Comparison of the Pharmacokinetics of CT-P13 Between Crohn's Disease and Ulcerative Colitis.

BACKGROUND: We aimed to compare trough infliximab levels and the development of antidrug antibody (ADA) for 1 year between Crohn's disease (CD) and ulcerative colitis (UC) patients who were biologic-naive, and to evaluate their impact on clinical outcomes. METHODS: This was a prospective, multicenter, observational study. Biologic-naive patients with moderate to severe CD or UC who started CT-P13, an infliximab biosimilar, therapy were enrolled. Trough drug and ADA levels were measured periodically for 1 year after CT-P13 initiation. RESULTS: A total of 267 patients who received CT-P13 treatment were included (CD 168, UC 99). The rates of clinical remission (72% vs. 32.3%, P <0.001) at week 54 were significantly higher in CD than in UC. The median trough drug level (µg/mL) was significantly higher in CD than in UC up to week 14 (week 2, 18.7 vs. 14.7, P <0.001; week 6, 12.5 vs. 8.6, P <0.001; week 14, 3.4 vs. 2.5, P =0.001). The median ADA level (AU/mL) was significantly lower in CD than in UC at week 2 (6.3 vs. 6.5, P =0.046), week 30 (7.9 vs. 11.8, P =0.007), and week 54 (9.3 vs. 12.3, P =0.032). Development of ADA at week 2 [adjusted odds ratio (aOR)=0.15, P =0.026], initial C-reactive protein level (aOR=0.87, P =0.032), and CD over UC (aOR=1.92, P <0.001) were independent predictors of clinical remission at week 54. CONCLUSION: Infliximab shows more favorable pharmacokinetics, including high drug trough and low ADA levels, in CD than in UC, which might result in better clinical outcomes for 1-year infliximab treatment in CD patients.

Incidence of colonoscopy-related perforation and risk factors for poor outcomes: 3-year results from a prospective, multicenter registry (with videos).

BACKGROUND AND AIMS: Perforation is a life-threatening adverse event of colonoscopy that often requires hospitalization and surgery. We aimed to prospectively assess the incidence of colonoscopy-related perforation in a multicenter registry and to analyze the clinical factors associated with poor clinical outcomes. METHODS: This prospective observational study was conducted at six tertiary referral hospitals between 2017 and 2020, and included patients with colonic perforation after colonoscopy. Poor clinical outcomes were defined as mortality, surgery, and prolonged hospitalization (> 13 days). Logistic regression was used to identify factors associated with poor clinical outcomes. RESULTS: Among 84,673 patients undergoing colonoscopy, 56 had colon perforation (0.66/1000, 95% confidence interval [CI] 0.51-0.86). Perforation occurred in 12 of 63,602 diagnostic colonoscopies (0.19/1000, 95% CI 0.11-0.33) and 44 of 21,071 therapeutic colonoscopies (2.09/1000, 95% CI 1.55-2.81). Of these, 15 (26.8%) patients underwent surgery, and 25 (44.6%) patients had a prolonged hospital stay. One patient (1.8%) died after perforation from a diagnostic colonoscopy. In the multivariate analysis, diagnostic colonoscopy (adjusted odds ratio [aOR] 196.43, p = 0.025) and abdominal rebound tenderness (aOR 17.82, p = 0.012) were independent risk factors for surgical treatment. The location of the sigmoid colon (aOR 18.57, p = 0.048), delayed recognition (aOR 187.71, p = 0.008), and abdominal tenderness (aOR 63.20, p = 0.017) were independent risk factors for prolonged hospitalization. CONCLUSIONS: This prospective study demonstrated that the incidence of colonoscopy-related perforation was 0.66/1000. The incidence rate was higher in therapeutic colonoscopy, whereas the risk for undergoing surgery was higher in patients undergoing diagnostic colonoscopy. Colonoscopy indication (diagnostic vs. therapeutic), physical signs, the location of the sigmoid perforation, and delayed recognition were independent risk factors for poor clinical outcomes in colonoscopy-related perforation.

Changes in radiomic and radiologic features in meningiomas after radiation therapy.

OBJECTIVES: This study evaluated the radiologic and radiomic features extracted from magnetic resonance imaging (MRI) in meningioma after radiation therapy and investigated the impact of radiation therapy in treating meningioma based on routine brain MRI. METHODS: Observation (n = 100) and radiation therapy (n = 62) patients with meningioma who underwent MRI were randomly divided (7:3 ratio) into training (n = 118) and validation (n = 44) groups. Radiologic findings were analyzed. Radiomic features (filter types: original, square, logarithm, exponential, wavelet; feature types: first order, texture, shape) were extracted from the MRI. The most significant radiomic features were selected and applied to quantify the imaging phenotype using random forest machine learning algorithms. Area under the curve (AUC), sensitivity, and specificity for predicting both the training and validation sets were computed with multiple-hypothesis correction. RESULTS: The radiologic difference in the maximum area and diameter of meningiomas between two groups was statistically significant. The tumor decreased in the treatment group. A total of 241 series and 1691 radiomic features were extracted from the training set. In univariate analysis, 24 radiomic features were significantly different (P < 0.05) between both groups. Best subsets were one original, three first-order, and six wavelet-based features, with an AUC of 0.87, showing significant differences (P < 0.05) in multivariate analysis. When applying the model, AUC was 0.76 and 0.79 for the training and validation set, respectively. CONCLUSION: In meningioma cases, better size reduction can be expected after radiation treatment. The radiomic model using MRI showed significant changes in radiomic features after radiation treatment.

Computed tomography findings of thyroid hemiagenesis: differentiation from hemithyroidectomy.

OBJECTIVES: Thyroid hemiagenesis is a rare congenital anomaly characterized by the lack of development of one thyroid lobe. The purpose of this study was to evaluate computed tomography (CT) findings of thyroid hemiagenesis and to establish useful CT criteria for differentiating thyroid hemiagenesis from the hemithyroidectomy state. METHODS: The CT images of 11 patients with thyroid hemiagenesis were retrospectively reviewed and compared with those of 100 (49 left and 51 right) patients in a hemithyroidectomy state. Image analysis was performed according to the following CT parameters: (a) side of thyroid hemiagenesis, (b) edge of the medial end of the remnant thyroid gland, (c) location of the medial end of the remnant thyroid gland, expressed as the angle of the medial end and (d) any other thyroid abnormality observed during the initial examination. RESULTS: The missing lobe occurred more often in the left than in the right lobe (72.7% vs. 27.3%) as well as concomitant isthmus agenesis (100% vs. 37.5%). The sharp edge of the medial end of the remnant thyroid gland was more common in thyroid hemiagenesis (64%) than in hemithyroidectomy (26%) (P = 0.0153). In left thyroid hemiagenesis, the angle of the medial end (63%) was more frequently > + 30° than in hemithyroidectomy (0%) (P < 0.0001). Two patients presented with hypothyroidism; the remaining nine showed a normal thyroid function. The associated thyroid diseases were autoimmune thyroiditis (n = 1) and papillary thyroid carcinoma (n = 1). CONCLUSIONS: The sharp edge of the medial end of the remnant thyroid gland and an angle of > + 30° for the medial end in cases wherein the left lobe is absent are useful CT features for distinguishing thyroid hemiagenesis from hemithyroidectomy.

Longitudinal Changes in Fecal Calprotectin Levels Among Pregnant Women With and Without Inflammatory Bowel Disease and Their Babies.

BACKGROUND & AIMS: The effect of pregnancy on inflammatory bowel disease (IBD) remains poorly understood. We aimed to monitor intestinal inflammation using fecal calprotectin (FC) in pregnant women and their babies during early life. METHODS: Pregnant women with or without IBD and their infants were prospectively enrolled. FC levels were measured at each trimester of pregnancy and in babies throughout the first 3 years of life. Repeated-measures analysis was applied to investigate changes in FC levels while adjusting for confounders. The FC levels were correlated with the bacterial abundance in both mothers and babies. RESULTS: Six hundred and fourteen fecal samples from 358 mothers (98 with IBD) and 1005 fecal samples from 289 infants (76 born to IBD mothers) were analyzed. Pregnant Patients with IBD maintained higher FC levels through pregnancy compared with controls (P = 7.5 × 10-54). FC gradually increased in controls and declined in Patients with IBD throughout pregnancy (P for interaction = 5.8 × 10-7). Babies born to mothers with IBD presented with significantly higher FC levels than those born to controls up to 3 years of age, after adjusting for sex, delivery mode, feeding behavior, and antibiotics exposure (2 weeks to 3 months of age, P = .015; 12-36 months of age, P = .00003). Subdoligranulum, Roseburia, Fusicatenibacter, and Alistipes negatively correlated, and Streptococcus, Prevotella, Escherichia-Shigella, and Bifidobacterium positively correlated with maternal FC levels at T3. Faecalibacterium, Bifidobacterium, and Alistipes showed negative correlations, and Streptococcus were positively correlated with FC levels within 3 months of birth. CONCLUSIONS: Pregnancy is associated with decreased inflammatory activity in mothers with IBD. Higher FC levels in babies born to mothers with IBD suggest subclinical inflammation in early life, the long-term consequences of which are uncertain.

Field-of-view enhanced integral imaging with dual prism arrays based on perspective-dependent pixel mapping.

A field-of-view (FOV)-enhanced integral imaging system is proposed by the combined use of micro-lens array (MLA) and dual-prism array (DPA). The MLA coupled with a DPA virtually function as a new type of the MLA whose FOV is much more increased than that of the original MLA, which enables the capturing of perspective-expanded elemental image arrays (EIAs) of input 3-D scenes and the FOV-enhanced reconstruction of them. For its practical operation, a two-step digital process called perspective-dependent pixel-mapping (PDPM) is also presented. With this PDPM method, picked-up EIAs with a couple of MLAs and DPAs are remapped into the new forms of EIAs to be properly reconstructed in the conventional integral imaging system. Operational performances of the proposed system are ray-optically analyzed. In addition, the feasibility of the proposed system is also confirmed from the computational and optical experiments with test 3-D objects on the implemented prototype. Experimental results finally show a two-times increase of the FOV range of the proposed system when it is compared with that of the conventional system.

A prospective multi-centre study of susceptibility map-weighted MRI for the diagnosis of neurodegenerative parkinsonism.

OBJECTIVES: This study aimed to compare susceptibility map-weighted imaging (SMwI) using various MRI machines (three vendors) with N-3-fluoropropyl-2-ß-carbomethoxy-3-ß-(4-iodophe nyl)nortropane (18F-FP-CIT) PET in the diagnosis of neurodegenerative parkinsonism in a multi-centre setting. METHODS: We prospectively recruited 257 subjects, including 157 patients with neurodegenerative parkinsonism, 54 patients with non-neurodegenerative parkinsonism, and 46 healthy subjects from 10 hospitals between November 2019 and October 2020. All participants underwent both SMwI and 18F-FP-CIT PET. SMwI was interpreted by two independent reviewers for the presence or absence of abnormalities in nigrosome 1, and discrepancies were resolved by consensus. 18F-FP-CIT PET was used as the reference standard. Inter-observer agreement was tested using Cohen's kappa coefficient. McNemar's test was used to test the agreement between the interpretations of SMwI and 18F-FP-CIT PET per participant and substantia nigra (SN). RESULTS: The inter-observer agreement was 0.924 and 0.942 per SN and participant, respectively. The diagnostic sensitivity of SMwI was 97.9% and 99.4% per SN and participant, respectively; its specificity was 95.9% and 95.2%, respectively, and its accuracy was 97.1% and 97.7%, respectively. There was no significant difference between the results of SMwI and 18F-FP-CIT PET (p > 0.05, for both SN and participant). CONCLUSIONS: This study demonstrated that the high diagnostic performance of SMwI was maintained in a multi-centre setting with various MRI scanners, suggesting the generalisability of SMwI for determining nigrostriatal degeneration in patients with parkinsonism. KEY POINTS: • Susceptibility map-weighted imaging helps clinicians to predict nigrostriatal degeneration. • The protocol for susceptibility map-weighted imaging can be standardised across MRI vendors. • Susceptibility map-weighted imaging showed diagnostic performance comparable to that of dopamine transporter PET in a multi-centre setting with various MRI scanners.

Efficacy of sigmoidoscopy for evaluating disease activity in patients with ulcerative colitis.

BACKGROUND: Endoscopic assessment of disease activity is a key parameter in the management of ulcerative colitis. Whether sigmoidoscopy alone is sufficient to evaluate the disease activity in ulcerative colitis lacks studies. METHODS: We retrospectively analyzed the medical records and endoscopic results of patients with ulcerative colitis followed by colonoscopy in seven tertiary hospitals between January 2012 and December 2018. Endoscopic disease activity was scored using the Mayo endoscopic subscore (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for each segment from the colonoscopy images. Concordance was evaluated by comparing the highest MES and UCEIS in the rectosigmoid and proximal regions to confirm the usefulness of sigmoidoscopy. RESULTS: A total of 500 colonoscopic examinations from 333 patients were enrolled. Only in 7.6% [k(kappa): 0.893, r(Spearman): 0.906, p < 0.001] and 8.6% [k(kappa): 0.890, r(Spearman): 0.914; p < 0.001] of cases, MES and UCEIS scored more severely in the proximal colon. Comparison of active disease (MES ≥ 2) in the rectosigmoid area and the entire colon showed a high concordance rate [k(kappa): 0.899, r(Spearman): 0.904, p < 0.001]. Endoscopic healing (MES = 0) also showed a high concordance rate [k(kappa): 0.882, r(Spearman): 0.887, p < 0.001]. In 38 cases (7.6%) of patients with a higher MES in the proximal area, it was significantly higher in patients with previous extensive colitis. CONCLUSIONS: Sigmoidoscopy and colonoscopy showed a high concordance rate. Therefore, sigmoidoscopy is considered a sufficient substitute for colonoscopy. However, colonoscopy should be considered in patients with previous extensive colitis.

Comparison of 1-Year Colectomy Risk Between the US and Korean Patients with Acute Severe Ulcerative Colitis: A Propensity Score Matching Analysis.

BACKGROUND: Colectomy risk after acute severe ulcerative colitis (ASUC) has not been compared between Eastern and Western countries. We compared the 1-year colectomy risk after ASUC between Korea and the USA. METHODS: Data on patients admitted for ASUC to five tertiary referral hospitals in Korea and Mount Sinai Hospital, New York, the USA, between January 2015 and January 2019 were reviewed retrospectively. For comparability between groups, a 1:1 propensity score matching (PSM) was performed. The primary outcome was colectomy, and secondary outcomes were mortality, readmission, and venous thromboembolism (VTE) within 1-year of the index admission for ASUC. The risk of each outcome was compared using Cox proportional hazards model in pre-matched cohort and Kaplan-Meier analysis with log-rank test in post-matched cohort. RESULTS: 290 ASUC patients were included in the study (121 Korea, 169 the USA). After PSM, 56 patients were selected in each group with no significant differences in baseline variables. At 1 year after ASUC, colectomy was less common in Korea than in the USA [3 (5.4%) vs. 24 (42.9%), p < 0.001]. The cumulative colectomy risk was significantly higher in the USA than in Korea in pre-matched cohort [adjusted hazard ratio 7.89, 95% confidence interval 3.23 to 19.22] and in post-matched cohort (log-rank p < 0.001), while there was no difference in cumulative risk of mortality, readmission, and VTE. CONCLUSION: Colectomy risk within 1 year of ASUC is significantly higher in the USA than in Korea. We observed no differences in mortality, readmission, and VTE between the two groups.

Lymphangitis Carcinomatosa in Neck Soft Tissue: Computed Tomography Findings With Emphasis on Differentiation From Cellulitis.

OBJECTIVE: Lymphangitis carcinomatosa (LC) is a rare form of metastasis. The purposes of this study were to evaluate computed tomography (CT) findings associated with LC in neck soft tissue and to determine those that were useful in distinguishing LC from cellulitis. METHODS: Contrast-enhanced CT images of 26 patients with pathologically confirmed LC (n = 5) and clinically proven cellulitis (n = 21) were reviewed retrospectively. The following CT findings were evaluated and compared between the 2 groups: subcutaneous fat infiltration, enlargement of muscle, thick irregular enhancement of the superficial cervical fascia, grouping of micronodules, focal intramuscular enhancement, localized fluid collection, and nodular skin thickening. RESULTS: Thick irregular enhancement of the superficial cervical fascia (80.0% vs 0%, P < 0.0005), grouping of micronodules (60.0% vs 0%, P < 0.005), and focal intramuscular enhancement (60.0% vs 4.8%, P < 0.05) were significantly more frequent in LC than in cellulitis. Other findings did not show statistical significance between both groups. CONCLUSIONS: When soft tissue swelling is present in the neck with either thick irregular enhancement of the superficial cervical fascia, grouping of micronodules, or focal intramuscular enhancement, the possibility of LC should be considered especially in patients with underlying malignancy.

Changes in computed tomography perfusion parameters and maximum contrast enhancement in patients having hydrocephalus with a ventriculoperitoneal shunt: a pilot study.

BACKGROUND: Acute hydrocephalus may decrease cerebral perfusion by increasing intracranial pressure. Computed tomography perfusion (CTP) has become a significant adjunct in evaluating regional and global cerebral blood flow (CBF). PURPOSE: To investigate the changes in cerebral perfusion parameters and maximum contrast enhancement (MCE) in patients with hydrocephalus with ventriculoperitoneal shunt (VPS). MATERIAL AND METHODS: We performed brain CTP in 45 patients, including those with subarachnoid hemorrhage (SAH)-induced hydrocephalus with VPS (n = 14, G1), hydrocephalus (not related to SAH) with VPS (n = 11, G2), SAH-induced hydrocephalus without VPS (n = 10, G3), and hydrocephalus (not related to SAH) without VPS (n = 10, G4). We measured the cerebral perfusion in the frontal white matter (FWM), centrum semiovale, basal ganglia (BG), and eight cortical lesions of interest and compared the differences in CTP parameters among the groups. RESULTS: Between the four groups, cerebral blood volume and MCE in the left FWM and CBF in the right FWM increased significantly in G1 and G2 who underwent VP shunt compared to G3 and G4, whereas perfusion significantly reduced in G3 and G4 who did not undergo VP shunt compared to G1 and G2. MCE in the left BG significantly increased in G2 and decreased in G3 and G4. SAH-induced hydrocephalus showed a lower perfusion than hydrocephalus (not related to SAH) in FWM. CONCLUSIONS: Perfusion changes in patients with hydrocephalus after VP shunt were seen in the FWM and BG, which appears to be the result of the hydrocephalus reducing brain perfusion in the deep part of the brain. We concluded that SAH slows brain perfusion recovery.

Faster generation of holographic video of 3-D scenes with a Fourier spectrum-based NLUT method.

In this article, a new type of Fourier spectrum-based novel look-up table (FS-NLUT) method is proposed for the faster generation of holographic video of three-dimensional (3-D) scenes. This proposed FS-NLUT method consists of principal frequency spectrums (PFSs) which are much smaller in size than the principal fringe patterns (PFPs) found in the conventional NLUT-based methods. This difference in size allows for the number of basic algebraic operations in the hologram generation process to be reduced significantly. In addition, the fully one-dimensional (1-D) calculation framework of the proposed method also allows for a significant reduction of overall hologram calculation time. In the experiments, the total number of basic algebraic operations needed for the proposed FS-NLUT method were found to be reduced by 81.23% when compared with that of the conventional 1-D NLUT method. In addition, the hologram calculation times of the proposed method, when implemented in the CPU and the GPU, were also found to be 60% and 66% faster than that of the conventional 1-D NLUT method, respectively. It was also confirmed that the proposed method implemented with two GPUs can generate a holographic video of a test 3-D scene in real-time (>24f/s).

Antioxidant Analogue 6-Amino-2,4,5-Trimethylpyridin-3-ol Ameliorates Experimental Colitis in Mice.

BACKGROUND: Oxidative stress has been suggested to be a factor contributing to the disease severity of inflammatory bowel disease (IBD). BJ-1108, a derivative of 6-amino-2,4,5-trimethylpyridin-3-ol, is reported to significantly inhibit the generation of reactive oxygen species (ROS) in vitro. However, whether this molecule affects intestinal inflammation is largely unknown. We aimed to investigate the effect of BJ-1108 on dextran sulfate sodium (DSS)-induced experimental colitis in mice. METHODS: Colitis was induced in mice with DSS, and disease severity was estimated by evaluating body weight, colon length, histology, immune cell infiltration, and intestinal permeability. We examined the protective effects of BJ-1108 on barrier function using Caco-2 cells. Last, we estimated the impact of BJ-1108 on the phosphorylation of NF-kB, PI3K/AKT, and mitogen-activated protein kinases. RESULTS: Mice treated with BJ-1108 exhibited improved disease severity, as indicated by evaluations of body weight, histological scores, spleen weight, and infiltrates of T cells and macrophages. The administration of BJ-1108 inhibited the colonic mRNA expression of IL-6 and IL-1ß in vivo. Additionally, BJ-1108 limited intestinal permeability and enhanced the expression of tight junction (TJ) proteins such as claudin-1 and claudin-3 in the DSS-induced colitis model. In an in vitro model using Caco-2 cells, BJ-1108 ameliorated cytokine-induced ROS generation in a dose-dependent manner and remarkably recovered barrier dysfunction as estimated by evaluating transepithelial electrical resistance and TJ protein expression. BJ-1108 suppressed the NF-kB/ERK/PI3K pathway. CONCLUSIONS: This study demonstrated that BJ-1108 ameliorated intestinal inflammation in an experimental colitis mouse model, suggesting possible therapeutic implications for IBD.

Comparison of different types of covered self-expandable metal stents for malignant colorectal obstruction.

BACKGROUND: Stent migration is one of the main drawbacks of covered self-expandable metal stent (SEMSs), occurring in up to 40% of malignant colorectal obstruction management cases. Various types of covered SEMSs have been developed to reduce this risk. We aimed to compare the effectiveness and complication rates of the flare-type covered SEMS (Flare) with those of the double-layered covered SEMS (ComVi). METHODS: We performed a prospective, randomized study in four tertiary referral centers between July 2016 and April 2018. Patients with malignant colorectal obstruction were eligible for the study. The primary outcome was migration rate as observed within the first month. Rates of technical success, clinical success, and complications within the first month were also assessed. RESULTS: A total of 60 patients were included (mean age, 70.5 ± 12.5 years; male, 31 [51.7%]). Flare and ComVi stents were applied in 30 patients each. The Flare and ComVi groups showed comparable technical success rates (90% [27/30] vs. 96.7% [29/30], p = 0.605) and clinical success rates (85.2% [23/27] vs. 75.9% [22/29], p = 0.589). Migration occurred in three (11.1%) and four (13.8%) cases in the Flare and ComVi groups, respectively, without significant difference (p = 0.99), and the risk of other complications, including perforation and re-obstruction, did not differ between the two groups. CONCLUSIONS: Our study indicates that both flare-shape and double-layered covered SEMSs are equally effective options for the management of malignant colorectal obstruction with low migration rates when compared with previously reported migration risk of covered SEMS.

Low Bone Mineral Density in Young Patients Newly Diagnosed with Inflammatory Bowel Disease.

BACKGROUND: The prevalence and risk factors of low bone mineral density (BMD) in Asian patients newly diagnosed with inflammatory bowel disease (IBD) have not been fully suggested. AIMS: We aimed to examine the prevalence and risk factors of low BMD in young Korean patients newly diagnosed with IBD. METHODS: We prospectively enrolled 132 patients aged less than 50 years and newly diagnosed with IBD from six tertiary referral centers in Korea between November 2014 and April 2017. BMD was measured by dual-energy X-ray absorptiometry, and then the Z-score was determined. We defined low BMD as a Z-score ≤ - 1.0. RESULTS: Of 68 patients with ulcerative colitis (UC), 22 (32.4%) had low BMD. Also, of 64 patients with Crohn's disease (CD), 24 (37.5%) showed low BMD. Results from multivariate regression analysis identified the risk factors for low BMD as a high level of alkaline phosphatase (ALP) (≥ 140 U/L) (P = 0.010) in UC patients, and being underweight (body mass index ≤ 18.5 kg/m2) (P = 0.017) in CD patients. CONCLUSIONS: Our study showed that about one-third of newly diagnosed IBD Asian patients had low BMD. The clinical factors associated with low BMD were a high level of ALP in UC patients, and being underweight, in CD patients. Therefore, measurements of BMD in young patients should be considered at the diagnosis of IBD.

Microvascular Reactivity Measured by Dynamic Near-infrared Spectroscopy Following Induction of General Anesthesia in Healthy Patients: Observation of Age-related Change.

Background: The purpose of this study was to investigate the effect of general anesthesia on microvascular reactivity and tissue oxygen saturation (StO2) using near-infrared spectroscopy in conjunction with vascular occlusion tests (VOT). Age-related changes of microvascular reactivity, that is, the capacity of capillary recruitment, were examined. Methods: This prospective observational study was performed on 60 patients without comorbidities who underwent elective surgery under general anesthesia. Baseline StO2 on thenar eminence, hemodynamics, and laboratory profile were monitored before (T0) and 30 min after general anesthesia (T1). During VOT, occlusion slope representing oxygen consumption of muscle and recovery slope representing microvascular reactivity were also collected at T0 and T1. Results: Baseline StO2 and minimum / maximum StO2 during VOT increased under general anesthesia. Occlusion slope decreased while the recovery slope increased under general anesthesia. To observe aging effect, Receiver operating characteristic analysis was performed and age less than 65 years old showed a fair performance in predicting the increase of microvascular reactivity after the induction of anesthesia (AUC 0.733, 95% CI 0.594-0.845, P= 0.003). For age-related analyses, 27 patients of younger group (< 65 years) and 26 patients of older group (≥ 65 years) were divided. Recovery slope significantly increased under general anesthesia in younger group (2.44 [1.91-2.81] % ∙ sec-1 at T0 and 3.59 [2.58-3.51] % ∙ sec-1 at T1, P <0.001), but not in older group (2.61 [2.21-3.20] % ∙ sec-1 at T0, 2.63 [1.90-3.60] % ∙ sec-1 at T1, P = 0.949). Conclusions: General anesthesia could improve StO2 through increase of microvascular reactivity and decrease of tissue metabolism. However, microvascular reactivity to capillary recruitment under general anesthesia significantly improves in younger patients, not in older patients.

Compact full-color holographic 3-D display based on undersampled computer-generated holograms and oblique projection imaging.

A compact full-color electro-holographic three-dimensional (3-D) display with undersampled computer-generated holograms (US-CGHs) and oblique projection imaging (OPI) is proposed. For its realization, undersampling conditions of the CGH enabling the complete recovery of image information are derived, and the OPI-based longitudinal-to-lateral depth conversion (LTL-DC) scheme allowing the simple reconstruction of full-color images is also proposed. Three-color off-axis US-CGHs are generated with their center-shifted principle fringe patterns (CS-PFPs) of the novel look-up table (NLUT) method, where center-shifts are calculated with the derived undersampling conditions of the CGH based on the generalized sampling theorem, and then multiplexed into the color-multiplexed hologram (CMH). The CMH is loaded on a SLM (spatial light modulator) and reconstructed by being illuminated with a multi-wavelength light source, where an original full-color image is reconstructed being spatially separated from the other color-dispersed images on the projected image plane with the OPI-based LTL-DC process, which enables us to view the original full-color image just with a simple filter mask. Performance analysis and successful experiments with the test 3-D objects in motion confirm the feasibility of the proposed system.

256-row multislice CT angiography in the postoperative evaluation of cerebral aneurysms treated with titanium clips: using three-dimensional rotational angiography as the standard of reference.

OBJECTIVE: To assess the diagnostic accuracy of 256-row multislice computed tomographic angiography (CTA) compared with three-dimensional rotational angiography (3DRA) in the postoperative evaluation of cerebral aneurysms treated with titanium clips. METHODS: A total of 128 patients (42 men, 86 women; mean age, 57.6 years) with 143 cerebral aneurysms treated using titanium clips underwent both CTA and 3DRA. Two reviewers retrospectively evaluated the following parameters on CTA and 3DRA: (1) residual/recurrent aneurysm (absent or present), (2) patency of parent artery (patent or occluded/severe stenotic (> 70%)), and (3) patency of adjacent branch (patent or occluded/absent). RESULTS: A total of 24 residual/recurrent aneurysms were detected by 3DRA. The sensitivity, specificity, and accuracy of CTA for the detection of residual/recurrent aneurysms were 83.3%, 100%, and 97.2% for reviewer 1 and 79.2%, 100%, and 96.5% for reviewer 2, respectively. The sensitivity, specificity, and accuracy of CTA for the evaluation of patency of parent artery were 100%, 100%, and 100%, respectively, for both reviewers. The sensitivity, specificity, and accuracy of CTA for evaluation of the patency of adjacent branch were 85.1%, 100%, and 92.3% for reviewer 1 and 82.4%, 100%, and 90.9% for reviewer 2, respectively. CONCLUSION: A 256-row multislice CTA is a valuable non-invasive tool for assessment of cerebral aneurysms treated with titanium clips. KEY POINTS: • A 256-row multislice CTA is an accurate imaging technique for the postoperative assessment of cerebral aneurysms treated with titanium clips. • Sensitivity of CTA for the detection of residual/recurrent aneurysms was 79-83% compared with 3DRA. • CTA is still limited in detecting residual/recurrent aneurysms of < 2 mm and small adjacent branches.

Comparison of Amyloid in Cerebrospinal Fluid, Brain Imaging, and Autopsy in a Case of Progressive Supranuclear Palsy.

Cerebrospinal fluid (CSF) amyloid-beta 1-42 (Aß1-42) and amyloid positron emission tomography (PET) are the 2 main Alzheimer disease amyloid biomarkers that have been validated in neuropathologically confirmed Alzheimer disease cases. Although many studies have shown concordance of amyloid positivity or negativity between CSF Aß1-42 and amyloid PET, several studies also reported discrepancies between these 2 Aß biomarkers. We conducted a comparison of CSF Aß1-42 level, amyloid PET, and autopsy findings in a case with progressive supranuclear palsy in which biomarker acquisition and postmortem pathologic examination were conducted almost at the same time. Our case with antemortem CSF Aß1-42 (+)/amyloid PET (-) who was pathologically confirmed with Aß pathology in the cerebral cortex may indicate CSF Aß1-42 is more sensitive for assessing in vivo Aß than amyloid PET.

Fecal calprotectin is more accurate than fecal immunochemical test for predicting mucosal healing in quiescent ulcerative colitis: a prospective multicenter study.

Objective: Non-invasive stool tests, including the fecal immunochemical test (FIT) and fecal calprotectin (FC), are reliable biomarkers for mucosal healing (MH) in ulcerative colitis (UC). However, which fecal test is superior for predicting MH in inactive UC patients requires evaluation. We aimed to compare the accuracy of FIT and FC results for predicting MH in quiescent UC patients.Methods: This prospective, multicenter study was conducted at three tertiary hospitals. UC patients in clinical remission for at least three months underwent colonoscopy and MH was evaluated using the Mayo endoscopic sub-score (MES). The receiver operating characteristic (ROC) curve and cutoff value with the best accuracy for predicting MH were assessed.Results: Among 127 patients, 65 (51.2%) showed MH (MES = 0). The area under the curve (AUC) for predicting MH (MES = 0) was significantly higher for FC than for FIT (AUC 0.858 (95% confidence interval (CI) 0.784-0.913) vs. 0.707 (95% CI 0.620-0.784), p < .001); there was no difference when MH included MES = 1 (MES ≤ 1) (AUC 0.820 (95% CI 0.742-0.883) vs. 0.813 (95% CI 0.734-0.877), p = .891). When the cutoff value was 70 µg/g for FC and 10 ng/mL for FIT, the sensitivity, specificity, positive predictive value and negative predictive value were 89.2, 71, 76.3, and 86.3, respectively, for FC and 92.3, 50, 65.9, and 86.1, respectively, for FIT.Conclusion: FC is more accurate than FIT for predicting MH in quiescent UC patients. The superiority of FC might be related to the distinctive performance of FC in differentiating inflammatory levels, particularly in low-grade mucosal activity.