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PURPOSE: This study aims to investigate a characteristic cerebellar hemisphere enhancement pattern on magnetic resonance imaging (MRI) that could aid in early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). MATERIALS AND METHODS: Pretreatment MR images of 57 patients with intracranial DAVFs between January 1, 2017, and February 28, 2023, were retrospectively analyzed. A total of 128 patients with confirmed alternative cerebellar lesions during the same period were included as a control group. All patients underwent enhanced MRI with a 3.0T scanner. The presence or absence of parallel enhanced linear striations on the surface of the cerebellar lesions was documented. Statistically significant differences were determined by the Fisher exact test. RESULTS: Cerebellar lesions were identified in 4 intracranial DAVF patients (7.0%). All 4 patients were male, with an average age of 64 years (range: 58-76 years). The pretreatment MR images of all 4 DAVF patients with cerebellar lesions demonstrated the characteristic tigroid enhancement pattern. Tortuous flow voids were present in the MR images of 3 of the 4 patients. Tigroid enhancement pattern was not observed in the remaining 53 intracranial DAVF patients and all control patients. The differences in the incidence of the pattern were significant (p=0.01). CONCLUSION: A characteristic tigroid enhancement pattern of the cerebellar hemisphere on MRI may aid in the early and specific diagnosis of intracranial DAVFs, allowing timely treatment and improving outcomes. CLINICAL IMPACT: The identification of a characteristic tigroid enhancement pattern on MRI for cerebellar hemisphere lesions holds significant promise for clinical practice. This pattern serves as a distinctive marker aiding in the early and specific diagnosis of intracranial dural arteriovenous fistulas (DAVFs). Clinicians can now utilize this innovative finding to expedite diagnostic workflows, enabling timely intervention and management strategies. The incorporation of this novel imaging feature enhances diagnostic accuracy, potentially reducing misdiagnosis rates and preventing delays in treatment initiation. Ultimately, this advancement may lead to improved patient outcomes and quality of care in neurosurgical and neuroradiological practice.
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The "hot cross bun" sign (HCBs) is a cruciform hyperintensity on T2-weighted imaging within the pons initially found in patients diagnosed as multiple system atrophy. However, recent findings have broadened the disease spectrum presented with HCBs. Here is a case report at an academic medical center. Cerebral magnetic resonance imaging (MRI), electroneuromyography, serum, and CSF analysis were performed. Literature is comprehensively reviewed. We investigated a woman presented with blurred speech and cerebellar ataxia. Her MRI showed the vertical line of HCBs 2 weeks after disease onset and gradually enhanced, presenting as an intact HCBs in a year. Glutamic acid decarboxylase 65-kDa isoform (GAD65) antibody IgG was detected in serum and CSF. The patient was diagnosed as GAD65 associated cerebellar ataxia and treated with corticosteroid and rituximab. We found 6 previously reported autoimmune cerebellar ataxia patients with HCBs. Anti-KLHL-11, anti-Homer-3, anti-Ri, and anti-Amphiphysin were associated. All patients had cerebellar ataxia with other neurological symptoms. Five patients were diagnosed with tumor. First-line immunotherapy including corticosteroid, intravenous immunoglobulin, and plasma exchange for most patients was unsatisfied. This case highlights the importance of considering GAD65 IgG evaluation in patients with progressive cerebellar syndrome and HCBs. Early diagnosis and therapy are challenging but imperative. Further studies are required in regard to therapeutic management.
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BACKGROUND: The level of depression among drug addicts is generally higher than normal. Hostility and sense of life meaning may influence depression and become risk factors for depression. This study has three research purposes. First, to analyze whether drug use can aggravate hostility and depression levels. Second, to assess whether the hostility has different effects on depression among drug addicts and non-addicts. Third, to examine whether the sense of life meaning has a mediating role between different groups (drug addicts and non-addicts). METHODS: This study was conducted from March to June 2022. 415 drug addicts (233 males and 182 females) and 411 non-addicts (174 males and 237 females) were recruited in Chengdu, Sichuan Province. After signing informed consent, their psychometric data were obtained using the Cook-Medley Hostility Scale (CMI), Beck Depression Inventory (BDI) and Meaning in Life Questionnaire (MLQ) questionnaires. Linear regression models were used to assess the impact of hostility and depression among drug addicts and non-addicts. Bootstrap mediation effect tests were used to further test the mediation effect of sense of life meaning between hostility and depression. RESULTS: The results showed four main outcomes. First, compared with non-addicts, drug addicts had higher levels of depression. Second, hostility exacerbated depression in both drug addicts and non-addicts. Compared with non-addicts, hostile affect had a greater effect on depression in drug addicts. Third, the sense of life meaning among females was higher than males. Fourth, for drug addicts, the sense of life meaning showed a mediating effect between social aversion and depression, while for non-addicts, the sense of life meaning showed a mediating effect between cynicism and depression. CONCLUSIONS: Depression is more severe in drug addicts. More attention should be paid to the mental health of drug addicts, because the elimination of negative emotions is conducive to reintegration into society. Our results provide a theoretical basis for reducing depression among drug addicts and non-addicts. As a protective factor, we can reduce their hostility and depression by improving the sense of life meaning.
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Usuários de Drogas , Hostilidade , Masculino , Feminino , Humanos , Fatores de Risco , Psicometria , Inquéritos e QuestionáriosRESUMO
BACKGROUND This study is to investigate the feasibility of low iodine concentration contrast material (CM) combined with low tube voltage and adaptive statistical iterative reconstruction (ASIR) in renal computed tomography angiography (CTA). MATERIAL AND METHODS A total of 136 patients were enrolled in this prospective trial, and randomly divided into two groups: group A (n=68) and group B (n=68). Group A received 120-kVp and iopromide (370 mg/mL) with filtered back projection (FBP) reconstruction, and group B received 100-kVp and iodixanol (270 mg/mL) with ASIR 40% (ASIR40). An equal iodine dose (300 mg/kg body weight) and the same iodine delivery rate (1,500 mg I/s) were given to all patients. Density, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were measured, and the image quality and visualization of renal arteries were scored. Dose-length product (DLP) and CT dose index volume (CTDIvol) were recorded, and effective doses (ED) were calculated. RESULTS There was no significant difference in image noise between groups A and B (p>0.05). The vessel attenuation, SNR, and CNR were significantly higher in group B than group A (all p<0.05). The subjective image quality and visualization of renal artery branches were similar in these two groups (p>0.05). Compared with group A, the CTDIvol, DLP, and ED in group B were decreased by 38.58%, 37.24%, and 37.24%, respectively (p=0.000). CONCLUSIONS Compared with 120-kVp with FBP reconstruction, the protocol of 100-kVp with ASIRP40 reconstruction provided high-quality renal CTA results, which allowed for reduced iodine concentration and decreased radiation dose.
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Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/administração & dosagem , Rim/irrigação sanguínea , Rim/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Iodo/administração & dosagem , Iohexol/administração & dosagem , Iohexol/análogos & derivados , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Razão Sinal-Ruído , Ácidos Tri-Iodobenzoicos/administração & dosagemRESUMO
OBJECTIVES: To determine the value of periportal hyperintensity sign from gadobenate dimeglumine (Gd-BOPTA)-enhanced hepatobiliary phase (HBP) magnetic resonance imaging (MRI) for predicting clinical outcomes in patients with decompensated cirrhosis. METHODS: A total of 199 cirrhotic patients who underwent Gd-BOPTA-enhanced MRI were divided into control group (n = 56) and decompensated cirrhosis group (n = 143). The presence of periportal hyperintensity sign on HBP MRI was recorded. The Cox regression model was used to investigate the association between periportal hyperintensity sign and clinical outcomes. RESULTS: There was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients (p < 0.05). After a median follow-up of 29.0 months (range, 1.0-90.0 months), nine out of 143 patients (6.2%) with decompensated cirrhosis died. Periportal hyperintensity sign on HBP MRI was a significant risk factor for death (hazard ratio (HR) = 23.677; 95% confidence interval (CI) = 4.759-117.788; p = 0.0001), with an area under the curve (AUC) of 0.844 (95% CI = 0.774-0.899). Thirty patients (20.9%) developed further decompensation. Periportal hyperintensity sign on HBP MRI was also a significant risk factor for further decompensation (HR = 2.594; 95% CI = 1.140-5.903; p = 0.023). CONCLUSIONS: Periportal hyperintensity sign from Gd-BOPTA-enhanced HBP MRI is valuable for predicting clinical outcomes in patients with decompensated cirrhosis. CRITICAL RELEVANCE STATEMENT: Periportal hyperintensity sign from gadobenate dimeglumine-enhanced hepatobiliary phase magnetic resonance imaging is a new noninvasive method to predict clinical outcomes in patients with decompensated cirrhosis. KEY POINTS: ⢠There was a significant difference in the frequency of periportal hyperintensity sign on HBP between compensated and decompensated cirrhotic patients. ⢠Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for death in patients with decompensated cirrhosis. ⢠Periportal hyperintensity sign on the hepatobiliary phase was a significant risk factor for further decompensation in patients with decompensated cirrhosis.
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OBJECTIVE: To assess the value of magnetic resonance imaging (MRI) grading scores based on lumbosacral muscle denervation edema in predicting the course of Guillain-Barré syndrome (GBS). METHODS: We collected data from 354 GBS patients and developed MRI grading criteria (5-point scale) based on the transverse area and longitudinal length of lumbosacral edema. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with GBS prognosis among 12 demographic and radiological features. Clinical models and clinical-MRI models were separately trained and validated by data from Institution 1. External test was performed using data from Institution 2. Differences between the models were assessed using the z-test. RESULTS: Four clinical factors (sex, albumin cytological dissociation in cerebrospinal fluid, medical research council [MRC] sum score at admission, and MRC sum score at discharge [odds ratio, 0.24-5.15; all p < 0.001]) and MRI grading scores (odds ratio, 2.44; p < 0.001) are independent prognostic factors for GBS patients. The shallow neural network achieved the best prognostic performance both clinical model (accuracy of external test cohort, 83.96%) and clinical-MRI model (accuracy of external test cohort, 90.56%). A significant difference between clinical and clinical-MRI model was also found (clinical model vs. clinical-MRI model, area under the receiver operating curve, 0.84 (95% CI: [0.71, 0.91]) vs. 0.97 (95% CI: [0.86, 0.99]), p < 0.001). INTERPRETATION: The MRI grading scores for muscle denervation edema may serve as a potential prognostic risk factor for GBS. Furthermore, they significantly improve the prognostic performance of standalone clinical model in predicting GBS prognosis.
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Síndrome de Guillain-Barré , Humanos , Síndrome de Guillain-Barré/diagnóstico por imagem , Síndrome de Guillain-Barré/líquido cefalorraquidiano , Prognóstico , Imageamento por Ressonância Magnética , Razão de Chances , Edema/complicaçõesRESUMO
AIMS: This study was designed to evaluate the magnetic resonance imaging (MRI) patterns of the lower limb muscles in dermatomyositis (DM) with anti-transcriptional intermediate factor 1-γ (anti-TIF1-γ) antibody. METHODS: This retrospective, observational, cross-sectional study enrolled 12 adult DM patients with anti-TIF1-γ antibody. Muscles were assessed for fascial edema, subcutaneous-tissue edema, muscle edema, and fatty replacement. These features were analyzed in relation to clinical characteristics. RESULTS: All 12 patients underwent hip and thigh MRI, and 8 completed calf MRI. All patients showed myofascial edema, muscle edema, and fatty replacement, and 8 out of 12 further exhibited subcutaneous-tissue edema. Specifically, myofascial edema of the gastrocnemius was observed in all patients (8/8). The vastus intermedialis and vastus lateralis muscles showed the most severe muscle edema, whereas the caput breve of the biceps femoris, semitendinosus, and soleus muscles exhibited the most severe fatty replacement. Although only 1 patient exhibited asymmetric muscle weakness, 9 showed asymmetric muscle edema, and 10 showed asymmetric fatty replacement. Changes in muscle edema positively correlated with creatine kinase (CK) levels. CONCLUSIONS: Myofascial edema of gastrocnemius was a prominent characteristic of anti-TIF1-γ-positive DM. Early detection of muscle edema, as well as CK levels, may be helpful for monitoring disease activity.
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Dermatomiosite , Adulto , Humanos , Dermatomiosite/complicações , Dermatomiosite/diagnóstico por imagem , Estudos Retrospectivos , Estudos Transversais , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Imageamento por Ressonância Magnética/métodos , Edema/diagnóstico por imagem , Edema/patologiaRESUMO
BACKGROUND: Late-onset Pompe disease (LOPD) is mainly characterized by progressive limb-girdle muscle weakness and respiratory impairment, whereas stroke and cerebrovascular abnormalities have been insufficiently studied in LOPD. This study aimed to evaluate the frequency and pattern of intracranial artery and brain parenchyma abnormalities in LOPD patients. RESULTS: Neuroimaging data from 30 Chinese adult LOPD patients were collected from our center. Seven patients (7/30) had acute cerebral infarction or hemorrhage. Brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) revealed artery abnormalities in 23 patients (23/30). Dilative arteriopathy was found in 19 patients (19/30), with vertebrobasilar dolichoectasia found in 17 patients and dilatation of the anterior circulation arteries found in 8 patients. The maximum diameter of the basilar artery was correlated with disease duration (p < 0.05). In addition, aneurysms (7/30) and fenestrations (3/30) were discovered. There were 14 patients with arterial stenosis (14/30), and both anterior and posterior circulation involvement occurred in 9 patients (9/14). Stenosis and dilative arteriopathy simultaneously occurred in 10 patients (10/30). White matter hyperintensities were present in 13 patients (13/28). Microbleeds, predominantly located in the cerebellum and brainstem, were detected in 7 patients (7/22) via susceptibility-weighted imaging. CONCLUSIONS: Intracranial vasculopathy involving both large arteries and small vessels is an important organ damage in LOPD patients. LOPD should be considered a key differential diagnosis in young adults with cryptogenic stroke, and a series of imaging evaluations of the brain and intracranial blood vessels is recommended as a routine workup in adult LOPD patients.
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Doença de Depósito de Glicogênio Tipo II , Humanos , Masculino , Feminino , Adulto , Doença de Depósito de Glicogênio Tipo II/patologia , Doença de Depósito de Glicogênio Tipo II/diagnóstico por imagem , Adulto Jovem , Pessoa de Meia-Idade , Angiografia por Ressonância Magnética , AdolescenteRESUMO
Hyperglycemia accelerates calcification of atherosclerotic plaques in diabetic patients, and the accumulation of advanced glycation end products (AGEs) is closely related to the atherosclerotic calcification. Here, we show that hyperglycemia-mediated AGEs markedly increase vascular smooth muscle cells (VSMCs) NF90/110 activation in male diabetic patients with atherosclerotic calcified samples. VSMC-specific NF90/110 knockout in male mice decreases obviously AGEs-induced atherosclerotic calcification, along with the inhibitions of VSMC phenotypic changes to osteoblast-like cells, apoptosis, and matrix vesicle release. Mechanistically, AGEs increase the activity of NF90, which then enhances ubiquitination and degradation of AGE receptor 1 (AGER1) by stabilizing the mRNA of E3 ubiquitin ligase FBXW7, thus causing the accumulation of more AGEs and atherosclerotic calcification. Collectively, our study demonstrates the effects of VSMC NF90 in mediating the metabolic imbalance of AGEs to accelerate diabetic atherosclerotic calcification. Therefore, inhibition of VSMC NF90 may be a potential therapeutic target for diabetic atherosclerotic calcification.
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Aterosclerose , Proteína 7 com Repetições F-Box-WD , Produtos Finais de Glicação Avançada , Camundongos Knockout , Músculo Liso Vascular , Miócitos de Músculo Liso , Proteínas do Fator Nuclear 90 , Receptor para Produtos Finais de Glicação Avançada , Animais , Masculino , Camundongos , Produtos Finais de Glicação Avançada/metabolismo , Músculo Liso Vascular/metabolismo , Músculo Liso Vascular/patologia , Aterosclerose/metabolismo , Aterosclerose/genética , Aterosclerose/patologia , Humanos , Proteína 7 com Repetições F-Box-WD/metabolismo , Proteína 7 com Repetições F-Box-WD/genética , Miócitos de Músculo Liso/metabolismo , Miócitos de Músculo Liso/patologia , Proteínas do Fator Nuclear 90/metabolismo , Proteínas do Fator Nuclear 90/genética , Receptor para Produtos Finais de Glicação Avançada/metabolismo , Receptor para Produtos Finais de Glicação Avançada/genética , Calcificação Vascular/metabolismo , Calcificação Vascular/patologia , Calcificação Vascular/genética , Camundongos Endogâmicos C57BL , Ubiquitinação , Diabetes Mellitus Experimental/metabolismo , Diabetes Mellitus Experimental/complicações , Diabetes Mellitus Experimental/genética , Diabetes Mellitus Experimental/patologia , Hiperglicemia/metabolismo , Hiperglicemia/genética , Placa Aterosclerótica/metabolismo , Placa Aterosclerótica/patologia , Placa Aterosclerótica/genética , ApoptoseRESUMO
People with drug addiction are more likely to suffer from sleep disorders than non-addicts. The roles that childhood adversity experiences and resilience play in the development of sleep disorders will be explored in this study. A total of 459 participants with drug addiction and 400 non-addicts were investigated with the Adverse Childhood Experiences (ACEs) Scale, Pittsburgh Sleep Quality Index (PSQI), and Connor-Davidson Resilience Scale from April 2019 to December 2020. Our results suggested that participants with drug addiction had worse sleep quality compared to non-addicts. Resilience acted as a mediator and significantly affected the relationship between ACEs and sleep quality. For all participants who experienced ACEs, individuals with high resilience reported lower PSQI score, the regulatory effect of medium and high resilience on sleep quality was better than that of low resilience. Moreover, comparing to the non-addicts who experienced mild ACEs, high resilience showed a good buffer effect on the sleep quality for people with drug addiction. And high resilience played a stronger regulatory role in females as compared to males. The results help to broaden the relevant research in the field of sleep and we should pay attention to the role of resilience in regulating sleep quality.
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Experiências Adversas da Infância , Resiliência Psicológica , Transtornos do Sono-Vigília , Transtornos Relacionados ao Uso de Substâncias , Masculino , Feminino , Humanos , Qualidade do Sono , Transtornos do Sono-Vigília/epidemiologiaRESUMO
Objectives: Cat-scratch disease (CSD) is an infectious disease caused by Bartonella henselae. The most typical symptom of patients with CSD is regional lymphadenopathy, while central nervous system lesions related to CSD are rare. Here, we present a case of an aged woman with CSD involving the dura mater with a manifestation similar to that of an atypical meningioma. Methods: The patient was followed up by our neurosurgery and radiology teams. Clinical information was recorded, and the pre- and post-operation CT results and magnetic resonance imaging (MRI) changes were collected. The paraffin-embedded tissue was sampled for the polymerase chain reaction (PCR) test. Results: In this study, we present the details of a 54 year-old Chinese woman admitted to our hospital with a paroxysmal headache for 2 years that had worsened in the past 3 months. Brain CT and MRI showed a meningioma-like lesion below the occipital plate. En bloc resection of the sinus junction area was performed. A pathological examination showed granulation tissue and fibrosis with acute and chronic inflammation, granuloma, and central stellate microabscess, which was suspected as the cat-scratch disease. The paraffin-embedded tissue was sampled for a polymerase chain reaction (PCR) test to amplify the corresponding pathogen gene sequence, which was Bartonella henselae. Conclusion: The case in our study underscores the fact that the incubation period of CSD may be very long. On the contrary, CSD can involve the meninges, resulting in tumor-like lesions.
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Early detection of tumors has great significance for formative detection and determination of treatment plans. However, cancer detection remains a challenging task due to the interference of diseased tissue, the diversity of mass scales, and the ambiguity of tumor boundaries. It is difficult to extract the features of small-sized tumors and tumor boundaries, so semantic information of high-level feature maps is needed to enrich the regional features and local attention features of tumors. To solve the problems of small tumor objects and lack of contextual features, this paper proposes a novel Semantic Pyramid Network with a Transformer Self-attention, named SPN-TS, for tumor detection. Specifically, the paper first designs a new Feature Pyramid Network in the feature extraction stage. It changes the traditional cross-layer connection scheme and focuses on enriching the features of small-sized tumor regions. Then, we introduce the transformer attention mechanism into the framework to learn the local feature of tumor boundaries. Extensive experimental evaluations were performed on the publicly available CBIS-DDSM dataset, which is a Curated Breast Imaging Subset of the Digital Database for Screening Mammography. The proposed method achieved better performance in these models, achieving 93.26% sensitivity, 95.26% specificity, 96.78% accuracy, and 87.27% Matthews Correlation Coefficient (MCC) value, respectively. The method can achieve the best detection performance by effectively solving the difficulties of small objects and boundaries ambiguity. The algorithm can further promote the detection of other diseases in the future, and also provide algorithmic references for the general object detection field.
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Detecção Precoce de Câncer , Neoplasias , Humanos , Mamografia , Semântica , Algoritmos , Neoplasias/diagnósticoRESUMO
Retinal illnesses such as age-related macular degeneration and diabetic macular edema will lead to irreversible blindness. With optical coherence tomography (OCT), doctors are able to see cross-sections of the retinal layers and provide patients with a diagnosis. Manual reading of OCT images is time-consuming, labor-intensive and even error-prone. Computer-aided diagnosis algorithms improve efficiency by automatically analyzing and diagnosing retinal OCT images. However, the accuracy and interpretability of these algorithms can be further improved through effective feature extraction, loss optimization and visualization analysis. In this paper, we propose an interpretable Swin-Poly Transformer network for performing automatically retinal OCT image classification. By shifting the window partition, the Swin-Poly Transformer constructs connections between neighboring non-overlapping windows in the previous layer and thus has the flexibility to model multi-scale features. Besides, the Swin-Poly Transformer modifies the importance of polynomial bases to refine cross entropy for better retinal OCT image classification. In addition, the proposed method also provides confidence score maps, assisting medical practitioners to understand the models' decision-making process. Experiments in OCT2017 and OCT-C8 reveal that the proposed method outperforms both the convolutional neural network approach and ViT, with an accuracy of 99.80% and an AUC of 99.99%.
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Retinopatia Diabética , Edema Macular , Doenças Retinianas , Humanos , Tomografia de Coerência Óptica , RetinaRESUMO
Aggressive behavior of drug addicts threatens human security and social stability, and Methamphetamine (MA) addicts show especially aggressive behavior. Researches showed that the decreased activity of dorsolateral prefrontal cortex (DLPFC) is closely related to violence and aggression, and continuous transcranial direct current stimulation (tDCS) on DLPFC can increase the activity of this position. So, the purpose of this study was to investigate the effect of tDCS on DLPFC for the aggressive behavior of MA addicts. Ninety MA addicts were recruited and randomly divided into anodal tDCS group, cathode tDCS group and sham tDCS group (current intensity was set as 2 mA, 2 mA and 0 mA, respectively). The tDCS intervention was conducted twice a day for five consecutive days. Taylor Aggression Paradigm (TAP) was used to measure the proactive aggressiveness and reactive aggressiveness of MA addicts at different time points (Pretest, Day 1, and Day 5). At the same time, we also recruited 30 healthy adult males as healthy controls, and measured their aggressiveness through TAP for comparative analysis. The results showed that the aggressiveness of MA addicts was significantly higher than that of healthy controls. The aggressiveness of MA addicts was effectively reduced by the anode intervention of tDCS on the left DLPFC, especially when they were subjected to high-intensity provocation, the 2-way interaction between time and tDCS group was statistically significant (F4,164 = 2.939, P = 0.022, ηp2 = 0.067). This study can provide a reference for how to correct the aggressive behavior of MA addicts.
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Estimulação Transcraniana por Corrente Contínua , Adulto , Humanos , Masculino , Agressão , Córtex Pré-Frontal Dorsolateral , Método Duplo-Cego , Córtex Pré-Frontal/fisiologia , Estimulação Transcraniana por Corrente Contínua/métodos , ViolênciaRESUMO
Observational studies have shown an association between liver dysfunction and hepatocellular carcinoma (HCC), but the causality relationship between them is unclear. We aimed to determine whether there is a bidirectional causal relationship between liver function indicators (alanine aminotransferase, ALT; aspartate aminotransferase, AST; alkaline phosphatase, ALP; γ-glutamyltransferase, GGT) and HCC. Our two-sample Mendelian randomization (MR) study acquired single nucleotide polymorphisms (SNPs) associated with liver function indicators (ALT, n = 134,182; AST, n = 134,154; GGT, n = 118,309; ALP, n = 105,030) and with HCC (n = 197,611) from publicly available genome-wide association studies (GWAS) of East Asian ancestry in Japan (BioBank Japan, BBJ). Univariable MR analyses were performed to identify whether the genetic evidence of exposure was significantly associated with outcome. Multivariable MR analysis was conducted to estimate the independent effects of exposures on outcome. Univariable MR analysis indicated that the level of ALT, AST, and GGT was the risk factor for HCC incidence. Meanwhile, multivariable MR analysis revealed that AST was an independent risk factor for HCC. The hazard ratio (HR) of the probability of HCC was 3.045 [95% confidence interval (95%CI), 1.697-5.463, p = 0.003] for AST. The results of reverse MR analyses showed that gene-predictive HCC incidence could increase the levels of AST (HR = 1.031, 95%CI: 1.009-1.054, p = 2.52 × 10-4) and ALT (HR = 1.040, 95%CI: 1.019-1.063, p = 0.005). Meanwhile, HCC may be negatively correlated with ALP levels (HR = 0.971, 95%CI: 0.947-0.995, p = 0.018). This study provides evidence to support that genetically predicted higher levels of AST are related to increased risk of HCC, with no strong evidence of a causal effect of genetically predicted ALP, ALP, and GGT on HCC. In addition, genetic predisposition to HCC could influence blood concentration of ALT, AST, and ALP. Thus, this may create a vicious cycle.
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Objectives: Postcontrast magnetic resonance imaging (MRI) is important for the differentiation between low-grade (WHO I) and high-grade (WHO II/III) meningiomas. However, nephrogenic systemic fibrosis and cerebral gadolinium deposition are major concerns for postcontrast MRI. This study aimed to develop and validate an accessible risk-scoring model for this differential diagnosis using the clinical characteristics and radiological features of precontrast MRI. Methods: From January 2019 to October 2021, a total of 231 meningioma patients (development cohort n = 137, low grade/high grade, 85/52; external validation cohort n = 94, low-grade/high-grade, 60/34) were retrospectively included. Fourteen types of demographic and radiological characteristics were evaluated by logistic regression analyses in the development cohort. The selected characteristics were applied to develop two distinguishing models using nomograms, based on full MRI and precontrast MRI. Their distinguishing performances were validated and compared using the external validation cohort. Results: One demographic characteristic (male), three precontrast MRI features (intratumoral cystic changes, lobulated and irregular shape, and peritumoral edema), and one postcontrast MRI feature (absence of a dural tail sign) were independent predictive factors for high-grade meningiomas. The area under the receiver operating characteristic (ROC) curve (AUC) values of the two distinguishing models (precontrast-postcontrast nomogram vs. precontrast nomogram) in the development cohort were 0.919 and 0.898 and in the validation cohort were 0.922 and 0.878. DeLong's test showed no statistical difference between the AUC values of the two distinguishing models (p = 0.101). Conclusions: An accessible risk-scoring model based on the demographic characteristics and radiological features of precontrast MRI is sufficient to distinguish between low-grade and high-grade meningiomas, with a performance equal to that of a full MRI, based on radiological features.
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Drug addiction is a common problem worldwide. Research has shown adverse childhood experiences (ACEs) to be an important factor related to drug addiction. However, there are few studies on how ACEs lead to drug addiction and the role of resilience and depression in this process. Thus, the main purposes of the study were to determine the proportion of those with adverse childhood experiences who take drugs in adulthood and how resilience and depression affect this relationship. The results showed that (1) greater severity of ACEs made individuals more likely to take drugs; (2) ACEs were positively correlated with depression, and resilience was negatively correlated with ACEs and depression; and (3) ACEs not only affected drug addiction through resilience or depression alone but also through the combined action of resilience and depression, indicating that depression led to drug addiction while resilience weakened the effect of ACEs on depression and drug addiction. Furthermore, in the serial mediation model, abuse, neglect, and family dysfunction were significant predictors of drug addiction. Our results are encouraging in that they provide guidance in understanding the complex relationships among ACEs, resilience, depression, and drug addiction.
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This study is to investigate the computed tomography (CT) image quality of the low- tube-voltage protocol with low contrast agent dose.CT portography was performed in 118 cirrhosis patients with body mass index (BMI) less than 25âkg/m under 2 protocols: Protocol A, tube voltage of 90âkVp/395 mAs and contrast agent dosage of 1.2âmL/kg, and, Protocol B, tube voltage of 120âkVp/200 mAs and contrast agent dosage of 1.5âmL/kg.The number of patients in each protocol was 59. The CT value noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) in portal veins was comparatively analyzed between the 2 protocols. The subjective image quality was further assessed on 5-point scales. Radiation dose was also recorded and statistical analysis was performed.The CT value, CNR, and SNR of the images were higher at 90âkVp than those at 120âkVp (Pâ<â.05). There was no significant difference in image noise between the 2 protocols (Pâ>â.05). The CT dose index volume, dose-length product, and effective dose at 90 kVp were 18.2%, 16.0%, and 16.0% less than that at 120âkVp, respectively. There was no difference in image quality score between the 2 protocols (Pâ>â.05). The average amount of contrast agent was decreased by 17.8% when the 90âkVp protocol was used.CT portography at 90âkVp combined with low-dosage contrast agent leads to a significant reduction in radiation dose and improved SNR and CNR, without deterioration of image quality.
Assuntos
Índice de Massa Corporal , Meios de Contraste/administração & dosagem , Iohexol/administração & dosagem , Cirrose Hepática/diagnóstico por imagem , Portografia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Relação Dose-Resposta a Droga , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doses de Radiação , Interpretação de Imagem Radiográfica Assistida por Computador/métodosRESUMO
OBJECTIVE: To explore the relationship between alterations in gliomas revealed by diffusional kurtosis imaging (DKI) and the histopathological microstructural changes. METHODS: Thirty-seven patients with cerebral gliomas underwent conventional MRI and DKI at 3.0T. Normalized fractional anisotropy (FA), mean diffusivity (MD) and mean kurtosis (MK) were compared in different regions of glioma tumors. Parameters with a high sensitivity and specificity regarding the discrimination of glioma grade were evaluated using receiver operating characteristic (ROC) curve analysis. Correlations between normalized FA, MD, and MK and histopathological findings (tumor cell density, total vascular area [TVA], and Ki-67 labeling index [LI]) were assessed using Pearson correlation analyses. RESULTS: Normalized FA, MD, and MK differed significantly between low-grade gliomas (LGGs) and high-grade gliomas (HGGs) (P=0.02, P=0.001 and P<0.001, respectively) at the center of the tumor. Normalized MK exhibited the highest sensitivity (80%) and specificity (100%) in distinguishing HGGs from LGGs. Relative to the tumor center, normalized MK was significantly increased in the tumor periphery (P<0.001) in LGGs and significantly decreased (P=0.002) in HGGs. The significant correlations were found between normalized MK and all histopathological findings (tumor cell density: r=0.596, P=0.006; TVA: r=0.764, P<0.001; and Ki-67 LI: r=0.766, P<0.001) among samples from the center of the tumor. CONCLUSION: DKI, especially concerning the MK parameter, demonstrated high sensitivity in the detection of microstructural changes in patients with brain gliomas.