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OBJECTIVE: To assess the diagnostic performance of dual-energy computed tomography (DECT) with the color-coded virtual non-calcium (VNC) technique for detecting acute fractures in patients after acute spine trauma, especially in an emergency clinical setting. MATERIALS AND METHODS: Our retrospective study included 31 patients presented to emergency department with suspected spine trauma. All patients underwent both DECT (80 kVp and 140 kVp) and MRI. Post-processing was performed using color-coded VNC technique. Two independent radiologists visually assessed color-coded VNC images in a random order, and one of the two readers re-assessed the images in 4 weeks after the initial assessment. They were allowed to read only color-coded VNC images and asked to determine the presence of acute fracture. To determine the standard reference point, the other two experienced radiologists made consensus readings on both grayscale CT and MRI. Sensitivity, specificity, PPV, NPV, and accuracy analyses were determined. Both intra- and inter-observer agreements were also calculated. RESULTS: A total of 217 vertebral bodies (65 thoracic and 152 lumbar vertebrae) were included in our study. Sensitivity was 83.3% and 76.7% for first and second readers, respectively. Specificity of 99.5% and 98.9%, PPV of 96.1% and 96.3%, NPV of 97.3% and 96.3%, and accuracy of 97.2% and 95.8%, respectively, were noted. Both intra-observer and inter-observer agreements indicated excellent agreement (κ = 0.86 and κ = 0.84, respectively). CONCLUSION: In spite of the relatively low sensitivity, DECT-based detection of acute spinal fractures showed good specificity, positive predictive value, negative predictive value, accuracy, and inter-/intra-observer agreements.
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Fracturas de la Columna Vertebral , Médula Ósea , Edema , Humanos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: We investigated whether various inflammatory and immune proteins in plasma predict intra-amniotic infection and imminent preterm delivery in women with preterm labor and compared their predictive ability with that of amniotic fluid (AF) interleukin (IL)-6 and serum C-reactive protein (CRP). METHODS: This retrospective cohort study included 173 consecutive women with preterm labor who underwent amniocentesis for diagnosis of infection and/or inflammation in the AF. The AF was cultured, and assayed for IL-6. CRP levels and cervical length by transvaginal ultrasound were measured at the time of amniocentesis. The stored maternal plasma was assayed for IL-6, matrix metalloproteinase (MMP)-9, and complements C3a and C5a using ELISA kits. The primary and secondary outcome criteria were positive AF cultures and spontaneous preterm delivery (SPTD) within 48 h, respectively. Univariate, multivariate, and receiver operating characteristic analysis were used for the statistical analysis. RESULTS: In bivariate analyses, elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery, whereas elevated plasma levels of MMP-9, C3a, and C5a were not associated with these two outcomes. On multivariate analyses, an elevated plasma IL-6 level was significantly associated with intra-amniotic infection and imminent preterm delivery after adjusting for confounders, including high serum CRP levels and short cervical length. In predicting intra-amniotic infection, the area under the curve (AUC) was significantly lower for plasma IL-6 than for AF IL-6 but was similar to that for serum CRP. Differences in the AUCs between plasma IL-6, AF IL-6, and serum CRP were not statistically significant in predicting imminent preterm delivery. CONCLUSIONS: Maternal plasma IL-6 independently predicts intra-amniotic infection in women with preterm labor; however, it has worse diagnostic performance than that of AF IL-6 and similar performance to that of serum CRP. To predict imminent preterm delivery, plasma IL-6 had an overall diagnostic performance similar to that of AF IL-6 and serum CRP. Plasma MMP-9, C3a, and C5a levels could not predict intra-amniotic infection or imminent preterm delivery.
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Amniocentesis/estadística & datos numéricos , Corioamnionitis/inmunología , Trabajo de Parto Prematuro/inmunología , Complicaciones Infecciosas del Embarazo/inmunología , Nacimiento Prematuro/inmunología , Adulto , Líquido Amniótico/inmunología , Líquido Amniótico/microbiología , Proteína C-Reactiva/análisis , Medición de Longitud Cervical , Corioamnionitis/sangre , Corioamnionitis/microbiología , Complemento C3a/análisis , Complemento C5a/análisis , Femenino , Edad Gestacional , Humanos , Interleucina-6/análisis , Interleucina-6/sangre , Pruebas de Detección del Suero Materno , Metaloproteinasa 9 de la Matriz/sangre , Análisis Multivariante , Trabajo de Parto Prematuro/microbiología , Valor Predictivo de las Pruebas , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/microbiología , Nacimiento Prematuro/microbiología , Curva ROC , Estudios RetrospectivosRESUMEN
Objectives To compare pregnancy outcomes of physical examination-indicated cerclage in twin pregnancies with acute cervical insufficiency with that of singletons. Methods This retrospective cohort study included 88 consecutive women (17 twins and 71 singletons) who had undergone physical examination-indicated cerclage because of acute cervical insufficiency (defined as painless cervical dilation with (1) prolapsed and/or visible membranes at the external cervical os on speculum examination and (2) a functional cervical length of zero on transvaginal ultrasound) between 160/7 and 236/7 weeks. The primary outcome measure was preterm delivery <34 weeks. Results (1) The frequency of preterm delivery <34 weeks was not significantly different between the two groups [twins, 56% (9/16) vs. singleton, 53% (37/70), P>0.999]. (2) The perinatal mortality was 21% (7/34) in twins and 32% (23/71) in singletons. (3) The median gestational age at delivery for twin pregnancies was 31.0 weeks (IQR, 22.6-36.5 weeks), which was similar to that of singleton pregnancies (median 32.4 weeks; IQR 22.3-38.3 weeks). (4) There were no significant differences in preterm delivery before 28 and 32 weeks, interval from cerclage to delivery within 1, 2, 4 and 8 weeks and neonatal morbidities between the two groups. Conclusion The obstetric and neonatal outcomes of physical examination-indicated cerclage in twin pregnancies were comparable to those in singleton pregnancies.
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Cerclaje Cervical/estadística & datos numéricos , Embarazo Gemelar/estadística & datos numéricos , Nacimiento Prematuro/prevención & control , Incompetencia del Cuello del Útero/cirugía , Adulto , Femenino , Humanos , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: We aimed to estimate whether elevated levels of complement C3a and C5a in amniotic fluid (AF) are independently associated with increased risks of intra-amniotic infection and/or inflammation (IAI) and spontaneous preterm delivery (SPTD) in women with cervical insufficiency or a short cervix (≤ 25 mm). METHODS: We conducted a retrospective cohort study of 96 consecutive women with cervical insufficiency (n = 62) or a short cervix (n = 34) at 17 to 27 weeks, and who underwent an amniocentesis. AF was cultured and analyzed for C3a and C5a by enzyme-linked immunosorbent assay kits. The primary outcome measures were IAI (defined as a positive AF culture and/or an elevated AF interleukin-6 level [≥ 7.6 ng/mL]) and SPTD at < 32 weeks. RESULTS: In multivariable analysis, AF level of C3a was the only variable significantly associated with IAI, whereas C5a level in AF and serum C-reactive protein level were not associated with IAI. Using SPTD at < 32 weeks as the outcome variable in logistic regression, elevated AF levels of C3a were associated with increased risk of SPTD at < 32 weeks after adjusting for other baseline confounders, whereas elevated AF levels of C5a were not. CONCLUSION: In women with cervical insufficiency or a short cervix, elevated AF level of C3a, but not C5a, is independently associated with increased risks of IAI and SPTD at < 32 weeks. These findings suggest that subclinical IAI or SPTD in the context of cervical insufficiency is related to activation of complement system in AF.
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Complemento C3a/análisis , Adulto , Amniocentesis , Líquido Amniótico , Cuello del Útero , Corioamnionitis , Complemento C5a , Femenino , Edad Gestacional , Humanos , Inflamación , Embarazo , República de Corea , Estudios Retrospectivos , SeúlRESUMEN
BACKGROUND: The anatomy and geometry of the carotid artery may play an important role in the pathogenesis of internal carotid artery (ICA) stenosis, but the exact nature of this role remains elusive. To clarify this issue, we sought to investigate age-related changes in the anatomy and geometry of the carotid artery in a Korean population. MATERIALS AND METHODS: We conducted a retrospective study of 300 subjects who underwent carotid contrast-enhanced magnetic resonance angiography at our clinic between 2014 and 2016. The subjects were divided into 7 groups according to age. The carotid arteries were segmented using semiautomated methods to obtain various measurements of carotid anatomy and geometry, as suggested by Thomas et al. The various age groups were compared for different parameters, including ICA angle, bifurcation angle, and vessel volume and diameter. RESULTS: Analysis of variance showed that with an increase in age, there were significant increases in vessel volume and diameter of the common carotid artery and ICA as well as the carotid bifurcation (P = .000). Significant age-related increase was also noted in the ICA angle and bifurcation angle (P = .000). The anatomical position of the ICA in subjects aged over 60 years was significantly higher than that in subjects below 40 years (12.5% versus .03%, P < .0001). CONCLUSIONS: Age-related increases were noted in vessel volume and diameter of the carotid artery and ICA as well as the bifurcation angle. The widening and rotation of the carotid artery increased with age.
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Envejecimiento , Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Angiografía por Resonancia Magnética , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Puntos Anatómicos de Referencia , Arterias Carótidas/patología , Enfermedades de las Arterias Carótidas/epidemiología , Enfermedades de las Arterias Carótidas/patología , Comorbilidad , Medios de Contraste/administración & dosificación , Estudios Transversales , Dilatación Patológica , Femenino , Humanos , Interpretación de Imagen Asistida por Computador , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Prevalencia , República de Corea/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Adulto JovenAsunto(s)
Neoplasias Endometriales/secundario , Melanoma/patología , Neoplasias Cutáneas/patología , Hemorragia Uterina/etiología , Anciano , Neoplasias Endometriales/patología , Neoplasias Endometriales/cirugía , Femenino , Humanos , Histerectomía , Inmunohistoquímica , Escisión del Ganglio Linfático , Posmenopausia , Salpingooforectomía , Melanoma Cutáneo MalignoRESUMEN
BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is characterized by clinical symptoms that are associated with bilateral and symmetric vasogenic edema in the parietal and occipital lobes. However, this is rarely present with predominant involvement of the brain stem and cerebellum (variant). PURPOSE: To evaluate which clinical or magnetic resonance imaging (MRI) findings can help to predict the prognosis of variant and classical type of PRES and whether or not there is difference between two types of PRES. MATERIAL AND METHODS: We retrospectively evaluated MRI and clinical findings from 49 patients with PRES. These patients were divided into two groups. In group I, patients had atypical distribution of lesions. In group II, patients had typical distribution of lesions. Follow-up MRI was performed on 26 patients. We assessed the MRI features, clinical data, and the patients' outcomes. RESULTS: The mean blood pressure (BP) was significantly higher in group I (195.52/121.09 mmHg and 156.78/99.53 mmHg for groups I and II, respectively). The other factors assessed were not significantly different between the two groups. Lesions in 24 of 26 patients reversed upon follow-up. Sequelae were observed in 11 patients (group I, 7; group II, 4). However, there were no significant differences between the two groups. Except for those patients who died, seven of the nine patients with sequelae upon follow-up imaging had hemorrhage or irreversibility of lesions. CONCLUSION: Even though BP influences the involvement of the brain stem, involvement of the brain stem is not influential on the prognosis. It seems that the influential factor to prognosis is the reversibility of lesions and hemorrhage.
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Imagen por Resonancia Magnética , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Adolescente , Adulto , Anciano , Presión Sanguínea , Edema Encefálico/patología , Tronco Encefálico/patología , Cerebelo/patología , Niño , Femenino , Estudios de Seguimiento , Predicción , Humanos , Masculino , Persona de Mediana Edad , Lóbulo Occipital/patología , Lóbulo Parietal/patología , Pronóstico , Estudios RetrospectivosRESUMEN
This corrects the article on p. 2034 in vol. 22, PMID: 34564957.
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OBJECTIVE: This study was investigated the mechanophysical properties of zinc phosphate cement (ZPC) with or without the copper doped bioglass nanoparticles (Cu-BGn) and their biological effect on dental pulp human cells and bacteria. MATERIALS AND METHODS: Cu-BGn were synthesized and characterized firstly and then, the experimental (Cu-ZPC) and control (ZPC) samples were fabricated with similar sizes and/or dimensions (diameter: 4 mm and height: 6 mm) based on the International Organization of Standards (ISO). Specifically, various concentrations of Cu-BGn were tested, and Cu-BGn concentration was optimized at 2.5 wt% based on the film thickness and overall setting time. Next, we evaluated the mechanophysical properties such as compressive strength, elastic modulus, hardness, and surface roughness. Furthermore, the biological behaviors including cell viability and odontoblastic differentiation by using dental pulp human cells as well as antibacterial properties were investigated on the Cu-ZPC. All data were analyzed statistically using SPSS® Statistics 20 (IBM®, USA). p < 0.05 (*) was considered significant, and 'NS' represents nonsignificant. RESULTS: Cu-BGn was obtained via a sol-gel method and added onto the ZPC for fabricating a Cu-ZPC composite and for comparison, the Cu-free-ZPC was used as a control. The film thickness (≤ 25 µm) and overall setting time (2.5-8 min) were investigated and the mechanophysical properties showed no significance ('NS') between Cu-ZPC and bare ZPC. However, cell viability and odontoblastic differentiation, alkaline phosphate (ALP) activity and alizarin red S (ARS) staining were highly stimulated in the extracts from the Cu-ZPC group compared to the ZPC group. Additionally, the antibacterial test showed that the Cu-ZPC extracts were more effective than the ZPC extracts (p < 0.05). SIGNIFICANCE: Cu-ZPC showed adequate mechanophysical properties (compressive strength, hardness, and surface roughness) and enhanced odontoblastic differentiation as well as antibacterial properties compared to the ZPC-only group. Based on the findings, the fabricated Cu-ZPC might have the potential for use in the field of dental medicine and clinical applications.
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Cobre , Nanopartículas , Cerámica/farmacología , Cobre/farmacología , Humanos , Ensayo de Materiales , Cemento de Fosfato de ZincRESUMEN
Metabolic encephalopathy is a critical condition that can be challenging to diagnose. Imaging provides early clues to confirm clinical suspicions and plays an important role in the diagnosis, assessment of the response to therapy, and prognosis prediction. Diffusion-weighted imaging is a sensitive technique used to evaluate metabolic encephalopathy at an early stage. Metabolic encephalopathies often involve the deep regions of the gray matter because they have high energy requirements and are susceptible to metabolic disturbances. Understanding the imaging patterns of various metabolic encephalopathies can help narrow the differential diagnosis and improve the prognosis of patients by initiating proper treatment regimen early.
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Encefalopatías Metabólicas , Imagen de Difusión por Resonancia Magnética , Encéfalo , Encefalopatías Metabólicas/diagnóstico , Corteza Cerebral , Diagnóstico Diferencial , Sustancia Gris , Humanos , Imagen por Resonancia MagnéticaRESUMEN
OBJECTIVES: To compare pregnancy outcomes according to the use of postoperative vaginal progesterone in patients who underwent ultrasound-indicated cerclage. METHODS: This was a retrospective cohort study of 86 consecutive asymptomatic singleton pregnancies who had undergone cerclage because of incidentally found short cervical length under 20 mm through transvaginal ultrasound between 16°/7 and 246/7 weeks' gestational age. Outcomes were compared according to the use of vaginal progesterone after cerclage. Primary outcome measure was preterm delivery < 34 weeks of gestation. RESULTS: (1) The frequency of preterm delivery < 34 weeks of gestation was significantly lower in patients with postoperative vaginal progesterone than those without (2.2 versus 18.4%, p = .021); (2) the median gestational age at delivery in the postoperative vaginal progesterone group was significantly longer than the control group (38.3 weeks (interquartile range, 37.5-39.1 weeks) versus 37.3 weeks (interquartile range 33.9-38.6 weeks), p = .020); (3) Multivariable logistic regression analysis demonstrated the use of vaginal progesterone after cerclage was found to be independently associated with decrease in preterm delivery before 34 weeks (Odds ratio 0.10; 95% confidence interval, 0.01-0.93) and 37 weeks (Odds ratio 0.24; 95% confidence interval, 0.07-0.85). CONCLUSIONS: The use of vaginal progesterone was associated with lower rates of preterm birth before 34 and 37 weeks of gestation in women who underwent ultrasound-indicated cerclage placement.
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Cerclaje Cervical , Nacimiento Prematuro , Cuello del Útero , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/prevención & control , Progesterona , Estudios RetrospectivosRESUMEN
We aimed to identify cervicovaginal fluid (CVF) protein biomarkers of microbial invasion of the amniotic cavity (MIAC) in women with preterm premature rupture of membranes (PPROM), using an antibody microarray. This retrospective cohort study included 99 consecutive women with singleton pregnancies and PPROM (23-33 weeks) who underwent amniocentesis and who gave CVF samples. CVF proteomes from the MIAC (n = 20) versus non-MIAC groups (n = 20) were comparatively profiled by an antibody microarray using a nested case-control study design. The seven candidate biomarkers of interest were validated in the total cohort (n = 99) by enzyme-linked immunosorbent assays (ELISA). For comparison with candidate markers, amniotic fluid (AF) white blood cell (WBC) count was also measured. The primary outcome measure was MIAC (defined as positive AF culture). Thirty of the proteins studied exhibited significant intergroup differences. Measurements of the total cohort with ELISA confirmed a significant increase in the levels of CVF IL-8, lipocalin-2, MIP-1α, MMP-9, and TIMP-1 in women with MIAC, independent of gestational age at sampling. A combined, non-invasive model was developed by using a stepwise regression procedure, which included CVF IL-8 and CVF MMP-9 (area under the curve [AUC] = 0.763), and this AUC was comparable with the AUC of AF WBC. Using protein-antibody microarray technology, we found several novel, independent, non-invasive biomarkers to identify MIAC in women with PPROM: IL-8, lipocalin-2, MIP-1α, MMP-9, and TIMP-1. Furthermore, the combined non-invasive model (IL-8 and MMP-9) was a useful independent predictor for MIAC with good discriminatory power, similar to AF WBC count.
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Líquido Amniótico/microbiología , Cuello del Útero/microbiología , Rotura Prematura de Membranas Fetales/microbiología , Vagina/microbiología , Adulto , Líquido Amniótico/metabolismo , Estudios de Casos y Controles , Cuello del Útero/metabolismo , Femenino , Rotura Prematura de Membranas Fetales/diagnóstico , Rotura Prematura de Membranas Fetales/metabolismo , Humanos , Embarazo , Análisis por Matrices de Proteínas , Sensibilidad y Especificidad , Vagina/metabolismoRESUMEN
PURPOSE: The purpose of this study was to determine which pefusion computed tomography (PCT) parameter is the most valid predictor of cerebral vascular reserve (CVR) as determined by Tc-hexamethylpropyleneamine oxime single-photon emission computed tomography (SPECT). METHODS: Single-photon emission computed tomography with acetazolamide challenge and PCT were used in 23 patients with unilateral steno-occlusive vascular disease. After coregistration of the PCT and SPECT images, we assessed the relationship between the PCT parameters and SPECT findings and the predictive values of the PCT parameters for decreased CVR. RESULTS: All PCT parameters of cerebral blood flow, cerebral blood volume, and mean transit time (MTT) were significantly correlated with SPECT regional cerebral blood flow ratios (P < 0.01). The MTT values more strongly correlated with acetazolamide effect than with cerebral blood volume or cerebral blood flow (P < 0.001). The MTT difference (values in the pathological hemisphere minus the values in the contralateral hemisphere) was a threshold of 1.5 seconds, with a sensitivity of 88% and a specificity of 70% for predicting decreased CVR. CONCLUSION: Mean transit time is the most predictive parameter for assessing decreased CVR in patients with unilateral steno-occlusive vascular disease.
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Acetazolamida , Estenosis Carotídea/diagnóstico por imagen , Trastornos Cerebrovasculares/diagnóstico por imagen , Oximas , Tecnecio , Tomografía Computarizada por Rayos X/métodos , Adulto , Anciano , Anciano de 80 o más Años , Volumen Sanguíneo , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Inhibidores de Anhidrasa Carbónica , Circulación Cerebrovascular , Enfermedad Crónica , Medios de Contraste , Femenino , Humanos , Yohexol/análogos & derivados , Masculino , Persona de Mediana Edad , Imagen de Perfusión/métodos , Valor Predictivo de las Pruebas , Intensificación de Imagen Radiográfica/métodos , Flujo Sanguíneo Regional , Reproducibilidad de los Resultados , Tomografía Computarizada de Emisión de Fotón Único/métodosRESUMEN
Fipronil is a highly effective insecticide with extensive usages; however, its distribution and toxic/health effects in the human population after chronic exposure have not yet been clearly identified. Our objectives were to determine the levels of serum fipronil and fipronil sulfone, a primary fipronil metabolite, in a general and sensitive human population using a birth cohort of parent-infant triads in Korea. We further investigated whether in utero exposure to fipronil and fipronil sulfone can affect health outcomes in newborn infants. Blood and umbilical cord blood from 169 participants, 59 mother-neonate pairs and 51 matching biological fathers, were collected; serum fipronil and fipronil sulfone (both blood and cord blood) and serum thyroid hormones (cord blood) were measured. Demographic, physiological, behavioral, clinical, and socioeconomic data for each participant were collected via a one-on-one interview and a questionnaire survey. Fipronil sulfone was detected in the serum of mothers, fathers, and infantile cord blood, while fipronil itself was not. Maternal fipronil sulfone levels were correlated to those of matched biological fathers and newborn infants. Adjusted analyses identified significant associations between parental fipronil sulfone levels and household income. Infantile fipronil sulfone levels were significantly associated with both maternal and paternal levels as well as maternal pre-pregnant BMI. Furthermore, infantile fipronil sulfone levels were inversely associated with cord blood T3 and free T3 levels as well as 5-min Apgar scores of newborn infants. Serum fipronil sulfone was detected in a specific population of mother-neonate pairs and their matched biological fathers in a manner suggestive of regular exposure to fipronil among urban residents. The findings also suggest that serum fipronil sulfone placentally transfers to the fetus and affects infantile adverse health outcomes. This is a first of its kind study; therefore, future studies are warranted.
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Sangre Fetal/química , Insecticidas/sangre , Pirazoles/sangre , Adulto , Puntaje de Apgar , Monitoreo Biológico , Femenino , Humanos , Recién Nacido , Masculino , Exposición Materna , Intercambio Materno-Fetal , Exposición Paterna , Embarazo , República de Corea , Hormonas Tiroideas/sangreRESUMEN
BACKGROUND: Although ultrasound (US) is routinely used for the preoperative evaluation of neck nodes in patients with papillary thyroid carcinoma (PTC), the diagnostic role of computed tomography (CT) has not been established. The purpose of our study is to determine the diagnostic accuracies of US, CT, and combined US and CT (US/CT) for detecting metastatic neck nodes in patients with PTC. METHODS: 165 consecutive patients (140 females and 25 males, mean age 47.9 years) with surgically proven PTC underwent US and CT for preoperative evaluation. CT was performed 2 or 3 months before radioiodine therapy. We assessed the diagnostic accuracies of US, CT, and US/CT using level-by-level analysis. RESULTS: In terms of predicting node metastases, overall sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of US were 51%, 92%, 77%, 81%, and 76%, respectively. Those of CT were 62%, 93%, 81%, 84%, and 80%, respectively, and those of US/CT were 66%, 88%, 79%, 77%, and 81%, respectively, at all neck levels. US/CT significantly increased sensitivity and demonstrated similar specificity compared with US alone in lateral neck levels (p = 0.02 and p = 1.0, respectively). US/CT increased sensitivity (p = 0.01), but decreased specificity compared with US alone in the central neck levels (p = 0.02). CT provided additional benefit for detecting metastatic nodes at more than one level in 8% of all patients, in 14% of patients with suspected nodal metastasis on US, and in 25% of patients with metastatic lymph nodes. CONCLUSIONS: The US/CT combination was found to be superior to US alone for the detection of metastatic lymph nodes in the lateral neck levels in PTC patients by level-by-level analysis.
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Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Diagnóstico por Imagen/métodos , Metástasis Linfática , Oncología Médica/instrumentación , Estadificación de Neoplasias/instrumentación , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Tomografía Computarizada por Rayos X/métodos , Ultrasonografía/métodos , Adolescente , Adulto , Anciano , Carcinoma Papilar/diagnóstico por imagen , Reacciones Falso Positivas , Femenino , Humanos , Masculino , Oncología Médica/métodos , Persona de Mediana Edad , Estadificación de Neoplasias/métodos , Estudios Retrospectivos , Neoplasias de la Tiroides/diagnóstico por imagenRESUMEN
OBJECTIVE: chest computed tomography (CT) images and their quantitative analyses have become increasingly important for a variety of purposes, including lung parenchyma density analysis, airway analysis, diaphragm mechanics analysis, and nodule detection for cancer screening. Lung segmentation is an important prerequisite step for automatic image analysis. We propose a novel lung segmentation method to minimize the juxta-pleural nodule issue, a notorious challenge in the applications. METHOD: we initially used the Chan-Vese (CV) model for active lung contours and adopted a Bayesian approach based on the CV model results, which predicts the lung image based on the segmented lung contour in the previous frame image or neighboring upper frame image. Among the resultant juxta-pleural nodule candidates, false positives were eliminated through concave points detection and circle/ellipse Hough transform. Finally, the lung contour was modified by adding the final nodule candidates to the area of the CV model results. RESULTS: to evaluate the proposed method, we collected chest CT digital imaging and communications in medicine images of 84 anonymous subjects, including 42 subjects with juxta-pleural nodules. There were 16 873 images in total. Among the images, 314 included juxta-pleural nodules. Our method exhibited a disc similarity coefficient of 0.9809, modified hausdorff distance of 0.4806, sensitivity of 0.9785, specificity of 0.9981, accuracy of 0.9964, and juxta-pleural nodule detection rate of 96%. It outperformed existing methods, such as the CV model used alone, the normalized CV model, and the snake algorithm. Clinical impact: the high accuracy with the juxta-pleural nodule detection in the lung segmentation can be beneficial for any computer aided diagnosis system that uses lung segmentation as an initial step.
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OBJECTIVE: We aimed to assess the correlations among multiple cytokine concentrations in the maternal plasma, cervicovaginal fluid (CVF), and amniotic fluid (AF) compartments in women with preterm premature rupture of membranes (pPROM), and to develop a prediction model based on non-invasive measures, having better sensitivity and specificity for the identification of microbial invasion of amniotic cavity (MIAC). METHOD: This retrospective study included 75 consecutive women with pPROM (20+0-34+0 weeks), who underwent amniocentesis. Both maternal plasma and CVF samples were collected at the time of amniocentesis. Stored AF, plasma and CVF samples were assayed for cytokine levels [interleukin (IL)-6, IL-8, monocyte chemotactic protein-1, macrophage inflammatory protein (MIP)-1α, MIP-1ß] using a multiplex immunoassay kit. RESULTS: Levels of inflammatory proteins measured in the CVF were significantly correlated with AF proteins levels, whereas none of the proteins in plasma correlated significantly with any in the AF or CVF. Proteins levels measured in the AF and CVF were significantly higher in women with MIAC compared to those without, whereas only high levels of IL-6 in plasma were significantly associated with MIAC. By using stepwise regression analysis, a non-invasive model (using clinical factors and CVF cytokine levels) for the prediction of MIAC was developed; the area under curve of this non-invasive model was similar to that of the invasive model (using clinical factors and AF cytokines). CONCLUSIONS: The levels of inflammatory proteins in the CVF correlated with those in the AF, whereas those in the plasma showed no correlation. A non-invasive model using clinical factors and CVF cytokine levels predicted the risk of MIAC in women with pPROM.
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Líquido Amniótico/metabolismo , Corioamnionitis/diagnóstico , Citocinas/metabolismo , Rotura Prematura de Membranas Fetales/diagnóstico , Infecciones por Mycoplasma/diagnóstico , Infecciones por Ureaplasma/diagnóstico , Adulto , Líquido Amniótico/microbiología , Corioamnionitis/metabolismo , Corioamnionitis/microbiología , Citocinas/sangre , Femenino , Rotura Prematura de Membranas Fetales/metabolismo , Rotura Prematura de Membranas Fetales/microbiología , Humanos , Mycoplasma/aislamiento & purificación , Infecciones por Mycoplasma/metabolismo , Infecciones por Mycoplasma/microbiología , Embarazo , Pronóstico , Estudios Retrospectivos , Ureaplasma/aislamiento & purificación , Infecciones por Ureaplasma/metabolismo , Infecciones por Ureaplasma/microbiología , Adulto JovenRESUMEN
OBJECTIVE: To determine whether vitamin D-binding protein (VDBP) in cervicovaginal fluid (CVF) is independently predictive of intra-amniotic infection and imminent spontaneous preterm delivery (SPTD, delivery within 48 hours) in women with preterm labor with intact membranes (PTL) or preterm premature rupture of membranes (PPROM). METHOD: This was a single-center retrospective cohort study. CVF samples for VDBP assays were obtained along with serum C-reactive protein (CRP) levels immediately after amniocentesis in consecutive women with PTL (n = 148) or PPROM (n = 103) between 23.0 and 34.0 weeks of gestation. VDBP levels in CVF were determined by enzyme-linked immunosorbent assay kits. The primary outcome measures were intra-amniotic infection [defined as positive amniotic fluid (AF) culture] and SPTD within 48 hours after sampling. RESULTS: In the multivariable analysis, elevated VDBP levels in CVF samples of PTL women were significantly associated with intra-amniotic infection and imminent preterm delivery, even after adjusting for potential confounders (e.g., gestational age at sampling, parity, and serum CRP). However, these relationships were not found in women with PPROM. In women with PTL, the areas under receiver operating characteristic curves of CVF VDBP level for predicting intra-amniotic infection and imminent preterm delivery were 0.66 and 0.71, with cut-off values of 1.76 µg/mL (sensitivity of 64.3% and specificity of 78.4%) and 1.37 µg/mL (sensitivity of 65.4% and specificity of 72.6%), respectively. The CVF VDBP levels were significantly higher in women with PPROM than in those with PTL. CONCLUSIONS: VDBP in the CVF independently predicts intra-amniotic infection and imminent preterm delivery in women with PTL, whereas in women with PPROM, an elevated VDBP level in CVF is not associated with increased risks of these two outcome variables.
Asunto(s)
Infecciones Bacterianas/metabolismo , Líquidos Corporales/metabolismo , Rotura Prematura de Membranas Fetales/metabolismo , Trabajo de Parto Prematuro/metabolismo , Complicaciones Infecciosas del Embarazo/metabolismo , Proteína de Unión a Vitamina D/metabolismo , Adulto , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Valor Predictivo de las Pruebas , Embarazo , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: Brain and bone metastases are common in patients with lung cancer. The development of metastasis is associated with poor survival in lung cancer patients. Although tumor morphologic features on radiographs are routinely assessed for differentiation between benign and malignant lung nodules, they are not used to predict metastasis. We assessed morphologic features of pulmonary adenocarcinomas with brain/bone metastasis on computed tomography (CT) to identify related factors for metastasis. METHODS: We performed a retrospective analysis of initial chest CT findings (size, type of contour, percentage of necrosis, enhancement, presence or absence of calcification, and air cavity) from 2009 to 2010 of patients with brain or bone metastasis and compared the findings with those of patients without metastases. RESULTS: In total, 128 patients were included (78 men, 52 women; mean age 69 years; range, 36 to 87). Nineteen patients had brain metastases and 32 had bone metastases. Morphologic features associated with brain metastasis included size ≥ 50 mm (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.24 to 9.17; p = 0.013), necrosis ≥ 30% (OR, 4.51; 95% CI, 1.62 to 12.55; p =0.002), and presence of calcification (OR, 3.97; 95% CI, 1.16 to 13.55; p = 0.035). Morphologic features associated with bone metastasis included necrosis ≥ 30% (OR, 4.639; 95% CI, 1.98 to 10.82; p < 0.001) and T 3 to 4 stage (OR, 2.53; 95% CI, 1.07 to 6.00; p = 0.031). CONCLUSIONS: We found that necrosis ≥ 30% was associated with pulmonary adenocarcinoma with brain and bone metastasis at initial chest CT morphologic feature. To validate these results, further research should be conducted.