Parotid elastography: a potential alternative to replace labial biopsy in classification of patients with primary Sjögren's syndrome?

BACKGROUND: There has been a substantial improvement in classifying patients with primary Sjögren's syndrome (pSS), with the new 2016 ACR/EULAR classification criteria. It was aimed to investigate the potential role of parotid elastography in the classification of patients with pSS, as well as the clinical diagnosis of those who do not otherwise fulfil the criteria. METHOD: This is a cross-sectional analysis of patients with pSS followed up in tertiary out-patient rheumatology clinic. Patients' medical records were retrospectively investigated whether or not clinically diagnosed pSS patients fulfil 2016 ACR/EULAR criteria sets. Elastographic evaluation of parotid and submandibular glands bilaterally was performed when presented for follow-up. Strain ratio, shear wave velocity and Pascal values of the glands were obtained. RESULTS: Clinical data on 179 patients with Sjögren's syndrome were investigated. Ninety-six patients with pSS and 30 gender and age-matched healthy controls were included in the study. Eighty-six percent of the clinically diagnosed patients satisfied the 2016 ACR /EULAR criteria and were considered 'criteria patients', and the remaining were considered 'non-criteria patients'. Both criteria and non-criteria patients had significantly higher parotid strain ratio and submandibular velocity compared with healthy controls (p < 0.001 and p < 0.001 for parotid strain ratio and p < 0.001 and p = 0.016 for submandibular velocity, respectively). Replacing labial gland biopsy findings with parotid strain ratio in the new classification criteria resulted in similar sensitivity and lower specificity, 91.6% and 80%, respectively. CONCLUSION: Parotid shear elastography is an easy and noninvasive method and might be a useful tool for the classification of patients with pSS, especially when labial gland biopsy is not feasible. Key Points • Salivary gland elastography (SGE) is a useful tool for the classification of patients with pSS. • SGE could be performed instead of labial biopsy without changing the diagnostic power of classification criteria.

THE EFFICIENCY OF ULTRASOUND ELASTOGRAPHY IN THE DIFFERENTIAL DIAGNOSIS OF THYROID NODULES.

AIM: To evaluate the efficiency of ultrasound elastography (USE) in the differential diagnosis of thyroid nodules. METHODS: One hundred thyroid nodules in 100 patients (79 females, 21 males, age range 18-78; mean age = 45.6 years) were evaluated with real-time freehand USE, using Hitachi EUB 7500 equipment and elasticity scores were obtained. The elasticity was scored as follows: Score 1, elasticity in the entire nodule; Score 2, mainly elastic nodule with the presence of inelastic areas not constant during real time examination; Score 3, constant inelastic areas prevalently arranged at the periphery of the nodule; Score 4, constant inelastic areas prevalently arranged at the center of the nodule; Score 5, no elasticity in the nodule. Also mean strain ratio values were calculated for all nodules. RESULTS: Eighty-four (86%) of cases were benign and sixteen (16%) were malignant. Elasticity score 3 and higher and strain ratio higher than 2.485 had statistically significant relation with malignancy (p < 0.05). CONCLUSIONS: USE including strain ratio calculations besides subjective evaluation of elasticity scores is an efficient imaging method which may contribute to the differential diagnosis of thyroid nodules.

Investigation of Bisphenol A as an endocrine disruptor, total thiol, malondialdehyde, and C-reactive protein levels in chronic obstructive pulmonary disease.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is a common health problem and it is associated with oxidant/antioxidant imbalance and systemic inflammation. Bisphenol A (BPA) is an endocrine disruptor agent, exerting a wide variety of metabolic effects. Also, BPA is related with oxidative stress, decreased antioxidant enzymes, and inflammation. The aim of this study is to investigate the relationships between COPD and serum BPA, C-reactive protein (CRP), malondialdehyde (MDA), and total thiol levels. PATIENTS AND METHODS: This study was enrolled at 83 subjects that they were divided into two groups: control (n=33), COPD (n=50). The serum BPA, CRP, MDA, and total thiol levels were analyzed. RESULTS: The CRP and BPA levels were significantly higher in the COPD patients than control subjects. The total thiol levels were significantly lower in COPD cases than the controls. There is no different between groups for MDA. Also, there had a linear relationship between BPA and CRP in correlation analysis. CONCLUSIONS: COPD is associated with high serum BPA, CRP and low total thiol levels in comparison with healthy individuals. It is suggested that BPA might have a role in the etiopathogenesis of COPD.

Multiple sclerosis and optic nerve: an analysis of retinal nerve fiber layer thickness and color Doppler imaging parameters.

PURPOSE: To compare both retinal nerve fiber layer thickness and orbital color Doppler ultrasonography parameters in patients with multiple sclerosis (MS) versus healthy controls. METHODS: This is an observational case-control study. Forty eyes from MS patients and twenty eyes from healthy volunteers were examined. Eyes were classified into three groups as group 1, eyes from MS patients with previous optic neuritis (n=20); group 2, eyes from MS patients without previous optic neuritis (n=20); and group 3, eyes from healthy controls (n=20). Following complete ophthalmologic examination and retinal nerve fiber layer thickness measurement for each group, blood flow velocities of posterior ciliary arteries, central retinal artery, ophthalmic artery, and superior ophthalmic vein were measured. Pourcelot index (resistive index), an indicator of peripheral vascular resistance, was also calculated. The statistical assessment was performed with the assistance of Pearson's Chi-square test, Mann-Whitney U-test, Kruskal-Wallis test, and Spearman's correlation test. RESULTS: The studied eyes exposed similar values in terms of intraocular pressure and central corneal thickness, implying no evidence in favor of glaucoma. All nerve fiber layer thickness values, except superior nasal quadrants, in group 1 were found to be significantly thinner than groups 2 and 3. Blood flow velocity and mean resistivity index parameters were similar in all the groups. CONCLUSIONS: In MS patients, especially with previous optic neuritis, diminished retinal nerve fiber layer thickness was observed. Contrary to several studies in the current literature, no evidence supporting potential vascular origin of ocular involvement in MS was found.

An evaluation of diaphragmatic movements in hemiplegic patients.

OBJECTIVE: The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. METHODS: 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. RESULTS: When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p<0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. CONCLUSION: The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.

Ala-9Val polymorphism of Mn-SOD gene in sickle cell anemia.

Oxidative stress may be contributory to the pathophysiology of the abnormalities that underlie the clinical course of sickle cell anemia. We looked for a possible genetic association between the functional polymorphism Ala-9Val in the human Mn-SOD gene and sickle cell anemia. One hundred and twenty-seven patients with sickle cell anemia and 127 healthy controls were recruited into the study. Alanine versus valine polymorphism in the signal peptide of the Mn-SOD gene was evaluated using a primer pair to amplify a 107-bp fragment followed by digestion with the restriction enzyme NgoMIV. In the sickle cell anemia patients, the frequency of Val/Val genotype was approximately 1.4-fold lower and that of Ala/Val was 1.3-fold higher compared to the controls. No significant difference in genotype frequencies was found between patients and controls (χ(2) = 4.561, d.f. = 2, P = 0.101). The Val-9 was the most common allele in patient and healthy subjects. No significant difference in allele frequencies was found between patients and controls (χ(2) = 1.496, d.f. = 1, P = 0.221). We conclude that the Mn-SOD gene polymorphism is not associated with sickle cell anemia.

Direct and indirect effects of kisspeptin on liver oxidant and antioxidant systems in young male rats.

Kisspeptin is a recently discovered hypothalamic peptide which plays an important role in the central control of reproductive functions. We have investigated direct and indirect effects of kisspeptin on the liver oxidative stress in young male rats. Twenty-four rats were divided into four groups (n = 6/group). First group served as control and received saline. Kisspeptin-10 was administered to the animals in the second group (20 nmol/rat/day), for a period of 7 days. Rats were given only one dose gosereline (0.9 mg/rat), a GnRH agonist in the third group. The last group received kisspeptin-10 with gosereline. The activities of catalase, superoxide dismutase (SOD), xanthine oxidase (XO), adenosine deaminase (AD) and level of malondialdehyde were studied in liver tissue. Serum samples were separated for total antioxidant capacity (TAC), total oxidant status (TOS), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, blood urea nitrogen (BUN), colesterol, high-density lipoprotein (HDL) and triglyceride. Kisspeptin increased the activities of SOD and catalase (p < 0.05). When compared to the control group, the levels of malondialdehyde, TOS and AST were lower, but levels of BUN, cholesterole, HDL and AD were higher in the other three groups (p < 0.05). In conclusion, our findings suggest that kisspeptin may have antioxidant and thus protective effects on the liver tissue.

Protective effects of caffeic acid phenethyl ester on iron-induced liver damage in rats.

Caffeic acid phenethyl ester (CAPE) is a natural product with potent anti-inflammatory, antitumor, and antioxidant activities, and attenuates inflammation and lipid peroxidation. The purpose of the present study was to investigate the effects of CAPE on iron-induced liver damage. Rats were divided into four groups and treated for 7 days with saline (control group), 10 micromol kg CAPE/day s.c. (CAPE group), 50 mg iron-dextran/kg i.p. (IRON group) and CAPE and iron at the same time (IRON+CAPE group). Seven days later, rats were killed and the livers were excised for biochemical analysis. The administration of IRON alone resulted in higher myeloperoxidase (MPO) activity and lipid peroxidation than in the control and CAPE treatment prevented the increase in MPO activity and malondialdeyde (MDA) level. No differences were observed in all four groups with regards to superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) activities. Our results collectively suggest that CAPE may be an available agent to protect the liver from injury via inhibition of MPO activity.

Single breath-hold diffusion-weighted MRI of the liver with parallel imaging: initial experience.

AIM: To evaluate prospectively the improvement in the signal:noise ratio (SNR), with the use of parallel technique in single breath-hold diffusion-weighted imaging (DWI) of the liver and its affect on apparent diffusion coefficient (ADC) measurements. MATERIALS AND METHODS: This study was approved by our institutional review board. Written informed consent was obtained from all participants. Fifteen patients underwent single breath-hold DWI of the liver with and without parallel imaging technique. SNR and ADC values were measured over a lesion-free right hepatic lobe by two radiologists in both series. When a focal hepatic lesion was present the contrast:noise ratio (CNR) and ADC were also measured. Paired Student's t-tests were used for statistical analysis. RESULTS: Mean SNR values of the liver were 20.82+/-7.54 and 15.83+/-5.95 for DWI with and without parallel imaging, respectively. SNR values measured in DWI using parallel imaging were found to be significantly higher (p<0.01). Mean ADC of the liver were 1.61+/-0.45 x 10(-3)mm(2)/s and 1.56+/-0.28 x 10(-3)mm(2)/s for DWI with and without parallel imaging, respectively. No significant difference was found between the two sequences for hepatic ADC measurement (p>0.05). Overall lesion CNR was found to be higher in DWI with parallel imaging. CONCLUSION: Parallel imaging is useful in improving SNR of single breath-hold DWI of the liver without compromising ADC measurements.

Blood-flow volume quantification in internal carotid and vertebral arteries: comparison of 3 different ultrasound techniques with phase-contrast MR imaging.

BACKGROUND AND PURPOSE: Optimal estimation of cerebral blood-flow volume (BFV) may be an important indicator for better evaluation of the patients with cerebrovascular disorders. In this study, we compared the BFV values at bilateral internal carotid and vertebral arteries of healthy volunteers obtained with color Doppler, power Doppler, and B-flow ultrasound (US) studies and tried to determine which examination is more correlated with MR phase-contrast quantification. METHODS: BFVs of the internal carotid and vertebral arteries of 40 healthy volunteers (19 men and 21 women; age range, 20-47 years) were measured by using color Doppler, power Doppler, B-flow US and MR phase-contrast imaging. The flow measurements obtained with the sonographic techniques were compared with MR phase contrast, which is accepted as the most reliable method for the estimation of cerebral BFV. RESULTS: Quantification with power Doppler imaging showed the highest values among sonography techniques, followed by color Doppler imaging, B-flow imaging (BFI), and MR phase-contrast flow quantification. There was a statistically significant difference between the flow-volume values obtained with these 4 different techniques (P < .05). BFI yielded the closest values (internal carotid arteries, 238.84 mL/min; vertebral arteries, 51.16 mL/min) to MR phase-contrast flow quantification study with higher correlation rates. CONCLUSION: Flow volumes obtained with BFI showed the highest correlation with MR phase-contrast imaging among 3 different sonography techniques. B-flow sonography may be a very effective and cost-efficient alternative for MR phase-contrast studies for the calculation of cerebral BFV.

Use of twinkling artifact in sonographic detection of intestinal pneumatosis.

Intestinal pneumatosis is a relatively rare condition that has been associated with a wide variety of abnormalities. Traditionally, this entity has been diagnosed by radiographic films, contrast series, or more accurately by computed tomography. However, reports describing findings of intestinal pneumatosis on sonographic examination, which is an important initial diagnostic tool for abdominal diseases, are limited. We suggest that twinkling artifact may be of value in the sonographic diagnosis of this condition. We report two cases of intestinal pneumatosis that were diagnosed initially by sonography with the aid of twinkling artifact.

Case report: Portal and systemic venous gas in a patient after lumbar puncture.

The presence of portal and systemic venous gas is traditionally regarded as an ominous radiological sign indicating a grave prognosis. With advances in imaging technology, the incidence of its detection has increased along with its association with clinically benign disorders. We present a young patient with systemic and portal venous gas after traumatic lumbar puncture.