[A case of metastatic breast cancer complicated by pulmonary tumor thrombotic microangiopathy]

Pulmonary tumor thrombotic microangiopathy is a malignancy-related complication with rapid progression and high mortality. To improve the understanding of the disease, early diagnosis and treatment are key to successful treatment. A 39-year-old patient with pulmonary hypertension transferred from another hospital was admitted to the First Affiliated Hospital of Guangzhou Medical University on September 26, 2021. The patient developed shortness of breath and progressive exacerbation over the past month. No pulmonary artery embolism was seen on computed tomography pulmonary angiography (CTPA) at the outside hospital where the breast cancer was diagnosed. Pulmonary tumor thrombotic microangiopathy was immediately considered on admission and oncological endocrine therapy was started. After treatment, the patient's dyspnoea improved, PET-CT showed significant tumor regression, and cardiac ultrasound showed a significant decrease in pulmonary artery pressure. The successful treatment experience of this case was summarized for reference.

Development and implementation of a pneumatic micro-feeder for poorly-flowing solid pharmaceutical materials

Consistent powder micro-feeding (<100 g/h) is a significant challenge in manufacturing solid oral dosage forms. The low dose feeding can well control the content consistency of the dosage forms, which improves drug efficiency and reduces manufacturing waste. Current commercial micro-feeders are limited in their ability to feed < 20 g/h of cohesive (i.e. powders of poor flowability) active pharmaceutical ingredients (API) and excipients (e.g. lubricants) with low fluctuation. To breach this gap, this study presents an advanced micro-feeder design capable of feeding a range of pharmaceutical-grade powders consistently at flow rates as low as 0.7 g/h with <20 % flow rate variation. This was possible due to a novel powder conveying concept utilising particle re-entrainment to minimise flow rate variations. This work details the design of this pneumatic micro-feeder and its excellent micro-feeding performance even for cohesive powders. The experimental studies investigated the influence of the process parameters (air pressure and air flow rate) and equipment configurations (insert size and plug position) on the feeding performance of different pharmaceutical-relevant powders, i.e., microcrystalline cellulose (MCC), croscarmellose sodium (CCS), crospovidone (XPVP) and paracetamol (APAP). It was shown that the system is capable of delivering consistent powder flow rates with good repeatability and stability.

PERPETRATION OF VIOLENCE BY FEMALE SEX WORKERS IN PAPUA NEW GUINEA: 'WE WILL CRUSH THEIR BONES'

There is a small but important body of literature on female sex workers' (FSWs) violence towards others, but little of that focused on low- and middle-income countries. Drawn from a larger biobehavioural study of FSWs in three cities in Papua New Guinea, we analyse the interviews from 19 FSWs who reported having perpetrated physical violence towards four major groups: (1) ex-husbands; (2) clients; (3) other sex workers and (4) other people (mainly women). Our study demonstrates that FSWs' use of violence arises from a complex set of social, material and gendered circumstances and cannot be addressed in isolation from other aspects of their lives.

[Application of adaptive statistical iterative reconstruction V (ASIR-V) in contrast-enhanced abdominal scanning with low-dose for liver cirrhosis]

Objective: To investigate the application of adaptive statistical iterative reconstruction-V (ASIR-V) in contrast-enhanced abdominal CT scanning with low-dose for liver cirrhosis. Methods: From June 2017 to May 2018, a total of 112 liver cirrhosis patients who underwent contrast-enhanced abdominal CT scanning were collected prospectively as the study group. According to Child-Pugh grading of liver function, the study group was divided into A, B and C groups. Thirty examiners with normal liver function who underwent contrast-enhanced abdominal CT scanning no abdominal diseases were collected as the control group. The control group applied 0 pre-ASIR-V. The study group applied 30%, 40% and 50% pre-ASIR-V in plain scanning, arterial and portal vein phase, respectively. The control and study group both combined with 60% post-ASIR-V. The difference of qualitative parameters (contrast to noise ratio of the liver, pancreas, spleen, abdominal aorta and portal vein), image noise and radiation dose were compared by One-way ANOVA. Subjective score of images were compared by Kruskal-Wallis H test. Results: The volume computed tomography dose index (CTDI(vol)), dose length product (DLP) and the effective dose (ED) of study group were lower than the control group in the same phase (F=13.354-28.192, P<0.01). And the ED were decreased by 1.12 (23.9%), 1.54 (33.5%), 2.14 mSv (46.7%). The CNR values of liver and portal vein in Child C group was 0.34-0.42 and 0.43-0.49 lower than that of Child A and control group, respectively (q=2.851-4.658, P<0.05). Image noise had no difference in study and control group. There were no statistical differences between each group of subjective score in arterial and portal vein phase. The mean score of Child C in portal phase was lower than 3, which affected the diagnosis. And there were significant difference among the control, Child A and Child C group(Z=26.734-29.218, P<0.05). Conclusions: According to the classification of liver function, liver cirrhosis combined with ASIR-V can ensure the image quality while reduce the radiation dose. When liver function is Child-Pugh A or B, preset 50%ASIR-V is recommended; 40%ASIR-V is recommended for Child-Pugh C.

[Relationship between one-stop CT spectral perfusion imaging parameters and expression of lymphatic microvessel density and vascular endothelial growth factor-C in axillary lymph nodes of rabbit VX2 breast cancer]

Objective: To analyze the correlation between quantitative parameters of one-stop spectral perfusion computed tomography imaging and the expression level of vascular endothelial growth factor-C(VEGF-C) and MLVD in metastatic lymph nodes of rabbit VX2 breast cancer. Methods: Thirty New Zealand purebred female rabbits were used to establish the lymph node metastasis model of rabbit VX2 breast cancer, one-stop spectral and perfusion CT imaging protocol was performed.The axillary lymph nodes were selected for corresponding image markers. The observed morphology of conventional HE staining and the EnVision method were used to quantitatively analyze VEGF-C expression and calculate MLVD.Pearson linear correlation was used to analyze the perfusion parameters of metastatic lymph node energy spectrum and the correlation of MLVD and VEGF-C expression. Results: Twenty-four experimental rabbits were successfully modeled and performed a one-stop CT scan on the 28th day. A total of 39 metastatic lymph nodes were included. The VEGF-C of metastatic lymph node was 20.0%±2.8%,and the MLVD was 12.5±3.5. There was a positive correlation between BF, AP(λHU), IC(VP), NIC(VP), VP(λHU) of metastatic lymph node and VEGF-C and MLVD (P<0.05). There was a positive correlation between lymph node IC(AP) and MLVD (P=0.027) and no correlation with VEGF-C expression (P=0.386).There was no correlation between BV, NIC(A)P and VEGF-C, MLVD(P>0.05). The correlation between VP(λHU) and MLVD was higher (r=0.448, P=0.001). Conclusions: One-stop CT spectral perfusion imaging quantitative parameters and pathological indicators have a good correlation, and it can reflect lymphatic vessel metastasis in lymph nodes.

[Application of half-dose spectral CT based on the automatic spectral imaging mode selection and adaptive statistical iterative reconstruction in the CT examination of upper abdomen in obese patients.]

Objective: To investigate the value of combined use of half-dose spectral CT based on the automatic spectral imaging mode selection (GSI Assist) and adaptive statistical iterative reconstruction (ASIR) in the CT examination of upper abdomen in obese patients as compared with conventional CT. Methods: Eight-two obese patients (body mass index≥29 kg/m(2)) were prospectively selected from October to December 2016, and contrast-enhanced CT during arterial phase (AP) and portal venous phase (PVP) were carried out in those patients.The patients were randomly assigned to the study group and control group with random number table (41 cases in each group). In the study group, half-dose spectral CT based on GSI Assist was applied and monochromatic images (40 to 70 keV, 10 keV as increment) were reconstructed using 50% ASIR (group A). In the control group, the fixed tube potential of 120 kVp was done with images reconstruction using 30% ASIR (group B). Quantitative parameters of radiation dose, CT value, contrast to noise ratio (CNR) and image noise were compared between the two groups by using two sample t test, while qualitative visual parameters (overall image quality as graded on a 5-point scale) were compared with Mann-Whitney U test. Results: There was significant difference in effective radiation dose between the two groups[(5.2±0.8) vs (10.4±1.7) mSv, t=-17.822, P<0.001], and it was decreased for 50% in group A. During the arterial phase (AP) and portal venous phase (PVP), at the energy level of 40 keV and 50 keV, higher CT values, higher or similar CNRs, higher image noise and lower overall image quality scores were found in group A when compared with group B. At the energy level of 60 keV, group A had higher CT values, higher or similar CNRs, similar overall image quality scores with higher or similar image noise as compared with group B. At the energy level of 70 keV, the two groups had similar CT values, CNRs and image noise, and higher overall image quality scores were found in group A. Conclusions: In obese patients, combined use of half-dose spectral CT based on GSI Assist and ASIR can reduce effective radiation dose up to 50% when compared with conventional upper abdominal CT.Monochromatic images at 70 keV can maintain CNR and improve overall image quality.

[Investigation of human brucellosis diagnosis and report quality in medical institutions in key areas of Shanxi province]

Objective: To evaluate the accuracy of human brucellosis diagnosis and reporting in medical institutions in Shanxi province, and understand the performance of clinical doctors to diagnose human brucellosis according to diagnostic criteria. Methods: Field investigation was conducted in 6 medical institutions in the key areas of human brucellosis in Shanxi province. The diagnosis data of the reported brucellosis cases in 2015 were collected and reviewed retrospectively for the evaluation of the diagnosis accuracy with systematic sampling method. The database was established with Excel 2010 and the descriptive analysis and statistical test were conducted with software R 3.3.2. Results: The diagnosis consistent rate of the 377 brucellosis cases reviewed was 70.8% (267/377), the diagnosis consistent rates in medical institutions at city-level and country-level were 77.0% (127/165) and 66.0% (140/212) respectively, the differences had significance (χ(2)=5.4, P=0.02). Among the reviewed cases, the diagnosis consistent rate of laboratory diagnosis and clinical diagnosis were 87.1% (256/294) and 13.3% (11/83) respectively, and the differences had significance (χ(2)=170.7, P<0.001). Among the 21 investigated clinical doctors, the numbers of the doctors who correctly diagnosed the suspected cases, probable cases and lab-confirmed cases were only 3, 0 and 8 respectively. All of the clinical doctors knew that it is necessary to report the brucellosis cases within 24 hours after diagnosis. Conclusion: The accuracy of human brucellosis diagnosis in key areas of human brucellosis in Shanxi was low, and the performance of the clinical doctors to diagnose human brucellosis according to diagnostic and case classification criteria was unsatisfied.

Low copy numbers of FCGR3A and FCGR3B associated with Chinese patients with SLE and AASV

Low-affinity Fcγ receptors (FcγR) act as key mediators of the pathogenic effects of autoantibodies. In this study, we aimed to determine whether copy number variations (CNVs) in FCGR3A and FCGR3B were associated with systemic lupus nephritis (SLE) and ANCA-associated systemic vasculitis (AASV) in Chinese individuals. A total of 1118 individuals were enrolled, including 415 SLE patients, 139 AASV patients, and 564 healthy controls. FCGR3A and FCGR3B copy numbers (CNs) were determined by both a paralogue ratio test and TaqMan quantitative PCR assay. In the susceptibility associations, a low FCGR3B CN was significantly associated with SLE ( p = 5.01 × 10^-3; odds ratio (OR) 1.71; 95% confidence interval (CI) 1.17-2.48) and AASV ( p = 0.04; OR = 1.72; 95% CI 1.02-2.88). A low FCGR3A CN was also significantly associated with SLE ( p = 6.02 × 10^-3; OR 2.72; 95% CI 1.30-5.71) and AASV ( p = 0.042; OR 2.64; 95% CI 1.00-6.93). Further subphenotype analysis revealed that low CNs of FCGR3A and FCGR3B were significantly associated with clinical manifestations in SLE and AASV patients. Therefore, in this case-control study, we identified low CNs of FCGR2A and FCGR3B to be common risk factors for SLE and AASV.

Postoperative MRI Evaluation of a Radiofrequency Cordotomy Lesion for Intractable Cancer Pain

BACKGROUND AND PURPOSE

There are limited data on the use of postoperative imaging to evaluate the cordotomy lesion. We aimed to describe the cordotomy lesion by using postoperative MR imaging in patients after percutaneous cordotomy for intractable cancer pain.

MATERIALS AND METHODS

Postoperative MR imaging and clinical outcomes were prospectively obtained for 10 patients after percutaneous cordotomy for intractable cancer pain. Area, signal intensity, and location of the lesion were recorded. Clinical outcomes were measured by using the Visual Analog Scale and the Brief Pain Inventory-Short Form, and correlations with MR imaging metrics were evaluated.

RESULTS

Ten patients (5 men, 5 women; mean age, 58.5 ± 9.6 years) were included in this study. The cordotomy lesion was hyperintense with central hypointense foci on T2-weighted MR imaging, and it was centered in the anterolateral quadrant at the C1-C2 level. The mean percentage of total cord area lesioned was 24.9% ± 7.9%, and most lesions were centered in the dorsolateral region of the anterolateral quadrant (66% of the anterolateral quadrant). The number of pial penetrations correlated with the percentage of total cord area that was lesioned (r = 0.78; 95% CI, 0.44-0.89; P = .008) and the length of T2-weighted hyperintensity (r = 0.85; 95% CI, 0.54-0.89; P = .002). No significant correlations were found between early clinical outcomes and quantitative MR imaging metrics.

CONCLUSIONS

We describe qualitative and quantitative characteristics of a cordotomy lesion on early postoperative MR imaging. The size and length of the lesion on MR imaging correlate with the number of pial penetrations. Larger studies are needed to further investigate the clinical correlates of MR imaging metrics after percutaneous cordotomy.

Screening and comparison of polychromatic and monochromatic image reconstruction of abdominal arterial energy spectrum CT

We screened the suitable image reconstruction to observe the abdominal artery and compare the quality between the polychromatic and the monochromatic reconstruction images of the abdominal artery spectrum CT. Eighty patients underwent Gemstone CT energy spectrum imaging to obtain an abdominal artery polychromatic image (140 kVp) and a monochromatic image from 40 ~ 140 keV. The CT value of region of interest (ROI) was measured on the polychromatic image and the single energy image. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the abdominal aorta and hepatic artery were determined. The images in each group underwent image quality subjective scoring by three experienced radiologists using a blinded method. Finally, comprehensive comparisons and image quality subjective scorings were performed on the CT, SNR, and CNR values of the abdominal aorta. The obtained data were statistically analyzed by SPSS 19.0 software. When the keV value was reduced, the CT value of the abdominal artery gradually increased, and the image noise also changed. The comprehensive comparisons and subjective scorings were finalized for each single energy image based on the abdominal artery image quality objective indicators (CT value, SNR, and CNR). Results revealed that the abdominal artery image quality in the 50 ~ 60 keV monochromatic group was better compared to the polychromatic group. Furthermore, onochromatic imaging had different impacts on the abdominal aorta and hepatic artery image qualities. In different types of abdominal arterial reconstruction images obtained using abdominal energy spectrum CT conventional enhanced scanning, the image quality of the 50 ~ 60keV monochromatic reconstruction was higher when compared with the polychromatic reconstruction. Thus, it is recommended to apply the conventional reconstruction for abdominal artery energy spectrum CT scanning.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Matrine alleviates early brain injury after experimental subarachnoid hemorrhage in rats: possible involvement of PI3K/Akt-mediated NF-κB inhibition and Keap1/Nrf2-dependent HO-1 inductionn

Matrine is a quinolizidine alkaloid derived from the herb Radix Sophorae Flavescentis, and possesses anti-oxidant, anti-inflammatory and anti-tumoral properties. However, its effectiveness against subarachnoid hemorrhage (SAH) is not well known. In this study, we investigated the effects of matrine on early brain injury (EBI) and the related potential mechanisms following SAH in rats. Our results showed that matrine pretreatment partially alleviated SAH-induced EBI, including neurological deficit, severity of SAH grade, brain edema, and blood-brain barrier (BBB) disruption in rats. In addition, SAH procedure induced BBB disruption with concomitant upregulation of MMP-9 expression and downregulation of tight junction proteins expression of BBB, namely, ZO-1 and occludin, which was partially reversed by matrine pretreatment. Matrine also reduced the increased levels of inflammatory cytokines TNF-α and IL-1β after the SAH operation. SAH induced neural cell apoptosis, as demonstrated by high apoptotic index and increased expression of Bax and caspase-3 proteins, as well as the reduced Bcl-2 expression, which were reversed by matrine pretreatment. Furthermore, matrine pretreatment partially suppressed SAH-induced Akt phosphorylation and IκB-α phosphorylation and degradation, and reduced NF-kB P65 protein levels. The expression of Keap1, Nrf2, and HO-1 proteins was distinctly enhanced in the SAH+matrine group, compared with the SAH+vehicle groups. Matrine pretreatment suppressed SAH-induced MMP-9 expression, which could be partially blocked by HO-1 inhibitor Sn-protoporphyrin IX (SnPP IX) but promoted by phosphatidylinositol 3-kinase (PI3K) inhibitor LY294002. Our results suggest that matrine may alleviate EBI after experimental subarachnoid hemorrhage in rats possibly via PI3K/Akt-mediated NF-κB inhibition and Keap1/Nrf2-dependent HO-1 induction.

Analysis of ectoparasites (chigger mites, gamasid mites, fleas and sucking lice) of the Yunnan red-backed vole (Eothenomys miletus) sampled throughout its range in southwest China

The Yunnan red-backed vole Eothenomys miletus (Rodentia: Cricetidae) is an endemic rodent species and reservoir host of zoonoses in southwest China. Based on a large host sample (2463 voles collected from 39 localities between 2001 and 2013), a general analysis of four categories of ectoparasite (fleas, sucking lice, chigger mites and gamasid mites) on E. miletus across its entire range of distribution was made. This analysis identified a total of 71 895 ectoparasites belonging to 320 species (30 species of flea, 9 of sucking louse, 106 of gamasid mite and 175 of chigger mite) with a high prevalence (87%), mean abundance (29.19) and mean intensity (33.69). Of the 18 vector species of zoonoses found on E. miletus, the flea Ctenophthalmus quadratus (Siphonaptera: Hystrichopsyllidae) and chigger mite Leptotrombidium scutellare (Trombidiformes: Trombiculidae) were the dominant species; these are the main vectors of zoonoses in China. All of the dominant parasite species showed an aggregated distribution pattern. Male voles harboured more species of parasite than females. Chigger mites represented the most abundant species group on voles and their prevalence was positively correlated with mean abundance (r = 0.73; P < 0.05). As a single rodent species, E. miletus has a high potential to harbour abundant ectoparasites with high species diversity and high rates of infestation. The sex of the vole affects ectoparasite infestation.

LincRNA-ROR induces epithelial-to-mesenchymal transition and contributes to breast cancer tumorigenesis and metastasis

LncRNAs have critical roles in various biological processes ranging from embryonic development to human diseases, including cancer progression, although their detailed mechanistic functions remain illusive. The lncRNA linc-ROR has been shown to contribute to the maintenance of induced pluripotent stem cells and embryonic stem cells. In this study, we discovered that linc-ROR was upregulated in breast tumor samples, and ectopic overexpression of linc-ROR in immortalized human mammary epithelial cells induced an epithelial-to-mesenchymal transition (EMT) program. Moreover, we showed that linc-ROR enhanced breast cancer cell migration and invasion, which was accompanied by generation of stem cell properties. Contrarily, silencing of linc-ROR repressed breast tumor growth and lung metastasis in vivo. Mechanistically, our data revealed that linc-ROR was associated with miRNPs and functioned as a competing endogenous RNA to mi-205. Specifically, linc-ROR prevented the degradation of mir-205 target genes, including the EMT inducer ZEB2. Thus our results indicate that linc-ROR functions as an important regulator of EMT and can promote breast cancer progression and metastasis through regulation of miRNAs. Potentially, the findings of this study implicate the relevance of linc-ROR as a possible therapeutic target for aggressive and metastatic breast cancers.

Multimodal retinal imaging in a Chinese kindred with familial amyloid polyneuropathy secondary to transthyretin Ile107Met mutation

OBJECTIVE

To investigate the ocular phenotype and gene mutation of a Chinese pedigree with familial amyloid polyneuropathy (FAP) and vitreous amyloidosis.

METHODS

A Chinese pedigree with familial amyloid polyneuropathy and vitreous amyloidosis was recruited. Combined phacoemulsification, vitrectomy and intraocular lens implantation were performed on the right eye of the index patient. Ophthalmic investigations were performed before and after surgery. The DNA from the pedigree was sequenced for the transthyretin (TTR) gene.

RESULTS

After vitrectomy, the best-corrected visual acuity of the patient improved from counting finger to 20/20. Red-free confocal ophthalmoscopy demonstrated perifoveal ring and several perivessel white sheaths. Optical coherence tomography (OCT) revealed cotton wool like reflections on the vitreoretinal interface. Electroretinogram and autofluorescence was normal. Amyloid was present in the vitreous specimen. A substitution of T to G at nucleotide 381 in exon 4 of TTR DNA (Ile107Met) was found. This mutation co-segregated with phenotype in the pedigree and was not detected in 200 controls.

CONCLUSIONS

TTR Ile107Met mutation is associated with vitreous amyloidosis and FAP. OCT and red-free imaging are helpful in identifying amyloid deposits in the retina.

Prevention and treatment of diarrhoea with Saccharomyces boulardii in children with acute lower respiratory tract infections

The aim of this study was to determine whether Saccharomyces boulardii prevents and treats diarrhoea and antibiotic-associated diarrhoea (AAD) in children. A total of 333 hospitalised children with acute lower respiratory tract infection were enrolled in a 2-phase open randomised controlled trial. During the 1st phase, all children received intravenous antibiotics (AB). They were randomly allocated to group A (S. boulardii 500 mg/day + AB, n=167) or group B (AB alone, n=166) and followed for 2 weeks. Diarrhoea was defined as ≥3 loose/watery stools/day during at least 2 days, occurring during treatment and/or up to 2 weeks after AB therapy had stopped. AAD was considered when diarrhoea was caused by Clostridium difficile or when stool cultures remained negative. In the 2nd phase of the study, group B patients who developed diarrhoea were randomly allocated to two sub-groups: group B1 (S. boulardii + oral rehydration solution (ORS)) and group B2 (ORS alone). Data from 283 patients were available for analysis. Diarrhoea prevalence was lower in group A than in group B (11/139 (7.9%) vs. 42/144 (29.2%); relative risk (RR): 0.27, 95% confidence interval (CI): 0.1-0.5). S. boulardii reduced the risk of AAD (6/139 (4.3%) vs. 28/144 (19.4%); RR: 0.22; 95% CI: 0.1-0.5). When group B patients developed diarrhoea (n=42), S. boulardii treatment during 5 days (group B1) resulted in lower stool frequency (P<0.05) and higher recovery rate (91.3% in group B1 vs. 21.1% in B2; P<0.001). The mean duration of diarrhoea in group B1 was shorter (2.31±0.95 vs. 8.97±1.07 days; P<0.001). No adverse effects related to S. boulardii were observed. S. boulardii appeared to be effective in the prevention and treatment of diarrhoea and AAD in children treated with intravenous antibiotics.

Hyperthyroid monkeys: a nonhuman primate model of experimental Graves' disease

Graves' disease (GD) is a common organ-specific autoimmune disease with the prevalence between 0.5 and 2% in women. Several lines of evidence indicate that the shed A-subunit rather than the full-length thyrotropin receptor (TSHR) is the autoantigen that triggers autoimmunity and leads to hyperthyroidism. We have for the first time induced GD in female rhesus monkeys, which exhibit greater similarity to patients with GD than previous rodent models. After final immunization, the monkeys injected with adenovirus expressing the A-subunit of TSHR (A-sub-Ad) showed some characteristics of GD. When compared with controls, all the test monkeys had significantly higher TSHR antibody levels, half of them had increased total thyroxine (T₄) and free T₄, and 50% developed goiter. To better understand the underlying mechanisms, quantitative studies on subpopulations of CD4+T helper cells were carried out. The data indicated that this GD model involved a mixed Th1 and Th2 response. Declined Treg proportions and increased Th17:Treg ratio are also observed. Our rhesus monkey model successfully mimicked GD in humans in many aspects. It would be a useful tool for furthering our understanding of the pathogenesis of GD and would potentially shorten the distance toward the prevention and treatment of this disease in human.

Erdheim-Chester disease of the central nervous system: new manifestations of a rare disease

BACKGROUND AND PURPOSE

ECD is a rare non-Langerhans-cell histiocytosis, which can involve the CNS; therefore, CNS imaging findings have been described in only a small number of patients. To gain additional insight into the CNS manifestations of ECD, we reviewed the findings on imaging of the brain, head and neck, and spine in patients with ECD who presented to our institution. Here, we illustrate manifestations that have not, to our knowledge, been previously described.

MATERIALS AND METHODS

CT, MR imaging, and PET/CT studies of the brain, maxillofacial region, and spine were reviewed in 11 patients with ECD.

RESULTS

Four new manifestations of ECD were present, including the following: a stellate appearance of intracranial extra-axial lesions, ependymal enhancement along the lateral ventricle with deep linear extension to the lentiform nucleus, irregular enhancement in the pons, and diffuse involvement of the vertebral column on PET/CT.

CONCLUSIONS

ECD has a variety of imaging appearances in the CNS, including new manifestations described herein. Neuroradiologists should be aware of these manifestations to avoid mistaking them for other disease processes.

FCGR3B copy number variation is not associated with lupus nephritis in a Chinese population

Copy number variation (CNV) is common in genomic regions encoding immune-related genes and can impact polygenic autoimmunity. FCGR3B CNV is associated with susceptibility to systemic autoimmunity in Caucasian populations. In this study, we examined FCGR3B CNV in patients with the autoimmune disease lupus nephritis (LN) in a Chinese population. The study includes 202 patients with histologically verified LN and 146 geographically matched healthy controls. To identify CNV at the FCGRB locus, quantitative polymerase chain reaction (PCR) was done with TaqMan( TM) probes and relative copy number was estimated with relative quantitative 2(-DeltaDeltaCt) method. The distribution of FCGR3B relative copy number did not differ significantly between the LN patients and the controls (1.17 +/- 0.42 for LN; 1.15 +/- 0.37 for controls; p = 0.627). The difference was still not significant when the data were stratified by gender. There was no significant difference when the LN patients were divided by pathological phenotype (proliferative LN compared with non-proliferative p = 0.511; AI < 12 compared with AI > or = 12, p = 0.401; and chronicity index (CI) < 4 compared with CI > or = 4, p = 0.058) or lupus disease activity index (SLEDAI < or = 10 compared with SLEDAI > 10, p = 0.996). The data suggest that FCGR3B CNV was not associated with LN development or progression in this Chinese population. These results were surprising given the strong in a Caucasian population.

Association between polymorphisms in the FCGRT gene and lupus nephritis in Chinese patients

OBJECTIVE

Studies on mouse models have indicated that the neonatal Fc receptor (FcRn) plays important roles in a variety of autoimmune diseases. A variable number of tandem repeat (VNTR) polymorphisms within the FCGRT gene have been detected, and were found to affect the expression and functioning of FcRn. This study investigated the possible association of FCGRT VNTR polymorphisms with susceptibility and clinical manifestations in patients with lupus nephritis (LN).

METHODS

A total of 404 Han Chinese subjects, comprising 200 patients with LN and 204 geographically-matched healthy controls, participated in the study. The FCGRT VNTR polymorphism was genotyped by DNA amplification using a touchdown polymerase chain reaction followed by polyacrylamide gel electrophoresis.

RESULTS

The distribution of VNTR polymorphisms within the FCGRT gene in Chinese subjects was different to that in Caucasians. Analysis of allele and genotype frequencies revealed no significant difference between LN patients and controls. There was no significant difference in the clinical features or prognosis in LN patients when stratified by VNTR polymorphism.

CONCLUSION

Our results suggest that VNTR polymorphisms within the FCGRT promoter are not associated with LN in the Chinese population.

3D MPRAGE improves classification of cortical lesions in multiple sclerosis

BACKGROUND

Gray matter lesions are known to be common in multiple sclerosis (MS) and are suspected to play an important role in disease progression and clinical disability. A combination of magnetic resonance imaging (MRI) techniques, double-inversion recovery (DIR), and phase-sensitive inversion recovery (PSIR), has been used for detection and classification of cortical lesions. This study shows that high-resolution three-dimensional (3D) magnetization-prepared rapid acquisition with gradient echo (MPRAGE) improves the classification of cortical lesions by allowing more accurate anatomic localization of lesion morphology.

METHODS

11 patients with MS with previously identified cortical lesions were scanned using DIR, PSIR, and 3D MPRAGE. Lesions were identified on DIR and PSIR and classified as purely intracortical or mixed. MPRAGE images were then examined, and lesions were re-classified based on the new information.

RESULTS

The high signal-to-noise ratio, fine anatomic detail, and clear gray-white matter tissue contrast seen in the MPRAGE images provided superior delineation of lesion borders and surrounding gray-white matter junction, improving classification accuracy. 119 lesions were identified as either intracortical or mixed on DIR/PSIR. In 89 cases, MPRAGE confirmed the classification by DIR/PSIR. In 30 cases, MPRAGE overturned the original classification.

CONCLUSION

Improved classification of cortical lesions was realized by inclusion of high-spatial resolution 3D MPRAGE. This sequence provides unique detail on lesion morphology that is necessary for accurate classification.

Improved identification of intracortical lesions in multiple sclerosis with phase-sensitive inversion recovery in combination with fast double inversion recovery MR imaging

BACKGROUND AND PURPOSE

Accurate detection and classification of purely intracortical lesions in multiple sclerosis (MS) are important in understanding their role in disease progression and impact on the clinical manifestations of the disease. However, detection of these lesions with conventional MR imaging remains a challenge. Although double inversion recovery (DIR) has been shown to improve the sensitivity of the detection of cortical lesions, this sequence has low signal-to-noise ratio (SNR), poor delineation of lesion borders, and is prone to image artifacts. We demonstrate that intracortical lesions can be identified and classified with greater confidence by the combination of DIR with phase-sensitive inversion recovery (PSIR) images.

MATERIALS AND METHODS

A total of 16 subjects with MS were included in this study. DIR, PSIR, and fluid-attenuated inversion recovery (FLAIR) images were acquired and inspected by 3 experts, with identification of lesions by consensus. PSIR and DIR images were jointly used to classify lesions as purely intracortical, mixed gray-white matter, and juxtacortical. The difference in the number of lesions detected in each category was compared between combined PSIR and DIR and conventional FLAIR.

RESULTS

PSIR consistently allowed a clearer classification and delineation of lesions. Combined PSIR and DIR images showed a 337% improvement in the total number of lesions detected compared with FLAIR alone. Detection of intracortical lesions was improved by 417% compared with FLAIR. Detection of mixed gray-white matter and juxtacortical lesions was improved by 396% and 130%, respectively, compared with FLAIR.

CONCLUSION

Reliable detection and classification of intracortical lesions in MS are greatly improved by combined use of PSIR and DIR.

Response to environmental flows in the lower Tarim River, Xinjiang, China: ground water

In China's west since the 1950s large-scale ecosystem degeneration has occurred through water diversions for agricultural purposes. Since 2000, 1038 x 10(6) m(3) of water have been released into the Tarim River with the result that water reached the terminal Taitema Lake for the first time in 30 years. This environmental flow raised water-table levels along 350 km of the river. To assess the response of the water-table, a comparison "pristine" site is compared with downstream monitored sites. The results show huge changes in water-table levels. The study verifies that the water-table is extremely responsive to environmental flows, that strong internal similarities exist along the length of the river, and that the effect on the water-table and hence likely riparian vegetation recovery can be tentatively predicted. The actual impacts of the restoration strategy are less than those originally expected politically, socially and within the scientific community. We make recommendations on more effective release strategies.