Identification of Neck Lymph Node Metastasis-Specific microRNA-Implication for Use in Monitoring or Prediction of Neck Lymph Node Metastasis.

MicroRNAs (miRNAs) have attracted attention as non-invasive cancer biomarkers in various cancers; however, they have not been adequately investigated in oral squamous cell carcinoma (OSCC). This study investigated the diagnostic performance of serum-derived miRNAs at initial diagnosis for primary neck lymph node metastasis and the predictive performance for late neck lymph node metastasis based on long-term (up to approximately 8 years) follow-up of patients with OSCC. The expression of miRNAs in 40 patients with OSCC was quantified using real-time PCR (qPCR), and a comprehensive statistical analysis of the correlation of miRNA expression for primary and late neck lymph node metastases was performed. For the diagnosis of primary neck lymph node metastases, miR-423 and miR-125 were accurate. The miRNA index for primary metastasis diagnosis (miR-PM) calculated by regression analysis showed high diagnostic accuracy. The miR-5100 was useful for predicting late neck lymph node metastases. The miRNA index for late metastasis prediction (miR-LM) calculated using regression analysis showed high prediction accuracy. MiRNAs were useful for diagnosing primary neck lymph node metastases in OSCC and predicting late neck lymph node metastases. It may help to consider individualized treatment, including follow-up, surgical methods, and postoperative management.

Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19.

Background Radiographic severity may help predict patient deterioration and outcomes from COVID-19 pneumonia. Purpose To assess the reliability and reproducibility of three chest radiograph reporting systems (radiographic assessment of lung edema [RALE], Brixia, and percentage opacification) in patients with proven SARS-CoV-2 infection and examine the ability of these scores to predict adverse outcomes both alone and in conjunction with two clinical scoring systems, National Early Warning Score 2 (NEWS2) and International Severe Acute Respiratory and Emerging Infection Consortium: Coronavirus Clinical Characterization Consortium (ISARIC-4C) mortality. Materials and Methods This retrospective cohort study used routinely collected clinical data of patients with polymerase chain reaction-positive SARS-CoV-2 infection admitted to a single center from February 2020 through July 2020. Initial chest radiographs were scored for RALE, Brixia, and percentage opacification by one of three radiologists. Intra- and interreader agreement were assessed with intraclass correlation coefficients. The rate of admission to the intensive care unit (ICU) or death up to 60 days after scored chest radiograph was estimated. NEWS2 and ISARIC-4C mortality at hospital admission were calculated. Daily risk for admission to ICU or death was modeled with Cox proportional hazards models that incorporated the chest radiograph scores adjusted for NEWS2 or ISARIC-4C mortality. Results Admission chest radiographs of 50 patients (mean age, 74 years ± 16 [standard deviation]; 28 men) were scored by all three radiologists, with good interreader reliability for all scores, as follows: intraclass correlation coefficients were 0.87 for RALE (95% CI: 0.80, 0.92), 0.86 for Brixia (95% CI: 0.76, 0.92), and 0.72 for percentage opacification (95% CI: 0.48, 0.85). Of 751 patients with a chest radiograph, those with greater than 75% opacification had a median time to ICU admission or death of just 1-2 days. Among 628 patients for whom data were available (median age, 76 years [interquartile range, 61-84 years]; 344 men), opacification of 51%-75% increased risk for ICU admission or death by twofold (hazard ratio, 2.2; 95% CI: 1.6, 2.8), and opacification greater than 75% increased ICU risk by fourfold (hazard ratio, 4.0; 95% CI: 3.4, 4.7) compared with opacification of 0%-25%, when adjusted for NEWS2 score. Conclusion Brixia, radiographic assessment of lung edema, and percentage opacification scores all reliably helped predict adverse outcomes in SARS-CoV-2 infection. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Little in this issue.

Pulmonary metastases from mucinous colorectal cancers and their appearance on CT: a case series.

Mucinous colorectal adenocarcinoma represents a small proportion of all colorectal cancers, characterised by mucinous tumour components. While its pattern of metastatic spread differs from that of conventional colorectal adenocarcinoma, pulmonary metastases are commonly seen in both mucinous and non-mucinous types. The assessment of pulmonary nodules in the context of malignancy is a commonly encountered problem for the radiologist given the high prevalence of benign pulmonary lesions. Low density of a pulmonary nodule on CT evaluation is one of the recognised and well-documented features of benignity that is used in the radiological assessment of such nodules. We present three cases of patients with histologically proven mucinous colorectal adenocarcinoma with evidence of pulmonary metastases. In all cases, the metastases were of low density on CT and in one case were initially suspected to represent benign hamartomatous lesions. There has been little documented about the density of mucinous pulmonary metastases on CT. We suspect the low density seen in the metastases in each case is accounted for by their high internal mucinous components. The cases presented here demonstrate the importance of recognising that mucinous colorectal metastases can be of low density and therefore mimic benign pathology. This review may help the radiologist to consider shorter interval follow-up of such lesions in the context of known mucinous neoplasms, or to investigate for an extrathoracic mucinous carcinoma in the presence of multiple low-density pulmonary nodules.

Collaboration between an NHS University Teaching Hospital and independent hospital to maintain CT colonography service provision during the 2020 COVID-19 pandemic.

Our trust performed CTCs at 93% of the capacity of the previous year, scanning 1265 patients in 2020, compared with 1348 in 2019. We describe the changes made to our service to achieve this, which included collaboration with the colorectal surgical team to prioritise existing CTC patients according to faecal-immunochemical tests and full blood count results, and the associated challenges which included image transfer delays and patient attendance for scans. Furthermore, the endoscopy and radiology services used the opportunity created by co-location at the same hospital site to provide a same day incomplete colonoscopy and staging service for optically confirmed cancers. Collaboration between the NHS and independent sector allowed us to achieve continuity of service provision during the height of the COVID-19 pandemic without substituting unprepared CT abdomen and pelvis instead of the more sensitive CTC.

Relationship between Oral Hypofunction, and Protein Intake: A Cross-Sectional Study in Local Community-Dwelling Adults.

Few studies have investigated the relationship between nutritional status and comprehensive assessment of oral hypofunction, especially protein intake-related sarcopenia. Thus, we explored these relationships in a large-scale cross-sectional cohort study using the seven-item evaluation for oral hypofunction and Diet History Questionnaire for nutritional assessment. We used the data from 1004 individuals who participated in the 2019 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan for analysis. We found that individuals with oral hypofunction were significantly older with a lower skeletal muscle index. Although there were few foods that had a significant difference between the groups with and without oral hypofunction, the consumption of beans and meats was significantly lower in women and men in the oral hypofunction group, respectively. According to the lower limit of the tentative dietary goal defined in Japan, comprehensive evaluation of oral hypofunction was significantly and independently associated with protein intake in both men and women (odds ratio, 1.70; 95% confidence interval, 1.21-2.35). In conclusion, we found that oral hypofunction was associated with targeted protein intake for sarcopenia and frailty prevention in middle-aged and older community-dwelling adults. Comprehensive evaluation of oral function with intervention in cases of hypofunction could inform clinicians to better prevent sarcopenia.

Association of Oral Hypofunction with Frailty, Sarcopenia, and Mild Cognitive Impairment: A Cross-Sectional Study of Community-Dwelling Japanese Older Adults.

Oral hypofunction is a new concept that addresses the oral function of older adults. Few studies have investigated the relationship between oral hypofunction and general health conditions such as frailty, sarcopenia, and mild cognitive impairment. This paper explores these relationships in a large-scale, cross-sectional cohort study. The relationships of oral hypofunction with frailty, sarcopenia, and mild cognitive impairment were examined using data from 832 individuals who participated in the 2018 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan. Individuals with frailty, sarcopenia, and mild cognitive impairment had significantly higher rates of oral hypofunction. Frailty was independently associated with deterioration of the swallowing function (odds ratio 2.56; 95% confidence interval, 1.26-5.20), and mild cognitive impairment was independently associated with reduced occlusal force (odds ratio 1.48; 95% confidence interval, 1.05-2.08) and decreased tongue pressure (odds ratio 1.77; 95% confidence interval, 1.28-2.43). There was no independent association found between sarcopenia and oral function. In conclusion, early intervention for related factors such as deterioration of the swallowing function in frailty, reduced occlusal force, and decreased tongue pressure in mild cognitive impairment could lead to the prevention of general hypofunction in older adults.

Low Detection Rate of Pulmonary Embolism in Patients Presenting to the Emergency Department With Suspected Coronavirus Disease 2019 (COVID-19): A Single-Centre UK Study.

PURPOSE: Critically ill patients with coronavirus disease 2019 (COVID-19) are at increased risk of thrombosis. There are limited data on PE rates in COVID-19 patients at presentation to the emergency department (ED). In this study, we evaluated the detection rates of PE in patients presenting to the ED with suspected and proven COVID-19. METHODS: A single-centre retrospective study was undertaken of 285 consecutive patients undergoing CT pulmonary angiogram (CTPA) in the Emergency Department at Nottingham University Hospitals NHS Trust in the United Kingdom between 25 March and 30 April 2020. At our institution, CTPA is performed in all patients undergoing CT for triage. The study group consisted of patients considered COVID-19 positive based on polymerase chain reaction (PCR) results and CTPA findings. The detection rate of PE in COVID-19 patients was compared to patients undergoing CTPA for suspected PE only and for suspected COVID-19 with no COVID CT findings and negative PCR (control group 1); and CTPAs prior to the coronavirus pandemic (control group 2). RESULTS: One of 48 patients in the study group had a PE (2%) compared to 25/215 (12%) in control group 1 and 10/50 (20%) in control group 2. Prevalence of PE in the study group was lower than in control group 1 (P = 0.058) and compared to control group 2 (P = 0.005). Eleven patients undergoing CTPA had negative PCR but positive CT for COVID-19. CONCLUSION: Detection rate of pulmonary embolus is low in patients with COVID-19 undergoing CTPA on a triage pathway.

Rare case of cystic artery pseudoaneurysm.

A patient with a cystic artery pseudoaneurysm (CAP) presented to the emergency department with upper abdominal and back pain. The patient also had clinical signs of sepsis. CT revealed gallstones with acute suppurative cholecystitis with a gallbladder perforation. In addition, a CAP was also suspected and subsequently diagnosed on CT angiography. The pseudoaneurysm was treated with embolisation and a cholecystostomy was performed for the gallbladder perforation. Following her acute admission, the patient underwent an elective cholecystectomy and made a good recovery post surgery.

Incidental radiological diagnosis of asymptomatic Abernethy malformations-two case reports.

The diagnosis of the rare congenital extrahepatic portosystemic shunts is of clinical significance because of the risk of hepatic encephalopathy; liver dysfunction; and associated cardiac, gastrointestinal, vascular, skeletal and genitourinary anomalies. This article describes two varying cases showing the same type of the extrahepatic congenital shunts (Type II). Both the patients were clinically asymptomatic. The first patient initially presented with unprovoked deep venous thrombosis and a staging CT scan was performed to identify any potential underlying malignancy. The second was a polytrauma patient in whom a congenital extrahepatic portosystemic shunt was identified on the CT scan performed to investigate the trauma-related injuries. The first case underwent hepatological investigations, including a fibroscan to rule out liver fibrosis, and was diagnosed as having a Type II congenital malformation, while the second case is under observation post recovery from his traumatic injuries and will be subsequently referred to the hepatology team in the future. Although uncommon, extrahepatic portosystemic shunts can cause significant morbidity and mortality, and all new cases diagnosed radiologically should be further investigated by referring them to a hepatologist.

Potential clinical implications of the "aortic collar" configuration of an anomalous left brachiocephalic vein.

We present a case report of an extremely rare congenital anomaly of the brachiocephalic vein in a previously healthy patient presenting with acute central pulmonary embolism. Clinical and imaging findings are discussed in the report along with several potential complications envisaged by the authors to inform clinicians about the importance of reporting this particular thoracic vascular variant.

P-glycoprotein in acute myeloid leukaemia: therapeutic implications of its association with both a multidrug-resistant and an apoptosis-resistant phenotype.

P-glycoprotein (Pgp) expression is an independent prognostic factor for response to remission-induction chemotherapy in acute myeloblastic leukaemia, particularly in the elderly. There are several potential agents for modulating Pgp-mediated multi-drug resistance, such as cyclosporin A and PSC833, which are currently being evaluated in clinical trials. An alternative therapeutic strategy is to increase the use of drugs which are unaffected by Pgp. However, in this review, we explain why this may be more difficult than it appears. Evidence from in vitro studies of primary AML blasts supports the commonly held supposition that chemoresistance may be linked to apoptosis-resistance. We have found that Pgp has a drug-independent role in the inhibition of in vitro apoptosis in AML blasts. Modulation of cytokine efflux, signalling lipids and intracellular pH have all been suggested as ways by which Pgp may affect cellular resistance to apoptosis; these are discussed in this review. For a chemosensitising agent to be successful, it may be more important for it to enhance apoptosis than to increase drug uptake.