Upregulations of high mobility group box 1 and TLR4/NF-κB signaling pathway in hippocampus and serum of rats with febrile seizure.

PURPOSE: The aim of this study was to explore the alternations regarding the HMGB1 and TLR4/NF-κB signaling pathway in juvenile rats with febrile seizure (FS). MATERIALS AND METHODS: During the animal modeling of the FS, seizures were triggered every four days by hot water (45 °C), and repeated ten times. After forty days' modeling, rats were divided into different groups according to the degree of seizure (FS (0) - FS (V)). Reverse transcription-polymerase chain reaction (RT-PCR) was used to evaluate the mRNA expressions of the HMGB1, TLR4 and NF-κB in the hippocampus, while Western-blot (WB) and immunofluorescence (IF) were employed to assess protein expressions. The enzyme-linked immunosorbent assay (ELISA) was used for analyzing the protein expressions in peripheral blood. RESULTS: The mRNA levels of the HMGB1, TLR4 and NF-κB in the hippocampus of both FS (V) and FS (IV) groups were significantly higher than WT, while there was no difference between FS (III) and WT. Concerning protein expressions, increased levels of the HMGB1, TLR4, and NF-κB in FS (V) were observed with a good consistency between the WB and IF, while no significant upregulation was shown in FS (IV). The ELISA results showed that the significance of the augmented proteins between the FS (V) and WT were smaller in the serum than the hippocampus. CONCLUSIONS: Our study shows seizure degree-related upregulations of HMGB1 and TLR4/NF-κB signaling pathway both in hippocampus and serum of juvenile rats with FS, suggesting the involvement of TLR/NF-κB pathway in inflammation promoted by HMGB1 during FS.

Case Report: A case of multisystem inflammatory syndrome in an 11-year-old female after COVID-19 inactivated vaccine.

Background: Multisystem inflammatory syndrome in children (MIS-C), also known as pediatric inflammatory, multisystem syndrome temporally associated with SARS-CoV-2, is a rare but serious complication of SARS-CoV-2 infection in children that typically occurs 2-6 weeks after SARS-CoV-2 infection. The pathophysiology of MIS-C is unknown. MIS-C, first recognized in April 2020, is characterized by fever, systemic inflammation, and multi-system organ involvement. Post-vaccination adverse effects have increased with COVID-19 vaccinations, and MIS linked to immunization with COVID-19 vaccines has also been observed. Case Report: An 11-year-old Chinese girl presented with a high-grade fever, rash, and dry cough for 2 days. She had her 2nd SARS-CoV-2 inactivated vaccination dose five days before hospital admission. On day 3 & 4, she experienced bilateral conjunctivitis, hypotension (66/47 mmHg), and a high CRP level. She was diagnosed with MIS-C. The patient's condition deteriorated rapidly, necessitating intensive care unit admission. The patient's symptoms improved after intravenous immunoglobulin, methylprednisolone, and oral aspirin therapy. She was discharged from the hospital after 16 days as her general condition, and laboratory biomarkers returned to normal. Conclusion: Inactivated Covid-19 vaccination might trigger MIS-C. Further research is needed to evaluate whether a correlation exists between COVID-19 vaccination and MIS-C development.

Consistent differences in brain structure and functional connectivity in high-altitude native Tibetans and immigrants.

It has been well-established that high-altitude (HA) environments affect the human brain; however, the differences in brain structural and functional networks between HA natives and acclimatized immigrants have not been well clarified. In this study, native HA Tibetans were recruited for comparison with Han immigrants (average of 2.3 ± 0.3 years at HA), with lowland residents recruited as controls. Cortical gray matter volume, thickness, and functional connectivity were investigated using magnetic resonance imaging data. In addition, reaction time and correct score in the visual movement task, hematology, and SpO2 were measured. In both Tibetans and HA immigrants vs. lowlanders, decreased SpO2, increased hematocrit and hemoglobin, and increased reaction time and correct score in the visual movement task were detected. In both Tibetans and HA immigrants vs. lowlanders, gray matter volumes and cortical thickness were increased in the left somatosensory and motor cortex, and functional connectivity was decreased in the visual, default mode, subcortical, somatosensory-motor, ventral attention, and subcortical networks. Furthermore, SpO2 increased, hematocrit and hemoglobin decreased, and gray matter volumes and cortical thickness increased in the visual cortex, left motor cortex, and right auditory cortex in native Tibetans compared to immigrants. Movement time and correct score in task were positively correlated with the thickness of the visual cortex. In conclusion, brain structural and functional network difference in both Tibetan natives and HA immigrants were largely consistent, with native Tibetans only showing more intense brain modulation. Different populations acclimatized to HA develop similar brain mechanisms to cope with hostile HA environmental factors.

Brain Structural and Functional Alterations in Native Tibetans Living at High Altitude.

Tibetans have adapted to high altitude environments. However, the genetic effects in their brains have not been identified. Twenty-five native Tibetans living in Lhasa (3650 m) were recruited for comparison with 20 Han immigrants who originated from lowlands and had been living in Lhasa for two years. The physiological characteristics, brain structure and neuronal spontaneous activity were investigated. Compared with Han immigrants, Tibetans showed higher peripheral oxygen saturation (SpO2), and lower heart rate, red blood cell counts, hematocrit, and hemoglobin. Tibetans showed increased gray matter volume in the visual cortex, hippocampus, and rectus; increased the amplitudes of low-frequency fluctuations (ALFF) values in the left putamen and left fusiform gyrus; and decreased voxel-mirrored homotopic connectivity (VMHC) values in the precentral gyrus. Moreover, Tibetans have decreased functional connectivity (FC) between the left precentral gyrus and the frontal gyrusand right precuneus. In Tibetans and Han immigrants, hemoglobin and hematocrit were negatively correlated with total gray matter volume in males, SpO2 was also positively correlated with ALFF in the left fusiform gyrus, while hemoglobin, and hematocrit were positively correlated with VMHC in the precentral gyrus and FC in the precentral gyrus with other brain regions, SpO2 was also found to be negatively correlated with VMHC in the precentral gyrus, and hemoglobin and hematocrit were negatively correlated with ALFF in the left putamen and left fusiform gyrus. In summary, genetic mutations may result in modulation of some brain regions, which was further confirmed by the identification of correlations with hemoglobin and hematocrit in these regions.

T1ρ, T2 and T2* mapping of lumbar intervertebral disc degeneration: a comparison study.

BACKGROUND: Early and accurate assessment of lumbar intervertebral disc degeneration (IVDD) is very important to therapeutic strategy. This study aims to correlate and compare the performances of T1ρ, T2 and T2* mapping for Pfirrmann grades and morphologic changes in the IVDD. METHODS: This prospective study included 39 subjects with 195 lumbar discs. T1ρ, T2 and T2* mapping were performed, and T1ρ, T2 and T2* values of nucleus pulposus (NP), and anterior and posterior annulus fibrosus were measured. IVDD was assessed with Pfirrmann grading and morphologic changes (normal, bulging, herniation and annular fissure). The performances of T1ρ, T2 and T2* relaxation times were compared for detecting early (Pfirrmann grade II-III) and advanced degeneration (Pfirrmann grade IV-V), as well as for morphologic changes. RESULTS: T2 relaxation times was strongly corelated with T1ρ and T2* relaxation times. Areas under the curves (AUCs) of T1ρ, T2 and T2* relaxation times of NP were 0.70, 0.87 and 0.80 for early degeneration, and 0.91, 0.95 and 0.82 for advanced degeneration, respectively. AUCs of T1ρ, T2 and T2* relaxation times of NP were 0.78, 0.83 and 0.64 for bulging discs, 0.87, 0.89 and 0.69 for herniated discs, and 0.79, 0.82 and 0.69 for annular tearing, respectively. The AUC of T2 relaxation time was significantly higher than those of T1ρ relaxation times (both P < 0.01) for early IVDD, and the AUCs of T1ρ and T2 relaxation times for assessing advanced degeneration and morphologic changes were similar (P > 0.05) but significantly higher than that of T2*relaxation time (P < 0.01). CONCLUSIONS: T2 mapping performed better than T1ρ mapping for the detection of early IVDD. T1ρ and T2 mapping performed similarly but better than T2* mapping for advanced degeneration and morphologic changes of IVDD.

Attention Network Changes of High-Altitude Migrants.

INTRODUCTION: The present study aimed to explore whether there are changes in the alerting, orienting, and executive network efficiencies of attention function between high altitude immigrants and low altitude residents.METHODS: Event-related potentials (ERP) were acquired during an attention network test (ANT). The high-altitude (HA) group comprised 22 college student immigrants who were born and raised at low altitudes and had lived at a HA (11,975 ft/3650 m) for 26 mo (tests were conducted when they returned to HA for 3 mo). The low-altitude (LA) group comprised 23 college students who had never visited HA areas before.RESULTS: Compared with the LA group, the HA group had a higher pulse rate, lower oxygen saturation level, and decreased alerting and orienting effects in the behavioral results. The ERP results of the HA group showed a smaller P1 in the occipital area, a larger N1 both in the parietal and occipital areas of the alerting network, and a smaller P1 and larger N1 in the orienting network than the LA group. In the executive control network, the N2 amplitude of the HA group was more negative and the P3 amplitude of the HA group decreased in incongruent conditions.DISCUSSION: Together, these findings suggest that high-altitude migrants are less effective at alerting and orienting than low-altitude residents. For executive control function, changes in the P3 amplitudes of incongruent conditions indicated a decrease in conflict inhibition underlying the executive-control network.An X, Tao G, Zhang X, Ma H, Wang Y. Attention network changes of high-altitude migrants. Aerosp Med Hum Perform. 2022; 93(11):791-799.

The human brain in a high altitude natural environment: A review.

With the advancement of in vivo magnetic resonance imaging (MRI) technique, more detailed information about the human brain at high altitude (HA) has been revealed. The present review aimed to draw a conclusion regarding changes in the human brain in both unacclimatized and acclimatized states in a natural HA environment. Using multiple advanced analysis methods that based on MRI as well as electroencephalography, the modulations of brain gray and white matter morphology and the electrophysiological mechanisms underlying processing of cognitive activity have been explored in certain extent. The visual, motor and insular cortices are brain regions seen to be consistently affected in both HA immigrants and natives. Current findings regarding cortical electrophysiological and blood dynamic signals may be related to cardiovascular and respiratory regulations, and may clarify the mechanisms underlying some behaviors at HA. In general, in the past 10 years, researches on the brain at HA have gone beyond cognitive tests. Due to the sample size is not large enough, the current findings in HA brain are not very reliable, and thus much more researches are needed. Moreover, the histological and genetic bases of brain structures at HA are also needed to be elucidated.

Ecthyma gangrenosum and severe neutropenic sepsis caused by Staphylococcus aureus infection in a previously healthy child: a case report.

Ecthyma gangrenosum (EG) is a potentially lethal skin infection mainly caused by Pseudomonas aeruginosa, but other causative pathogens have also been reported. EG usually occurs locally and often arises in immunocompromised patients. The fatality rate can be extremely high if a systemic infection leading to sepsis occurs. EG and severe sepsis caused by Staphylococcus aureus infection are extremely rare in healthy children. However, upon occurrence, disease progression can be rapid, and the mortality rate is high. This current case report describes a previously healthy child with no underlying diseases who developed EG in the facial and perianal regions following S. aureus infection. The infection rapidly progressed to sepsis, septic shock, and persistent severe neutropenia. The patient also developed drug-resistant bacterial infections that spread rapidly and resulted in multiorgan failure. The patient was treated with antibiotics, but she died of organ failure despite extracorporeal membrane oxygenation support. EG caused by S. aureus has the potential to progress rapidly, leading to septic shock and severe neutropenia. Patients should be identified at an early stage and promptly treated with antibiotics. However, the improvement of neutropenia and prevention of secondary infections remain the focus of our research.

Resting-State Neuronal Activity and Functional Connectivity Changes in the Visual Cortex after High Altitude Exposure: A Longitudinal Study.

Damage to the visual cortex structures after high altitude exposure has been well clarified. However, changes in the neuronal activity and functional connectivity (FC) of the visual cortex after hypoxia/reoxygenation remain unclear. Twenty-three sea-level college students, who took part in 30 days of teaching at high altitude (4300 m), underwent routine blood tests, visual behavior tests, and magnetic resonance imaging scans before they went to high altitude (Test 1), 7 days after they returned to sea level (Test 2), as well as 3 months (Test 3) after they returned to sea level. In this study, we investigated the hematological parameters, behavioral data, and spontaneous brain activity. There were significant differences among the tests in hematological parameters and spontaneous brain activity. The hematocrit, hemoglobin concentration, and red blood cell count were significantly increased in Test 2 as compared with Tests 1 and 3. As compared with Test 1, Test 3 increased amplitudes of low-frequency fluctuations (ALFF) in the right calcarine gyrus; Tests 2 and 3 increased ALFF in the right supplementary motor cortex, increased regional homogeneity (ReHo) in the left lingual gyrus, increased the voxel-mirrored homotopic connectivity (VMHC) value in the motor cortex, and decreased FC between the left lingual gyrus and left postcentral gyrus. The color accuracy in the visual task was positively correlated with ALFF and ReHo in Test 2. Hypoxia/reoxygenation increased functional connection between the neurons within the visual cortex and the motor cortex but decreased connection between the visual cortex and motor cortex.

Pharmacokinetics and pharmacodynamic interaction of bergamottin with atorvastatin in rats.

1. The pharmacokinetics and pharmacodynamic of concomitant administration of atorvastatin with bergamottin were investigated perspectives to reveal the potential herb-drug interaction between these two drugs.2. The hyperlipidaemia-induced Wistar rats received atorvastatin with or without bergamottin (2.5 mg/kg). The concentration of atorvastatin in the rats' serum was determined using an established HPLC/MS/MS method. The pharmacokinetic parameters were calculated using DAS software. Lipid levels were determined.3. Bergamottin increases the Cmax (from 48 ± 5 ng/mL to 89 ± 7 ng/mL), AUC0-∞ (from 176 ± 27 to 552 ± 131 h∗µg/L), and the elimination half-life of atorvastatin (t1/2) of atorvastatin. Co-administration of atorvastatin with bergamottin decreased total cholesterol (by 14%), low-density lipoproteins-cholesterol (by 20%), and triglyceride (by 12%), but increased thigh-density lipoprotein-cholesterol, when compared with atorvastatin alone.4. Co-administration of bergamottin and atorvastatin alters both pharmacokinetics and pharmacodynamics of atorvastatin. This study provides pre-clinical information evidence that bergamottin could potentiate the therapeutic efficacy of atorvastatin or increase its accumulation and adverse effects.

Single-direction diffusion-weighted imaging may be a simple complementary sequence for evaluating fetal corpus callosum.

OBJECTIVES: To explore the feasibility of single-direction diffusion-weighted imaging (DWI) for assessing the fetal corpus callosum (CC). METHODS: This prospective study included 67 fetuses with normal CC and 35 fetuses suspected with agenesis of the corpus callosum (ACC). The MR protocols included HASTE, TrueFISP, and single-direction DWI. Two radiologists independently evaluated the optimal visibility and the contrast ratio (CR) of the normal fetal CC. The Chi-squared test or Fisher's exact test was used to compare the proportions of "good" visibility (score ≥ 3, and the CC was almost/entirely visible) between single-direction DWI and HASTE/TrueFISP. The CR difference between single-direction DWI and HASTE/TrueFISP was detected using the paired t-test. The diagnostic accuracies were determined by comparison with postnatal imaging. In fetuses suspected of ACC, we measured and compared the length and area of the mid-sagittal CC in the single-direction DWI images. RESULTS: The proportion of "good" visibility in single-direction DWI was higher than that in HASTE/TrueFISP, with p < 0.0001. The mean CR from single-direction DWI was also higher than that of TrueFISP and HASTE (both with p < 0.0001). The diagnostic accuracy of the single-direction DWI combined with HASTE/TrueFisp (97.1%, 34/35) was higher than that of the Haste/TrueFISP (74.3%, 26/35) (p = 0.013). The length and area of the PACC (p < 0.001, p = 0.001, respectively) and HCC (p < 0.001, p = 0.018, respectively) groups were significantly lower than those of the normal group. CONCLUSIONS: The single-direction DWI is feasible in displaying fetal CC and can be a complementary sequence in diagnosing ACC. KEY POINTS: • We suggest a simple method for the display of the fetal CC. • The optimal visibility and contrast ratio from single-direction DWI were higher than those from HASTE and TrueFISP. • The diagnostic accuracy of the single-direction DWI combined with HASTE/TrueFISP sequences (97.1%, 34/35) was higher than that of the Haste/TrueFISP (74.3%, 26/35).

Severe pediatric Mycoplasma pneumonia as the cause of diffuse alveolar hemorrhage requiring veno-venous extracorporeal membrane oxygenation: A case report.

Background: Diffuse alveolar hemorrhage (DAH) is an acute life-threatening disease often associated with immunocompromised patients and systemic disorders, such as infections, vasculitis, and toxins. Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in children, which rarely causes respiratory failure and fulminant disease; However, a rapid progression may occur in some patients. Mycoplasma pneumonia-associated DAH is rare. Case Presentation: We report a case of severe pediatric mycoplasma pneumonia in an immuno-competent child. This patient's condition progressed rapidly, with severe lung lesions associated with pleural effusion, coagulopathy, diffuse alveolar haemorrhage and severe respiratory distress requiring ventilator and intravenous extracorporeal membrane oxygenation (VV-ECMO) support. She was discharged upon successful treatment. Conclusion: Diffuse alveolar hemorrhage associated with Mycoplasma pneumoniae in children is very rare, and clinicians should be aware of the potential rapid onset of the disease. Early detection and diagnosis are very important. The main treatment measures include anti-infection and supportive measures such as mechanical ventilation, but as in our case, success with both prone positioning for more than 10 h per day and VV-ECMO was life-saving.

Evaluation of MRI Features and Neurodevelopmental Outcomes for Prenatally Diagnosed Periventricular Pseudocysts.

Objectives: This study aimed to evaluate the morphologic features and neurodevelopmental outcomes of individuals prenatally diagnosed with a periventricular pseudocyst (PVPC). Methods: Pregnant women with a fetus prenatally diagnosed with PVPC by MRI were enrolled in this retrospective study. The fetuses with PVPCs were divided into group 1 (isolated PVPC) and group 2 (PVPC with additional findings). The surviving infants underwent brain MRI examinations and the Gesell Developmental Scale (GDS) test after birth. Independent sample t-tests were used to compare the differences in the developmental quotient (DQ) between group 1 and group 2. We also analyzed the correlations among the DQ, location (unilateral/bilateral), size (diameter), and number (single/multiple) of the PVPCs in group 1 using Lasso regression. Results: In total, 131 infants (group 1: 78 infants, group 2: 53 infants) underwent MRI examinations after birth, and 97 infants (group 1: 59 infants, group 2: 38 infants) underwent the GDS test. Upon follow-up, the sizes of the cysts had become smaller or disappeared after birth. The average DQ in group 2 was lower than that in group 1 (all with p < 0.001). In group 1, the location (unilateral/bilateral), size (diameter), and number (single/multiple) of the PVPC did not affect the DQ. Conclusions: The PVPCs became smaller or disappeared after birth. Isolated PVPCs usually have a normal presentation after birth regardless of the location, number, or size. For PVPCs with additional findings, the neurodevelopmental outcomes were inferior to those in isolated PVPCs.

Electrophysiological mechanisms underlying hypoxia-induced deficits in visual spatial and non-spatial discrimination.

Impaired visual cognition in residents of hypoxic environment has been widely reported; however, the underlying electrophysiological mechanisms remain unclear. In this study, 23 college students underwent three sessions of a Clock task test before a 30-day high-altitude exposure (Test 1) and 1 week (Test 2) and 3 months (Test 3) after they returned to lowlands. The Clock task consists of a visual spatial angle and a visual non-spatial color discrimination subtask. Simultaneously, electroencephalography (EEG) was recorded during the Clock task. The behavioral results showed that, compared with Test 1, accuracy in Test 2 was significantly decreased in both the Angle and Color tasks, and reaction time (RT) was significantly increased in the Angle task. The event-related potentials results showed that, during both tasks amplitudes of the occipital N1 and P3 components during both tasks were significantly decreased in Test 2, compared with Test 1. Moreover, N1 amplitude was negatively correlated with RT and positively correlated with accuracy. Further time-frequency EEG analysis showed that theta power at occipital sites was significantly decreased in both tasks in Test 2, compared with Test 1, and was negatively correlated with RT in the Angle task. In Test 3, both the behavioral performance and EEG activity recovered to the baseline level in Test 1. These findings suggested that hypoxia impairs both visual spatial and visual non-spatial discriminations, and these impairments can recover after subjects return to lowlands. Inhibition of brain electrophysiological activity in the visual cortex may explain the deficits in visual cognition.

Dopamine Imaging in Living Cells and Retina by Surface-Enhanced Raman Scattering Based on Functionalized Gold Nanoparticles.

Retinal dopamine is believed to be involved in the development of myopia, which is projected to affect almost half of the world population's visual health by 2050. Direct visualization of dopamine in the retina with high spatial precision is essential for understanding the biochemical mechanism during the development of myopia. However, there are very few approaches for the direct detection of dopamine in the visual system, particularly in the retina. Here, we report surface-enhanced Raman scattering (SERS)-based dopamine imaging in cells and retinal tissues with high spatial precision. The surface of gold nanoparticles is modified with N-butylboronic acid-2-mercaptoethylamine and 3,3'-dithiodipropionic acid di(N-hydroxysuccinimide ester), which shows excellent specific reaction with dopamine. The existence of dopamine triggers the aggregation of gold nanoparticles that subsequently form plasmonic hot spots to dramatically increase the Raman signal of dopamine. The as-synthesized SERS nanoprobes have been evaluated and applied for dopamine imaging in living cells and retinal tissues in form-deprivation (FD) myopia guinea pigs, followed by further investigation on localized dopamine levels in the FD-treated mice. The results suggest a declined dopamine level in mice retina after 2-week FD treatment, which is associated with the development of myopia. Our approach will greatly contribute to better understanding the localized dopamine level associated with myopia and its possible treatments. Furthermore, the imaging platform can be utilized to sensing other important small molecules within the biological samples.

Exploring the impact of chronic high-altitude exposure on visual spatial attention using the ERP approach.

Introduction: Previous studies have reported the slowing of reaction times to attentionally demanding tasks due to a reduction in cognitive resource as a result of chronic high-altitude exposure. However, it is still largely unknown whether this reaction slowness can be attributed to the attentional allocation change and/or response patterns. Methods: To clarify this issue, this study investigated attention-related (N2pc and N2 cc) and response-related (MP and RAP) event-related potentials (ERPs) to identify the performance of a visual search task by individuals who had lived in high-altitude areas for three years compared with those living at sea level. Results: This study showed that the reaction times in response to a visual search task were significantly longer in the high-altitude subjects than in the sea level subjects. Corresponding to this behavioral observation, we found a significantly lower N2pc amplitude and a larger N2 cc amplitude in the high-altitude subjects, suggesting a reduction in spatial attention allocation to the target (N2pc) in these subjects, indicating they need to work harder to preclude cross-talk between response selection and attention direction (N2 cc). Moreover, we also discovered higher MP amplitudes and longer RAP latencies in the high-altitude subjects, which further indicated that these subjects were slower and required greater cortical activation while preparing and executing correctly selected responses (MP and RAP). Conclusion: Nevertheless, this study collectively provided new insights into the attention reaction slowness from high-altitude exposure.

Competition among the attentional networks due to resource reduction in Tibetan indigenous residents: evidence from event-related potentials.

This study used the attention network test (ANT) to evaluate the alerting, orienting, and executive network efficiencies of attention related to indigenous residents who were born and raised until early adulthood in different high-altitude areas (2900-m, 3700-m, and 4200-m) at the same location (3700-m) where these residents had been living for approximately 2 years in Tibet. We further applied the event-related potential (ERP) method to identify the underlying neurophysiological basis. Based on the ANT, we found that, in the 4200-m residents, executive function was increased but the orienting function was decreased, and the executive and orienting network scores were oppositely correlated. The behavioral findings were supported by the ERP data, showing that the P3 amplitude changes indicated that the executive function was over-active under conflict conditions and that the N1 amplitude change indicated a decreased orienting function in the 4200-m residents. In addition, the changed P3 amplitudes were significantly correlated with intelligence performance across the residents only in the 4200-m group. The present study provided evidence for competition among the attentional networks due to high-altitude exposure in indigenous residents, and showed the existence of a threshold of the influence of high altitudes on attentional function in the brain.

Invasive placenta previa: Placental bulge with distorted uterine outline and uterine serosal hypervascularity at 1.5T MRI - useful features for differentiating placenta percreta from placenta accreta.

OBJECTIVES: To characterise MRI features of invasive placenta previa and to identify specific features for differentiating placenta percreta (PP) from placenta accreta (PA). METHODS: Forty-five women with PP and 93 women with PA who underwent 1.5T placental MRI were included. Two radiologists independently evaluated the MRI features of invasive placenta previa, including our novel type of placental bulge (i.e. placental bulge type-II, characterized by placental bulge with distorted uterine outline). Pearson's chi-squared or Fisher's two-sided exact test was performed to compare the MRI features between PP and PA. Logistic stepwise regression analysis and the area under the receiver operating characteristic curve (AUC) were performed to select the optimal features for differentiating PP from PA. RESULTS: Significant differences were found in nine MRI features between women with PP and those with PA (P <0.05). Placental bulge type-II and uterine serosal hypervascularity were independently associated with PP (odds ratio = 48.618, P < 0.001; odds ratio = 4.165, P = 0.018 respectively), and the combination of the two MRI features to distinguish PP from PA yielded an AUC of 0.92 for its predictive performance. CONCLUSION: Placental bulge type-II and uterine serosal hypervascularity are useful MRI features for differentiating PP from PA. KEY POINTS: • Placental bulge type-II demonstrated the strongest independent association with PP. • Uterine serosal hypervascularity is a useful feature for differentiating PP from PA. • MRI features associated with abnormal vessels increase the risk of massive haemorrhage.

An inflammatory myofibroblastic tumor in the transplanted liver displaying quick wash-in and wash-out on contrast-enhanced ultrasound: A case report.

RATIONALE: Inflammatory myofibroblastic tumor (IMT) is an uncommon mesenchymal neoplasm, and its presence in a grafted liver is exceedingly rare. PATIENT CONCERNS: A 54-year-old woman was admitted to our hospital with a half-month history of intermittent melena. She had undergone deceased-donor liver transplantation (LT) for hepatitis B virus related liver cirrhosis without hepatocellular carcinoma 5 months previously. DIAGNOSIS: Laboratory examination showed impaired liver and renal functions and Epstein-Barr virus (EBV) infection, but tumor markers within normal ranges. Gastroscopy showed esophageal varices. Ultrasound and computed tomography angiography revealed an ill-defined and irregular solitary lesion in the porta hepatis, encasing both the portal vein and the hepatic artery. The lesion was characterized by arterial hyper-enhancement and hypo-enhancement in the remaining phases with contrast-enhanced ultrasound (CEUS). The lesion was finally confirmed as an IMT by ultrasound-guided biopsy. INTERVENTION: The patient received conservative treatment, including immunosuppression, endoscopic variceal ligation, antibiotics, steroids, and antiviral agents. OUTCOME: The patient's gastrointestinal bleeding was controlled, but the symptoms associated with portal hypertension worsened. Attempts to perform a transjugular intrahepatic portosystemic shunt were unsuccessful, and she unfortunately died soon after. LESSONS: A differential diagnosis of IMT should be considered in LT recipients presenting with EBV infection, normal tumor markers, and a de novo hepatic lesion with quick wash-in and wash-out on CEUS. Ultrasound is associated with the advantages of convenience and nonionizing radiation, and should thus be the priority approach for monitoring transplanted liver.

Assessment of tibial and common peroneal nerves in diabetic peripheral neuropathy by diffusion tensor imaging: a case control study.

OBJECTIVES: To determine the diagnostic accuracy and interobserver performance of diffusion tensor imaging (DTI) in diabetic peripheral neuropathy (DPN) and detect correlations with electrophysiology. METHODS: Twelve healthy volunteers (controls) and ten DPN patients were enrolled to undergo MR examinations. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of tibial nerve (TN) and common peroneal nerve (CPN) were measured. Unpaired t test and Levene tests were performed to assess differences between the two groups. Receiver operating characteristic (ROC) analysis was performed for FA and ADC values. Pearson correlation coefficient was used to assess the correlation between DTI and electrophysiology parameters in the patient group. RESULTS: The FA values of TN and CPN in the DPN group were significantly lower and ADC were higher than the control group (p < 0.05). Interobserver agreement was excellent. FA positively correlated and ADC negatively correlated with motor nerve conduction velocity (MCV) (p < 0.05). There were no significant differences between motor nerve conduction amplitude and DTI parameters (p > 0.05). Moderate diagnostic accuracy of DTI was seen in the diagnosis of DPN. CONCLUSIONS: DTI demonstrates moderate diagnostic accuracy and excellent interobserver performance in the detection of DPN involving the TN and CPN. There is moderate correlation with MCV. KEY POINTS: • FA values of TN and CPN are significantly lower in DPN. • ADC values of TN and CPN are significantly higher in DPN. • DTI demonstrates moderate diagnostic accuracy in detection of DPN. • There is excellent interobserver performance in DTI measurements. • Moderate correlation is seen between DTI parameters and MCV.