Effect of lipiodol marking before CT-guided cryoablation on the outcome of sporadic renal cell carcinoma

PURPOSE

This retrospective study evaluates the impact of preoperative lipiodol marking on the outcomes of computed tomography (CT)-guided cryoablation for histologically diagnosed sporadic renal cell carcinoma (RCC).

METHODS

This study analyzed the data of 173 patients who underwent CT-guided cryoablation for histologically proven sporadic RCC at a single institution between April 2014 and December 2020. The local control rate (LCR), recurrence-free survival rate (RFSR), overall survival rate (OSR), changes in renal function, and complications in patients with (n = 85) and without (n = 88) preoperative lipiodol marking were compared.

RESULTS

The 5-year LCR and 5-year RFSR were significantly higher in patients with lipiodol marking (97.51% and 93.84%, respectively) than in those without (72.38% and 68.10%, respectively) (P value <0.01, log-rank test). There were no significant differences between the two groups regarding the 5-year OSR (97.50% vs. 86.82%) or the deterioration in chronic kidney disease stage (12.70% vs. 16.43%). Grade ≥3 complications occurred in patients with lipiodol marking (n = 2, retroperitoneal hematoma and cerebral infarction in 1 patient each) and without (n = 5; urinary fistula in 2, colonic perforation in 2, urinary infection in 1).

CONCLUSION

Lipiodol marking before CT-guided cryoablation for sporadic RCC is a feasible approach to improving local control and RFS while mitigating the decline in renal function. Additionally, it may help reduce complications.

Multiparametric assessment of microvascular invasion in hepatocellular carcinoma using gadoxetic acid-enhanced MRI

PURPOSE

To elucidate how precisely microvascular invasion (MVI) in hepatocellular carcinoma (HCC) can be predicted using multiparametric assessment of gadoxetic acid-enhanced MRI.

METHODS

In this retrospective single-center study, patients who underwent liver resection or transplantation of HCC were evaluated. Data obtained in patients who underwent liver resection were used as the training set. Nine kinds of MR findings for predicting MVI were compared between HCCs with and without MVI by univariate analysis, followed by multiple logistic regression analysis. Using significant findings, a predictive formula for diagnosing MVI was obtained. The diagnostic performance of the formula was investigated in patients who underwent liver resection (validation set 1) and in patients who underwent liver transplantation (validation set 2) using a receiver operating characteristic curve analysis. The area under the curves (AUCs) of these three groups were compared.

RESULTS

A total of 345 patients with 356 HCCs were selected for analysis. Tumor diameter (D) (P = 0.021), tumor washout (TW) (P < 0.01), and peritumoral hypointensity in the hepatobiliary phase (PHH) (P < 0.01) were significantly associated with MVI after multivariate analysis. The AUCs for predicting MVI of the predictive formula were as follows: training set, 0.88 (95% confidence interval (CI) 0.82,0.93); validation set 1, 0.81 (95% CI 0.73,0.87); validation set 2, 0.67 (95% CI 0.51,0.80). The AUCs were not significantly different among three groups (training set vs validation set 1; P = 0.15, training set vs validation set 2; P = 0.09, validation set 1 vs validation set 2; P = 0.29, respectively).

CONCLUSION

Our multiparametric assessment of gadoxetic acid-enhanced MRI performed quite precisely and with good reproducibility for predicting MVI.

Safety and clinical contribution of computed tomography-guided biopsy for cervical spine lesion

INTRODUCTION

The purpose is to clarify the safety and clinical contribution of computed tomography (CT)-guided percutaneous needle-biopsy for patients with cervical spine lesion.

MATERIAL AND METHODS

Between June 2015 and August 2022, CT-guided percutaneous needle biopsies were performed for 15 cervical spine lesions of 15 patients (8 male, 7 female; 2-81 years old). The technical success, clinical contribution, and safety were evaluated. Technical success was defined as the completion of the biopsy procedure. Clinical contribution was defined as any contribution to the therapeutic strategy. Safety was assessed by the Common Terminology Criteria for Adverse Events, version 5.0.

RESULTS

The technical success rate was 100%. In all 15 patients, nontarget organs (e.g., major vessels, spinal cord) could be avoided. The post-biopsy histological diagnoses were myeloma (n = 2), metastatic adenocarcinoma (n = 2), chordoma (n = 2), Langerhans cell histiocytosis (n = 3), and one case each of malignant lymphoma, schwannoma, pyogenic spondylitis, non-pyogenic spondylitis, degenerative change, and non-pathological fracture. All of these diagnoses contributed to the therapeutic strategy decisions. One case of grade 2 pain was observed, but no complications with grade 3 or more were observed during or after the biopsies.

CONCLUSION

CT-guided percutaneous needle biopsies for cervical spine lesions were safe and clinically beneficial.

Deep learning-based magnetic resonance imaging reconstruction for improving the image quality of reduced-field-of-view diffusion-weighted imaging of the pancreas

BACKGROUND

It has been reported that deep learning-based reconstruction (DLR) can reduce image noise and artifacts, thereby improving the signal-to-noise ratio and image sharpness. However, no previous studies have evaluated the efficacy of DLR in improving image quality in reduced-field-of-view (reduced-FOV) diffusion-weighted imaging (DWI) [field-of-view optimized and constrained undistorted single-shot (FOCUS)] of the pancreas. We hypothesized that a combination of these techniques would improve DWI image quality without prolonging the scan time but would influence the apparent diffusion coefficient calculation.

AIM

To evaluate the efficacy of DLR for image quality improvement of FOCUS of the pancreas.

METHODS

This was a retrospective study evaluated 37 patients with pancreatic cystic lesions who underwent magnetic resonance imaging between August 2021 and October 2021. We evaluated three types of FOCUS examinations: FOCUS with DLR (FOCUS-DLR+), FOCUS without DLR (FOCUS-DLR-), and conventional FOCUS (FOCUS-conv). The three types of FOCUS and their apparent diffusion coefficient (ADC) maps were compared qualitatively and quantitatively.

RESULTS

FOCUS-DLR+ (3.62, average score of two radiologists) showed significantly better qualitative scores for image noise than FOCUS-DLR- (2.62) and FOCUS-conv (2.88) (P < 0.05). Furthermore, FOCUS-DLR+ showed the highest contrast ratio (CR) between the pancreatic parenchyma and adjacent fat tissue for b-values of 0 and 600 s/mm2 (0.72 ± 0.08 and 0.68 ± 0.08) and FOCUS-DLR- showed the highest CR between cystic lesions and the pancreatic parenchyma for the b-values of 0 and 600 s/mm2 (0.62 ± 0.21 and 0.62 ± 0.21) (P < 0.05), respectively. FOCUS-DLR+ provided significantly higher ADCs of the pancreas and lesion (1.44 ± 0.24 and 3.00 ± 0.66) compared to FOCUS-DLR- (1.39 ± 0.22 and 2.86 ± 0.61) and significantly lower ADCs compared to FOCUS-conv (1.84 ± 0.45 and 3.32 ± 0.70) (P < 0.05), respectively.

CONCLUSION

This study evaluated the efficacy of DLR for image quality improvement in reduced-FOV DWI of the pancreas. DLR can significantly denoise images without prolonging the scan time or decreasing the spatial resolution. The denoising level of DWI can be controlled to make the images appear more natural to the human eye. However, this study revealed that DLR did not ameliorate pancreatic distortion. Additionally, physicians should pay attention to the interpretation of ADCs after DLR application because ADCs are significantly changed by DLR.

Extracellular volume fraction determined by dual-layer spectral detector CT: Possible role in predicting the efficacy of preoperative neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma

PURPOSE

To clarify the relationship between extracellular volume (ECV) measured by dual-energy CT (DECT) and efficacy of preoperative neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC), as compared with single-energy CT (SECT).

METHODS

We enrolled 67 patients with PDAC who underwent dynamic contrast-enhanced CT with a dual-energy CT system prior to NAC. Attenuation values were measured on unenhanced and the equilibrium-phase 120-kVp equivalent CT images for PDAC and the aorta. ΔHU-tumor, ΔHU-tumor/ΔHU-aorta, and SECT-ECV were calculated. Iodine densities of the tumor and aorta were measured in the equilibrium phase, and DECT-ECV of the tumor was calculated. Response to NAC was evaluated and the correlation between imaging parameters and response to NAC was statistically assessed.

RESULTS

Tumor DECT-ECVs were significantly lower in the response group (n = 7) than in the non-response group (n = 60), with most significant difference (p = 0.0104). DECT-ECV showed highest diagnostic value with an Az value of 0.798. When using the optimal cut off value of DECT-ECV (<26.0 %), sensitivity, specificity, accuracy, positive predictive value, and negative value for predicting response group were 71.4 %, 85.0 %, 83.6 %, 35.7 % and 96.2 %, respectively.

CONCLUSION

PDAC with lower DECT-ECV can potentially show better response to NAC. DECT-ECV might be a useful biomarker for predicting response to NAC in patients with PDAC.

Study of the K_{L}→π^{0}νν[over ¯] Decay at the J-PARC KOTO Experiment

The rare decay K_{L}→π^{0}νν[over ¯] was studied with the dataset taken at the J-PARC KOTO experiment in 2016, 2017, and 2018. With a single event sensitivity of (7.20±0.05_{stat}±0.66_{syst})×10^{-10}, three candidate events were observed in the signal region. After unveiling them, contaminations from K^{±} and scattered K_{L} decays were studied, and the total number of background events was estimated to be 1.22±0.26. We conclude that the number of observed events is statistically consistent with the background expectation. For this dataset, we set an upper limit of 4.9×10^{-9} on the branching fraction of K_{L}→π^{0}νν[over ¯] at the 90% confidence level.

Effectiveness of therapeutic standard concentration barium enema for colonic diverticular bleeding: Preliminary results

Purpose

To evaluate the effectiveness of a therapeutic barium enema as a treatment for colonic diverticulum bleeding, by using a standard concentration as a diagnostic examination.

Methods

We retrospectively analyzed 68 cases of the patients admitted to our hospital with colonic diverticular bleeding between October 2012 and September 2017. We evaluated the following items: (1) the presence/absence of a previous history of diverticular bleeding, (2) the use of medications (anticoagulants, nonsteroidal anti-inflammatory drugs, and antiplatelet drugs), (3) the location of bleeding, (4) the presence/absence of previous treatment and the result, (5) the time between bleeding and the beginning of the barium enema, (6) procedural success, (7) the clinical success of the initial hemostasis, (8) the clinical success of preventing recurrence, and (9) complications such as perforation and diverticulitis associated with this procedure.

Results

Four patients (three men and one woman; age range 60–85 years; median age 76 years) who underwent therapeutic barium enema with a concentration equivalent for diagnostic purpose (78 w/v%) were included. The follow-up period ranged from 11 to 12 months (median 12 months). All three patients who received a barium enema for initial hemostasis were successfully treated. All four patients remained free from recurrence during the follow-up period. There was no complication due to barium in this series.

Conclusion

Although we had no statistical evidence, a therapeutic barium enema with a standard concentration as a diagnostic examination may be effective for both the initial hemostasis and preventing the recurrence of colonic diverticular bleeding without complications.

Search for K_{L}→π^{0}νν[over ¯] and K_{L}→π^{0}X^{0} Decays at the J-PARC KOTO Experiment

A search for the rare decay K_{L}→π^{0}νν[over ¯] was performed. With the data collected in 2015, corresponding to 2.2×10^{19} protons on target, a single event sensitivity of (1.30±0.01_{stat}±0.14_{syst})×10^{-9} was achieved and no candidate events were observed. We set an upper limit of 3.0×10^{-9} for the branching fraction of K_{L}→π^{0}νν[over ¯] at the 90% confidence level (C.L.), which improved the previous limit by almost an order of magnitude. An upper limit for K_{L}→π^{0}X^{0} was also set as 2.4×10^{-9} at the 90% C.L., where X^{0} is an invisible boson with a mass of 135  MeV/c^{2}.

Interference Effect between ϕ and Λ(1520) Production Channels in the γp→K^{+}K^{-}p Reaction near Threshold

The ϕ-Λ(1520) interference effect in the γp→K^{+}K^{-}p reaction has been measured for the first time in the energy range from 1.673 to 2.173 GeV. The relative phases between ϕ and Λ(1520) production amplitudes were obtained in the kinematic region where the two resonances overlap. The measurement results support strong constructive interference when K^{+}K^{-} pairs are observed at forward angles but destructive interference for proton emission at forward angles. Furthermore, the observed interference effect does not account for the sqrt[s]=2.1  GeV bump structure in forward differential cross sections for ϕ photoproduction. This fact suggests possible exotic structures such as a hidden-strangeness pentaquark state, a new Pomeron exchange, or rescattering processes via other hyperon states.

MAPKs, activator protein-1 and nuclear factor-κB mediate production of interleukin-1β-stimulated cytokines, prostaglandin E₂ and MMP-1 in human periodontal ligament cells

BACKGROUND AND OBJECTIVE

Determination of the interleukin-1 (IL-1) signaling cascades that lead to the production of various inflammatory mediators and catabolic factors may clarify attractive targets for therapeutic intervention for periodontitis. We comprehensively assessed the involvement of MAPKs, activator protein-1 (AP-1) and nuclear factor-κB (NF-κB) in IL-1β-induced production of interleukin-6 (IL-6), interleukin-8 (IL-8), prostaglandin E(2) (PGE(2) ) and MMP-1 in human periodontal ligament cells.

MATERIAL AND METHODS

Human periodontal ligament cells were pretreated with an inhibitor for each of the MAPKs or NF-κB and subsequently treated with IL-1β. Following treatment, phosphorylation of three types of MAPK (ERK, p38 MAPK and c-Jun N-terminal kinase), IκB kinase (IKK) α/β/γ and IκB-α, as well as the DNA binding activity of AP-1 and NF-κB and the production of IL-6, IL-8, PGE(2) and MMP-1, were determined by western blotting, a gel mobility shift assay and ELISA, respectively.

RESULTS

The three MAPKs, simultaneously activated by IL-1β, mediated the subsequent DNA binding of AP-1 at various magnitudes, while IKKα/β/γ, IκB-α and NF-κB were also involved in the IL-1 signaling cascade. Furthermore, IL-1β stimulated the production of IL-6, IL-8, PGE(2) and MMP-1 via activation of the three MAPKs and NF-κB, because inhibitors of these significantly suppressed the IL-1β-stimulated production of these factors.

CONCLUSION

Our results strongly suggest that MAPK, AP-1 and NF-κB mediate the IL-1β-stimulated synthesis of IL-6, IL-8, PGE(2) and MMP-1 in human periodontal ligament cells. Therefore, inhibition of activation of MAPK, AP-1 and/or NF-κB may lead to therapeutic effects on progression of periodontitis.

Increased serum concentrations of secretory leukoprotease inhibitor in patients with primary Sjögren's syndrome

BACKGROUND

Secretory leukoprotease inhibitor (SLPI), a 12 kDa serine antiprotease, is produced by serous cells including salivary and lacrimal glands.

OBJECTIVE

We sought to assess whether serum levels of SLPI in patients with primary Sjogren's syndrome (SS) are elevated and correlated with conventional and laboratory indices of disease activity.

PATIENTS AND METHODS

SLPI levels were determined by ELISA of serum from 21 primary SS, and 26 age-matched normal controls.

RESULTS

Increased SLPI concentrations were found in primary SS patients (p < 0.01). Serum SLPI levels were positively correlated with the duration of the disease (r = 0.517, p < 0.025), but not with age, erythrocyte sedimentation rate, CRP, immunoglobulins, number of extraglandular manifestations and saliva production. SLPI levels were also positively correlated with serum levels of beta 2-microglobulin (r = 0.607, p < 0.01).

CONCLUSION

Determination of serum SLPI may provide a new simple noninvasive technique for evaluation of primary SS.

Character of a wheat amylase inhibitor preparation and effects on fasting human pancreaticobiliary secretions and hormones

BACKGROUND & AIMS

Amylase inhibition induces carbohydrate tolerance, satiety, and weight loss and prolongs gastric emptying, effects that may be useful in the treatment of obesity and non-insulin-dependent diabetes mellitus. The aim of this study was to determine (1) purity of a wheat amylase inhibitor preparation, (2) intraduodenal concentration of the wheat amylase inhibitor preparation that inhibits > 90% amylase activity (which causes carbohydrate malabsorption), and (3) if the inhibitor alters pancreaticobiliary secretions or intraluminal pH.

METHODS

High-performance liquid chromatography followed by electrophoresis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis were used for characterization. Groups of 3 subjects received intraduodenal infusions of 3.0, 4.5, or 6.0 mg/mL of the inhibitor for 90 minutes during the middle of a 270-minute essential amino acid solution infusion (which stimulates 50% maximal pancreatic enzyme secretion). Pancreatic enzyme and bile acid delivery to the duodenum were measured for a 270-minute period.

RESULTS

The inhibitor is 96% protein, 59% containing 0.19, 0.28, 0.38, and 0.53 inhibitors. The 0.38 inhibitor has the most antipancreatic alpha-amylase activity. The inhibitor reduced amylase activity in the duodenum dose dependently (r = 0.7; P = 0.04); > 4 mg/mL inhibited > 90% amylase activity but did not affect delivery of other enzymes or bile acids to the duodenum or gastric or duodenal pH.

CONCLUSIONS

The preparation has a high protein purity and a high specific activity against alpha-amylase activity and effectively inhibits human pancreatic amylase activity secreted into the duodenum.

[Relation among lifestyle, social network, blood pressure and serum lipids in the elderly]

The relationships among seven lifestyle factors including stress, which is focused on as a risk factor for cardiovascular disease recently, social network, blood pressure and serum lipids in the elderly were examined in a cross sectional study of 85 males and 65 females aged 60 years or over in the city of Sayama, Saitama Prefecture. The seven lifestyle factors were as follows: (1) amount of alcohol consumption, (2) cigarette smoking, (3) Physical exercise, (4) sleeping time per night, (5) nutritional balance, (6) body weight, and (7) stress. As social network factors, marital status and coping factor for stress and/or anxiety were introduced. Stressful life events strongly associated with stress status were also discussed. In this study, it was clear that age, alcohol consumption, stress status and stressful life events caused higher blood pressure. On the other hand, the social network was associated with lifestyle status and a controlled blood pressure level. Obesity and physical exercise were significantly associated with serum lipids. There results suggest that it is very important for the maintenance and promotion of health and risk reduction of disease among the elderly to control socio-psychological factors such as stress and stressful life event, and that a social network helps maintain a healthy lifestyle.

[Effects of crowding on immune functions in mice]

The effects of several types of crowding on immune functions were studied in mice. This study consisted of two experiments. Experiment one: Male BALB/c mice were initially housed in groups of four mice per cage. After fourteen days of acclimation, the mice were randomly divided into three groups, Control (four mice per cage, control group), Crowd-I (four mice per small space) and Crowd-II (sixteen mice per cage). These conditions were maintained for seven days. The results of experiment one were as follows: (1) The percentage of lymphocytes in the blood of Crowd-II was significantly lower than that of Control (p < 0.05). (2) The percentage of neutrophils and the absolute number of neutrophils in blood of Crowd-II were significantly higher than in Control (p < 0.05). (3) Superoxide production activity (NBT reduction activity) of blood neutrophils in Crowd-II tended to be depressed, and phagocytic activity of neutrophils was significantly depressed in Crowd-II as compared with Control (p < 0.01). These results suggest that the complexity of interrelationships among mice caused by an increase in the number of animals per cage is a very important stress factor. Experiment two: Male BALB/c mice were initially housed in groups of five mice per cage. After fourteen days of acclimation, the mice were divided into three groups, Control (five mice per cage, control group), Crowd-(1) (five mice per cmall space) and Crowd-(2) (twenty mice per cage). In Control and Crowd-(1), the same mice were used as in the acclimation period. These conditions were maintained for seven days. In this period, on the second day, all the mice were injected intraperitoneally with sheep red blood cells (SRBC). The results of experiment two were as follows: (1) The specific humoral immune response to SRBC was investigated in terms of the number of PFC in the spleens and hemagglutination in sera, but significant differences were not found among the groups. (2) Plasma IgG levels in the Crowd-(1) were significantly higher than those in Control (p < 0.05). (3) Both superoxide production activity and phagocytic activity of neutrophils were significantly depressed in Crowd-(2) as compared with Control (p < 0.01, respectively), whereas each neutrophil function of Crowd-(1) tended to be enhanced as compared with Control.