Safety and Technical Feasibility of Percutaneous Renal Cryoablation of Central Tumors without Pyeloperfusion.

PURPOSE: To assess the safety and technical success of percutaneous cryoablation (PCA) without pyeloperfusion in 94 patients with central renal tumors. MATERIALS AND METHODS: A retrospective review of all central renal tumors treated by PCA without pyeloperfusion was performed. Central tumors were defined as those involving the renal sinus fat on preprocedural cross-sectional imaging. Patient demographics and baseline tumor characteristics were recorded. The details of the PCA procedure, primary and secondary technical success, rates of local recurrence, adverse events (AEs), cancer-specific survival (CSS), and overall survival (OS) were compiled. RESULTS: Ninety-four patients (48 females [51%]; mean age, 68.2 years [range, 38-87 years]) with 94 central renal tumors were included. The mean maximal tumor diameter and mean RENAL nephrometry score were 37 mm (range, 15-67 mm) and 8 (range, 4-11), respectively. Primary technical success was achieved in 94% (n = 88) of procedures. Of the patients who did not achieve primary technical success, 3 underwent successful repeat PCA (secondary technical success, 97%; n = 91/94). The other 3 patients were surveilled for residual disease. Twenty-four patients (26%) required hydrodissection during PCA. Six patients (6%) experienced major AEs after PCA including hemorrhage requiring embolization (n = 3), hemorrhage requiring transfusions with admission (n = 2), and perinephric abscess necessitating drain placement (n = 1). Twenty-two patients (23%) experienced minor AEs. Nine patients (10%) experienced local recurrence during the follow-up period. OS was 94% (n = 88/94), whereas CSS was 98% (n = 92/94) during the study follow-up period (mean, 16 months [range, 1-102 months]). CONCLUSIONS: PCA of central renal tumors appears to be safe with high rates of technical success, even without the use of pyeloperfusion.

Utility of the RENAL Nephrometry Scoring System in Predicting Adverse Events and Outcomes of Percutaneous Microwave Ablation of Renal Tumors.

PURPOSE: To assess the utility of the radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, and location relative to polar lines (RENAL) nephrometry scoring system at predicting adverse events and outcomes in percutaneous microwave ablation (MWA) of renal tumors. MATERIALS AND METHODS: A retrospective review of 116 patients who underwent MWA from 2004 to 2018 at 2 large university hospitals was conducted. Patient demographics and tumor characteristics were collected. The RENAL nephrometry scores were calculated, and procedure-related adverse events were stratified into minor and major (the Society of Interventional Radiology classification of class C or higher). Technical and oncologic outcomes were based on follow-up magnetic resonance imaging and computed tomography scans after ablation. RESULTS: The mean RENAL score was 6.6 (range, 4-11), and the mean tumor size was 24 mm. Follow-up ranged between 16 and 161 weeks (median, 50 weeks; mean, 65 weeks). Oncologic control was achieved in 96% (n = 111) of patients. The major and minor adverse event rates were 8.6% (n = 10) and 17% (n = 19), respectively. The mean RENAL score for patients with recurrent and/or residual tumor (8.2 ± 2.7) was higher than that for patients without disease recurrence (6.5 ± 3.5, P = .05). However, in a multivariate analysis, the RENAL score was not found to be an independent predictor of oncologic outcomes (odds ratio, 1.548; P = .092). CONCLUSIONS: The RENAL nephrometry score has minimal utility for predicting outcomes and adverse events in MWA of renal tumors. The inconsistent nature of RENAL nephrometry scoring in percutaneous ablation procedures underscores the need for an ablation-specific risk stratification system.

External Validation of the Percutaneous Renal Ablation Complexity Scoring System in Patients Undergoing Percutaneous Cryoablation or Microwave Ablation of Renal Tumors.

PURPOSE: To assess the ability of the Percutaneous Renal Ablation Complexity (P-RAC) scoring system to predict procedural complexity or adverse events (AEs) in adult patients undergoing percutaneous thermal ablation of renal tumors. MATERIALS AND METHODS: A retrospective review of 240 consecutive adult patients who underwent percutaneous thermal renal ablation from 2004 to 2018 was conducted. The P-RAC score was calculated for each renal tumor and procedural complexity recorded. A correlation coefficient was calculated for the P-RAC score and both the number of probes used and procedural duration. Receiver operating characteristic curves assessed the score's ability to predict the use of adjunctive techniques and/or major AEs, classified according to the Society of Interventional Radiology guidelines. RESULTS: For the entire cohort, there was a weak correlation between P-RAC scores and both the number of probes used (r = 0.31; P < .001) and procedural duration (r = 0.18; P = .03). When evaluating only patients treated with microwave ablation (MWA), no correlation between P-RAC scores and either the number of probes (P = .7) used or procedural duration (P = .4) was found. The area under the curve (AUC) for the P-RAC score to predict the use of adjunctive techniques was 0.55 and 0.53 for the entire cohort and MWA group, respectively. The AUC for the P-RAC score to predict major AEs was 0.70, 0.71, and 0.73 for the entire cohort, MWA group, and cryoablation group, respectively. CONCLUSIONS: The P-RAC scoring system is limited in its ability to predict percutaneous thermal renal tumor ablation procedural complexity, especially in patients treated with MWA. The scoring system may have a role in identifying patients at risk of major AEs.

BND-VGG-19: A deep learning algorithm for COVID-19 identification utilizing X-ray images.

During the past two years, a highly infectious virus known as COVID-19 has been damaging and harming the health of people all over the world. Simultaneously, the number of patients is rising in various countries, with many new cases appearing daily, posing a significant challenge to hospital medical staff. It is necessary to improve the efficiency of virus detection. To this end, we combine modern technology and visual assistance to detect COVID-19. Based on the above facts, for accurate and rapid identification of infected persons, the BND-VGG-19 method was proposed. This method is based on VGG-19 and further incorporates batch normalization and dropout layers between the layers to improve network accuracy. Then, the COVID-19 dataset including viral pneumonia, COVID-19, and normal X-ray images, are used to diagnose lung abnormalities and test the performance of the proposed algorithm. The experimental results show the superiority of BND-VGG-19 with a 95.48% accuracy rate compared with existing COVID-19 diagnostic methods.

Percutaneous Retrieval of Venous Bullet Embolism.

PURPOSE: Bullet fragment embolization is a rare but potentially fatal complication of traumatic gunshot injury. Herein, we present a case of a patient who demonstrated migration of a bullet fragment from the lower chest into the left common iliac vein. Continual identification of foreign bodies on trauma imaging is of the utmost importance. Identifying and treating this rare entity can help vascular interventionalists improve patient outcomes. CASE REPORT: Our patient presented to the emergency room after sustaining 2 gunshot wounds to the right axilla. Initial imaging demonstrated 2 bullet fragments: one in the right axilla and another in the lower chest overlying the heart. A subsequent trauma computed tomography was performed 13 minutes later and demonstrated a bullet fragment in the left common iliac vein, which had embolized from the original location in the lower chest. Interventional radiology was consulted to perform foreign body removal. A transcutaneous approach was utilized, and the bullet embolus was removed successfully without complication. CONCLUSION: Bullet fragment embolization is a rare entity with complications ranging from critical limb ischemia to venous thrombosis or obstruction. This case helps to demonstrate the importance of identifying and accounting for bullet fragments in gunshot trauma imaging.

Long noncoding RNA SNHG16 contributes to the development of bladder cancer via regulating miR-98/STAT3/Wnt/ß-catenin pathway axis.

This study aimed to investigate the role and the possible mechanism of the long noncoding small nucleolar RNA host gene 16 (SNHG16) in bladder cancer development. The expression of SNHG16 in the tumor tissues and plasma of patients with bladder cancer as well as bladder cancer cell lines was detected. T24 cells were then transfected with sh-SNHG16 to further investigate the effects of suppression of SNHG16 on T24 cell proliferation, apoptosis, migration, and invasion. In addition, the regulatory relationships between SNHG16 and miR-98 as well as the target of miR-98 were explored. Besides, the association between SNHG16 and the Wnt/ß-catenin pathway was further elucidated. The SNHG16 expression was upregulated in the tumor tissues and plasma of patients with bladder cancer, as well as bladder cancer cells. Suppression of SNHG16 inhibited T24 cell proliferation, promoted apoptosis, and suppressed migration and invasion in vitro. In addition, SNHG16 negatively regulated miR-98 expression and regulated the malignant behaviors of T24 cells through sponging miR-98. Moreover, signal transducer and activator of transcription 3 (STAT3) was identified as a functional target of miR-98, and miR-98 regulated the malignant behaviors of bladder cancer cells by targeting STAT3. Besides, suppression of SNHG16 inhibited the activation of the Wnt/ß-catenin pathway, which was further regulated by miR-98 and STAT3, indicating that the effects of SNHG16/miR-98/STAT3 on T24 cells were achieved through the Wnt/ß-catenin pathway. Our findings reveal that long noncoding RNAs SNHG16 is upregulated in bladder cancer and contributes to the development of bladder cancer possibly via regulating the miR-98/STAT3/Wnt/ß-catenin pathway axis. The SNHG16/miR-98/STAT3/Wnt/ß-catenin pathway axis may provide a new strategy for bladder cancer treatment.

Intraosseous pseudomeningocele of the mobile spine: a case report and review of the literature.

BACKGROUND: Pseudomeningoceles most commonly occur due to prior trauma or surgery and are often located in the posterior paraspinous tissues. Here, we report a case of an intraosseous pseudomeningocele that mimicked an intra-osseous T2 hyperintense lesion in the L1 vertebral body. CASE DESCRIPTION: A 64-year-old male presented with back, left lateral thigh and left knee pain lasting several months. He had no prior history of trauma or surgery. Radiographs of the lumbar spine showed mild levoscoliotic curvature of the lumbar spine, Baastrup's changes between the spinous processes, multilevel degenerative disc disease and facet arthropathy. Magnetic resonance imaging (MRI) of the lumbar spine performed without intravenous contrast showed severe spinal canal stenosis from L1-L2 to L3-L4 and moderate spinal canal stenosis at L4-L5. MRI also showed a 2.5-cm T2 hyperintense lesion involving the posterior aspect of the L1 vertebral body, with questionable contiguity with cerebrospinal fluid. Computed tomography (CT) myelogram was performed instead of biopsy. CT myelogram showed contiguity of the lesion with the intrathecal contrast and a rent in the posterior longitudinal ligament and anterior dura consistent with an intraosseous pseudomeningocele. The patient opted for non-operative management of the pseudomeningocele and his lumbar stenosis due to medical comorbidities. CONCLUSIONS: This case illustrates a rare case of an intra-osseous pseudomeningocele and highlights the importance of CT myelogram for diagnosis.

Percutaneous Cryoablation of the Horseshoe Kidney: An Initial Experience.

Between June 2006 and January 2016, 6 renal cryoablation procedures were performed in 5 patients with horseshoe kidneys. Renal cell carcinoma (RCC) accounted for 5 of the tumors, and the sixth was a carcinoid tumor. All 6 procedures were technically successful. The patient with the carcinoid tumor developed local tumor progression 38 months after ablation. Technique effectiveness was achieved in all 5 patients with RCC. Two complications occurred: obstructive hematuria and transient inguinal neuralgia after ablation. In this small initial experience, percutaneous cryoablation appears feasible in treatment of primary tumors in horseshoe kidneys.

Biochemical and biophysical investigation of the brain-derived neurotrophic factor mimetic 7,8-dihydroxyflavone in the binding and activation of the TrkB receptor.

7,8-dihydroxyflavone (7,8-DHF), a newly identified small molecular TrkB receptor agonist, rapidly activates TrkB in both primary neurons and the rodent brain and mimics the physiological functions of the cognate ligand BDNF. Accumulating evidence supports that 7,8-DHF exerts neurotrophic effects in a TrkB-dependent manner. Nonetheless, the differences between 7,8-DHF and BDNF in activating TrkB remain incompletely understood. Here we show that 7,8-DHF and BDNF exhibit different TrkB activation kinetics in which TrkB maturation may be implicated. Employing two independent biophysical approaches, we confirm that 7,8-DHF interacts robustly with the TrkB extracellular domain, with a Kd of ∼10 nm. Although BDNF transiently activates TrkB, leading to receptor internalization and ubiquitination/degradation, in contrast, 7,8-DHF-triggered TrkB phosphorylation lasts for hours, and the internalized receptors are not degraded. Notably, primary neuronal maturation may be required for 7,8-DHF but not for BDNF to elicit the full spectrum of TrkB signaling cascades. Hence, 7,8-DHF interacts robustly with the TrkB receptor, and its agonistic effect may be mediated by neuronal development and maturation.

Ribosomal protein S7 regulates arsenite-induced GADD45α expression by attenuating MDM2-mediated GADD45α ubiquitination and degradation.

The stress-responding protein, GADD45α, plays important roles in cell cycle checkpoint, DNA repair and apoptosis. In our recent study, we demonstrate that GADD45α undergoes a dynamic ubiquitination and degradation in vivo, which process can be blocked by the cytotoxic reagent, arsenite, resulting in GADD45α accumulation to activate JNKs cell death pathway, thereby revealing a novel mechanism for the cellular GADD45α functional regulation. But the factors involved in GADD45α stability modulations are unidentified. Here, we demonstrated that MDM2 was an E3 ubiquitin ligase for GADD45α. One of MDM2-binding partner, ribosomal protein S7, interacted with and stabilized GADD45α through preventing the ubiquitination and degradation of GADD45α mediated by MDM2. This novel function of S7 is unrelated to p53 but seems to depend on S7/MDM2 interaction, for the S7 mutant lacking MDM2-binding ability lost its function to stabilize GADD45α. Further investigations indicated that arsenite treatment enhanced S7-MDM2 interaction, resulting in attenuation of MDM2-dependent GADD45α ubiquitination and degradation, thereby leading to GADD45α-dependent cell death pathway activation. Silencing S7 expression suppressed GADD45α-dependent cytotoxicity induced by arsenite. Our findings thus identify a novel function of S7 in control of GADD45α stabilization under both basal and stress conditions and its significance in mediating arsenite-induced cellular stress.

Mediator of ERBB2-driven cell motility (MEMO) promotes extranuclear estrogen receptor signaling involving the growth factor receptors IGF1R and ERBB2.

In addition to nuclear estrogen receptor (ER) acting as a transcription factor, extranuclear ER also plays an important role in cancer cell growth regulation through activation of kinase cascades. However, the molecular mechanisms by which extranuclear ER exerts its function are still poorly understood. Here, we report that mediator of ERBB2-driven cell motility (MEMO) regulates extranuclear functions of ER. MEMO physically and functionally interacted with ER. Through its interaction with the growth factor receptors IGF1R and ERBB2, MEMO mediated extranuclear functions of ER, including activation of mitogen-activated protein kinase (MAPK) and protein kinase B/AKT, two important growth regulatory protein kinases, and integration of function with nuclear ER. Activation of MAPK and AKT was responsible for MEMO modulation of ER phosphorylation and estrogen-responsive gene expression. Moreover, MEMO increased anchorage-dependent and -independent growth of ER-positive breast cancer cells in vitro and was required for estrogen-induced breast tumor growth in nude mice. Together, our studies identified MEMO as a new component of extranuclear ER signalosome and suggest an essential role for MEMO in the regulation of ER-positive breast cancer cell growth.

The telomere/telomerase binding factor PinX1 is a new target to improve the radiotherapy effect of oesophageal squamous cell carcinomas.

Chemoradiotherapy (CRT) is a standard treatment for oesophageal squamous cell carcinoma (ESCC) in its advanced stages. The telomerase/telomere interacting protein PinX1 contributes to telomere maintenance, tumourigenicity, and influences the DNA damage agent-induced apoptotic response in telomerase-positive cancer cells. However, the clinical and biological significance of PinX1 in human ESCCs remains unclear. We examined the expression dynamics of PinX1 by immunohistochemistry in a learning cohort (n = 98) and a validation cohort (n = 59) of ESCC patients treated with definite chemoradiotherapy (CRT). A series of in vivo and in vitro assays were performed to elucidate the effect of PinX1 on ESCC cells' CRT response and underlying mechanisms. Knockdown of PinX1 did not affect ESCC cells' chemosensitivities to 5-fluorouracil and cisplatin, but substantially increased ESCC cells' therapeutic efficacy of radiation both in vitro and in vivo. Ectopic overexpression of PinX1 dramatically enhanced ESCC cells' resistance to radiotherapy. Furthermore, we demonstrated that PinX1 resistance to radiotherapy (RT) was attributed to PinX1 maintaining telomere stability, reducing ESCC cell death by RT-induced mitosis catastrophe (MC). High expression of Pinx1 correlated positively with ESCC's resistance to CRT, and was a strong and independent predictor for short disease-specific survival (DSS) of ESCC patients. Our data suggest that PinX1 could serve as a novel predictor for a CRT response to ESCC patients, and the pathway of PinX1-mediated telomere stability might represent a new target to improve the RT effect of ESCC.

Gastrostomy Exchange With Displacement Into the Jejunum.

A 54-year-old female with a gastrostomy tube presented with persistent nausea, vomiting, and abdominal pain. On physical examination, the gastrostomy tube was completely advanced into the abdominal cavity with only the external retention ring and hub on the exterior. The first step in the workup was obtaining a scout radiograph. This imaging was appropriate to show the location of the gastrostomy catheter which was overlying the left upper quadrant. The distal tip was heading in the direction of the left lower quadrant. The course of the gastrostomy catheter did not follow the expected direction of the duodenal C-loop. Proceeding forward, contrast was injected through the existing catheter which showed opacification of the jejunal bowel loops. The patient could now be properly diagnosed with gastroenteric intussusception and proper measures could be taken. Following the injected contrast showing jejunal opacification, a stiff Glidewire was advanced through the existing catheter all the way into the jejunum. Deflation of the balloon and removal of the catheter caused an almost instantaneous change in the course of the Glidewire to the more conventional path following the course of the duodenal C-loop. A sheath was then advanced over the wire which was now shown crossing the midline in the proper gastroduodenojejunal course. The final step was to advance a new 22-French MIC gastrostomy catheter over the Glidewire. The contrast was then injected to demonstrate proper opacification of the rugal folds and gastric fundus. The patient reported an immediate resolution of symptoms and was later discharged.