Effects of combining multiple dose reduction techniques on coronary computed tomography angiography.

BACKGROUND: Coronary computed tomography angiography (CCTA) is the preferred non-invasive examination method for coronary heart disease. However, the radiation from computed tomography has become a concern since public awareness of radiation hazards continue to increase. AIM: To explore the value of multiple dose reduction techniques for CCTA. METHODS: Consecutive normal and overweight patients were prospectively divided into two groups: Group A1, patients who received multiple dose reduction scans (n = 82); and group A2, patients who received conventional scans (n = 39). The scan parameters for group A1 were as follows: Isocentric scan, tube voltage = 80 kV, and tube current control using 80% smart milliampere. The scan parameters for group A2 were as follows: Normal position, tube voltage = 100 kV, and smart milliampere. RESULTS: The average effective doses (EDs) for groups A1 and A2 were 1.13 ± 0.35 and 3.36 ± 1.30 mSv, respectively. There was a statistically significant difference in ED between the two groups (P < 0.01). Furthermore, noise was significantly lower, and both signal-to-noise ratio and contrast signal-to-noise ratio were higher in group A2 when compared to group A1 (P < 0.01). Moreover, the subjective image quality (IQ) scores were excellent in both groups, in which there was no significant difference in subjective IQ score between the two groups (P = 0.12). CONCLUSION: Multiple dose reduction scan techniques can significantly decrease the ED of patients receiving CCTA examinations for clinical diagnosis.

Magnetic Resonance Imaging Features and Misdiagnosis of Spinal Epidural Cavernous Hemangioma.

OBJECTIVE: Spinal epidural cavernous hemangiomas (SECHs) are rare, and merely a few have previously been described in case reports. The present study aims to explore the magnetic resonance imaging (MRI) features of SECHs and analyze the causes of their preoperative misdiagnosis. METHODS: The present retrospective study included 11 patients (three male and eight female patients, mean age ± standard deviation: 47.55±17.39 years old) with histopathologically confirmed SECH between January 2015 and April 2021. The MRI features of SECH were analyzed by two radiologists. RESULTS: The cervical, thoracic and thoracolumbar segments were involved in 2, 7 and 2 patients, respectively. All lesions grew along the long axis of the spine. The tumors were shuttle-shaped in six patients, oval in two patients, pseudopodia-shaped in one patient, clamp-shaped in one patient, and growing outward along the intervertebral foramen in one patient. Nine SECHs had relatively uniform isointense or hypointense T1-weighted imaging (T1WI) and hyperintense T2-weighted imaging (T2WI) signals. On the T2WI, filamentary low-signal shadows (i.e., the hairline or grid sign) with significant contrast enhancement and asymptotic strengthening were observed. Two SECHs had mixed high and low signals on T1WI and T2WI, with significant heterogeneous enhancement, hemorrhage, and hemosiderin deposition. The SECH was misdiagnosed as meningioma, neurofibromatosis and schwannoma in 1, 1 and 4 patients, respectively, while this was not diagnosed in one patient. The preoperative diagnosis was correct in merely approximately 36% of patients. Among the four patients with a correct preoperative diagnosis, hemosiderin deposition was found in three patients and small tortuous vascular shadows were found in one patient. CONCLUSION: SECH presents as a long spindle-shaped mass, and the "'pen cap sign" is common at the lesion edges. SECH also exhibits a hairline or grid sign on T2WI. Furthermore, some lesions present with hemorrhage and hemosiderin deposition. Therefore, the hairline, grid sign and hemosiderin deposition are valuable diagnostic features of SECH.

Imaging Features of Lymphoepithelial-Like Carcinoma of the Salivary Glands.

OBJECTIVE: Lymphoepithelial-like carcinoma of the salivary glands (LELCSG) is a rare tumour of unknown aetiology. No studies have reported the imaging features of primary LELCSG. METHODS: The clinical information and imaging features of eight patients with LELCSG were reviewed. Computed tomography (n = 4 patients) and magnetic resonance imaging (n = 4 patients) features were analysed by two radiologists to identify the location, number, size, shape, boundary, signal intensity and enhancement of LELCSG. RESULTS: The study included four women and four men, and the mean size of the tumours was 32.88 ± 3.41 mm (range, 27-38 mm). The tumours affected the parotid gland in six cases and the submandibular gland in two cases. The eight cases were evaluated by radiologists. All tumours were lobulated; three had clear edges and five had blurred edges. There was no necrosis in six tumours, while two tumours exhibited slight necrosis without bleeding. All eight tumours showed multiple nodular changes and extensive fusion. Four tumours with magnetic resonance imaging (MRI) were isointense or slightly hyperintense on T1-weighted imaging (T1WI) and obvious homogeneous enhancement on contrasted enhanced T1WI scan, while slightly hyperintense on T2-weighted imaging (T2WI). The other four lesions were isodense on computed tomography (CT) scan. The degree of enhancement varied among the eight tumours. The necrotic zones of the eight tumours did not exhibit any enhancement. CONCLUSIONS: LELCSG is a lobulated, multi-nodular tumour, with some fused nodules. LELCSG lesions showed isointensity or slight hyperintensity on T1WI MRI, slight hyperintensity on T2WI MRI and isodense on CT scan. Larger tumours may exhibit some necrosis, but the necrotic cysts were relatively rare. Uniform enhancement was observed in non-necrotic areas on enhanced CT and MRI scan. The multi-nodular feature may be valuable for diagnosis.

Altered gut microbiome compositions are associated with the severity of asthma.

BACKGROUND: Despite substantial evidence on the contribution of the diversity of the gut microbiome to the pathogenesis of asthma and allergic diseases, little is known about their relationship with asthma severity and/or clinical phenotypes. We analyzed the difference in composition of the gut microbiome between subjects with asthma and healthy subjects and explored its role in the development of asthma. METHODS: Fecal samples from 15 subjects with severe asthma (SA), 14 with non-severe asthma (NSA), and 15 healthy subjects were assessed by 16S ribosomal RNA gene sequencing methods to identify the gut bacterial composition. RESULTS: Compared with those in the NSA group, patients in the SA group had a higher dose of inhaled corticosteroids, and there were more atopic subjects (60% vs. 35.7%, respectively). No significant differences were found at the phylum level either in operational taxonomic unit numbers or in diversity scores among the SA, NSA, and healthy groups. However, at the family level, the relative abundance of Acidaminococcaceae in the SA group was remarkedly lower than that in the group with healthy subjects (P<0.05). Furthermore, Veillonellaceae and Prevotellaceae were significantly more common in samples from the SA group than in those from the NSA group (P<0.05). In the SA group, positive correlations were observed between the relative abundance of Veillonellaceae and mid-expiratory flow 25% (MEF25%) predicted (r=0.538, P=0.047), as well as between the relative abundance of Acidaminococcaceae and body mass index (r=0642, P=0.010). Principal component analysis suggested that the relative abundances of Acidaminococcaceae and Prevotellaceae were associated with severe asthma. Moreover, we found that class Betaproteobacteria, order Burkholderiales, and family Alcaligenaceae were significantly different among the groups defined by serum immunoglobulin E (IgE) levels. CONCLUSIONS: Our findings suggest that altered gut microbiome compositions are involved in the severity of asthma and that there are specific bacteria related to different asthma phenotypes in terms of serum IgE levels.

Early radiologic and bronchoscopic changes after bronchial thermoplasty in patients with severe asthma.

Bronchial thermoplasty (BT) is a treatment to reduce the airway smooth muscle mass by delivering radiofrequency thermal energy to the airways. BT is used in patients with severe asthma. The present study reported on cases of pneumothorax directly after BT and retrospectively analyzed early radiologic and bronchoscopic modifications after BT. The clinical data and radiologic and bronchoscopic findings of 12 patients with severe asthma who were subjected to BT between July 2014 and October 2017 were analyzed. A total of 33 chest radiographs were collected within 18-24 h after BT. Radiological abnormalities were observed in 32 radiographs as atelectasis (53.1%), peribronchial consolidations (84.4%), pleural effusion (18.8%), effusion in oblique fissures (3.1%), pleural thickening (6.3%) and pneumothorax (3.1%). Of note, one patient suffered pneumothorax after the third BT session and underwent chest drain insertion, followed by mechanical ventilation at the intensive care unit and multiple bronchoscopic interventions, which revealed extensive phlegm plugs. A total of six patients with worsened symptoms and lobar atelectasis also required bronchoscopic intervention, which revealed that phlegm plugs occluded the bronchus in the treated lobe. No bronchoscopic intervention was required in the remaining five patients. During 16-30 days of follow-up, 95.7% of the findings on chest radiography were resolved. To the best of our knowledge, the present study reported the first case of pneumothorax following BT. Early radiologic modifications such as atelectasis and peribronchial consolidations appear common after BT. However, whether bronchoscopic intervention is required for atelectasis following BT warrants further investigation. Of note, BT should be audited and recorded in detail to ideally contribute to a framework of clinical trials to improve risk-benefit evaluations and the selection of patients likely to benefit from treatment.

[CT imaging features and misdiagnosis analysis of occult anterior calcaneal process fracture].

OBJECTIVE: To explore CT imaging features and reason for missed diagnosis of clinical practice of occult anterior calcaneal process fracture. METHODS: From July 2013 to November 2018, the clinical data of 13 patients with occult an anterior calcaneal process fracture were retrospectively analyzed, including 2 males and 11 females, aged from 22 to 54 years old. Classification of fracture, displacement of fracture, direction of fracture line, size of fracture, with or without tarsal coalition, other fractures and misdiagnosis, the time from injury to diagnosis, condition of treatment and fracture healing were observed according to case history, data of X-ray and CT. RESULTS: Thirteen patients were diagnosed as occult anterior calcaneal process fracture after CT examination. According to Degan classification, 9 patients were type I, 4 patients were typeII; 4 patients were occurred displacement, and 9 patients did not occurred displacement. On the horizontally CT, fracture line of 12 patients showed transverse, 1 patient oblique, and the size of fracture ranged from 0.40 to 1.72 cm; while on the sagittal view, fracture line of 12 patients showed vertical, 1 patient oblique, and the size of fracture ranged from 0.10 to 0.59 cm. No patients combined with talocalcaneal and scaphoid bridge. Six patients were simple anterior calcaneal process fracture, 7 patients combined with other fractures. Eight patients were misdiagnosed. The time from injury to diagnose ranged from 0 to 21 days. Nine patients with type Iwere performed conservative treatment, 6 patients healed well and 3 patients with fracture line less than 1 cm on horizontally view occurred fracture nonunion. Four patients with type II did not perform operation, and fracture were not union, regardless of fracture size. CONCLUSIONS: Occult anterior calcaneal process fracture have high rate of missed diagnosis in clinical practice. CT imaging features of fracture showed that most fracture line were transverse on CT horizontal plane while vertical on CT sagittal plane, as well as small side of fragment on CT sagittal plane with differernt sizes of fragment on CT horizontal plane; type Ifracture with fragment less than 1 cm on CT horizontal plane and type II both have high rate of nonunion while treated with conservative treatment.

Hydrogen gas inhalation enhances alveolar macrophage phagocytosis in an ovalbumin-induced asthma model.

BACKGROUND: Maintaining an airway clear of bacteria, foreign particles and apoptotic cells by alveolar macrophages is very essential for lung homeostasis. In asthma, the phagocytic capacity of alveolar macrophages is significantly reduced, which is thought to be associated with increased oxidative stress. Hydrogen (H2) has been shown to exert potent antioxidant and anti-inflammatory effects, yet its effects on phagocytosis of alveolar macrophages are unknown. This study is aimed to evaluate the beneficial effects of hydrogen gas inhalation on alveolar macrophage phagocytosis in an ovalbumin (OVA)-induced murine asthma model. METHODS: Female C57BL/6 mice were intraperitoneally sensitized with OVA before they were subject to airway challenge with aerosolized OVA. Hydrogen gas was delivered to the mice through inhalation twice a day (2 h once) for 7 consecutive days. Phagocytic function of alveolar macrophages isolated from bronchoalveolar lavage fluid was assessed by fluorescence-labeled Escherichia coli as well as flow cytometry. RESULTS: Alveolar macrophages isolated from OVA-induced asthmatic mice showed decreased phagocytic capacity to Escherichia coli when compared with those of control mice. Defective phagocytosis in asthmatic mice was reversed by hydrogen gas inhalation. Hydrogen gas inhalation significantly alleviated OVA-induced airway hyperresponsiveness, inflammation and goblet cell hyperplasia, diminished TH2 response and decreased IL-4 as well as IgE levels, reduced malondialdehyde (MDA) production and increased superoxide dismutase (SOD) activity. Concomitantly, hydrogen gas inhalation inhibited NF-κB activation and markedly activated Nrf2 pathway in OVA-induced asthmatic mice. CONCLUSIONS: Our findings demonstrated that hydrogen gas inhalation enhanced alveolar macrophage phagocytosis in OVA-induced asthmatic mice, which may be associated with the antioxidant effects of hydrogen gas and the activation of the Nrf2 pathway.

Blockade of the NLRP3/Caspase-1 Axis Ameliorates Airway Neutrophilic Inflammation in a Toluene Diisocyanate-Induced Murine Asthma Model.

Multiple studies have addressed the vital role of Nod-like receptor protein 3(NLRP3)/caspase-1/IL-1ß signaling in asthma. Yet, the role of NLRP3/caspase-1 in toluene diisocyanate (TDI)-induced asthma is still obscure. The aim of this study is to investigate the role of the NLRP3/caspase-1 axis in TDI-induced asthma. Using an established murine model of TDI-induced asthma as described previously, we gave the asthmatic mice a highly selective NLRP3 inhibitor, MCC950, as well as the specific caspase-1 inhibitors VX-765 and Ac-YVAD-CHO for therapeutic purposes. Airway resistance was measured and bronchoalveolar lavage fluid was analyzed. Lungs were examined by histology, immunohistochemistry, Western blotting, and flow cytometry. TDI exposure elevated the expression of NLRP3 and caspase-1 that was coupled with increased airway hyperresponsiveness (AHR), neutrophil-dominated cell infiltration, pronounced goblet cell metaplasia, extensive collagen deposition, and increased TH2/TH17 responses. Both VX-765 and Ac-YVAD-CHO effectively inhibited the activation of caspase-1 in TDI-asthmatic mice that was accompanied by dramatic attenuation of AHR, airway inflammation, and airway remodeling, in addition to a decreased TH2 response and lower levels of IL-18 and IL-1ß. MCC950 blocked the activation of NLRP3 and downregulated protein expression of caspase-1, IL-1ß, and IL-18 in TDI-exposed mice. Furthermore, MCC950 remarkably alleviated AHR, airway inflammation, airway remodeling, and significantly suppressed TH2/TH17 responses. These findings suggested that blockade of the NLRP3/caspase-1 axis effectively prevents the progression of TDI-induced asthma and could be used as therapeutic targets for asthmatics.

IL-17F, rather than IL-17A, underlies airway inflammation in a steroid-insensitive toluene diisocyanate-induced asthma model.

Steroid insensitivity constitutes a major problem for asthma management. Toluene diisocyanate (TDI) is one of the leading allergens of asthma that induces both T-helper Th2 and Th17 responses, and is often associated with poor responsiveness to steroid treatment in the clinic.We sought to evaluate the effects of inhaled and systemic steroids on a TDI-induced asthma model and to find how interleukin (IL)-17A and IL-17F function in this model. BALB/c mice were exposed to TDI for generating an asthma model and were treated with inhaled fluticasone propionate, systemic prednisone, anti-IL-17A, anti-IL-17F, recombinant IL-17A or IL-17F.Both fluticasone propionate and prednisone showed no effects on TDI-induced airway hyperresponsiveness (AHR), bronchial neutrophilia and eosinophilia, and epithelial goblet cell metaplasia. TDI-induced Th2 and Th17 signatures were not suppressed by fluticasone propionate or prednisone. Treatment with anti-IL-17A after TDI exposure led to increased AHR, aggravated mucus production and airway eosinophil recruitment, accompanied by amplified Th2 responses, whereas anti-IL-17F ameliorated TDI-induced AHR and airway neutrophilia, with decreased Th17 responses. Recombinant IL-17A and IL-17F showed opposite effects to the monoclonal antibodies.IL-17A and IL-17F exert distinct biological effects during airway inflammation of a TDI-induced asthma model, which is unresponsive to both inhaled and systemic steroids.

Transient Receptor Potential Ion Channels Mediate Adherens Junctions Dysfunction in a Toluene Diisocyanate-Induced Murine Asthma Model.

Disruption of epithelial cell-cell junctions is essential for the initiation and perpetuation of airway inflammation in asthma. We've previously reported compromised epithelial barrier integrity in a toluene diisocyanate (TDI)-induced occupational asthma model. This study is aimed to explore the role of transient receptor potential vanilloid 4 (TRPV4) and transient receptor potential ankyrin 1 (TRPA1) in the dysfunction of adherens junctions in TDI-induced asthma. Mice were sensitized and challenged with TDI for a chemical-induced asthma model. Selective blockers of TRPV4 glycogen synthase kinase (GSK)2193874, 5 and 10 mg/kg) and TRPA1 (HC030031, 10 and 20 mg/kg) were intraperitoneally given to the mice. Immunohistochemistry revealed different expression pattern of TRPV4 and TRPA1 in lung. TDI exposure increased TRPV4 expression in the airway, which can be suppressed by GSK2193874, while treatment with neither TDI alone nor TDI together with HC030031 led to changes of TRPA1 expression in the lung. Blocking either TRPV4 or TRPA1 blunted TDI-induced airway hyperreactivity, airway neutrophilia and eosinophilia, as well as Th2 responses in a dose-dependent manner. At the same time, membrane levels of E-cadherin and ß-catenin were significantly decreased after TDI inhalation, which were inhibited by GSK2193874 or HC030031. Moreover, GSK2193874 and HC030031 also suppressed serine phosphorylation of glycogen synthase kinase 3ß, tyrosine phosphorylation of ß-catenin, as well as activation and nuclear transport of ß-catenin in mice sensitized and challenged with TDI. Our study suggested that both TRPV4 and TRPA1 contribute critically to E-cadherin and ß-catenin dysfunction in TDI-induced asthma, proposing novel therapeutic targets for asthma.

[Efficacy of intravenous immunoglobulin in the adjuvant treatment of patients with severe sepsis: a Meta analysis].

Objective: To investigate the possibility of improving the prognosis of patients with severe sepsis by different kinds of intravenous immunoglobulin (IVIG). Methods: PubMed database, EMBase, Cochrane clinical trial database, CNKI, and Wangfang database etc were retrieved. The search time was from database creation to September 2015,which included all prospective studies of the effectiveness of IVIG compared with non-IVIG in all adult patients with severe sepsis. Main end-point parameter was total mortality rate; secondary end-point parameters were short-term (＜ 7 days) mortality,28-day mortality, length of intensive care unit (ICU) and hospital stay, and mortality due to septic shock or multiple organ failure (MOF). RevMan 5.3 was used for Meta analysis. Results: Finally,16 prospective studies including 12 randomized controlled trails (RCT) and 4 prospective cohort studies were enrolled, referred to 1 819 patients, 892 patients were in IVIG group, 927 patients receiving human albumin, placebo or blank control were in control group. Compared with the control group, IVIG could reduce the total mortality rate of patients with severe sepsis [relative risk (RR) =0.71,95％ confidence interval (95％CI) =0.57-0.87,P =0.001].After the high-risk research was eliminated, it was shown that the IVIG could reduce the total mortality rate in patients with severe sepsis (RR =0.80, 95％CI =0.65-0.98, P =0.03).But IVIG could not reduce the 28-day mortality rate (RR =0.60, 95％CI =0.35-1.04, P =0.07), short-term mortality rate (RR =1.06, 95％CI =0.76-1.46,P =0.74), the mortality rate of septic shock (RR =0.55, 95％CI =0.29-1.03, P =0.06) and the mortality rate of MOF (RR =0.91, 95％CI =0.63-1.33, P =0.64).In fact, the length of stay in ICU [weighted mean difference (WMD) =-0.02, 95％CI =-0.03-0.25, P =0.86] and the total length of stay in hospital (WMD =-2.34,95％CI =-7.05-2.37,P =0.33) were similar. In subgroup, the 28-day mortality rate of patients with severe sepsis in the IgM group (RR =0.50, 95％CI =0.25-1.01, P =0.05) was significantly lower than that of IgG group (RR =0.72, 95％CI =0.40-1.30, P =0.28). Conclusions: IVIG can reduce the total mortality rate of patients with severe sepsis. Compared with IgG, IgM-enriched IVIG has certain advantages in patients with severe sepsis, but cannot reduce the short-term mortality rate, mortality rate of septic shock and MOF, and also cannot shorten the length of ICU stay and the total length of hospital day.