Fetal Aortic Blood Flow Velocity and Power Doppler Profiles in the First Trimester: A Comprehensive Study Using High-Definition Flow Imaging.

OBJECTIVES: This study aimed to establish reference values for fetal aortic isthmus blood flow velocity and associated indices during the first trimester, utilizing a novel ultrasonographic technique known as high-definition flow imaging (HDFI). Additionally, the correlation between Doppler profiles of aortic blood flow and key fetal parameters, including nuchal thickness (NT), crown-rump length (CRL), and fetal heartbeat (FHB), was investigated. METHODS: A total of 262 fetuses were included in the analysis between December 2022 and December 2023. Utilizing 2D power Doppler ultrasound images, aortic blood flow parameters were assessed, including aortic peak systolic velocity (PS), aortic end-diastolic velocity (ED), aortic time average maximal velocity (TAMV), and various indices such as aortic systolic velocity/diastolic velocity (S/D), aortic pulsatile index (PI), aortic resistance index (RI), aortic isthmus flow velocity index (IFI), and aortic isthmic systolic index (ISI). Concurrently, fetal FHB, NT, and CRL were evaluated during early trimester Down syndrome screening. RESULTS: Significant findings include a positive correlation between gestational age (GA) and PS (PS = 3.75 × (GA) - 15.4, r2 = 0.13, p < 0.01), ED (ED = 0.42 × (GA) - 0.61, r2 = 0.04, p < 0.01), PI (PI = 0.07 × (GA) + 1.03, r2 = 0.04, p < 0.01), and TAMV (TAMV = 1.23 × (GA) - 1.66, r2 = 0.08, p < 0.01). In contrast, aortic ISI demonstrated a significant decrease (ISI = -0.03 × (GA) + 0.57, r2 = 0.05, p < 0.05) with gestational age. No significant correlation was observed for aortic RI (p = 0.33), S/D (p = 0.39), and IFI (p = 0.29) with gestational age. Aortic PS exhibited positive correlations with NT (0.217, p = 0.001) and CRL (0.360, p = 0.000) but a negative correlation with FHB (-0.214, p = 0.001). Aortic PI demonstrated positive correlations with CRL (0.208, p = 0.001) and negative correlations with FHB (-0.176, p = 0.005). Aortic TAMV showed positive correlations with NT (0.233, p = 0.000) and CRL (0.290, p = 0.000) while exhibiting a negative correlation with FHB (-0.141, p = 0.026). Aortic ISI demonstrated negative correlations with NT (-0.128, p = 0.045) and CRL (-0.218, p = 0.001) but a positive correlation with FHB (0.163, p = 0.010). CONCLUSIONS: Power Doppler angiography with Doppler ultrasound demonstrates the ability to establish accurate reference values for fetal aortic blood flow during the first trimester of pregnancy. Notably, aortic PS, TAMV, and ISI exhibit significant correlations with NT, CRL, and FHB, with ISI appearing more relevant than IFI, PS, TAMV, and FHB. The utilization of HDFI technology proves advantageous in efficiently detecting the site of the aortic isthmus compared to traditional color Doppler mode in early second trimesters.

Association of Aortic Arch Calcification with Acute Ischemic Stroke Subtypes and Endovascular Thrombectomy Outcomes.

PURPOSE: To analyze the aortic arch calcification (AAC) on computed tomography (CT) scans, with the goal of predicting the subtypes of patients with ischemic stroke and endovascular thrombectomy (EVT) outcomes. MATERIALS AND METHODS: Automated analysis was used to quantify AAC on CT scans. From January 2020 to March 2021, 119 patients diagnosed with ischemic stroke were analyzed, and the feasibility of EVT was assessed; 43 underwent the procedure. RESULTS: AAC was present in 117 (98.3%) of 119 patients. There was a significant difference (P <.001) in AAC severity among all patients with ischemic stroke according to the Trial of ORG 10172 in Acute Stroke Treatment classification. In patients who underwent EVT, AAC severity was significantly related to the thrombolysis in cerebral infarction grade, thrombectomy procedure time, and modified Rankin scale at discharge (P =.002, P =.035 and P =.015, respectively). Multivariate logistic regression analysis also showed that severe AAC (volume, ≥1,000 mm3) (adjusted odds ratio [OR], 12.1; adjusted 95% confidence interval [CI]), 2.1-36.4; P =.001) and intracranial atherosclerotic disease (adjusted OR, 9.5; adjusted 95% CI, 2.3-33.7; P =.001) were both independently associated with poor thrombolysis reperfusion rate. CONCLUSIONS: A high proportion of patients with ischemic stroke have AAC, the severity of which is a potential imaging marker of ischemic stroke subtypes and the outcome of EVT.

Papillary thyroid carcinoma occurring with undifferentiated pleomorphic sarcoma: A case report.

BACKGROUND: Papillary thyroid cancer (PTC) is the most common malignant tumor of the thyroid. However, the coexistence of PTC and sarcoma in one patient is rare. In this article, we report the case of a patient who presented with both PTC and undifferentiated pleomorphic sarcoma (UPS), which has not been previously reported in the online Medline database (PubMed). CASE SUMMARY: A 71-year-old man was admitted to our hospital for a mass on the right side of his neck for one month, which rapidly enlarged within 2 wk with distending pain. The patient was diagnosed with a thyroid malignancy by fine-needle aspiration and underwent total thyroidectomy and bilateral central lymph node dissection. Histology and immunohistochemistry revealed features of both PTC and UPS. The thyroid cancer 8 gene detection kit results showed BRAF and telomerase reverse transcriptase mutations. The disease progressed rapidly, and the patient died four months after surgery from extensive lung metastasis. CONCLUSION: Our report highlights the patient's pathological characteristics and related genetic mutations. Due to the rapid development and poor prognosis of cooccurring PTC and sarcoma, it is important for clinical physicians and pathologists to raise awareness of this type of tumor.

Clinical Outcomes and Oral Health-Related Quality of Life after Periodontal Treatment with Community Health Worker Strategy in Patients with Type 2 Diabetes: A Randomized Controlled Study.

Interventions engaging community health workers (CHW) for diabetes management aim to improve diabetes care and self-management behaviors among patients. We evaluated the effects of nonsurgical periodontal treatment (NSPT) with the CHW strategy on oral self-care behaviors, periodontal status and oral health-related quality of life (OHQoL) in patients with type 2 diabetes mellitus (T2DM). The participants were randomly assigned to experimental (EG; n = 35) and control (CG; n = 33) groups. All participants received NSPT, whereas the patients in the EG also received one-on-one 30 min lessons from a CHW over 4 weeks. The EG exhibited greater improvement in the probing pocket depth (ß = -0.2, effect size [ES] = 0.61) and clinical attachment level (ß = -0.2, ES = 0.59) at 1-month follow-up than the CG did. The ES increased over the 1-, 3- and 6-month follow-ups, indicating an increase in OHQoL (ES = 0.19, 0.60, and 0.62, respectively) in the EG. The patients in the EG were more likely to change their oral self-care behaviors than patients in the CG were. The NSPT with CHW strategy had a positive effect on 1-month periodontal treatment outcomes, long-term OHQoL and oral self-care behaviors in patients with T2DM.

Magnetic impurity in a triple-component semimetal.

We investigate the effects of a magnetic impurity in a multiband touching fermion system, specifically, a triple-component semimetal with a flat band, which can be realized in a family of transition metal silicides (CoSi family). When the chemical potential coincides with the flat band, it is expected that the impurity response of this system will be very different from that of an ordinary Dirac or Weyl semimetal of which the density of states at the Fermi level vanishes. We first determine the phase diagram within the mean-field approximation. Then, we study the local moment regime by employing two different methods. In the low temperature regime, the Kondo screening is analyzed by the variational wavefunction approach and the impurity contributions to the magnetic susceptibility and heat capacity are obtained, while at higher temperature, we use the equation of motion approach to calculate the occupation number of the impurity site and the impurity magnetic susceptibility. The results are compared and contrasted with those in the usual Fermi liquid and the Dirac/Weyl semimetals.

Impact of type 2 diabetes on postoperative outcome after hip fracture: nationwide population-based study in Taiwan.

The impact of diabetes mellitus (DM) on hip fracture (HFx) is still controversial. We used nationwide population-based data in Taiwan to observe postoperative outcomes of HFx in patients with type 2 diabetes mellitus (T2DM) and found that the impact of T2DM may be related to medication of blood glucose control. OBJECTIVE: Published studies evaluating diabetic patients with HFx have shown controversial outcomes. We assessed the impact of T2DM on postoperative outcomes after HFx in elderly patients using the nationwide population database in Taiwan. RESEARCH DESIGN AND METHODS: We used data from the National Health Research Institute in Taiwan to recruit patients who had undergone operations for HFx between 2000 and 2009. The recruited patients with T2DM were divided into the oral antidiabetic drug (OAD) cohort and the insulin cohort according to the use or non-use of insulin. Patients without DM were propensity score matched in a 1:1 ratio by four variables. We used the χ2 test, linear regression and Cox proportional hazards model to assess variables, including length of hospital stay, medical cost, complications, early readmission, and 1-year mortality. RESULTS: We identified 5490 subjects in total. The insulin cohort exhibited prolonged hospital stay (11.8 days), higher medical costs, more complications within 30 and 90 after hip surgery, earlier readmission, and higher 1 year mortality rate (25.8%) than the OAD and non-DM cohorts. The OAD cohort had longer hospital stay (10.1 days) and higher readmission rate but fewer complications and mortality rates (14.9%) than the non-DM cohort. CONCLUSIONS: After matching confounding factors, the T2DM with OAD control groups were not associated with higher complication or mortality rates but were associated with higher readmission rates. However, diabetic patients with insulin control have poor outcome. The impact of T2DM on the postoperative outcomes of patients with HFx may be related to blood glucose control medication.

The use of non-contrast-enhanced MRI to evaluate serial changes in endoleaks after aortic stenting: a case report.

BACKGROUND: Aortic dissection is a life-threatening syndrome that sometimes requires emergency intervention, and endovascular aortic aneurysm repair (EVAR) is a treatment option. Long-term image follow-up is also required for patients after EVAR due to possible complications. CASE PRESENTATION: We present the case of a 73-year-old male with underlying chronic renal disease diagnosed with a type A aortic dissection who underwent EVAR. Four-dimensional (three spatial dimensions combined with time) phase-contrast magnetic resonance imaging (4D PC-MRI) was performed during regular follow-up in preference to contrast-enhanced computed tomography or simple MRI while taking his poor renal function into consideration. CONCLUSIONS: We considered this preferable given his issues with renal function.

Diffusivity parameters of diffusion tensor imaging and apparent diffusion coefficient as imaging markers for predicting the treatment response of patients with trigeminal neuralgia.

OBJECTIVE: Trigeminal neuralgia (TN) is facial pain that is usually caused by neurovascular compression syndrome and is characterized by suddenly intense and paroxysmal pain. Radiofrequency lesioning (RFL) is one of the major treatments for TN, but the treatment response for RFL is sometimes inconsistent, and the recurrence of TN is not uncommon. This study aimed to estimate the outcome predictors of TN treated with RFL by using the parameters of diffusion tensor imaging (DTI). METHODS: Fifty-one patients with TN who were treated with RFL were enrolled in the study. MRI was performed in all patients within 1 week before surgery. The visual analog scale was used to evaluate symptom severity at three time points: before, 1 week after, and 3 months after RFL. The involved cisternal segment of the trigeminal nerves was manually selected, and the histograms of each of the diffusivity metrics-including the apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial diffusivity (AD), and radial diffusivity (RD)-were measured. The differences in the means, as well as the kurtosis and skewness of each of the diffusivity metrics between the nonrecurrent and recurrent groups, were then analyzed using the Mann-Whitney U-test. RESULTS: There were significantly lower kurtosis values (a broader peak of the distributional curves) for both FA and ADC in the recurrent group (p = 0.0004 and 0.015, respectively), compared to the nonrecurrent group. The kurtoses of AD and RD, as well as the mean and skewness of all other diffusivity metrics, did not show significant differences between the two groups. CONCLUSIONS: The pretreatment diffusivity metrics of DTI and ADC may be feasible imaging biomarkers for predicting the outcome of TN after RFL. A clarification of the kurtosis value of FA and ADC is helpful for determining the prognosis of patients after RFL.

O-GlcNAcylation disrupts STRA6-retinol signals in kidneys of diabetes.

BACKGROUND: O-GlcNAcylation is an important mechanism of diabetic complication. Retinoid homeostasis regulates cell-physiological functions through STRA6-retinol signaling. Therefore, we investigated whether O-GlcNAcylation disrupted STRA6-retinol signals in diabetes. METHODS: Immunoprecipitation and proximity ligation assay were used to investigate O-GlcNAcylation of STRA6-retinol signals in kidneys of db/db and ob/ob mice. Western blot and immunohistochemistry were done for STRA6/CRBP1/LRAT/RALDH1/RARs pathway, GFAT, OGT, TGFß1 and collagen 1 level. HPLC and ELISA for retinol, retinal, and retinoic acid concentrations were performed in vivo and vitro. RBP4 binding with STRA6 was measured in vitro. To verify whether O-GlcNAcylation disrupted STRA6-retinol signals, treatment of TMG and OSMI-1, transfection of OGA and OGT, and OGT siRNA were performed in HK-2 cells. RESULTS: STRA6 and RALDH1 were highly O-GlcNAc-modified in glomeruli and tubules of db/db and ob/ob mice. RBP4, p-Try, p-JAK2, and p-STAT5 on STRA6 immunoprecipitate were reduced. Cellular retinol signals (CRBP1, LRAT, ADH, retinol, retinal, RA, RARα, RARγ and RXRα) remarkably decreased in kidneys of db/db, ob/ob mice and HG-cultured cells. TMG and OGT transfection induced O-GlcNAcylation of STRA6 and RALDH1, repressed RBP4-bound STRA6, and retinol signals in NG-cultured cells. OSMI-1, OGA transfection, and OGT silence reversed O-GlcNAc-modification of STRA6 and RALDH1, and rescued the decrease of retinol signals, and reversed the increase of TGFß1 and collagen 1 in HG-treated cells. CONCLUSIONS: O-GlcNAcylation significantly modified STRA6 and RALDH1, suppressed RBP4 binding activity, and disrupted retinol signals in the kidney of diabetes. GENERAL SIGNIFICANCE: This study first indicates that STRA6-retinol signals were directly disrupted by O-GlcNAcylation in diabetic kidney.

Severe Hypoglycemia as a Predictor of End-Stage Renal Disease in Type 2 Diabetes: A National Cohort Study.

Aims: This study investigated whether there is a link between severe hypoglycemia and progression into end-stage renal disease (ESRD) in patients with type 2 diabetes. Methods: Tapping into Taiwan's Health Insurance Research Database, we identified all type 2 diabetes patients between 1996 and 2013 and identified those diagnosed with a severe hypoglycemia episode during an emergency department visit and those who were not. Controls were then matched 1:1 for age, sex, index year, and medication. Results: We identified 468,421 type 2 diabetes patients diagnosed as having severe hypoglycemia in an emergency department visit. Compared with controls, these patients with SH had a higher risk of all-cause mortality (Hazard Ratio (HR), 1.76; 95% confidence interval, 1.61⁻1.94) and progressed into ESRD within a shorter period of time. Results were similar after controlling for competing risk. Conclusion: Severe hypoglycemia is significantly associated with worsening renal dysfunction in patients with type 2 diabetes and hastened progression into ESRD.

Association of Renal Elasticity and Renal Function Progression in Patients with Chronic Kidney Disease Evaluated by Real-Time Ultrasound Elastography.

Glomerulosclerosis and tubulointerstitial fibrosis are associated with lower renal parenchymal elasticity. This study was designed to evaluate the predictive ability of renal elasticity in patients with chronic kidney disease (CKD). 148 non-CKD patients and 227 patients with CKD were recruited. 145 (38.7%) were female, 166 (73.1%) had diabetes, the mean estimated glomerular filtration rate (eGFR) was 33.9 ± 15.8 ml/min/1.73 m2 and the median urinary protein-to-creatinine ratio (UPCR) 502 (122-1491) mg/g. Patients with later stages of CKD had lower renal elasticity values, indicating stiffer kidneys (p < 0.001), and smaller kidney (p < 0.001). Renal elasticity correlated with log-transformed UPCR (ß = -7.544, P < 0.001). Renal length correlated with age (ß = -0.231, P < 0.001), sex (ß = -3.730, P < 0.001), serum albumin level (ß = -3.024, P = 0.001), body mass index (ß = 0.390, P = 0.009) and eGFR (ß = 0.146, P < 0.001). In fully-adjusted logistic regression model, the odds ratio (OR) per 10 unit change in renal elasticity for rapid renal deterioration was 0.928 (95% CI, 0.864-0.997; P = 0.042). The OR per 1 mm change in renal length for rapid renal deterioration was 1.022 (95% CI, 0.994-1.050; P = 0.125). Renal elasticity is associated with proteinuria and rapid renal deterioration in patients with CKD.

Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus.

OBJECTIVE: To validate a hypothesized model exploring the influencing pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycosylated hemoglobin (HbA1c) levels in patients with type 2 diabetes (T2DM). METHODS: Overall, 295 patients with T2DM were recruited from five endocrine clinics in Taiwan through convenience sampling. Data regarding personal characteristics, empowerment perceptions, health literacy, self-efficacy, self-care behaviors, and HbA1c levels were collected. A structural equation modeling was used to validate the hypothesized model. RESULTS: Significant direct pathways were determined from empowerment perceptions to health literacy, from health literacy to self-efficacy, from self-efficacy to self-care behaviors, and from self-care behaviors to HbA1c levels. CONCLUSIONS: The empowerment perceptions and health literacy relatively influenced self-efficacy and self-care behaviors. Self-efficacy and self-care behaviors relatively influenced glycemic control in patients with T2DM. PRACTICE IMPLICATIONS: Modifying self-care behaviors have been demonstrated to be the most essential for improving glycemic control. To improve self-care behaviors, healthcare providers should target improving self-efficacy, and enhancing health literacy can be considered to be a potential strategy for improving self-efficacy. To enhance health literacy, healthcare providers could use an empowerment approach rather than an authoritative approach that emphasizes patient compliance in managing patients with T2DM.

Abnormally Low or High Ankle-Brachial Index Is Associated with Proliferative Diabetic Retinopathy in Type 2 Diabetic Mellitus Patients.

Although some studies have reported that low ankle-brachial index (ABI) is associated with diabetic retinopathy (DR) in diabetic patients, it remains controversial as to which stage of DR. The aim of this study is to assess whether peripheral artery disease (PAD), indicated by abnormally low or high ABI, is associated with different stages of DR in patients with type 2 diabetes mellitus (DM), and further evaluate the risk factors. A total of 2001 (858 men and 1143 women) patients with type 2 DM who underwent ABI measurement in an outpatient clinic were enrolled. PAD was defined as ABI < 0.9 or ≧ 1.3 in either leg. DR was classified as non-DR, nonproliferative DR and proliferative DR stages. The clinical data were analyzed and the risk factors for abnormal ABI were determined by multivariate logistic regression analysis. The prevalence of ABI < 0.9 or ≧ 1.3 was 3.0%. Multivariate forward logistic regression analysis identified proliferative DR (vs. non-DR) was associated with abnormal ABI (odds ratio, 1.718; 95% confidence interval, 1.152 to 2.562; p = 0.008), but nonproliferative DR was not. Furthermore, the presence of coronary artery disease, cerebrovascular disease, declining renal function and patients without diuretics use were associated with abnormal ABI in patients with proliferative DR. Our study in patients of type 2 DM demonstrated that PAD was associated with proliferative DR. We emphasize the recommendation of performing the ABI test in this population at risk.

The impact of severe hypoglycemia on renal impairment in type 2 diabetes.

AIMS: Hypoglycemia has been reported to be associated with the development of microvascular events. Therefore, it is important to assess the impact of severe hypoglycemia on renal dysfunction in type 2 diabetes. METHODS: We conducted a retrospective cohort study in a large tertiary care hospital from 2004 to 2013. A total of 101 patients with type 2 diabetes from the outpatient department with a history of severe hypoglycemia were studied. A random sample of 101 patients with type 2 diabetes without any hypoglycemia was selected by matching values of baseline blood creatinine, age, sex and diabetic duration. RESULTS: Baseline blood creatinine (1.42 ± 0.75 mg/dL) significantly increased to 1.77 ± 1.26 and 1.93 ± 1.54 mg/dL, and baseline eGFR (44.37 ± 26.13 ml/min/1.73 m(2)) decreased to 41.28 ± 27.70 and 37.64 ± 24.54 ml/min/1.73 m(2) at the onset of hypoglycemia and the follow-up visit in severe hypoglycemia group; while no significant changes were observed in the group without any hypoglycemia. Multiple linear regression analysis showed that severe hypoglycemia is an independent risk factor for increase in blood creatinine and decrease in eGFR in all patients with type 2 diabetes, and that baseline creatinine, longer diabetic duration and lower HbA1c are risk factors for the deterioration of renal impairment in the group with severe hypoglycemia. CONCLUSION: Our results showed that severe hypoglycemia is associated with deterioration of renal function in type 2 diabetes with chronic kidney disease and the patients with higher baseline creatinine and a longer diabetic duration could be more vulnerable to aggravation of renal function impairment.

Electrical transport through a quantum dot side-coupled to a topological superconductor.

We propose to measure the differential conductance G as a function of the bias V for a quantum dot side-coupled to a topological superconductor to detect the existence of the chiral Majorana edge states. It turns out that G for the spinless dot is an oscillatory (but not periodic) function of eV due to the coupling to the chiral Majorana edge states, where -e is the charge carried by the electron. The behaviour of G versus eV is distinguished from that of a multi-level dot in three respects. First of all, due to the coupling to the topological superconductor, the value of G will shift upon adding or removing a vortex in the topological superconductor. Next, for an off-resonance dot, the conductance peak in the present case takes a universal value e(2)/(2h) when the two leads are symmetrically coupled to the dot. Finally, for a symmetric setup and an on-resonance dot, the conductance peak will approach the same universal value e(2)/(2h) at a large bias.