Blood Oxygen Level-Dependent MR Imaging of Lower Extremities in Peripheral Artery Disease and Its Correlation With Walking Performance.

BACKGROUND: A noninvasive and reliable approach to quantitatively measure muscle perfusion of lower extremity is needed to aid the diagnosis and treatment of peripheral artery disease (PAD). PURPOSE: To verify the reproductivity of using blood oxygen level-dependent (BOLD) imaging to evaluate perfusion in lower extremities, and explore its correlation with walking performance in patients with PAD. STUDY TYPE: Prospective observational study. SUBJECTS: Seventeen patients with lower extremity PAD (mean age: 67 ± 6 years, 15 males) and eight older adults (controls). FIELD STRENGTH/SEQUENCE: Dynamic multi-echo gradient echo T2* weighted imaging at 3T. ASSESSMENT: Perfusion was analyzed in regions of interest according to muscle groups. Perfusion parameters were measured, such as minimum ischemia value (MIV), time to peak (TTP), and gradient during reactive hyperemia (Grad) by two independent users. Walking performance experiments including short physical performance battery (SPPB) and 6-minute walk were tested in patients. STATISTICAL TESTS: BOLD parameters were compared using Mann-Whitney U test and Kruskal-Wallis test. Relations between parameters and walking performance were assessed by Mann-Whitney U test and Spearman's correlation coefficient. RESULTS: Good to perfect agreement was demonstrated for all perfusion parameters of interuser reproducibility, and the interscan reproducibility of MIV, TTP, and Grad was good. The TTP of the patients was longer than that of the controls (87.85 ± 38.85 s vs. 36.54 ± 7.27 s), while the Grad of patients was smaller (0.16 ± 0.12 msec/s vs. 0.24 ± 0.11 msec/s). Among PAD patients, the MIV was significantly lower in the low SPPB subgroup (score 6-8) than in the high SPPB group (score 9-12), and the TTP was negatively correlated with 6-minute walk distance (ρ = -0.549). DATA CONCLUSION: BOLD imaging method had overall good reproducibility for the perfusion assessment of calf muscles. The perfusion parameters were different between PAD patients and controls, and were correlated with lower extremity function. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Ideal cardiovascular health metrics have better identification of arthritis.

BACKGROUND: This study aimed to explore the association between ideal cardiovascular health metrics (ICVHM) and arthritis (AR), as well as the interactions of various indicators in ICVHM on AR in US adults. METHODS: We involved 17,041 participants who were interviewed by NHANES from 2011 to 2018. AR included osteoarthritis or degenerative arthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis and other arthritis (Other AR). Logistic regression was applied to analyze the association between AR and ICVHM. Mixed graphical model (MGM) was used to explore the interaction between variables in ICVHM. RESULTS: Higher ICVHM scores had a protective effect on AR. Compared to "≤1" score, the ORs of AR in participants with 2, 3, 4, and ≥5 were 0.586, 0.472, 0.259, and 0.130, respectively. Similar results were also found in different types of AR. ICVHM has a maximum area under the curve value of 0.765 and the interaction between blood pressure and total cholesterol was 0.43. CONCLUSIONS: ICVHM correlates significantly with AR and is better at identifying AR than individual indicators. ICVHM can be better improved by controlling the indicators with stronger interactions. Our findings provide guidance for promoting health factors, which have important implications for identification and prevention of AR.

Comparison of neuroimaging features of histiocytic neoplasms with central nervous system involvement: a retrospective study of 121 adult patients.

OBJECTIVES: To compare neuroimaging characteristics of three types of histiocytoses, namely Langerhans cell histiocytosis (LCH), Erdheim-Chester disease (ECD), and Rosai-Dorfman disease (RDD), with central nervous system (CNS) involvement. METHODS: A total of 121 adult patients with histiocytoses (77 LCH, 37 ECD, and 7 RDD) and CNS involvement were retrospectively included. Histiocytoses were diagnosed based on histopathological findings combined with suggestive clinical and imaging features. Brain and dedicated pituitary MRIs were systematically analyzed for tumorous, vascular, degenerative lesions, sinus, and orbital involvement and for hypothalamic pituitary axis involvement. RESULTS: Endocrine disorders, including diabetes insipidus and central hypogonadism, were more common in LCH patients than in ECD and RDD patients (p < 0.001). In LCH, tumorous lesions were mostly solitary (85.7%), located in the hypothalamic pituitary region (92.9%), and without peritumoral edema (92.9%), while in ECD and RDD, tumorous lesions were often multiple (ECD: 81.3%, RDD: 85.7%), their distribution was more widespread with meninges mostly involved (ECD: 75%, RDD: 71.4%), and they most likely presented with peritumoral edema (ECD: 50%, RDD: 57.1%; all p ≤ 0.020). Vascular involvement was an exclusive imaging characteristic of ECD (17.2%), which was not observed in LCH or RDD; this was also associated with a higher risk of death (p = 0.013, hazard ratio = 11.09). CONCLUSION: The typical characteristic of adult CNS-LCH was endocrine disorders with radiological findings limited to the hypothalamic pituitary axis. The pattern of multiple tumorous lesions with predominant involvement of meninges was the main manifestation of CNS-ECD and CNS-RDD, while vascular involvement was pathognomonic for ECD and associated with poor prognosis. CLINICAL RELEVANCE STATEMENT: Involvement of the hypothalamic-pituitary axis is the typical imaging characteristic of Langerhans cell histiocytosis. Multiple tumorous lesions, predominantly involving but not limited to meninges, occur in most Erdheim-Chester disease and Rosai-Dorfman disease patients. Vascular involvement occurs only in Erdheim-Chester disease patients. KEY POINTS: • The different distribution patterns of brain tumorous lesions can help differentiate among LCH, ECD, and RDD. • Vascular involvement was an exclusive imaging finding of ECD and was associated with high mortality. • Some cases with atypical imaging manifestations were reported to further expand the knowledge on these diseases.

Assessment of idiopathic inflammatory myopathy using a deep learning method for muscle T2 mapping segmentation.

OBJECTIVE: To investigate the utility of an automatic deep learning (DL) method for segmentation of T2 maps in patients with idiopathic inflammatory myopathy (IIM) against healthy controls, and also the association of quantitative T2 values in patients with laboratory and pulmonary findings. METHODS: Structural MRI and T2 mapping of bilateral thigh muscles from patients with IIM and healthy volunteers were segmented using dedicated software based on a pre-trained convolutional neural network. Incremental and federated learning were implemented for continuous adaptation and improvement. Muscle T2 values derived from DL segmentation were compared between patients and healthy controls, and T2 values of patients were further analyzed with serum muscle enzymes, and interstitial lung disease (ILD) which was diagnosed and graded based on chest HRCT. RESULTS: Overall, 64 patients (27 patients with dermatomyositis, 29 with polymyositis, and 8 with antisynthetase syndrome (ASS)) and 10 healthy controls were included. By using DL-based muscle segmentation, T2 values generated from T2 maps accurately differentiated patients from those of controls (p < 0.001) with a cutoff value of 36.4 ms (sensitivity 96.9%, and specificity 100%). In patients with IIM, muscle T2 values positively correlated with all the serum muscle enzymes (all p < 0.05). ILD score of patients with ASS was markedly higher than that of those without ASS (p = 0.011), while dissociation between the severity of muscular involvement and ILD was observed (p = 0.080). CONCLUSION: Automatic DL could be used to segment thigh muscles and help quantitatively assess muscular inflammation of IIM through T2 mapping. KEY POINTS: • Muscle T2 mapping automatically segmented by deep learning can differentiate IIM from healthy controls. • T2 value, an indicator of active muscle inflammation, positively correlates with serum muscle enzymes. • T2 mapping can detect muscle disease in patients with normal muscle enzyme levels.

Use of IDEAL-IQ in Quantifying Femoral Bone Marrow Involvement in Gaucher Disease.

OBJECTIVE: To quantitatively measure femoral bone marrow involvement in patients with Gaucher disease (GD) by using fat fraction (FF) derived from the iterative decomposition of water and fat with echo asymmetry and least-squares estimation quantitation (IDEAL-IQ) technique. METHODS: Bilateral femora of 23 patients with type 1 GD receiving low-dose imiglucerase treatment were prospectively scanned using structural magnetic resonance imaging sequences and an IDEAL-IQ sequence. Femoral bone marrow involvement was evaluated by both semiquantification (bone marrow burden [BMB] score based on magnetic resonance imaging structural images) and quantification (FF derived from IDEAL-IQ) methods. These patients were further divided into subgroups according to whether they underwent splenectomy or had bone complications. The interreader agreement of measurements and the correlation between FF and clinical status were statistically analyzed. RESULTS: In patients with GD, both BMB and FF evaluation of femora showed good interreader concordance (intraclass correlation coefficient = 0.98 and 0.99, respectively), and FF highly correlated with BMB score ( P < 0.001). The longer the duration of disease, the lower the FF ( P = 0.026). Femoral FF was lower in subgroups with splenectomy or bone complications than those without splenectomy or bone complications (0.47 ± 0.08 vs 0.60 ± 0.15, 0.51 ± 0.10 vs 0.61 ± 0.17, respectively, both P < 0.05). CONCLUSION: Femoral FF derived from IDEAL-IQ could be used to quantify femoral bone marrow involvement in patients with GD, and low bone marrow FF may predict worse outcomes of GD patients in this small-scale study.

LXR activation ameliorates high glucose stress-induced aberrant mitochondrial dynamics via downregulation of Calpain1 expression in H9c2 cardiomyoblasts.

Liver-X-receptor (LXR) has previously been shown to exert a cardioprotective effect against the development of diabetic cardiomyopathy (DCM) associated with a reduction in mitochondrial dysfunction. However, the underlying mechanism by which LXR activation attenuates the structural and functional mitochondrial impairments caused by high glucose (HG) stress remains unclear. We demonstrate here that LXR activation inhibits HG stress-induced mitochondrial dysfunction and ameliorates aberrant mitochondrial dynamics. Furthermore, LXR activation regulates mitochondrial dynamics by inhibiting HG stress-induced upregulation of Calpain1 expression. These data indicate that amelioration of Calpain1-mediated aberrant mitochondrial dynamics may be at least part of the mechanism underlying the cardioprotective effects of LXR against HG stress. Therefore, LXR is a potentially attractive molecular target for treating cardiac mitochondrial dysfunction in patients with diabetes.

Colorimetric identification of miRNA-195 sequence for diagnosing osteosarcoma.

Improving biosensing performance is mandatory for biomolecular recognition and disease identification. Gold nanoparticle (GNP)-based colorimetric assay is the easy and cost-effective identification method by a naked eye detection. In this research, osteosarcoma biomarker (miRNA-195) was identified by citrate-capped GNP-colorimetric assay. As salt-induced aggregation was used to observe the color changes of GNP, sodium chloride (NaCl) and capture DNA were optimized as 50 mM and ∼20 pmol, respectively. The capture DNA only on GNP could not stabilize under high NaCl, and the color of GNP turned into purple. At the same time, when capture DNA was hybridized with target, the condition can stabilize the GNP under higher NaCl, which retains the GNP color as red. This simple assay reaches the limit of detection of target miRNA-195 as ∼40 fmol. Control experiments with noncomplementary DNA turned the solution into purple, indicating the specific detection of target. The mixture of target in diluted serum retains the color of the GNP solution to be red, indicating the selective detection of target DNA. This simple assay helps to quantify the level of miRNA-195 target DNA and to diagnose the osteosarcoma.

Evaluation of Patients with Angiographically-Confirmed Coronary Artery Disease to Investigate the Association Between Epicardial Fat Thickness and Atrial Fibrillation.

BACKGROUND Epicardial fat thickness (EFT) is increasingly recognized as an independent risk factor of the presence, severity, and recurrence of atrial fibrillation (AF). We investigated the associations between EFT and AF prevalence and identified its correlation with other risk factors. MATERIAL AND METHODS A total of 199 participants who underwent coronary angiography and had confirmed coronary artery disease (CAD) were enrolled in this study. The EFT was measured by echocardiography and the association of EFT with other AF risk factors was evaluated by multivariate logistic regression analysis. RESULTS The EFT was significantly higher in patients with comorbidity of AF and CAD than those with CAD alone (6.86±1.96 mm vs 5.91±1.71 mm, P<0.001). Logistic regression analysis indicated that EFT was a predictive factor of the occurrence of AF in CAD, after adjusting for body mass index (BMI), systolic blood pressure (SBP), left circumflex artery (LCX) stenosis, LA diameter, B-type natriuretic peptide (BNP), creatinine (Cr), and blood urea nitrogen (BUN). LA diameter, SBP, and LCX stenosis are also independent risk factors for CAD complicated by AF. Correlation analysis revealed significant positive linear correlations between EFT and BMI (P<0.01), EFT, and LA diameter (P<0.05), as well as positive correlations between LA diameter and BNP, Cr, or BUN. CONCLUSIONS Epicardial fat thickness is a strong predictor for AF prevalence in patients with CAD, independent of other AF risk factors such as LA diameter, BMI, and SBP, while LA diameter, SBP, and LCX stenosis are also independent AF risk factors for CAD.

De novo transcriptome in roots of switchgrass (Panicum virgatum L.) reveals gene expression dynamic and act network under alkaline salt stress.

BACKGROUND: Soil salinization is a major limiting factor for crop cultivation. Switchgrass is a perennial rhizomatous bunchgrass that is considered an ideal plant for marginal lands, including sites with saline soil. Here we investigated the physiological responses and transcriptome changes in the roots of Alamo (alkaline-tolerant genotype) and AM-314/MS-155 (alkaline-sensitive genotype) under alkaline salt stress. RESULTS: Alkaline salt stress significantly affected the membrane, osmotic adjustment and antioxidant systems in switchgrass roots, and the ASTTI values between Alamo and AM-314/MS-155 were divergent at different time points. A total of 108,319 unigenes were obtained after reassembly, including 73,636 unigenes in AM-314/MS-155 and 65,492 unigenes in Alamo. A total of 10,219 DEGs were identified, and the number of upregulated genes in Alamo was much greater than that in AM-314/MS-155 in both the early and late stages of alkaline salt stress. The DEGs in AM-314/MS-155 were mainly concentrated in the early stage, while Alamo showed greater advantages in the late stage. These DEGs were mainly enriched in plant-pathogen interactions, ubiquitin-mediated proteolysis and glycolysis/gluconeogenesis pathways. We characterized 1480 TF genes into 64 TF families, and the most abundant TF family was the C2H2 family, followed by the bZIP and bHLH families. A total of 1718 PKs were predicted, including CaMK, CDPK, MAPK and RLK. WGCNA revealed that the DEGs in the blue, brown, dark magenta and light steel blue 1 modules were associated with the physiological changes in roots of switchgrass under alkaline salt stress. The consistency between the qRT-PCR and RNA-Seq results confirmed the reliability of the RNA-seq sequencing data. A molecular regulatory network of the switchgrass response to alkaline salt stress was preliminarily constructed on the basis of transcriptional regulation and functional genes. CONCLUSIONS: Alkaline salt tolerance of switchgrass may be achieved by the regulation of ion homeostasis, transport proteins, detoxification, heat shock proteins, dehydration and sugar metabolism. These findings provide a comprehensive analysis of gene expression dynamic and act network induced by alkaline salt stress in two switchgrass genotypes and contribute to the understanding of the alkaline salt tolerance mechanism of switchgrass and the improvement of switchgrass germplasm.

Pulmonary manifestations of Erdheim-Chester disease: clinical characteristics, outcomes and comparison with Langerhans cell histiocytosis.

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis that typically affects many organs, including the lung and pleura. However, there are few studies concerning pulmonary involvement in ECD patients, as well as the difference of pulmonary involvement between ECD and Langerhans cell histiocytosis (LCH). We performed a retrospective study of 54 ECD patients, and compared the pulmonary manifestations with those of adult LCH patients in our centre. The median age of diagnosis of the 54 ECD patients was 48 years (range 9-66 years). Chest computed tomography (CT) scans revealed lung involvement in 49 (91%) patients and pleural involvement in 34 (63%). Thirty-three (61%) patients had interstitial lung disease (ILD) with varying degrees of interlobular septal thickening, micronodules, and ground-glass opacities. ECD and LCH patients with pulmonary involvement showed significant differences in smoking status (P < 0·001), respiratory symptoms (P = 0·001) such as cough and pneumothorax (P < 0·001), and radiological findings, including cysts (P < 0·001), opacities (P < 0·001), and pleural thickening (P < 0·001). With a median follow-up duration of 24 months (range, 1-84 months), the estimated three-year overall survival (OS) of this entire ECD cohort was 90·2%. Patients with ILD tended to have worse progression-free survival (PFS) than those with no ILD (P = 0·29).

Integrated Analysis of the Transcriptome and Metabolome Revealed Candidate Genes Involved in GA3-Induced Dormancy Release in Leymus chinensis Seeds.

Leymus chinensis is a perennial forage grass that has good palatability, high yield and high feed value, but seed dormancy is a major problem limiting the widespread cultivation of L. chinensis. Here, we performed transcriptomic and metabolomic analysis of hulled and de-hulled seeds of L. chinensis treated with or without GA3 to investigate the changes in gene and metabolites associated with dormancy release induced by GA3. The germination test revealed that the optimum concentration of GA3 for disruption of L. chinensis seed dormancy was 577 µM. A total of 4327 and 11,919 differentially expressed genes (DEGs) and 871 and 650 differentially abundant metabolites were identified in de-hulled and hulled seeds treated with GA3, respectively, compared with seeds soaked in sterile water. Most of the DEGs were associated with starch and sucrose metabolism, protein processing in the endoplasmic reticulum, endocytosis and ribosomes. Furthermore, isoquinoline alkaloid biosynthesis, tyrosine metabolism, starch and sucrose metabolism, arginine and proline metabolism, and amino sugar and nucleotide sugar metabolism were significantly enriched pathways. Integrative analysis of the transcriptomic and metabolomic data revealed that starch and sucrose metabolism is one of the most important pathways that may play a key role in providing carbon skeletons and energy supply for the transition of L. chinensis seeds from a dormant state to germination by suppressing the expression of Cel61a, egID, cel1, tpsA, SPAC2E11.16c and TPP2, enhancing the expression of AMY1.1, AMY1.2, AMY1.6 and GLIP5, and inhibiting the synthesis of cellobiose, cellodextrin, and trehalose while promoting the hydrolysis of sucrose, starch, cellobiose, cellodextrin, and trehalose to glucose. This study identified several key genes and provided new insights into the molecular mechanism of seed dormancy release induced by GA3 in L. chinensis. These putative genes will be valuable resources for improving the seed germination rate in future breeding studies.

Factors contributing to diagnostic delay of Caroli syndrome: a single-center, retrospective study.

BACKGROUND: Caroli syndrome (CS) is a rare congenital disorder without pathognomonic clinical symptoms or laboratory findings; therefore, the diagnosis is often delayed. The objective of this study was to investigate the diagnostic delay and associated risk factors in CS patients. METHODS: This was a retrospective analysis of 16 CS patients admitted to a single tertiary medical center on mainland China. The diagnostic timelines of CS patients were reviewed to demonstrate the initial findings of CS at diagnosis, the risk factors associated with diagnostic delay, and potential clues leading to early diagnosis. RESULTS: The median diagnostic delay was 1.75 years (range: 1 month to 29 years, interquartile range: 6.2 years) in 16 enrolled CS patients. Sex, age, and initial symptoms were not associated with diagnostic delay. 87.5% of CS patients were diagnosed by imaging, and the accuracies of ultrasonography, computed tomography (CT), and magnetic resonance cholangiopancreatography were 25, 69.2, and 83.3%, respectively. The median diagnostic delays for patients with or without CT performed at the first hospital visited according to physician and radiologist suspicion of the diagnosis were 7.4 months and 6 years, respectively (p = 0.021). Hepatic cysts with splenomegaly were detected by ultrasound in over half of CS patients. CONCLUSIONS: The majority of CS patients were not diagnosed until complications of portal hypertension had already developed. Recognition and early suspicion of the disease were important factors influencing diagnostic delay of CS. Hepatic cysts plus splenomegaly detected by US might raise the clinical suspicion to include CS in the differential diagnosis.

Multisystemic Imaging Findings in Chinese Patients With Erdheim-Chester Disease.

OBJECTIVE. Radiology is essential for diagnosing and managing Erdheim-Chester disease (ECD), a rare multisystemic non-Langerhans cell histiocytic neoplasm. This study aimed to systemically investigate imaging characteristics of patients with ECD. MATERIALS AND METHODS. Radiographic, CT, and MR images of 28 Chinese patients (14 male, 14 female; 5-65 years old) diagnosed with ECD on histopathology at our medical center between January 2014 and January 2019 were retrospectively analyzed. Two radiologists analyzed the images in consensus and recorded the imaging manifestations qualitatively. RESULTS. Seventeen of the 23 patients (73.9%) who underwent CNS evaluation had findings positive for ECD including supratentorial and infratentorial regions; infiltration of the corpus callosum, choroid plexus, pineal body, and walls of cerebral arteries; and brain nodules mimicking metastases. In the facial and orbital regions, postorbital masses (34.8%) and masses in the nasal sinuses and mastoid processes were noted. Moreover, bone involvement was found in 27 (96.4%) patients, with lower extremities most commonly affected (85.7%); pathologic fracture caused by bone involvement was also observed. On chest CT, pulmonary parenchyma, mesenchyme, pleura, and mediastinum were seen to be infiltrated by ECD (57.1%). Half (50.0%) of the 28 patients had cardiovascular involvement with infiltration of the aorta and its branches, coronary arteries, or branches of the superior mesenteric artery resulting in stenosis and ischemic symptoms. In addition to retroperitoneal involvement in 13 (46.4%) patients, a presacral mass wrapping bilateral pelvic ureters and thickening of the mesentery, peritoneum, and omentum were also detected. CONCLUSION. Patients with ECD should be evaluated systemically, because involvement of vital organs could be lethal.

Differential effects of and mechanisms underlying the protection of cardiomyocytes by liver-X-receptor subtypes against high glucose stress-induced injury.

Liver-X-receptors (LXRs) are ligand-activated transcription factors belonging to the nuclear receptor superfamily. The two popular homologous receptor subtypes, LXRα and LXRß, exhibit differential expression patterns, thereby probably playing different roles in different contexts. This study aimed to evaluate the different roles of the two LXR subtypes and the mechanisms underlying their protection of cardiomyocytes against high-glucose stress. Silencing of LXRα, but not LXRß impaired normal LXR-mediated cardioprotective effects against high glucose-induced oxidative stress, apoptosis, and inflammation. Mechanistically, silencing of small ubiquitin-like modifier (SUMO)1 or SUMO2/3 did not affect LXR-mediated cardioprotective effects; however, these were impaired in response to nuclear receptor corepressor (NCoR) silencing. Together, these findings indicate that LXRα, but not LXRß, protects against high glucose-induced cardiomyocyte injury, probably via the NCoR-dependent transrepression of downstream target genes.

Simultaneous Multislice Accelerated Diffusion Tensor Imaging of Thigh Muscles in Myositis.

OBJECTIVE: Diffusion tensor imaging (DTI) has long been proposed as a potential tool for quantitatively evaluating muscle lesions of dermatomyositis (DM) and polymyositis (PM), but adapting DTI to thigh muscles requires minimizing acquisition time. We investigated the clinical feasibility of using SMS-EPI-DTI (simultaneous multislice [SMS] accelerated echo planar imaging [EPI] DTI) to image and analyze the anisotropic diffusion characteristics of thigh muscles in patients with DM or PM. SUBJECTS AND METHODS: Both thighs of 20 patients (seven patients with DM and 13 patients with PM) and 10 healthy control subjects were prospectively scanned using SMSEPI-DTI. Tractographic images and DTI-derived parameters, including fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values and three eigenvalues (λ1, λ2, and λ3), were obtained from four selected muscles (vastus medialis, vastus intermedius, adductor magnus, and semimembranosus) and were analyzed. After Bonferroni correction, p < 0.017 (0.05/3) was considered to denote statistical significance. RESULTS: SMS-EPI-DTI allowed imaging of both thighs of patients with DM or PM and healthy control subjects within approximately 5 minutes. For each of the four measured muscles, FA values for patients with edematous muscles were lower than those for patients with unaffected muscles and healthy control subjects with normal muscles (p < 0.017 for all). The ADC and λ1, λ2, and λ3 values of edematous muscles were significantly higher than those for patients with unaffected muscles and healthy control subjects (p < 0.017 for all). Unaffected muscles of patients and healthy control subjects were similar in terms of all parameters (p > 0.017 for all). CONCLUSION: SMS-EPI-DTI is clinically feasible for imaging thigh muscles and quantitatively evaluating edematous muscles of patients with DM or PM.

Combined use of iterative reconstruction and monochromatic imaging in spinal fusion CT images.

BACKGROUND: Spinal fusion surgery is an important procedure for treating spinal diseases and computed tomography (CT) is a critical tool for postoperative evaluation. However, CT image quality is considerably impaired by metal artifacts and image noise. PURPOSE: To explore whether metal artifacts and image noise can be reduced by combining two technologies, adaptive statistical iterative reconstruction (ASIR) and monochromatic imaging generated by gemstone spectral imaging (GSI) dual-energy CT. MATERIAL AND METHODS: A total of 51 patients with 318 spinal pedicle screws were prospectively scanned by dual-energy CT using fast kV-switching GSI between 80 and 140 kVp. Monochromatic GSI images at 110 keV were reconstructed either without or with various levels of ASIR (30%, 50%, 70%, and 100%). The quality of five sets of images was objectively and subjectively assessed. RESULTS: With objective image quality assessment, metal artifacts decreased when increasing levels of ASIR were applied (P < 0.001). Moreover, adding ASIR to GSI also decreased image noise (P < 0.001) and improved the signal-to-noise ratio (P < 0.001). The subjective image quality analysis showed good inter-reader concordance, with intra-class correlation coefficients between 0.89 and 0.99. The visualization of peri-implant soft tissue was improved at higher ASIR levels (P < 0.001). CONCLUSION: Combined use of ASIR and GSI decreased image noise and improved image quality in post-spinal fusion CT scans. Optimal results were achieved with ASIR levels ≥70%.

Meningitis in a Chinese adult patient caused by Mycoplasma hominis: a rare infection and literature review.

BACKGROUND: Mycoplasma hominis, a well known cause of neonatal infection, has been reported as a pathogen in urogenital infections in adults; however, central nervous system (CNS) infections are rare. We report here the first case of M. hominis meningitis in China, post neurosurgical treatment for an intracerebral haemorrhage in a 71-year-old male. CASE PRESENTATION: We describe a 71-year-old man who developed M. hominis meningitis after neurosurgical treatment and was successfully treated with combined azithromycin and minocycline therapy of 2 weeks duration, despite delayed treatment because the Gram stain of cerebrospinal fluid (CSF) yielded no visible organisms. The diagnosis required 16S rDNA sequencing analysis of the cultured isolate from CSF. Literature review of M. hominis CNS infections yielded 19 cases (13 instances of brain abscess, 3 of meningitis, 1 spinal cord abscess and 1 subdural empyema each). Delay in diagnosis and initial treatment failure was evident in all cases. With appropriate microbiological testing, antibiotic therapy (ranging from 5 days to 12 weeks) and often, multiple surgical interventions, almost all the patients improved immediately. CONCLUSIONS: Both our patient findings and the literature review, highlighted the pathogenic potential of M. hominis together with the challenges prompted by rare infectious diseases in particular for developing countries laboratories with limited diagnostic resources.

[Localized Scleroderma of Lower Extremities:Clinical and Magnetic Resonance Imaging Features].

OBJECTIVE: To evaluate the clinical and musculoskeletal characteristics of localized scleroderma with lower extremities affected. METHODS: All the localized scleroderma patients,who received magnetic resonance (MR ) examinations of affected lower extremities at Peking Union Medical College Hospital from April 2013 to June 2014,were retrospectively reviewed. Their clinical data and laboratory results of antinuclear antibody,anti-double stranded-DNA antibody, and anti-extractable nuclear antigen antibody were collected and analyzed. All the MR examinations were non-contrast imaging using Siemens Skyra 3.0T MR scanner. RESULTS: There were 16 localized scleroderma patients with lower extremities affected, 11 of whom were linear scleroderma, 4 generalized morphea, and 1 deep morphea. Female to male ratio was 1:2.2. The mean age was 22.5 years. The mean time span was 7.4 years. Four of the 14 patients (28.6%) who received antinuclear antibody test were positive. All the 10 patients who received anti-double stranded-DNA antibody test and the 7 patients who received anti-extractable nuclear antigen antibody test were negative. The most common musculoskeletal MR features were subcutaneous septal thickening (16/16) and fascial thickening (11/16). The thickened speta and fascia could either be hypointenstiy or hyperintensity on turbo inversion recovery magnitude/proton density weighted imaging. Other MR manifestations were intramuscular speta thickening (3/16), muscular abnormal signals (1/16), and bone marrow abnormal signals (2/16). CONCLUSION: Musculoskeletal manifestations of the lower extremities with localized scleroderma can be well revealed using MR imaging.