Cochlin produced by follicular dendritic cells promotes antibacterial innate immunity.

Cochlin, an extracellular matrix protein, shares homologies with the Factor C, a serine protease found in horseshoe crabs, which is critical for antibacterial responses. Mutations in the COCH gene are responsible for human DFNA9 syndrome, a disorder characterized by neurodegeneration of the inner ear that leads to hearing loss and vestibular impairments. The physiological function of cochlin, however, is unknown. Here, we report that cochlin is specifically expressed by follicular dendritic cells and selectively localized in the fine extracellular network of conduits in the spleen and lymph nodes. During inflammation, cochlin was cleaved by aggrecanases and secreted into blood circulation. In models of lung infection with Pseudomonas aeruginosa and Staphylococcus aureus, Coch(-/-) mice show reduced survival linked to defects in local cytokine production, recruitment of immune effector cells, and bacterial clearance. By producing cochlin, FDCs thus contribute to the innate immune response in defense against bacteria.

Gastric Ultrasound Assessing Gastric Emptying of Preoperative Carbohydrate Drinks: A Randomized Controlled Noninferiority Study.

BACKGROUND: Tools for the evaluation of gastric emptying have evolved over time. The purpose of this study was to show that the risk of pulmonary aspiration is not increased with carbohydrate drink, by demonstrating that the gastric antral cross-sectional area (CSA) of the NO-NPO group is either equivalent to or less than that of the NPO (nil per os) group. METHODS: Sixty-four patients scheduled for elective laparoscopic benign gynecologic surgery were enrolled and randomly assigned to the NPO group (n = 32) or the NO-NPO group (n = 32). After having a regular meal until midnight before surgery, the NPO group fasted until surgery, while the NO-NPO group ingested 400 mL of a carbohydrate drink at midnight and freely up to 2 hours before anesthesia. The primary outcome was the gastric antral CSA by gastric ultrasound in right lateral decubitus position (RLDP). Noninferiority was defined as a mean difference of CSA <2.8 cm2. Secondary outcomes included CSA in supine position, gastric volume (GV), GV per weight (GV/kg), GV/kg >1.5 mL/kg, and Perlas grade. RESULTS: CSA in RLDP was not different between the NPO group (6.25 ± 3.79 cm2) and the NO-NPO group (6.21 ± 2.48 cm2; P = .959). The mean difference of CSA in RLDP (NO-NPO group - NPO group) was 0.04 (95% confidence interval [CI], -1.56 to 1.64), which was within the noninferiority margin of 2.8 cm2. CSA was not different between the 2 groups (4.17 ± 2.34 cm2 in NPO group versus 4.28 ± 1.23 cm2 in NO-NPO group; P = .828). GV in NPO group (70 ± 56 mL) was not different from NO-NPO group (66 ± 36 mL; mean difference, 3.66; 95% CI, -20 to 27; P = .756). GV/kg in the NPO group (1.25 ± 1.00 mL/kg) was not different from the NO-NPO group (1.17 ± 0.67 mL/kg; P = .694). The incidence of GV/kg > 1.5 mL/kg was not different between NPO (31.3%) and NO-NPO group (21.9%; P = .768). The median (interquartile range) of the Perlas grade was 1 (0-1) in NPO group and 0.5 (0-1) in NO-NPO group (P = .871). CONCLUSIONS: Preoperative carbohydrates ingested up to 2 hours before anesthesia do not delay gastric emptying compared to midnight fasting, as evaluated with gastric ultrasound.

Deubiquitination of NLRP3 by BRCC3 critically regulates inflammasome activity.

NLRP3 is an important pattern recognition receptor involved in mediating inflammasome activation in response to viral and bacterial infections as well as various proinflammatory stimuli associated with tissue damage or malfunction. Upon activation, NLRP3 assembles a multimeric inflammasome complex comprising the adaptor ASC and the effector pro-caspase-1 to mediate the activation of caspase-1. Although NLRP3 expression is induced by the NF-κB pathway, the posttranscriptional molecular mechanism controlling the activation of NLRP3 remains elusive. Using both pharmacological and molecular approaches, we show that the activation of NLRP3 inflammasome is regulated by a deubiquitination mechanism. We further identify the deubiquitinating enzyme, BRCC3, as a critical regulator of NLRP3 activity by promoting its deubiquitination and characterizing NLRP3 as a substrate for the cytosolic BRCC3-containing BRISC complex. Our results elucidate a regulatory mechanism involving BRCC3-dependent NLRP3 regulation and highlight NLRP3 ubiquitination as a potential therapeutic target for inflammatory diseases.

Ultrasound evaluation of postsurgical shoulder after rotator cuff repair: comparison of clinical results.

BACKGROUND: The relationship between the imaging parameters on postoperative ultrasound (US) other than repaired tendon integrity with clinical outcome such as postoperative residual pain has not been well defined. PURPOSE: To investigate whether the repaired tendon thickness and subdeltoid fluid collection after rotator cuff repair are correlated with early postoperative clinical outcome. MATERIAL AND METHODS: This retrospective study included 54 patients who underwent repair of the arthroscopic rotator cuff either by suture-bridge or single-row technique and postoperative US. We assessed the relationship between the sonographic parameters, including repaired supraspinatus tendon thickness and subdeltoid fluid collection, with the clinical outcome represented by the Korean Shoulder Scoring system (KSS) score using correlation coefficients (R). Also, the subgroup analysis was done to assess the differences by surgical technique and patients' age. RESULTS: There was a significant inverse relationship between the amount of subdeltoid fluid collection and degree of self-assessed pain improvement of the patients (P < 0.05), although every KSS category showed statistically insignificant tendency of inverse relationship with the fluid thickness. However, there was no statistically significant relationship between the thickness of repaired supraspinatus tendon and KSS scores. In patients aged >60 years, a statistically significant inverse relationship between thickness of subdeltoid fluid collection and difference value of the KSS scores in category of function was observed with both interpreters (P = 0.015 and P = 0.04, respectively). CONCLUSION: Subdeltoid fluid collection measured on US after repair of the arthroscopic rotator cuff in the early postoperative period has significant association with the patients' subjective clinical outcome.

Types of posterolateral corner injury associated with both bundle and selective-bundle ACL tears.

BACKGROUND: It is unknown whether a selective-bundle tear of the anterior cruciate ligament (ACL) shows a different prevalence of posterolateral corner (PLC) injury than a both-bundle tear. PURPOSE: The prevalence of injury of PLC stabilizer in relation to the type of combined ACL tear (both-bundle and selective-bundle tears) has been investigated. MATERIAL AND METHODS: This retrospective study included 94 patients who were diagnosed with an ACL tear after knee joint magnetic resonance imaging and underwent arthroscopic surgery. We compared the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. We used Fischer exact tests to compare the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. RESULTS: Both-bundle tears occurred in 55 cases (56%) and selective-bundle tears in 39 cases (44%). The most common PLC injury with an ACL tear was inferior popliteomeniscal fascicle (PMF) injury, followed by superior PMF injury. The prevalence of each PLC injury was higher for both-bundle tears than selective-bundle tears, with the exception of popliteus tendon injury diagnosed by reader 1 (P.H.J). However, these differences were statistically significant for superior PMF injury only ( p < 0.05). The prevalence of PLC injury was unrelated to the type of selective-bundle tear (anteromedial vs posterolateral). CONCLUSION: Superior PMF injury is more common in both-bundle tears than selective-bundle tears. There is no statistically significant difference in the prevalence of PLC injury between both-bundle tears and selective-bundle tears.

Usefulness of the quantitative evaluation of diffusion-weighted mri in the diagnosis of anterior cruciate ligament tears.

PURPOSE: To evaluate the usefulness of the diffusion-weighted imaging (DWI) in the diagnosis of anterior cruciate ligament (ACL) tear using the contrast-to-noise ratio (CNR) and apparent diffusion coefficient (ADC) values according to the different b values. MATERIALS AND METHODS: Institutional review board approval was acquired. We evaluated 74 patients (M:F = 43:31, mean age of 44 years) who underwent 3.0 Tesla knee MR with DWI because of the possibility of ACL tear due to trauma. Region of interest measurements were performed. We (two radiologists) measured the signals of the DWI and derived ADC values on the oblique sagittal DWI with b values of 0, 600, and 1000. The diagnostic accuracies of the conventional MR image and each DWI with an ADC value with a different b value were evaluated. The CNR and ADC values were compared using the Mann-Whitney U-test. The diagnostic performances of the various imaging methods were evaluated using the sensitivity, specificity, and accuracy for differentiating between normal and ACL injury as determined by the use of conventional MRI with additional DWIs with McNemar test. The arthroscopic or clinical findings were used as the reference standard. RESULTS: The mean CNRs of ligament tears with b values of 600 and 1000 were significantly higher than those of normal ligament (22 versus 7 and 9 versus 4, P value < 0.05). The sensitivities and the accuracies of the DWI were significantly lower than the conventional MRIs (P value < 0.001). CONCLUSIONS: The CNRs of the torn ACL with each b value (600 and 1000) were significantly higher those of than normal ligament, although the ADC values of the torn ligament were not different from normal ligament. Addition of the DWI to the conventional MRI did not improve diagnostic performance. J. Magn. Reson. Imaging 2016;44:1116-1122.

Peroneal tendon pathology evaluation using the oblique sagittal plane in ankle MR imaging.

BACKGROUND: Because peroneal tendons course from the lateral side of the proximal fibula through the posterior side of the distal fibula, correct diagnosis of the tendon pathology on an orthogonal sagittal plane can be difficult. PURPOSE: To evaluate the diagnostic usefulness of oblique sagittal imaging (peroneal view) for evaluation of peroneal tendon pathology. MATERIAL AND METHODS: This retrospective study included 69 patients at our institution who underwent routine ankle magnetic resonance imaging (MRI) using the peroneal view. Twenty-three patients underwent arthroscopy. Anatomic identification of the peroneal tendons on orthogonal sagittal MRI sequences and peroneal views were evaluated. Two radiologists evaluated the peroneal tendons based on an entire length view, an entire width view, and margin sharpness using a 4-point scale. Diagnostic accuracy using orthogonal sagittal and peroneal views was evaluated by calculating sensitivity, specificity, and accuracy. Arthroscopic or clinical findings were used as the reference standard. RESULTS: Total anatomical scores on the peroneal view were higher than those of the orthogonal sagittal views (P < 0.001). Both readers were able to identify anatomy of the tendon using the full length, full width and sharp margin, and determined that the peroneal view was better when compared with the orthogonal sagittal views (P < 0.001). Although the sensitivity and accuracy of the peroneal view in the diagnosis of peroneal tendon injury were slightly higher than orthogonal view, the values were not statistically significant. CONCLUSION: Peroneal views provide better anatomic evaluation of the peroneal tendons itself, although cannot show significant superiority in the diagnostic performances.

Modified thoracolumbar injury classification and severity score (TLICS) and its clinical usefulness.

BACKGROUND: Thoracolumbar injury classification and severity score (TLICS) is not very reliable for assessment of injury to the posterior ligament complex, even when scored by experts. It is not reasonable to score every compression fracture or burst fracture the same as there is great variety in the severity of compression fractures and burst fractures. PURPOSE: To propose a modified TLICS (mTLICS) and evaluate the performance of the mTLICS system by measuring the agreement between scores determined by radiologists using both systems and actual treatment procedure delivered. MATERIAL AND METHODS: We retrospectively evaluated 134 patients with acute lumbar and thoracic spinal trauma after undergoing magnetic resonance imaging (MRI) using new mTLICS and conventional TLICS system. Inter-observer agreements of TLICS and mTLICS scores were analyzed using the kappa statistic. Nonparametric correlation analysis was used to determine correlation (R) among each score and the surgical intervention. RESULTS: The mTLICS system showed slightly higher correlation than TLICS (Rs, TLICS, 0.592 and 0.613 vs. mTLICS, 0.628 and 0.639). If we consider a total maximal score of 4 to be a negative surgical indication, mTLICS showed significantly higher sensitivities than TLICS, and if we consider a total minimal score of 4 to be a positive surgical indication, mTLICS showed significantly higher specificities than TLICS. CONCLUSION: The mTLICS score corrects deficiencies in the TLICS system that lead to ambiguity in the radiological diagnostic criteria. mTLICS is a more suitable scoring system than TLICS for predicting surgical management accurately, especially for morphological injuries.

Src is a novel potential off-target of RXR agonists, 9-cis-UAB30 and Targretin, in human breast cancer cells.

9-cis-UAB30 (UAB30) and Targretin are well-known retinoid X receptor (RXR) agonists. They were highly effective in decreasing the incidence of methylnitrosourea (MNU)-induced mammary cancers. However, whether the anti-mammary cancer effects of UAB30 or Targretin originate from the activation of RXR is unclear. In the present study, we hypothesized that UAB30 and Targretin not only affect RXR, but likely influence one or more off-target proteins. Virtual screening results suggest that Src is a potential target for UAB30 and Targretin that regulates extracellular matrix (ECM) molecules and cell motility and invasiveness. In vitro kinase assay data revealed that UAB30 or Targretin interacted with Src and attenuated its kinase activity. We found that UAB30 or Targretin substantially inhibited invasiveness and migration of MCF-7 and SK-BR-3 human breast cancer cells. We examined the effects of UAB30 and Targretin on the expression of matrix metalloproteinases (MMP)-9, which are known to play an essential role in tumor invasion. We show that activity and expression of MMP-9 were decreased by UAB30 or Targretin. Western blot data showed that UAB30 or Targretin decreased AKT and its substrate molecule p70(s6k), which are downstream of Src in MCF-7 and SK-BR-3 cells. Moreover, knocking down the expression of Src effectively reduced the sensitivity of SK-BR-3 cells to the inhibitory effects of UAB30 and Targretin on invasiveness. Taken together, our results demonstrate that UAB30 and Targretin each inhibit invasion and migration by targeting Src in human breast cancer cells.

Initial Performance of Radiologists and Radiology Residents in Interpreting Low-Dose (2-mSv) Appendiceal CT.

OBJECTIVE: The objective of our study was to prospectively evaluate the initial diagnostic performance and learning curve of a community of radiologists and residents in interpreting 2-mSv appendiceal CT. SUBJECTS AND METHODS: We included 46 attending radiologists and 153 radiology residents from 22 hospitals who completed an online training course of 30 2-mSv CT cases. Appendicitis was confirmed in 14 cases. Most of the readers had limited (≤ 10 cases, n = 32) or no (n = 118) prior experience with low-dose appendiceal CT. The order of cases was randomized for each reader. A multireader multicase ROC analysis was performed. Generalized estimating equations were used to model the learning curves in diagnostic performance. RESULTS: Diagnostic performance gradually improved with years of training. The average AUC was 0.94 (95% CI, 0.90-0.98), 0.92 (0.88-0.96), 0.90 (0.85-0.96), and 0.86 (0.80-0.92) for the attending radiologists, senior residents, 2nd-year residents, and 1st-year residents, respectively. We did not observe any notable intrareader learning curves over the training course of the 30 cases except a decrease in reading time. Diagnostic accuracy and sensitivity were significantly affected by the reader training level and prior overall experience with appendiceal CT but not by the prior specific experience with low-dose appendiceal CT. CONCLUSION: The learning curve is likely prolonged and forms gradually over years by overall radiology training and clinical experience in general rather than by experience with low-dose appendiceal CT specifically.

Pre-operative CT predictors associated with 30-day adverse events in patients with appendiceal inflammatory masses who underwent immediate appendectomies.

PURPOSE: To retrospectively evaluate pre-operative CT predictors that are associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses. METHODS: This retrospective study was approved by our institutional review board, and the requirement for informed consent was waived. One hundred forty-four consecutive patients who underwent immediate appendectomies and were diagnosed with appendiceal inflammatory masses by pre-operative CT from January 2005 to December 2013 at a tertiary hospital were included. The main outcome measure was 30-day adverse events. Patient demographics and data for inflammatory markers including leukocyte counts, segmented neutrophils, and C-reactive protein levels were collected by a single radiologist. Pre- and post-operative CT findings were evaluated for features of appendiceal inflammatory masses, associated findings, and post-operative adverse events by two radiologists in a blinded fashion with consensus to assess surgical and pathologic results, post-operative outcomes, and original CT interpretations. Appendiceal inflammatory masses were defined as complicated appendicitis with a phlegmon or an abscess that was identified on pre-operative CT exam. Factors associated with 30-day adverse events were assessed using logistic regression analysis. RESULTS: A total of 22 (15%) of the 144 patients (mean age [±SD] 44.6 ± 22.0 years, range 3-97 years) experienced 30-day adverse events: ten intra-abdominal abscesses, three wound infections, two cases of peritonitis, two small bowel obstructions, two intra-abdominal abscesses with peritonitis, one intra-abdominal abscess with wound infection, one intra-abdominal abscess with small bowel obstruction, and one case of peritonitis with small bowel obstruction. In univariate analysis, the presence of appendicolith (odds ratio [OR] 2.49, p = 0.048) and high-grade obstruction (OR 3.79; p = 0.01) were associated with adverse events. High-grade obstruction (adjusted OR 3.05; p = 0.04) was the only independent pre-operative predictor associated with 30-day adverse events in patients with appendiceal inflammatory masses. CONCLUSIONS: High-grade obstruction was an independent pre-operative CT predictor associated with 30-day adverse events in patients who underwent immediate appendectomies for appendiceal inflammatory masses.

T2 relaxation times of the glenohumeral joint at 3.0 T MRI in patients with and without primary and secondary osteoarthritis.

BACKGROUND: Quantitative magnetic resonance imaging (MRI) of cartilage has recently been applied to patients with osteoarthritis (OA). T2 mapping is a sensitive method of detecting changes in the chemical composition and structure of cartilage. PURPOSE: To establish baseline T2 values of glenohumeral joint cartilage at 3.0 T and compare T2 values among subjects with and without OA. MATERIAL AND METHODS: The study involved 30 patients (18 women, 12 men; median age, 67 years; age range, 51-78 years) with primary (n = 7) and secondary OA (n = 23) in the glenohumeral joint and 34 subjects without OA (19 women, 15 men; median age, 49 years; age range, 23-63 years). All subjects were evaluated by radiography and 3.0 T MRI including a multi-echo T2-weighted spin echo pulse sequence. The T2 value of the cartilage was measured by manually drawing the region of interest on the T2 map. Per-zone comparison of T2 values was performed using Mann-Whitney U test. RESULTS: Median T2 values differed significantly between subjects without OA (36.00 ms [interquartile range, 33.89-37.31 ms]) and those with primary (37.52 ms [36.84-39.11], P = 0.028), but not secondary (36.87 ms [34.70-41.10], P = 0.160) OA. Glenohumeral cartilage T2 values were higher in different zones between patients with primary and secondary OA than in subjects without OA. CONCLUSION: These T2 values can be used for comparison to assess cartilage degeneration in patients with shoulder OA. Significant differences in T2 were observed among subjects without OA and those with primary and secondary OA.

Dietary intake of vitamin K in relation to bone mineral density in Korea adults: The Korea National Health and Nutrition Examination Survey (2010-2011).

Low vitamin K nutritional status has been associated with increased risk of fracture, however inconsistent results exist to support the role of vitamin K on bone mineral density depending on ethnic difference and gender. Our objective was to determine vitamin K intake in Korean adults, examine correlation between vitamin K intake and bone mineral density. This study analyzed raw data from the fifth Korea National Health and Nutrition Examination Survey for adults (2,785 men, 4,307 women) aged over 19 years. Cross-sectional analyses showed only positive association between vitamin K intake and femur bone mineral density in men after adjusting bone-related factors. However, women in high tertiles of vitamin K intake had a significantly higher bone mineral density both in femur and lumber as compared to women in lowest tertiles (p<0.05). The risk for osteoporosis was decreased as vitamin K intake increased in women, but this effect was not persisted after adjusting factors. The findings of this study indicate that low dietary vitamin K intake was associated with low bone mineral density in subjects. From these results we may suggest an increase in dietary vitamin K intakes for maintaining bone mineral density. (2010-02CON-21-C, 2011-02CON-06-C).

Breast-specific gamma imaging: correlations with mammographic and clinicopathologic characteristics of breast cancer.

OBJECTIVE: The purpose of this article is to evaluate the correlations between breast-specific gamma imaging (BSGI) findings and mammographic and clinicopathologic characteristics of breast cancer. MATERIALS AND METHODS: Our study included 56 breast cancers that had undergone BSGI between August 2010 and December 2012. We reviewed imaging findings (BSGI and mammography) with histopathologic findings, including tumor size, histologic type, nuclear grade, presence of ductal carcinoma in situ (DCIS), and presence of extensive intraductal component (EIC); and immunochemical features, including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (ERBB2, formerly HER2), Ki67, and p53. We classified cancers into positive or negative groups on the basis of BSGI visibility and investigated the statistical differences in mammographic and histopathologic characteristics between the BSGI-positive and -negative groups. RESULTS: Among 56 malignancies, 48 (85.7%) were shown to be BSGI positive. Patients in the BSGI-positive group were statistically significantly older than those in the BSGI-negative group (p = 0.027). BSGI-positive cancers were statistically significantly larger than BSGI-negative cancers (p = 0.002). Cancers 1.0 cm or larger, unlike those of subcentimeter size, were statistically significantly more visible on BSGI (p = 0.004). The mammographic findings and mammographic densities did not statistically significantly differ between the BSGI-positive and -negative groups. Invasiveness of cancer showed no statistically significant difference on BSGI finding. Cancers with a DCIS component tended to be BSGI positive, but without statistical significance (p = 0.051). Visibility on BSGI was not statistically significantly associated with EIC, nuclear grade, ER, PR, ERBB2, Ki67, and p53. CONCLUSION: The sensitivity of BSGI for breast cancer was 85.7%. Breast cancers in older patients, cancers larger than 1.0 cm, and cancers with the DCIS component tended to be visible on BSGI. BSGI was an equally sensitive tool to detect the breast cancer in women with fatty and dense breast.

The clinical correlation of a new practical MRI method for grading cervical neural foraminal stenosis based on oblique sagittal images.

OBJECTIVE: The purpose of this study was to determine whether each grade in a new system suggested by Park et al. (Park system) to assess cervical neural foraminal stenosis validly correlates with the associated clinical findings and to evaluate the interobserver agreement in grading between two MRI readers. MATERIALS AND METHODS: We evaluated 166 patients (98 men and 68 women; mean age, 46 years) at our institution who underwent oblique sagittal MRI of the cervical spine. Using the new Park grading system, two radiologists evaluated the MRI findings for the presence and grade of cervical neural foraminal stenosis at the most narrow point. A neurosurgeon assessed the associated clinical manifestations. A positive neurologic manifestation of the cervical neural foraminal stenosis was defined as more than one positive neurologic clinical manifestation combined with more than one positive neurologic sign. Interobserver agreements between the two radiologists were analyzed using kappa statistics. Correlation coefficients (R) to assess the relationship between the grade and neurologic manifestations were calculated with nonparametric correlation analysis (Spearman correlation). The relationship between the assigned grade and the clinical manifestations was analyzed several ways: vertebrae level (C4-5, C5-6, or C6-7) and by age group (< 46 years and ≥ 46 years). RESULTS: Among patients who were evaluated by each reader to be grade 0, only 19 (17%) and 20 patients (18%) showed positive neurologic manifestations, respectively, with most patients showing negative neurologic manifestations. Among the patients who were grade 2 and 3, one reader found all patients and the second reader found all but one patient (100% and 93%, respectively) to have positive neurologic manifestations. According to the correlation coefficients, each Park grade was moderately correlated with the associated neurologic manifestations, such that higher grades were associated with more severe clinical manifestations. If we consider grade 2 or 3 MRI findings positive for identifying positive neurologic manifestations, the sensitivities and specificities were 39.7% and 99.0% (reader 1) and 39.7% and 99.0% (reader 2), respectively. CONCLUSION: The Park system, based on oblique sagittal MRI sections, provides a reliable and reproducible assessment of the severity of cervical neural foraminal stenosis. According to the Park system, grades 2 and 3 are associated with positive neurologic manifestations, and the Park system successfully predicts positive neurologic manifestations at these grades.

Comparison between arthroscopic findings and 1.5-T and 3-T MRI of oblique coronal and sagittal planes of the knee for evaluation of selective bundle injury of the anterior cruciate ligament.

OBJECTIVE: The purpose of this study was to evaluate the diagnostic usefulness of combining oblique sagittal and oblique coronal MRI views of the anterior cruciate ligament (ACL) with traditional orthogonal views for the evaluation of selective-bundle ACL injury and to evaluate whether there is a statistical difference in diagnostic ability between 1.5-T and 3-T MRI. MATERIALS AND METHODS: This retrospective study included 114 patients who underwent knee MRI (46 on 1.5 T and 68 on 3 T) and arthroscopy at our institution. Two radiologists evaluated orthogonal views and ACL views on 1.5-T and 3-T MRI in variable combinations. They diagnosed ACL views as normal, entire ligament tear, anteromedial bundle tear, or posterolateral bundle tear. The surgeon then confirmed tears in the anteromedial or posterolateral bundle of the ACL arthroscopically if a selective-bundle tear did exist. The arthroscopically confirmed diagnoses were used as the reference standard. The values were statistically analyzed. RESULTS: Sixty-seven percent of patients showed an ACL tear on arthroscopy, and 33% had a selective bundle tear; of these, 75% were anteromedial bundle tears and 25% were posterolateral bundle tears. On 1.5-T MRI, specificities of each view and combined views were the same (80%). The sensitivities and accuracies of the combined views were higher than the individual views; differences between individual views ranged from 4% to 15%. Reader 1 saw statistically significant differences between the oblique coronal and combined views. Although the performances of reader 2 showed similar results, the p values exceeded the critical value of statistical significance (0.063). On 3-T MRI, differences in specificities between the orthogonal and combined views and between the orthogonal and oblique coronal views were statistically significant (p, 0.016 and 0.008 for readers 1 and 2, respectively). There were no significant differences in the diagnostic performance of 1.5-T and 3-T MRI. CONCLUSION: The oblique coronal view and the combination of the orthogonal view and both additional ACL views provide better diagnostic information with an improvement in specificity on 3-T MRI compared with orthogonal views alone in the diagnosis of selective-bundle tears. Although diagnostic performance was not improved with the addition of the oblique views over orthogonal views on 1.5-T imaging, diagnostic performance was improved on 3-T MRI. Accuracies for individual imaging planes were not significantly different when comparing 1.5-T and 3-T MRI.

Preoperative prediction model for conversion of laparoscopic to open cholecystectomy in patient with acute cholecystitis: based on clinical, laboratory, and CT parameters.

OBJECTIVE: To identify preoperative computed tomography (CT) predictors associated with conversion from laparoscopic to open cholecystectomy and to propose the risk scoring model for prediction of conversion by integrating clinical, laboratory, and CT parameters. METHODS: The institutional review board approved this retrospective study, and informed consent was waived. One hundred eighty-three patients who underwent a laparoscopic cholecystectomy for acute cholecystitis were evaluated for clinical, laboratory, and CT parameters. Associations between conversion and these parameters were assessed by using univariate and multivariate logistic regression analysis. The risk scoring model was devised using a regression coefficient-based scoring method. RESULTS: Conversion to open cholecystectomy was performed in 30 patients (17%). Multivariate analysis identified age older than 60 years, male, and pericholecystic fluid as independent predictors of conversion. The preoperative prediction model to calculate the risk score for conversion showed sensitivity of 83% and specificity of 72%, with an area under the receiver operator curve of 0.83. CONCLUSIONS: Pericholecystic fluid collection was the only CT parameter with clinical parameters of age older than 60 years and male in prediction for conversion in acute cholecystitis. The preoperative prediction model using these 3 parameters can be adapted easily in clinical practice with a good discrimination.

Differentiation of early perforated from nonperforated appendicitis: MDCT findings, MDCT diagnostic performance, and clinical outcome.

To determine the CT findings and assess their diagnostic performance in differentiating early perforated appendicitis from nonperforated appendicitis, and to compare therapeutic approaches and clinical outcomes between two types of appendicitis. Our retrospective study was approved by our institutional review board and informed consent was waived. From July 2012 to July 2013, 339 patients [mean age 40.8 years; age range 19-80 years; 183 male (mean age 40.5 years; age range 19-79 years) and 156 female (mean age 41.2 years; age range 19-80 years)] who underwent appendectomy with preoperative CT examination for suspected acute appendicitis were included, with exclusion of 37 patients with specific CT findings for advanced perforated appendicitis. And they were categorized into nonperforated and early perforated appendicitis groups according to surgical and pathologic reports. The following CT findings were evaluated by two radiologists blinded to pathologic and surgical findings: transverse diameter of the appendix, thickness of the appendiceal wall, the depth of intraluminal appendiceal fluid, appendiceal wall enhancement, presence or absence of focal defect in the appendiceal wall, intraluminal appendiceal air, appendicolith/fecalith, periappendiceal changes, cecal wall thickening, and free fluid. The type of surgical procedures, performance of surgical drainage, and the length of hospital stay were recorded. Univariate and multivariate logistic regression analysis were used to determine the CT findings for differentiating early perforated appendicitis from nonperforated appendicitis, a total of 75 (22%) of the 339 patients was diagnosed with early perforated appendicitis. Focal wall defect [adjusted odds ratio (aOR), 23.40; p < 0.001], circumferential periappendiceal changes (aOR, 5.63; p < 0.001), appendicoliths/fecaliths (aOR, 2.47; p = 0.015), and transverse diameter of the appendix (aOR, 1.22; p = 0.003) were independently differentiating variables for early perforated appendicitis. The transverse diameter of the appendix (≥11 mm) had the highest sensitivity (62.7%) and focal wall defect in the appendiceal wall showed the highest specificity (98.8%). The prevalence of surgical drainage was higher (p = 0.001) and the mean hospital stay was approximately one day longer (p < 0.001) in the early perforated group than nonperforated group. CT can be helpful in differentiating early perforated appendicitis from nonperforated appendicitis, although the sensitivity of the evaluated findings was somewhat limited.

The usefulness of the oblique coronal plane in knee MRI on the evaluation of the posterior cruciate ligament.

BACKGROUND: Imaging findings of posterior cruciate ligament (PCL) injury may be equivocal, particularly when the patient has suffered a partial ligament tear. Some PCLs are positioned more horizontally, making it difficult to diagnose injury based on routine imaging planes alone due to partial volume artifact. PURPOSE: To evaluate the diagnostic accuracy of combining oblique coronal imaging (PCL view) with traditional orthogonal views for PCL evaluation. MATERIAL AND METHODS: This retrospective study included 20 patients with PCL injury and 43 patients with intact PCL who underwent PCL view imaging. Anatomic identification of PCL pathology on the orthogonal magnetic resonance imaging (MRI) sequences and PCL views was evaluated. Subjective scoring of the PCL was performed by two radiologists who assessed the possibility of a PCL tear based on an entire length view, an entire width view, and margin sharpness according to a 4-point scale. Diagnostic accuracy using these two views was evaluated by calculating the sensitivity, specificity, and accuracy. Arthroscopic and clinical findings were used as the reference standard. RESULTS: Total scores for the PCL view were higher than those of orthogonal views (P < 0.001). Both readers found that anatomic identification using the full width view and sharp margin to be superior using the PCL view compared with the orthogonal views (P < 0.001). The specificities and accuracies were higher in cases where an additional PCL view was provided, but did not show statistical significance. CONCLUSION: PCL view provides better anatomic evaluation of the PCL and mild improvement in the specificity and accuracy.

Metabolic remodeling in cancer and senescence and its therapeutic implications.

Cellular metabolism is a flexible and plastic network that often dictates physiological and pathological states of the cell, including differentiation, cancer, and aging. Recent advances in cancer metabolism represent a tremendous opportunity to treat cancer by targeting its altered metabolism. Interestingly, despite their stable growth arrest, senescent cells - a critical component of the aging process - undergo metabolic changes similar to cancer metabolism. A deeper understanding of the similarities and differences between these disparate pathological conditions will help identify which metabolic reprogramming is most relevant to the therapeutic liabilities of senescence. Here, we compare and contrast cancer and senescence metabolism and discuss how metabolic therapies can be established as a new modality of senotherapy for healthy aging.