The Value of Nerve Ultrasound to Diagnose and Follow Up the Multifocal Neurolyphomatosis in the Upper Limb---- Case Report and Literature Review.

INTRODUCTION: Neurolymphomatosis (NL) is a rare disease. Ultrasound (US) plays a crucial role in diagnosing and following up the NL. CASE PRESENTATION: A 59-year-old man was hospitalized with acute pain in the left upper extremity. Ultrasound revealed segmental swelling of multiple nerves around his left elbow with abundant blood flow signals. Contrast-Enhanced Ultrasound (CEUS) showed a rapid, complete and homogenous enhancement in the nerve lesions in the early arterial phase. The NL was confirmed by imaging and flow cytometry, and he accepted chemotherapy. The posttherapeutic ultrasound showed that the nerves in the left upper limb were basically normal. Unfortunately, the patient died of cerebral metastasis in 5 months. CONCLUSION: The nerve US and CEUS can show specific manifestations and provide more diagnostic information about NL.

Targeted macrophage phagocytosis by Irg1/itaconate axis improves the prognosis of intracerebral hemorrhagic stroke and peritonitis.

BACKGROUND: Macrophages are innate immune cells whose phagocytosis function is critical to the prognosis of stroke and peritonitis. cis-aconitic decarboxylase immune-responsive gene 1 (Irg1) and its metabolic product itaconate inhibit bacterial infection, intracellular viral replication, and inflammation in macrophages. Here we explore whether itaconate regulates phagocytosis. METHODS: Phagocytosis of macrophages was investigated by time-lapse video recording, flow cytometry, and immunofluorescence staining in macrophage/microglia cultures isolated from mouse tissue. Unbiased RNA-sequencing and ChIP-sequencing assays were used to explore the underlying mechanisms. The effects of Irg1/itaconate axis on the prognosis of intracerebral hemorrhagic stroke (ICH) and peritonitis was observed in transgenic (Irg1flox/flox; Cx3cr1creERT/+, cKO) mice or control mice in vivo. FINDINGS: In a mouse model of ICH, depletion of Irg1 in macrophage/microglia decreased its phagocytosis of erythrocytes, thereby exacerbating outcomes (n = 10 animals/group, p < 0.05). Administration of sodium itaconate/4-octyl itaconate (4-OI) promoted macrophage phagocytosis (n = 7 animals/group, p < 0.05). In addition, in a mouse model of peritonitis, Irg1 deficiency in macrophages also inhibited phagocytosis of Staphylococcus aureus (n = 5 animals/group, p < 0.05) and aggravated outcomes (n = 9 animals/group, p < 0.05). Mechanistically, 4-OI alkylated cysteine 155 on the Kelch-like ECH-associated protein 1 (Keap1), consequent in nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) and transcriptional activation of Cd36 gene. Blocking the function of CD36 completely abolished the phagocytosis-promoting effects of Irg1/itaconate axis in vitro and in vivo. INTERPRETATION: Our findings provide a potential therapeutic target for phagocytosis-deficiency disorders, supporting further development towards clinical application for the benefit of stroke and peritonitis patients. FUNDING: The National Natural Science Foundation of China (32070735, 82371321 to Q. Li, 82271240 to F. Yang) and the Beijing Natural Science Foundation Program and Scientific Research Key Program of Beijing Municipal Commission of Education (KZ202010025033 to Q. Li).

Ultrasound features and differential diagnosis for superficial nodular fasciitis.

BACKGROUND: Nodular fasciitis (NF) has nonspecific clinical manifestations and is often misdiagnosed as sarcoma. The investigations of imaging methods for NF were limited. OBJECTIVE: To analyze the ultrasound (US) features of NF, and to evaluate the diagnostic value of US for NF. MATERIALS AND METHODS: A total of 61 NF patients were recruited retrospectively, and 551 lesions in the subcutaneous fat layer were included for comparison. We evaluated the ultrasound features of the patients and divided the NF cases into three types. Chi-square test or Fisher exact test were conducted to detect the potential difference in the distributions of three types in the two groups. RESULTS: Among the 61 NF cases, 65.6% were in the upper extremities (n = 40). The proportion of type 1, 2, and 3 were 57.4%, 24.6%, and 18.0%, respectively. NF were significantly more likely locating in the upper extremities than the other soft tissue tumors (p < 0.001). Type 1 and type 2 of sonographic features were significantly more commonly observed in NF than other soft tissue tumors among the three types (p < 0.001). CONCLUSION: The type 1 and type 2 of US features can help to distinguish NF from other lesions. US has great potential to improve the diagnostic accuracy and reduce the unnecessary surgery.

Comparison of transmural healing and mucosal healing as predictors of positive long-term outcomes in Crohn's disease.

BACKGROUND: Transmural healing (TH) is being increasingly recognized for reflecting deep remission in Crohn's disease (CD). The long-term clinical significance of achieving TH is still not fully known. We aimed to evaluate TH as a predictor of long-term positive outcomes using intestinal ultrasonography (US), with comparison with the established endpoint mucosal healing (MH). METHODS: CD patients were consecutively recruited from September 2015 to August 2018 at a single tertiary hospital. All patients were evaluated at baseline and followed up at 6 months prospectively with a guideline-based treatment regimen. Achieving TH/MH or not was evaluated by US/colonoscopy at the first follow-up. Long-term outcomes including steroid-free clinical remission (CR), drug escalation, hospitalization, and surgery, were recorded after at least another 12 months. RESULTS: We identified 77 patients with a median age of 30 years (range, 12-73 years). Twenty-five (32%) patients achieved TH, and 31 (40%) patients achieved MH. TH and MH were poorly correlated (Cohen's κ = 0.387; p < 0.05). Univariate analysis showed that both MH and TH were associated with better long-term outcomes. In multivariate analysis, TH was an independent predictor of steroid-free CR [odds ratio (OR), 52.6; p < 0.001], drug escalation (OR, 0.1; p = 0.002), and hospitalization (OR, 0.05; p = 0.005), while MH was an independent predictor of drug escalation (OR, 0.3; p = 0.05). Smoking habit was the only predictor of surgery (OR, 6.6; p = 0.02). CONCLUSION: TH is an independent predictor of more favorable long-term outcomes than MH, suggesting that TH could become the potential treatment endpoint in CD.Plain language summary: Transmural healing predicts good prognosis in Crohn's disease The therapeutic endpoints of Crohn's disease keep evolving. The long-term clinical significance of achieving transmural healing is not fully discovered.Transmural healing is an independent predictor of more favorable long-term outcomes than mucosal healing.Transmural healing could become the potential treatment endpoint in Crohn's disease.

Rare intestinal fistula caused by primary lymphoma of the gastrointestinal tract: Two case reports and literature review.

RATIONALE: Primary lymphoma that arises from the intestine is an uncommon malignant tumour, while intestinal fistula caused by primary lymphoma is even rarer. Non-specific clinical performance makes early diagnosis difficult, although imaging modalities might play an essential role in the detection of intestinal fistula. PATIENT CONCERNS: Patient 1: A 60-year-old male hospitalized with diarrhoea and abdominal pain for seven months underwent computed tomography enterography (CTE) that demonstrated ileum internal fistula and ileac-sigmoid colon fistula. Ultrasound (US) showed small intestinal wall thickened and development of a fistula of the sigmoid colon due to malignance. Patient 2: A 43-year-old male presented with abdominal pain and diarrhoea lasting one year. US revealed a fistula between the sigmoid colon and the ileum, and CTE showed that the wall of the partial sigmoid colon was abnormally thickened and enhanced with an ileal-sigmoid fistula that strongly suggested the diagnosis of lymphoma. DIAGNOSES: Both the two patients were diagnosed as intestinal fistula caused by primary non-Hodgkin's intestinal lymphoma. INTERVENTIONS: The patient 1 underwent surgery followed by chemotherapy. The patient 2 accepted chemotherapy. OUTCOMES: Two patients' general conditions remained stable and the imaging revealed no recurrence after follow-up of about 12 months. LESSIONS: Cross-sectional imaging, such as US and CT, plays an essential role in intestinal lymphoma fistula diagnosis.

[Salidroside inhibits inflammatory factor release in BV-2 cells through p38 and JNK pathways].

Salidroside is the major bioactive component of Rhodiola sachalinensis. Studies have shown that salidroside has anti-inflammatory effects. In the present study, we examined whether salidroside inhibited inflammatory reaction in BV-2 microglial cells and thereby inhibited PC12 apoptosis. BV-2 cells were induced by lipopolysaccharides (LPS, 100 µg/L) and/or salidroside (10 mg/L), and then the conditioned medium was collected. Real time-PCR was used to detect IL-6 and TNF-α mRNA expression. The contents of IL-6 and TNF-α in medium were detected by ELSIA. Conditioned medium was added to PC12 culture medium and cell counting kit-8 and Hoechst 33258 were used to assess cell viability and cell apoptosis, respectively, after 24 h of incubation. The levels of phospho-p38 mitogen-activated protein kinase (p-p38) and phospho-c-Jun N-terminal kinase (p-JNK) in BV-2 cells were examined by Western blot analysis. The result showed that salidroside pretreatment decreased the expression of IL-6 and TNF-α as well as phosphorylation of p38 and JNK induced by LPS in BV-2 cells. The inhibitors of p38 (SB202190) and JNK (SP600125) could reduce IL-6 and TNF-α mRNA expression that was induced by LPS. Combined utilization of SB202190, SP600125 and salidroside could attenuate the effects of LPS. After conditioned medium treatment, PC12 cell viability and cell apoptosis were ameliorated in pretreatment + LPS group compared with LPS group. These results suggest that salidroside inhibits PC12 cell apoptosis by decreasing inflammatory factor release as well as p38 and JNK activation in activated microglia.

EKG-triggered CT data acquisition to reduce variability in coronary arterial calcium score.

PURPOSE: To test the hypothesis that computed tomographic (CT) scanning during optimal electrocardiographic (EKG) triggering can minimize image motion artifact and reduce interexamination variation of coronary arterial calcification (CAC) score at electron-beam CT. MATERIALS AND METHODS: Two hundred patients underwent electron-beam CT once and again 5 minutes later to evaluate interexamination variability of CAC score. Group 1 (104 patients) underwent scanning with use of an optimal EKG-triggering protocol (EKG triggering performed individually at the time of least coronary arterial motion during the cardiac cycle); group 2 (96 patients) underwent scanning with use of conventional 80% R-R interval triggering (the most common protocol with the electron-beam CT scanner). Interexamination, intraobserver, and interobserver variations of CAC measurements were compared between groups by using unpaired t tests for both Agatston and volumetric scores (in square millimeters). RESULTS: Coronary arterial motion artifacts were found in 26% (27 of 104) versus 80% (77 of 96) of patients in groups 1 and 2, respectively (P <.0001). Intraobserver, interobserver, and interexamination variabilities in volumetric score were derived, with values of 1.2%, 9.2%, and 15.9% in group 1 and 2.1%, 11.3%, and 25.9% in group 2, respectively. Interexamination variabilities in both Agatston and volumetric score were significantly reduced with individualized EKG triggering, as compared with conventional triggering (P <.05), but intra- and interobserver variabilities were not (P >.05). CONCLUSION: Optimal EKG triggering improves the reproducibility of CAC measurement by reducing coronary arterial motion artifacts.

Causes of interscan variability of coronary artery calcium measurements at electron-beam CT.

RATIONALE AND OBJECTIVES: The authors performed this study to investigate the causes of interscan variability of coronary artery calcium measurements at electron-beam computed tomography (CT). MATERIALS AND METHODS: Two sets of electron-beam CT scans were obtained in 298 consecutive patients who underwent electron-beam CT to screen for coronary artery calcium. Interscan variations of coronary artery calcium characteristics and the effects of heart rate, electrocardiographic (ECG) triggering method, image noise, and coronary motion on interscan variability were analyzed. RESULTS: The interscan mean variabilities were 21.6% (median, 11.7%) and 17.8% (median, 10.8%) with the Agatston and volumetric score, respectively (P < .01). Variability decreased with increasing calcification score (34.6% for a score of 11-50 and 9.4% for a score of 400-1,000, P < .0001). The absolute difference in Agatston score between scans was 44.1 +/- 95.6. The correlation coefficient between the first and second sets of scans was 0.99 (P < .0001). Lower interscan variability was found in younger patients (<60 years), patients with stable heart rates (heart rate changing less than 10 beats per minute during scanning), patients with no visible coronary motion, and those with an optimal ECG triggering method (P < .05 for all). Results of multivariate logistic analysis showed that changes in calcium volume, mean attenuation, and peak attenuation were significant predictors of interscan variability and caused the interscan variations of the coronary artery calcium measurements (r2 = 0.83, P < .0001). CONCLUSION: Coronary calcification at electron-beam CT varies from scan to scan. Volumetric scoring and optimal ECG triggering should be used to reduce interscan variability. Baseline calcium score and interscan variability must be considered in the evaluation of calcium progression.

Noninvasive assessment of coronary artery bypass graft patency and flow characteristics by electron-beam tomography.

OBJECTIVE: To evaluate the flow characteristics and accuracy for the detection of patent or occluded coronary artery bypass grafts (CABG) with multi-slice flow study of electron-beam tomography (EBT). METHODS: One hundred and twenty-three patients who had undergone CABG surgery were enrolled in this study. Flow datasets were assessed with time-density curves by EBT. The EBT results were blindly compared with post-operative cardiac catheterizations in 26 patients. RESULTS: Image quality was adequate to evaluate in 111 patients (90.2%). Flow curves of bypass grafts were technically adequate in 265 of 309 (85.8%) saphenous-vein grafts (SVG) and 35 of 56 (62.5%) internal mammary artery (IMA) grafts (p < 0.05). In comparison to conventional angiographic results, EBT correctly identified 14 of 16 occluded grafts (sensitivity, 87.5%) and 68 of 75 patent grafts (specificity, 90.7%), yielding an accuracy of 90.1%. The intra-graft flows of the IMA and SVG were 4.9 +/- 2.2 ml/min/g and 6.9 +/- 2.8 ml/min/g, respectively (p < 0.001), which was 31.6 +/- 20.4% and 39.4 +/- 21.9% of the ascending aorta's flow (16.7 +/- 5.0 ml/min/g) (p < 0.001). CONCLUSION: EBT flow study can be used in the assessment of CABG patency and quantification of intra-graft flow of patent CABG vessels.