Diagnostic value of contrast-enhanced ultrasound in hepatic epithelioid hemangioendothelioma / 中华肝脏病杂志

Objective: To investigate the features of contrast-enhanced ultrasound (CEUS) in hepatic epithelioid hemangioendothelioma (HEHE) in order to improve the preoperative diagnosis rate. Methods: CEUS images of 32 pathologically-proven cases of hepatic epithelioid hemangioendothelioma from January 2004 to August 2021 were collected. Lesions were analyzed to observe the features of enhancement mode, enhancement intensity, and distinct enhancement phases. Results: Among the 32 cases, one had a solitary lesion, 29 had multiple lesions, and two had diffuse-type lesions. Contrast-enhanced ultrasound revealed a total of 42 lesions in 32 cases. In terms of arterial phase enhancement, 18 lesions had overall enhancement, six lesions had uneven dendritic enhancement, 16 lesions had rim-like enhancement, and two lesions had just slight peripheral spot enhancement around the lesions. Among the three cases, there were multiple lesions that had overall enhancement and ring enhancement. In terms of the enhancement phase, 20 lesions showed "fast progression", 20 lesions showed "same progression", and two lesions showed "slow progression". During the late arterial or early portal venous phases with rapid washout, all lesions manifested as hypoechoic. With peaked enhanced intensity, 11 lesions had a lower enhancement intensity than the surrounding normal liver parenchyma; 11 lesions had the same enhancement degree as the surrounding normal liver parenchyma; and 20 lesions had a higher enhancement degree than the surrounding normal liver parenchyma. All 16 ring-enhancing lesions had marked hyperenhancement. In the typical enhancing lesions, four showed hyperenhancement, five showed low enhancement, and nine showed isoenhancement. In the dendrite-enhancing lesions, there were two isoenhancing and four hypoenhancing. Contrast-enhanced ultrasound delineated the boundaries of all lesions more clearly than two-dimensional ultrasound. Conclusion: Contrast-enhanced ultrasound has certain value in the diagnosis of hepatic epithelioid hemangioendothelioma.

Advances in Molecular Targeted Ultrasound Contrast Agents / 中国医学科学院学报

In real-time ultrasound,molecular targeted contrast agent is introduced into the blood circulation through peripheral intravenous injection to enhance the imaging signal of target lesions after binding to the corresponding intravascular receptors,which can realize early diagnosis,staging of diseases,assessment of treatment response,and targeted treatment.In addition,molecular targeted ultrasound contrast agents provide a platform for the delivery of drugs and genes via microbubbles,and nanoscale contrast agents can be infiltrated through vascular endothelium into the interstitial space of the lesion for imaging or treatment.The available studies of molecular targeted ultrasound contrast agents mainly focus on the preclinical trials.Some clinical trials have been conducted in humans and preliminarily confirm the safety and feasibility of targeted ultrasound contrast agents.The molecular targeted ultrasound contrast agents enjoy a broad prospect in clinical application.

Research progress on animal models of contrast-induced acute kidney injury / 中南大学学报(医学版)

Contrast-induced acute kidney injury (CI-AKI) refers to acute kidney injury that occurs after intravascular contrast media is applied. It is the third most common cause for acute renal failure in hospitalized patients and can cause severe renal impairment and adverse cardiovascular outcomes. In severe cases, it can even lead to the death of the patient. Due to its complicated pathogenesis, the pathogenesis of CI-AKI has not yet been elucidated. Therefore, it is of great significance to further study the pathogenesis for the prevention of CI-AKI. Moreover, a good animal model of CI-AKI is an important tool for in-depth research on the pathogenesis of acute kidney injury induced by contrast agents.

Genetic analysis of a Chinese pedigree affected with Mucopolysaccharidosis type ⅢA / 中华医学遗传学杂志

OBJECTIVE@#To explore the clinical and genetic characteristics of a patient with hypertrophic cardiomyopathy as the initial manifestation of Mucopolysaccharidosis type Ⅲ A (MPS Ⅲ A).@*METHODS@#A female patient with MPS Ⅲ A who was admitted to the Affiliated Hospital of Jining Medical University in January 2022 and her family members (seven individuals from three generations) were selected as the study subjects. Clinical data of the proband were collected. Peripheral blood samples of the proband was collected and subjected to whole exome sequencing. Candidate variants were verified by Sanger sequencing. Heparan-N-sulfatase activity was determined for the disease associated with the variant site.@*RESULTS@#The proband was a 49-year-old woman, for whom cardiac MRI has revealed significant thickening (up to 20 mm) of left ventricular wall and delayed gadolinium enhancement at the apical myocardium. Genetic testing revealed that she has harbored compound heterozygous variants in exon 17 of the SGSH gene, namely c.545G>A (p.Arg182His) and c.703G>A (p.Asp235Asn). Based on guidelines from the American College of Medical Genetics and Genomics (ACMG), both variants were predicted to be pathogenic (PM2_Supporting +PM3+PP1Strong+PP3+PP4; PS3+PM1+PM2_Supporting +PM3+PP3+PP4). Sanger sequencing confirmed that her mother was heterozygous for the c.545G>A (p.Arg182His) variant, whilst her father, sisters and her son were heterozygous for the c.703G>A (p.Asp235Asn) variant. Determination of blood leukocyte heparan-N-sulfatase activity suggested that the patient had a low level of 1.6 nmol/(g·h), whilst that of her father, elder and younger sisters and son were all in the normal range.@*CONCLUSION@#The compound heterozygous variants of the SGSH gene probably underlay the MPS ⅢA in this patient, for which hypertrophic cardiomyopathy is an associated phenotype.

Relationship of Microvascular Obstruction with Global and Regional Myocardial Function Determined by Cardiac Magnetic Resonance after ST-Segment Elevation Myocardial Infarction / 中国医学科学杂志(英文版)

Objective To investigate the impact of microvascular obstruction (MVO) on the global and regional myocardial function by cardiac magnetic resonance feature-tracking (CMR-FT) in ST-segment-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention.Methods Consecutive acute STEMI patients who underwent cardiac magnetic resonance imaging 1 - 7 days after successful reperfusion by percutaneous coronary intervention treatment were included in this retrospective study. Based on the presence or absence of MVO on late gadolinium enhancement images, patients were divided into groups with MVO and without MVO. The infarct zone, adjacent zone, and remote zone were determined based on a myocardial 16-segment model. The radial strain (RS), circumferential strain (CS), and longitudinal strain (LS) of the global left ventricle (LV) and the infarct, adjacent, and remote zones were measured by CMR-FT from cine images and compared between patients with and without MVO using independent-samples t-test. Logistic regression analysis was used to assess the association of MVO with the impaired LV function.Results A total of 157 STEMI patients (mean age 56.66 ± 11.38 years) were enrolled. MVO was detected in 37.58% (59/157) of STEMI patients, and the mean size of MVO was 3.00 ±3.76 mL. Compared with patients without MVO (n =98 ), the MVO group had significantly reduced LV global RS (t= -4.30, P < 0.001), global CS (t= 4.99, P < 0.001), and global LS ( t= 3.51, P = 0.001). The RS and CS of the infarct zone in patients with MVO were significantly reduced (t= -3.38, P = 0.001; t= 2.64, P = 0.01; respectively) and the infarct size was significantly larger (t= 8.37, P < 0.001) than that of patients without MVO. The presence of LV MVO [OR= 4.10, 95%CI: 2.05 - 8.19, P<0.001) and its size [OR=1.38, 95%CI: 1.10-1.72, P=0.01], along with the heart rate and LV infarct size were significantly associated with impaired LV global CS in univariable Logistic regression analysis, while only heart rate (OR=1.08, 95%CI: 1.03 - 1.13, P=0.001) and LV infarct size (OR=1.10, 95%CI: 1.03 - 1.16, P=0.003) were independent influencing factors for the impaired LV global CS in multivariable Logistic regression analysis.Conclusion The infarct size was larger in STEMI patients with MVO, and MVO deteriorates the global and regional LV myocardial function.

Multiparametric ultrasound for the assessment of testicular lesions with negative tumoral markers / 亚洲男科学杂志(英文版)

The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.

The value of cardiac MRI in the risk stratification in patients with hypertrophic cardiomyopathy / 中华心血管病杂志

Objective: To explore the value of cardiac magnetic resonance imaging (CMR) in the risk stratification of hypertrophic cardiomyopathy (HCM). Methods: HCM patients who underwent CMR examination in Fuwai Hospital between March 2012 and May 2013 were retrospectively enrolled. Baseline clinical and CMR data were collected and patient follow-up was performed using telephone contact and medical record. The primary composite endpoint was sudden cardiac death (SCD) or and equivalent event. The secondary composite endpoint was all-cause death and heart transplant. Patients were divided into SCD and non-SCD groups. Cox regression was used to explore risk factors of adverse events. Receiver operating characteristic (ROC) curve analysis was used to assess the performance and the optimal cut-off of late gadolinium enhancement percentage (LGE%) for the prediction of endpoints. Kaplan-Meier and log-rank tests were used to compare survival differences between groups. Results: A total of 442 patients were enrolled. Mean age was (48.5±12.4) years and 143(32.4%) were female. At (7.6±2.5) years of follow-up, 30 (6.8%) patients met the primary endpoint including 23 SCD and 7 SCD equivalent events, and 36 (8.1%) patients met the secondary endpoint including 33 all-cause death and 3 heart transplant. In multivariate Cox regression, syncope(HR=4.531, 95%CI 2.033-10.099, P<0.001), LGE% (HR=1.075, 95%CI 1.032-1.120, P=0.001) and left ventricular ejection fraction (LVEF) (HR=0.956, 95%CI 0.923-0.991, P=0.013) were independent risk factors for primary endpoint; Age (HR=1.032, 95%CI 1.001-1.064, P=0.046), atrial fibrillation (HR=2.977, 95%CI 1.446-6.131, P=0.003),LGE% (HR=1.075, 95%CI 1.035-1.116, P<0.001) and LVEF (HR=0.968, 95%CI 0.937-1.000, P=0.047) were independent risk factors for secondary endpoint. ROC curve showed the optimal LGE% cut-offs were 5.1% and 5.8% for the prediction of primary and secondary endpoint, respectively. Patients were further divided into LGE%=0, 0<LGE%<5%, 5%≤LGE%<15% and LGE%≥15% groups. There were significant survival differences between these 4 groups whether for primary endpoint or secondary endpoint (all P<0.001) and the accumulated incidence of primary endpoint was 1.2% (2/161), 2.2% (2/89), 10.5% (16/152) and 25.0% (10/40), respectively. Conclusion: LGE is an independent risk factor for SCD events as well as all-cause death and heart transplant. LGE is of important value in the risk stratification in patients with HCM.

Radiación y medios de contraste en embarazo y lactancia: lo que el clínico necesita saber / Radiation and contrast media in pregnancy and lactation: what the clinician needs to know

Introducción: el uso de técnicas de imagenología es habitual e incluso indispensable en algunos procesos diagnósticos. Sin embargo, su indicación en mujeres embarazadas y en período de lactancia es controvertida. Objetivo: presentar una revisión narrativa sobre los riesgos asociados al uso de imágenes con radiación y medio de contraste en embarazo y periodo de lactancia, con énfasis en las recomendaciones y aplicaciones clínicas que el médico tratante debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de la literatura relevante sobre los riesgos y consideraciones especiales del uso de medios de contraste en el embarazo y lactancia. Resultados: los riesgos de la radiación ionizante sobre el feto varían de acuerdo al estadio del embarazo, por lo que la indicación del estudio debe ponderar los riesgos y beneficios. En las dosis clínicas en embarazo y lactancia, el uso de contraste yodado como basados en gadolinio no tienen efectos deletéreos en la salud de la madre ni la del feto. Sin embargo, las sociedades internacionales recomiendan limitar su uso. Conclusión: si bien la indicación de estudios de imagen que utilizan radiación ionizante en el embarazo y lactancia es seguro, el médico clínico debe conocer los posibles riesgos de la radiación ionizante en este grupo de pacientes. Respecto a los medios de contraste, el único efecto adverso reportado es la disfunción tiroidea transitoria en hijos de madres que recibieron medios de contraste yodado.

Introduction: the use of imaging techniques is essential in some diagnostic processes. However, its indication in pregnant and lac-tating women is controversial. Objective: To present a narrative review of the risks associated with using images with radiation and contrast media in pregnancy and lactation. Emphasis will be put on the recommendations and clinical applications that the physician must consider before its indication. Methods: a bibliographic review of the relevant literature on the risks and special considerations of contrast media in pregnancy and lactation was performed. Results: the risks of ionising radiation on the fetus vary according to the stage of pregnancy, so the indication of the study must balance the risks and benefits. The use of iodinated and gadolinium-based con-trast agents in clinical doses in pregnancy and lactation has no effects on the health of the mother or the fetus. However, international societies recommend limiting its use. Conclusion: Although the indication for imaging studies using ionising radiation in pregnancy and lactation is safe, the clinician must be aware of the possible risks of ionising radiation in this group of patients. The only adverse effect reported is transient thyroid dysfunction in children of mothers who received iodinated contrast media.

Enhancement patterns of adrenal nodules on magnetic resonance imaging

ABSTRACT Objective: To compare enhancement patterns of typical adrenal adenomas, lipid-poor adenomas, and non-adenomas on magnetic resonance imaging (MRI). Materials and Methods: Evaluation of adrenal nodules larger than 1.0 cm, with at least 2-year follow-up, evaluated on MRI in January 2007 and December 2016. Two different protocols were included - upper abdomen MRI (delayed phase after 3 minutes) and abdomen and pelvis MRI (delayed phase after 7 minutes) - and nodules were divided in typical adenomas (characterized on out-of-phase MRI sequence), lipid-poor adenomas (based on follow-up imaging stability) and non-adenomas (based on pathological finding or follow-up imaging). T2-weighted and enhancement features were analyzed (absolute and relative washout and enhancement curve pattern), similarly to classic computed tomography equations. Results: Final cohort was composed of 123 nodules in 116 patients (mean diameter of 1.8 cm and mean follow up time of 4 years and 3 months). Of them, 98 (79%) nodules had features of typical adenomas by quantitative chemical shift imaging, and demonstrated type 3 curve pattern in 77%, mean absolute and relative washout of 29% and 16%, respectively. Size, oncologic history and T2-weighted features showed statistically significant differences among groups. Also, a threshold greater than 11.75% for absolute washout on MRI achieved sensitivity of 71.4% and specificity of 70.0%, in differentiating typical adenomas from non-adenomas. Conclusion: Calculating absolute washout of adrenal nodules on MRI may help identifying proportion of non-adenomas.

Mecânica Atrial na Cardiomiopatia Hipertrófica: Discriminando Hipertrofia de Fibrose Ventricular / Atrial Mechanics in Hypertrophic Cardiomyopathy: Discriminating between Ventricular Hypertrophy and Fibrosis

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e' estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH.

Abstract Background Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities. Objectives We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients. Methods Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05. Results Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027). Conclusions LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.

Associations of Infarct Size and Regional Myocardial Function Examined by Cardiac Magnetic Resonance Feature Tracking Strain Analysis with the Infarct Location in Patients with Acute ST-Segment Elevation Myocardial Infarction / 中国医学科学杂志(英文版)

Objective To quantitatively evaluate the associations of infarct size, regional myocardial function examined by cardiac magnetic resonance feature tracking (CMR-FT) strain analysis with infarct location in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention.Methods Cardiac magnetic resonance images were retrospectively analyzed in 95 consecutive STEMI patients with successful reperfusion. The patients were divided into the anterior wall myocardial infarction (AWMI) and nonanterior wall myocardial infarction (NAWMI) groups. Infarct characteristics were assessed by late gadolinium enhancement. Global and regional strains and associated strain rates in the radial, circumferential and longitudinal directions were assessed by CMR-FT based on standard cine images. The associations of infarct size, regional myocardial function examined by CMR-FT strain analysis with infarct location in STEMI patients were evaluated by the Spearman or Pearsonmethod. Results There were 44 patients in the AWMI group and 51 in the NAWMI group. The extent of left ventricular enhanced mass was significantly larger in patients with AWMI compared with the NAWMI group (24.47±11.89, 21.06±12.08 %LV; t=3.928, P = 0.008). In infarct zone analysis, strains in the radial, circumferential and longitudinal directions were remarkably declined in the AWMI group compared with the NAWMI group (z=-20.873, -20.918, -10.357, all P < 0.001). The volume (end-systolic volume index), total enhanced mass and extent of enhanced mass of the left ventricular were correlated best with infarct zone strain in the AWMI group (all P < 0.001). Conclusion In STEMI patients treated by percutaneous coronary intervention, myocardial damage is more extensive and regional myocardial function in the infarct zone is lower in the AWMI group compared with the NAWMI group.

Can paricalcitol increase the effectiveness of n-acetylcysteine in contrast induced acute kidney prophylaxis in rats? A biochemical and histopathological study / ¿Puede el paricalcitol aumentar la eficacia de la n-acetilcisteína en la profilaxis renal aguda inducida por contraste en ratas? Un estudio bioquímico e histopatológico

SUMMARY: N-Acetylcysteine (NAC) is used for contrast induced acut kidney injury (CI-AKI) prophylaxis because of its antioxidant effects. Paricalcitol, which has reno-protective effects, is likely to provide a more effective prophylaxis when added to NAC treatment. The study was designed based on this hypothesis. The study was organised to include 4 groups each consisting of 7 rats. Group 1 was the control group, and Group 2 included rats with CI-AKI. Rats in Group 3 were administered NAC at a dose of 100 mg/kg via oral gavage once a day for 5 days. Rats in group 4 were administered paricalcitol at a dose of 0.4 mcg/kg once a day for 5 days in addition to NAC. CI-AKI was induced after the treatments in both groups. The study was terminated on the sixth day. Samples were collected from the rats' sera and kidney tissues to study oxidant and antioxidant parameters; kidney function tests were also studied. There were significant differences between the contrast nephropathy group (Group 2) and NAC and NAC+paricalcitol groups with respect to serum urea and creatinine levels. When the same groups were compared regarding oxidant (TOS-MDA) and antioxidant (TAC-Paraoxonase) parameters, we observed that the oxidant parameters increased in serum and kidney tissue samples with NAC use, and that effect was strengthened by the addition of paricalcitol to NAC treatment. However, despite increased antioxidant effectiveness, we observed no decrease in urea and creatinine levels when paricalcitol was added for CI-AKI in rats. There was no significant difference between Group 3 and Group 4. Paricalcitol provides a more potent antioxidant effect in both serum and kidney tissue samples when added to NAC treatment in rats with CI-AKI. Despite increased antioxidant parameters, however, paricalcitol does not provide a significant decrease in urea and creatinine levels.

RESUMEN: Debido a sus efectos atioxidantes la N- acetilcisteína (NAC) se usa para la profilaxis de la lesión renal aguda inducida por contraste (CI-AKI). Es probable que el paricalcitol, que tiene efectos renoprotectores, proporcione una profilaxis más eficaz cuando se agrega al tratamiento con NAC. En base a esta hipótesis el estudio fue diseñado para incluir cuatro grupos cada uno compuesto por siete ratas. El grupo 1 fue el grupo control y el grupo 2 incluyó ratas con CI-AKI. A las ratas del Grupo 3 se les administró NAC con una dosis de 100 mg/kg por sonda oral una vez al día, durante 5 días. A las ratas del grupo 4 se les administró paricalcitol a una dosis de 0,4 mcg/kg una vez al día durante 5 días, además de NAC. Se indujo CI-AKI después de los tratamientos en ambos grupos. El estudio finalizó el sexto día. Se recolectaron muestras de suero y tejidos renales de ratas para estudiar los parámetros oxidantes y antioxidantes; También se estudiaron las pruebas de función renal. Hubo diferencias significativas entre el grupo de nefropatía por contraste (Grupo 2) y los grupos NAC y NAC+paricalcitol con respecto a los niveles séricos de urea y creatinina. Cuando se compararon los mismos grupos con respecto a los parámetros oxidantes (TOS-MDA) y antioxidantes (TAC-Paraoxonase), observamos que los parámetros oxidantes aumentaron en muestras de suero y tejido renal con el uso de NAC, y ese efecto se vio reforzado por la adición de paricalcitol a tratamiento NAC. Sin embargo, a pesar de una mayor eficacia antioxidante, no observamos una disminución en los niveles de urea y creatinina cuando se agregó paricalcitol para CI-AKI en ratas. No hubo diferencias significativas entre el Grupo 3 y el Grupo 4. El paricalcitol proporciona un efecto antioxidante más potente tanto en muestras de suero como de tejido renal cuando se agrega al tratamiento con NAC en ratas con CI-AKI. Sin embargo, a pesar del aumento de los parámetros antioxidantes, el paricalcitol no proporciona una disminución sig- nificativa en los niveles de urea y creatinina.

Application of stereology in liver volume measurements using computed tomography scan / Aplicación de la estereología en mediciones de volumen hepático mediante tomografía computarizada

SUMMARY: The application of stereology in hepatobiliary conditions is essential in liver volume estimation. Computerized topographic scan with contrast is a reliable method in liver scanning for precise boundaries demarcation. Liver volumetry varies in relation to different factors. Reports showed a correlation of liver volume with sex and body mass index. Steady relation between age and ethnicity is not established. This study aimed to design a protocol for liver volume measurement and apply it in the estimation of volume among the Sudanese population use stereology. Recruitment of the study population was obtained in the royal scan clinic in Khartoum by making an announcement for participation in the study. Patients with a history of hepatobiliary diseases were excluded. CT abdomen with contrast was obtained in DICOM format and transferred to computer-based software for image analysis. A protocol was designed and validated and then applied in volume estimation using software MRIcro for image display, ImageJ for volume estimation, and Onis 2.6 as image viewer. 300 apparently healthy volunteers were recruited. The protocol reliability result was 0.805. Absolute mean liver volume was 3261.32 ± 1365.313 cm3. High liver volume among females was detected than among males. A positive correlation was detected between volume and body mass index (p-value 0.001) regardless of sex. Relation with age showed a rough steady rise till the age of 50 years then it started to decline steadily. The relationship was detected in liver volume with sex and body mass index. More studies are needed to investigate the relationship between ethnicity and age groups.

RESUMEN: La aplicación de la estereología en condiciones hepatobiliares es fundamental en la estimación del volumen hepático. El escaneo topográfico computarizado con contraste es un método confiable en el escaneo del hígado para la demarcación precisa de sus límites. La volumetría hepática varía en función de diferentes factores. Los informes mostraron una correlación del volumen del hígado con el sexo y el índice de masa corporal. No se establece una relación estable entre la edad y la etnia. Este estudio tuvo como objetivo diseñar un protocolo para la medición del volumen hepático de la población sudanesa usando la estereología. El reclutamiento de la población de estudio fue realizado en la clínica de exploración real en Jartum mediante un anuncio de participación. Se excluyeron los pacientes con antecedentes de enfermedades hepatobiliares. Se obtuvo TC de abdomen con contraste en formato DICOM y se transfirió a un software informático para el análisis de imágenes. Se diseñó y validó un protocolo y luego se aplicó en la estimación de volumen utilizando el software MRIcro para la visualización de imágenes, ImageJ para la estimación de volumen y Onis 2.6 como visor de imágenes. Se reclutaron 300 voluntarios sanos. El resultado de la fiabilidad del protocolo fue 0,805. El volumen hepático medio absoluto fue 3261,32 ± 1365,313 cm3. Se detectó un volumen más elevado de hígado en las mujeres que en los hombres. Se detectó una correlación positiva entre el volumen y el índice de masa corporal (valor de p 0,001) independientemente del sexo. La relación con la edad mostró un aumento continuo y brusco hasta los 50 años, luego comenzó a disminuir de manera constante. Se detectó la relación del volumen hepático con el sexo y el índice de masa corporal. Se necesitan más estudios para investigar la relación entre la etnia y los grupos etarios.

Consenso conjunto de la Asociación Colombiana de Nefrología e Hipertensión Arterial (Asocolnef) y la Asociación Colombiana de Radiología (ACR) sobre recomendaciones basadas en la evidencia de la lesión* renal aguda asociada al uso de medios de contraste yodados (LRA-MCI) / Consensus of the Asociación Colombiana de Nefrología e Hipertensión Arterial (Asocolnef) and the Asociación Colombiana de Radiología (ACR) on evidence-based recommendations for acute kidney injury* associated with the use of iodinated contrast media (AKI-ICM)

Introducción: La lesión renal aguda asociada con el uso de medios de contrastes yodados (LRA-MCI) es un trastorno iatrogénico con potenciales implicaciones en morbilidad y mortalidad, motivo de preocupación en los servicios de imágenes. Los últimos años han marcado cambios importantes en la concepción que se tiene sobre esta entidad, desde una definición más precisa y su verdadera incidencia hasta el impacto real de algunas estrategias para su prevención.Objetivo: Generar recomendaciones basadas en la evidencia para el uso de medios de contraste yodados e n pacientes sometidos a procedimientos radiológicos terapéuticos y de diagnóstico, mediante un consenso de expertos. Metodología: A partir de la formulación de preguntas de investigación relacionadas con la LRA-MCI se realizó la búsqueda de evidencia en PubMed, Embase y Scopus, entre enero de 2013 y agosto de 2022. Los artículos se seleccionaron por medio de una revisión sistemática y con la metodología de consenso Delphi modificado. La calidad de los documentos se valoró aplicando instrumentos de evaluación de calidad de la evidencia de los documentos. Resultados:Se formularon 22 recomendaciones para el manejo de pacientes que requieren administración de medio de contraste yodado. Un panel de 11 expertos, entre los que se contó con 4 nefrólogos, 4 radiólogos y 1 nefrólogo pediatra, participaron en la elaboración del consenso en 5 sesiones virtuales y 15 horas de trabajo.Conclusiones: El término lesión renal aguda asociada al uso de medios de contraste yodados (LRA-MCI) debe usarse idealmente y abandonar otras definiciones que infieren una causalidad manifiesta. Su incidencia: los datos recientes demuestran que se ubica muy por debajo de lo tradicionalmente considerado. Solo una baja tasa de filtración glomerular estimada (TFGe) se considera factor de riesgo independiente. Respecto a su prevención, únicamente la hidratación ha mostrado un potencial beneficio como medida nefroprotectora.

Introduction: Acute kidney injury associated with the use of iodinated contrast media (AKI-ICM) is an iatrogenic disorder with potential implications in morbidity and mortality, a cause for concern in imaging services. The last few years have marked important changes in the conception of this entity, from a more precise definition and its true incidence to the real impact of some strategies for its prevention. Objective: To generate evidence-based recommendations for the use of iodinated contrast media in patients undergoing diagnostic and therapeutic radiological procedures, by means of an expert consensus. Methodology: Based on the formulation of research questions related to AKI-ICM, a search for evidence was carried out in PubMed, Embase and Scopus, between January 2013 and August 2022. The articles were selected by means of a systematic review and with the modified Delphi consensus methodology. The quality of the papers was assessed by applying paper evidence quality assessment instruments. Results: Twenty-two recommendations were formulated for the management of patients requiring administration of iodinated contrast medium. A panel of 11 experts, including 4 nephrologists, 4 radiologists and 1 pediatric nephrologist, participated in the development of the consensus in 5 virtual sessions and 15 hours of work. Conclusions: The term acute kidney injury associated with the use of iodinated contrast media (AKI-ICM) should ideally be used and other definitions that infer overt causality abandoned. Its incidence: recent data show that it is well below that traditionally considered. Only a low estimated glomerular filtration rate (eGFR) is considered an independent risk factor. Regarding its prevention, only hydration has shown a potential benefit as a nephroprotective measure

The effect of adding ytterbium trifluoride on the radiopacity, compressive strength, setting time and bioactivity of biodentine: an in vitro study / Efeito da adição de trifluoreto de itérbio na radiopacidade, resistência à compressão, tempo de presa e bioatividade da biodentina: estudo in vitro

Objective: This study aimed to evaluate the radiopacity, compressive strength, setting time and bioactivity of Biodentine after modification with Ytterbium Tri-Fluoride (YbF3) in three different concentrations. Material and Methods: Radiopacity was determined using the equivalence in millimeters of aluminum (mm Al) from digital radiographs. Compressive strength was evaluated using a universal testing machine. The initial and final setting times were evaluated using Gillmore needle. The bioactive potential was evaluated using the environmental scanning electron microscope (ESEM) connected with Energy Dispersive X-ray analysis (EDX) and X-ray Diffractometer (XRD) at three different time intervals. pH was measured using a pH-meter. Data were analyzed using one-way ANOVA followed by Tukey's post hoc tests (P≤ 0.05). Results: Radiopacity of Biodentine with 2.5%, 5% and 7.5% YbF3 was significantly higher than unmodified Biodentine (P ≤ 0.05). Unmodified Biodentine showed the highest mean compressive strength values compared to all other groups (p≤ 0.05). The addition of YbF3 to Biodentine has extended the final setting time except for the 2.5% YbF3 group that showed no significant difference compared to the control. All groups showed an alkaline pH at 28 days, ESEM coupled with EDX analysis showed evidence of dense globules of calcium phosphate on the surface indicating enhancement of bioactivity. Conclusion: 2.5% YbF3 can be a promising radiopacifying agent to Biodentine with improvement in radiopacity, bioactive potential and maintaining the setting time and compressive strength at acceptable level as indicated by the ISO standards (AU)

Objetivo: O estudo buscou avaliar a radiopacidade, resistência à compressão, tempo de presa e bioatividade da Biodentina modificada por Trifluoreto de itérbio (YbF3). Materiais e Métodos: YbF3 foi incorporado ao pó de Biodentina e dividido em 4 grupos (X0, X1, X2 e X3) de acordo com a concentração de YbF3; 0%, 2.5%, 5% e 7.5% do peso, respectivamente. Os espécimes foram preparados para cada experimento com um total de 40 espécimes para cada teste (n=10 por grupo). A radiopacidade foi determinada através do uso equivalente em milímetros de alumínio. A resistência a compressão foi avaliada através do uso de uma máquina de teste universal. O tempo inicial e final foi avaliado através de uma agulha de Gillmore. O potencial bioativo foi avaliado através do Microscópio Eletrônico de Varredura (ESEM), conectado com a análise de espectroscopia de raios X por energia dispersiva (EDX) e difração de raio X (DRX). O pH foi mensurado através do uso de um pHmetro. Os dados foram analisados pelo ANOVA seguido do Test Tukey. Resultados: A radiopacidade nos grupos X1, X2 e X3 foi significantemente maior do que no grupo X0. O grupo X0 mostrou a maior resistência à compressão comparado com os outros grupos. A adição de YbF3 a Biodentina excedeu o tempo final exceto pelo grupo X1, que não apresentou diferença estatística significante quando comparado com o grupo X0. Todos os grupos apresentaram um pH alcalino com 28 dias. ESEM com análise EDX mostrou evidência de densos glóbulos de fosfato de cálcio na superfície, indicando uma melhora na bioatividade. Conclusão: 2.5% YbF3 é um promissor radiopacificador para Biodentina, que aumentou a radiopacidade e potencial bioativo enquanto manteve o tempo definido e a resistência à compressão em níveis aceitáveis como indica a norma ISO.(AU)

Nanobubbles: A Novel Targeted Drug Delivery System

Abstract Nanobubbles are nanometer size bubbles having different constituents of varying physicochemical characteristic for the inner core and outer shell. Nanobubbles are mainly fabricated to improve the stability, bioavailability and improve the biodistribution of the delivered drug to the specific targeted site. Their small sizes bubbles allow the possibility of extravasation from blood vessels into the surrounding tissues and ultrasound-targeted site-specific release with minimal invasiveness. Nanobubbles are developing as important contrast agents for imaging and carriers for drug delivery at targeted region. Sonication is the primary method for preparation of nanobubbles followed by thin-layer evaporation, high shear emulsification, mechanical agitation and coacervation or coalescence. With exposure to ultrasound/extracorporeal shock waves, the drug is liberated from the nanobubbles into the target cells. This review paper is an effort to reveal the different formulation development techniques briefly and varying shell and core content for developing nanobubbles.

Contrast-induced acute kidney injury in patients submitted to coronary angioplasty: prospective cohort / Lesión renal aguda inducida por contraste en pacientes sometidos a angioplastia coronaria: una cohorte prospectiva / Lesão renal aguda induzida por contraste em pacientes submetidos à angioplastia coronariana: coorte prospectiva

ABSTRACT Objective: To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. Method: Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. Results: The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [−0.089; −0.040]; p < 0.0001). Conclusion: CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.

RESUMEN Objetivo: Analizar la incidencia, los factores de riesgo y las asociaciones de resultados clínicos para Lesión Renal Aguda Inducida por Contraste (LRA-IC) en pacientes con Síndrome Coronario Agudo (SCA) después de angioplastia coronaria. Método: Cohorte prospectiva de 182 pacientes monitorizados durante tres meses tras realizada la angioplastia, en el periodo entre julio de 2020 y junio de 2021. Se evaluaron las variables sociodemográficas, clínicas y relacionadas con el procedimiento. Resultados: La incidencia de LRA-IC fue del 35,7% (n = 65) y se asoció con la edad avanzada, la diabetes mellitus y la enfermedad renal crónica (p = 0,004, p < 0,001 y p = 0,009, respectivamente). De los 17 pacientes que fallecieron dentro de los 90 días, el 76,5% tenía LRA-IC (n = 13), la razón de probabilidad entre muerte y LRA-IC fue aproximadamente 7,2 veces (intervalo de confianza, IC del 95%, [2,41;26,36]; p = 0,001). La disminución de una unidad en la hemoglobina basal del paciente demostró un aumento del 6,5% para LRA-IC (IC del 95%, [-0,089; -0,040]; p < 0,0001). Conclusión: En los pacientes con SCA después de angioplastia, la LRA-IC tiene una alta incidencia y está relacionada con la diabetes mellitus y la enfermedad renal crónica, presentando altas tasas de mortalidad.

RESUMO Objetivo: Analisar a incidência, os fatores de risco e as associações dos desfechos clínicos para Lesão Renal Aguda Induzida Por Contraste (LRA-IC) em pacientes com Síndrome Coronariana Aguda (SCA) após angioplastia coronariana. Método: Coorte prospectivo de 182 pacientes seguidos por três meses após angioplastia, entre julho de 2020 e junho de 2021. As variáveis foram sociodemográficas, clínicas e relacionadas ao procedimento. Resultados: A incidência de LRA-IC foi de 35,7% (n = 65) e esteve associada à idade avançada, diabetes mellitus e doença renal crônica (respectivamente p = 0,004, p < 0,001 e p = 0,009). Dos 17 pacientes que faleceram em até 90 dias, 76,5% tiveram LRA-IC (n = 13), a razão de chances entre óbito e LRA-IC foi de aproximadamente 7,2 vezes (intervalo de confiança (IC) 95%, [2,41;26,36]; p = 0.001). A diminuição de uma unidade na hemoglobina basal do paciente demonstrou um aumento de 6,5% para LRA-IC (IC 95%, [-0,089; -0,040]; p < 0,0001). Conclusão: Em pacientes com SCA após angioplastia, a LRA-IC tem alta incidência e está relacionada com diabetes mellitus e doença renal crônica, apresentando altos índices de mortalidade.