[A comparative study on the depth of cure, hardness and microleakage applied to primary teeth of different types of bulk-fill resins].

Objective: To compare the depth of cure, surface hardness and microleakage applied to primary teeth of three types of bulk-fill resins, so as to provide reference for clinical application. Methods: Composite resin FiltekTM Z350 XT (group A) and giomer Beautifil Ⅱ (group B) were used as controls, high-viscosity bulk-fill resin FiltekTM Bulk Fill (group C), sonic-activated bulk-fill resin SonicFill 2 (group D) and flowable bulk-fill resin SDR® flow+(group E) were studied. The microstructure of each group was observed by scanning electron microscope (SEM). Specimens of each group were prepared (6 pieces per group), and the Vickers microhardness of the surface layer and different depths of each group were measured, and then the depths of cure were calculated. Twenty-five primary molars dentin were filled by resins of each group (5 teeth per group), sliced, then aged, slices of each group were developed by silver ion staining. SEM was used to observed the distribution of silver ions. Microleakage of each group were analyzed by Jonckheere-Terpstra rank sum test. Results: SEM showed that the filler particles in groups A and C were spherical and evenly distributed. The shape of the fillers in groups B, D and E were polygonal and unevenly distributed. The surface hardness of groups A, B, C, D and E were (84.97±6.30), (65.04±5.95), (57.80±1.18), (60.77±2.34), (33.32±1.83) MPa respectively. Group A had the highest hardness, while group E was the lowest, and the differences between the two groups and other groups was statistically significant (P<0.05). There were no statistically significant differences among groups B, C, and D (P>0.05). The curing depths of groups A, B, C, D and E were 2.6, 3.4, 5.8, 3.8 and 7.8 mm respectively. The largest microleakage was found in group E [2% (1/50) for grade 0, 22% (11/50) for grade 1, 30% (15/50) for grade 2, 24% (12/50) for grade 3, and 22% (11/50)for grade 4], which was statistically different from other groups (P<0.05). No statistically significant differences were found among other 3 groups (P>0.05). Conclusions: Both high-viscosity and sonic-activated bulk-fill resins have the greater depth of cure, the same hardness and microleakage as giomer, which might be an option for restoration in primary teeth.

The Detection of Motor Bearing Fault with Maximal Overlap Discrete Wavelet Packet Transform and Teager Energy Adaptive Spectral Kurtosis.

Motor bearings are one of the most critical components in rotating machinery. Envelope demodulation analysis has been widely used to demodulate bearing vibration signals to extract bearing defect frequency components but one of the main challenges is to accurately locate the major fault-induced frequency band with a high signal-to-noise ratio (SNR) for demodulation. Hence, an enhanced fault detection method combining the maximal overlap discrete wavelet packet transform (MODWPT) and the Teager energy adaptive spectral kurtosis (TEASK) denoising algorithms is proposed for identifying the weak periodic impulses. The Teager energy power spectrum (TEPS) defines the sparse representation of the filtered signals of the MODWPT in the frequency domain via the Teager energy operator (TEO); the TEASK helps determine the most informative frequency band for demodulation. The methodology is compared in terms of performance with the fast Kurtogram and the Autogram methods. The simulation and practical application examples have shown that the proposed MODWPT-TEASK method outperforms the above two methods in diagnosing defects of motor bearings.

[Clinicopathological characteristics of HPV(+) oropharyngeal squamous cell carcinoma].

Objective: To observe the clinicopathologic features of oropharyngeal squamous cell carcinoma associated with human papilloma virus (OPSCC-HPV) and discuss the role and value of different in situ hybridization (ISH) detection methods for HPV in pathologic diagnosis. Methods: Fifteen cases of OPSCC-HPV were collected from Department of Pathology, Beijing Tongren Hospital, Capital Medical University from January 2016 to August 2018. These cases were diagnosed in accordance with the WHO classification of head and neck tumors. The histopathologic features and the clinicopathologic data were retrospectively analyzed. Immunohistochemistry (two-step EnVision method) was done to evaluate the expression of p16, Ki-67 and p53. ISH was used to detect HPV DNA (6/11 and 16/18). RNAscope technology was used to evaluate the presence of HPV mRNAs (16 and 18). Results: The mean age for the 15 patients (8 males, 7 females) was 47 years (range from 30 to 69 years). OPSCC-HPV typically presentedat an advanced clinical stage, six patients had cervical lymphadenopathy (large and cystic), seven had tonsillar swelling, one had tumor at base of tongue, and one had odynophagia. Microscopically the tumors exhibited distinctive non-keratinizing squamous cell carcinoma morphology. Cervical nodal metastases were large and cystic, with thickening of lymph node capsules. OPSCC-HPV raised from crypt epithelium and extended beneath the tonsillar surface epithelial lining as nests and lobules, often with central necrosis. Tumor cells displayed a high N: C ratio, and high mitotic and apoptotic rates. Tumor nests are often embedded within lymphoid stroma, and may be infiltrated by lymphoid cells.Fifteen cases (15/15) were strongly positive for p16; Ki-67 index were 60%-90%; they were focally positive or negative for p53. Ten cases (10/10) were negative for HPV 6/11 DNA, and one case(1/10) was focally positive for HPV16/18 DNA. Eleven cases (11/11) were strongly positive for HPV16 mRNA, one case was focally positive for HPV18 mRNA. Conclusions: OPSCC-HPV is a pathologically and clinically distinct form of head and neck squamous cell carcinoma. OPSCC-HPV is associated with high-risk HPV (type 16) in all cases. Detection of high-risk HPV16 mRNA by RNAscope is of great significance in the final diagnosis and pathogen identification.

[A comparative study on early childhood caries detection by using international caries detection and assessment system-â ¡ and WHO criteria].

Objective: To investigate and compare the sensitivities of early childhood caries detection by using international caries detection and assessment system (ICDAS)-Ⅱ and WHO criteria. Methods: A total of 449 3-year-old children from four day care kindergartens in Beijing were enrolled in this study. Both ICDAS-Ⅱ and WHO criteria were used to assess the prevalence of caries in the given subjects. The decayed, missing, and filled teeth (dmft) index scores were calculated. In ICDAS-Ⅱ system, four cut-off points (D1, D2, D3 and D4) were employed to differentiate sound and decayed teeth: D1 (score 0 as sound, scores 1-6 as caries); D2 (0-1 sound, 2-6 caries); D3 (0-2 sound, 3-6 caries) and D4 (0-3 sound, 4-6 caries). SPSS software was used to analyze the data to decide the significance of differences. Results: The caries prevalence using ICDAS-Ⅱ were 76.6% (344/449), 71.3% (320/449), 52.8% (237/449) and 46.1% (207/449) for D1 to D4, respectively; the corresponding mean dmft scores were 4.95±4.85, 4.41±4.77, 2.54±3.69 and 1.97±3.10. The sites with highest caries prevalence were occlusal surface of mandibular molars in groups of D1 and D2 and proximal surface of maxillary anterior teeth in groups D3 and D4. In contrast, the caries prevalence was 48.8% (219/449) and the mean dmft was 2.27±3.54 when using WHO criteria, significantly lower than the detection rates by using ICDAS-Ⅱ (D1-D2) (P=0.00). This suggested that ICDAS-Ⅱ system was a more sensitive method in detecting early childhood caries. Conclusions: ICDAS-Ⅱ system might be superior in detection of incipient caries and be of specific value in prevention of early childhood caries.

[Impact on the incidence of postoperative ventricular arrhythmias after cardiac resynchronization therapy defibrillator with quadripolar lead].

Objective: To evaluate incidence of postoperative ventricular arrhythmias in patients who received cardiac resynchronization therapy defibrillator (CRT-D ) with left ventricular quadripolar lead. Methods: The patients received CRT-D who had complete follow-up data in Anhui Provincial Hospital from June 2013 to June 2016 were included and divided into quadripolar lead group and bipolar lead group according to the type of left ventricular lead. And ventricular arrhythmia (VA), implantable cardioverter-defibrillator (ICD) shocks treatment, antitachycardia pacing therapy (ATP), and other indicators of the two groups were compared. Prognosis of the two groups was assessed by re-hospitalization for heart failure and cardiac death. Results: Of the 220 patients enrolled in the study, 58 patients were in quadripolar lead group and 162 in bipolar lead group, and there were no significant differences in baseline characteristics between the two groups. The VA episode per patient was not significantly different between the two groups [(0.60±2.38) VA per person vs (0.93±2.24) VA per person, P=0.055]; the quadripolar lead group had significantly lower burden of VA compared with bipolar lead group [(0.22±0.91) per person-year vs (0.46±1.13) per person-year, P=0.044]. Compared with bipolar lead group, there were significant reduction in both the ICD shocks per patient and the burden of ICD shocks in quadripolar lead group: [(0.12±0.36) shocks per person vs (0.23±0.52) shocks per person, P=0.034] and [(0.04±0.17) per person-year vs (0.12±0.46) per person-year, P=0.029], respectively. There were no significant differences between the two groups in both the ATP per patient and the burden of ATP: [(1.07±3.77) ATP per person vs (1.26±3.01) ATP per person, P=0.073] and [(0.38±1.39) per person-year vs (0.63±1.48) per person-year, P=0.058], respectively. And there were no significant differences between the two groups for the survival (P=0.496). Conclusion: Compared with bipolar lead group, the burden of VA could be significantly reduced after CRT-D in the quadripolar lead group.

[Morphology character and reduction methods of sagittally unstable intertrochanteric fractures].

OBJECTIVE: To investigate the morphology character of sagittally unstable intertrochanteric fractures and reduction methods. METHODS: A retrospective study was used to analyze the clinical data of sagittally unstable intertrochanteric fractures cases, which were treated with proximal femoral nail anti-rotation (PFNA) fixation from March 2009 to June 2016. In the study, 36 cases were followed up completely, in which 17 cases accepted open reduction, and the other 19 cases accepted minimally invasive reduction. The operation time, amount of bleeding, the fluoroscopy times, postoperative radiographic measurements, such as tip-apex distance (TAD) and sliding distance of the spiral screw, and hip Harris scores were analyzed. The morphology character of the fractures was documented and investigated. RESULTS: The average follow-up time was 15 months. The amount of bleeding of the open reduction group was (170.5±19.7) mL, and the amount of bleeding of the minimally invasive group was (54.7±12.5) mL. The amount of bleeding of the minimally invasive group was significantly less than that of the open reduction group (P<0.001). Between the two groups, there were no significant differences in other evaluation parameter, including operation time (P=0.054), the fluoroscopy times (P=0.053), fracture healing time (P=0.305), postoperative radiographic measurements, such as TAD (P=0.317) and sliding distance of the spiral screw (P=0.206), and hip Harris scores (P=0.459). In regard to morphology character of the fractures, the proximal anterior unstable fractures with separation displacement were more common than the proximal posterior unstable fractures with impaction. The characteristic feature of the proximal anterior unstable fractures was the proximal anterior and medial long oblique fracture, and a V shape cortical defect in the distal fracture fragment on the externally rotation X-ray. CONCLUSION: Sagittally unstable intertrochanteric fractures can be divided into the proximal anterior unstable fractures with separation displacement, and the proximal posterior unstable fractures with impaction. The two types have their own morphology character individually. The reduction should be performed by minimally invasive techniques.

Molecular analysis of MLH1 variants in Chinese sporadic colorectal cancer patients.

Single nucleotide polymorphisms (SNPs) in mismatch repair genes, especially in the MLH1 gene, are closely associated with susceptibility to hereditary nonpolyposis colorectal cancer. However, few relevant findings are available regarding the association between sporadic colorectal cancer (SCRC) and SNPs of MLH1 in Chinese patients. Therefore, the present study aimed to describe the pathogenic association between three important MLH1 polymorphisms and SCRC in the Chinese population. Peripheral blood samples from 156 SCRC patients and 311 healthy controls were collected. DNA was purified from peripheral blood, and the V384D, R217C, and I219V polymorphisms were evaluated using high-resolution melting analysis and direct sequencing. The association between the three important MLH1 polymorphisms and clinical pathological features of the SCRC patients was analyzed. In addition, PMS2-MLH1 protein interactions were determined by co-immunoprecipitation (Co-IP) to determine the protein functional alteration induced by these SNPs. Among the three polymorphisms, V384D was significantly associated with the risk of SCRC (OR = 31.36, P < 0.0001). The allele frequencies were 4.81 and 0.16% in the SCRC group. No association was found between SCRC and R217C, or between SCRC and I219V. Moreover, the allele frequency of R217C was significantly higher in the SCRC patients younger than 60 years than in those older than 60 years. Co-IP showed that the MLH1 R217C, V384D, and I219V variants had relative binding abilities with PMS2 of 0.59, 0.70, and 0.80, respectively, compared with the wild-type. These findings suggest that MLH1 V384D could be a promising genetic marker for susceptibility to SCRC.

Gallbladder carcinoma: causes of misdiagnosis at CT.

Gallbladder carcinomas can present with varied imaging features on computed tomography. The three major imaging features include (1) focal or diffuse wall thickening with or without irregularity of the gallbladder; (2) polypoidal intraluminal mass; and (3) large mass obscuring and replacing the gallbladder, often extending to the liver. Patterns of wall thickening or polypoid growth are often confused with various benign gallbladder diseases due to overlap of imaging findings. Moreover, gallbladder carcinomas that coexist with benign gallbladder diseases make accurate preoperative diagnosis more difficult. Recently, high-resolution ultrasound (HRUS) has been regarded as a problem-solving tool for gallbladder diseases. In this article, we will illustrate various imaging presentations of gallbladder cancer, along with imaging pitfalls and recently updated HRUS findings.

Gastrointestinal stromal tumours (GISTs) with a thousand faces: atypical manifestations and causes of misdiagnosis on imaging.

Gastrointestinal stromal tumours (GISTs) can lead to emergency situations, such as gastrointestinal bleeding, intestinal obstruction, and tumoural rupture with haemoperitoneum or peritonitis. In addition, if a GIST grows exophytically to a large size, it is often misdiagnosed as a tumour arising from adjacent organs. Sometimes, the atypical appearance of GISTs on imaging causes diagnostic confusion. In this article, we illustrate a variety of GISTs with atypical presentations and also discuss the important diagnostic clues for differentiating GISTs from other lesions.

The prevesical space: anatomical review and pathological conditions.

The prevesical space is the largest potential space within the pelvic extraperitoneal space. Located anterosuperior to the bladder, it has complex communications with the adjacent pelvic extraperitoneal spaces, rectus sheath, and retroperitoneum. The prevesical space is also the site of various pathological processes, and can act as a conduit for the spread of these conditions. Therefore, awareness of the detailed anatomy and potential routes of communication may help radiologists in making accurate diagnoses of pathological conditions involving the prevesical space.

Comparison of the clinical characteristics and imaging findings of acute cholangitis with and without biliary dilatation.

OBJECTIVE: To evaluate the causes of acute cholangitis without biliary dilatation and to compare the clinical characteristics and the imaging findings between patients with acute cholangitis with and without biliary dilatation. METHODS: 93 patients diagnosed with acute cholangitis underwent contrast-enhanced CT. Among them, 17 patients were classified as not having biliary dilatation (Group 1) and 76 patients were classified as having biliary dilatation (Group 2). The causes of acute cholangitis were evaluated in both groups. Clinical characteristics and imaging findings were compared between the two groups. RESULTS: The causes of acute cholangitis without biliary dilatation included common bile duct (CBD) stones (n=11), CBD sludge (n=3), a passed stone (n=1) and unknown causes (n=2). The total bilirubin levels of Group 1 were significantly lower than those of Group 2 (p=0.001). By contrast, Group 1 had higher median alanine aminotransferase (ALT) levels than Group 2 (p=0.04). The length of hospital stay was significantly longer in Group 2 than in Group 1 patients (p<0.001). In the imaging findings, the extent of transient hepatic attenuation differences (THADs) (p=0.003) were significantly smaller in Group 1 than in Group 2. CONCLUSION: CBD stones and sludge were the most common causes of acute cholangitis in patients without biliary dilatation. These patients showed lower levels of bilirubin and higher levels of ALT than those with acute cholangitis with biliary dilatation, and had a shorter duration of hospital stay. The extent of THADs was the only discriminative CT finding between the two groups. ADVANCES IN KNOWLEDGE: Acute cholangitis can present without biliary dilatation on imaging, and the most common causes are CBD stones and sludge. The patients with acute cholangitis without biliary dilatation have different clinical characteristics and imaging findings compared with those with acute cholangitis presenting with biliary dilatation.

Perforated tumours in the gastrointestinal tract: CT findings and clinical implications.

Perforation usually requires emergency surgery and may affect the prognosis of patients with gastrointestinal tumours. Accurate pre-operative diagnosis of these conditions is important because proper management such as curative surgical treatment may be needed. The aims of this article are to illustrate CT appearances of perforated tumours of the gastrointestinal tract and to discuss their impact on clinical management.

Time-resolved MR angiography for detecting and grading ovarian venous reflux: comparison with conventional venography.

OBJECTIVE: The purpose of this study was to compare the diagnostic accuracy of time-resolved MR angiography (TR-MRA) with that of conventional venography for the detection and grading of ovarian venous reflux, which aid in the diagnosis of pelvic venous congestion. METHODS: We performed a retrospective analysis of 19 consecutive patients who underwent TR-MRA and conventional venography. The images were analysed by two radiologists in a randomised "blinded" manner. With the use of conventional venography as a gold standard, the images were reviewed to determine if differences in the detection and grading of ovarian venous reflux were seen between TR-MRA and conventional venography; the sensitivity, specificity and accuracy of TR-MRA compared with that of conventional venography were evaluated. The McNemar test was performed to determine the significance of any differences. Interobserver agreement was analysed using generalised κ statistics. RESULTS: There was no significant difference between TR-MRA and conventional venography for grading ovarian venous reflux (p>0.05). The sensitivity, specificity and diagnostic accuracy of TR-MRA were found to be 66.7%, 100% and 78.9%, and 75%, 100% and 84.2%, respectively, for the two observers. The weighted κ-values indicated excellent agreement between the two observers for grading ovarian venous reflux on TR-MRA (κ = 0.894). CONCLUSION: TR-MRA is an accurate method for accessing pelvic venous congestion.

Vascular endothelial growth factor (VEGF) and the VEGF soluble receptor-1 (sFlt-1) in chorionic villus tissue from Chinese women with early recurrent spontaneous abortion.

This case-control study explored the relationship between early recurrent spontaneous abortion (RSA) and the expression of two genes: VEGFA, the gene encoding vascular endothelial growth factor (VEGF); and fms-related tyrosine kinase 1 (FLT1), the gene encoding the soluble VEGF receptor-1 (sFlt-1). Women experiencing RSA or undergoing induced abortions in the early stage of normal pregnancy were recruited to the study (n = 30 per group). There were no significant between-group differences in maternal age or duration of pregnancy. The levels of VEGF and sFlt-1 mRNA in chorionic villus tissue samples were examined by quanti tative reverse transcription-polymerase chain reaction. Levels of sFlt-1 and VEGF mRNA in the chorionic villus tissue of women with RSA were significantly higher than levels in the control group. This study demonstrated that there is a relationship between early RSA and VEGF and sFlt-1 levels, suggesting that over-expression of the FLT1 and VEGFA genes may be associated with the pathogenesis of RSA.

The detection and discrimination of malignant and benign focal hepatic lesions: T2 weighted vs diffusion-weighted MRI.

OBJECTIVE: The purpose of this study was to evaluate the use of diffusion-weighted imaging (DWI) for the detection and characterisation of focal hepatic lesions compared with the use of T(2) weighted imaging. METHOD: 45 patients with 97 hepatic lesions (51 malignant lesions and 46 benign lesions) were included in this retrospective study. Malignant hepatic lesions included 12 hepatocellular carcinomas, 26 metastases and 13 intrahepatic cholangiocarcinomas. Benign hepatic lesions included 19 haemangiomas and 27 cysts. The MRI protocol for the upper abdomen included T(2) weighted images, in- and opposed-phase T(1) weighted images and dynamic T(1) weighted images. Breath-hold fat-suppressed single-shot echo planar DWI was performed with the following parameters: 1338/66; b factors, 0, 50 and 800 s mm(-2). Two independent observers reviewed the T(2) weighted images and the DWI to detect and to characterise the hepatic lesions. RESULTS: For detection of malignant hepatic lesions, the use of DWI showed a significantly higher detection rate than the use of T(2) weighted images (p<0.05). However, there was no significant difference between the use of DWI and T(2) weighted images for benign hepatic lesions. For the differentiation between malignant and benign hepatic lesions, there was no significant difference in sensitivity, specificity and accuracy between the use of T(2) weighted images and the use of DWI. CONCLUSION: The use of DWI was better for the detection of malignant hepatic lesions than the use of T(2) weighted images. However, for detection of benign hepatic lesions and characterisation of hepatic lesions, the use of DWI was equivalent to the use of T(2) weighted images.

Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels.

OBJECTIVES: The aim of this study was to evaluate the relationships between the severity of appendicitis as depicted on CT and blood inflammatory markers of serum white blood cell (WBC) count and C-reactive protein (CRP). METHODS: CT images in 128 patients (109 surgically proven and 19 with clinically excluded appendicitis) were retrospectively reviewed. Two radiologists by consensus evaluated and scored (using a 0, 1 or 2 point scale) severities based on CT-determined appendiceal diameters, appendiceal wall changes, caecal changes, periappendiceal inflammatory stranding and phlegmon or abscess formation. We investigated whether CT findings were significantly related to elevated WBC counts or CRP levels and performed the correlations of WBC counts and CRP levels with CT severity scores. Patients were also subjectively classified using four grades from normal (Grade I) to perforated appendicitis (Grade IV) on the basis of CT findings to evaluate differences in WBC counts and CRP levels between grades. RESULTS: Only appendiceal wall changes and the phlegmon or abscess formation were related to elevated WBC counts and CRP levels, respectively (p<0.05). CT severity scores were found to be more strongly correlated with CRP levels (r = 0.669) than with WBC counts (r = 0.222). On the basis of CT grades, the WBC counts in Grade I were significantly lower than in other grades (p<0.001), whereas CRP levels in Grade IV were significantly higher than in other grades (p<0.001). CONCLUSION: CRP levels were found to correlate with CT-determined acute appendicitis severity and could be a useful predictor for perforated appendicitis, whereas WBC counts might be useful to detect early acute appendicitis.

Mitochondrial dysfunction-induced amphiregulin upregulation mediates chemo-resistance and cell migration in HepG2 cells.

The aim of this study was to investigate the contribution of mitochondrial dysfunction to chemoresistance and migration of hepatoma cells. We found that inhibition of mitochondrial respiration and mitochondrial DNA (mtDNA) depletion resulted in induction of amphiregulin (AR) expression in HepG2 cells. Upon oligomycin treatment of HepG2 cells, the cytosolic Ca(2+) was significantly raised after 30 min, and the intracellular level of reactive oxygen species (ROS) was elevated 2.2-fold after 4 h. Moreover, the condition medium of oligomycin-treated HepG2 cells was found to stimulate the migration of SK-Hep-1 cells. On the other hand, oligomycin-induced cisplatin-resistance and cell migration of HepG2 cells were attenuated by AR-specific RNA interference (#L-017435, Dharmacon) and a neutralizing antibody (MAB262, R&D Systems), respectively. Together, these findings suggest that mitochondrial dysfunction induced Ca(2+) mobilization, and ROS overproduction, which modulated the chemo-resistance and migration of hepatoma cells through the induction and activation of AR.

Identification of the normal appendix in healthy adults by 64-slice MDCT: the value of adding coronal reformation images.

The aim of this study was to assess retrospectively the value of adding coronal reformation images to the identification of the normal appendix using 64-slice multidetector CT (MDCT). 200 consecutive healthy adults with no history of abdominal surgery underwent abdominal CT using 64-slice MDCT without oral contrast administration and were enrolled in the study. Two gastrointestinal radiologists first interpreted the axial images only; after a 2-week interval, they then interpreted both the axial and the coronal images while blinded to the first interpretation. The identification of the normal appendix was interpreted using a four-point scale: 1, not identified; 2, identified with low confidence; 3, probably identified; 4, definitely identified. Agreement between the readers was determined with the use of weighted kappa statistics. Differences in confidence ratings for identification of the appendix were determined with the Wilcoxon signed rank test. The agreement between the readers was higher when both axial and coronal images were reviewed (kappa = 0.85) than when only the axial scans images were reviewed (kappa = 0.43). The mean confidence scores for the identification of the normal appendix by the two readers were significantly higher when both the axial and coronal images were reviewed (mean, 3.81+/-0.498 and 3.83+/-0.485 for the two readers, respectively) than when only the axial images were reviewed (mean, 3.27+/-0.819 and 3.47+/-0.856, respectively) (all p<0.01). Therefore, adding coronal reformation images to 64-slice MDCT significantly improves inter-reader agreement and confidence in the identification of the normal appendix.

Iron-generated hydroxyl radicals kill retinal cells in vivo: effect of ferulic acid.

Siderosis bulbi is vision threatening. An investigation into its mechanisms and management is crucial. Experimental siderosis was established by intravitreous administration of an iron particle (chronic) or FeSO(4) (acute). After siderosis, there was a significant dose-responsive reduction in eletroretinogram (a/b-wave) amplitude, and an increase in OH level, greater when caused by 24 mM FeSO(4) than that by 8 mM FeSO(4). Furthermore, the FeSO(4)-induced oxidative stress was significantly blunted by 100 microM ferulic acid (FA). Siderosis also resulted in an excessive glutamate release, increased [Ca(++)](i), and enhanced superoxide dismutase immunoreactivity. The latter finding was consistent with the Western blot result. Obvious disorganization including loss of photoreceptor outer segments and cholinergic amacrines together with a wide-spreading ferric distribution across the retina was present, which were related to the eletro-retinographic and pathologic dysfunctions. Furthermore, b-wave reduction and amacrine damage were respectively, significantly, dose-dependently, and clearly ameliorated by FA. Thus, siderosis stimulates oxidative stress, and possibly, subsequent excitotoxicity, and calcium influx, which explains why the retina is impaired electro-physiologically and pathologically. Importantly, FA protects iron toxicity perhaps by acting as a free radical scavenger. This provides an approach to the study and treatment of the iron-related disorders such as retained intraocular iron and Alzheimer disease.

Metastasis to the appendix from a hepatocellular carcinoma manifesting as acute appendicitis: CT findings.

Metastasis to the appendix is extremely rare. Moreover, metastasis from a hepatocellular carcinoma (HCC) has not been reported in the English language literature. We report a case of metastasis to the appendix from a HCC in a 50-year-old man who presented with pain in the right lower quadrant of the abdomen, representing acute appendicitis. On CT, a hypervascular mass occupying the lumen of the appendix with distension of the appendiceal tip and surrounding peritoneal seeding of the HCC were observed. This is the first report of CT findings of metastasis to the appendix from a HCC.