A diagnostic test of three-dimensional magnetic resonance elastography imaging for preoperative prediction of microvascular invasion in patients with T1 stage clear cell renal carcinoma.

Background: Detection of microvascular invasion (MVI) of kidney tumors is important for selecting the optimal therapeutic strategy. Currently, the prediction of MVI lacks an accurate imaging biomarker. This study evaluated the performance of three-dimensional (3D) magnetic resonance elastography (MRE) imaging in predicting microvascular invasion (MVI) of T1 stage clear cell renal carcinoma (ccRCC). Methods: In this prospective study, we conducted pre-surgical imaging with a clinical 3.0 T magnetic resonance imaging (MRI) system. Firstly, 83 consecutive patients were enrolled in this study. A 3D MRE stiffness map was generated and transferred to a post-processing workstation. Contrast-enhanced computed tomography (CT) was conducted to calculate the tumor enhancement ratio. The presence of MVI was evaluated by histopathological analysis and graded according to the risk stratification based upon the number and distribution. The mean stiffness and CT tumor enhancement ratio was calculated for tumors with or without MVI. The diagnostic performance [sensitivity, specificity, positive predictive value, negative predictive value, area under the curve (AUC)] and independent predicting factors for MVI were investigated. Results: Finally, A total of 80 patients (aged 46.7±13.2 years) were enrolled, including 22 cases of tumors with MVI. The mean MRE stiffness of kidney parenchyma and kidney tumors was 4.8±0.2 and 4.5±0.7 kPa, respectively. There was significant difference in the mean MRE stiffness between tumors with MVI (5.4±0.6 kPa) and tumors without MVI (4.1±0.3 kPa) (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and the AUC for mean stiffness in the prediction of MVI were 100%, 75%, 63%, 96%, and 0.87 [95% confidence interval (CI): 0.72, 0.94], respectively. The corresponding values for the CT tumor enhancement ratio were 90%, 80%, 63%, 96%, and 0.88 (95% CI: 0.71, 0.93), respectively. The odds ratio (OR) value for MRE tumor stiffness and CT kidney tumor enhancement ratio in the prediction of MVI was 2.9 (95% CI: 1.8, 3.7) and 1.2 (95% CI: 1.0, 1.7), respectively (P>0.05). Conclusions: 3D MRE imaging has promising diagnostic performance for predicting MVI in T1 stage ccRCC, which may improve the reliability of surgical strategy selection with T1 stage ccRCC.

Arterial Spin Labeling MRI for Predicting Microvascular Invasion of T1 Staging Renal Clear Cell Carcinoma Preoperatively.

BACKGROUND: Microvascular invasion (MVI) is a valuable factor for T1 staging renal clear cell carcinoma (ccRCC) operation strategy decision, which is confirmed histopathologically post-operation. This study aimed to prospectively evaluate the performance of arterial spin labeling (ASL) MRI for predicting MVI of T1 staging ccRCC preoperatively. METHODS: 16 volunteers and 39 consecutive patients were enrolled. MRI examinations consisted of ASL (three post label delays separately) of the kidney, followed by T1 and T2-weighted imaging. Two sessions of ASL were used to evaluate the reproducibility on volunteers. Renal blood flow of renal cortex, medulla, the entire and solid part of the tumor were measured on ASL images. Conventional imaging features were extracted. MVI and WHO/ISUP classification were evaluated histopathologically. A paired t-test was used to compare the renal cortex and medulla between ASL 1 and ASL 2. The reproducibility was assessed using the intraclass correlation. Differences in mean perfusion between the entire and the solid parts of tumors with or without MVI were assessed separately using Student's t test. The diagnostic performance was assessed. Logistic regression analysis was used to indicate the independent prediction index for MVI. RESULTS: The two sessions of ASL showed no significant difference between the mean cortex values of RBF. The cortical RBF measurements demonstrated good agreement. 12 ccRCCs presented with MVI histopathologically. Mean perfusion of the solid part of tumors with MVI were 536.4 ± 154.8 ml/min/100 g (PLD1), 2912.5 ± 939.3 ml/min/100 g (PLD2), 3280.3 ± 901.2 ml/min/100 g (PLD3). Mean perfusion of the solid part of tumors without MVI were 453.5 ± 87.2 ml/min/100 g (PLD1), 1043.6 ± 695.8 ml/min/100 g (PLD2), 1577.6 ± 1085.8 ml/min/100 g (PLD3). These two groups have significant difference at all the PLDs (p < 0.05). The RBF of PLD1 of the solid part of tumor perfusion showed well diagnostic performance for predicting MVI: sensitivity 75%, specificity 100%, positive predictive value 66.7%, and negative predictive value 95.7%. The maximum diameter of the tumor, ill-defined margin, and the solid part of tumor perfusion were the independent prediction index for MVI. CONCLUSION: ASL MR imaging has good reproducibility for renal cortex, and good diagnostic performance for predicting MVI for ccRCC.

Paraneoplastic Cerebellar Degeneration Associated with Pelvic Liposarcoma: A Rare Case Report.

Paraneoplastic cerebellar degeneration (PCD) is one of the most common paraneoplastic neurological syndromes characterized by the rapid development of severe cerebellar ataxia. In this report, a 23-year-old female with noticeable dizziness and gait instability was described. The enhanced CT scanning suggested the presence of a pelvic tumor. Then, PCD was established. Postoperative pathological result defined it as a liposarcoma (LS) with dedifferentiation. Interestingly, clinical symptoms disappeared after the surgical removal of the pelvic tumor. To our knowledge, this was the first case report with PCD due to LS.

[Preventive Effect of Fangshuan Capsule on PCI-induced Myocardial Damage and Vascular Endo- thelial Injury in Patients with Unstable Angina Pectoris].

Objective To observe the prevention of Fangshuan Capsule (FC) on percutaneous coronary intervention (PCI) induced myocardial damage and vascular endothelial injury in patients with un- stable angina pectoris (UAP). Methods Totally 100 UAP patients undergoing PCI were assigned to the control group and the treatment group by random digit table, 50 in each group. All patients received routine Western medicine therapy. Those in the treatment group additionally took FC, 6 pills each time, three times per day for at least 2 days before PCI operation. The therapeutic course for each group was 2 weeks. The clinical therapeutic effect was observed in the two groups. Heart rate (HR), systolic blood pressure (SBP) , changes of myocardial oxygen consumption ( HR x SBP, kPa/min) were compared. The levels of serum troponin I (cTn 1), creatinine kinase-MB (CK-MB) , myoglobin (MYO) , endothelin (ET), and nitric oxide (NO) were measured before PCI, and 6, 12, 24 h, 3 and 7 days after PCI. Results The markedly effective rate of Chinese medical syndromes was 54% (17/50) and the total effective rate was 94% (47/50) in the treatment group, obviously higher than those of the control group [26% (13/50) and 88% (44/50) ; P <0. 01]. Compared with before treatment in the same group, HR, SBP, myocardial oxygen consumption, and plasma ET level were reduced, plasma NO level was elevated in two groups after treatment (P <0.05, P <0. 01). cTnl concentration increased at 6, 12, 24 h, and day 3 (P <0. 05, P <0. 01 ) ; CK-MB concentration was elevated at 6, 12, and 24 h (P <0. 05, P <0. 01) ; MYO concentration increased at 6 and 12 h (P < 0. 01) in the control group after treatment. cTnl concentration increased at 12 and 24 h (P <0. 05, P <0. 01); CK-MB concentration was elevated at 6 and 12 h (P <0. 05) ; MYO concentration increased at 6 h (P <0. 01) in the treatment group after treatment. Compared with the control group at the same time point, HR, myocardial oxygen consumption, and plasma ET level decreased (P <0. 05); cTnl decreased at 6, 12, and 24 h (P <0. 05); CK-MB concentration decreased at 12 h (P <0. 05); MYO concentration decreased at 6 and 12 h (P <0. 05) in the treatment group after treatment. Conclusion FC could effectively improve scores of Chinese medical syndromes after PCI surgery, reduce myocardial oxygen consumption, attenuate myocar- dial damage and vascular endothelial injury in UAP patients after PCI.

Diagnostic Utility of Diffusion-weighted Magnetic Resonance Imaging in Differentiating Small Solid Renal Tumors (≤ 4 cm) at 3.0T Magnetic Resonance Imaging.

BACKGROUND: The aim of this study was to assess the performance of apparent diffusion coefficient (ADC) measurement obtained with diffusion-weighted magnetic resonance imaging (DW-MRI) to distinguish renal cell carcinomas (RCCs) from small benign solid renal tumors (≤ 4 cm). METHODS: In this cross-sectional study, 49 consecutive patients with histopathologically confirmed small solid renal tumors, and seven healthy volunteers were imaged using nonenhanced MRI and DW-MRI. The ADC map was calculated using the b values of 0, 50, 400, and 600 s/mm 2 and values compared via the Kruskal-Wallis and Mann-Whitney tests. The utility of ADC for differentiating RCCs and benign lesions was assessed using a receiver operating characteristic curve. Multiple nonenhanced MRI features were analyzed by Logistic regression. RESULTS: The tumors consisted of 33 cases of clear-cell RCCs (ccRCCs) and 16 cases of benign tumors, including 14 cases of minimal fat angiomyolipomas and 2 cases of oncocytomas. The ADCs showed significant differences among benign tumors ([0.90 ± 0.52] × 10-3 mm 2 /s), ccRCCs ([1.53 ± 0.31] × 10-3 mm 2 /s) and the normal renal parenchyma ([2.22 ± 0.12] × 10-3 mm 2 /s) (P < 0.001). Moreover, there was statistically significant difference between high and low-grade ccRCCs (P = 0.004). Using a cut-off ADC of 1.36 × 10-3 mm 2 /s, DW-MRI resulted in an area under the curve (AUC), sensitivity, and specificity equal to 0.839, 75.8%, and 87.5%, respectively. Nonenhanced MRI alone and the combination of imaging methods led to an AUC, sensitivity and specificity equal to 0.919, 93.9%, and 81.2%, 0.998, 97%, and 100%, respectively. The Logistic regression showed that the location of the center of the tumor (inside the contour of the kidney) and appearance of stiff blood vessel were significantly helpful for diagnosing ccRCCs. CONCLUSIONS: DW-MRI has potential in distinguishing ccRCCs from benign lesions in human small solid renal tumors (≤ 4 cm), and in increasing the accuracy for diagnosing ccRCCs when combined with nonenhanced MRI.

Ethyl 5,8-dibromo-2-dibromo-methyl-6,7-dimeth-oxyquinoline-3-carb-oxy-late.

The title compound, C(15)H(13)Br(4)NO(4), was obtained via radical bromination reaction of ethyl 6,7-dimeth-oxy-2-methyl-quinoline-3-carboxyl-ate and N-bromo-succinimide (NBS) in the presence of benzoyl peroxide (BPO) under photocatalytic conditions. The quinoline ring system is approximately planar with a maximum deviation from the mean plane of 0.035 (1) Å. The dihedral angle between the six-membered rings is 2.33 (2)°. The meth-oxy O atoms of the two neighboring meth-oxy groups are in-plane while their methyl C atoms are located on either side of the quinolyl ring plane at distances of -1.207 (1) and 1.223 (1) Å.

2-(3-Morpholino-prop-yl)-2,3-dihydro-1H-pyrrolo-[3,4-b]quinolin-1-one monohydrate.

In the title compound, C(18)H(21)N(3)O(2)·H(2)O, the fused-ring system is approximately planar [maximum atomic deviation = 0.028 (3) Å]; the morpholine ring displays a chair conformation. The crystal packing is stabilized by classical inter-molecular O-H⋯O and O-H⋯N hydrogen bonds and weak C-H⋯O hydrogen bonds between the organic mol-ecules and the water mol-ecules.

Effect of Xin'anning Nasal Drop in treating coronary heart disease with unstable angina pectoris.

OBJECTIVE: To observe the clinical efficacy of Xin'anning Nasal Drop (XAND) in treating coronary heart disease with unstable angina pectoris (CHD-UAP). METHODS: Sixty patients with CHD-UAP were assigned, according to the randomizing number table, to two groups, the control group treated with conventional Western medicine, and the treated group treated with conventional Western medicine plus XAND. The clinical efficacy and the changes of S-T segment in resting EKG and total ischemia burden (TIB) in 24-h dynamic EKG were observed. RESULTS: The clinical efficacy, including the effect of angina alleviation, its initiation, and the effect of TCM syndrome score reduction, were significantly superior in the treated group to those in the control group ( P<0.05 or P<0.01). The degree and extent of myocardial ischemia were significantly improved in both groups ( P<0.01), but the improvement in the treated group was better than that in the control group ( P<0.05). Moreover, it was worth mentioning that the immediate effect in the treated group was better than that in the control group, and the reduction of TIB, the improvement in heart rate and myocardial oxygen consumption (immediately after the first administration or by the end of the therapeutic course), and systolic blood pressure after treatment in the former were all superior to those in the latter, showing significant difference (P<0.05 or P<0.01). CONCLUSION: XAND has a quick effect in alleviating angina in patients with CHD-UAP, and it is worthy of further studies and spreading in clinical practice. unstable angina pectoris, Xin'anning Nasal Drop, clinical study