Hiding in plain sight: How incorporating honest discussion of racial and social (in)justice into medical education can inspire change.

The carnage wrought by systemic racism through social, judicial, and health injustices compels us to work towards a system that is fair and just for patients and colleagues. The evidence that change is necessary in medicine is hiding in plain sight in literature, oral histories, medical records, and news media. Notwithstanding this evidence, changing a system 400 years in the making will require a major paradigm shift. One of the many ways our department sought to catalyze such a shift was through media consumption, reflection, and discussion. Reading and studying literature and humanities in medicine can awaken our consciousness by making medicine an embodied practice that considers the totality of patients' lives in ways that a disembodied, purely scientific approach cannot. Thus, we started a Racial and Social Justice Book Club to normalize discussions about racial and social (in)justice and examine everything through an anti-racist lens. Herein, we describe our experiences in the inaugural year of the Book Club, a space to lend credence and dignity to the voices, experiences, and stories of folks who have long been marginalized by power structures in America, including medicine.

Adding value in the era of COVID-19: Increasing usage of a patient-centered radiology consultation service.

OBJECTIVE: To examine the effects of COVID-19 pandemic on our department's Radiology Consultation Service (RCS) related to breast imaging, and how utilization of the provided services may have differed as compared to prior to the pandemic. MATERIALS AND METHODS: A retrospective cohort study of patients and health care providers who consulted the RCS, as well as those patients who had a screening mammogram and/or ultrasound between January 1, 2019 and September 1, 2020. Consultations were performed by an RRA, RN and one of 17 breast imaging radiologists assigned to consults on daily. Descriptive statistics were performed to describe the study subject population. RESULTS: Between January 1, 2020 and July 31, 2020, a total of 1623 consultations were performed, in comparison to the control period from the year prior (January 1, 2019 to July 31, 2019), when a total of 1398 consultations were performed, representing a 16% increase in one year. Between March 1, 2020 and June 30, 2020, a total of 679 consultations were performed, in comparison to the control period from the year prior (March 1, 2019 to June 30, 2019), when 583 consultations were performed, representing a 16.5% increase in a four-month period. 350 out of 679 (36.8%) consultations addressed COVID concerns. CONCLUSIONS: While much of radiology experienced an unprecedented decrease in imaging studies during the initial peak of COVID-19 crisis, the RCS at our institution showed a significant increase in services provided, evolving to address pressing concerns related to COVID-19.

Expression of mitochondrial membrane-linked SAB determines severity of sex-dependent acute liver injury.

SH3 domain-binding protein that preferentially associates with Btk (SAB) is an outer-membrane docking protein for JNK-mediated impairment of mitochondrial function. Deletion of Sab in hepatocytes inhibits sustained JNK activation and cell death. The current study demonstrates that an increase in SAB expression enhanced the severity of acetaminophen-induced (APAP-induced) liver injury. Female mice were resistant to liver injury and exhibited markedly decreased hepatic SAB protein expression compared with male mice. The mechanism of SAB repression involved a pathway from ERα to p53 expression that induced miR34a-5p. miR34a-5p targeted the Sab mRNA coding region, thereby repressing SAB expression. Fulvestrant or p53 knockdown decreased miR34a-5p and increased SAB expression in female mice, leading to increased injury from APAP and TNF/galactosamine. In contrast, an ERα agonist increased p53 and miR34a-5p, which decreased SAB expression and hepatotoxicity in male mice. Hepatocyte-specific deletion of miR34a also increased the severity of liver injury in female mice, which was prevented by GalNAc-ASO knockdown of Sab. Similar to mice, premenopausal women expressed elevated levels of hepatic p53 and low levels of SAB, whereas age-matched men expressed low levels of p53 and high levels of SAB, but there was no difference in SAB expression between the sexes in the postmenopausal stage. In conclusion, SAB expression levels determined the severity of JNK-dependent liver injury. Female mice expressed low levels of hepatic SAB protein because of the ERα/p53/miR34a pathway, which repressed SAB expression and accounted for the resistance to liver injury seen in these females.

Clinical improvement associated with targeted interruption of the cerebellothalamic tract following MR-guided focused ultrasound for essential tremor.

OBJECTIVE The objective of this study was to evaluate the utility of diffusion tensor imaging (DTI) tractography-based targeting of the dentatorubrothalamic tract (DRT) for magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy in patients with essential tremor (ET) and correlate postprocedural tract disruption with clinical outcomes. METHODS Four patients received preprocedural and immediate postprocedural DTI in addition to traditional anatomical MRI sequences for MRgFUS thalamotomy. Optimal ablation sites were selected based on the patient-specific location of the DRT as demonstrated by DTI (direct targeting) and correlated with traditional atlas-based measurements for thalamic ventral intermediate nucleus (Vim) lesioning (indirect targeting). Fiber tracts were displayed three-dimensionally during the procedure and used in conjunction with clinical signs of tremor control for fine correction of the ablation site. Immediately following the conclusion of the procedure, the MRgFUS head frame was removed and patients were placed in a 32-channel MRI head coil for follow-up DTI and anatomical MRI sequences. RESULTS All patients had excellent postoperative tremor control and successful pre- and postprocedural DTI fiber tracking of the corticospinal tract, medial lemniscus, and DRT. Immediate postprocedure DTI failed to track the DRT ipsilateral to the lesion site with a preserved contralateral DRT, coincident with substantial resolution of contralateral tremor. CONCLUSIONS DTI can reliably identify the optimal ablation target and demonstrates tract disruption on immediate postprocedural imaging. A clinical improvement of ET was observed immediately following the procedure, correlating with DRT disruption and suggesting that interruption of the DRT is a consequence of clinically successful MRgFUS thalamotomy. These findings may have utility for both MRgFUS procedure planning in surgically naive patients and retreatment of patients who have previously undergone unsuccessful thalamic Vim lesioning.

New insights into the role and mechanism of c-Jun-N-terminal kinase signaling in the pathobiology of liver diseases.

The c-Jun-N-terminal-kinase (JNK) family is highly conserved across species such as Drosophila, C. elegans, zebrafish and mammals, and plays a central role in hepatic physiologic and pathophysiologic responses. These responses range from cell death to cell proliferation and carcinogenesis, as well as metabolism and survival, depending on the specific context and duration of activation of the JNK signaling pathway. Recently, several investigators identified the key molecules in the JNK activation loop which include apoptosis signal-regulating kinase (ASK1) and SH3-domain binding protein 5 (Sab) and their involvement in acute or chronic liver disease models. Thus, regulating JNK activation through modulating the JNK activation loop may represent an important new strategy in the prevention and treatment of acute and chronic liver diseases. In this review, we will discuss the molecular pathophysiology of the JNK activation loop and its role in the pathogenesis of liver diseases. (Hepatology 2018;67:2013-2024).

Program requirements for fellowship education in venous and lymphatic medicine.

Background In every field of medicine, comprehensive education should be delivered at the graduate level. Currently, no single specialty routinely provides a standardized comprehensive curriculum in venous and lymphatic disease. Method The American Board of Venous & Lymphatic Medicine formed a task force, made up of experts from the specialties of dermatology, family practice, interventional radiology, interventional cardiology, phlebology, vascular medicine, and vascular surgery, to develop a consensus document describing the program requirements for fellowship medical education in venous and lymphatic medicine. Result The Program Requirements for Fellowship Education in Venous and Lymphatic Medicine identify the knowledge and skills that physicians must master through the course of fellowship training in venous and lymphatic medicine. They also specify the requirements for venous and lymphatic training programs. The document is based on the Core Content for Training in Venous and Lymphatic Medicine and follows the ACGME format that all subspecialties in the United States use to specify the requirements for training program accreditation. The American Board of Venous & Lymphatic Medicine Board of Directors approved this document in May 2016. Conclusion The pathway to a vein practice is diverse, and there is no standardized format available for physician education and training. The Program Requirements for Fellowship Education in Venous and Lymphatic Medicine establishes educational standards for teaching programs in venous and lymphatic medicine and will facilitate graduation of physicians who have had comprehensive training in the field.

c-Jun N-terminal kinase mediates mouse liver injury through a novel Sab (SH3BP5)-dependent pathway leading to inactivation of intramitochondrial Src.

UNLABELLED: Sustained c-Jun N-terminal kinase (JNK) activation has been implicated in many models of cell death and tissue injury. Phosphorylated JNK (p-JNK) interacts with the mitochondrial outer membrane SH3 homology associated BTK binding protein (Sab, or SH3BP5). Using knockdown or liver-specific deletion of Sab, we aimed to elucidate the consequences of this interaction on mitochondrial function in isolated mitochondria and liver injury models in vivo. Respiration in isolated mitochondria was directly inhibited by p-JNK + adenosine triphosphate. Knockdown or liver-specific knockout of Sab abrogated this effect and markedly inhibited sustained JNK activation and liver injury from acetaminophen or tumor necrosis factor/galactosamine. We then elucidated an intramitochondrial pathway in which interaction of JNK and Sab on the outside of the mitochondria released protein tyrosine phosphatase, nonreceptor type 6 (SHP1, or PTPN6) from Sab in the inside of the mitochondrial outer membrane, leading to its activation and transfer to the inner membrane, where it dephosphorylates P-Y419Src (active), which required a platform protein, docking protein 4 (DOK4), on the inner membrane. Knockdown of mitochondrial DOK4 or SHP1 inhibited the inactivation of mitochondrial p-Src and the effect of p-JNK on mitochondria. CONCLUSIONS: The binding to and phosphorylation of Sab by p-JNK on the outer mitochondrial membrane leads to SHP1-dependent and DOK4-dependent inactivation of p-Src on the inner membrane; inactivation of mitochondrial Src inhibits electron transport and increases reactive oxygen species release, which sustains JNK activation and promotes cell death and organ injury. (Hepatology 2016;63:1987-2003).

2D mammography, digital breast tomosynthesis, and ultrasound: which should be used for the different breast densities in breast cancer screening?

PURPOSE: To determine which modalities [2D mammography (2D), digital breast tomosynthesis (DBT), whole breast sonography (WBS)] are optimal for screening depending on breast density. METHODS: Institutional retrospective cohort study of 2013 screening mammograms (16,789), sorted by modalities and density. RESULTS: Cancer detection is increased by adding WBS to 2D (P=.02) for the overall study population. Recall rate was lowest with 2D+DBT (10.2%, P<.001) and highest with 2D+DBT+WBS (23.6%, P<.001) for the overall study population as well. CONCLUSION: Women with dense and nondense breasts benefit from reduced recall rate with the addition of DBT; however, this benefit is negated with the addition of WBS.

Recurrence patterns after endovenous laser treatment of saphenous vein reflux.

INTRODUCTION: The patterns of recurrent varicose veins after endovascular ablation of the saphenous veins are not well described. METHODS: The current study describes the ultrasound defined recurrence patterns seen in 58 patients (79 limbs) who returned for evaluation of recurrent varicose veins from a cohort of 802 patients treated with endovenous laser ablation and subsequent sclerotherapy from March 2000 to March 2007 with clinical follow-up until May 2014. FINDINGS: The most common ultrasound defined recurrence patterns leading to the varicose veins were new reflux in the anterior accessory saphenous and small saphenous veins as well as recanalization of the treated saphenous segment. Neovascularization at the saphenofemoral junction and incompetent perforating veins as the source of the recurrent veins were not seen. CONCLUSIONS: The patterns of recurrence following thermal ablation of saphenous veins are different to those seen after surgery. Specifically, new reflux in other saphenous veins is responsible for most recurrent varicose veins and neovascularity seems to be unusual following endovenous laser ablation.

The development and implementation of a patient-centered radiology consultation service: a focus on breast density and additional screening options.

Increasingly, states are mandating notification to patients if they are found to have dense breast tissue. Information describes the increased risk of cancer and limitations of mammography for this patient group. Such notification often creates anxiety and results in uncertainty as no evidence-based guidelines for additional screening of dense breasts are available. Through an organized consultation service, patients and physicians were provided consultations with radiologists in order to ensure an appropriate screening plan based on individualized histories and preferences. This manuscript describes our dense breast consultation program, examines initial data, and provides lessons for practices interested in providing similar service.

Ultrasound strain elastography in assessment of cortical mechanical behavior in acute renal vein occlusion: in vivo animal model.

To assess the correlation of quantitative ultrasound strain parameters with the severity of cortical edema in renal vein occlusion, we prospectively performed ultrasound strain elastography on a canine acute renal vein occlusion model prior to and following 10, 20, and 40min of renal vein ligation. Strain and strain relaxation time representing the deformation and relaxation of the renal cortices and reference soft tissue were produced by the external compression with the ultrasound transducer and estimated using commercially available 2-D speckle tracking software. Cortical thickness was additionally measured. Repeated-measures analysis of variance was used to examine the difference in cortical thickness, strain ratio (mean cortical strain divided by mean reference tissue strain), and strain relaxation time ratio (cortical relaxation time divided by reference tissue relaxation time) prior to and after renal vein ligation. Pearson's correlation coefficient was applied to test the relationship between strain parameters and the time of the renal vein ligation. There was a strong positive correlation between the duration of renal vein ligation and strain (R(2)=0.97) and strain relaxation time (R(2)=0.98) ratios. Significant differences in strain and strain relaxation time ratios were found at all measured timepoints (all P≪.001). Cortical thickness, however, showed no significant difference between timepoints (P=.065). Our result suggest that strain and strain relaxation time ratios may be used as quantitative markers for the assessment of the renal cortical mechanical behavior in subclinical acute renal vein occlusion.

Ten commandments for effective clinical decision support for imaging: enabling evidence-based practice to improve quality and reduce waste.

OBJECTIVE: We describe best practices for effective imaging clinical decision support (CDS) derived from firsthand experience, extending the Ten Commandments for CDS published a decade ago. Our collective perspective is used to set expectations for providers, health systems, policy makers, payers, and health information technology developers. CONCLUSION: Highlighting unique attributes of effective imaging CDS will help radiologists to successfully lead and optimize the value of the substantial federal and local investments in health information technology in the United States.

Core content for training in venous and lymphatic medicine.

The major venous societies in the United States share a common mission to improve the standards of medical practitioners, the educational goals for teaching and training programs in venous disease, and the quality of patient care related to the treatment of venous disorders. With these important goals in mind, a task force made up of experts from the specialties of dermatology, interventional radiology, phlebology, vascular medicine, and vascular surgery was formed to develop a consensus document describing the Core Content for venous and lymphatic medicine and to develop a core educational content outline for training. This outline describes the areas of knowledge considered essential for practice in the field, which encompasses the study, diagnosis, and treatment of patients with acute and chronic venous and lymphatic disorders. The American Venous Forum and the American College of Phlebology have endorsed the Core Content.

Recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts: a first quarter experience.

PURPOSE: The aim of this study was to determine the recall rate of screening ultrasound with automated breast volumetric scanning (ABVS) in women with dense breasts (BI-RADS density classification 3 or 4 on mammogram). MATERIALS AND METHODS: In this retrospective cohort study, at the end of the "first quarter" (August-October 2013) of use, our practice database was searched for all ABVS examinations performed and specifically, the positive examinations (defined as abnormal/BI-RADS 0) for which patients were recalled for additional imaging evaluation with handheld ultrasound (HHUS); the latter group was reviewed with respect to final BI-RADS and pathology if relevant. RESULTS: During the 3-month study time period, 558 ABVS studies were performed: 453 (81%) were initially BI-RADS 1 or 2 and 105 (19%) were BI-RADS 0-incomplete and recalled, corresponding with an overall recall rate of 19%; specifically, the recall rate trended down from 24.7% in August to 12.6% in October. To date, 98 of the 105 recalled women have returned for HHUS, with the resultant final BI-RADS as follows: 25/98=25% BI-RADS 1, 46/98=47% BI-RADS 2, 13/98=13% BI-RADS 3, 14/98=15% BI-RADS 4, and 0/98=0% BI-RADS 5. All biopsies performed to date of the ABVS-detected BI-RADS 4 lesions have yielded benign results, with the most common pathology being fibroadenoma. CONCLUSION: The recall rate of screening ABVS in women with dense breasts at our institution was under 20% overall during its first quarter of use, and trended down from nearly 25% in the first month to under 13% in the third. The clinical implication is that ABVS does have a learning curve, but that is a potentially feasible way to meet the increasing demands for screening ultrasound in women with dense breasts.

Corticomedullary strain ratio: a quantitative marker for assessment of renal allograft cortical fibrosis.

OBJECTIVES: To quantitatively assess the correlation between the corticomedullary strain ratio and cortical fibrosis in renal transplants. METHODS: Using quasistatic ultrasound elasticity imaging, we prospectively assessed the corticomedullary strain ratio in renal allografts of 33 patients who underwent renal transplant sonography and biopsy. Based on Banff score criteria for renal cortical fibrosis, 33 allografts were divided into 2 groups: group 1 (n = 19), with mild (<25%) fibrosis; and group 2 (n = 14), with moderate (>26%) fibrosis. We used 2-dimensional speckle-tracking software to perform offline analysis of cortical and medullary strain induced by external compression by the ultrasound transducer. We then calculated the corticomedullary strain ratio (cortical normalized strain/medullary normalized strain; normalized strain = developed strain/applied strain [deformation from the abdominal wall to the pelvic muscles]). An unpaired 2-tailed t test was used to determine differences in normalized strain and the strain ratio between the groups. Receiver operating characteristic curve analysis was performed to determine the best strain ratio cutoff value for identifying moderate fibrosis. RESULTS: Normalized strain differed between the cortex and medulla (mean ± SD: group 1, 4.58 ± 2.02 versus 2.58 ± 1.38; P = .002; group 2, 1.71 ± 0.42 versus 2.60 ± 0.87; P = .0011). The strain ratio in group 1 was higher than in group 2 (2.06 ± 1.33 versus 0.70 ± 0.20; P = .0007). The area under the receiver operating characteristic curve was 0.964. The sensitivity and specificity of a strain ratio cutoff value of 0.975 for determining moderate fibrosis were 92.9% and 94.7%, respectively. CONCLUSIONS: Strain values vary in different compartments of the kidney. The corticomedullary strain ratio on ultrasound elasticity imaging decreases with increasing renal cortical fibrosis, which makes it potentially useful as a noninvasive quantitative marker for monitoring the progression of fibrosis in renal transplants.

Renal transplant elasticity ultrasound imaging: correlation between normalized strain and renal cortical fibrosis.

After transplantation, over a widely variable time course, the cortex of the transplanted kidney becomes stiffer as interstitial fibrosis develops and renal function declines. Elasticity ultrasound imaging (EUI) has been used to assess biomechanical properties of tissue that change in hardness as a result of pathologic damage. We prospectively assessed the hardness of the renal cortex in renal transplant allograft patients using a normalized ultrasound strain procedure measuring quasi-static deformation, which was correlated with the grade of renal cortical fibrosis. To determine cortical strain, we used 2-D speckle-tracking software (EchoInsight, Epsilon Imaging, Ann Arbor, MI, USA) to perform offline analysis of stored ultrasound loops capturing deformation of renal cortex and its adjacent soft tissue produced by pressure applied using the scanning transducer. Normalized strain is defined as the mean developed strain in the renal cortex divided by the overall mean strain measured in the soft tissues from the abdominal wall to pelvic muscles. Using the Banff scoring criteria for renal cortical fibrosis as the gold standard, we classified 20 renal transplant allograft biopsy tissue samples into two groups: group 1 (n = 10) with mild (<25%) renal cortical fibrosis and group 2 (n = 10) with moderate (26%-50%) renal cortical fibrosis. An unpaired two-tailed t-test was used to determine the statistical difference in strains between patients with mild and those with moderate renal cortical fibrosis. Receiver operating characteristic curve analysis was performed to assess the accuracy of developed strain and normalized strain in predicting moderate renal cortical fibrosis. The reference strain did not significantly differ between the two groups (p = 0.10). However, the developed renal cortical strain in group 1 with mild fibrosis was higher than that in group 2 with moderate fibrosis (p = 0.025). The normalized strain in group 1 was also higher than that in group 2 (p = 0.0014). The areas under receiver operating characteristic curves for developed strain and normalized strain were 0.78 and 0.95, respectively. The optimal cutoff for distinguishing moderate renal cortical fibrosis was -0.08 for developed strain (sensitivity = 0.50, specificity = 1.0) and 2.5 for normalized strain (sensitivity = 0.80, specificity = 1.0). In summary, renal cortex strain is strongly correlated with grade of renal cortical fibrosis. Normalized strain is superior to developed strain in distinguishing moderate from mild renal cortical fibrosis. We conclude that free-hand real-time strain EUI may be useful in assessing the progression of cortical fibrosis in renal transplant allografts. Further prospective study using this method is warranted.

Correlation between Doppler parameters and renal cortical fibrosis in lupus nephritis: a preliminary observation.

To assess the relationship between renal Doppler parameters and renal cortical fibrosis in lupus nephritis (LN), we retrospectively reviewed 24 patients with LN underwent both renal color Doppler sonography and renal biopsy. The angle-corrected Doppler parameters, including peak systolic velocity (PSV), end diastolic velocity (EDV) and resistive index (RI) at the main and interlobar renal arteries were measured. The Doppler parameters and PSV and EDV ratios of the interlobar artery to main renal artery were compared with histopathologic analysis of the kidney biopsy specimen. On the basis of renal cortical fibrosis, the 24 cases of LN were divided into two groups: mild (6%-25%) renal cortex fibrosis (n = 13) and moderate (26%-50%) renal cortex fibrosis (n = 11). An independent-samples two tailed t test was used to statistically analyze the differences in PSV, EDV and RI between the two groups. Receiver operating characteristic was analyzed for assessing the accuracy of interlobar artery PSV and EDV in predicting moderate renal cortical fibrosis. In our result, both PSV and EDV in moderate renal cortex fibrosis were lower than that in mild renal cortex fibrosis. There were statistically significant differences in PSV and EDV at the interlobar artery, EDV and RI at the main renal artery, and PSV and EDV ratios of the interlobar artery to main renal artery between the two groups (all p < 0.05). The area under receiver operating characteristic curves of PSV and EDV for predicting >26% renal cortical fibrosis was 0.96 and 0.90, respectively. The optimal cutoff values for differentiating >26% renal cortical fibrosis from those <25% were PSV 30 cm/s (sensitivity = 0.92; specificity = 1) and EDV 13 cm/s (sensitivity = 0.77; specificity = 1). Therefore, the values of PSV and EDV at the interlobar artery can potentially be used as hemodynamic indicators of renal cortical fibrosis, which may non-invasively assist in monitoring the progression of renal cortical fibrosis in LN, especially in patients with contraindications to renal biopsy.

Novel vein closure procedure using a proprietary cyanoacrylate adhesive: 30-day swine model results.

PURPOSE: To conduct a pilot study to demonstrate a novel method of using a proprietary cyanoacrylate (CA) for closure of superficial veins. MATERIALS AND METHODS: Right and left superficial epigastric veins from two swine models were utilized due to the vein's similarities with the human great saphenous vein. Under ultrasound guidance, access was gained and a 5-F delivery catheter was advanced to the junction of the superficial epigastric and abdominus rectus veins. A dispenser gun was then utilized to inject 0.16 mL of CA while compression was applied cephalad to the end of the catheter. Immediately after delivery, the catheter was pulled back 3 cm and manual compression was employed for 30 seconds. After this first injection, the ultrasound probe was repositioned caudad to the injection and cephalad to the catheter tip and another 0.16 mL injection was delivered with immediate 3 cm pullback of the delivery system. Manual compression was applied at the caudad end of the treated vein for 30 seconds. This process was repeated until the entire target segment was treated. RESULTS: At 30 days postimplantation, the treated veins were occluded with no evidence of recanalization or migration. Histological findings revealed that the lumen was dilated by coalescing, arborizing clear spaces with entrapped lytic erythrocytes, demarcated by a thin band of granular eosinophilic material. Spindle cells with dense eosinophilic matrix replaced the tunica intima and disrupted the tunica media. CONCLUSION: Results of this initial study demonstrated that intravascular injection of CA is feasible for closure of superficial veins in animal models. These findings warrant further animal studies of this proprietary CA to assess efficacy, safety and its effects on perivenous structures.

Cyanoacrylate adhesive for the closure of truncal veins: 60-day swine model results.

BACKGROUND: The introduction of cyanoacrylate (CA) within a blood vessel triggers polymerization, followed by an inflammatory reaction. METHODS: A sheath was positioned 2.0 cm caudad to the junction of the superficial epigastric and abdominus rectus veins in 2 swine, followed by ultrasound-guided injection of 0.16 mL of CA glue. After glue delivery, the catheter was pulled back 3 cm, compression was applied to the treatment site, and the process was repeated for the entire length. At 60 days postimplantation, the veins were harvested surgically and examined histologically. RESULTS: The histologic changes were consistent with a chronic foreign-body-type inflammatory response. Venous closure, segmental wall thickening, and fibrosis were observed. CONCLUSION: Injection of CA is feasible for closure of superficial veins in animal models. Vein closure is achieved via an inflammatory process which ultimately leads to fibrosis.

Doppler parameters in renal transplant dysfunction: correlations with histopathologic changes.

OBJECTIVES: The aim of this study was to assess the relationship between intrarenal Doppler parameters and histopathologic changes shown on kidney biopsy in renal transplant dysfunction. METHODS: We retrospectively reviewed the records of 113 patients (61 men and 52 women; age range, 22-76 years; mean age ± SD, 50.9 ± 12.7 years) who underwent both transplanted kidney sonography and biopsy from May 1, 2007, to May 31, 2009. Doppler parameters of the interlobar arteries, including the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were compared with kidney biopsy findings. According to histopathologic findings, the 113 patients were divided into two groups: 1, interstitial fibrosis/tubular atrophy and vascular/glomerular sclerosis (n = 79); and 2, edematous changes in glomeruli without fibrosis (n = 34). The correlations between Doppler parameters and histopathologic findings were statistically analyzed. RESULTS: There were statistically significant differences in the PSV and EDV of the interlobar arteries between groups 1 and 2. Both the PSV and EDV in group 1 were significantly lower than those in group 2 (P < .001). There was no significant difference in the RI of the interlobar arteries between the two groups (P > .05). There were no significant differences in the PSV, EDV, and RI of the main renal artery between the two groups (all P > .05). CONCLUSIONS: The PSV and EDV of the interlobar artery have statistical correlations with histopathologic types in renal transplant dysfunction. Both the PSV and EDV in interstitial fibrosis/tubular atrophy and vascular/glomerular sclerosis seem lower than those in glomerulopathy without fibrosis. Hence, the PSV and EDV of the interlobar artery may potentially be used as hemodynamic indicators for monitoring the progress of renal transplants.