Predictive value of cyst/tumor volume ratio of pituitary adenoma for tumor cell proliferation.

BACKGROUND: MRI has been widely used to predict the preoperative proliferative potential of pituitary adenoma (PA). However, the relationship between the cyst/tumor volume ratio (C/T ratio) and the proliferative potential of PA has not been reported. Herein, we determined the predictive value of the C/T ratio of PA for tumor cell proliferation. METHODS: The clinical data of 72 patients with PA and cystic change on MRI were retrospectively analyzed. PA volume, cyst volume, and C/T ratio were calculated. The corresponding intraoperative specimens were collected. Immunohistochemistry and hematoxylin-eosin staining were performed to evaluate the Ki67 index and nuclear atypia. Patients were categorized according to the Ki67 index (< 3% and ≥ 3%) and nuclear atypia (absence and presence). Univariate and multivariate analyses were used to identify the significant predictors of the Ki67 index and nuclear atypia. The receiver operating characteristic curve assessed the prediction ability of the significant predictors. RESULTS: Larger tumor volumes, smaller cyst volumes, and lower C/T ratios were found in patients with higher Ki67 indexes and those with nuclear atypia (P < 0.05). C/T ratio was an independent predictor of the Ki67 index (odds ratio = 0.010, 95% confidence interval = 0.000-0.462) and nuclear atypia (odds ratio = 0.010, 95% confidence interval = 0.000-0.250). The predictive value of the C/T ratio did not differ significantly from that of tumor volume (P > 0.05) but was better than that of cyst volume (P < 0.05). The area under the curve of the C/T ratio for predicting the Ki67 index and nuclear atypia was larger than that for predicting cyst volume and tumor volume. CONCLUSIONS: C/T ratios can be used to predict PA tumor proliferation preoperatively. Our findings may facilitate the selection of surgery timing and the efficacy evaluation of surgery.

Health-related quality of life in Chinese individuals with type 2 diabetes mellitus: a multicenter cross-sectional study.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a chronic and life-threatening disease. Health-related quality of life (HRQoL) is vital for individuals with T2DM. However, little is known about the impact of psychological stability factors on HRQoL among individuals with T2DM in mainland China. METHODS: This multicenter cross-sectional study was conducted in five tertiary grade-A hospitals in Chongqing, China, from January to December 2019. A total of 385 individuals with T2DM were included by the convenient sample method. Fear of Progression (FOP) Questionnaire-short Form, Hypoglycemia Fear Survey II, diabetes-management self-efficacy scale, and EuroQol-5 Dimensions were used for data collection. RESULTS: The mean age of the 385 individuals was 57.65 (SD = 15.15) years, three-quarters of whom had a high school or above education level. The participants in our study had moderate HRQoL and were more likely to have poor scores in the pain/discomfort dimension. The FOP level was moderate on average, and 23.1% of individuals suffered from psychological dysfunction. The participants had higher levels of fear of hypoglycemia (FOH) and self-efficacy (SE). Multiple steppage-regression analysis predicted that higher levels of FOP and FOH, reduced SE, older age, longer duration since diagnosis, lower educational attainment, higher levels of HbA1c, and living with comorbid conditions were related to lower HRQoL. CONCLUSION: This study showed that the HRQoL among Chinese T2DM patients may be impaired by increased FOP and FOH, decreased SE, and poor glycemic control. In addition, as the patient's age and duration since diagnosis increase, their HRQoL further declines. We recommend improving HRQoL by encouraging individuals to attain more health education and resilience skills to enhance SE and reduce negative emotions among individuals with T2DM.

MRI features of pituitary adenoma apoplexy and their relationship with hypoxia, proliferation, and pathology.

OBJECTIVE: We aim to study the MRI features of pituitary adenoma (PA) apoplexy and their relationship with hypoxia, proliferation, and pathology. METHODS: Sixty-seven patients with MRI signs of PA apoplexy were selected. According to the MRI signs, they were divided into the parenchymal group and the cystic group. The parenchymal group had a low signal area on T2WI without cyst >2 mm and this area was not significantly enhanced on the corresponding TW1 enhancement. The cystic group had a cyst >2 mm on T2WI, and the cyst showed liquid stratification on T2WI or high signal on T1WI. The relative T1WI (rT1WI) enhancement value and relative T2WI (rT2WI) value of non-apoplexy areas were measured. Protein levels of hypoxia-inducible factor-1 (HIF-1α), pyruvate dehydrogenase kinase 1 (PDK1), and Ki67 were detected with immunohistochemistry and Western blot. Nuclear morphology was observed with HE staining. RESULTS: The rT1WI enhancement average value, rT2WI average value, Ki67 protein expression level, and the number of abnormal nuclear morphology of non-apoplexy lesions in the parenchymal group were significantly lower than those in the cystic group. The protein expression levels of HIF-1α and PDK1 in the parenchymal group were significantly higher than those in the cystic group. HIF-1α protein was positively correlated with PDK1 but negatively correlated with Ki67. CONCLUSION: When there is PA apoplexy, the ischemia and hypoxia of the cystic group are lesser than those of the parenchymal group, but the proliferation is stronger.

A novel rat model for cerebral venous sinus thrombosis: verification of similarity to human disease via clinical analysis and experimental validation.

BACKGROUND: Cerebral venous sinus thrombosis (CVST) is a rare neurovascular disorder with highly variable manifestations and clinical courses. Animal models properly matched to the clinical form of CVST are necessary for elucidating the pathophysiology of the disease. In this study, we aimed to establish a rat model that accurately recapitulates the clinical features of CVST in human patients. METHODS: This study consisted of a clinical analysis and animal experiments. Clinical data for two centres obtained between January 2016 and May 2021 were collected and analysed retrospectively. In addition, a Sprague-Dawley rat model of CVST was established by inserting a water-swellable rubber device into the superior sagittal sinus, following which imaging, histological, haematological, and behavioural tests were used to investigate pathophysiological changes. Principal component analysis and hierarchical clustering heatmaps were used to evaluate the similarity between the animal models and human patients. RESULTS: The imaging results revealed the possibility of vasogenic oedema in animal models. Haematological analysis indicated an inflammatory and hypercoagulable state. These findings were mostly matched with the retrospective clinical data. Pathological and serological tests further revealed brain parenchymal damage related to CVST in animal models. CONCLUSIONS: We successfully established a stable and reproducible rat model of CVST. The high similarity between clinical patients and animal models was verified via cluster analysis. This model may be useful for the study of CVST pathophysiology and potential therapies.

Epidemiological and clinical characteristics of severe hand-foot-and-mouth disease (HFMD) among children: a 6-year population-based study.

BACKGROUND: Hand-foot-and-mouth disease (HFMD) is considered to be self-limited, however, severe HFMD is a deadly threat for children worldwide, therefore, it is essential to define the clinical and epidemiologic characteristics of children with severe HFMD and identify the risk factors of death. METHODS: Between 2013 and 2018, children who diagnosed with severe HFMD from Chongqing, China were enrolled in this population-based study. A total of 459 severe HFMD children cases were identified during the study period, including 415 survivors and 44 fatal cases. Demographic, geographical, epidemiological and clinical data of the cases were acquired and analyzed. RESULTS: Risk factors of the death because of severe HFMD children included female, aged 1 ~ 3 years, enterovirus 71 infection, falling ill in winter, more than one children in home, being taken care of by grandparents, the caregivers' education not more than 9 years, having fever more than 3 days, consciousness disorders, general weakness, vomiting, general weakness, abnormal pupillary light reflex, repeated cough, tachypnea, moist rales, white frothy sputum, pink frothy sputum, and cyanosis on lips or the whole body, tachycardia, arrhythmia, cold limbs, pale complexion, weakened pulse. (all p < 0.05). Spatial-temporal analysis detected high-value clusters, the most likely cluster located at rural countries in the northern parts of Chongqing, from January, 2015 to July, 2017. (p < 0.01). Besides, some urban districts were also found high incidence of severe HFMD cases according to the incidence maps. CONCLUSIONS: The detection of clinical risk factors and the temporal, spatial and socio-demographic distribution epidemiological characteristics of severe HFMD contribute to the timely diagnosis and intervention, the results of this study can be the reference of further clinical and public health practice.

Comparative Study of Pulsed Versus Continuous High-Intensity Focused Ultrasound Ablation Using In Vitro and In Vivo Models.

OBJECTIVES: To compare the efficacy of pulsed high-intensity focused ultrasound (PHIFU) versus continuous high-intensity focused ultrasound (CHIFU) ablation at identical doses. METHODS: Continuous and pulsed HIFU (1200 J) at duty cycles (DCs) of 60% and 20% were examined for their capacity to ablate bovine liver tissue in vitro and rabbit liver tissue in vivo. After ablation, grayscale changes and pathologic characteristics were observed or measured, and the tissue necrosis volume, energy efficiency factor, and average grayscale density were calculated. RESULTS: The pulsed mode generated greater liquefaction necrosis. An inconspicuous grayscale change was observed for PHIFU at a DC of 20% in some samples, which appeared as an elliptical cavity. The energy efficiency factor of PHIFU at a DC of 60% was significantly lower than that of CHIFU, as observed both in vitro and in vivo (P < .05). The grayscale value and average grayscale density in response to CHIFU were significantly greater than those in response to PHIFU (60% or 20%; P < .05). Histopathologic analysis revealed liquefaction necrosis in all PHIFU groups. CONCLUSIONS: At identical doses, compared with CHIFU, a single session of PHIFU can generate liquefaction necrosis and at a higher DC can improve ablation efficiency. This increased efficacy of PHIFU may involve enhancement of tissue destruction by cavitation effects and a reduction in the obstruction effect of endogenous microbubbles through cavitation effects or a more effective diffusion of heat.

Intraventricular Shunt as a Treatment for Entrapped Temporal Horn After Removal of Ventricular Meningioma: A Report of Two Cases.

Entrapped temporal horn (ETH) is a complication following resection of ventricular trigone tumors. It is a special localized hydrocephalus. Obstruction of cerebrospinal fluid outflow following resection of ventricular trigone tumors leads to dilation of the temporal horn and the production of the local space-occupying effect. This article presents two cases of ETH following the resection of ventricular trigone tumors. Our Intraventricular shunt is an effective treatment that uses a T-connector to connect a reservoir with two catheters. We presented temporal-frontal horn shunt and trigone-front horn shunt. A patient presented with ETH shunt dependency. Our intraventricular shunt surgery achieved a good prognosis.

The Effect of Dexamethasone on Neuroinflammation and Cerebral Edema in Rats With Traumatic Brain Injury Combined With Seawater Drowning.

OBJECTIVE: To investigate the effect and mechanism of dexamethasone (DX) on axonal injury after traumatic brain injury (TBI) combined with seawater drowning (SWD) in rats. METHODS: To gain an in-depth understanding of TBI + SWD in rats, we established the compound injury model of rats by the Marmarou method and intratracheal pumping of seawater to simulate the pathological conditions. Rats in the DX group received intraperitoneal injections of DX (1 mg/kg) immediately after injury, and rats in the sham group and TBI + SWD group received intraperitoneal injections of the same amount of normal saline. RESULTS: Hematoxylin-eosin (HE) showed that DX improved matrix looseness, cell swelling, and nuclear condensation 168 hours after injury. Immunohistochemistry (IHC) staining showed that the protein expression of AQP4 was decreased in the DX group compared with the TBI + SWD group from 12 hours to 168 hours after injury. DX decreased the modified neurological severity score (mNSS) significantly at 24 hours and 168 hours after injury (P < 0.05). At 72 h and 168 h after injury, DX significantly lowered the expressions of IL-8 and TNF-α (P < 0.05). CONCLUSION: DX may play a neuroprotective role by reducing cerebral edema and inflammatory response after TBI + SWD injury in rats.

Predictors of fear of diabetes progression: A multi-center cross-sectional study for patients self-management and healthcare professions education.

Objective: Excessive fear of progression can affect the mental health, social function, and wellbeing of patients with chronic diseases. This study investigated the fear of progression (FoP) and the socio-demographic and clinical predictors among patients with type 2 diabetes mellitus (T2DM). Method: The present study is a multi-center cross-sectional study. Inpatients with T2DM were recruited by a multi-stage convenience sampling method from the department of endocrinology in 5 tertiary hospitals in Southwest China. 459 T2DM patients were consecutively enrolled. Socio-demographic, clinical data, and answers to the fear of progression questionnaire (FoP-Q) were collected. Results: 385 patients with complete data were eligible. The average score of FoP-Q-SF was 26.84 and 23.1% of patients reached the dysfunctional fear of progression criterion. The greatest fears were worrying about "disease progression," "the adverse reactions of medication," and "relying on strangers for activities of daily living." Health education (P < 0.001), age (P = 0.002), hypoglycemia history (P = 0.006), employment status (P = 0.025) and duration since being diagnosed with type 2 diabetes mellitus (P = 0.032) were the related factors of fear of progression. Conclusion: Early assessment of the fear of progression was imperative to identify dysfunctional fear of progression in patients with type 2 diabetes mellitus. Meanwhile, the meaning of these predictors for strengthening healthcare professions education and patients self-management might help healthcare givers timely perform related interventions and help patients reduce their fear of progression thus actively cooperate with T2DM treatments.

Liquid-liquid extraction combined with online cleanup for the simultaneous determination of PAHs by GC-MS/MS and their hydroxylated metabolites by LC-MS/MS in human fingernails.

A method was developed for the simultaneous determination of polycyclic aromatic hydrocarbons (PAHs) and their hydroxylated metabolites (OH-PAHs) in human fingernails using liquid-liquid extraction and online purification. After surface decontamination by rinsing with acetone, the fingernails were digested with sodium hydroxide and subjected to liquid-liquid extraction with a mixture of n-hexane and methyl tertbutyl ether. The organic extract was then fractionated using a silica-based solid-phase extraction (SPE) cartridge to obtain a PAH fraction eluted with n-hexane/dichloromethane (v/v, 95:5) and an OH-PAH fraction eluted with dichloromethane/ethyl acetate (v/v, 50:50). The PAH fraction was directly injected into an online gel permeation chromatography-gas chromatography-triple quadrupole tandem mass spectrometry (GPC-GC-MS/MS) system, enabling rapid determination of 16 PAHs. A parallel online SPE liquid chromatography tandem mass spectrometry (LC-MS/MS) method was used to determine 12 OH-PAHs. Validation experiments showed that the recovery of PAH and OH-PAH were within range of 67.4%-105.1% (RSD ≤ 10.1%) and 72.8%-102.3% (RSD ≤ 10.9%), respectively, with limits of quantitation (LOQ) of 0.06-0.8 ng/g and 0.15-3.1 ng/g, respectively. Forty-two human fingernail samples from residents of Southern China were analyzed to establish background PAH and OH-PAH levels in this region. Several PAHs and OH-PAHs were detected, at concentrations of 97.5 to 3,687 ng/g for PAHs and 24.2 to 767 ng/g for OH-PAHs. The dominant homologues were two- and three-ring PAH isomers, notably naphthalene (Nap), fluorene (Flu), and phenanthrene (Phe), as well as the corresponding hydroxylated metabolites 2-OH-Nap, OH-Flu, and OH-Phe. Smoking, consuming barbecued food, and age had no significant effects on PAH exposure, but a larger sample would be required to confirm this finding. The online purification strategy presented here expedites cleanup and purification during analysis of human fingernails and should facilitate non-invasive biomonitoring of PAHs in humans, particularly when analyzing large numbers of samples.

Fear of hypoglycaemia among patients with type 2 diabetes mellitus: a cross-sectional study.

To investigate the fear of hypoglycaemia in patients with type 2 diabetes mellitus (T2DM), to identify factors related to this fear, and thus to provide evidence for clinical assessment. A total of 385 patients with T2DM who were admitted to the departments of endocrinology in five tertiary grade-A hospitals in Chongqing, China were included in this study. A questionnaire for general information and a Chinese version of Hypoglycemia Fear Survey (HFS) were used to collect the data. The average total score on the HFS was 71.67 ± 17.06 (HFS-W was 38.15 ± 10.57; HFS-B was 33.52 ± 9.54).The three items with the highest average score for HFS-W were not recognising low blood glucose (BG), not having food available, experiencing a hypoglycaemic episode alone, and for HFS-B were eating large amount of snacks, measuring BG six or more times per day, and keeping BG > 150 mmol/L. Regressions showed that number of hospitalisations for T2DM, receiving health education on diabetes, age and hypoglycaemia history because of T2DM were associated with fear of hypoglycaemia (all p < 0.05). Fear of hypoglycaemia in hospitalised patients with T2DM was strongly associated with diabetes health education, hospitalisation for diabetes, age, and hypoglycaemia history. Medical professionals should attach importance to the specific psychological interventions, health education on diabetes and the early prevention of hypoglycaemia or diabetic complications for patients with T2DM to reduce the fear of hypoglycaemia and improve their health status.

PAHs and their hydroxylated metabolites in the human fingernails from e-waste dismantlers: Implications for human non-invasive biomonitoring and exposure.

Non-invasive human biomonitoring methods using hair and fingernails as matrices are widely used to assess the exposure of organic contaminants. In this work, a total of 72 human fingernails were collected from workers and near-by residents from a typical electronic waste (e-waste) dismantling site, and were analyzed for human exposure to polycyclic aromatic hydrocarbons (PAHs) and their mono-hydroxyl metabolites (OH-PAHs). The concentrations of PAHs and OH-PAHs were obtained as 7.97-551 and 39.5-3280 ng/g for e-waste workers (EW workers), 7.05-431 and 27.3-3320 ng/g for non-EW workers, 7.93-289 and 124-779 ng/g for adult residents, and 8.88-1280 and 181-293 ng/g for child residents, respectively. The composition profiles of PAHs in the human fingernails of the four groups were similar, with isomers of Phe, Pyr and Fluo being the predominated congeners, while 2-OH-Nap accounted for more than 70% of the total OH-PAHs. These contaminants were found most in the fingernails of EW workers, followed by non-EW workers, adult residents, and child residents, indicating e-waste dismantling activities are the major sources of PAH exposure. However, significantly higher levels of PAHs with 4-6 rings were observed only in workers as opposed to the residents, and a significant correlation between 3-OH-Flu (p < 0.05) and 2-OH-Phe (p < 0.01) in the fingernails and urine was observed, but no significant correlation was found between the concentration of OH-PAHs in matched hair and fingernail samples. In addition, the levels of PAHs in fingernails increased with the age of EW workers. This is the first study to explore the accumulation and distribution of PAHs and OH-PAHs in human fingernails, which would provide valuable insight into non-invasive biomonitoring and health risk assessment of PAHs.

Outcomes of Preinjury Use of Statins in Patients with Traumatic Brain Injury: A Systematic Review and Meta-analysis.

BACKGROUND: No completely effective pharmacotherapies have been developed to improve the outcomes of traumatic brain injury (TBI). Given the reporting of cohort studies suggesting that preinjury statin use may reduce TBI-associated mortality, this study aimed to evaluate the effects of statin use in patients with TBI. METHODS: This study was performed according to the PRISMA guidelines. The PubMed, Embase, Cochrane Central, Web of Science, and China National Knowledge Infrastructure databases were searched from inception until April 13, 2021, using a search strategy that included 2 main terms: "statins" and "traumatic brain injury." The outcomes were mortality, hospital length of stay, and intensive care unit length of stay, which were evaluated using a random-effects model and represented by the pooled risk ratio with 95% confidence intervals. RESULTS: The search results identified 7 eligible studies, with a total of 111,935 patients with brain injury. Preinjury statin use in patients with TBI was associated with a significantly decreased risk of mortality compared with that in nonusers (risk ratio, 0.75; 95% confidence interval, 0.59-0.94; I2 = 53%). Subgroup analysis showed that statin withdrawal might increase mortality. Sensitivity analysis showed that the results were stable and robust. CONCLUSIONS: Preinjury statin use may contribute to mortality reduction in patients with TBI, whereas statin withdrawal might increase mortality. In clinical management, statin use should not be discontinued after TBI.