Diagnostic Performance of High-Resolution Vessel Wall MR Imaging Combined with TOF-MRA in the Follow-up of Intracranial Vertebrobasilar Dissecting Aneurysms after Reconstructive Endovascular Treatment

BACKGROUND AND PURPOSE

Few studies have reported the utility of high-resolution vessel wall MR imaging in the follow-up of endovascularly treated vertebrobasilar dissecting aneurysms. This study aimed to evaluate the diagnostic performance of high-resolution vessel wall MR imaging combined with TOF-MRA in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.

MATERIALS AND METHODS

Patients with intracranial vertebrobasilar dissecting aneurysms with reconstructive endovascular treatment and followed up with TOF-MRA, high-resolution vessel wall MR imaging, and DSA were included. With DSA as the criterion standard, the diagnostic performance of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA in the evaluation of aneurysm occlusion status and parent artery patency was assessed. Visualization of the stented artery on TOF-MRA and high-resolution vessel wall MR imaging was rated on a 5-point scale.

RESULTS

Twenty-seven patients with 29 aneurysms were included. The sensitivity, specificity, positive predictive value, and negative predictive value of TOF-MRA, high-resolution vessel wall MR imaging, and high-resolution vessel wall MR imaging combined with TOF-MRA for diagnosing aneurysm remnants were 80.0%, 100.0%, 100.0%, and 82.4%; 53.3%, 100.0%, 100.0%, and 66.7%; and 93.3%, 100.0%, 100.0%, and 93.3%, respectively. For the visualization of the stented artery, the mean score of high-resolution vessel wall MR imaging was significantly higher than that of TOF-MRA (4.88 [SD, 0.32] versus 2.53 [SD, 1.25], P < .001). In the evaluation of parent artery patency (normal or pathologic), whereas TOF-MRA had a sensitivity, specificity, positive predictive value, and negative predictive value of 100.0%, 8.0%, 14.8%, and 100.0%, respectively, high-resolution vessel wall MR imaging was completely consistent with the DSA.

CONCLUSIONS

High-resolution vessel wall MR imaging combined with TOF-MRA at 3T showed good diagnostic performance in the follow-up of intracranial vertebrobasilar dissecting aneurysms after reconstructive endovascular treatment.

High-density lipoprotein cholesterol and carcinogenesis

High-density lipoprotein cholesterol (HDLC) has been recognized to be associated with atherosclerosis. In the past few years many studies have found that HDLC is also related to tumor development and progression. Despite some opposing views, a large number of studies support a negative association between HDLC and tumor incidence. Measuring serum HDLC concentrations may facilitate assessment of the prognosis of cancer patients and provide a biomarker for tumors. However, there is a lack of molecular mechanism studies on the link between HDLC and tumors. In this review we discuss the impact of HDLC on the incidence and prognosis of cancer in different systems, as well as prospects for the prediction and treatment of cancer in the future.

Positive correlation between NLR and PLR in 10,458 patients with endometriosis in reproductive age in China

OBJECTIVE

The platelet-lymphocyte ratio (PLR) and neutrophil-lymphocyte ratio (NLR), which can be easily measured from whole blood counts, are composite reflections of significant inflammatory response pathways. However, the relationship between PLR and NLR in patients with ovarian endometriosis is only partially supported by clinical evidence. This study aimed at identifying useful markers for early diagnosis by examining the relationship between PLR and NLR in patients with ovarian endometriosis.

PATIENTS AND METHODS

Between June 2015 and December 2022, we gathered clinical data of 10,458 endometriosis patients who visited the Gynecology Division of the Affiliated Hospital of Jining Medical University. All statistical analyses were performed using the R statistical package.

RESULTS

The results of the univariate analysis, smoothed curve fitting, multiple regression analysis, and subgroup analysis revealed that NLR was always positively correlated with PLR. Further analysis based on the curve fitting threshold effect revealed a significant positive correlation between NLR and PLR when NLR < 2.07 (β: 34.49). Furthermore, when NLR > 2.07, there was a significant positive correlation between NLR and PLR (β: 16.93).

CONCLUSIONS

The finding that NLR and PLR have a positive correlation confirms that inflammation plays a role in the pathogenesis of ovarian endometriosis. Therefore, PLR and NLR could be used as new biomarkers for the diagnosis of endometriosis.

Is TikTok a high-quality source of information on thyroid cancer?

PURPOSE

Increased Internet users tend to use online video platforms as a source of medical information. There are many thyroid cancer-related videos on TikTok, the most popular short-video application in China. However, quality evaluation of these videos remains absent. The aim of this study is to evaluate the quality of thyroid cancer-related videos on TikTok.

METHODS

A search was performed on TikTok with the keyword "thyroid cancer". The top 100 videos in the search results were selected. Characteristics of videos including video length, duration on TikTok, thumbs up, thumbs up/day, comments, comments/day, favorites, favorites/day, reposts, and reposts/day were collected. The Patient Education Materials Assessment Tool (PEMAT), modified DISCERN (mDISCERN), Video Information and Quality Index (VIQI), and Global Quality Score (GQS) were applied to assess the quality of videos.

RESULTS

Among the 100 videos in this study, most were uploaded by surgical physicians (n = 50), and the most common topic was anatomy/basic facts (n = 21). The mean scores of the PEMAT, PEMAT-U, and PEMAT-A were 71.18 ± 16.56, 82.23 ± 15.00, and 44.00 ± 37.57, respectively. Among the five questions of the mDISCERN tool, 71, 90, 82, 9, and 28 videos were evaluated as "yes", respectively. The mean scores of mDISCERN, VIQI, and GQS were 2.80 ± 1.03, 14.87 ± 2.27, and 3.72 ± 1.00, respectively. The characteristics and quality of videos are significantly different based on the uploader and content.

CONCLUSIONS

The quality of thyroid cancer information on TikTok is unsatisfactory. There is a need for high-quality thyroid cancer-related information on short-video platforms for patient education.

Orthogonal and complementary measurements of properties of drug products containing nanomaterials

Quality control of pharmaceutical and biopharmaceutical products, and verification of their safety and efficacy, depends on reliable measurements of critical quality attributes (CQAs). The task becomes particularly challenging for drug products and vaccines containing nanomaterials, where multiple complex CQAs must be identified and monitored. To reduce (i) the risk of measurement bias and (ii) the uncertainty in decision-making during product development, the combination of orthogonal and complementary analytical techniques are generally recommended by regulators. However, despite frequent reference to "orthogonal" and "complementary" in guidance documents, neither term is clearly defined. How does one determine if two analytical methods are orthogonal or complementary to one another? Definitions are needed to design a robust characterization strategy aligned to regulatory needs. Definitions for "orthogonal" and "complementary" are proposed that are compatible with existing metrological terminology and are applicable to complex measurement problems. Orthogonal methods target the quantitative evaluation of the true value of a product attribute to address unknown bias or interference. Complementary measurements include a broader scope of methods that reinforce each other to support a common decision. Examples of the application of these terms are presented, with a focus on measurement of physical properties of nano-enabled drug products, including liposomes and polymeric nanoparticles for cancer treatment, lipid-based nanoparticles (LNPs) and virus-like particles for nucleic acid delivery. The proposed framework represents a first step in advancing the assessment of the orthogonality and complementarity of two measurements and it can potentially serve as the basis for a future international standard. This framework may help product developers to implement more efficient product characterization strategies, accelerate the introduction of novel medicines to the clinic and be applicable to other therapeutics beyond nanomaterial-containing pharmaceuticals.

HbA1c variability is associated with adverse outcomes in heart failure patients with and without diabetes

Funding Acknowledgements

Type of funding sources: None.

Background

Glycemic control is an important clinical issue in the management of patients with heart failure (HF). Variability of Glycated hemoglobin A1c (HbA1c) has been proven to be a predictor of cardiovascular events. However, previous studies mainly focused on general population and patients with coronary artery disease, while less is known about the effect of long-term HbA1c variability on clinical outcomes in HF patients.

Purpose

To evaluate the association of HbA1c variability and the risk of all-cause mortality and rehospitalization in patients with HF irrespective of their diabetic status.

Methods

By using the data from the well-validated Clinical Data Analysis Reporting System (CDARS), HF patients from 2003-2020 who had more than 3 times HbA1c measurements after the diagnosis of HF were included (N=65950, mean age was 66.5±12.0 years and 39409 (52.9%) were male). Average successive variability (ASV) ( average absolute difference between successive values), standard deviation (SD) of HbA1c were calculated. Hazard ratio (HR) of all-cause mortality and HF rehospitalization were estimated using competing risk regression with Cox proportional-hazard model.

Results

During a median follow-up of 7.2 years, 52446 (79.5%) patients developed HF rehospitalization and 34508 (52.3%) died. After adjusting for confounders, each unit change of HbA1c ASV or SD was significantly associated with higher risk of all-cause mortality, as well as higher risk of HF-rehospitalization (Figure 1). Among the study population, 48673 (73.8%) was diabetic while the remaining 17277 (26.2%) were non-diabetic. Interestingly, HbA1c variability had a stronger impact to non-diabetic compared to diabetic patients (P for interaction &lt;0.001) in predicting all-cause mortality and HF rehospitalization (Table 1).

Conclusion

In patients with HF, a greater HbA1c variability was associated with an increased risk of HF rehospitalization and all-cause mortality. Such effect was stronger in non-diabetic compared with diabetic. HbA1c variability, irrespective of baseline diabetic status, should be evaluated in HF patients for better risk-stratification.

[Correlation between intestinal and respiratory flora and their metabolites in a rat pneumoconiosis model]

Objective: Differential flora and differential metabolites shared by the intestinal and respiratory tracts of rats were screened to analyze the possible role of changes in intestinal flora and metabolites in the progression of pneumoconiosis in rats. Methods: In April 2020, 18 SD rats were randomly divided into three groups (control group, coal mine dust group and silica group, 6 in each group) , rats in the coal mine dust group and silica group were perfused with 1 ml of 50 mg/ml coal mine well dust suspension and silica suspension by nontracheal exposure, respectively. While rats in the control group were perfused with an equal dose of sterilized normal saline. Twenty four weeks after dust staining, rat feces, throat swabs, and lung lavages were collected. 16SrDNA gene sequencing and UHPLC-QTOF-MS untargeted metabolomics were used to analyze the flora and metabolites in feces, throat swabs and lung lavage fluid of rats in each group, to screen for shared differential flora and shared differential metabolites in intestinal and respiratory tract, and the correlation analysis between the differential flora and metabolites was performed using Spearman's statistics. Results: Compared with the control group, a total of 9 species shared differential flora between intestinal and respiratory tract were screened at phylum level, and a total of 9 species shared differential genus between intestinal and respiratory tract were screened at genus level in the coal mine dust group, mainly Firmicutes, Actinobacteria, Streptococcus, Lactobacillus, etc. Compared with the control group, a total of 9 shared differential flora were screened at the phylum level, and a total of 5 shared differential genus were screened at the genus level in the silica group, mainly Proteobacteria, Actinobacteria, Allobactera, Mucilaginibacter, etc. Compared with the control group, a total of 7 shared differential metabolites were screened for up-regulation of Stigmatellin, Linalool oxide and Isoleucine-leucine in both intestinal and respiratory tract in the coal mine dust group. Compared with the control group , a total of 19 shared differential metabolites werescreened in the silica group, of which Diethanolamine, 1-Aminocyclopropanecarboxylic acid, Isoleucine-leucine, Sphingosine, Palmitic acid, D-sphinganine, 1, 2-dioleoyl-sn-glycero-3-phosphatidylcholine, and 1-Stearoyl-2-oleoyl-sn-glycerol 3-phosphocholine were up-regulated in both the intestinal and respiratory tract. Conclusion: There is a translocation of intestinal and respiratory flora in pneumoconiosis rats, and rats have an imbalance of lipid metabolism during the progression of pneumoconiosis.

The Anti-Inflammatory Effect of miR-140-3p in BMSCs-Exosomes on Osteoarthritis

PURPOSE OF THE STUDY Articular cartilage injury is a common disease in daily life, with a high incidence. The aim of this study was to investigate the effect and mechanism of miRNA-140-3p in bone mesenchymal stem cells (BMSCs)-derived exosomes under hypoxia on inflammatory articular chondrocytes. MATERIAL AND METHODS To simulate the pathological status of arthritis, rat chondrocytes were used to establish the osteoarthritis (OA) model by IL-1β (10 μg/ml) as a modulating in vitro, and exosomes were isolated by differential ultra-high speed centrifugation. The cell counting kit-8, wound healing and flow cytometry assays were utilized to assess proliferation, migration and apoptosis of chondrocytes, respectively. Lipogenic and chondrogenic differentiation of chondrocytes were detected by oil red O staining and toluidine blue staining individually. The expressions of miR-140-3p and chondrocyte-specific gene mRNA were investigated using qRT-PCR. Western blot was applied to assess chondrocyte associated proteins and BMSC-Exo surface protein markers, and immunohistochemistry was adopted to detect the staining of collagen I and II. RESULTS Under scanning electronic microscope, the shape of exosomes was almost round. Exosome treatment prominently impaired the inhibition of chondrocytes' proliferative and migrative ability by IL-1β. It was found hypoxia had a more marked impact on proliferation, expression of collagen II and apoptosis in OA chondrocytes than normoxia, as well as a stronger effect on weakening adipose differentiation and enhancing chondrogenic differentiation in inflammatory chondrocytes. Furthermore, incubation with BMSC-Exo overexpressing miR-140-3p can remarkably increase the survival rate and migration in inflammatory chondrocytes. In addition, overexpression of miR-140-3p was found to enhance the chondrogenic differentiation of inflammatory chondrocytes. Furthermore, we found that the healing effect of exosomes on inflammatory chondrocytes under hypoxic conditions was produced by a rise in miR-140-3p expression within them and that hypoxia-mediated upregulation of miR-140-3p expression occurred through HIF-1α. CONCLUSIONS Under hypoxia, BMSC-Exo enhanced the chondrogenic phenotype, increased the viability of inflammatory chondrocytes. The overexpression of miR-140-3p in BMSC-Exo is beneficial to protect joints and delaying the pathogenesis in OA. Key words: HIF-1α, apoptosis, lipogenic differentiation, chondrogenic differentiation.

Extended p_{3/2} Neutron Orbital and the N=32 Shell Closure in ^{52}Ca

The one-neutron knockout from ^{52}Ca in inverse kinematics onto a proton target was performed at ∼230  MeV/nucleon combined with prompt γ spectroscopy. Exclusive quasifree scattering cross sections to bound states in ^{51}Ca and the momentum distributions corresponding to the removal of 1f_{7/2} and 2p_{3/2} neutrons were measured. The cross sections, interpreted within the distorted-wave impulse approximation reaction framework, are consistent with a shell closure at the neutron number N=32, found as strong as at N=28 and N=34 in Ca isotopes from the same observables. The analysis of the momentum distributions leads to a difference of the root-mean-square radii of the neutron 1f_{7/2} and 2p_{3/2} orbitals of 0.61(23) fm, in agreement with the modified-shell-model prediction of 0.7 fm suggesting that the large root-mean-square radius of the 2p_{3/2} orbital in neutron-rich Ca isotopes is responsible for the unexpected linear increase of the charge radius with the neutron number.

Development and validation of a novel nomogram predicting pseudohypoxia type pheochromocytomas and paragangliomas

PURPOSE

Pseudohypoxia type (PHT) pheochromocytomas and paragangliomas (PPGLs) are more likely to metastasize and have a poor prognosis. However, application of genetic tests has many restrictions. The study aims to establish a novel nomogram for predicting the risk of PHT PPGLs.

METHODS

This retrospective cross-sectional study included 242 patients with pathology confirmed PPGLs in one tertiary care center in China in 2010-2021. Clinical and biochemical characteristics were collected. Next-generation sequencing was performed in all PPGLs patients for detection of mutation. Univariate and multivariable logistic regression analyses were used to select risk factors for constructing the nomogram. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the discrimination of the nomogram and the calibration curve was performed.

RESULTS

Four variables including age ≤ 35 years, hypertension, 24 h urinary output of urinary vanillylmandelic acid (VMA) ≥ 100 umol/24 h and urinary 17-ketosteroide (17 KS) ≤ 50 umol/24 h levels were independently associated with PHT PPGLs in the logistic regression analysis and were included in the nomogram. The nomogram showed a good discrimination performance with AUC of 0.829 [95% confidence interval (CI), 0.767-0.891] in the training set and 0.797 (95%CI, 0.659-0.935) in the validation set, respectively. The calibration curve showed a bias-corrected AUC of 0.809 vs. 0.795, and a Hosmer-Lemeshow (H-L) test yielded a p value of 0.801 vs. 0.885, indicating the nomogram's good ability to distinguish PHT PPGLs from non-PHT PPGLs.

CONCLUSION

Our study has proposed a novel nomogram for individualized prediction of the PHT PPGLs, which may make contributions to guide the patients' personalized management, follow-up, and treatment.

[Retrospective analysis and a cross-sectional questionnaire survey of lung cancer concomitant with interstitial lung disease]

Objective: To describe the clinical characteristics and prognosis of lung cancer concomitant with interstitial lung disease (LC-ILD), and to understand the current status of knowledge of LC-ILD by physicians in the departments related to the treatment of the disease. Methods: We conducted a retrospective analysis of in-hospitalized pathology identified lung cancer (LC) patients who were admitted to our hospital between January 2014 and December 2018. After reviewing their chest CT imagings and pathological reports, 70 patients who were concomitant with interstitial lung disease (ILD) were enrolled in our study. On the other hand, a cross-sectional survey using an online questionnaire was conducted in LC-ILD management doctors who came from 29 provincial hospitals. The perceptions of demographic features, LC characteristics and management, ILD characteristics and management, and the prognosis of LC-ILD were investigated. Results: Among the 70 enrolled LC-ILD cases, there were 52 males, and the mean age was (64.3±7.63) years (ranged from 49 years to 84 years). There were 51 patients who were older than 59 years. The most common pathological pattern of LC was adenocarcinoma. Most of them were diagnosed with LC and ILD simultaneously, and they were usually treated with chemotherapy while unresectable. There were 11 patients (15.7%) with positive EGFR or ALK mutation. Forty-five patients (64.3%) died during the follow-up, and 33 were died from LC progression. There were no significant differences between the surgical group and non-surgical group on age, pathological patterns, EGFR or ALK mutation. However, LC-ILD patients in the surgical group were diagnosed with earlier TNM classification and with better prognosis. A total of 1 014 doctors answered the questionnaire completely. In the feedback, patients aged 60 years and older (785 doctors/77.4%), and male patients (720 doctors/71%) were the predominant LC-ILD patients. Adenocarcinoma (390 doctors/38.5%), adenocarcinoma or squamous-cell cancer (SCC) (182 doctors/17.9%), and SCC (151 doctors/14.9%) were considered as the common pathological patterns of LC-ILD patients. In most doctors' feedback, the EGFR or ALK mutation was not common for LC-ILD: low (646 doctors/63.7%) or hardly (306 doctors/30.5%) positive mutation. The diagnosis of ILD was earlier than LC (506 doctors/49.9%) or there was no identified precedence of LC and ILD diagnosis (208 doctors/20.5%). Most of the doctors (693 doctors/68.3%) agreed that the vital factor for surgery or not was the severity of ILD for LC-ILD patients. There were great divergences on the treatment protocol both for the advanced LC and ILD. The patients with LC-ILD were died mostly from LC progression and ILD exacerbation (542 doctors/53.5%), followed by ILD exacerbation (237 doctors/23.4%) or LC progression (226 doctors/22.3%). Conclusions: The elderly male patients were predisposed to LC-ILD, and adenocarcinoma was the common pathological pattern. The LC-ILD patients with non-advanced LC who were performed with surgery had better prognosis. However, it is recommended to consider whether to perform surgery in combination with the severity of the ILD.

Laparoscopic excision for intrapelvic schwannoma of the sciatic nerve: A case report

Schwannoma is a benign tumor of the nerve sheath originating from Schwann cells. The tumor rarely occurs in the sciatic nerve. The patient in the present case report was a 58-year-old woman presenting with pain in the right hip and leg, as well as numbness of the right lower limb. Magnetic resonance imaging revealed a solid tumor of 2.9 cm in diameter in the right pelvic space. The mass was considered to be a neurogenic tumor originating from the right sciatic nerve. Total laparoscopic surgery was performed to safely separate the tumor from the surrounding tissues, with preservation of the right sciatic nerve. The pathological result suggested a schwannoma. The patient recovered well with a transient numbness in the right heel. The laparoscopic approach used for this intrapelvic schwannoma of the sciatic nerve was safe and feasible, with the advantages of a magnified surgical field and small skin incision. However, the specific surgical approach should be based on the detailed condition of each patient and the experience of the surgeon with regard to laparoscopic surgery on benign presacral tumors and rectal tumors.