Lumbar Scheuermann's disease found in a patient with osteogenesis imperfecta (OI) caused by a heterozygous mutation in COL1A2 (c.4048G > A): a case report.

BACKGROUND: Osteogenesis imperfecta (OI) is a heterogeneous connective tissue disorder characterized by increased bone fragility and a series of extraskeletal manifestations. Approximately 90 % of OI cases are caused by type I collagen variants encoded by the collagen type I alpha 1 (COL1A1) or type I alpha 2 (COL1A2) gene. Lumbar Scheuermann's disease is an atypical type of Scheuermann's disease accompanied by Schmorl's nodes and irregular endplates but without pronounced kyphosis. Although the etiology of Scheuermann's disease is unclear, genetic and environmental factors are likely. CASE PRESENTATION: Here, we report a 32-year-old male patient who experienced multiple brittle fractures. Gene sequencing revealed a heterozygous mutation, c.4048G > A (p.G1350S), in the COL1A2 gene, and the patient was diagnosed with OI. Magnetic resonance imaging of his thoracolumbar spine revealed multiple Schmorl's nodes. CONCLUSIONS: This is the first reported case of OI coexisting with the spinal presentation of Scheuermann's disease. It is speculated that the COL1A2 gene mutation might be an underlying novel genetic cause of Scheuermann's disease. In conclusion, this case demonstrates the relationship between Scheuermann's disease and OI for the first time and enriches the genotype-phenotype spectrum of OI.

Screening and identification of biomarkers associated with the diagnosis and prognosis of lung adenocarcinoma.

BACKGROUND: In this study, we aimed to identify the pathogenesis and prognostic biomarkers of lung adenocarcinoma (LUAD). METHODS: Differentially expressed mRNAs (DEmRNAs) and single nucleotide polymorphism (SNP) mutant genes were screened. In addition, enrichment and protein-protein interaction (PPI) network analyses of the SNP-mutated genes were performed. Thereafter, the correlation between gene mutation and expression was analyzed. Finally, the mutated genes associated with LUAD prognosis were validated on the basis of The Cancer Genome Atlas (TCGA) database. RESULTS: A total of 2502 DEmRNAs were initially screened in this study. We identified 756 SNP-mutated genes from more than 30 cases. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis revealed that the mutated genes involved in LUAD were mainly associated with the ECM-receptor interaction, focal adhesion, and calcium signaling pathways. Tumor protein p53 (TP53) and neurexin 1 (NRXN1) with the higher degree were chosen as the hub genes in the PPI network. In addition, the correlation analysis revealed six genes, including assembly factor for spindle microtubules (ASPM), centromere protein F (CENPF), contactin 3 (CNTN3), catenin delta 2 (CTNND2), PKHD1 like 1 (PKHD1L1), and semaphorin 6D (SEMA6D), and three SNP mutations at ASPM rs368020495, CENPF rs762653487, and PKHD1L1 rs768349010 sites that were found to be associated with LUAD prognosis. Further validation showed that among the aforementioned six mutated genes, CENPF was upregulated and SEMA6D was downregulated. CONCLUSION: CENPF, SEMA6D, TP53, and NRXN1 were found to be closely associated with the development of LUAD.

Criss-cross heart with double-outlet right ventricle, subpulmonary ventricular septal defect, and bicuspid pulmonary valve.

Criss-cross heart (CCH) is an extremely rare complex congenital heart malformation. It accounts for less than 0.1% of congenital heart diseases. Here, we describe a unique case of CCH with double-outlet right ventricle, huge subpulmonary ventricular septal defect, bicuspid pulmonary valve, and right-hand aortic arch. The anatomic features were observed with echocardiography, and the diagnosis was confirmed at surgery. Many variations of CCH have been described. The present case expands the spectrum of this entity and may provide new insight into this complex anatomy.

Endothelin-1 expression and alterations of cerebral microcirculation after experimental subarachnoid hemorrhage.

INTRODUCTION: Cerebral vasospasm (CVS) after subarachnoid hemorrhage (SAH) often leads to poor outcomes in SAH patients. Overexpression of endothelin-1 (ET-1) could contribute to the development of CVS. The purpose of this study was to investigate cerebral microcirculation by whole-brain perfusion CT scan and ET-1 expression following SAH. METHODS: SAH was induced in rabbits. Cerebral blood flow (CBF), cerebral blood volume (CBV), time to peak (TTP), and mean transit time (MTT) were measured with CT perfusion techniques at days 1, 4, 7, and 14 following SAH. Expression of ET-1 was determined by ELISA accordingly. Histological sections of the brain tissue were also examined. RESULTS: Whole-brain perfusion showed that CBV and TTP increased at day 4 and maintained elevated rate until day 14. MTT increased at day 4, peaked at day 7, and then decreased at day 14. CBV of the occipital lobe was greater than that in the frontal and parietal lobes at day 4. CBF of the occipital lobe increased significantly compared to that of other lobes at day 7. ET-1 expression in the SAH group was significantly greater than that in the control at various time points. Moreover, ET-1 levels were positively correlated with MTT value. CONCLUSION: CTP detects changes in cerebral microcirculation following SAH. Microcirculation of each lobe was different and could be quantified to identify high-risk areas of cerebral ischemia. ET-1 expression was significantly increased and was correlated with MTT as well, suggesting that ET-1 influences cerebral microcirculation following SAH.

Osteosarcoma metastasis: prospective role of ezrin.

Osteosarcoma is the most commonly diagnosed primary malignant bone tumor, with similar global incidence rate across childhood and adolescence. Patients with localized disease have a 5-year survival period of 80 %; however, the prognosis is poor in those with metastatic osteosarcoma. The origin of the primary tumor is most frequently the metaphyseal (actively growing) regions of the distal femur, proximal tibia, and proximal humerus, although the tumor can develop in any bone, and the most likely sites for metastasis are the lungs and bone. Ezrin is a member of the ezrin-radixin-moesin (ERM) family of proteins that functions as a cross-linker between the actin cytoskeleton and the plasma membrane, and ezrin also plays a positive role in maintaining cell shape and polarity and facilitates membrane-trafficking pathways, cell migration, cell signaling, growth regulation, and differentiation. There is strong evidence to suggest that ezrin is necessary for osteosarcoma metastasis. The objective of the current review is to summarize the know-how about metastatic progression in osteosarcoma, with a focus on ezrin. Despite the promise that preliminary studies on ezrin have shown, there is a great need to further analyze the role of ezrin in osteosarcoma metastasis and to determine its usefulness as a biomarker for the disease.

CT perfusion-derived mean transit time of cortical brain has a negative correlation with the plasma level of Nitric Oxide after subarachnoid hemorrhage.

BACKGROUND: Vasospasm of both large and small parenchymal arteries may contribute to the occurrence of delayed ischemic neurological deficits, and nitric oxide(NO) is an important mediators in the development of cerebral vasospasm after subarachnoid hemorrhage (SAH). We used a rabbit two-hemorrhage model to investigate changes in plasma NO after SAH, and the relationship between NO and brain microcirculation. METHODS: SAH was induced in rabbits and a control group was sham operated. There were 32 rabbits in each group that survived the second operation, and they were randomly assigned to four groups of eight rabbits each for follow-up assessments on Days 1, 4, 7, or 14, respectively. Cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were calculated at six regions of interest (ROIs): symmetrical areas of the frontal, parietal-occipital, and temporal lobes. Before the contrast CT scan, blood was drawn from the central artery of the ear for measurement of plasma NO. RESULTS: In the control group, there was no difference in CBV, CBF, and MTT in the six ROIs, and plasma NO was unchanged. Compared to controls, in the SAH group, CBV decreased slightly in the six ROIs (P > 0.05), frontal lobe CBF decreased, MTT increased (P < 0.05, for both), and NO plasma levels were significantly lower (P < 0.01). CONCLUSIONS: There was a significant correlation between the increase in MTT and the decrease in plasma NO (P < 0.05), We hypothesized that normalization of NO might have a positive influence on brain microcirculation following SAH.

Correlation Between Quantitative Value of Endolymphatic Hydrops and Hearing Threshold Using Magnetic Resonance Imaging.

OBJECTIVES: This study investigated the relationship between quantitative value of endolymphatic hydrops in the affected ear and the hearing threshold in patients with unilateral Meniere's disease. STUDY DESIGN: Prospective study. METHODS: Forty patients with unilateral definite Meniere's disease were diagnosed in outpatient clinic. We recorded their clinical symptoms (duration of vertigo and tinnitus and duration of vertigo attacks), and obtained the hearing thresholds of high, middle, and low by pure tone audiometry. A 3D-FLAIR MRI revealed endolymphatic hydrops and assessed quantitative values of cochlear and vestibular endolymphatic hydrops. We assessed the correlation between hearing thresholds and quantitative values of endolymphatic hydrops. RESULTS: All patients showed varying degrees of endolymphatic hydrops in the affected ear. With the duration of vertigo, tinnitus and vertigo attacks as control variables, partial correlation analysis showed that the correlation coefficients between quantitative value of cochlear hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.581, 0.610, and 0.125, respectively. The correlation coefficients between quantitative value of vestibular hydrops and hearing thresholds of low, middle, and high tone in the affected ear were 0.727, 0.569, and 0.201, respectively. CONCLUSIONS: The degree of endolymphatic hydrops in Meniere's disease can be revealed and assessed by 3D-FLAIR MRI after intravenous administration of double doses of gadoterate meglumine. Clinical evaluation of endolymphatic hydrops in Meniere's disease can be assisted by low- and middle-tone hearing thresholds, thereby providing anatomical support for the clinical symptoms of Meniere's disease.

[Three-dimensional computed tomography in postoperative evaluation of the knees after anterior cruciate ligament reconstruction].

This study evaluated the clinical value of three-dimensional computed tomography (3D-CT) images in the knees following arthroscopic anterior cruciate ligament (ACL) reconstruction. Sixty-five consecutive patients underwent arthroscopic ACL reconstruction with single-incision and single-tunnel techniques. Preoperative and postoperative (12 months in between) clinical evaluation were performed using the Lysholm knee score and a KT-1000 arthrometer (side to side). Computed tomography (CT) of the knees was performed in a week after operation in all cases and at mean follow-up of 12 months. All of the clinical evaluation scales performed showed an overall improvement. 3D-CT images can display not only the bone tunnels of the knees including femoral and tibia very distinctly, but also the contour of the reconstructed ACL including adjacent structures. The average femoral tunnel diameter increased significantly (3%) from (9.15 +/- 0.03) mm postoperatively to (9.48 +/- 0.5) mm after 12 months; tibial tunnel increased significantly (12%) from (9.11 +/- 0.09) mm to (10.2 +/- 0.3) mm. There was no statistical difference between tunnel enlargements. So multi-slices spiral CT can evaluate the contour and changes of contour and changes of the knee after ACL reconstruction, which will be helpful in the intraoperative location and postoperative assessment of the knees.

The Correlation Between Endolymphatic Hydrops and blood-labyrinth barrier Permeability of Meniere Disease.

OBJECTIVES: This study was designed to assess the correlation between the grades of endolymphatic hydrops and the blood-labyrinth barrier permeability in the affected ear in Meniere's disease, following the administration of intravenous gadolinium contrast. STUDY DESIGN: Prospective study. METHODS: The quantitative values of endolymphatic hydrops were determined after intravenous injection of a double-dose of gadobutrol in 39 patients with unilateral definite Meniere's disease. Additionally, the signal intensity ratio of bilateral cochlear basal turns was evaluated and analyzed; The correlation between the grades of the endolymphatic hydrops and the signal intensity ratio of the cochlear basal turns in the affected ear was examined. RESULTS: The grades of the endolymphatic hydrops can be quantitatively evaluated using magnetic resonance imaging (MRI). The signal intensity ratio of the cochlear basal turns in the affected ear was significantly higher than in the unaffected ear (P = .001); there was a positive correlation between the signal intensity ratio of the cochlear basal turn and the grades of cochlear (r = 0.634, P = 0.000) and vestibular(r = 0.559, P = .000) hydrops in the affected ear. CONCLUSIONS: The increased permeability of the blood-labyrinth barrier may play a role in the process of endolymphatic hydrops in Meniere's disease.

The Correlation Between Endolymphatic Hydrops and Clinical Features of Meniere Disease.

OBJECTIVES: The purpose of this study was to investigate the grades of endolymphatic hydrops determined by gadolinium-contrast magnetic resonance (MR) and correlation to the clinical features in patients with Meniere disease. STUDY DESIGN: Prospective study. METHODS: A total of 24 patients suffering from unilateral Meniere disease with either definite or probable clinical diagnosis were included. The duration of vertigo, duration of tinnitus, duration of vertigo attacks, hearing thresholds, and canal paresis (CP) value of caloric tests were assessed. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (MRI) was performed 4 hours after intravenous injection of double dose of gadobutrol (Gd) to show endolymph and perilymph, and the grades of endolymphatic hydrops were measured. Additionally, the correlation between clinical features and the grades of endolymphatic hydrops of cochlea and vestibular were evaluated. RESULTS: Different grades of the endolymphatic hydrops in the impaired ear were revealed by MRI. The Spearman correlation showed a strong correlation between the hearing thresholds of low, middle, and high tone and the grades of cochlea and vestibular hydrops (P < .05); However, no significant correlation between the duration of vertigo, duration of tinnitus, duration of vertigo attacks, CP value, and endolymphatic hydrops was determined (P > .05). CONCLUSION: By visualizing the endolymph and perilymph of inner ear in patients with Meniere disease assisted with intravenous injection of double doses of Gd, the grades of endolymphatic hydrops could be assessed. As a result, the grades of endolymphatic hydrops in patients with Meniere disease can be used to predict the level of hearing impairment. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:E144-E150, 2021.

Comparison of inner ear MRI enhancement in patients with Meniere's disease after intravenous injection of gadobutrol, gadoterate meglumine, or gadodiamide.

PURPOSE: To compare the enhancement results of three gadolinium contrast agents in the inner ear of patients with Meniere's disease 4 h after intravenous injection of gadobutrol, gadoterate meglumine, or gadodiamide. METHODS: We enrolled 60 patients with a definitive diagnosis of unilateral Meniere's disease and divided them into three groups of 20 patients; each group received a double dose of gadobutrol, gadoterate meglumine, or gadodiamide. The postcontrast signal intensity of the basal cochlear turn was scored quantitatively, and qualitative visual evaluation of the cochlea, vestibule and semi-circular canals was also performed. The results of both evaluations were compared between the three patient groups. RESULTS: The cochlear basal turn signal intensity of the gadobutrol group was significantly higher than that of the gadoterate meglumine and gadodiamide groups; however, no significant difference was observed between the gadoterate meglumine and gadodiamide groups. The intensity of visualization of the semi-circular canals was significantly better in the bilateral gadobutrol group than in the gadoterate meglumine and gadodiamide groups; however, there was no significant difference in terms of the intensity of visualization of the semi-circular canals between the gadoterate meglumine and gadodiamide groups. There were no significant differences in the intensity of visualization of the cochlea and vestibule among the three groups. CONCLUSIONS: Compared with gadoterate meglumine and gadodiamide, gadobutrol can provide a higher degree of perilymphatic enhancement and better anatomical details of the semi-circular canals in the ears of patients with Meniere's disease.

Differential Diagnosis of Endolymphatic Hydrops Between "Probable" and "Definite" Ménière's Disease via Magnetic Resonance Imaging.

OBJECTIVES: To investigate the grade of endolymphatic hydrops in patients with "probable" and "definite" Ménière's disease via magnetic resonance imaging (MRI) and to determine whether MRI could assist clinicians in differential diagnosis between probable and definite Ménière's disease. STUDY DESIGN: Prospective study. SETTING: Three-dimensional FLAIR MRI (fluid-attenuated inversion recovery) to examine endolymphatic hydrops in Ménière's disease. METHODS: A total of 51 patients diagnosed with probable (n = 20) or definite (n = 31) unilateral Ménière's disease were enrolled. Three-dimensional FLAIR MRI was performed to evaluate the grade of endolymphatic hydrops. The differences in endolymphatic hydrops between the probable and definite groups were analyzed. RESULTS: The grade of endolymphatic hydrops was more severe in the definite group than in the probable group (P < .05). CONCLUSION: MRI revealed a higher grade of endolymphatic hydrops in patients with definite Ménière's disease than in patients with probable Ménière's disease. As a result, it may be clinically useful and an effective tool in the differentiation between definite and probable Ménière's disease.

Initial partial response and stable disease according to RECIST indicate similar survival for chemotherapeutical patients with advanced non-small cell lung cancer.

BACKGROUND: Stable disease (SD) has ambiguous clinical significance for patients according to the dominant Response Evaluation Criteria in Solid Tumours (RECIST). The primary aims of the study were: (1) to clarify the clinical significance of SD by comparing the progression-free survival (PFS) of response and SD patients with advanced non-small cell lung cancer (NSCLC) after the first two courses of the standard first-line platinum-based chemotherapy; (2) to explore the relationship between the percentage change in tumour size and PFS among initial SD patients, in order to provide some guidance for clinicians in deciding continuation/termination of the current treatment at a relative early time. METHODS: A total of 179 advanced NSCLC patients whose baseline CT image was available for review were included in the study. Another CT image was taken in the initial assessment after chemotherapy. A comparison of PFS between initial partial response (PR) and SD was used to determine whether significant differences exist. The relationship between the early percentage of change in tumour size of initial SD patients and their PFS was investigated. In addition, overall survival (OS), the secondary endpoint in this study, was investigated as well. RESULTS: Patients with initial PR are not significantly distinguished from those with initial SD when their PFS is concerned (median PFS 249 days [95% confidence interval, 187-310 days] versus 220 days [95% confidence interval, 191-248 days], p > 0.05). Their median OS was 364 days (95% confidence interval, 275-452 days) for the initial PR patients versus 350 days (95% confidence interval, 293-406 days) for the initial SD patients, which suggests no significant difference as well p > 0.05). In addition, all the initial SD patients enjoyed similar PFS and OS. CONCLUSIONS: Initial PR and SD enjoy similar PFS and OS for patients with advanced NSCLC. Within the initial SD subgroup, different percentages of tumour shrinkage or increase undergo similar PFS and OS. RECIST remains a reliable norm in assessing the effectiveness of chemotherapy for patients with advanced NSCLC before functional assessment has been integrated into the criteria.

Antipsychotic Effects on Cortical Morphology in Schizophrenia and Bipolar Disorders.

Background: Previous studies of atypical antipsychotic effects on cortical structures in schizophrenia (SZ) and bipolar disorder (BD) have findings that vary between the short and long term. In particular, there has not been a study exploring the effects of atypical antipsychotics on age-related cortical structural changes in SZ and BD. This study aimed to determine whether mid- to long-term atypical antipsychotic treatment (mean duration = 20 months) is associated with cortical structural changes and whether age-related cortical structural changes are affected by atypical antipsychotics. Methods: Structural magnetic resonance imaging images were obtained from 445 participants consisting of 88 medicated patients (67 with SZ, 21 with BD), 84 unmedicated patients (50 with SZ, 34 with BD), and 273 healthy controls (HC). Surface-based analyses were employed to detect differences in thickness and area among the three groups. We examined the age-related effects of atypical antipsychotics after excluding the potential effects of illness duration. Results: Significant differences in cortical thickness were observed in the frontal, temporal, parietal, and insular areas and the isthmus of the cingulate gyrus. The medicated group showed greater cortical thinning in these regions than the unmediated group and HC; furthermore, there were age-related differences in the effects of atypical antipsychotics, and these effects did not relate to illness duration. Moreover, cortical thinning was significantly correlated with lower symptom scores and Wisconsin Card Sorting Test (WCST) deficits in patients. After false discovery rate correction, cortical thinning in the right middle temporal gyrus in patients was significantly positively correlated with lower HAMD scores. The unmedicated group showed only greater frontotemporal thickness than the HC group. Conclusion: Mid- to long-term atypical antipsychotic use may adversely affect cortical thickness over the course of treatment and ageing and may also result in worsening cognitive function.

Casticin protects against IL-1ß-induced inflammation in human osteoarthritis chondrocytes.

Casticin, an active compound isolated from Vitex rotundifolia L., was reported to possess anti-inflammatory activity. However, the effect of casticin on inflammatory response in human osteoarthritis (OA) chondrocytes remains unclear. In the current study, we examined the anti-inflammatory effects of casticin on chondrocytes exposed to interleukin-1ß (IL-1ß). Our results demonstrated that casticin treatment significantly improved cell viability in chondrocytes exposed to IL-1ß. Casticin significantly inhibited IL-1ß-induced NO and PGE2 production, and iNOS and COX-2 expression in human OA chondrocytes. It also suppressed the levels of TNF-α and IL-6, as well as decreased production of MMP-3, MMP-13, ADAMTS-4 and ADAMTS-5 in IL-1ß-stimulated chondrocytes. Furthermore, casticin prevented IL-1ß-induced NF-κB activation in chondrocytes. Taken together, these findings showed that casticin attenuates inflammatory responses in chondrocytes stimulated with IL-1ß, possibly through the NF-κB signaling pathway. Thus, casticin may serve as a potential anti-inflammatory agent in the treatment of OA.

Preoperative Prediction of Axillary Lymph Node Metastasis in Breast Cancer using Radiomics Features of DCE-MRI.

The accurate and noninvasive preoperative prediction of the state of the axillary lymph nodes is significant for breast cancer staging, therapy and the prognosis of patients. In this study, we analyzed the possibility of axillary lymph node metastasis directly based on Magnetic Resonance Imaging (MRI) of the breast in cancer patients. After mass segmentation and feature analysis, the SVM, KNN, and LDA three classifiers were used to distinguish the axillary lymph node state in 5-fold cross-validation. The results showed that the effect of the SVM classifier in predicting breast axillary lymph node metastasis was significantly higher than that of the KNN classifier and LDA classifier. The SVM classifier performed best, with the highest accuracy of 89.54%, and obtained an AUC of 0.8615 for identifying the lymph node status. Each feature was analyzed separately and the results showed that the effect of feature combination was obviously better than that of any individual feature on its own.

Protective effects of 3,4-dihydroxyphenylethanol on spinal cord injury-induced oxidative stress and inflammation.

3,4-Dihydroxyphenylethanol (DOPET) is a potent antioxidant polyphenolic compound. In this study, our objective was to investigate the underlying mechanism of the neuroprotective role of DOPET in attenuating spinal cord injury (SCI). Initially, SCI was induced by performing surgical laminectomy on the rats at T10-T12 level. Then, the neurological function-dependent locomotion was measured using Basso Beattie Bresnahan score, which declined in the SCI-induced group. Increased antioxidant levels such as superoxide dismutase, glutathione peroxidase, and glutathione along with other parameters such as increased lipid peroxidation (LPO) and myeloperoxidase (MPO) activities were all observed in the SCI group. Levels of proinflammatory cytokines such as tumor necrosis factor-α and interleukin-1ß were upregulated in the serum and spinal cord tissue as observed on the immunoblot. Interestingly, protein levels of apoptotic markers such as Bax, cleaved caspase 3 and RT-PCR analysis-based mRNA level of pro-inflammatory cytokine, nuclear factor- κ activated B cells (NF-κB) were significantly upregulated in the spinal cord tissue. Nonetheless, antiapoptotic factor such as B-cell lymphoma 2 (Bcl-2) protein expression was downregulated in the same group. However, on administering 10 mg/kg of DOPET, the neuronal function was rescued, antioxidants were restored back to the normal levels, LPO and MPO activities were reduced in conjunction with downregulated levels of proinflammatory cytokines and apoptotic markers in the SCI group. These findings show that DOPET could potentially target multiple signalling pathways to combat SCI.

Influence of Myocardial Hemorrhage on Staging of Reperfused Myocardial Infarctions With T2 Cardiac Magnetic Resonance Imaging: Insights Into the Dependence on Infarction Type With Ex Vivo Validation.

OBJECTIVES: This study sought to determine whether T2 cardiac magnetic resonance (CMR) can stage both hemorrhagic and nonhemorrhagic myocardial infarctions (MIs). BACKGROUND: CMR-based staging of MI with or without contrast agents relies on the resolution of T2 elevations in the chronic phase, but whether this approach can be used to stage both hemorrhagic and nonhemorrhagic MIs is unclear. METHODS: Hemorrhagic (n = 15) and nonhemorrhagic (n = 9) MIs were created in dogs. Multiparametric noncontrast mapping (T1, T2, and T2*) and late gadolinium enhancement (LGE) were performed at 1.5- and 3.0-T at 5 days (acute) and 8 weeks (chronic) post-MI. CMR relaxation values and LGE intensities of hemorrhagic, peri-hemorrhagic, nonhemorrhagic, and remote territories were measured. Histopathology was performed to elucidate CMR findings. RESULTS: T2 of nonhemorrhagic MIs was significantly elevated in the acute phase relative to remote territories (1.5-T: 39.8 ± 12.8%; 3.0-T: 27.9 ± 16.5%; p < 0.0001 for both) but resolved to remote values by week 8 (1.5-T: -0.0 ± 3.2%; p = 0.678; 3.0-T: -0.5 ± 5.9%; p = 0.601). In hemorrhagic MI, T2 of hemorrhage core was significantly elevated in the acute phase (1.5-T: 17.7 ± 10.0%; 3.0-T: 8.6 ± 8.2%; p < 0.0001 for both) but decreased below remote values by week 8 (1.5-T: -8.2 ± 3.9%; 3.0-T: -5.6 ± 6.0%; p < 0.0001 for both). In contrast, T2 of the periphery of hemorrhage within the MI zone was significantly elevated in the acute phase relative to remote territories (1.5-T: 35.0 ± 16.1%; 3.0-T: 24.2 ± 10.4%; p < 0.0001 for both) and remained elevated at 8 weeks post-MI (1.5-T: 8.6 ± 5.1%; 3.0-T: 6.0 ± 3.3%; p < 0.0001 for both). The observed elevation of T2 in the peri-hemorrhagic zone of MIs and the absence of T2 elevation in nonhemorrhagic MIs were consistent with ongoing or absence of histological evidence of inflammation, respectively. CONCLUSIONS: Hemorrhagic MIs are associated with persisting myocardial inflammation and edema, which can confound staging of hemorrhagic MIs when T2 elevations alone are used to discriminate between acute and chronic MI. Moreover, given the poor prognosis in patients with hemorrhagic MI, CMR evidence for myocardial hemorrhage with persistent edema may evolve as a risk marker in patients after acute MI.

Age-Related Alterations of White Matter Integrity in Adolescents and Young Adults With Bipolar Disorder.

BACKGROUND: Alterations of white matter integrity during adolescence/young adulthood may contribute to the neurodevelopmental pathophysiology of bipolar disorder (BD), but it remains unknown how white matter integrity changes in BD patients during this critical period of brain development. In the present study, we aimed to identify possible age-associated alterations of white matter integrity in adolescents and young adults with BD across the age range of 13-30 years. METHODS: We divided the participants into two groups by age as follows: adolescent group involving individuals of 13-21 years old (39 patients with BD and 39 healthy controls) and young adult group involving individuals of 22-30 years old (47 patients with BD and 47 healthy controls). Diffusion tensor imaging (DTI) was performed in all participants to assess white matter integrity. RESULTS: In the adolescent group, compared to those of healthy controls, fractional anisotropy (FA) values were significantly lower in BD patients in the left inferior longitudinal fasciculus, splenium of the corpus callosum and posterior thalamic radiation. In the young adult group, BD patients showed significantly decreased FA values in the bilateral uncinate fasciculus, genu of the corpus callosum, right anterior limb of internal capsule and fornix compared to healthy controls. White matter impairments changed from the posterior brain to the anterior brain representing a back-to-front spatiotemporal directionality in an age-related pattern. CONCLUSIONS: Our findings provide neuroimaging evidence supporting a back-to-front spatiotemporal directionality of the altered development of white matter integrity associated with age in BD patients during adolescence/young adulthood.