initial intervention methods to evaluate the risk factors of reintervention. Method Thirty-eight neonates with PA/IVS or CPS/IVS admitted to Shanghai Xinhua Hospital between June 2009 and November 2014 who underwent PBPV as initial procedures were respectively studied. We analyzed their clinical features, the immediate and short-term outcome of PBPV, and evaluated the risk factors for reintervention. Results Thirty-eight neonates with PA/IVS and CPS/IVS who underwent PBPV as initial procedures were included in our study with a mean age of 13 ± 8 days. Among the 12 patients who underwent reintervention, 7 patients had PA/IVS (64%) and 5 had CPS/IVS (36%). Patients with PA/IVS ( p = 0.005), small pulmonary valve diameter ( p = 0.035), and bad pulmonary valve development were important risk factors. The immediate and short-term outcome of PBPV was better in patients who did not need reintervention, and the peak-to-peak pulmonary transvalvular gradient in the 1st month after PBPV had the best capability in predicting reintervention with help of receiver operating characteristic curve and the logistic regression analysis. Days of prostaglandin E1 (PGE1) infusion after PBPV >5 days was also found to be a risk factor for reintervention. Conclusion The short- and mid-term outcome of pulmonary valve perforation and PBPV in neonates with PA/IVS and CPS/IVS was favorable. Risk factors include PA/IVS, small pulmonary valve, bad short-term pulmonary valve development, the peak-to-peak pulmonary transvalvular gradient in the 1st month after procedure >42 mmHg, and PGE1 infusion >5 days.
Abstract Purpose To assess the associations between cruciferous vegetable (CV) intake, GST gene polymorphisms, and colorectal cancer (CRC) in a population of Chinese men. Methods Using incidence ...density sampling, CRC cases ( N = 340) diagnosed before December 31, 2010 within the Shanghai Men's Health Study were matched to noncases ( N = 673). CV intake was assessed from a food frequency questionnaire and by isothiocyanate levels from spot urine samples. GSTM1 and GSTT1 were categorized as null (0 copies) versus non-null (1 or 2 copies). Conditional logistic regression was used to calculate odds ratios and 95% confidence intervals for the association between CV intake and GST gene variants with CRC, and statistical interactions were evaluated. Results CRC risk was not associated with CV intake, whether measured by self-report or by urinary isothiocyanate nor with GST gene variants. No statistical interactions were detected between CV intake and GST gene variants on the odds of CRC. Stratifying by timing of urine sample collection and excluding CRC cases diagnosed in the first 2 years did not materially alter the results. Conclusions This study provides no evidence supporting the involvement of CV intake in the development of CRC in Chinese men.
Abstract Background Cholesterol-overloaded high-density lipoprotein (HDL) particles exert a negative impact on the antiatherogenic function of HDL in experimental studies. However, it remains unclear ...whether cholesterol-overloaded HDL particle is involved in the development of atherosclerosis in humans. Objectives The objective of this study was to explore whether cholesterol-overloaded HDL particles are associated with the progression of carotid atherosclerosis in a cardiovascular disease–free population. Methods Baseline HDL particle number was measured using nuclear magnetic resonance spectroscopy in 930 participants ages 45 to 74 years in a community-based cohort study. An estimate of cholesterol molecules per HDL particle (HDL-C/P ratio) was calculated as the ratio of HDL cholesterol to HDL particles. HDL-C/P ratio was categorized as <41.0 (lowest), 41.0 to 46.9, 47.0 to 52.9, and ≥53.0 (highest) using a fixed increment method. Modified Poisson regression was used to assess the association between HDL-C/P ratio and 5-year progression of carotid atherosclerosis as indicated by progression of carotid plaques and change in total plaque area (TPA). Results Mean baseline HDL-C/P ratio was 46.4 ± 9.3 (range 23.8 to 86.9). Baseline HDL-C/P ratio was significantly associated with 5-year progression of carotid atherosclerosis. Participants with the highest HDL-C/P ratio had 1.56-fold (95% confidence interval: 1.14 to 2.13; p = 0.006) increased progression compared with those with the lowest level. Among participants without baseline plaque, TPA in re-examination was larger by 9.4 mm2 in the subgroup with the highest level when compared with the lowest level. Conclusions Our findings suggest that cholesterol-overloaded HDL particles are independently associated with the progression of carotid atherosclerosis. This may explain why in recent trials raising HDL cholesterol was not beneficial. This study strongly suggests that the combination of cholesterol content and particle number determines the antiatherogenic function of HDLs, rather than either parameter alone.
To compare the therapeutic effects of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) on patients with macular corneal dystrophy (MCD) and to analyze the risk factors of ...postoperative recurrence.
Retrospective, interventional, comparative case series.
Fifty-one patients (78 eyes) with MCD treated by PK or DALK at Shandong Eye Institute between January 1992 and December 2010.
The medical records of the patients were reviewed retrospectively.
Best-corrected visual acuity, corneal endothelial density, complications, recurrence, graft survival, and risk factors for recurrence.
Penetrating keratoplasty was performed in 57 eyes, and DALK was performed in 21 eyes. The mean follow-up time was 5.1±4.1 years (range, 1.0-18.0 years). The best-corrected visual acuity of the PK group was much better than that of the DALK group at 1, 2, 3, and 5 years. The corneal endothelial density was reduced to 1000 cells/mm2 or less within 5 years in 21.6% (11/51) of eyes treated by PK and in none of the eyes treated by DALK. The 1-year incidence rate of complications was 21.1% in the PK group, higher than the 4.8% rate in the DALK group. At the last visit, the rate of graft clarity was 87.7% and 85.7% in the 2 groups, respectively. Ten eyes (17.5%) treated by PK had recurrent MCD, with a rate of 0.8%, 7.7%, and 40% at 1, 5, and 10 years, respectively, whereas 9 eyes (42.9%) treated by DALK demonstrated recurrence, with a rate of 14.3% and 49.5% at 1 and 5 years, respectively. The recurrence risk was higher in patients whose age was 18 years or younger at onset or younger than 30 years at surgery. The recurrence risk after DALK was 5.066 times higher than that after PK.
Penetrating keratoplasty more often immediately improves the visual acuity of patients with MCD, but many complications seem to be inevitable, especially continuous loss of corneal endothelium. Despite poor visual acuity and recurrence after surgery, DALK may produce fewer complications overall and more durable stability of the ocular surface compared with PK. The selection of PK or DALK for MCD should depend on the actual need and situation of certain patients.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Abstract GATA3 has been recognized as the novel marker for identifying primary and metastatic breast carcinomas, consistently showing that GATA3 was significantly more sensitive than traditional ...marker GCDFP15 and Mammaglobin (MGB). However, clinically useful groups of breast carcinomas status were not identified, which was determining appropriate treatment strategy, affecting the prognosis. In this study, we undertook a comparative study of the marker GATA3 and GCDFP15 and MGB in clinically useful groups of paired primary and metastatic breast cancer. We retrieved 64 cases of matched primary and metastatic breast cancer from the surgical pathology archive at our institution. According to the emerging St. Gallen 2015 consensus, the clinically useful groups were divided into ER and/or PR (+), HER2 (−), abbreviated as A; ER and/or PR (+), HER2 (+), abbreviated as B; ER and PR (−), HER2 (+), abbreviated as C; ER, PR and HER2 (−), abbreviated as D; each group contained 16 cases (n = 16). Tissue microarrays were created, with three 1-mm punch specimens from each case. The tissue microarrays were cut at a 4-μm thickness and stained with monoclonal antibodies to GATA3, GCDFP15 and MGB. Staining intensity (0 ~ 3+) and extent (0% to 100%) were scored with an H-score calculated (range, 0 to 300). Sensitivities by varying H-score cutoffs (any; ≥50; ≥150) for a positive result in the clinically useful groups of matched primary or metastatic breast cancer among GATA3, GCDFP15 and MGB. GATA3 was significantly more sensitive than GCDFP15 and MGB in a majority of paired primary or metastatic breast cancer groups, including all groups, A and B groups ( P < .05) rather than C and D groups ( P > .05). However, GATA3 in conjunction with GCDFP15 and MGB detection could improve the sensitivity of C group ( P < .05) rather than D group ( P > .05). Significantly, good coincidence was observed between primary and metastatic tumor GATA3 expression (kappa value =0.826> 0.75) as compared with the coincidence of GCDFP15 (kappa value =0.492< 0.75) and MGB (kappa value =0.593< 0.75) (both P < .05). In conclusion, GATA3 expression did not show the same sensitivity for the clinically useful groups of breast cancer. GATA3 expression is positively correlated with ER-positive, PR-positive, and HER2-positive carcinomas. In addition, the matched primary and metastatic tumor expression of GATA3 show good coincidence. We propose the careful selection of GATA3 for identifying hormone receptor-negativity of breast cancer, especially in the case of triple-negative breast cancer.
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