Diagnostic validity of the vesical imaging-reporting and data system (VI-RADS): a real-world study

OBJECTIVES

Preoperative Vesical Imaging-Reporting and Data System (VI-RADS) becomes widespread. We aimed to validate the diagnostic performance of VI-RADS in differentiating muscle-invasive (MIBC) from non-muscle-invasive bladder cancer (NMIBC) in a real-world setting.

METHODS

Between December 2019 and February 2022 suspected primary bladder cancer patients were reviewed. Those with proper multiparametric MRI (mpMRI) protocol for VI-RADS before any invasive treatment were included. Patients were locally staged according to transurethral resection, second resection, or radical cystectomy as the reference standard. Two experienced genitourinary radiologists who were blinded to clinical and histopathological data evaluated the mpMRI images independently and retrospectively. The diagnostic performance of both radiologists and the interreader agreement were analyzed.

RESULTS

Among 96 patients, 20 (20.8%) had MIBC, and 76 (79.2%) had NMIBC. Both radiologists had great diagnostic performance in diagnosing MIBC. The first radiologist had an area under curve (AUC) of 0.83 and 0.84, the sensitivity of 85% and 80%, and the specificity of 80.3% and 88.2% for VI-RADS ≥3 and ≥4, respectively. The second radiologist had an area under curve (AUC) of 0.79 and 0.77, the sensitivity of 85% and 65%, and the specificity of 73.7% and 89.5% for VI-RADS ≥3 and ≥4, respectively. The overall VI-RADS score agreement between the two radiologists was moderate (κ = 0.45).

CONCLUSION

VI-RADS is diagnostically powerful in differentiating MIBC from NMBIC prior to transurethral resection. The agreement between radiologists is moderate.

Papilloedema due to Chiari I malformation

The Chiari I malformation is a congenital abnormality characterised by downward displacement of the cerebellar tonsils through the foramen magnum into the cervical spine. It presents clinically most often in young adult women. Known ocular manifestations linked to Chiari I consist primarily of oculomotor paresis with cranial nerve VI palsy and convergence/divergence abnormalities. Papilloedema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To highlight this unusual complication, the authors report a 64-year-old female who developed papilloedema as the only presenting neurological symptom resulting from a Chiari I malformation.

Diffusion-weighted imaging of solid or predominantly solid gynaecological adnexial masses: is it useful in the differential diagnosis?

OBJECTIVES

This study investigated whether diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values provide specific information that allows the diagnosis of solid or predominantly solid gynaecological adnexial lesions, especially whether they can discriminate benign and malignant lesions.

METHODS

DWI was performed in 37 patients with histologically proven solid or predominantly solid adnexial lesions (22 malignant and 15 benign neoplasms). The lesions in our data set were divided into two groups, all adnexial lesions or lesions of ovarian origin, for evaluation. The areas of the highest signal intensity on DWI (b = 800 s mm(-2)) and the lowest ADC values within the lesions were evaluated.

RESULTS

On DWI, high signal intensity was observed more often in malignant than in benign lesions (p<0.0001). There was no significant difference between the ADC values of the malignant and benign lesions in either the adnexial (0.88±0.16 vs 0.84±0.42; p = 0.96) or the ovarian (0.85±0.14 vs 1.05±0.2; p = 0.133) lesions. When signal intensities on DWI were compared, however, malignant lesions had higher values than the benign lesions in both the adnexial (0.69±0.21 vs 0.29±0.13; p<0.0001) and the ovarian lesions (0.75±0.14 vs 0.37±0.24; p = 0.003).

CONCLUSION

On DWI, high signal intensity was observed more frequently with the malignant lesions.

Expression of the NR2B-NMDA receptor trafficking complex in prefrontal cortex from a group of elderly patients with schizophrenia

Dysregulated glutamate neurotransmission has been implicated in the pathophysiology of schizophrenia. In particular, hypofunction of the NMDA glutamate receptor has been proposed to play an important role in mediating cognitive deficits in patients. The two NMDA receptor subunits, NR2A and NR2B, are distinctly regulated during development and are associated with different intracellular pathways and functions, which suggest that these receptors play separate roles in the control of higher cognitive functions such as learning and memory. Trafficking of the NR2B subunit-containing receptor is regulated by a microtubule-associated trafficking complex consisting of the KIF17, APBA1, CASK, and mLin7 proteins. Several studies have demonstrated an integrated functional regulation of this trafficking complex with NR2B receptor subunit expression, which in turn has been linked to higher cognitive functions. In the present work, we investigated whether expression of this NR2B-associated trafficking complex might be abnormal in schizophrenia. We analyzed the expression of KIF17, APBA1, CASK, mLin7A and mLin7C in postmortem brain from patients with schizophrenia a comparison group. Analysis of transcripts for all of these proteins revealed particularly prominent expression in cortical layer III and layer IV, which overlapped with NR2B but not NR2A transcripts. We found altered expression of transcripts for the CASK, ABPA1, and mLin7 molecules and the CASK, mLin7 proteins, suggesting that NR2B-containing NMDA receptor transport could be selectively compromised in schizophrenia, and that these changes likely involve altered NR2B function in a subset of cortical neurons.

A peptide derived from type 1 thrombospondin repeat-containing protein WISP-1 inhibits corneal and choroidal neovascularization

PURPOSE

Ocular neovascularization is the primary cause of blindness in a wide range of prevalent ocular diseases including proliferative diabetic retinopathy, exudative age-related macular degeneration, and retinopathy of prematurity, among others. Antiangiogenic therapies are starting to give promising results in these diseases. In the present study the antiangiogenic potential of an 18-mer peptide derived from type 1 thrombospondin repeat-containing protein WISP-1 (wispostatin-1) was analyzed in vitro with human retinal endothelial cell proliferation and migration assays. The peptide was also tested in vivo in the corneal micropocket and the laser-induced choroidal neovascularization (CNV) mouse models.

METHODS

Human retinal endothelial cells were treated with the WISP-1 peptide and in vitro migration and proliferation assays were performed. Also evaluated was the antiangiogenic effect of this peptide in vivo using the corneal micropocket assay and the laser-induced CNV model.

RESULTS

Wispostatin-1 derived peptide demonstrated antimigratory and antiproliferative activity in vitro. Wispostatin-1 completely abolished bFGF-induced neovascularization in the corneal micropocket assay. The peptide also demonstrated significant inhibition of laser-induced CNV.

CONCLUSIONS

An inhibitory effect of Wispostatin-1 on ocular neovascularization was found in vitro and in vivo. The identification of novel and potent endogenous peptide inhibitors provides insight into the pathogenesis of corneal and choroidal neovascularization. The results demonstrate potential for therapeutic application in prevalent ocular disease.

Comparison of fibrin glue and suture in the healing of teat incisions in lactating goats

The aims of this study were to investigate whether fibrin glue can be used to close experimentally induced incisions of the teat (mammary papillae) in lactating goats and to compare the healing of the glued with the sutured incisions. Four clinically healthy lactating dairy goats, namely 8 mammary papillae were used. After surgical preparation of the papillae, a 3.5 cm long incision of each papilla was made through skin, muscular layer and mucosa into the papillary sinus. The wounds in the right papillae in all goats were closed with U-shaped uninterrupted 00 chromic catgut sutures. The wounds in the left papillae in all goats were closed, using fibrin glue. One incision was seen to be dehisced and fistulous one day after in fibrin glued teats. The animals were slaughtered 8 days after surgical manipulation. The mammary papillae were removed and examined in the viewpoint on gross and microscopic findings. The healing of wounds was slower and feeble in glued mammary papillary incisions, however faster and stronger in sutured incisions on day 8 after operations. But, available outcomes like less tissue thickness and positive cosmetic results could be obtained byfibrin glue used on mammary papillary incisions, which are very important for teats to be milked by hand and milking machine. Results suggest that it is advisable to use only one or two simple interrupted sutures in teat incisions glued with fibrin to prevent the dehiscence but with a more reliable healing than the sutured incisions.

Technetium-99m 2-methoxy-isobutyl-isonitrile uptake scintigraphy in detection of the bone marrow infiltration in multiple myeloma: correlation with MRI and other prognostic factors

Whole-body scintigraphy with Technetium-99m 2-methoxy-isobutyl-isonitrile ((99m)Tc-MIBI) has been proposed as a useful method for demonstrating the areas of active bone marrow infiltration in multiple myeloma (MM). In this study, we compared the (99m)Tc-MIBI scan with magnetic resonance imaging (MRI), skeletal X-ray survey, and biochemical markers of disease activity in MM to determine its potential in predicting the extension of the disease. Twenty-four myeloma patients had undergone to the (99m)Tc-MIBI scan. Only two patients showed negative results in the (99m)Tc-MIBI scan; one had clinically active disease, and the other was on remission. MRI was performed to 18 clinically active patients, and 16 of them showed positive myelomatous bone marrow involvement. No significant difference was found between the (99m)Tc-MIBI scan and MRI in predicting the extension of bone marrow infiltration in MM (p = 0.11). (99m)Tc-MIBI scores were correlated with bone marrow neoplastic plasma cell ratio (p = 0.005), serum paraprotein level (p < 0.001), serum lactate dehydrogenase (p = 0.031), and beta-2 microglobulin (p = 0.045). The (99m)Tc-MIBI scan showed disease activity better than the skeletal X-ray survey (x2 = 5.299, p = 0.021). A significant decrease was found in posttreatment (99m)Tc-MIBI scores of the patients with positive overall response (p = 0.016). The (99m)Tc-MIBI scan is a noninvasive test that can show the extension of the disease in MM. It seems that the (99m)Tc-MIBI scan and MRI show extension and intensity of the myelomatous bone marrow infiltration equally well. The (99m)Tc-MIBI scan can be an alternative to MRI when it is not available or if there is any limitations for its usage.

Acute torsion of a wandering spleen: imaging findings

Wandering spleen is a rare entity characterized by incomplete fixation of the spleen by lienorenal and gastrosplenic ligaments. It can migrate to the lower abdomen or pelvis and can be congenital or acquired. We report a case of torsion of a wandering spleen for which there was correlative imaging by ultrasonography, Doppler ultrasonography, computed tomography, magnetic resonance imaging, and angiography. To our knowledge, this is the first reported case in which all these modalities were used in the diagnostic evaluation.

Utilising an ileal segment in the posterior urethral replacement procedures using anal sphincter to provide continence in dogs

We aimed to replace an ileal segment in the place of posterior urethra using the anal sphincter as a continence mechanism. The experiment was carried on three male street dogs. In the first stage, only urethral replacement with an ileal segment was done and pulled through the anal sphincter in a male dog to see if anal sphincter would do any help for continence. A protruding stoma was created on the perineum. Perineal end of the ileal segment was sutured to the bulbous urethra in the other two male dogs to provide urethral patency in the second step of the operation. The dog in which the first operation was made gained continence on the 12th postoperative day. The other two male dogs, in which ileourethral anastomosis were made, became continent on the postoperative 12th and 15th days. No residual urine was found by catheterisation performed after urination. In controls, neither the stoma nor the anastomosis sites developed stenosis. This procedure may be applied in patients with complete incontinence who can not be corrected by any other surgical procedures, and a very good cosmetic result may be obtained.

Blood and tissue findings in the diagnosis of mesenteric ischaemia: an experimental study

In this experimental study, after inducing mesenteric ischaemia in dogs, we investigated routine blood biochemistry, serum malondialdehyde (MDA) levels, histopathological changes and tissue MDA levels in the liver and intestines. The study group included 10 dogs. Six dogs which underwent sham operation served as controls. In the study group, the MDA level in liver tissue increased after superior mesenteric artery (SMA) ligation. Various degrees of necrosis were seen in the ileal biopsies 10 hours after the ligation. Hyperaemia and focal necrosis in the liver accompanied the intestinal necrosis if it was limited within the mucosa. However, massive or centrilobular necrosis was observed in the liver of those dogs which had intestinal necrosis that extended into muscular layers. MDA levels in intestinal tissue measured after SMA ligation were significantly higher than the preligation levels. On the other hand, the difference between serum and tissue MDA levels was not significant. The alterations in MDA were not significant in the sham group. Thus it is concluded that the serum MDA levels are valuable markers of diagnosis in intestinal ischaemia.

Protection of intestinal anastomoses in septic environment with peritoneal graft and polyglycolic acid mesh: an experimental study

We carried out an experimental study in dogs to evaluate the outcome of large bowel anastomosis with 6 stitches (Group C, n : 6) in a septic environment with protection by a polyglycolic acid (PGA) mesh (Group M, n : 12) or peritoneal graft (Group P, n : 12). Thirty dogs were used to compare the techniques. Two dogs in each group were re-operated after 3, 5, 7, 14, 28 and 90 days. They were evaluated for adhesion formation, lumen diameter (anastomotic index), clinical features, histologic appearance and quality of healing at the anastomotic sites. All dogs in group P and group M survived, whereas 2 dogs in the control group died of anastomotic leakage and 3 dogs were re-operated for anastomotic leakage and peritonitis. In group M, one dog was reoperated because of the anastomotic leakage and two dogs were reoperated because of the anastomotic stenosis. Also, 4 anastomoses showed evidence of moderate stenosis. In group P, three anastomoses were graded as minimal stenosis. Histopathologic evaluation showed more complete epithelization, less inflammation, and less adhesion in group P than group M. We could not find any study in the literature that described and compared both techniques. We report here the results of such a study.

Relating depressive symptoms to Machiavellianism in a Turkish sample

The Turkish forms of Beck Depression Inventory and The Mach IV Scale were administered to all 690 students of a Military Medical School. There was a significant correlation of .21 between scores on the Beck Depression Inventory and those on the Mach IV scale for the 658 men. This was not surprising, given the characteristics of Machiavellian people previously described.