Patients With Type 2 Diabetes Mellitus and Early Diabetic Kidney Disease Exhibit Lower Computed Tomography-measured Skeletal Muscle Attenuation Values: A Propensity Score-matched Study.

OBJECTIVE: To investigate the association between computed tomography-measured quality characteristics of skeletal muscle (SM) and early diagnosis of diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study included patients diagnosed with T2DM, with and without early DKD, between January 2019 and December 2021. To reduce potential bias, propensity score matching (PSM) was performed. The area and computed tomography attenuation values for SM and different abdominal adipose depots were measured. After PSM, logistic and multiple linear regression analyze were performed to analyse risk factors for early DKD. RESULTS: A total of 267 patients were enrolled (mean age, 61.67 years ± 10.87; 155 men) and divided into two groups: T2DM with early DKD (n = 133); and T2DM without DKD (n = 134). After PSM, 230 patients were matched (T2DM with early DKD [n = 115]; and T2DM without DKD [n = 115]), with no statistical differences in general characteristics between the two groups (P > .05). In multivariate logistic regression analysis, high-density lipoprotein cholesterol (odds ratio [OR] 0.14; 95% confidence interval [CI] 0.04-0.49; P = .002), uric acid (OR 1.01; 95% CI 1.00-1.01; P = .006), and SM attenuation value (OR 0.94; 95% CI 0.90-0.98; P = .003) were independent risk factors for early DKD. Multiple linear regression analysis revealed significant correlations between SM attenuation value and cystatin C (ß = -0.39, P = .004), urine albumin-to-creatinine ratio (ß = -0.26, P = .026), and estimated glomerular filtration rate (ß = 0.31 P = .009) after adjustment for confounders. CONCLUSION: Patients with T2DM and lower SM attenuation values may exhibit a higher risk for early DKD than those with higher values, which provides a potential imaging biomarker for early DKD diagnosis.

Abdominal adipose tissue and type 2 diabetic kidney disease: adipose radiology assessment, impact, and mechanisms.

Diabetic kidney disease (DKD) is a significant healthcare burden worldwide that substantially increases the risk of kidney failure and cardiovascular events. To reduce the prevalence of DKD, extensive research is being conducted to determine the risk factors and consequently implement early interventions. Patients with type 2 diabetes mellitus (T2DM) are more likely to be obese. Abdominal adiposity is associated with a greater risk of kidney damage than general obesity. Abdominal adipose tissue can be divided into different fat depots according to the location and function, including visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), perirenal adipose tissue (PAT), and renal sinus adipose tissue (RSAT), which can be accurately measured by radiology techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI). Abdominal fat depots may affect the development of DKD through different mechanisms, and radiologic abdominal adipose characteristics may serve as imaging indicators of DKD risk. This review will first describe the CT/MRI-based assessment of abdominal adipose depots and subsequently describe the current studies on abdominal adipose tissue and DKD development, as well as the underlying mechanisms in patients of T2DM with DKD.

Multiparametric MRI manifestations of the spontaneous intratumoral coagulative necrosis in HCC.

PURPOSE: To investigate the MRI manifestations of the spontaneous intratumoral coagulative necrosis (iCN) in patients with hepatocellular carcinoma (HCC) and its value in predicting the postoperative early recurrence (≤ 2 years). METHODS: Patients with HCC who underwent preoperative multiparametric MRI between January 2015 and February 2019 were enrolled in this retrospective study. The MRI manifestations of iCNs on TIWI, T2WI, and ADC were recorded. The sensitivity and specificity of MRI for the detection of iCNs were also evaluated. A multivariable Cox proportional hazards model and the Kaplan-Meier method were used to verify the value of histologically-confirmed and MRI-identified iCNs, respectively, in predicting early recurrence. RESULTS: A total of 163 patients (median age, 56 years; interquartile range, 49-64 years; 139 men) with HCCs were evaluated, of whom 27(16.6%) had histologically-confirmed iCNs. MRI identified 92.6% (25 of 27; 95% confidence interval [CI] 74.2%, 98.7%) of iCNs (sensitivity), with a specificity of 79.4% (78 of 136; 95% CI 71.4%, 85.7%), based on non-enhancement on post-contrast MRI. And the MRI-identified iCNs were characterized by a similar appearance to surrounding tumour tissue shown on pre-contrast MRI but not enhanced on post-contrast MRI. The multivariable Cox proportional hazards model revealed that only the presence of histologically-confirmed iCN was independently associated with early HCC recurrence (hazard ratio = 2.73; 95% CI 1.20, 6.21; P = 0.017). The Kaplan-Meier curve showed that the presence of MRI-identified iCN was also associated with early recurrence (P < 0.001). CONCLUSION: Multiparametric MRI identified iCNs with high sensitivity and modest specificity. The presence of iCNs is associated with early HCC recurrence.

Association between higher intermuscular adipose tissue and decreased renal function in patients with systemic lupus erythematosus mediated by insulin resistance.

OBJECTIVES: To quantify the relationship between abdominal computed tomography (CT)-based body composition parameters and renal function in systemic lupus erythematosus (SLE) patients and evaluate the potential effect of insulin resistance on this relationship. METHODS: SLE patients from institutions A and B between January 2017 and August 2023 were enrolled. Areas and attenuation values of subcutaneous adipose tissue, visceral adipose tissue, intermuscular adipose tissue (IMAT), and skeletal muscle index on CT images were measured at the L3 vertebral level. Logistic regression analysis was used to identify risk factors associated with decreased renal function. Linear regression models were used to describe the relationships between body composition parameters and estimated glomerular filtration rate (eGFR). Finally, we used a single-point insulin sensitivity estimator to indirectly reflect the degree of insulin resistance and assess its mediating effect on the association between IMAT area and decreased renal function. RESULTS: Three-hundred thirty-nine SLE patients from institution A (internal dataset) and 114 SLE patients from institution B (external validation dataset) were included. Multivariate logistic regression revealed that IMAT area (odds ratio (OR)institution A: 1.05 (95% confidence intervals (95% CI): 1.01, 1.10), and ORinstitution B: 1.19 (95% CI: 1.03, 1.39)) was an independent risk factor for decreased renal function in SLE patients. In the adjusted linear regression model, high IMAT area was significantly associated with reduced eGFR (ßinstitution A = -1.15, Pinstitution A = 0.005; ßinstitution B = -0.98, Pinstitution B = 0.049). Additionally, insulin resistance contributed a mediating role of 22.8% to the association. CONCLUSION: High IMAT area was associated with decreased renal function in SLE patients and insulin resistance mediated this relationship. CRITICAL RELEVANCE STATEMENT: High intermuscular adipose tissue area is associated with decreased renal function in systemic lupus erythematosus patients mediated by insulin resistance and is correlated with chronicity index in lupus nephritis patients. KEY POINTS: High intramuscular adipose tissue (IMAT) area was associated with decreased renal function in systemic lupus erythematosus (SLE) patients. Insulin resistance mediated the association between IMAT area and eGFR. IMAT area was associated with chronicity index in lupus nephritis patients.

Treatment Protocols in the Efficacy and Safety of Anti-EGFR Medicines in Combination with Standard Therapy for Patients with Nasopharyngeal Cancer: A Meta-Analysis.

Objective: This study was conducted to compare the efficacy of standard therapy (radiotherapy/RT/CT) with that of antiepidermal growth factor receptor (anti-EGFR) monoclonal antibody (NPC) therapy in patients with advanced nasopharyngeal cancer. Methods: A meta-analysis was performed to meet the objective of this study. The English databases PubMed, Cochrane Library, and Web of Science were searched. The literature review compared anti-EGFR-targeted therapy with conventional therapy practices. The main outcome measure was overall survival (OS). Secondary goals were progression-free survival (PFS), locoregional recurrence-free survival (LRRFS), distant metastasis-free survival (DMFS), and adverse events (grade 3). Results: The database search resulted in 11 studies, with a total of 4219 participants. It was found that combining an anti-EGFR regimen with conventional therapy did not enhance OS (hazard ratio [HR] = 1.18; 95%confidence interval [CI] = 0.51-2.40; p = 0.70) or PFS appreciably (HR = 0.95; 95%CI = 0.51-1.48; p = 0.88) in patients with nasopharyngeal carcinoma. While LRRFS increased considerably (HR = 0.70; 95%CI = 0.67-1.00; p = 0.01), the combined regimen did not improve DMFS (HR = 0.86; 95%CI = 0.61-1.12; p = 0.36). Treatment-related adverse events included haematological toxicity (RR = 0.2; 95%CI = 0.08-0.45; p = 0.01), cutaneous reactions (RR = 7.05; 95%CI = 2.15-23.09; p = 0.01), and mucositis (RR = 1.96; 95%CI = 1.58-2.09; p = 0.01). Conclusions: Individuals who have nasopharyngeal cancer do not have an increased chance of surviving until a local recurrence of their disease if they get normal therapy in addition to an anti-EGFR regimen. However, this combination does not enhance overall survival. On the other hand, this factor adds to an increase in the number of adverse effects.

Sex-Specific Computed Tomography Abdominal Fat and Skeletal Muscle Characteristics in Type 2 Diabetic Retinopathy Patients With/Without Comorbid Diabetic Kidney Disease.

RATIONALE AND OBJECTIVES: To investigate differences in sex-specific computed tomography abdominal fat and skeletal muscle (SM) characteristics between type 2 diabetic retinopathy (DR) patients with and without diabetic kidney disease (DKD). MATERIALS AND METHODS: This retrospective study included type 2 diabetes mellitus DR patients with/without DKD between January 2019 and July 2021. Visceral adipose tissue (VAT), subcutaneous adipose tissue, perirenal adipose tissue (PAT), intramuscular adipose tissue, and SM areas were measured. Univariate and multivariate logistic regression analyses were used to analyze risk factors for DKD. Correlation and multiple linear regression analyses were used to clarify the association between computed tomography abdominal fat, SM characteristics, and cystatin C. RESULTS: Two hundred and forty-one patients were enrolled and divided into DR with DKD group (n = 142) and DR without DKD group (n = 99). In men, hypertension (OR: 5.21; 95%CI: 1.93-14.05; p = 0.001), diastolic pressure (OR: 1.07; 95%CI: 1.01-1.12; p = 0.011), hemoglobin (OR: 0.94; 95%CI: 0.92-0.97; p < 0.001) and PAT attenuation value (OR: 1.09; 95%CI: 1.01-1.17; p = 0.026) were independent risk factors for DKD progression in DR patients, while the VAT index (VATI) (OR: 1.03; 95%CI: 1.01-1.05; p = 0.014) was an independent risk factor for female patients. Multiple linear regression analysis revealed significant correlations between hypertension (ß = 0.22, p = 0.002) and hemoglobin (ß = -0.53, p < 0.001) with cystatin C in men, and a significant correlation between VATI and cystatin C (ß = 0.35, p = 0.037) in women after adjustment for confounders. CONCLUSION: Female DR patients with elevated VAT level may suffer from a higher risk of DKD than that in male patients.

Development and External Validation of a Nomogram Including Body Composition Parameters for Predicting Early Recurrence of Hepatocellular Carcinoma After Hepatectomy.

RATIONALE AND OBJECTIVES: Body composition, including adipose and muscle tissues, evaluated by computer tomography is correlated with the prognosis of hepatocellular carcinoma (HCC). However, its relationship with early recurrence (ER) remains unclear. This study aimed at establishing and validating a nomogram based on body composition and clinicopathological indices to predict ER of HCC. MATERIALS AND METHODS: One hundred ninety-five patients from institution A formed the training cohort and internal validation cohort, and 50 patients from institution B formed the external validation cohort. Independent predictors of ER were identified using LASSO and Cox regression analyses. The performance of nomogram was evaluated using the calibration curve, concordance index (C-index), area under the curve (AUC), and decision curve analysis (DCA). RESULTS: After data screening, the nomogram was constructed using eight independent predictors of ER, including the tumor size, alpha fetoprotein, body mass index, Edmondson Steiner grade, visceral adipose tissue radiodensity, intermuscular adipose tissue index, intramuscular adipose tissue content, and skeletal muscle area. The calibration curve exhibited excellent concordances, with C-indices of 0.808 (95%CI: 0.771-0.860), 0.802 (95%CI: 0.747-0.942), and 0.804 (95%CI: 0.701-0.861) in training, internal validation, and external validation cohorts, respectively. In addition, compared to conventional staging systems and pure clinical model, the nomogram exhibited a higher AUC and wider range of threshold probabilities in DCA, which indicated better discriminative ability and greater clinical benefit. Finally, patients with nomogram scores of <183.07, 183.07-243.09, and >243.09 were considered to have low, moderate, and high risks of ER, respectively. CONCLUSION: The nomogram exhibits excellent ER predictive ability for patients with HCC who underwent hepatectomy.

MRI-based preoperative markers combined with narrow-margin hepatectomy result in higher early recurrence.

PURPOSE: To investigate the applicability of MRI-based preoperative risk markers in assisting clinicians to define an appropriate surgical margin width for patients with solitary hepatocellular carcinoma. METHODS: Patients who underwent preoperative MRI with hepatectomy were randomly divided into development (65%) and internal validation (35%) datasets between January 2015 and January 2019. Multivariate logistic analysis was used to evaluate MRI-based markers of early recurrence (≤2 years) in the development dataset. Independent factors in the development dataset were investigated using a multivariable Cox analysis. The multivariable logistic and Cox models were verified using the risk score system in the validation dataset. Recurrence-free survival (RFS) was calculated according to MRI-based preoperative markers together with a narrow or wide margin in all datasets. RESULTS: A narrow resection margin was identified as an independent risk factor for early postoperative recurrence (P < 0.001) according to multivariable Cox analysis. RFS was significantly shorter in patients with narrow resection margins than that of those with wide resection margins (P < 0.005). Patients with the three MRI-based preoperative markers (tumour size > 5 cm, substantial necrosis, and non-smooth margins) combined with a narrow resection margin had a shorter RFS than that of those with a wide margin (P < 0.005). Patients without these markers also benefitted from a wide margin (P < 0.05). CONCLUSIONS: MRI-based preoperative risk markers in combination with narrow resection margins were associated with a higher recurrence rate compared with wide resection margins, and hence, such patients may benefit from a wide-margin hepatectomy.

Effect of glutenin and gliadin modified by protein-glutaminase on retrogradation properties and digestibility of potato starch.

The glutenin (Glu) and gliadin (Gli) were modified by protein-glutaminase (PG) to obtain soluble glutenin (PG-Glu) and gliadin (PG-Gli), and PG-Glu or PG-Gli was added to potato starch (PS) according to different amounts (0.5%, 1.0%, and 1.5%, based on dry starch weight, w/w) to explore the effect of modified proteins on the retrogradation behavior and digestibility of PS. The results showed that the long-term retrogradation of PS was accelerated by the addition of PG-Glu or PG-Gli. The addition of PG-Glu or PG-Gli led to an increase in hydrogen bonds within starch molecules and induced a significant increase in resistant starch content. The hydrolysis kinetic parameters, C∞ and K, both decreased with the increasing level of modified protein, indicating the deceleration of hydrolysis rate by the addition of PG-Glu or PG-Gli. In summary, the addition of PG-Glu or PG-Gli could promote the retrogradation of PS and mitigate the digestion of starch.

Effects of sodium tripolyphosphate modification on the structural, functional, and rheological properties of rice glutelin.

In this study, rice glutelin isolated from glutinous rice was modified by sodium tripolyphosphate at different sodium tripolyphosphate concentrations (1%, 4%, 7%). The structural, functional and rheological properties of phosphorylated rice glutelin were investigated. The results indicated that phosphorylated rice glutelin samples showed small particle size and high absolute zeta potential values. Phosphorylation reaction was occurred between -OH and -NH2 groups in rice glutelin and sodium tripolyphosphate, as confirmed by Fourier transform infrared spectroscopy and X-ray photoelectron spectroscopy. The particle surface of phosphorylated rice glutelin samples became very rough and exhibited some small convex and concave holes. Moreover, the solubility, emulsifying and foaming properties, thermal stability and apparent viscosity of phosphorylated rice glutelin samples were significantly increased. These results suggest that the solubility, emulsification and rheological properties of rice glutelin are significantly improved after phosphorylation, which will be beneficial to expand the application of rice glutelin in food industry.

The effects of phosphorylation modification on the structure, interactions and rheological properties of rice glutelin during heat treatment.

Rice glutelin (RG) and phosphorylated rice glutelin (PPRG) were treated with heating for different time (15, 30, and 45 min), the effects of phosphorylation modification on the structure, interactions and rheological properties of rice glutelin during heat treatment were investigated. The results showed that the turbidity of PPRG samples were higher than those of RG samples after heating. Particle size distribution showed that the protein aggregates with particle size of 1000-1500 nm were formed after heating for 45 min. Changes in protein structure indicated that the protein unfolded after heating for a short time, and aggregated when heating time extended to 45 min. In addition, the microstructure of PPRG sample became tight when heated for 45 min. Rheological analysis showed that phosphorylation modification and heat treatment improved RG viscoelasticity. These results suggest that phosphorylation modification improves thermal aggregation of RG, which will facilitate the application of RG in food industry.