Non-contrast-enhanced magnetic resonance urography for measuring split kidney function in pediatric patients with hydronephrosis: comparison with renal scintigraphy.

BACKGROUND: Split kidney function (SKF) is critical for treatment decision in pediatric patients with hydronephrosis and is commonly measured using renal scintigraphy (RS). Non-contrast-enhanced magnetic resonance urography (NCE-MRU) is increasingly used in clinical practice. This study aimed to investigate the feasibility of using NCE-MRU as an alternative to estimate SKF in pediatric patients with hydronephrosis, compared to RS. METHODS: Seventy-five pediatric patients with hydronephrosis were included in this retrospective study. All patients underwent NCE-MRU and RS within 2 weeks. Kidney parenchyma volume (KPV) and texture analysis parameters were obtained from T2-weighted (T2WI) in NCE-MRU. The calculated split KPV (SKPV) percent and texture analysis parameters percent of left kidney were compared with the RS-determined SKF. RESULTS: SKPV showed a significant positive correlation with SKF (r = 0.88, p < 0.001), while inhomogeneity was negatively correlated with SKF (r = - 0.68, p < 0.001). The uncorrected and corrected prediction models of SKF were established using simple and multiple linear regression. Bland-Altman plots demonstrated good agreement of both predictive models. The residual sum of squares of the corrected prediction model was lower than that of the uncorrected model (0.283 vs. 0.314) but not statistically significant (p = 0.662). Subgroup analysis based on different MR machines showed correlation coefficients of 0.85, 0.95, and 0.94 between SKF and SKPV for three different scanners, respectively (p < 0.05 for all). CONCLUSIONS: NCE-MRU can be used as an alternative method for estimating SKF in pediatric patients with hydronephrosis when comparing with RS. Specifically, SKPV proves to be a simple and universally applicable indicator for predicting SKF.

Intratumoral tertiary lymphoid structures promote patient survival and immunotherapy response in head neck squamous cell carcinoma.

Tertiary lymphoid structures (TLSs) hold the potential role in the prediction of immunotherapy response in several clinical trials. TLSs in head neck squamous cell carcinoma (HNSCC) have been investigated through IHC analysis, whereas there is no TLS gene signature to evaluate the level of TLS neogenesis. We here proposed a TLS signature containing 13 chemokines and determined TLS-hi and TLS-low groups in HNSCC samples from The Cancer Genome Atlas. TLS-hi condition signified a better overall survival. A more inflamed immune infiltrative landscape was identified in the TLS-hi tumors characterized by higher proportion of T cells, TCR/BCR activation and antigen processing. High level of TLSs has a determined role in the clinical significance of T cells. Interesting discovery was that innate lymphoid cells and cancer-associated fibroblasts were positively associated with TLS neogenesis in TME of HNSCC. Furthermore, by integrated TLSs with stromal cells and score, immune cells and score, TMB and malignant cells, we proposed a novel HNSCC TME classifications (HNSCC-TCs 1-5), unravelling the counteracted role of stromal cells and score in inflamed immune landscape, which may provide a novel stromal targeted modality in HNSCC therapy. Finally, we verified that TLS statue is an ideal predictor for immune checkpoint blockade immunotherapy. Current study indicated that the TLSs serve as a novel prognostic biomarker and predictor for immunotherapy, which may provide directions to the current investigations on immunotherapeutic strategies for HNSCC.

WHO/ISUP grade and pathological T stage of clear cell renal cell carcinoma: value of ZOOMit diffusion kurtosis imaging and chemical exchange saturation transfer imaging.

OBJECTIVES: To evaluate the value of ZOOMit diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) imaging in predicting WHO/ISUP grade and pathological T stage in clear cell renal cell carcinoma (ccRCC). METHODS: Forty-six patients with ccRCC were included in this retrospective study. All participants underwent MRI including ZOOMit DKI and CEST. The non-Gaussian mean kurtosis (MK), mean diffusivity (MD), magnetization transfer ratio asymmetry (MTRasym (3.5 ppm)), and Ssat (3.5 ppm)/S0 were analyzed based on different WHO/ISUP grades and pT stages. Binary logistic regression was used to identify the best combination of the parameters. Pearson's correlation coefficients were calculated between CEST and diffusion-related parameters. RESULTS: The ADC, MD, and Ssat (3.5 ppm)/S0 values were significantly lower for higher WHO/ISUP grade tumors, whereas the MK and MTRasym (3.5 ppm) were higher in higher WHO/ISUP grade and higher pT stage tumors. MTRasym (3.5 ppm) combined with MD (AUC, 0.930; 95% CI, 0.858-1.000) showed the best diagnostic efficacy in evaluating the WHO/ISUP grade. MTRasym (3.5 ppm) and MK were mildly positively correlated (r = 0.324, p = 0.028). Ssat (3.5 ppm)/S0 was moderately positively correlated with ADC (r = 0.580, p < 0.001), mildly positively correlated with MD (r = 0.412, p = 0.005), and moderately negatively correlated with MK (r = -0.575, p < .001). CONCLUSION: The microstructural and biochemical assessment of ZOOMit DKI and CEST allowed for the characterization of different WHO/ISUP grades and pT stages in ccRCC. MTRasym (3.5 ppm) combined with MD showed the best diagnostic performance for WHO/ISUP grading. KEY POINTS: • Both diffusion kurtosis imaging (DKI) and chemical exchange saturation transfer (CEST) can be used to predict the WHO/ISUP grade and pathological T stage. • MTRasym (3.5 ppm) combined with MD showed the highest AUC (0.930; 95% CI, 0.858-1.000) in WHO/ISUP grading. • MTRasym at 3.5 ppm showed a positive correlation with mean kurtosis.

Accuracy and Challenges in the Vesical Imaging-Reporting and Data System for Staging Bladder Cancer.

BACKGROUND: The Vesical Imaging-Reporting and Data System (VI-RADS) scoring system has been widely used to stage bladder cancer (BCa) since 2018. PURPOSE: To describe the characteristics of cases with discordant T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) scores in patients with BCa and further verify the accuracy of the VI-RADS scoring system and the necessity of dynamic contrast-enhanced (DCE) sequence. STUDY TYPE: Retrospective. SUBJECTS: A total of 106 patients (include 16.5% female) with bladder cancer. SEQUENCE: T2WI (fast spin echo), DWI (echo planer imaging), and DCE (gradient echo). ASSESSMENT: Some cases are difficult to score according to the system, mainly when the T2WI (category 4) and DWI (category 2) sequence scores are discordant, termed the discordant group below. The complementary group will be termed concordant group. Each MRI sequence was reviewed respectively according to the 5-point VI-RADS scoring system by three observers. The diagnostic ability of sequences for evaluating muscle invasion by BCa was calculated using histopathology as the reference standards. STATISTICAL TESTS: Receiver operating characteristic (ROC) curve, DeLong test, intraclass correlation coefficient. A P value of 0.05 or less was considered statistically significant. RESULTS: Fourteen cases (13.2%) had discordant VI-RADS scoring system. In the discordant group, the area under the ROC curve (AUC) of DCE was 0.875, while the T2WI and DWI showed limited diagnostic performance (AUCs = 0.50). In the concordant group, there was no significant difference in diagnostic efficacy between the overall VI-RADS (AUC: 0.950) and the combination of T2WI and DWI (AUC: 0.946) (P = 0.56). Among all patients, the AUC of overall VIRADS was 0.939 with a 3 or greater cutoff value. DATA CONCLUSION: The DCE was crucial in the discordant group for evaluating muscle-invasiveness, while DCE may not be necessary for the concordant group. The VI-RADS scoring system performed with overall good diagnostic performance in evaluating muscle-invasiveness in BCa patients. EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 3.

The feasibility investigation of AI -assisted compressed sensing in kidney MR imaging: an ultra-fast T2WI imaging technology.

OBJECT: To explore the feasibility and clinical application of AI -assisted compressed sensing (ACS) technology in kidney MR imaging. METHODS: 33 patients were enrolled in this study, affiliated to our hospital from September 2020 to April 2021. The patients underwent T2-weighed sequences of both the ACS scan and the conventional respiratory navigator (NAVI) scan. We evaluated the subjective image quality scores, including the sharpness of image edge, artifact and the overall image quality, and compared the objective image quality indicators such as scanning time, signal-to-noise ratio (SNR), and contrast signal-to-noise ratio (CNR). The Wilcoxon's rank sum test and the paired t test were used to compare the image quality between ACS and NAVI groups. The p-value less than 0.05 indicated a statistically significant difference. RESULTS: The edge sharpness of the ACS group was significant lower than that of the NAVI group (p < 0.01), however, there were no significant differences in the artifact and the overall rating of image quality between the two groups (p > 0.05). In terms of the objective image quality scores, the scanning time of the ACS group is significantly lower than that of control group. The SNR and CNR of ACS group were significantly higher than those of NAVI group (SNR:3.63 ± 0.76 vs 3.04 ± 0.44, p < 0.001; CNR: 14.44 ± 4.53 vs 12.05 ± 3.32, p < 0.001). In addition, the subjective and objective measurement results of the two radiologists were in good agreement (ICC = 0.61-0.88). CONCLUSION: ACS technology has obvious advantages when applied to kidney MR imaging, which can realize ultra-fast MR imaging. The images can be acquired with a single breath-hold (17 s), which greatly shortens the scanning time. Moreover, the image quality is equal to or better than the conventional technology, which can meet the diagnostic requirements. Thus, it has obvious advantages in diagnosis for kidney disease patients with different tolerance levels for the clinical promotion.

Alterations of actin cytoskeleton and arterial protein level in patients with obstructive jaundice.

Vascular hypo-responsiveness to vasopressors in patients with obstructive jaundice (OJ) is a common anesthetic event, which leads to perioperative complications and increased mortality. The cause of this clinical issue remains unclear. In this study, we estimated the actin cytoskeleton and arterial protein level in the artery of OJ patients by proteomic analysis. Ten patients with OJ due to bile duct diseases or pancreatic head carcinoma were enrolled, while another ten non-jaundice patients with chronic cholecystitis or liver hemangioma as the control group. Vascular reactivity to noradrenaline was measured before anesthesia on the day of surgery. Artery samples in adjacent tissues of removed tumor were collected and evaluated by 2-dimensional electrophoresis. Proteins with differential expression were detected by MALDI-TOF mass spectrometry with immunoblot confirmation. The results confirmed the phenomenon of vascular hypo-reactivity in OJ patients as suppressed aortic response to noradrenaline were existed in these patients. We also found that actin cytoskeleton and several actin-binding proteins were up- or down-regulated in the artery of OJ patients. These proteins changed in OJ patents might be the basic mechanism of vascular hypo-reactivity, further studies to uncover the role of these proteins in OJ is critical for clinical treatment of these patients.

Folic acid alleviates jaundice of phenylhydrazine (PHA)-induced neonatal rats by reducing Lys-homocysteinylation of albumin.

Neonatal jaundice is a common symptom that occurs in neonates during the first month of their life and is generally divided into physiological and pathological subtypes. In serious cases, pathological neonatal jaundice frequently shows complications including seizures, cerebral palsy, and kernicterus. However, due to the unclear pathogenesis of pathological neonatal jaundice, effective drugs for this disease remain unsatisfied. In the present study, we first estimated the protective effects of folic acid (FA) on phenylhydrazine (PHA) or homocysteine (Hcy)-injected neonatal rats (2-3 days aged). Intriguingly, we found that FA significantly decreased the elevated total bilirubin (TBIL) and direct bilirubin (DBIL) concentration, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) activity in PHA- or Hcy-injected rats, indicating that FA improves liver functions. Meanwhile, our results also showed that the plasma Hcy level and N-homocysteinylation (N-Hcy) modification of albumin were significantly elevated in the jaundice rats, which were obviously reversed after FA administration. Furthermore, we identified a novel N-Hcy modification site K545 of human serum albumin (HSA) using LC-MS/MS, and the mutagenesis assay in HEK293 further validated these observations. Besides, we demonstrated that the N-Hcy modification of albumin functionally inhibits the bilirubin-binding ability of albumin without altering its protein level both in vitro and in vivo. Altogether, we highlight a mechanism that FA reduces the plasma Hcy level and thereby enhance the bilirubin-binding ability of albumin, which may provide a novel therapeutic strategy for the treatment of pathological neonatal jaundice.

Baseline neutrophil-lymphocyte ratio is associated with survival for infant living donor liver transplantation for biliary atresia.

Living donor liver transplantation (LDLT) in infants for congenital biliary atresia (BA) poses various challenges nowadays. We aim to investigate independent preoperative risk factors for LDLT in infants. We retrospectively analyzed medical records of infant patients who underwent LDLT surgery for BA from 1 July 2014 to 31 December 2016. Cox regression was used to explore risk factors. The Kaplan-Meier method was used to calculate the recipient and graft survival, and subgroup analysis was then applied according to the risk factors. Independent t test or Mann-Whitney U test was applied for comparison of certain factors between survival patients and death. A total of 345 infant LDLT for BA were included in the analysis. In the multivariate Cox-regression model, 3 factors were determined as independent risk factors for recipient and graft survival, there were neutrophil-lymphocyte ratio (NLR), pediatric end-stage liver disease (PELD), and recipient age. The HR (95% CI) of baseline NLR for recipient and graft survival were 1.25 (1.12-1.38) and 1.25 (1.13-1.39), with all P < .0001. Kaplan-Meier curves for NLR using different cut-offs (1.5; 1, 2) suggested that higher baseline NLR was significantly associated with recipient and graft survival. The subgroup analysis indicated that for infants with elevated NLR, the recipient survival was significantly lower when their age >6 months or PELD >20. Our results indicate that infants with higher baseline NLR value may have lower survival rate 3 years after transplantation. Further investigations about broaden the application of pre- and post-transplant NLR to guide nutrition intervention and immunosuppression therapy are necessary.

Cannabinoid Receptor-2 Activation in Keratinocytes Contributes to Elevated Peripheral ß-Endorphin Levels in Patients With Obstructive Jaundice.

BACKGROUND: Cholestatic diseases are often accompanied by elevated plasma levels of endogenous opioid peptides, but it is still unclear whether central or peripheral mechanisms are involved in this process, and little is known about the change of pain threshold in these patients. The purpose of this study was to determine the preoperative pain threshold, postoperative morphine consumption, and central and peripheral ß-endorphin levels in patients with obstructive jaundice. This study also tests the hypothesis that activation of the cannabinoid receptor-2 (CB2R) in skin keratinocytes by endocannabinoids is the mechanism underlying circulating ß-endorphin elevation in patients with obstructive jaundice. METHODS: The electrical pain thresholds, 48-hour postoperative morphine consumption, concentrations of ß-endorphin in plasma and cerebrospinal fluid, skin and liver ß-endorphin expression, and plasma levels of endocannabinoids were measured in jaundiced (n = 32) and control (n = 32) patients. Male Sprague-Dawley rats and human keratinocytes (human immortalized keratinocyte cell line [HaCaT]) were used for the in vivo and in vitro experiments, respectively. Mechanical and thermal withdrawal latency, plasma level, and skin expression of ß-endorphin were measured in CB2R-antagonist-treated and control bile duct-ligated (BDL) rats. In cultured keratinocytes, the effect of CB2R agonist AM1241-induced ß-endorphin expression was observed and the phosphorylation of extracellular-regulated protein kinases 1/2, p38, and signal transducer and activator of transcription (STAT) pathways were investigated. RESULTS: This study found (1) the plasma level of ß-endorphin (mean ± standard error of the mean [SEM]) was 193.9 ± 9.6 pg/mL in control patients, while it was significantly increased in jaundiced patients (286.6 ± 14.5 pg/mL); (2) the electrical pain perception threshold and the electrical pain tolerance threshold were higher in patients with obstructive jaundice compared with controls, while the 48-hour postoperative morphine consumption was lower in the jaundiced patients; (3) there was no correlation between plasma ß-endorphin levels, electrical pain thresholds, and 48-hour postoperative morphine consumption in patients with obstructive jaundice; (4) the plasma level of the endogenous cannabinoid anandamide was increased in the jaundiced patients; (5) CB2R antagonist treatment of the BDL rats reduced ß-endorphin levels in plasma and skin keratinocytes, while it did not alter the nociceptive thresholds in BDL and control rats; (6) the endocannabinoid anandamide-induced ß-endorphin synthesis and release via CB2R in cultured keratinocytes; and (7) phosphorylation of extracellular-regulated protein kinases 1/2 is involved in the CB2R-agonist-induced ß-endorphin expression in keratinocytes. CONCLUSIONS: CB2R activation in keratinocytes by the endocannabinoid anandamide may play an important role in the peripheral elevation of ß-endorphin during obstructive jaundice.

Use of Helicopter Emergency Medical Services in the Transport of Patients With Known or Suspected Coronavirus Disease 2019.

OBJECTIVE: Limited information exists regarding the response of helicopter emergency medical services (HEMS) programs to patients with known or suspected coronavirus disease 2019 (COVID-19). The purpose of this study was to determine changes in flight operations during the early stages of the pandemic. METHODS: A survey of the American College of Emergency Physicians Air Medical Section was conducted between May 13, 2020, and August 1, 2020. COVID-19 prevalence was defined as high versus low based on cases > 2,500 or ≤ 2,500. RESULTS: Of the 48 respondents, the majority (89.6%) reported that their patient guidelines had changed because of COVID-19; 89.6% of programs reported transporting COVID-19-positive patients, whereas 91.5% reported transporting persons under investigation. The majority of respondents reported additional training in COVID-19 airway management (79.2%) and personal protective equipment use (93.6%). Permitted aerosol-generating procedures included bilevel positive airway pressure (40.4%) and high-flow nasal oxygen (66.0%). No difference in guideline changes, positive COVID-19/persons under investigation transport restrictions, or permitted aerosol-generating procedures were noted between high- and low-prevalence settings. CONCLUSION: COVID-19 has resulted in changes to HEMS guidelines regardless of local disease prevalence. The pandemic has persisted sufficiently long that data regarding the effectiveness of guideline changes should be analyzed. In the absence of definitive data, national best practices should be developed to guide COVID-19 HEMS transport.

Distant survival for patients undergoing surgery using volatile versus IV anesthesia for hepatocellular carcinoma with portal vein tumor thrombus: a retrospective study.

BACKGROUND: Whether anesthesia type is associated with the surgical outcome of Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) remains to be determined. This study aims to investigate the impact of volatile inhalational anesthesia (INHA) versus total IV anesthesia (TIVA) on the survival outcomes in HCC patients with PVTT. METHODS: A cohort of in-patients whom were diagnosed of HCC with PVTT in Eastern Hepatobiliary Surgery Hospital, Shanghai, China, from January 1, 2008 to December 24, 2012 were identified. Surgical patients receiving the INHA and TIVA were screened out. The overall survival (OS), recurrence-free survival (RFS) and several postoperative adverse events were compared according to anesthesia types. RESULTS: A total of 1513 patients were included in this study. After exclusions are applied, 263 patients remain in the INHA group and 208 in the TIVA group. Patients receiving INHA have a lower 5-year overall survival rate than that of patients receiving TIVA [12.6% (95% CI, 9.0 to 17.3) vs. 17.7% (95% CI, 11.3 to 20.8), P = 0.024]. Results of multivariable Cox-regression analysis also identify that INHA anesthesia is significantly associated with mortality and cancer recurrence after surgery compare to TIVA, with HR (95%CI) of 1.303 (1.065, 1.595) and 1.265 (1.040, 1.539), respectively. Subgroup analysis suggested that in more severe cancer patients, the worse outcome related to INHA might be more significant. CONCLUSION: This retrospective analysis identifies that TIVA is associated with better outcomes compared with INHA. Future prospective studies clinical and translational studies are required to verify this difference and investigate underlying pathophysiology.

Establishment of extraction design space for ursolic acid from Paulowniae Flos based on the concept of quality by design.

INTRODUCTION: The application of quality by design (QbD) concept needs to be strengthened in the field of traditional Chinese medicine research. The extraction process has an important influence on the effectiveness of the drug, and the combination of QbD and the extraction process of the active ingredient helps to improve the effectiveness of the drug. OBJECTIVE: To establish the extraction design space for ursolic acid (UA) from Paulowniae Flos based on the concept of QbD. METHODS: The extraction yield of the target component UA was taken as critical quality attributes (CQAs), extraction time, extraction temperature, ethanol concentration and liquid-solid ratio, as critical process parameters (CPPs). Box-Behnken design (BBD) was applied to optimise the design space and the chromatographic conditions were performed on a Shimadzu C18 reversed-phase column with 0.1% (v/v) acetic acid aqueous water-acetonitrile (7:13, v/v) as the mobile phase at a 1 mL/min flow rate, using UA standard as a control and detection at 210 nm. RESULTS: The single factor investigation and BBD experiment were used to construct the design space, while verification experiments and methodological validation were used to demonstrate that the space was robust and analytical methods were appropriate. The operating space of ethanol concentration 93-98%, liquid-solid ratio 28-37 mL/g and extraction temperature 70-78.3°C was recommended. CONCLUSION: The proposed methodology can help to promote the quality control of the Chinese medicine extraction process and facilitate the production operation of the enterprise easier.

The effect of a coix seed oil injection on cancer pain relief.

BACKGROUND: Pain is one of the most commonly reported symptoms in patients with advanced cancer, but is still less than optimally treated. The effect of traditional Chinese medicine in cancer pain treatment is nowadays getting more and more attention. OBJECTIVE: To investigate the effect of a coix seed oil injection on cancer pain relief in a cancer center in a tertiary hospital in China. METHODS: Patients in the treatment group received a coix seed oil injection for 2 weeks, while patients in the control group received equivalent 0.9% saline. The numeric rating scale was used to assess the pain level. The Quality of Life Questionnaire-Core 30 was used to assess life quality. The adverse drug reactions during the treatment process were observed. RESULTS: Patients in the coix seed treatment group had significantly superior efficacy on pain control over those in the control group. Coix seed therapy significantly improved patients' scores reflecting by the Quality of Life Questionnaire-Core 30 (QLQ-C30) scale. In addition, the occurrence of adverse reactions such as constipation and nausea in the treatment group was significantly lower than that in the control group. CONCLUSION: The coix seed oil injection effectively reduced the pain level of cancer patients, significantly improved their life quality, and had no obvious adverse effects.

Living Donor Liver Transplantation in Biliary Atresia Children with Pulmonary Hypertension.

OBJECTIVE: Though living donor liver transplantation (LDLT) is commonly performed for pediatric patients with biliary atresia (BA), pulmonary hypertension (PH) is seldom encountered or reported previously. The aim of this study is mainly to identify the prevalence of PH in pediatric patients undergoing liver transplantation and assess whether PH significantly augment the operative risk and evaluate the outcomes in this series of patients. DESIGN: Retrospectively cohort study. SETTING: Renji hospital, Shanghai, China. PARTICIPANTS: This study comprised 161 pediatric patients undergoing LDLT. INTERVENTIONS: Patient diagnosed of PH in preoperative examination was compared to those without PH in intra- or post- operative complications or outcomes. MEASUREMENTS AND MAIN RESULTS: We collected clinical records of LDLT surgery for pediatric patients during the year of 2016 in our hospital. Results suggested that pediatric patients undergoing LDLT had a substantial number of PH with a prevalence of 16.1% in this study. No significant difference was identified between two groups of patients regarding intraoperative outcomes and postoperative complications and mortality. CONCLUSION: LDLT is a safe procedure in a selected group of BA patients with PH, however, further long-term clinical investigations and mechanical researches are needed.

Association between Anaesthetic Technique and Oncological Outcomes after Colorectal Carcinoma Liver Metastasis Resection.

Background: Recently published studies suggest that the anaesthetic technique used during oncologic surgery can improve patient outcomes. Therefore, the authors evaluated the survival of patients with resected colorectal carcinoma liver metastases (CRCLMs) who received either EGA (general anaesthesia [GA] combined with epidural anaesthesia [EA]) or GA alone. Methods: We conducted an ambispective cohort study including 225 post-surgical CRCLM patients between May 2007 and July 2012 and performed a follow-up investigation of survival in July 2017. Results: The basic characteristics in the two groups were largely similar. The median (quartiles) recurrence interval for all patients was 10 (2.5, 23) months, and the median (quartiles) survival for CRCLM patients post-surgically was 37 (30.5, 51.5) months. Perioperative EA was associated with survival (P =0.039, log-rank test), with an estimated hazard ratio of 0.737 (95% CI 0.551-0.985) in the univariate analysis. Kaplan-Meier estimates of survival for GA and EGA suggested that GA might provide better outcomes than EGA [P=0.028, hazard ratio of 0.7328 (95% CI 0.5433-0.9884)]. Significant differences in anaesthesia techniques were found (P=0.048), with an adjusted estimated hazard ratio of 0.741 (95% CI 0.550-0.998) in the multivariate analysis. Subgroup analyses of patients in different age groups (< 40, ≥ 40 but <60, and ≥ 60 years old) suggested that no significant differences existed among all three subgroups. Conclusions: Compared with EGA, GA may provide a better survival outcome for CRCLM patients. The benefits of anaesthetic techniques in oncological surgery are most likely related to certain cancer types.

Turn-on fluorescent detection of captopril in urine samples based on hydrophilic hydroxypropyl ß-cyclodextrin polymer.

Here, one kind of hydrophilic hydroxypropyl ß-cyclodextrin cross-linked polymer (HP-CDP) was prepared and used to establish a "turn-on" fluorescent probe for selective determination of captopril in biological samples. The HP-CDP has been synthesized in one step by cross-linking (2-hydroxypropyl)-ß-cyclodextrin (HP-ß-CD) with a rigid aromatic group linker tetrafluoroterephthalonitrile (TFT), and the synthesis parameters of HP-CDP were optimized with water solubility, yield, and adsorption capacity as indicators. When it was used as a luminescent material, we have found an interesting phenomenon that the fluorescence emission of HP-CDP was quenched after forming a coordination compound with ferric ions, and then recovered after adding a certain concentration of captopril, since captopril can reduce the ferric iron to ferrous ions and cause ligand replacement. Based on this observation, a novel turn-on fluorescent method was developed for the determination of captopril. The method exhibited good linearity in the range of 9.2 × 10-7 to 4.6 × 10-4 M (R2 = 0.9982) and a low detection limit of 1.8 × 10-7 M at optimum HP-CDP concentration, ferric ion concentration, pH, and incubation time. Moreover, interference experiments demonstrated that this fluorescence sensor had excellent selectivity that can commendably resist the interference from potential foreign substances. The proposed method has been successfully applied to determine captopril in human urine samples and may provide outstanding application potential in the future development of sensors. In addition, it is believed that HP-CDP also has a wide range of applications, for example, as a solubilizer, pollutant adsorbent, or drug carrier. Graphical abstract ᅟ.

Depiction of transplant renal vascular anatomy and complications: unenhanced MR angiography by using spatial labeling with multiple inversion pulses.

PURPOSE: To evaluate the ability to depict anatomy and complications of renal vascular transplant with unenhanced magnetic resonance (MR) angiography with spatial labeling with multiple inversion pulses (SLEEK) and to compare the results with color Doppler (CD) ultrasonography (US), digital subtraction angiography (DSA), and intraoperative findings. MATERIALS AND METHODS: This study was approved by the institutional review board, and written informed consent was received before examination. Seventy-five patients who underwent renal transplantation were examined with unenhanced MR angiography with SLEEK and CD US. DSA was performed in 15 patients. Surgery was performed in eight patients. The ability of SLEEK to show transplant renal vascular anatomy and complications was evaluated by two experienced radiologists who compared the results with CD US, DSA, and intraoperative findings. RESULTS: Patients successfully underwent SLEEK MR angiography. Transplant renal vascular anatomy was assessed in 87 arteries and 78 veins. Renal vascular complications from transplantation were diagnosed in 23 patients, which included 14 with arterial stenosis, three with arterial kinking, two with arteriovenous fistulas, two with venous stenosis, one with pseudoaneurysms, and one with fibromuscular dysplasia. Three patients had two renal transplants and nine patients had nine accessory renal arteries. More accessory renal arteries were detected with SLEEK than with CD US. Correlation was excellent between the stenosis degree with SLEEK and DSA (r = 0.96; P < .05). For those with significant artery stenosis (>50% narrowing) proved with DSA (n = 7) or surgery (n = 3), positive predictive value was 91% (10 of 11). CONCLUSION: Unenhanced MR angiography with SLEEK preliminarily proved to be a reliable diagnostic method for depiction of anatomy and complications of renal vascular transplant. It may be used for evaluation of patients with renal transplant, and in particular for those with renal insufficiency.